Background: Caesarean delivery is one of the most commonly performed operations today. Caesarean births have become safer. Primary caesarean section in a multipara means first caesarean section done in the patients who had delivered vaginally once or more. Mainly the baby and the placenta are responsible for caesarean section in multipara. Methods: It was a prospective randomized hospital based study of primary caesarean sections performed in multiparous patients at Dhiraj General Hospital at the Department of Obstetrics and Gynecology. In this study analysis of the cases in relation to different factors have been done. Results: Amongst the various indications for caesarean section in multipara, fetal distress (25.58%) and antepartum hemorrhage (22.09%) were with the highest incidence. Conclusion: Previous vaginal delivery gives the patient as well as her relatives a false sense of security. There are many cases where a caesarean becomes mandatory for her. The fact that a multipara has had one or more vaginal deliveries should be regarded as an optimistic historical fact, not as diagnostic-criteria for spontaneous delivery of the pregnancy at hand. [Int J Reprod Contracept Obstet Gynecol 2013; 2(3.000): 320-324

Background: From historical times termination of pregnancy was practiced with or without legal and social sanctions. Over the last few years, induced abortions have gained more popularity because of safe techniques and medications available. Induced abortion means willful termination of pregnancy before the period of viability. Medical abortion in the second trimester with misoprostol alone has been shown to be affective, although in comparison with the combination of mifepristone and misoprostol, misoprostol-only protocols have required higher doses, side effects are more common and the time to complete the abortion is longer. Methods: Total of 50 eligible women were enrolled for this study and were divided in two groups of 25 each of the case group and control group. This study was conducted in the Dhiraj General Hospital, Piparia, Waghodia. Women in the case group were given Tablet Mifepristone (200 mg) orally followed by Tablet Misoprostol (200 mcg) vaginally after 24 hours which may be repeated every 6 hrs till 5 doses. Women in control group were given Tablet Misoprostol (200 mcg) vaginally which may be repeated every 6 hrs till 5 doses. Results: The combination of mifepristone and misoprostol is now an established and highly effective and safe method for medical method second trimester abortion. The combination of mifepristone with misoprostol significantly reduces the abortion to induction interval and also have fewer side effects and complications and also reduces the dose of misoprostol. Where mifepristone is not available or affordable, misoprostol alone has also been shown to be effective, although a higher total dose is needed and efficacy is lower than for the combined regimen. Therefore, whenever possible, the combined regimen should be used. Conclusions: Mifepristone followed by misoprostol was more effective and has a shorter IAI and fewer side effects. [Int J Reprod Contracept Obstet Gynecol 2013; 2(3.000): 315-319

Background: It is important to examine every step in any surgery to identify and evaluate its imortance, necessity and purpose with a view to find its better alternatives if they can be found at all. The most appropriate surgical procedure is the one which takes minimum time to be complete, simplest to perform, causing least damage and least complication for the patient. Present study was undertaken to assess the benefits of the Misgav Ladach cesarean section technique in comparison to the conventional Pfannenstiel technique in the tertiary care hospital and evaluate the operative parameters like efficacy, safety, duration of surgery, blood loss, need for suture material, post-operative pain and post-operative stay in hospital.Methods: All the women posted for emergency cesarean section in the Obstetrics OT at Sir T Hospital, Bhavnagar, Gujarat were included in this study. Some of the common indications at our hospital for cesarean section were fetal distress, cephalopelvic disproportion, failure of progress of labour, breech presentation, previous cesarean section and failed induction. Informed consent was taken. All the patients were randomly allocated to two groups with 50 women in each group. Group 1 Pfannenstiel incision and Group 2 Misgav Ladach.Results: The duration of surgery, blood loss and post-operative pain were significantly less in the Misgav Ladach group (P<0.001).Conclusions: Misgav Ladach technique of cesarean section has many advantages and should be used routinely.

Background: Gestational diabetes (GDM) represents carbohydrate intolerance first discovered in pregnancy, occurs in 3.8-21% of pregnancies. Postpartum glucose intolerance returns to normal in majority. However, there is high risk of developing impaired glucose tolerance or overt diabetes mellitus later in life. Balanced diet at proper time can help achieving glycemic control. It also helps women with GDM to avoid need for insulin reducing costs of treatment.Methods: Study was done in Dhiraj Hospital in Obstetrics and Gynecology department. Study duration was 1.5 years. It was a prospective study comprising of patients who came with raised blood glucose levels on their 1st visit.Results: Prevalence of GDM (2.87%) is observed to be comparable to various other centres. Highest number of GDM cases was observed in age group of 26-30 years (62.96%). Control of glycemia with diet could be achieved in majority of women (53.85%) at 3 months post-partum as reflected by FBS levels. Incidence of Macrosomia (29.63%) and LSCS (77.78%) could not be lessened by glycemic control with diet in women with GDM.Conclusions: Prevalence of GDM was comparable to that of other studies. Rate of caesarean section was very high and main indications being foetal distress and cephalopelvic disproportion. Maternal and perinatal morbidity increases as duration of GDM increases. Control of glycemia with dietary treatment can help reduce occurrence of complications in mother and baby. It requires proper compliance, absence of which calls for need of insulin in most of patients with uncontrolled glycemia since first.

Background: The present study was done to determine the relative contribution of each of ten groups of robson´s classification to overall cesarean section rate and identify modifiable group for intervention to reduce the cesarean rate.Methods: Retrospective review of record of cesarean section from the statistical Dept of Obstetrics and Gynecology sir T. hospital, Bhavnagar from January 2017 to October 2017 and classify them in to Robson´s ten group classification system to find out total number of cesarean among total number of delivery in above 10 months duration.Results: Total number of delivery in my study institute in 10 months was 3804 out of them 1182 was cesarean section, so the overall cesarean section rate in Sir T. hospital, Bhavnagar was 31%. Group 1 (Nulliparous, single cephalic, >37 weeks in spontaneous labor), 2 (Nulliparous, single cephalic, >37 weeks, induced or CS before labor) and 5 (Previous CS, single cephalic, >37 weeks) contributes for around 66% of total cesarean. Group 5 (Previous CS, single cephalic, >37 weeks) was the major contributor among all. Least common cause of cesarean was group 8 (All multiple pregnancies (including previous CS)) and group 9 (All abnormal lies including previous CS).Conclusions: Incidence of cesarean was more common with patient having previous cesarean section. So, to decrease cesarean rate trial of labour should be given to the patient who was suitable for vaginal birth after cesarean section. Adequate assessment of pelvis and giving trial to patient having borderline pelvis also decrease the rate of cesarean in primi gravid (group 1).