INTRODUCTIONAccording to millennium development goals (MDG) in 2015, the goal number five was to improve the maternal health is falling way below our target. Our aim in reducing maternal mortality by 75% has not been met with MDG.1 Pregnant women's health status is not reflected by mortality indicators alone hence the concept of severe acute maternal morbidity (SAMM) is an apt for the present health providing system. 2,3 SAMM has been studied extensively in the recent past as a complement for maternal mortality and also to evaluate the quality of obstetric care in that particular institution. This concept is superior over maternal death in drawing attention to surviving women's reproductive health and lives and is equally applicable in developing countries as well as developed countries. In many developed countries, maternal mortality has fallen to single digits whereas near miss cases are more and hence useful in evaluation of the present system. Moreover, they have the advantage of not being as rare as maternal deaths for providing adequate information, as well as still being rare enough not to overload clinicians and data collection personnel within the facility. 4 Till recently there were no criteria set for identification of these cases for routine implementation, and wider application of this concept was limited.5 But in ABSTRACTBackground: According to millennium development goals (MDG) in 2015, the goal number five was to improve the maternal health is falling way below our target. Our aim in reducing maternal mortality by 75% has not been met with MDG. Pregnant women's health status is not reflected by mortality indicators alone hence the concept of severe acute maternal morbidity (SAMM) is an apt for the present health providing system. The main objectives of the study were to; (1) To determine the frequency of maternal near miss, maternal near miss incidence ratio (MNMR), maternal near miss to mortality ratio and mortality index; (2) To compare the nature of near miss events with maternal mortality; (3) To observe the trend of near miss events. Methods: It was a retrospective study design conducted at Late B.R.K.M Government medical college, Jagdalpur, Chhattisgarh, India during September 2013 to August 2014. The study population includes near miss cases and maternal deaths. Cases were defined based on WHO criteria 2009. Results: Out of 3539 deliveries, 39 wear near miss cases during the study period. The maternal near miss incidence ratio was 11.9/1000 live births, maternal near miss to mortality ratio was 2.05:1, and mortality index was 32.7%. Hemorrhage was the leading cause (43.5%), followed by severe anemia (15.38%), rupture uterus (15.38%), preeclampsia/eclampsia (12.82%), sepsis (5.12%), complicated malaria (5.12%) and hepatitis (2.56%). Maternal mortality ratio (MMR) was 580/100000 live births. Conclusions: Hemorrhage was the leading cause of near miss events. As near miss analysis indicates the quality of health care, it is worth presenting in national indices.

INTRODUCTIONIn India current method of family planning is (1) Family sterilization 34% (2) Male sterilization. 1% (3) pills 4% IUD 2%and condom 6% (4) any traditional method 7% (5) non user 46%. The modern IUCD is highly effective, safe, long acting, coitus independent and rapidly reversible method of contraception with few side effects. It is most cost effective method of contraception today. Many women also find the IUCD to be very convenient because it requires little action once it is in place. 1The postpartum period is potentially an ideal time to begin contraception women are more strongly motivated to do so at this time, which also has the advantage of being convenient for both patients and healthcare providers.2 Postpartum period is a very vulnerable period both for women and infant. Initiation of contraception during this period is important to prevent unintended pregnancy and short birth intervals. It can avert more than 30% of maternal deaths and 10% of child mortality. Pregnancy occurring within six months of the last delivery holds a 7.5-fold increased risk for induced abortion and a 1.6-fold increased risk of stillbirth. ABSTRACTBackground: This study is aimed at determining the safety, efficacy and expulsion of PPIUCD. This study also aims to determine the rates of complications (bleeding, pelvic infection, lost strings, and displacement) following PPIUCD insertion among the women in one year period. Methods: This study was conducted at department of obstetrics and gynecology, Late B.R.K.M Govt. medical college, Jagdalpur, Chattishgarh. Women admitted and delivered were counseled and those who fulfilled the medical eligibility criteria and had no contra indication for PPIUCD were provided the PPIUCD services. Results: Total women 600, lost to follow-up 329, complications 162 (expulsion 14, bleeding 35, string problem 44), removal 102. Conclusions: The PPIUCD (Cu380A) is demonstrably safe, effective, has high retention rate. The expulsion rate is not very high and it can be reduced with correct techniques, correct selection of clients, and correct time selection for the client.

Background: The sickle cell disease is major public health problem which causes high morbidity and mortality in India. It is observed that SCD is scourge in Chhattisgarh since long past. Sickle cell disease is a term for a group of genetically inherited disorders characterized by production of abnormal hemoglobin. “Hemoglobin-S” results from a point mutation in the beta globin gene. The main objective is to study the incidence of pregnant women with sickle cell disease.Methods: It is a hospital based prospective study. It was conducted at Obstetrics and Gynecology department of LTBRKM Govt. Medical College, Jagdalpur, Chhattisgarh. The study was carried out from August 2014 to October 2015. The study included screening of all patients attending antenatal clinic and in labour ward during emergency. 75 cases were found to be sickling positive. Permission from Institutional Ethics Committee was obtained.Results: The incidence of SCD in India is 44%, in Chhattisgarh is 17%.At our institute in pregnant women is 1.75%. The incidence of HbAs group was 70.66% and HbSS was 26.66%. In Hb AS group maximum 47% patients were in age group of 26-30 years. and also in same age group the incidence of HbSS group was 60%. In age group of 31-35 years. 22% of patients were of HbAS group, but only 10% of patients were of HbSS group. HbAS group and HbSS group the percentage of primi gravida were 49% and 60% respectively. It is noted that in HbAS group only 3% of patients had parity >4, but in HbSS group it was 10%.Conclusions: In conclusion, it has been shown that the clinical statuses of the most sickle cell diseases patience were not seriously affected by pregnancy if they are given appropriate prenatal care. All pregnant women should be screened for sickle sell hemoglobinopathy in endemic region, like in our state Chhattisgarh.

Background: Induction of labor is one of the great challenges for obstetric care provider. Misoprostol is used for induction of labor by various routes with the advantages in being cheap and stable at room temperature and widely available even in resource-poor settings.Methods: A randomized controlled study was conducted in the obstetrics and gynecology department of Govt. Medical College and associated Maharani Hospital, Bastar, Chhattisgarh, India over a period of 1.75 years from September 2014 to May 2016. Study has comprised of 200 pregnant women admitted in the department for induction of labor fulfilling the inclusion and exclusion criteria. Data was collected and analyzed by SPSS 16.0. z-test and chi-square test to compare the safety and efficacy of both the routes of misoprostol use for IOL.Results: There were insignificant differences in number of doses required for induction with satisfactory maternal and neonatal outcome but shorter (12 hours) induction delivery interval with sublingual Misoprostol induction. Most of the cases of both the groups were delivered by vaginal route (86% and 62%) within 12 hours of induction(58% and 42%) yet significant (p value < 0.001) number of cases had undergone caesarean in group of vaginal misoprostol administration (29%) with major indications of meconium stained liquor (3% and 12%) and non assuring fetal heart rate (1% and 10%).Conclusions: Although both the routes of induction by Misoprostol are well tolerated by the women with satisfactory neonatal outcome, sublingual Misoprostol has an added advantage of quicker delivery, less caesarean and ease of administration indicates better safety and effectiveness.

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