INTRODUCTIONWHO has defined menopause as the permanent cessation of menstruation resulting from the loss of ovarian follicular activity.1 Postmenopausal bleeding (PMB) is defined as abnormal uterine bleeding occurring after one year of menopause. Common menopausal age in Indian women is around 42-50 years. It is a common clinical problem, occuring in approximately 3%-5% of post menopausal women and represents one of the most common reasons for referral to gynaecological services, largely due to suspicion of an underlying genital tract malignancy.2,3 Aetiology of post menopausal bleeding includes benign causes like proliferative or atrophic ABSTRACT Background: Post-menopausal bleeding (PMB) is a frequent and alarming sign and exclusion of genital tract malignancy should be the primary aim of investigation. Approximately 1 in 10 women experiences this problem. Increasing time interval between menopause and onset of post-menopausal bleeding is highly indicative of malignancy. Objectives of this study were to study the various etiologies and risk factors of post-menopausal bleeding and to find the prevalence of malignant pathology in women with post-menopausal bleeding. Methods: Prospective observational study carried out in Obstetrics and Gynecology department of SBKSMIRC (Shrimati Bhikhiben Kanjibhai Shah Medical Institute and Research Centre), Dhiraj general hospital, comprising of 150 consecutive cases of postmenopausal bleeding occurring after one year of menopause, presenting in OPD or admitted in Gynecology or emergency ward with the same complaint. Patients were assessed clinically as well as thoroughly investigated to find out exact etiology. Pap smears, tranvaginal ultrasound, fractional curettage and biopsies were done. Statistical analysis of data was done after compiling and tabulation of data. Mean±SD for age and percentages for etiologies were calculated and compared with other studies. Results: Benign aetiology was seen in 74% of the cases, malignant aetiology in 24% which is a significant proportion of menopausal women presenting with Post-menopausal bleeding. 58% (87/150) patients were in the age group 50-59 and presented after five to ten years of menopause. Commonest benign aetiology was atrophic endometrium 25.4% and another 32.5% had functional endometrium as cause of PMB (proliferative 13.2%, hyperplasia 13.2% and secretory 6.1%). Among malignancies carcinoma cervix was the commonest, 52.7%, (12.6%) of study population followed by carcinoma endometrium, 25% (6% of total population), thus making thorough and proper evaluation of all cases of PMB mandatory to pick up malignant lesions at early stage and initiate treatment accordingly. Conclusions: Post-menopausal bleeding has become a common complaint in gynecology OPD and considering its possible association with malignancy, even slightest amount of bleeding demands proper work up.

Background: Induction of labour can be defined as “Artificial initiation of uterine contractions before the onset of spontaneous labour, after the period of viability, by any methods, for purpose of vaginal delivery.” The key factor for a successful induction is the status of cervix, its form, consistency and dilatation which is determined by the Bishop score. In case of unfavourable cervix or in the pregnancies remote from the term; prostaglandins are more effective than any other method of induction. Introduction of misoprostol, PGE1 analogue, for the induction of labour in 1993 and its approval for clinical use by ACOG (American College of Obstetrics and Gynecology) in 1999 has been the most significant advancement. It is the latest drug for induction of labour which is cheap and stable at room temperature and is being used worldwide in different doses and by various routes. We compared the most commonly preferred two routes; vaginal and oral in terms of success of induction and noted the adverse events and side effects in both routes.Methods: This was a prospective comparative study carried out at SBKSMIRC (Shrimati Bhikhiben Kanjibhai Shah Medical Institute and Research Centre), Dhiraj general hospital, Vadodara, Gujarat, 200 patients who required induction of labour were recruited after applying inclusion and exclusion criteria and were randomly divided in two groups- Group A meant to receive 50µg oral misoprostol, Group B - meant to receive 25µg vaginal misoprostol repeated 4 hourly up to maximum of five doses. Progress of labour was charted on the partograph. The mean induction delivery interval, mode of delivery, maternal and neonatal outcomes and complications were observed.Results: The mean induction to delivery interval was significantly less in vaginal group than oral (23.3±12.4 hours in oral vs. 17.3±10 hours in vaginal). Vaginal delivery and cesarean section rates were comparable in both groups (76% in Group A vs. 72% in Group B for vaginal delivery, 18% vs. 20% for Cesarean section, respectively). 58% patients in Group A required more than two doses as compared to 39% in group B, though the difference was statistically not significant. Significant number of patients required added oxytocin administration in Group A (72%). No major complications or adverse events were observed. Neonatal hyperbilirubinemia was seen more in Group A.Conclusions: Both Oral misoprostol in a dose of 50μg and vaginal misoprostol 25 μg every four hours, to a maximum of five doses, have the potential to induce labour safely and effectively. The vaginal route however is beneficial in effecting delivery in lesser time with few numbers of doses as compared to oral route.

Background: Postpartum haemorrhage (PPH) is the leading cause of maternal mortality, accounting for about 35% of all maternal deaths. These deaths have a major impact on the lives and health of the families affected. Thus, anticipation as well as proper management of 3rd stage of labour is mandatory. The objective of this study was to compare expectant and active management of third stage of labour in preventing post-partum blood loss and having impact on prevention of maternal mortality in local population. Advantages and disadvantages of both techniques might be over estimated.Methods: Prospective comparative study carried out in Obstetrics and Gynecology department of SBKSMIRC (Shrimati Bhikhiben Kanjibhai Shah Medical Institute and Research Centre), Dhiraj general hospital, comprising of 200 laboring women admitted directly or from OPD to labour room for expected vaginal delivery. They were randomly allocated to group A (expectant management) and group B (active management). Labour progress was charted on partograph and interventions recorded. Statistical analysis of data was done after compiling and tabulation of data. Mean±SD for descriptive variables were calculated and appropriate statistical tests applied to determine significance.Results: Average PPBL (post-partum blood loss) was 360.5ml in group A as compared to 290.6ml in group B. 12 patients in group A had blood loss more than 500ml while none in group B. 66% cases in group B had duration of third stage of labour less than 5 min as compared to only 22% in group A. the mean duration of third stage was 13.46±8.3 in group A while 5.32±3.05 in group B. these differences were statistically significant.Conclusions: Active management of the third stage of labour is associated with less blood loss as well as a shorter duration of third stage compared with expectant management. It is reasonable to advocate this regime.

Background: To identify and evaluate various maternal factors associated with low birth weight babies delivered at term and to find out prevalence of LBW babies delivered at term at Dhiraj hospital.Methods: A single arm cross-sectional observational study was conducted in obstetrics & gynaecology department of Dhiraj Hospital, from June 2021 to December 2021. A total 250 patients fulfilling inclusion and exclusion criteria were enrolled. Data was collected from the labour room register statistics as reference for comparison. Maternal factors like-maternal age, parity, anemia, booking status, pregnancy induced hypertension, ante-natal iron and protein supplements, tobacco addiction, placenta previa, gender of newborn etc were studied. Data were analyzed with the help of chi-square test and were also presented by visual diagrams.Results: From the study, the prevalence of LBW at term in Dhiraj hospital was around 22.36%. Out of 250 in sample group, 63.6% mothers were anemic. Almost over 50% mothers with LBW had not taken regular iron supplements. Around 67% mothers not adequately visited (4 antenatal visits) hospital during antenatal period. Primipara mothers (58%) associated more with LBW babies than Multipara (42%). Pregnancy induced hypertension and placenta previa significantly affects birth weight. Around 30% LBW show maternal history of tobacco addiction.Conclusions: Although the prevalence of LBW in India has declined over the past decade, it remains still high. Anemia is the most important modifiable factors contributing birth weight. Iron and Protein supplementation need to be attention to prevent LBW. A comprehensive global strategy is required to reduce LBW which must include multiple elements: improving maternal status, treating PIH (or other associated condition), and providing adequate maternal care.

Background: This study of last three years undertaken to determine the types of breast lumps as seen by an obstetrician and gynecologist and to determine the high risk factors for diagnosing malignant breast lump and guide patient for early and proper management. Methods: The diagnostic triad of clinical examination, FNAC and mammography was used to help detect a malignant mass. Results: Out of 202 cases, 162 were of benign breast lump and 40 of malignant breast lump. Age and family history were the most important risk factors. Other risk factors were nulliparity, first child after 30 years of age and postmenopausal age. Fibroadenoma was the most common benign tumor usually occurring at a younger age. Of the 40 cases of malignant breast lump, only 45% were detected early. Conclusion: All gynecologist should examine patient’s reproductive organs as well breast and also learn patient - how to examine breast herself regularly. Thus all obstetrician and gynecologist should participate in the breast cancer screening and help detect this malignancy in its early stage. [Int J Reprod Contracept Obstet Gynecol 2013; 2(3.000): 288-291