Background: Perimenopause is described as years prior to menopause that encompasses the change from normal ovulatory cycle to cessation of menses, ending 12 months after the last menses. International federation of gynaecology and obstetrics (FIGO) developed a new classification PALM-COEIN in order to standardize the factors associated with AUB. It classifies AUB as polyp, adenomyosis, leiomyoma, malignancy and hyperplasia (PALM) - structural abnormalities Coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not yet classified (COEIN) - unrelated to structural abnormalities. Objectives of this study were to categorise the causes of AUB in perimenopausal women in context to PALM COEIN classification system. Correlation of co-morbities (diabetes, hypertension and thyroid disorders) with AUB in perimenopausal age group.Methods: This is a retrospective study from the month of May 2019 to October 2019, considering 100 patients of perimenopausal age group (40 to 55 years of age group) in J. K. Hospital Bhopal, Madhya Pradesh with complaints of abnormal uterine bleeding, admitted in gynae ward.Results: Most of the patients in the current study were between 45-50 years of age i.e. 44%. Menorrhagia was the commonest menstrual disorder encountered in 52% of patients. As per FIGO; AUB-L constituted 42% AUB-O constituted 12%, AUB-P constituted 11%, AUB-A 10%, AUB-M constituted 8% AUB-E constituted 8%, not yet classified constituted 4% of total cases.Conclusions: AUB (PALM-COEIN) for causes of abnormal uterine bleeding classification was very useful in categorizing cases of AUB. It suggests that etiology of AUB and also gives place for presence of multiple factors as a cause of AUB in a particular case.

Introduction: The process of child bearing is a beautiful experience for a woman but unfortunately it is fraught with some unpredictable dangers. One of them is an abruptio placenta which is defined as premature separation of a normally implanted placenta, before the delivery of the fetus. It occurs in up to 1.0% of all pregnancy and can be associated with severe maternal and fetal complications. Material and Methods: The study done on antenatal patients of Sultania Zanana Hospital, Bhopal from 1 st april 2008 to 31 st march 2009. Patients clinically diagnosed as abruptio placentae were included in the study and were followed throughout their stay in the hospital. Result: The study showed the incidence of abruptio placenta to be 1.6%. It was found 1.8 times more commonly in multigravida than primigravida patients. Incidence was found much higher in patients with PIH, Pre-eclempsia and eclempsia (4.35%?). The association of maternal smoking and placental abruption has been well documented and in our study 9.6% of patients were found to be smokers. The incidence of abruptio placentae was 2.3% among multifetal gestation which is 1.43 times the incidence in general population. Preterm deliveries showed an increased incidence of abruptio placentae. Mortality rate of babies in our study was 52.05%. Conclusion: This study denoted that high parity, younger age, PIH, pre-eclempsia, eclempsia, multifetal gestation and smoking are the major risk factors for abruptio placentae. Thus proper antenatal care, proper booking, screening of high risk factors, timely referral are the various pillars need to be strengthened in our population to reduce the occurrence and the complication arising out of this catastrophe.

Introduction:We tried to evaluate the effectiveness of 2 months oral contraceptive pill (OCP) pretreatment for clomiphene citrate (CC) resistant cases followed by repeat clomiphene citrate treatment. Material and Methods: In this study of 100 patients, 30 met the criteria of clomiphen citrate resistant anovulation . Before starting OCPs day 3 hormone profile assayed. All 30patients were given 2 months of continuous OCPs for hypothalamic -pituitary-ovarian axis suppression. After withdrawal bleeding, their day 3 hormonal profile assayed and clomiphene citrate was given from day 3-day7. Follicular growth monitored by sonography from day 12 till max size (>20mm) reached. 10,000 IU Hcg given to those patients who failed to show spontaneous rupture. Ovulation was confirmed by S. Progesterone assay on day 21. Pregnancy confirmed by S. Beta hCG level and 7 weeks amenorrhoea. Result: A total number of 30 patients completed 75 treatment cycles. 23 of them achieved ovulation. There were significant changes observed in hormonal profile in response to OCP treatment. 17 beta estradiol levels decreased to 58%, 63% reduction noted in LH level, androgen decreased by 56%. FSH level also decreased but not so significantly. 23 patients ovulated out of 30 patients (76.6%) which resulted in high ovulatory cycle 55/75 (73.2%) and Cumulative pregnancy rate 60% (18/30). Conclusion: This study showed the excellent ovulation and pregnancy rate following OCP suppression. This mode of treatment is a cheaper alternative to GnRH therapy for poor anovulatory women.

Background: The objective of this study was to assess the maternal and neonatal outcomes in patients with preterm labor pains and also to correlate threatened abortion with preterm pains.Methods: The study conducted was a prospective observational study. 100 cases of preterm labor admitted to JK hospital, Bhopal over a period of 2 years with singleton gestation between 28 to 36+6 weeks were included.Results: Maximum preterm deliveries were in the late preterm group (80%). Correlation of preterm labor with threatened abortion was not significant (OR=1.03; p>0.05). 42% cases delivered vaginally and 58% by LSCS. Prolongation of pregnancy after tocolytic therapy was upto 12 hours in 35% cases, 12-24 hours in 40% cases and >24 hours in only 15% cases. The most commonly encountered neonatal complication was RDS, 37%, out of which 9% required resuscitation at birth and 8% required ventilator support followed by jaundice in 23%, sepsis in 3% cases and NEC in 4% cases. The association between gestational age and requirement of resuscitation at birth (X2=19.9; p=0.00), need of ventilator (X2=12.6; p=0.002) and neonatal RDS (X2=6.9; p=0.031) was found to be significant.Conclusions: Preterm births are major obstetric problem that have an extensive impact on neonatal morbidity and mortality.