Background:The problem of high perinatal morbidity and mortality is a great challenge to obstetricians and neonatologists in the developing countries. Breech presentation which is one of the commonest malpresentations is a major cause of high morbidity and mortality. The optimum mode of delivery of breech in order to minimise the risk to both the mother and the baby still remains controversial. Aims & objectives: The current study was conducted to find out the associated factors for different modes of delivery in breech presentation and also to compare the maternal and perinatal outcome between vaginal delivery (VD) and Caesarean section (CS) for singleton term pregnancy with breech presentation. Methods: A prospective study was done during the period October 2011 to March 2013. All pregnant women with singleton breech presentation with gestational age > 37 weeks admitted at the department of Obstetrics and Gynaecology, Regional Institute of Medical Sciences (RIMS), Imphal were the study subjects. Those not willing to participate in the study, multiple pregnancy, preterm pregnancy, pregnancy with chronic illness, intra-uterine death, complicated pregnancy like ante-partum haemorrhage, pregnancy associated with gynaecological problems like fibroids, cervical polyps etc. and having history of any uterine surgery were excluded from the study. Socio-demographic details were obtained by using a pre-tested, semistructured interview schedule. This was followed by a detailed history-taking and a thorough clinical examination. Relevant routine and sophisticated laboratory investigations were also performed wherever indicated. The study-subjects were followed up until discharge from the department. Data were analysed by using SPSSv16.0. Result: The CS rate was found to significantly higher among booked women, nulliparous women, women not in labour at the time of admission, complete breech and women with a higher gestational age and baby's weight more than 3 kg. Clients' age, religion, prior stay and fundal localization at cornua, although seemed to be slightly higher among CS cases, the associations were not found to be statistically significant. Apgar scores at 1 and 5 min, necessity for admission in Neonatal Intensive Care Unit (NICU) and neonatal deaths were found to be significantly lower to those babies delivered by CS compared to those delivered by VD. But, regarding maternal outcome, post-delivery blood transfusion was found to be significantly more necessary for CS compared to that of VD. Conclusion: Vaginal delivery confers more benefit to the mother whereas CS increases safety to the newborn. Bigger studies are needed to determine whether a potential benefit for the newborns outweighs the increased risk for the mothers associated with caesarean section. Meanwhile, great care, skill and judgment have to be exercised on case-based approach to get the best results.

Background: Induction of labour is indicated when the benefits to either the mother or foetus outweigh those of continuing the pregnancy. Many drugs or methods have been tried for the purpose, the latest addition being prostaglandins. Objective: The present study was taken up to compare the safety and efficacy of 50 µg intra-vaginal Misoprostol and a single dose of 0.5 mg intra-cervical Dinoprostone in induction of labour. Methods: 220 women admitted in RIMS during the period Jan 2003-Aug 2004 and needing induction of labour were randomly allocated into two groups, each group consisting of 110 women. To one group Misoprostol was given while the other group got Dinoprostone. These two groups were followed up up-to the perinatal period. Result: The mean Bishop's score at 4th hour were found to be significantly increased in both the groups, the mean score at 4th hour being significantly higher in Misoprostol group as compared to Dinoprostone group (5.77 Vs 4.83). The need for oxytocin augmentation was significantly less in Misoprostol group. The induction-delivery period was also found to be much shorter in this group when compared to Dinoprostone group (10.8±4.8 hours Vs 12.0±7.7 hours). The proportion of vaginal delivery was comparable in the two groups. Apgar scores of babies in the two groups also were comparable. Maternal and perinatal complications were very less in both the groups. Conclusion: Both intra-vaginal Misoprostol and intra-cervical Dinoprostone were found to be effective and safe for induction of labour. However, Misoprotol is less expensive, easy to administer and more effective than Dinoprostone with minimal side effects when cases are monitored properly.

It is a retrospective cross sectional study of Caesarean sections conducted in a tertiary care centre in the present millennium. The study is conducted to ascertain the 1) Incidence 2) Indications 3) Fetal and maternal outcomes & complications. All caesarean sections conducted at the Regional Institute of Medical Sciences Hospital Imphal during the period January 2003 to December 2003 were included. Data was analysed using simple mathematical calculations. Two thousand and twenty-four caesarean deliveries were conducted out of total of 10,483 deliveries. There were 2 maternal deaths and 17 fetal/neonatal deaths. The incidence of caesarean deliveries is on the rise. In spite of much advancement in the present day medical care and obstetric care, caesarean deliveries still carry significant risk to the mother as well as to the newborns, and much more have to be done to improve outcome.