INTRODUCTIONWHO defines menopause as permanent cessation of menstruation resulting from loss of ovarian activity. 1 Postmenopausal bleeding (PMB) is defined as abnormal uterine bleeding occurring after 1 year of menopause. Common menopausal age in Indians is 45-50 years. Postmenopausal women constitute only 1% of female population. Postmenopausal bleeding represents one of the most common reasons for referral to gynaecological services, largely due to suspicion of an underlying endometrial malignancy.2 A woman not taking hormone replacement therapy (HRT) who bleeds after the menopause has a 10% risk of having genital cancer and a further 10% risk of significant pathology.3 Therefore, postmenopausal bleeding should always be investigated no matter how minimal or non-persistent.Etiology of post-menopausal bleeding include: nongynaecological causes like trauma or a bleeding disorder, use of hormone replacement therapy, vaginal atrophy, endometrial hyperplasia (simple, complex, and atypical), endometrial carcinoma usually presents as PMB but 25% occur in premenopausal women. Other causes include endometrial polyps or cervical polyps, carcinoma of Results:The commonest finding of pelvic USG was increased endometrial thickness (>4mm) (80%). The histopathological analysis showed proliferate endometrium (36.3%), atrophic endometrium (16.6%), cystoglandular hyperplasia (10%) and endometrium hyperplasia (6.6%). Incidence of cervical and endometrial carcinomas was 10% and 6.6%, respectively. Conclusion: the postmenopausal bleeding is an important symptom and requires careful and timely assessment to eliminate the possibility of malignancy as soon as possible.

INTRODUCTIONBreech is the common nonvertex presentation in 3-4% of pregnancies all over the world.1 Percentage of breech presentation and deliveries decreases with advancing gestational age, from 22% of births prior to 28 weeks to 7% of births at 32weeks to 1-3% of births at term. 1Incidence decreases towards term due to spontaneous version. So, an active process is involved in limiting this spontaneous version and it results in breech presentation. 2Breech presentation results from uterine anomalies, cornuofundal insertion of placenta, placenta previa, oligohydramnios, fetal getal growth restriction, prematurity, short umbilical cord, fetal anomalies like hydrocephalus, swellings in front of the neck.1 Hence, we should look for the presence of uterine anomalies, site of placenta and fetal anomalies in all cases of breech presentation. Perinatal mortality is increased 3-4fold with breech presentation irrespective of the mode of delivery. 1 Prematurity, cord prolapse and difficulties during vaginal breech delivery especially of the aftercoming head add to the increased perinatal mortality and morbidity following vaginal breech delivery.1 On the otherhand, through planned caesarean delivery, atleast at term, reduces the ABSTRACT Background: The present study was undertaken to study the incidence, aetiology and obstetric outcome of breech presentation in pregnancy in a teaching hospital in a rural area. Methods: The present retrospective observational study was conducted in the department of obstetrics and gynaecology at Bhaskar Medical College and Bhaskar General Hospital, Yenkepally, Telangana from May 2014 to March 2017. 50 cases of breech presentation were included in the study. Demographic data like age, parity, gestational age of first detection of breech, aetiological factors of breech, mode of delivery, neonatal outcome were noted from case records. Results: The incidence of breech was 1.4% in pregnancies attending Bhaskar general hospital. 74% were in the age group of 20-24yrs & 20% were in the age group of 25-29yrs. Primis accounted for 62% of the study group. Common etiologies of breech presentation were oligohydramnios (28%) and uterine anomalies (28%). No obvious fetal anomalies were noted. Majority (96%) of cases were delivered by caesarean section for breech associated with oligohydramnios, gestational hypertension, intrauterine fetal growth restriction and preterm. Neonatal outcome was good in breech delivered by caesarean section. Conclusions: Breech delivery is a high risk pregnancy with adverse fetal outcomes during pregnancy and labour. Though caesarean section for breech presentation is not universally recommended, caesarean section can reduce the perinatal mortality and morbidity compared to vaginal birth for term breech pregnancy. Mode of delivery should be decided based on the case and obstetrician's skill.

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