General anaesthesia for obstetric surgery has distinct characteristics that may contribute towards a higher risk of accidental awareness during general anaesthesia. The primary aim of this study was to investigate the incidence, experience and psychological implications of unintended conscious awareness during general anaesthesia in obstetric patients. From May 2017 to August 2018, 3115 consenting patients receiving general anaesthesia for obstetric surgery in 72 hospitals in England were recruited to the study. Patients received three repetitions of standardised questioning over 30 days, with responses indicating memories during general anaesthesia that were verified using interviews and record interrogation. A total of 12 patients had certain/ probable or possible awareness, an incidence of 1 in 256 (95%CI 149-500) for all obstetric surgery. The incidence was 1 in 212 (95%CI 122-417) for caesarean section surgery. Distressing experiences were reported by seven (58.3%) patients, paralysis by five (41.7%) and paralysis with pain by two (16.7%). Accidental awareness occurred during induction and emergence in nine (75%) of the patients who reported awareness. Factors associated with accidental awareness during general anaesthesia were: high BMI (25-30 kg.m -2 ); low BMI (<18.5 kg.m -2 ); out-of-hours surgery; and use of ketamine or thiopental for induction. Standardised psychological impact scores at 30 days were significantly higher in awareness patients (median (IQR [range]) 15 (2.7-52.0 [2-56]) than in patients without awareness 3 (1-9 [0-64]), p = 0.010. Four patients had a provisional diagnosis of post-traumatic stress disorder. We conclude that direct postoperative questioning reveals high rates of accidental awareness during general anaesthesia for obstetric surgery, which has implications for anaesthetic practice, consent and follow-up.

Background: Amniotic fluid index (AFI) is commonly used to estimate amniotic fluid volume. A proper AFI is between 10 and 24 centimetres. If it is below 5 cm, it is can represent oligohydramnios, and in case AFI is above 24 cm, it can represent polyhydramnios. This study was undertaken to determine whether measuring AFI at term is useful in the prediction of perinatal outcome.Methods: A prospective study of 250 pregnant women with gestational age between 37 and 42 weeks was conducted at Sola Civil Hospital. AFI was measured in each patient using the Phelan’s technique and the perinatal outcome was studied. The results were analysed and presented in the form of tables and graphs.Results: Total 250 patients were studied. Out of them, 33 patients (13.2%) had AFI <=5, 215 (86%) had AFI between 6 and 24; and 2 patients (0.8%) had AFI >=25.19 out of 33 (57.57%) patients with AFI <= 5, had to undergo caesarean section, out of which, 12 caesarean sections (63.15%) were taken for non-reassuring foetal status. 36.27% (78/215) of patients with AFI between 6 and 24 underwent caesarean section, out of which 38.46% (30/78) underwent caesarean section for non-reassuring foetal status.Conclusions: In the presence of oligohydramnios, the rates of LSCS due to foetal distress, the occurrence of low Apgar score and of low birth weight are higher than in patients with normal liquor at term. Thus, measuring the amniotic fluid index at term can be helpful in the prediction of perinatal outcome.

The gestational age at which the delivery occurs is important in determining the perinatal outcome. In this study, the foetal outcome was analysed according to the gestational age in weeks in spontaneous vaginal delivery occurring between 36 completed weeks to 40 completed weeks of gestation. To study the foetal outcome according to the weeks of gestation in spontaneous vaginal delivery occurring between 36 completed weeks to 40 completed weeks of gestation. A retrospective study of women who spontaneously delivered vaginally, at gestational age between 36 completed weeks to 40 completed weeks from 1 July 2019 to 30 September 2019 was conducted at GMERS Medical College and Hospital, Sola.Total 390 cases were studied.Foetal outcome in terms of birth weight, APGAR score at 1 minute, and NICU admissions were noted and analysed according to the weeks of gestation at delivery, and entered into a database.The results were analysed and presented in the form of tables and graphs. The average birth weight increased with increase in the weeks of gestation at the time of the spontaneous delivery. The average birth weight of neonates born in 36th, 37th and 38th week was 2.314Kg, 2.623Kg and 2.704Kg, respectively. 14.28% of the babies born in the 36th week of gestation were admitted to the NICU. 4.705% and 4.347% of the babies born in the 37thand 38th week of gestation respectively, were admitted to the NICU.The Mean APGAR score of the neonates born in 36th, 37th, 38th and 39th week were 8.714, 9.235, 9.347, and 9.645, respectively. Thus, the mean APGAR score increased by the weeks of gestation at the time of the spontaneous delivery. Unnecessary induction of labour or elective LSCS before 39 weeks should be discouraged. In case of elective deliveries, unless there is a health risk to the mother or baby, it is best to wait to deliver until reaching full term at 39 weeks.

Heterotopic pregnancy is the existence of 2 or more simultaneous pregnancies with separate implantation sites, one of which is tubes or ovaries or other ectopic site. The estimated incidence in the general population is estimated at 1:35,000 (for a naturally conceived pregnancy). With increasing trend in assisted reproductive technique, the frequency of heterotopic pregnancies was increased to be between 1:100 to 1:7,000. A 36 yrs third gravida (P1, L1, A1) presented with 2 month amenorrhoea In Doppler usg there was evidence of irregular solid component at periphery with echogenic tissue around showing ring vascularity and burning ring fire sign present. There is evidence of mild free fluid collection in the pouch of Doughlas pre operative and post operative injection 17 –oh progesterone acetate (proleutone) used and post operative tidilan injection. Left sided laparoscopic salpingectomy was done. The material was collect in endobag and afterward sent it for histopathological examination which confirms trophoblastic tissue and presence of ectopic pregnancy. There is no proven role of medical management in this because of high Bhcg titer which helps to continue it afterwards. Like other cases if there was no facility for laparoscopy, laparotomy for salpingectomy is another option. Diagnosis of heterotopic rare and challenging but proper ultrasonography skills and broad mind set helps in diagnosis.