BACKGROUNDIt is a study of the analysis of cases where Caesarean section was done for the first time in a women who had previous vaginal delivery of a viable neonate. The various indications for Caesarean section, incidence, indications and maternal and foetal outcomes were studied.

OBJECTIVES:To determine the causes of puberty menorrhagia and to evaluate the efficacy of medical management. MATERIALS AND METHODS: This is a prospective observational study included 48 patients who presented with menorrhagic cycles in the pubertal age group to Princess Esra Hospital, DCMS from January 2013 to December 2013.Each case was assessed by thorogh history, physical examination and relevant laboratory investigations. RESULTS: In 28 patients immaturity of hypothalamic pitutuary ovarian endometrial axis was considered to be the cause as their ultrasound and hormonal assays were normal. 10 had PCOS, 3 had hypothyroidsm, 4 had tuberculosis, 1 patient had thrombocytopenia, 2 patients had symptomatic fibroid uterus. Blood and its components were given to 8 patients. CONCLUSION: Puberty menorrhagia is a distressing condition which can lead to severe complications and may require blood transfusion. Most of the cases are due to anovulatory cycles with immaturity of the hypothalamo -pitutuary -ovarianendometrial axis. The current epidemic of childhood obesity may increase the symptoms of polycystic ovarian disease and underscores the importance of its early and accurate diagnosis with emphasis on lifestyle modification.