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Objective: To compare efficacy, safety and tolerance of combination of Mifepristone and Misoprostol versus Misoprostol alone in induction of labour in late intrauterine fetal death (>24 weeks). Methods: This prospectively study included 160 women with late intrauterine fetal death (IUFD) after 24 weeks of gestation and divided the women randomly into two groups each containing 80 women. In Group-A : Mifepristone 200 mg single dose was given and after 24 hrs Tab Misoprostol (intravaginally) administered and repeated 4 hourly upto a maximum of 5 doses, while in Group-B : Only Tab Misoprostol administered intravaginally 4 hourly upto maximum 5 doses. Induction-delivery interval and number of doses of Misoprostol was calculated.    Results: The mean induction-delivery interval in Group-A was 13.02 ± 3.74 hours and in Group-B was 16.09 ± 2.99 hours (p-value <0.0001). Mean doses of Misoprostol required in Group-A was 3.36 ± 1.08 hours and in Group-B was 4.32 ± 0.65 hours (p-value <0.0001). Conclusion: Combination of Mifepristone and Misoprostol is more effective as comparison to Misoprostol in terms of induction-delivery interval and number of doses of misoprostol required.    Keywords: IUFD, mifepristone, misoprostol, induction of labour, induction-delivery interval.

Objective: The study was conducted to compare the outcome of labour between the unengaged and engaged head at the onset of labour at term in primigravidas. The aim was to determine the course of labour in between unengaged and engaged head in primigravida at term  at the onset of labour and to study the maternal and neonatal outcome. Design: A prospective hospital-based comparative study. Methods: In this prospective comparative study, primigravida women at onset of labour at term who were admitted in labour room and satisfying inclusion and exclusion criteria were included. Group (I) study group included 110 primigravida at term with unengaged (at 37-41weeks) head at onset of labour and in Group (II) Control Group 110 primigravida at term with engaged (at 37-41weeks).  Detailed clinical history, physical examination and investigation are reported. The duration of stages of labour and total duration of labour and its partographic analysis, need for Induction and augmentation of labour or surgical intervention, mode of delivery and fetomaternal outcome was recorded. Results: In Group I, 83.64% cases went into spontaneous labour while 90 % cases in Group II. 16.36% cases in group I and 10% cases in group II needed induction of labour with PGE2 gel. In group I, 68.18% required augmentation of labour compared to 33.63% in group II. Duration of 1st ,2nd stage of labour and total duration was more in group I as compare to group-II. Incidence of normal vaginal delivery and LSCS were 52.73%,32.73%respectivaly in group I while 71.82%,17.27% respectively in group II, the difference was statistically significant with p-value 0.011. Fetomaternal morbidity which was higher in group-I as compare to group-II was documented which was not statistically significant. Conclusion: The unengaged head in primigravida at the onset of labour at term can have normal vaginal delivery with appropriate induction and augmentation of labour and constant vigilance throughout the labour by partograph monitoring. Which can reduce primary caesarean delivery rate, maternal morbidity and healthcare expenditure in unengaged primigravida. Proper trial of labour in primigravida with unengaged head at term in the absence of cephalopelvic disproportion, vaginal delivery is possible with watchful expectancy with appropriate means of intervention. Keywords: Primigravida, Engaged, Unengaged, Lower segment caesarean section.

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Background: It is a study of the assessment of risk factor of primary caesarean section in multigravida women who has had previous vaginal delivery of viable neonates. Aim of Study: To study the risk factor of primary caesarean section in a multigravida. Methods: Prospective study, hospital based descriptive type of observational study conducted in department of Obstetrics & Gynaecology, SMS Medical College, Jaipur, India from June 2018 to August 2019 ,1000 multipara women previous delivered vaginally  with gestational age >28 weeks with giving written and informed consent were included and excluded previous caesarean section and Labor was monitored by using partograph. Decision for caesarean section was based on clinical evaluation of progress of labor, fetal and maternal condition and complications were noted. Statistical analysis: Continuous variable was expressed as Mean and Standard deviation. Nominally / Categorized variable was summarized as Proportion. Parametric and Nonparametric Tests used for continuous and nominal variable as per yield of data. Result: 42.18% women in the age group of 26- 30 years and 71.90% were second gravida. 67.30% had emergency caesarean section. Among the various risk factor of caesarean section, malpresentation was commonest (12.79%). Conclusion: There are many cases where a caesarean section becomes mandatory for her. Many unforeseen complications occur in women who previously had a normal vaginal delivery.