OBJECTIVES:It is a study of the analysis of cases where caesarean section was done for the first time in parous women who had previous vaginal delivery of a viable neonate. The various indications, incidence according to age, gravidity, maternal and fetal outcome were studied. METHODS: It is a prospective study of over 200 cases of caesarean section done for the first time in parous women admitted at Government General Hospital, Basaveshwar Teaching and General Hospital, Sangameshwar Hospital, Gulbarga for a period of 18 months. RESULTS: The primary caesarean section rate was 10.28 percent. Maximum incidence of caesarean section was seen in the age group of 25-29 years and majority belonged to second and third gravid. 68 percent of women did not receive any antenatal care. Malpresentation, ante partum haemorrhage, CPD and fetal distress were most common indications for caesarean section. Post operative morbidity was seen in 14 percent of cases. There was no maternal mortality seen. Perinatal mortality rate was 105 for 1000 live births. CONCLUSIONS: It is clear from our study that Primary caesarean section in parous women is not uncommon. Though to a small extent, they are contributing to rise is total caesarean section rates seen. A parous woman needs good obstetric care to improve maternal and neonatal outcome and still keeping caesarean section to a lower rate. KEY WORDS: caesarean section, parous women, multiparous INTRODUCTION:There is worldwide increase in caesarean section rates. 1,2 Chile and Brazil have the highest caesarean section rates in the world being 40% and 37% respectively. 3 Mean caesarean rate in Asia is estimated to be 15.9% and 17.8% in respectively. 2 Most of the studies on caesarean section on parous women with previous normal delivery dates back to 1960's and 1970's where cesarean rates were low as 2.5-11.3% annually. 4,5,6,7,8,9,10 A recent study has demonstrated that the primary cesarean rate in 2002 was 13.3% among parous women as compared to 18% among nuliparous women in United States. 4 The relative ease with which some multiparous are delivered in the presence of faulty positions and presentations may account for the false sense of security. 11 The limited research in this area may be due to this false notion. It is for these reasons, we have examined trends in primary cesarean rates among parous women with previous normal vaginal delivery with respect to indications, maternal age and parity and the outcome.

Background: Maternal mortality is a strong indicator for measuring the health care provided to the women by any society. Motherhood is an event of joy and celebrations for every family. It is tragic that deaths occur during pregnancy and childbirth and most are preventable. The aim is to study the incidence of maternal mortality, assess the epidemiological aspects, causes of maternal mortality and avoidable factors that can prevent maternal deaths.Methods: A retrospective hospital based study was conducted in the Department of OBG, Gulbarga Institute of Medical Sciences, a tertiary level health care referral centre in Kalaburgi, Karnataka, India over a period of 2 years from January, 2016 to December, 2017.Results: A total of 65 deaths were analysed. The mortality rate in study period was 364 per 1,00,000 live births. Maximum maternal deaths were reported in the age group 20-24 years. More deaths were reported in multiparous women (55.8%) as compared to primiparous women (44.2%). Most of them were unbooked cases (60%). The classic triad of haemorrhage (38.4%), hypertensive disorders (29.2%) and sepsis (12%) were the major direct causes of maternal death. Anemia was the major indirect cause of death. Other indirect causes of maternal death were jaundice, heart disease, respiratory disease and epilepsy.Conclusions: Majority of maternal deaths were preventable by proper antenatal care, early detection of high risk pregnancies and their timely referral to tertiary care centre.

Background: Emergency Obstetric Hysterectomy (EOH) is removal of uterus following vaginal delivery, Emergency LSCS or within the puerperium period. Because of increasing caesarean deliveries, the number of scarred uterus is increasing exposing the gravid women to increasing morbidity from uterine rupture, placenta accrete and placenta previa thus increasing the incidence of Emergency obstetric hysterectomy. The aim was to determine the incidence, demographic details, high risk factors and fetomaternal outcome of patients who underwent EOH.Methods: This was a retrospective study where data was collected from the record sheets of patients who underwent Emergency Obstetric Hysterectomy from January 2016 to December 2017 in the department of OBG, GIMS Gulbarga. Maternal age, parity, socioeconomic status, antenatal care, high risk factors and fetomaternal outcome were analysed.Results: During the study period there were 17,820 deliveries out of which 20 cases underwent EOH giving an incidence of 0.12%. Most of patients were uneducated, unbooked, low SES and of rural background and were multiparous. Main cause for EOH were rupture uterus, PPH and morbidly adherent placenta. There were 2 cases of maternal mortality and fetal mortality was 65%.Conclusions: Though EOH is a lifesaving procedure it curtails the reproductive capacity of the women. Proper antenatal care, early referral, timely decision and skill of surgeon in performing this procedure is important.

Hypertensive disorders are the most common medical disorders in pregnancy contributing significantly to maternal and perinatal mortality and morbidity worldwide. The incidence is around 3-10% of all pregnancies. Antihypertensive drugs are often used to lower blood pressure with the aim of preventing its progression to adverse outcomes for the mother, at the same time they should not have adverse effects on the uteroplacental circulation and the fetus. The risk of developing severe hypertension is reduced to half by using antihypertensive medications. The objective of this study is to study efficacy and safety of Labetalol in lowering blood pressure in patients with moderate gestational hypertension. METHODThis is a prospective observational study where fifty six pregnant patients with moderate gestational hypertension on labetalol are included in the study. Reduction in hypertension and frequency of side effects were studied. The statistical level of significance was taken at P <0.05. RESULTThe result showed labetalol is effective in control of blood pressure and well tolerated with free of side effects. CONCLUSIONLabetalol is a safe, well tolerated and effective in controlling blood pressure in moderate gestational hypertension. KEYWORDSModerate Gestational Hypertension, Labetalol. HOW TO CITE THIS ARTICLE:Kanaki AA, Kanaki AR, Rampure N, et al. Efficacy and safety of labetalol in the management of moderate gestation hypertension -a prospective observational study.