Aims and objectives:To classify the cesarean section (CS) in different groups of Robson's ten-group classification system (TGCS) and comparing the rate and relative size of groups with that of previous year at the tertiary hospital. . The data collected included parity, mode of previous delivery, gestational age, onset of labor-spontaneous or induced, delivery notes of labor ward, and operative notes of CS. This data was then applied to the Robson's TGCS for the year 2014 and compared with that of 2013. Results:The total deliveries during 2014 were 12,930 and in 2013 were 15,182. The number of CSs during 2014 was 3,793 and in 2013 it was 3,917. Cesarean section rate in 2014 was 29.33% while in 2013 it was 25.8%.The CS rate has come down to half in group I (nulliparous, single, cephalic ≥ 37 weeks, in spontaneous labor) and to onefourth in group III [multiparous (excluding previous CS) single, cephalic ≥ 37 weeks, in spontaneous labor] in 2014. Conclusion:Robson's TGCS is easy to classify. Clinical significance:The study showed reduction in CS rate by half in group I and by one-third in group III in 2014 in our institution. This was probably due to the increased awareness among the staff of the institute by the previous year study about higher CS rate.

Background: Episiotomy is the surgical enlargement of the vaginal orifice by an incision on the perineum during the last part of the second stage of labour or delivery. Episiotomy, incision of the perineum at the time of vaginal childbirth, is a common surgical procedure experienced by women. This study is done to compare use of restrictive episiotomy and routine episiotomy in primigravidae undergoing vaginal birth.Methods: This is a prospective cohort study designed to analyse the outcome of the restrictive use of episiotomy in comparison to routine use of episiotomy. Total 100 primigravidae women reporting to labour room in spontaneous labour/induction of labour were included and two cohorts were formed. Both the cohorts were evaluated during labour, immediate postpartum period and first postnatal day and data was tabulated and analysed.Results: Vaginal and paraurethral tears were noted in 14% primigravidae in the routine episiotomy group and 22.22% in the restrictive episiotomy group with no statistically significant association. Number of cases sustaining perineal tear in restrictive group was 15.55% and extension of episiotomy in the routine group was 26% with no statistically significant association. Requirement of suturing was far less in restrictive group (20%) as compared to routine group (100%), as 64.45% of the patients in restrictive group delivered with an intact perineum. The restrictive use of episiotomy does not prolong the second stage of labour and has requirement of significantly less pain relief compared to the routine group. Complication rate was higher in the routine group and perineal laceration and pain severity, was less in restrictive episiotomy group. However, neonatal complications were similar in the two groups.Conclusions: This study identified fair to good evidence suggesting that immediate outcomes following routine use of episiotomy are no better than those of restrictive use. Indeed, routine use is harmful to the degree that some proportion of women who would have had lesser injury instead had a surgical incision.

Background: With the advent of electronic foetal monitoring, a relationship between foetal movement and foetal heart rate was observed and that relationship formed the basis for non-stress test (NST). Doppler USG plays an important role in foetal growth restriction (FGR) pregnancies where hemodynamic rearrangements occur in response to foetal hypoxemia. It is now proved that significant Doppler changes occur with reduction in foetal growth at a time when other foetal well-being tests are still normal. This study was done to find out the comparative usefulness of Doppler and NST in the management of FGR and severe preeclampsia and subsequent correlation with perinatal outcome. Methods: This prospective study was conducted on pregnant women with severe preeclamsia and/or FGR beyond 30 weeks of gestation at AHRR Delhi. 50 pregnancies complicated with severe preeclampsia and/or FGR beyond 30 weeks of gestation were selected. Patients meeting the inclusion criteria were subjected to NST. Umbilical arterial Doppler flow was obtained at weekly or twice weekly interval depending on the severity by pulsed wave color doppler indices were measured during foetal apnea by the same examiner at the free loop site where the clearest waveform signal could be visualized. Of 3 measurements, the mean average of S/D ratio was recorded and followed up with serial Doppler assessment and non-stress test. Data was collected and statistical analysis was carried out. Results: The Doppler showed changes earlier than NST giving a significant lead time of up to 20 days with an average of 4.94 days. The UA S/D had the highest sensitivity (88%) and diagnostic accuracy (94%) in predicting the adverse perinatal outcome. The sensitivity and specificity of Doppler as compared to NST was 82.6% and 63.0% respectively with a diagnostic accuracy of 72%. The Doppler has negative predictive value of 80.95% and positive predictive value of 65.5%. Color Doppler has diagnostic accuracy of 72%. The mortality rate in reversal of diastolic flow was 77.77% and in absent UA flow was 16.66%. 12% foetuses were found to have AEDV in UA and among them 66.66% had both FGR+PE as maternal complication. There was 83.33% rate of LSCS, 16.66% neonatal mortality rate, 83.33% NICU stay rate and 66.66% complication rate in neonates. Whereas 18% had REDV and among that 88.88% had both FGR+PE as maternal complication, a similar rate of LSCS, 77.77% rate of neonatal mortality, 100 % NICU stay and 66.66% complication rate in the neonates. Conclusions: Combined foetal testing modalities such as Doppler, NST and biophysical profile provide a wealth of information regarding foetal health. Integrated foetal testing would be ideal for individualized care of the preterm compromised foetuses for timed intervention.

No abstract

Background: Generalised Peritonitis is a common surgical emergency and its treatment remains a challenge despite advances in surgical techniques, antimicrobial therapy and intensive care support. The commonest etiological factors are perforation of hollow viscus and appendicitis. The aim was to study the most common cause of perforation peritonitis, associated risk factors, modes of clinical presentation, management, postoperative complications, and comorbid conditions influencing the morbidity and mortality in rural set up.Methods: 50 patients of peritonitis of over 10 years of age managed in our institution from July 2015 to November 2016 were studied and followed up on a three-monthly basis for a period varying from 12 months to 2 years with an average of 18 months.Results: Appendicular perforation was the most common cause of peritonitis followed by peptic ulcer perforation. Perforation peritonitis constituted 26% of total emergency operations performed with a male to female ratio of 2.84:1 and age between 41-50 years. Patients presenting within 24 hours of perforation had an uneventful recovery whereas those presenting after 24 hours had significant postoperative complications. The serum CRP levels provided as good prognostic marker. It remained high in complicated cases. Out of 56% complication rate, wound infection was the commonest.Conclusions: Early diagnosis and surgical intervention plays a crucial role in early recovery, though the end result depends on many factors like age of the patient, degree of peritoneal contamination and presence of comorbid diseases. This study also highlights the role of CRP as a serum prognostic marker.