Background: Caesarean section (CS) is one of the most common obstetric procedures worldwide and an increased rate of caesarean section has been observed in recent studies. Maternal morbidities and mortality associated with repeat caesarean section is an important health problem. The present study aims at knowing the various intraoperative complications encountered during repeat caesarean sections. Objective was to study the incidence and type of surgical difficulties encountered in repeat cesarean sectionsMethods: It was a prospective observational study of 118 cases of repeat cesarean sections. Intra-operative findings of all cases were analyzed to know the difficulties encountered because of previous cesarean section.Results: In present study, out of total 118 cases of previous cesarean sections, 71 (60.17%) cases were of previous one caesarean section and 47(39.83%) were of previous two cesarean sections. Following intraoperative morbidities were encountered – adhesions (1 caesarean section vs 2 caesarean section – 40.85 vs 65.96% respectively) , thin lower uterine segment (1 caesarean section vs 2 caesarean section – 21.13 vs 36.17% respectively), advanced bladder(1 caesarean section vs 2 caesarean section – 15.49 vs 36.17 % respectively) , extension of uterine incision(1 caesarean section vs 2 caesarean section – 9.86 vs 19.15% respectively) , scar dehiscence(1 caesarean section vs 2 caesarean section –7.04 vs 31.91% respectively), excess blood loss (1 caesarean section vs 2 caesarean section –7.04 vs 19.15% respectively), 1 case of placenta accrete was found in previous 2 caesarean section 2.13%) which needed caesarean hysterectomy. uterine rupture and bladder injury seen in one patients of previous 2caesarean section. Time taken for surgery was more in repeat CS group Delivery.Conclusions: An increasing number of CS is accompanied by increased maternal morbidity. Intraoperative complication which increase the risk of morbidity are adhesion, placenta accreta. It is prudent to involve a senior experienced obstetrician in repeat cesarean section. The best way to reduce this is by reducing primary caesarean section rates. Patients with previous caesarean section should be considered as high risk and should be counseled for regular antenatal check-up and they should be given option of vaginal birth after CS whenever possible.

Background: Pregnancy is associated with volume overload producing significant vascular and hemodynamic adaptations in cardiovascular physiology. Present study was designed to follow up gradual adaptations in cardiovascular hemodynamics during the course of pregnancy using Doppler echocardiography which is reproducible and noninvasive technique. Methods: In present prospective study of 50 women, were divided into 2 groups of 25 each: control group & study group (pregnant patient in I trimester, II trimester & III trimester). They were non-invasively analysed for cardiovascular function and systemic hemodynamics using echocardiography and compared with control group. The data was analysed using ANOVA for comparison within the group and student's t-test for comparison between the groups. p value <0.05 was considered to be significant. Results: Mean age and height in control and study groups were comparable. Weight gain was within the expected range with advancement of pregnancy. Heart rate was increased in I and II trimesters with peak rise in III trimester. The difference between control group and study groups was statistically significant (p < 0.05).Systolic blood pressure was slightly decreased in all the trimesters as compared to control group which was statistically not significant. There was gradual increase in SBP from I to III trimesters. Diastolic blood pressure progressively decreased in I and II trimesters and then increased in III trimester. The difference in DBP between control group and I, II trimesters of pregnancy was significant (p<0.05).Systemic vascular resistance progressively decreased with advancement of pregnancy and difference was statistically significant (p <0.05) . Cardiac output is steadily increased in all trimesters of pregnancy with peak at 36 weeks and was statistically significant (p<0.05). It was due to increase in both heart rate and Stroke volume. Ejection fraction also increased in all trimesters. Conclusions: Present study shows significant functional changes in the cardiovascular dynamics during pregnancy. Doppler echocardiography provides an excellent noninvasive method for the evaluation and serial analysis of hemodynamic changes. These results will help in distinguishing abnormal echocardiographic changes from the normal physiologic changes of pregnancy. Therefore maternal echocardiography should be introduced into the antenatal management protocol, which will help to identify women at high risk to developing cardiovascular complications and there by early intervention.

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To study maternal and fetal outcome among obstetric patients with deranged liver function tests. 2) To study the relationship between type of liver disease based on etiology and maternal and fetal outcome METHODS: 3 years prospective and retrospective study was carried out from Jan 2011 to Jan 2014 at rural medical Centre. 40 cases of pregnancy with deranged liver function tests were analyzed for incidence, maternal and fetal outcome. RESULTS: 1) Incidence of liver disease during pregnancy was 1.6%.in our study. 2) Majority of causes of jaundice were pregnancy specific. 3) Common causes of deranged liver function tests in the pregnancy were pregnancy induced hypertension with HELLP syndrome (37%), acute fatty liver of pregnancy (37%) and viral hepatitis (20%). 4) Overall maternal and perinatal mortality found in our study were 17.5% and 35% respectively. 5) Majority cases of HELLP & acute fatty liver of pregnancy were young primes (20-30years) at 32-34 weeks of gestation. 5) All cases of HELLP were associated with pregnancy induced hypertension. 6) Disseminated intravascular coagulation was most common morbidity. 8) 14 cases (56%). 7) Maternal mortality was highest 35% in acute fatty liver of pregnancy which reduces to 18% if unbooked cases with uncorrected disseminated intravascular coagulation are excluded. 8) Perinatal mortality was highest with HELLP syndrome (50%). CONCLUSION: 1) Majority of causes of deranged liver function tests during 3rd trimester were pregnancy induced. 2) Maternal and fetal outcome depends on gestational age of presentation, early recognition of the disease and tertiary care support.

Background: Preeclampsia is associated with higher prevalence of abnormal global left ventricular function. So, present study was designed to compare these changes in normal and preeclamptic pregnancies using echocardiography.Methods: In present study, 25 patients with pre-eclampsia with singleton pregnancy between 20-30 years (study group) were compared with 25 age matched healthy pregnant women (control group). They were non-invasively analyzed for cardiovascular hemodynamics using echocardiography. The data was analyzed using student's t-test. P value <0.05 was considered to be significant. Results: Mean stroke volume in pre-eclampsia group was 72.4±5.1 ml v/s 67.7±5.6 ml in control group and the difference was statistically significant. Mean Cardiac output in preeclampsia group was64.2±3.4 lit/min v/s 5.69±0.47 lit/min in control group which is statistically significant. Mean Systemic vascular resistance (dyne.sec cm-5) in pre-eclampsia group was 1468.22±5.7 v/s 957.7±131 in control group which is statistically significant. Mean Ejection fraction (%) in pre-eclampsia group was 68.31±5.1 v/s 66.54±4.7 in control group which is statistically significant.Conclusions: Doppler echocardiography provides an excellent non-invasive method for evaluation of hemodynamic changes during pregnancy. Therefore if it is introduced into antenatal protocol, could help to identify subset of pre-eclamptic women who are at high risk to developing complications and thereby can do early intervention.