Gestational diabetes mellitus (GDM) is on the rise globally. In view of the increasing prevalence of GDM and fetal and neonatal complications associated with it, there is a splurge of research in this field and management of GDM is undergoing a sea change. Trends are changing in prevention, screening, diagnosis, treatment and future follow up. There is emerging evidence regarding use of moderate exercise, probiotics and vitamin D in the prevention of GDM. Regarding treatment, newer insulin analogs like aspart, lispro and detemir are associated with better glycemic control than older insulins. Continuous glucose monitoring systems and continuous subcutaneous insulin systems may play a role in those who require higher doses of insulin for sugar control. Evidence exists that favors metformin as a safer alternative to insulin in view of good glycemic control and better perinatal outcomes. As the risk of developing GDM in subsequent pregnancies and also the risk of overt diabetes in later life is high, regular assessment of these women is required in future. Lifestyle interventions or metformin should be offered to women with a history of GDM who develop pre-diabetes. Further studies are required in the field of prevention of GDM for optimizing obstetric outcome.

INTRODUCTIONHysterectomy is one of the most common surgical procedures performed by the gynaecologist. It can be performed by abdominal and vaginal route. Vaginal hysterectomy (VH) has several advantages over abdominal hysterectomy (TAH), and may be appropriate for up to 80% of benign uterine conditions. 1,2 Evidence supports TAH only when documented pathologic conditions preclude the vaginal route. 3,4 Even recent study in United States shows 82% were TAH, only 13% were VH and 5% were laparoscopic assisted in teaching hospitals.5 Aim of our study is to compare between vaginal route versus abdominal route of hysterectomy in terms of intra operative and post operative complications. METHODSA retrospective study was done in department of Obstetrics and Gynaecology of Sri Manakula Vinayagar Medical College and Hospital in Puducherry, India from January 2010 to July 2012. Study was done in women who had undergone vaginal or abdominal hysterectomy in that period. Women in any age group who underwent vaginal or abdominal hysterectomy for benign conditions were included in the study. Women who underwent hysterectomy for uterine prolapse, indications that would generally require an abdominal approach such as endometriosis, pelvic inflammatory disease were excluded from the study. Vaginal hysterectomy was done in those with uterine size ≤ 14 weeks, unrestricted uterine mobility, and absence of adnexal pathology.Information such as clinical history, physical examination findings, haemoglobin level preoperatively, indication for ABSTRACT Background: Hysterectomy is one of the most common surgical procedures performed by the gynaecologist. It can be performed by vaginal and abdominal route. Gynaecologic surgeons worldwide continue to use the abdominal approach for a large majority of hysterectomies that could be performed vaginally despite well-documented evidence that vaginal hysterectomy has better outcome. Aim of our study is to compare vaginal route versus abdominal route of hysterectomy in terms of intra operative and post operative complications. Methods: A retrospective study was done in 229 women who had undergone hysterectomy (176 abdominal hysterectomies and 53 vaginal hysterectomies) from January 2010 to July 2012. Information on the indications, operative procedures, and complications were extracted and analysed. Results: The mean duration of surgery in VH group was 79.6 min and that of TAH group was 99.2 min. The mean blood loss was also more in case of TAH group than that of VH group (215ml vs. 167ml). Bladder injury occurred in 1 case in VH (1.9%) and in 4 cases in TAH (2.3%). Ureter injury occurred in 1(0.6%) case in TAH group. Wound infection developed in 10 cases of TAH group whereas only one case in VH group developed vault infection. Conclusions:Vaginal hysterectomy is associated with quicker recovery, early mobilization, shorter hospitalization, less operative and post operative morbidity when compared to abdominal hysterectomy.

Glucose challenge test (GCT) has been used as an effective screening test for gestational diabetes mellitus (GDM), though it has its own limitations. Hence, we assessed the effectiveness of fasting plasma glucose (FPG) as a simpler alternative procedure. A prospective study was done in 500 pregnant women with gestational age between 22 and 37 weeks. FPG, GCT and GTT were performed in all patients using the glucose oxidase/peroxidase method. The overall sensitivity and specificity of GCT were 75.0% and 92.0%, respectively and the corresponding values for FPG were 88.8% and 95.2%. The positive predictive value and negative predictive value were 42.2% and 97.9% for GCT and 59.2% and 99.1% for FPG, respectively. We conclude that FPG can be used as an effective screening tool for gestational diabetes mellitus.

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Various pharmacological methods of labour analgesia include epidural analgesia, injections and inhalational agents. 1 Alternative non-pharmacological approaches are