Background: World health organization has promoted modified partograph with action line, 4 hour to left of alert line. While others have used various action line 2, 3, or 4 hours to initiate and guide ‘‘active management’’ decisions. Objectives of the study were to evaluate outcome of labour in terms of caesarean section rate, augmentation of labour and fetal outcome in whom labour has been managed with 4-hour vs 2-hour action line on WHO modified partograph.Methods: This was a randomized, prospective, comparative study. Primigravida, 19-28 years, with single live foetus in vertex presentation without any medical and obstetrical complications, at term pregnancy have been included in the study. Results were compared between Group A, with 100 cases, in whom labour has been managed with WHO modified Partograph with 4-hour action line and Group B, with 100 cases, in whom labour has been managed with that of 2-hour action line.Results: The present study shows that more women in 2-hour arm crossed the action line, compared with the 4-hour arm, and therefore received more interventions to augment labour.  Rate of caesarean section is more in group B (11%) than in group A (9%) which is statistically nonsignificant.Conclusions: Neonatal outcome measured with APGAR score at 5 minute, has shown no significant difference in both groups. Therefore, partograph with 2-hour action line doesn’t show any superiority over that of 4-hour action line but to be associated with higher incidence of intervention. Further research is required in this field of active management.

Background: The prevalence of anemia in India is increasing day by day and covers almost one third population. Anemia during pregnancy leads many perinatal complications such as miscarriage, abortion and still birth. So, the aim of the study was to determine prevalence of anemia during pregnancy and its association with adverse perinatal outcomes in region of Madhya Pradesh.Methods: The study population consisted of 15-49 years women of reproductive age group from the state Madhya Pradesh, India, which were taken from the National Family Healthy Survey-4 (2015-16). Various perinatal outcomes along with age and residence was cross tabulated and frequencies were generated. The chi-square statistic was used to test the significance.Results: In severe anaemic women prevalence of miscarriage (74.0%) was statistically significantly higher (p<0.05) as comparison to other forms of anemia. Also, in the age group 25-29 years and rural population prevalence of miscarriage (40% and 55%) was highly significant (p<0.001) as comparison to other age group and urban population.Conclusions: The severity of anemia is directly proportional to poor and adverse perinatal outcomes in pregnancy.

The purpose of this review article is to analyse evidence on the use of ventilatory strategies and associated cointerventions in adult patients with COVID-19 induced acute respiratory distress syndrome (ARDS) and to provide treatment recommendations based on these interventions. For each recommendation mentioned, it is important to consider the quality of the evidence reviews thoroughly before applying these recommendations to specific clinical situations or policy decisions. No guideline or recommendations can consider all the compelling clinical features of individual patients, as they are unique. Thus, it is imperative that clinicians, patients, policy makers, and other stakeholders should not regard these recommendations as mandatory. However, this review article, impartially discusses the nuances of treatment available and management protocols followed in many centres around the world for the consumption of all treating physicians.

BACKGROUND:Clonidine is an α2 adrenoreceptor agonist that has been shown to effectively prolong the duration of analgesia when administered intrathecally or in the epidural space along with local anaesthetic. AIMS AND OBJECTIVE: This study was designed to evaluate the effect of two different doses of intrathecal clonidine (37.5 µg and 75 µg) on the duration of analgesia and side effects produced by hyperbaric bupivacaine 0.5%. MATERIALS AND METHODS: A prospective hospital based, randomized and double blind study. Selected 75 patients who was scheduled for elective below umbilical surgeries were randomly allocated to one of three groups. Group I (n=25, control group) received 3ml hyperbaric bupivacaine, Group II (n=25) 3ml hyperbaric bupivacaine + 37.5 µg clonidine and Group III (n=25) 3 ml hyperbaric bupivacaine + 75μg clonidine intrathecally. Total volume (4ml) remained constant by adding sterile water. Data were analyzed by using SPSS software ver.18. RESULTS: The (mean ±SD) duration of analgesia was found to be 171.3±6.37 mins in Group I, 217.7±7.01 mins in Group II and 257.1±6.50 mins in Group III (p<0.05). It shows that 37.5g & 75g intrathecal clonidine increases the duration of analgesia of 15mg hyperbaric bupivacaine by about 46 mins & 86 mins respectively. The addition of intrathecal clonidine upto 75 µg does not cause any significant major side effect except mild sedation, without an increase in incidence of hypotension, bradycardia and respiratory depression. CONCLUSION: Intrathecal clonidine (37.5g & 75g) as an adjuvant to hyperbaric bupivacaine 0.5% prolong the duration of analgesia in a dose dependent manner without increase in incidence of significant side effects. KEYWORDS: hyperbaric bupivacaine, intrathecal clonidine, spinal anaesthesia. INTRODUCTION:Spinal anaesthesia is a well-established technique. It is easy to perform, to provide fast onset and effective sensory and motor block. Now a days bupivacaine is a commonly used local anaesthetic drug in spinal anaesthesia. However duration of spinal analgesia by bupivacaine is limited upto 75-150 min. Therefore various additives like clonidine, opioids, neostigmine, ketamine and epinephrine separate or in combination were used along with bupivacaine for prolongation of the effect, to improve the quality of analgesia and to minimize the requirement for postoperative analgesics.Clonidine is an α2 adrenoreceptor agonist that has been shown to effectively prolong the duration of analgesia when administered intrathecally or in the epidural space. (1,2,3) The α2 adrenergic agonist clonidine has a variety of different actions including the ability to potentiate the effects of local anaesthetics. Such prolongation of the effects of local anesthetics has been reported with oral. (4) IV (5) and intrathecal clonidine. (6,7) However, unlike spinal opioids, clonidine does not produce pruritus, urinary retention, respiratory depression, vomiting with no or minimum CNS depression. However, intrathecal clonidine at high doses is associated with brady...