Background: Critically ill obstetric patients pose challenges to the intensive care unit team due to their altered physiology as well as due the presence of the foetus and safety of both the mother and the foetus is of paramount importance.Methods: All antenatal and postnatal cases within 42days of delivery requiring ICU admission from October 2014 to September 2016. Detailed history taken and outcome noted. Results were subjected to statistical evaluation using SSP software.Results: (n=75): obstetric reasons (n=51, 68%) of which 21(28%) had PPH and 17(22.6) had hypertensive disorders of pregnancy. Non-obstetric reasons (n=24, 32%) of which 7(9.3%) cases had jaundice and 4(5.3%) had malaria. Mechanical ventilation was needed in the majority of cases (n=44, 58.7%) followed by inotropic support (n=30, 40%).Maternal mortality was 16%. Mortality was higher (n=8, 66.6%) among patients admitted for obstetric reasons as opposed to non-obstetric indications (n=4, 33.3%).Conclusions: Early detection and prompt referral to the tertiary centre with intensive care facilities should be promoted among the medical fraternity to reduce the incidence of ICU admissions and maternal mortality. All residents of obstetrics and gynaecology should have short mandatory training phase in critical care. Multicentre randomised studies are required for formulating evidence-based national guidelines.

Background: To differentiate ovarian mass as benign or malignant could change clinical approach. Finding a screening and diagnostic method for ovarian cancer is challenging due to high mortality and insidious symptoms. Risk malignancy index (RMI) has the advantage of rapid and exact triage of patients with ovarian mass.Methods: Prospective study carried for 2 years at NRI Medical College and General Hospital, Chinakakani, Mangalagiri, Andhra Pradesh, India. 79 patients with ovarian mass were investigated and risk malignancy index (RMI-3 and RMI-4) calculated. Final confirmation was done based on histopathological report. Sensitivity, specificity, positive predictive value and negative predictive value were calculated for RMI 3 and RMI 4 taking histopathology as control and comparison was done.Results: (n=79); 50 (63.29%) cases were benign and 29 (36.70%) were malignant based on histopathology. RMI 4 is more sensitive (68.96%) than RMI 3 (62.06%), but RMI 3 is more specific (94%) than RMI 4 (92%).The positive predictive value of RMI-3 and RMI-4 were 85.71%  and 83.33% respectively. The negative predictive value for RMI-4 and RMI-3 were 83.63% and 81.03% respectively.Conclusions: With increasing age, chance of malignancy increases. RMI 4 was more sensitive than RMI-3, however less specific than RMI 3 in differentiating benign and malignant tumors. The positive predictive value is slightly more for RMI 3, than RMI 4. Negative predictive value is slightly more for RMI 4, than RMI 3.

Pregnancy with renal disease is associated with high risk for both mother and fetus with adverse outcomes. Criteria for considering pregnancy in renal transplanted patients include good post-transplant health for 2 years, stable allograft function with a serum creatinine <1.5 mg/dl, absence of rejection, control of blood pressure, absence of proteinuria. Authors report a case of 26-year-old, primigravida had renal transplantation done in NRI Medical College and treated with immunosuppressive therapy with tablets Tacrolimus 1mg twice daily, Azathioprine 50mg twice daily, Prednisolone 10mg once daily and continued till delivery. Developed gestational hypertension treated with tablet Amlodipine 5mg once daily. Elective caesarean section done for contracted pelvis. Post-natal period was uneventful and discharged on immunosuppressive therapy and contraceptive advice. Post-renal transplantation pregnancy should have multidisciplinary approach for. With close medical and obstetric follow up, successful outcome for both mother and infant is possible.

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BACKGROUND Abnormal uterine bleeding (AUB) is a common problem mainly seen in peri-menopausal and post-menopausal women. AUB has a negative impact on quality of life and in turn affects the efficiency of women. Hysteroscopy in this new era is increasingly becoming the investigation of choice for the evaluation of AUB, owing to the direct visualization of the uterine cavity, and its ability to pinpoint the aetiology in most of the cases. METHODS This is a prospective study. 100 cases with abnormal uterine bleeding (AUB) underwent hysteroscopy and biopsy was taken from suspected area. They then underwent dilatation and curettage and tissue samples were sent for histopathological examination. The findings on hysteroscopy and histopathological examination were correlated. Data obtained was subjected to statistical analysis and results derived was analysed in terms of sensitivity, specificity, positive predictive value and negative predictive value. RESULTS 42 (42%) cases with AUB were seen in the age group of 40-49. Most common symptom was menorrhagia 70 (70%) seen in the age group 40-49 years. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of hysteroscopy was 97.18%, 96.55%, 98.57% and 93.33% and that of histopathology was 89.13%, 96.29%, 95.34% and 91.22% respectively. All 5 cases of carcinoma diagnosed on hysteroscopy were confirmed by histopathology. CONCLUSIONS Hysteroscopy should be considered as the gold standard for diagnosis of intrauterine pathologies and it should be included in the management of AUB.