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Background: High caesarean section rate worldwide including India is matter of concern. The aim of this study is to analyse caesarean section rate at tertiary care centre according to Modified Robson’s classification.Methods: This retrospective study was conducted at Shri Guru Ram Rai Institute of Medical and Health Sciences (SGRRIMHS) and Shri Mahant Indiresh Hospital at Dehradun from April 2018 to September 2018. All women delivered during this period were classified according to modified Robson’s classification using their maternal characteristics and obstetric history. For each group, authors calculated the caesarean section rate within the group and its contribution to overall caesarean section rate.Results: Out of total 1302 women delivered, 395 underwent CS (30.3%).The major contribution to overall caesarean section rate was 33.4% by group 5 (Previous CS, singleton, cephalic, >37weeks) followed by 16.7% by group 1 (nullipara, singleton, cephalic, >37 weeks, spontaneous labour), 12.4% by group 3 ( multipara, singleton, cephalic, >37 weeks, spontaneous labour ).CS rates among various group ranges from 100% among women with abnormal lie (group 9) to 77.5% in nulliparous breech (group 6), 73.7% in previous CS (group 5) and least 11.2%  in multipara induced or pre labour CS (group 4).Conclusions: Modified Robson classification is simple, systematic, reproducible and can be effectively utilized in analyzing delivering women. Major contribution to overall caesarean section is made by previous CS.

Background: Preterm birth defined as birth before 37 weeks of gestation is a significant public health issue. Identification of patients at risk of preterm labour while ruling out those who are not is a fundamental but challenging goal for clinicians. This study was done to evaluate bed side dipstick test for detecting fetal fibronectin in cervico-vaginal secretions as a predictor of preterm delivery in symptomatic and asymptomatic high risk group.Methods: This was a hospital based prospective, double blinded study. We enrolled 100 pregnant women presenting with or without symptoms of preterm delivery, between 20 and 35 weeks of gestation. A rapid bed side dipstick test was performed to detect FFN in cervico-vaginal secretions of all enrolled women (symptomatic and asymptomatic high risk women) and results were evaluated for prediction of preterm labour. Qualitative data were analyzed by using Chi-square and Fisher’s exact test and quantitative data were analyzed by using unpaired Student’s t test and Mann-Whitney test. P value < 0.05 was considered significant.Results: In symptomatic group sensitivity, specificity, PPV and NPV of FFN test in predicting delivery within 48 hours, 7days 14days and preterm delivery was 100%, 63.2%, 46.2%, 100%; 100%, 72.7%, 65.4%, 100%; 100%, 75%, 69.2%, 100%; 80%, 76%, 76.9%, 79.2% respectively. In asymptomatic high risk group, sensitivity, specificity, PPV and NPV of FFN test in predicting preterm delivery (<37weeks) was 0%, 87.5%, 0%, 77.8%.Conclusions: The high negative predictive value may be of value in avoiding unnecessary interventions with potentially hazardous medications and identifying symptomatic women who are not in true labour and also allaying anxiety of asymptomatic high risk women.

Background: Maternal, fetal, and neonatal outcomes in parturients with intrahepatic cholestasis of pregnancy (ICP) have been retrospectively documented. We aimed to present pregnancy outcomes of parturients with ICP who underwent delivery. The study was conducted during a 1-year period in a tertiary care centre. Methods: Data from 1 January to 31 December 2017 were collected to identify parturients with ICP. Results: Almost 3/4th of births came to a vaginal delivery (76.74%) and only 10 parturients had cesarean delivery. 4 of 10 parturients underwent nonelective cesarean section, while 6 had elective cesarean delivery. 15.15 % vaginal deliveries were instrumental. The most common indications for emergency LSCS and instrumental deliveries was fetal distress followed by failure to progress of labour. Most births occurred at or after 37 weeks of gestation (65%). Regarding neonatal outcomes in terms of birth weight and Apgar scores at 1 and 5 min, they were positive, as well. None of the babies had Apgar score < 7 at 5 minutes. No case of perinatal death was observed. Conclusions: Although the results were generally positive, larger studies need to be conducted to evaluate the maternal and fetal outcomes in ICP and correlation with serum bile acid levels.