Background: Foetal death or stillbirth is a major obstetrical complication and a devastating experience for the pregnant patients and relatives. Worldwide an estimate of at least 3.2 million stillbirths occurs each year. There are intensified demands on medical, political and epidemiological ground for proper determination and classification of causes of perinatal death. The aim of this study was to test a new classification system- Re. Co. De. Classification (Relevant Condition at Death) for stillbirths to improve our understanding of the main causes and conditions associated with foetal deaths.Methods: This study was a hospital based Prospective study conducted in department of obstetrics and Gynaecology, SZH, Bhopal. The study included 463 women who were admitted with Intra Uterine Foetal Demise. All cases were evaluated and after delivery the stillborn baby, the placenta and cord were examined. The causes were classified according to Re. Co. De. System.Results: The analysis of the new classification system Re. Co. De. Allowed attributable causes to about 90.72% of causes of still births explained where 9.28% were unexplained. The commonest cause was found to be class F4-Toxaemia of pregnancy (13.17%) followed by class A7- IUGR (10.58%), class C1-Abruptio placentae (10.36%), class E3-Obstructed labour (9.8%) and class A1- Lethal congenital malformations (8.42%).Conclusions: The Re. Co. De. Classification system gives us a better understanding of antecedents of stillbirths and the clinical practices, which need to be addressed to reduce perinatal mortality and have a better obstetric result in the next pregnancy.

Background: Critically ill eclampsia patients present a unique challenge to the obstetrician, anesthesiologist and intensivists. In developing countries, maternal mortality is still high due to lack of good maternal antenatal services and obstetric intensive care. This study aims to provide a comprehensive review for the management and outcome of critically ill eclampsia patients admitted in the obstetric intensive care unit (ICU), GMC, Bhopal.Methods: This study was a hospital based cross sectional study. The study included 145 eclampsia patients who were admitted in obstetric ICU for critical care management. For each eligible patient, sociodemograhic profile, indications of ICU admission, data on ICU interventions and maternal outcome were documented.Results: During study period, total obstetric admission were 19,815 and 14,731 live births. Out of 348 eclampsia patients, 145 patients were admitted to the obstetric ICU, giving an ICU admission rate of 9.8/1000 live births. 98.03% patients were unbooked referred obstetric emergencies.The average duration of stay in obstetric ICU was 5.4+3.1 days. 72.9% patients had antepartum eclampsia, 17.2% patients had postpartum eclampsia and 10.8% patients had intrapartum eclampsia. 41% patients received mechanical ventilation, 90% patients received oxygen and advanced monitoring, 48.6% patients received vasoactive drugs and 53.7% patients received blood transfusions. There were 26 maternal deaths giving a case fatality rate of 17.93%.Conclusions: Early referral of eclampsia patients or at risk patients to a tertiary care centre may help to reduce maternal morbidity and mortality. Early diagnosis and prompt treatment through a multidisciplinary team in an ICU setting can prevent complications and reduce morbidity and mortality.

Background: Preeclampsia is a multisystem, highly variable disorder unique to pregnancy. For preeclampsia arising remote from term, supportive and temporizing measures are used to improve perinatal outcome. However, the magnitude of the maternal risks associated with expectant management is unclear. The PIER (preeclampsia integrated estimate of risk) score is a recently designed tool which assesses maternal signs, symptoms, and laboratory findings to generate a valid and reliable algorithm for predicting maternal and perinatal outcome in patients with preeclampsia.Methods: The present study was a prospective hospital based observational study carried out in Department of Obstetrics and Gynecology, Sultania Zanana Hospital, Gandhi Medical College, Bhopal. A total of 125 women with preeclampsia who fulfilled the inclusion criteria were included in the study. Along with history and examination, all relevant and required investigations were done. The fullPIERS calculator was used to calculate the risk of adverse maternal outcome.Results: In the present study, 82(65.6%) women were in the low risk category and only 4 (4.87%) had adverse maternal outcome. High risk patients were 6 (4.8%) and amongst them 5 (83.33%) women had adverse maternal outcome (p-value <0.00001). The result was statistically significant in identifying high risk cases in our study.Conclusions: The fullPIERS calculator gave good results in prediction of adverse maternal outcome according to risk score in women with preeclampsia in our study. It will help the clinicians better manage the patients with preeclampsia specially remote from term and also help health workers in primary and secondary care centres to identify women who are or may become severely ill and who need specialist care and prevent delays in transporting these women to facilities where they can receive appropriate care.

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Background: Infertility is one of the most important and underappreciated reproductive health problems in developing countries. Inability to conceive bears a social stigma which causes societal repercussion and personal suffering. The advent of hysterolaparoscopy have redefined the evaluation and treatment of infertile women. Study aimed to assess the role of hysterolaparoscopy in the evaluation of female infertility.Methods: This prospective observational study was done in the department of obstetrics and gynaecology, Gandhi Medical College, Sultania Zanana Hospital, Bhopal, during the period between 1st December 2016 to 30th November 2017. 104 infertile patients either with primary or secondary infertility were included after thorough evaluation.Results: Out of 104 infertile patients, 82(78.8%) women had primary infertility and rest 22(21.1%) women had secondary infertility. In primary infertility group, most common laparoscopic finding was PCOD in 24(29%) women and in secondary infertility group, tubal blockage was seen in 9(40%) women. The most common pathology seen in hysteroscopy was submucous fibroid in 6(7.3%) women with primary infertility, whereas in secondary infertility group, synechiae was found in 2(9%) patients and septum was seen in 1(4.5%) patient. Out of 104 patients, 33 (31.7%) patients underwent various interventions. The most common intervention was ovarian drilling for PCOS in 21(63.3%) patients followed by hysteroscopic cannulation in 5(15.5%) patients.Conclusions: Hysterolaparoscopy is a very useful tool that can detect various structural abnormalities in multiple sites like uterus, tubes, ovaries and peritoneal cavity in the same sitting. When done by experienced hands and proper selection of patients, hysterolaparoscopy can be considered as a definitive investigative procedure for evaluation of female infertility.