BACKGROUND To evaluate the efficacy of dinoprostone vaginal pessary for cervical ripening and labour induction in term pregnant women. METHODS This was a prospective observational study conducted at Sri Ramachandra Institute of Higher Education and Research from September 2016 to September 2018. The study included pregnant women with singleton pregnancy and gestational age (GA) between 37 weeks and 41 weeks of gestation. The estimated sample size was 100. All 100 women were induced with dinoprostone vaginal pessary. RESULTS The average induction to active phase interval was 10 hours 58 minutes. About 60.3 % of primigravida had an active phase time interval of 12 hours 03 minutes; and 95.2 % of primigravida delivered < 24 hours with a mean induction to delivery time interval of 17 hours 36 minutes. 4 % of primigravida had failed induction. About 84.8 % of multigravida delivered with mean induction to active phase time interval of 08 hours 57 minutes and 100 % of multigravida delivered < 24 hours with a mean induction to delivery time interval of 12 hours 19 minutes. Out of 100 patients, 80 % of patients delivered by spontaneous vaginal delivery with episiotomy, 5 % of patients delivered by assisted vaginal delivery with episiotomy and 15 % of patients delivered by Caesarean section. Almost 97 % of multiparous women delivered vaginally. No adverse maternal and neonatal outcome was noted in the present study. CONCLUSIONS Dinoprostone vaginal pessary is highly effective in the induction of labour at term in properly selected cases. In terms of success and failure, dinoprostone vaginal pessary does not differ much from dinoprostone gel. KEY WORDS Labour Induction, Propess, Dinoprostone

BACKGROUND This study was conducted to evaluate the maternal and fetal outcome of fever in pregnancy. METHODS The present study was a prospective observational study conducted from April 2012 – March 2014 among patients in the Department of Obstetrics and Gynaecology, Sri Ramachandra Institute of Higher Education and Research Institute, and they were followed up to the time of delivery to determine the maternal and foetal outcome. This is a prospective study and sample size was 120 patients. All patients admitted with fever irrespective of the gestational age and parity were included in the study. The ethical committee of Ramachandra Medical College and Hospital approved the study. Reference CSP-MED / 13 / AUG / 08 / 47. RESULTS Fever in pregnancy nearing term has been associated with adverse outcomes. Even elevated temperature in the first trimester can lead to fetal loss. Urinary tract infection was the most common infection during pregnancy. E. coli was the most common organism isolated. Other aetiologies encountered were dengue, malaria, scrub typhus, leptospirosis, enteric fever, H1N1, Influenza A viral fever, respiratory tract infections, and chicken pox. The most frequently seen adverse outcome in this study was abortion. There was one maternal mortality due to H1N1 and one neonatal mortality due to dengue haemorrhagic fever which was transmitted to the fetus. There was one fetus with multiple anomalies and the mother had a history of chicken pox in the first trimester. There were 15 cases of premature rupture of membrane and 12 cases had preterm labour. Intrapartum fever was associated with postpartum haemorrhage and meconium-stained liquor in some mothers. CONCLUSIONS Fever during pregnancy can potentially lead to adverse maternal and perinatal outcomes even at a low-grade temperature of a short duration of less than a week. Even elevated temperature in the first trimester can lead to fetal loss. Fever in pregnancy nearing term has been associated with adverse perinatal outcomes. Some virulent organisms can lead to fetal anomalies and maternal death. KEY WORDS Fever in Pregnancy, Maternal Outcome, Foetal Outcome

BACKGROUND Oligohydramnios is defined as the amniotic fluid index < 5 cms measured through ultrasound techniques. It is becoming a major health care issue in the antenatal period. We wanted to identify and quantify the maternal and foetal outcome in patients with decreased liquor using amniotic fluid index. METHODS This study is a retrospective study done in the labour room of Sri Ramachandra Medical College, Porur, Chennai between January 2017 to March 2019. A total of 9600 deliveries were conducted during the study period of which clinically suspected cases in the second and third trimester were 106 in number. Various parameters like antenatal history, ultrasound parameters like gestational age, placental localisation, amniotic fluid volume, congenital anomalies of the foetus, APGAR score at 1 min and 5 mins and perinatal mortality were noted. RESULTS In the total of 9600 deliveries, 106 (1.1%) were having oligohydramnios. All women between 21-25 years (57.89%) of age had decreased amniotic fluid index. Anaemia and PIH were the most common factors associated with oligohydramnios. Caesarean section was 50% and vaginal delivery was 36.8% in women with low amniotic fluid index. Variable heart rate deceleration (10.52%) was seen in babies born to women with decreased amniotic fluid index. Higher incidence of low Apgar score <7 at 1 min and 5 min and meconium stained liquor was observed among cases with very low AFI [6 (15.2%) and 5 (13.15%) respectively] and low AFI (22.2%) respectively. Higher incidence of IUGR was observed in very low AFI [16 (42.10%)]. Decreased amniotic fluid index is associated with increased perinatal morbidity and mortality and still births. CONCLUSIONS Foetal distress, meconium passage and low APGAR score at 1 min and 5 mins were associated with low amniotic fluid index and these patients required careful monitoring and follow up during antenatal and intranatal period.

BACKGROUND Meconium stained Amniotic fluid is associated with higher rate of caesarean delivery, increased need for neonatal resuscitation and meconium aspiration syndrome. The risk factors for meconium stained amniotic fluid are both maternal and foetal. The maternal factors are hypertension, gestational diabetes mellitus, maternal chronic respiratory or cardiovascular diseases, post term pregnancy, preeclampsia and eclampsia. The foetal factors include oligohydramnios, intrauterine growth restriction and poor biophysical profile. We wanted to determine the maternal and foetal outcome and mode of delivery in patients with meconium stained liquor during labour. METHODS This retrospective study was conducted from January 2017 to March 2019 on patients admitted to labour ward in Sri Ramachandra Medical University. Out of 9600 deliveries over the period of 2 years, 110 patients who met the inclusion criteria were enrolled in the study. RESULTS The results of maternal and foetal outcome and mode of delivery were analyzed statistically. Increasing grade of meconium stained liquor is associated with increased adverse outcome. Association of meconium stained liquor with abnormal cardiotocography is associated with poor outcome, increased caesarean section rate and increased neonatal complications. CONCLUSIONS Meconium stained liquor alone is not associated with an adverse neonatal outcome. 90% of babies remained asymptomatic in spite of meconium stained liquor and required only routine care. Increasing grade of meconium stained liquor is associated with adverse maternal and foetal outcome. Association of meconium stained liquor with abnormal cardiotocography is associated with poor outcome, increased cesarean section rate, increased neonatal complications.