Background: The Robson system is the most widely accepted classification system available for analysing characteristics of delivering women worldwide. Several authors have tried modifications in the existing system. The objective of this study was to modify the existing system with relevance to caesarean section rates in various obstetric population and to identify major factors contributing to it.Methods: This study was performed in Government Medical College, Thrissur from January 2017 to June 2017. All women delivered during this period were classified according to the modified system consisting of 8 groups using their maternal characteristics and obstetric history. Each major group were sub classified into 3: women who went into spontaneous labour/ induced labour/ CS done before labour. For each group, we calculated the contribution to overall CS and Primary CS separately. Women with Previous CS were analyzed as a separate group. This classification was intended to directly estimate primary as well as repeat CS rates and indirectly the VBAC rates. Results: Out of total 1337 women delivered, 413 underwent CS (30.8%). The contribution made by previous CS group to overall CS was 61.5%, and the repeat section rate was 91.3%. The primary CS rate was 15% and the maximum contribution was made by term induced primigravida followed by Primigravida with Breech presentation. VBAC rate was 8.6%.Conclusions: Our modified Robson system can be effectively utilized in analysing delivering women and provide valuable information regarding the delivery characteristics with particular relevance to Caesarean sections.

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INTRODUCTIONStress urinary incontinence is a symptom or sign indicating that the woman has involuntary loss of urine associated with exertion in the absence of detrusor contraction. It has a significant impact on quality of life. It's prevalence varies from 4% to 35% depending upon the variation in population studied. 1 The treatment options include initial conservative therapies (i.e., lifestyle interventions, pelvic floor muscle training, and bladder training), followed by surgery, which is an option for women whose quality of life is still impaired after a diagnosis of genuine stress incontinence. In transobturator tape (TOT) procedure, a small incision is placed in the groins and in the vagina under the urethra. The mesh is placed under the urethra in the correct position without having to pass needles blindly through the retropubic space, as in transvaginal tape (TVT). The ABSTRACT Background: Stress urinary incontinence is a symptom or sign indicating that the woman has involuntary loss of urine associated with exertion in the absence of detrusor contraction. It has a significant impact on quality of life. TOT insertion is a popular procedure being done now. Studies related to quality of life assessment following Trans obturator tape (TOT) insertion is sparingly reported. Objectives of present study were to evaluate the quality of life following TOT insertion in patients with stress urinary incontinence and to assess the post operative complications. Methods: This is a prospective study done in the Department of Obstetrics and Gynecology, Government Medical College, Thrissur from January 2015 to December 2016. 48 women with Stress urinary incontinence who underwent TOT insertion were included in the study, out of which 30 patients were followed up. The King's Health Questionnaire was used for assessment. Data was analyzed using Epi Info 7 and Microsoft Excel. The statistical analysis was done using student t-test. Results: At 6 months follow up 86.66% (26) of patients had significant improvement in quality of life. 2 patients (6.66%) had postoperative voiding dysfunction, required recatheterisation, discharged after relief of symptoms. 2 patients (6.66%) had urge incontinence, advised medical management and was sent home, showed no improvement even after 6 months. 2 patients (6.66%) had continuous incontinence, fistula ruled out. Now they were lost to our follow up. Most common late post operative complication was groin pain. None had mesh erosion, bladder and bowel injuries. Conclusions: TOT is a safe and effective procedure for the treatment of stress urinary incontinence (SUI) which significantly improves the quality of life.

Background: Cesarean Section is the most commonly performed abdominal operation in women all over the world. Variable rates of cesarean section are reported between and within countries. Cesarean section at full cervical dilatation with an impacted fetal head can be technically difficult and is associated with increased trauma to the lower uterine segment and adjacent structures, as well as increased hemorrhage and infection.Methods: This is a comparative cross-sectional study comparing maternal and neonatal outcome between first stage and second stage cesarean section performed at Govt Medical College Thrissur.Results: In present study out of 90 cesarean sections 30 were performed in second stage and 60 in first stage.74 % were primigravida in second stage cs group. Arrest due to malposition was major indication for second stage (76% of cases). The most important complication among second stage cs group was PPH (76.7%) and majority of them needed blood transfusion. These complications were less in first stage cs group. Other Complications like increased duration of surgery (mean=53.3 min), post op fever (36% post op Wound infection (13.3%) was seen in second stage group. Fetal complications like low APGAR scores were seen in 16.7% of cases compared to first stage group and most of them needed resuscitation.Conclusions: Women undergoing cesarean section in second stage of labour had increased maternal and fetal morbidity. They required special care and hence Operation should ideally perform and supervised by an experienced obstetrician. Timely decision for cesarean section should be made especially when risk factors for failure to progress are present.

Background: Peripartum hysterectomy is a life-saving procedure resorted to when conservative measures fail to control obstetric haemorrhage. Several predisposing factors, suboptimal care and lack of infrastructure may lead to this emergency procedure. We wanted to find out factors associated with peripartum hysterectomy and the adverse maternal outcomes at our centre.Methods: A retrospective case series analysis of 40 cases of peripartum hysterectomy performed over a period of 5 years from January 2010 to December 2014 at Government Medical College Hospital, Thrissur, Kerala was done.Results: The incidence of peripartum hysterectomy was 0.29%. The most common indication for peripartum hysterectomy was hysterectomy was uterine atony (50%). Thirty-five women (88%) were between 20 and 35 years. Most of the subjects were unbooked. There were two maternal deaths (case fatality rate of 5%) following peripartum hysterectomy during this period. All the subjects required blood transfusion.Conclusions: Prompt performance hysterectomy before the patient’s clinical condition deteriorates is the key to success. The incidence of adherent placenta is increasing, so every effort should be taken to reduce the caesarean section rates globally.