Given the flexibility of the classifications, we constructed a hybrid model based on the woman-characteristics system with additional layers of other classification. Indication-based classification answers why, Robson classification answers on whom, while through our hybrid model we get to know why and on whom cesarean deliveries are being performed.

Background: Hypertensive disorders of pregnancy are among the most common medical complications of pregnancy and major cause of maternal, fetal and neonatal morbidity and mortality. The purpose of this study was to compare the efficacy and safety of intravenous hydralazine and labetalol for management of severe hypertensive disorders of pregnancy.Methods: This prospective study was conducted among 100 women admitted with SBP ≥ 160 or DBP ≥ 110 mmHg or both. Patients were divided into 2 groups randomly: labetalol and hydralazine group.Results: Majority of patients (38%) were in the age group of 21-25 years and primigravida (52%). There was more significant decrease in the systolic, diastolic and mean arterial blood pressure at the end of 15 and 30 minutes in labetalol group. Labetalol required fewer doses as compared to hydralazine to achieve the target blood pressure (average 1.95 versus 3.1). Total numbers of term deliveries were 19 (38%) in hydralazine group and 16 (32%) in labetalol group. Pre-term deliveries in hydralazine and labetalol group were 14 (28%) and 15 (30%) respectively. Headache was significantly more common in hydralazine treated patients than labetalol group.Conclusions: Both hydralazine and labetalol were effective and well-tolerated in the treatment of severe hypertensive disorders of pregnancy. Labetalol may be preferred because it was more effective in lowering the systolic blood pressure, diastolic blood pressure and mean arterial pressure to achieve target levels with less number of doses.

Background: Thyroid disorders specifically the hypothyroidism has been associated with menstrual disturbances in women of reproductive age group. The objective of this study was to estimate the prevalence of thyroid dysfunction and its correlation with menstrual disorders in women of reproductive age group.Methods: A hospital based prospective analytical study was carried out in the department of Obstetrics and Gynaecology of Nalanda Medical College and Hospital, Patna from March 2017 to March 2018. 56 women of reproductive age group between 18 to 45 years presenting with menstrual disorders (like menorrhagia, oligo/hypomenorrhea, polymenorrhea, metrorrhagia, and amenorrhea) were recruited in this study. Thyroid function test was done in all patients. Statistical analysis done.Results: Maximum number of patients were seen in the age group of 31-40 years. Most common menstrual complain was menorrhagia (46.42%) followed by hypo/oligomenorrhoea (17.86%). In patients with menstrual disorders, 41.07 % had thyroid disorders in which subclinical hypothyroidism was prevalent in 17.86%, overt hypothyroidism in 12.5%, and overt hyperthyroidism in 5.35% of the women. Menorrhagia was the commonest menstrual disorder (52.94%) seen in hypothyroid patients followed by polymenorrhoea. A high degree positive correlation was observed between thyroid dysfunction and menstrual disorder (Pearson correlation coefficient, r=0.93).Conclusions: Our study concluded that thyroid dysfunction should be considered as an important etiological factor for menstrual irregularity. Thus, thyroid function tests should be performed in all patients with menstrual irregularities to avoid unnecessary interventions like curettage and hysterectomy.

Vulvar lichen sclerosus (VLS) is a chronic inflammatory disorder, which affects women of all ages. It is one of the most common pathologies presenting to vulvar clinics. However, uncertainty continues to exist about its etiopathogenesis, diagnosis and treatment. Studies suggest a multifactorial origin as far as etiology is concerned, including a genetic, autoimmune, hormonal and local infectious background. There is often a delay in diagnosis of VLS due to its asymptomatic nature and lack of awareness in patients as well as physicians. Embarrassment of patients due to private nature of the disease and failure to examine the genital skin properly are the other reasons for delay in diagnosis. Conventionally, treatment includes topical corticosteroids as a first-line therapy with alternative options such as topical calcineurin inhibitors, topical and systemic retinoids, other steroid creams, various destructive techniques and surgical removal of affected tissues. New therapeutic approaches are coming into effect in gynecological practice due to potential risks of the above-mentioned methods. Stem cell and platelet-rich plasma therapy, energy-based modalities such as the fractional CO2 laser, photo dynamic therapy, and high intensity focused ultrasound, and new topical medicines, are some of the new options applied to improve the efficacy of treatment avoiding the side effects of conventional methods. Refinement of surgical techniques for restoring vulvar anatomy is leading to improved patient outcomes. This review summarizes current perspectives on the etiopathogenesis, diagnosis and treatment for vulvar lichen sclerosus.

OBJECTIVE:-To assess the quality of pain relief , obstetrical outcome, effect on rate of cesarean section & instrumental delivery.MATERIAL & METHOD:-100 patient in labour were selected based on inclusion criteria, informed consent taken prior to study . Epidural analgesia given and we retrieved the course of labour & delivery and management of epidural analgesia done.RESULT:-A total 100 patients, 94 patients was having adequate pain relief, 38 normal vaginal delivery, 47 instrumental delivery, 15 cesarean section.CONCLUSION:-Epidural analgesia for painless labour is safe & effective method with very less side effect, no increase in rate of CD &IVD or prolongation of labour.