Introduction: Perinatal asphyxia is one of the major causes of neonatal morbidity and mortality. Fetal Cardiotocography (CTG) has been used for long to predict fetal asphyxia. Despite its popularity, it has not been proved to be an ideal tool for monitoring as, although a normal trace is indicative of a normal acid-base status at birth, in about 98% of cases, an abnormal trace has a low positive predictive value in term of fetal acidosis (pH less than 7.25) .An undisputed evidence of perinatal asphyxia is metabolic acidosis on arterial cord blood or very early neonatal samples: pH< 7 and base deficit >12 mmol/L Aim: To see the correlation between suspicious/pathological CTG and umbilical cord blood pH at birth in term pregnancies.Material and methods: This was a hospital based prospective randomized observational study over a period of 1 year. It was conducted on 165 pregnant women with singleton term pregnancy admitted to labour ward for delivery and having suspicious / pathological CTG trace or meconium stained liquor with normal CTG trace. Immediately after the birth of the neonate, umbilical cord was clamped, cut and umbilical artery cord blood was collected in a pre -heparinized syringe and sent for pH analysis. Cord blood pH of less than 7.2 was interpreted as acidosis.Results: The number of acidotic cases (as determined by cord blood pH less than 7.2) was 2(5.6%) in normal traces whereas 34 cases (94.4%) of normal traces were non acidotic. In the suspicious traces, 2 cases (3.2%) were acidotic and 59 cases (96.8%) were non acidotic. In the pathological category, 13 cases (19.1%) were acidotic and 55 cases (80.9%) were non acidotic. There was no significant association of CTG category with cord blood pH, acidosis, pO2 or pCo2 values but that with presence of MSL and grade of MSL was statistically significant.Conclusion: Abnormal CTG while being a good predictor of the presence of MSL and also the grade of MSL, is a poor predictor of the presence of fetal acidosis and neonatal status after birth. Fetal monitoring using cardiotocography was associated with considerable false positive results. Thus, using fetal heart rate abnormalities alone as a measure of diagnosis of fetal distress during labour is a contributing factor of increasing rate of cesarean sections.

Feto-maternal haemorrhage is the transmission of fetal blood cells to the maternal blood stream. It is quite common in small volumes- occurring in most pregnancies. Large volumes of feto-maternal haemorrhage can have serious consequences. Some risk factors are identified, but they are not always present. Decreased perception of fetal movements is most important clinical sign, together with a pathological NST. Prompt diagnosis and immediate obstetric care is fundamental, as serious risk to the fetus might result from this condition. Author described the case report of 35 years old G3P1L1A1 with 37 weeks 5 days pregnancy, who came in outpatient department with reduced perception of fetal movements during the previous 10 hours. There was no history of abdominal trauma. Cardiotocograph showed nonreactive NST with minimal beat to beat variability for more than 40minutes. An emergency caesarean section was performed and a female limp baby delivered with heart rate <60/minutes, pale, no respiration and no reflexes. Baby resuscitated with bag and tube ventilated. APGAR score was 3/5/6 at 0, 1, and 5 minutes. Fetal haemoglobin at the first hour of life was 3.0gm/dl. Kleihauer-Betke test revealed 265.7ml of fetal erythrocytes in the maternal blood stream. Despite being rare, it is important to detect a massive feto-maternal haemorrhage. Fetal anemia could be suspected, but the diagnosis was only made after delivery. This case reveals the importance of keeping a high suspicion in obstetric practice, as feto-maternal haemorrhage is a rare but potentially catastrophic event for a fetus.

Background: The study aims to evaluate whether instillation of levo-bupivacaine intraperitoneally decreases post-operative pain after laparoscopic gynaecological surgeries, using VAS pain Scale. Methods: Randomized placebo controlled double blinded study conducted at tertiary care hospital in New Delhi. 90 ASA I & II women scheduled to undergo elective laparoscopic gynaecological surgeries. 20 ml 0.5% levo-bupivacaine diluted with 40ml normal saline (total 60ml) intraperitoneally at the end of surgery before closure of ports along with port site infiltration of levo-bupivacaine (3-5 ml) in intervention group and 60 ml normal saline intraperitoneally in control group. Results: Mean pain scores were significantly lower (p<0.01) in the intervention group when compared to the control group for initial 4 hours of the study after that mean pain score was lower in intervention group than control group but it was statistically not significant. The requirement of rescue analgesia was also significantly lesser in intervention group compared to control group. Conclusions: Levo-bupivacaine is an easy, cheap and non-invasive method which provides good analgesia in the immediate postoperative period after laparoscopic gynaecological surgery, without adverse effects, especially in the early postoperative period. This improves patients experience and should be made an integral part of all minimal gynaecological endoscopic surgery.