Marked improvement was noticed in this new paradigm and more multicentric trial is needed to check the increasing trend of CD.

Objectives To study the present status and effect of paradigm shift in the epidemiology of HIV amongst pregnant women in urban set up. Aims The purpose of the study is to evaluate the paradigm shift in overall screening and management strategy of HIV in antenatal women for last four and half years in an urban medical college. Methods The study was conducted from 1st January 2004 to 30th June 2008 and all registered and unregistered pregnant women who attended ICTC clinic and also for emergency admission (unregistered) were counseled and blood samples were tested as per NACO guidelines with cafeteria choice of opt in and opt out strategy. Reactive women in antenatal period were counseled and discussed about anti-retroviral therapy (ART) and universal treatment regime. Seroprevalent women were counseled about their spouse, personal habits and demographic status. Marked improvement was seen in the use of contraceptive and drug abuse. During labor mother and baby were given nevirapine as per NACO guidelines. Results The seroprevalence of HIV reactive women in our Centre was 0.23, 0.19, 0.14 and 0.12% in the year

BACKGROUNDPostpartum haemorrhage continues to be leading cause of maternal death worldwide. In low resource set up, where there is non-availability of oxytocin, oral misoprostol effectively reduces the haemorrhage in third stage of labour.The aim of this study was to compare the effectiveness of oral misoprostol 600 mcg with intramuscular oxytocin 10 IU in the active management of third stage of labour. MATERIALS AND METHODSThis was a prospective study performed at R. G. Kar Medical College and Hospital to compare the efficacy of oral misoprostol with intramuscular oxytocin in the active management of third stage of labour. In group A, 27(50%) women without risk of PPH were randomly allocated to receive 600 mcg misoprostol orally and in group B also 27(50%) women included by random allocation among total 54 total samples to receive 10 units of oxytocin intramuscularly within 1 minute of delivery. The efficacy and the safety of these two drugs were assessed on the basis of, percentages reduced in haemoglobin (Hb) and haematocrit (Hct) level in pre-delivery and 24 hours post-delivery, requirement of extra uterotonic agents, need for exploration and evacuation of uterus, blood transfusion requirement and duration of third stage of labour. RESULTSIt was observed that oral misoprostol was as effective as intramuscular oxytocin in prevention of post-partum haemorrhage (PPH). There was no statistically significant difference in the duration of third stage of labour, requirement of extra uterotonics (misoprostol group 11.1% vs. 7.4% oxytocin group), and blood transfusion requirements in the two study groups. CONCLUSIONOral misoprostol 600 mcg appears to be as effective as intramuscular oxytocin 10 IU in reducing blood loss during the third stage of labour.

Introduction: Labour, a physiological process for majority of foetuses, often acts as a challenge to foetal reserves causing foetal hypoxia. Foetal monitoring with intrapartum cardiotocography is an important tool to enable timely intervention to reduce adverse neonatal outcomes like postnatal cerebral palsy. Aim: To determine an association between cardiotocography tracing and umbilical artery cord blood pH in term pregnancies in labour where the influence of drugs and the presence of other comorbid medical/obstetric adverse outcomes have been ruled out. Materials and Methods: This cross-sectional, hospital-based, observational study involved singleton uncomplicated term pregnancies with a normal baseline cardiotocography and spontaneous labour onset and progression admitted to the labour ward of R.G. Kar Medical College and Hospital, Kolkata, West Bengal, India. Intrapartum continuous cardiotocography traces were recorded and those showing abnormal traces were documented and delivery expedited within two hours. Total of 90 such consecutive women were included in the study and umbilical arterial cord blood sample was taken for all these pregnancies immediate postpartum. Cardiotocography traces were then statistically compared with cord blood parameters and the findings were computed using Statistical Package for the Social Sciences (SPSS) software version 22.0. Results: Out of 90 participants the mean age was 24.21±3.43 years, most (43, 47.8%) of them were in between 21 to 25 years. Of the abnormal traces, 51 (56.7%) were NICE Category II (Suspicious) and 39 (43.3%) were NICE category III (pathological). Cord blood analysis revealed that 40% had a pH<7, 44.4% had blood lactate levels above 6 mmol/L and another 47.7% had a base deficit ≥12 mmol/L. On crosstabulation and Chi-square analysis, these were all found to be statistically significant (p-value <0.05). Abnormalities of Foetal Heart Rate (FHR) and baseline variability had higher Odds ratio of predicting umbilical artery acidemia with Odd’s ratio for baseline variability abnormality as high as 2.768. Conclusion: Although there has been a rising trend towards operative deliveries, the overall incidence of neonatal morbidity due to cerebral palsy is still on the rise. Cardiotocography can be a very important tool to identify neonatal acidosis in “at risk” foetuses and helps in timely intervention giving long term best outcomes.