The novel corona virus disease (COVID-19) has unfolded into a pandemic and is continuing to propagate at a frightening speed. The aim of this article is to share our protocol for performing a safe surgical tracheostomy in this COVID-19 era. Tracheostomy procedures have a high risk of aerosol generation. To standardize institutional safety measures with tracheostomy, we advocate using a dedicated tracheostomy protocol applicable to all patients including those suspected of having COVID-19. We also did explore the current literature and recommendations for tracheostomy in patients with COVID-19 and studied the previous data from severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1), the virus responsible for the SARS outbreak of 2003. We have prepared a protocol for performing a safe surgical tracheotomy in patients affected by COVID-19. Surgeons who might be involved in performing the tracheostomies should become familiar with these guidelines.

Background: Oligohydramnios is a frequent complication of pregnancy that is associated with increased perinatal morbidity and mortality. Once diagnosed; oligohydramnios should further lead to intensive fetal surveillance including ultrasound evaluation. The aim of the study was to determine obstetric outcome in term low risk pregnancy with AFI less than or equal to 5 and to assess whether antepartum oligohydramnios is associated with adverse perinatal outcome.Methods: 200 patients in third trimester in the hospital with evidence of oligohydramnios (AFI less than or equal to 5) were selected after satisfying inclusion and exclusion criteria and studied prospectively. Observations regarding the outcome of labour in form of maternal and perinatal parameters including AFI value, CTG features, mode of delivery, LSCS rate, meconium stained, APGAR score, birth weight and NICU admission were made.Results: Overall perinatal outcome with respect to CTG, 128 (64%) out of 200 patients had non-reactive CTG and only 72 (36%) had reactive CTG. 128 (64%) of non-reactive CTG delivered by LSCS, 72 (36%) delivered by labour natural. Nil labour natural in the subset of AFI 1 to 2, birth weight (<2.5 kg-8% and >2.5 kg-92%), Apgar score (<7 at 1-5 mins:18%), still birth (1%), meconium (58.5%), NICU admission (6%) and perinatal mortality (2%).Conclusions: AFI measurement of less than 5 cm detected after 37 completed weeks of gestation with a low risk pregnancy is found to be an indicator of adverse pregnancy outcome with higher fetal distress, meconium stained liquor and higher caesarean section rate. AFI assessment serves as an important tool and remains as an effective screening test in predicting fetal distress in labour that requires caesarean section.

Background: A normal delivery is what every woman wishes to have. The objective of this study was to find out the maternal and neonatal outcome and background characteristics of women delivering vaginally in a tertiary care center in Chennai, South India.Methods: For this one-year study, with power above 80%, Parturition records were selected by computerized random numbers, for a calculated sample size. Salient demographic features such as age, residential background and religion were noted. Details of obstetric history, past and current, delivery and baby details and admission to NICU were analyzed. Acceptance of postpartum contraception was noted.Results: A total of 338 women delivered vaginally. Majority of 63%, were from urban background. Late referrals were 19.2% of women,38.5% women had antenatal complications. Primigravida were 49.7%. Nearly 91.4% of women delivered naturally. Previous pregnancy loss was noted in 14.8%. Term deliveries were in 72% of women, and 2.7% of women delivered twins. Average birth weight among primi was 2.5kg and in multi it was 2.8 kg. There were no maternal deaths. Perinatal deaths of 2.96%, of which 90% were preterm births, and all among babies with birth weight below 1.5 kg.Conclusions: The larger majority of 91.4% of women had natural vaginal delivery. Primigravida were 49.7%, and 63% were from urban background. Antenatal complications, obstetric, medical or other complications were noted in 38.5 % of women. Most often observed complications were Gestational hypertension, Gestational diabetes, and Hypothyroidism. NICU care was required for 18% of babies. Preterm births were16.6%. Perinatal deaths were seen in 2.96% of babies. There were no maternal deaths.