OBJECTIVE:To confirm the clinical diagnosis in patient with first trimester bleeding. To evaluate the role of pelvic ultrasound, in management of first trimester bleeding. To correlate the outcome of pregnancy, with fetal activity seen on pelvic ultrasound. METHODS: Study includes all Obstetric cases attending Bhabha Atomic Research Centre and Hospital with history of bleeding per vaginum in first trimester of pregnancy during the study period October 2011 to September 2013. RESULT: In our study we have evaluated 100 cases of bleeding in the first trimester of pregnancy to know the role of ultrasound examination. On mere clinical examination, it was not possible to diagnose many cases correctly. There was a disparity of 72% between clinical and sonological diagnosis. Out of 86 cases clinically diagnosed as threatened abortion only 50 cases were confirmed as threatened abortion by ultrasonography. Rest 36 cases were misdiagnosed clinically. Sonographically diagnosed 50 cases were followed and all 50cases continued as normal pregnancy. 8 cases of these 50 threatened abortions had chorionic hemorrhage in ultrasonography findings, but all 8 cases also continued as normal pregnancy. These 36 clinically misdiagnosed cases were diagnosed correctly on ultrasonography as 12 cases of complete abortion, 4 cases of incomplete abortion, 1 case of inevitable abortion, 11 cases of missed abortion, 1 case of complete mole and 7 cases of blighted ovum. 1 cases of complete abortion was diagnosed by sonography only. 3 cases were clinically diagnosed as incomplete abortion, but only 1 was confirmed on sonography, rest 2 cases were case of missed abortion and blighted ovum. All 8 cases of blighted ovum was ultrasonography diagnosis only. None of them could be diagnosed clinically. 3 cases of ectopic pregnancy were diagnosed clinically and also confirmed on ultrasonography. 1 case of complete mole was an ultrasonography diagnosis only. CONCLUSION: Bleeding per vaginum in the first trimester is one of the most common causes for the majority of emergency admissions to the obstetrics department and also vaginal bleeding is most frequent indication of first trimester ultrasonography. The common causes of bleeding during first trimester include abortions, ectopic pregnancy and molar pregnancy. Ultrasound is a non-invasive, non-ionizing and easily available method of investigation to assess the patients with first trimester bleeding which is highly accurate in diagnosing the actual causes of bleeding and guides the clinician in choosing the appropriate line of management and prevents mismanagement of the cases. Ultrasound can assess some findings which are helpful in predicting the prognosis of the pregnancy. Life threatening emergency like ectopic when evaluated by ultrasound gives scope for conservative approach without affecting the fertility status.

Background: There is a rising trend of caesarean deliveries worldwide. Although a very commonly performed abdominal surgery, there is no ideal operative procedure in the literature. Several studies compared short term and long-term outcomes of closure and non-closure of peritoneum, but there is no consensus whether either procedure is beneficial to patients. Variability of results may be due to bias involved in these studies as two groups compared had different characteristics (including obstetrics and non-obstetrics laparotomies, elective and emergency caesareans, Pfannenstiel as well as vertical incisions; in the same study) which are likely to affect short term outcomes besides those due to peritoneal closer and non-closure. Aims and objectives of the study were to perform an unbiased assessment of short-term outcomes in elective LSCS in unscarred abdomens by Pfannenstiel incisions between closure (CG) and non-closure of peritoneum (NCG).Methods: Prospective randomised controlled study method used in the study.Results: The operating time was significantly more (p=0.01) with difference of additional 10 minutes in CG with standard error of mean for time being 3.7688. Pain score was more in CG on post-operative day 1 and 2 (p=0.0003 and 0.008 respectively). Additional anaesthesia and analgesia were not needed in this group.Conclusions: Apart from operative timing and pain score in early post-op period, there was no significant difference in short term outcomes between CG and NCG during elective caesarean section. Hence only long-term effects of these procedures need to be considered prior to recommending ideal steps of elective caesarean section procedure.

Background: Cancer cervix is in the top rank of gynecological cancers in the developing countries cervical cancer has a long latent period and can be prevented by simple treatment of cervical intraepithelial neoplasm. The incidence of invasive cancer can be decreased by early detection of preinvasive stage which can be treated at the same sitting, “see & treat approach” strategy. Objectives were to estimate the strength of correlation in detecting preinvasive lesions of cervix between colposcopy and directed biopsy and to correlate various socio-demographic data with cervical pre-invasive and invasive lesion. To compare the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of colposcopy with colposcopic directed biopsy.Methods: On selecting the patients based on the criteria, per speculum examination was done and in the presence of abnormal cervix, advised for PAP smear. Based on PAP smear scaled according to Bethedsa staging, patients were accordingly advised for colposcopy. Reid’s colposcopic index applied and biopsy was taken over the site with highest score and sent for HPE in a labelled bottle with fixative.Results: Colposcopy when compared to histopathology had a sensitivity of 100 %, specificity of 48.3%, with PPV of 22.4 % and NPV of 100 %. The p value was 0.001 suggesting a significant strength of agreement between colposcopic diagnosis using Reid’s index and histopathological diagnosis.Conclusions: Correlation of colposcopic impression with directed biopsy is described as the reference investigation or ‘gold standard’ for the diagnosis of cervical precancerous lesions.

Background: Maternal morbidity and mortality has been an utmost priority worldwide as it is an indicator of healthcare system. In order to bring it down, it has become the need of the hour to decrease the number of caesarean sections as it is one of the most common cause of morbidity among women. Every institution should have an audit to determine the rate of caesarean section and corresponding indications in order to implement new protocols or modify existing ones to improve caesarean section rates.Methods: All women who underwent caesarean section between time period Jan 2015- Dec 2019 were included. All vaginal deliveries were excluded. Delivery and operative registers, logbooks and online entries were used for data collection in the obstetric and gynecologic department. A retrospective data collection was done, tabulated and entered in excel sheet.Results: Robson’s group 1, group 2, group 5 were the main contributors to overall caesarean section rate. The major indications for caesarean section were found to be as previous caesarean section (33%), non-progress of labor (22%) followed by meconium stained liquor, cephalopelvic disproportion both around 10%.Conclusions: Robson’s group 1, group 2, group 5 were the main contributors to the overall caesarean section rate. The major indications for caesarean section were found as previous caesarean section and non-progress of labor. Further studies are needed for comparison and to make amendments to protocols.