INTRODUCTIONNationally unplanned pregnancy rate is 21% of all pregnancies.1 In India 65% of women in the first year postpartum have an unmet need for family planning, out of which only 26% of woman are using any method of contraception. Hence, contraceptive counselling has become an integral part of antenatal and postpartum programme as pregnant and postpartum women are generally highly motivated towards controlling the fertility, either in spacing out there children or stopping their fertility altogether. Postpartum period is one of the sensitive time of woman's life when she is in contact with health care facility known as crisis oriented and when both mother and newborn need a special care. Postpartum contraceptive options are limited. Barrier contraceptives and progesterone only pills, both are user and compliance dependent methods and therefore have high failure rates. Traditionally, Cu T insertion was limited to interval period. But now, recent studies on postpartum contraceptive methods have suggested the use of Cu T in postpartum period which can provide long term and effective contraception with failure rate of <1%.Percentage of institutional deliveries in India is 41%.2 As the number of institutional deliveries is increasing, postpartum Cu T insertion can provide a unique opportunity to increase the contraceptive prevalence ABSTRACT Background: The use of Cu T in postpartum period can provide long term and effective contraception and this study compares PPIUCD versus interval IUCD. Methods: 300 women enrolled in the study were divided into two groups. Postpartum group-150; Postplacental or within 10 minutes/intracaesarean/within 48 hrs of delivery. Interval Group 150; after 6 weeks of delivery / postmenstrual. Cu T 380A was used in the study. Contraindication for PPIUCD were between 48 hrs and 6 wks postpartum, chorioaminionitis, PROM >18 hrs, unresolved PPH and puerperal sepsis. All were followed up for 6 months. Results:The continuation rate at 6 months was 81.81% in interval group and 88.23% in postpartum group. Complications occurred in 15.33% cases after PPIUCD and in 19.33% cases after interval IUCD. Expulsion rate was significantly higher in PPIUCD as compared to interval insertions (6.96% v/s 2.2%; p value <0.05). Removal rate of IUCD was almost similar in both the groups (4% in PPIUCD v/s 6.0% in interval). Conclusions: PPIUCD is an effective, safe, convenient, low cost and long term method of postpartum contraception irrespective of the mode of delivery.

Resurgence of kala-azar in India has posed many problems. Apart from endemic areas, cases are being reported from nonendemic area. Other than diagnostic difficulties, resistance to stibogluconateand relapses are common problem in sporadic visceral leishmaniasis (VL). We present one case in detail and give brief description of nine other cases, hailing from nonendemicarea, Uttarakhand, during the period from December 2005 to September 2011, diagnosed in our teaching hospital. The patients in our study were diagnosed as VL by clinical findings and confirmed by demonstration of LD bodies in splenic or bone marrow smears. Six cases were treated successfully with amphotericin. One case died during treatment and three cases lost to follow up.Clinician should suspect and investigate for VL in patients with pyrexia of unknown origin even when the disease is not endemic in a specific region for early diagnosis.

Background: Menstruation is a biological event imbued with social, cultural and personal significance. Due to impact of social media and internet the incidence of indulging in unprotected sexual intercourse and unplanned pregnancies are rapidly increasing among teenagers. Objectives were to assess the knowledge regarding safe sex and contraceptive methods and compare the menstrual and sexual awareness among adolescent girls in rural and urban settings.Methods: The health questionnaire was prepared from WHO adolescent health manual as reference base. The adolescent survey was done.Results: In present study maximum number of girls had attained menarche between 12-15 years in both groups. The study showed lack of menstrual hygiene among rural girls in compare to urban girls where 79% girls use either sanitary pads or cotton and in comparison to urban girls, rural girls had more restrictions in going out.Conclusions: Education regarding proper physiology of menses and there should be open discussion regarding restrictions and taboos related to menses at the school level to minimise the false beliefs.

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Intestinal obstruction (IO) in pregnancy is rare at 1 in 2500 to 1 in 16709 deliveries with an incidence of 0.001% to 0.003%. Although uncommon, IO in pregnancy carries significant maternal (6%) and fetal (26%) mortality. A 30-year-old, primigravida, at 33weeks 4 days of gestation presented to the emergency obstetrics department of Swaroop Rani Nehru Hospital, Prayagraj, Uttar Pradesh, India with a 2-day history of diffuse abdominal pain, distension and obstipation. The decision of emergency caesarean section was taken and a 2.5kg healthy female baby was delivered. Surgical opinion was sought intraoperatively. Segmental resection and anastomosis, adhesiolysis and appendicectomy was done. Patient discharged on 10 post-operative day along with her baby in satisfactory condition. Diagnosis of SBO can be difficult to make as symptoms are often attributed mistakenly to pregnancy and there can be a reluctance to request plain films owing to the risks of ionising radiation. Both of these factors can lead to a delay in diagnosis and initiating treatment. Clinical suspicion is vital and joint management between surgeons and obstetricians is crucial. In agreement with previous literature reviews regarding the need for prompt laparotomy in most cases of SBO, we recommend that patients with confirmed adhesional obstruction may be managed conservatively in the first instance but with a low threshold for progressing to laparotomy.