Background: Bacteriuria is a major risk factor for developing symptomatic urinary tract infection which is associated with significant maternal and fetal risks. Various studies have put a prevalence of asymptomatic bacteriuria between 2-10% in pregnancy. Maternal and fetal complications like gestational hypertension, anaemia, premature delivery, IUGR, and low birth weight are commonly associated with pyelonephritis which occurs as a result of undiagnosed or inadequately treated infections of the urinary tract. The primary objective was to find out the prevalence of asymptomatic bacteriuria in pregnancies less than 28 weeks gestation in our hospital and to study the various adverse pregnancy outcomes in the study group.Methods: This was a cross sectional study done over a period of 12 months at this tertiary care centre in Government sector in Trivandrum, Kerala. A sample size was calculated statistically and 400 women with gestational age less than 28 weeks attending the outpatient department were included in this study. A structured proforma, urine microscopy and urine culture and sensitivity were the study tools.Results: Prevalence of asymptomatic bacteriuria in our study population was 8.25%. Commonest pathogen isolated was E.coli in 57.14% cases. Maternal morbidity was higher in women with asymptomatic bacteriuria (24.2%) than those without (12.5%). Fetal morbidity in women with asymptomatic bacteriuria was 24% whereas it was 12.5% in those without it. Preterm labour, preeclampsia and prematurity were the common morbidities noted.Conclusions: Since pregnant women with asymptomatic bacteriuria were at an increased risk of adverse maternal and fetal outcome, routine screening for asymptomatic bacteriuria preferably in the first trimester is highly recommended.

INTRODUCTION Dengue is an acute mosquito-borne viral infection that places a significant socioeconomic and disease burden in India. 1,2 Classic dengue fever (DF) is defined by the World Health Organization as an acute febrile illness with two or more of the following signs or symptoms: intense headache , retro-orbital pain, myalgia, arthralgia, rash, leukopenia and hemorrhagic manifestations. The clinical severity of disease has a wide spectrum, and according to the World Health Organization (WHO) dengue classification scheme, there are four grades ranging from uncomplicated dengue fever (DF) to dengue hemorrhagic fever (DHF) and devastating dengue shock syndrome (DSS). DHF is currently defined by the following four World Health Organization (WHO) criteria:  Fever or recent history of fever lasting 2-7 days  Any hemorrhagic manifestation.

Gynaecological morbidities is any condition, disease or dysfunction of the reproductive system that is not associated with pregnancy, which includes reproductive tract infections, cervical cell changes, prolapse, urinary tract infection, back pain due to osteoporosis. 1 The community based prevalence of these morbidities are influenced by demographic, social, cultural and behavioural factors. Women do not consider it as a significant health problem or hesitate to talk about it. The onset of the menopause not only signals the end of a woman's reproductive function but also the start of a new ABSTRACT Background: Gynaecological morbidities is any condition, disease or dysfunction of the reproductive system that is not associated with pregnancy which include reproductive tract infections, cervical cell changes, prolapse, urinary tract infection, back pain due to osteoporosis. The community based prevalence of gynaecological morbidities are influenced by demographic, social, cultural and behavioural factors. Geriatric gynaecological problem especially in tribal population has not received adequate attention in India. It is a fact that, health seeking behaviour forms an important component in formulating health programs as successful interventions depends on the accessibility and acceptability ,both of which relates to social factors. The objective of this study was to assess the gynaecological morbidities of aged (>60 years) tribal women in Trivandrum district living in various settlement areas and also to study their health seeking behavior. Methods: 11 panchayats were selected where the density of tribal population was high, and using cluster sampling method, a sample size of119 was arrived at, and these many women were included in this study out of the total of 2362 aged tribal women residing in Trivandrum. 12 camps were conducted in settlement areas during the period of one year of study. Socio-demographic, general health, and gynaecological examination was conducted and findings noted in a proforma. Results: 47.1% women had one or more coexistent gynaecological morbidities. 16% had clinical evidence of vaginitis, 9.2% had urinary tract infection, 12.6% had prolapse of some degree, 3.4% had cervical lesions. 80% of tribal women belonged to low socio economic status. 74.8% tribal women were anaemic. However around 80% had health seeking behaviour. The rest did not seek because of inaccessibility or shyness to discuss gynaecological morbidities. Conclusions: Aged trial women harbour considerable gynaecological morbidities. Inspite of having a very high level of health seeking behaviour it was noted in the current study that the prevalence of anaemia was very high. Therefore there is an urgent need to further improve health facilities and health care in these areas.

Background: The greatest risks to life are in its very beginning. Although a good start in life begins well before birth, it is just before, during, and in the very first hours and days after birth that life is most at risk. This prospective case control study was designed on maternal risk factors for perinatal mortality.Methods: This was a case control study conducted in the Department of Obstetrics and Gynecology and Department of Paediatrics, Medical College Trivandrum for one year period in 2004-2005. The cases were all the fresh and macerated still births and early neonatal death cases during the study period. The controls were chosen as the next delivery entry in the OR register.Results: During this period, the total number of deliveries was 14,796 and there were 431 perinatal deaths. The perinatal mortality rate was 29.12. This was much higher compared to Kerala’s perinatal mortality rate of 10, the reason being that the study is conducted in a tertiary referral hospital with one of the best new born care nurseries and a large number of referrals. The most significant risk factors for perinatal mortality were low socio-economic status, referrals, late registration, prematurity, low birth weight, intra-uterine growth restriction, maternal diseases like gestational hypertension and gestational diabetes and intrapartum complications like abruption.Conclusions: Perinatal mortality rate serves as the most sensitive index of maternal and neonatal care. Good antenatal care and prevention of preterm birth may play a key role in further reduction of PMR.

Background: Thrombocytopenia in pregnancy occurs due to several etiologies which include both pregnancy specific and non pregnancy related causes. It is second only to anemia as the most common hematological abnormality encountered in pregnancy. Better antenatal care has led to increased detection. Once diagnosed, it is important to further evaluate and to determine the cause to optimize management. Several studies have been undertaken across the world; however there are very few studies in Kerala hence this study. The aim of this study was to determine the risk factors of thrombocytopenia in pregnancy.Methods: This was a case control study undertaken in the Department of Obstetrics and Gynecology, Medical college Hospital, Trivandrum, Kerala. Using purposive sampling, a sample size of 96 cases and 96 controls were included in this study. “Cases” were antenatal women with thrombocytopenia and “controls” were consecutive women without it. Study period was 18 months and analysis was done using SPSS version 22.Results: In 49% of subjects ,the cause was identified as gestational thrombocytopenia,39.5% cases were due to hypertensive disorders of pregnancy.10.4% was due to ITP. SLE, AFLP, Dengue infection, HUS and APLA were rare causes of thrombocytopenia in our hospital. Of the 96 cases enrolled in the study,88 were diagnosed during pregnancy. Amongst the hypertensive disorders,16.7% was due to gestational hypertension,10.4% due to preeclampsia and 7.4% were due to HELLP syndrome.82.3% of patients with thrombocytopenia in this study were asymptomatic.Conclusions: Thrombocytopenia should be evaluated by making a practice of routinely checking the platelet count and peripheral smear in early pregnancy and also in third trimester to enable early diagnosis since most cases may be asymptomatic.