Introduction: Immediate postpartum intrauterine contraceptive device insertion is an excellent family planning method which provided safe effective, long term and reversible contraception to women in the delivery setting. Hence, the present study was undertaken to assess the clinical outcome of immediate postpartum insertion of intrauterine contraceptive device in terms of safety and efficacy and to compare the two routes of insertion i.e. in vaginal deliveries and cesarean section.Objective: 1. To study awareness level of PPIUCD among parturient. 2. To study safety and efficacy of PPIUCD insertion. Materials and Methods: A cohort of 100 vaginal and 100 cesarean deliveries with PPIUCD insertion were studied over a period of 1 year and followed for three months in this prospective interventional study. Outcome measures of safety were perforation, irregular bleeding, unusual vaginal discharge and infection. Outcome measures of efficacy were pregnancy, expulsions, discontinuation and incidence of coiled up/ undescended strings. The data was compiled and analyzed. Results: In the present study only 34.5% (N=69) of the study sample were aware of the PPIUCD while the rest 65.5% were unaware. No serious complications such as pregnancy or perforation were encountered in our series. Most common complication reported in both the groups was excessive bleeding PV followed by pain in lower abdomen. Spontaneous expulsion of the device was noted in 3% of vaginal insertions and none in the cesarean insertion. Conclusion:PPIUCD is an excellent method to limit or space child births. It is offered to a woman in a setting when she is highly motivated and genuinely needs it.

BACKGROUND:Minimizing blood loss during surgery is important because of the associated morbidity. In addition intraoperative bleeding can obstruct the view of operative field and lead to complications, in particular dissection during vaginal hysterectomy can be hampered by blood loss, because the main blood supply is not ligated until after much of the dissection has been done. Several methods to control blood loss have been used including hydro dissection with saline as well as with the injection of vaso constrictors. AIMS: To compare blood loss, operative time, postoperative complication rates in patients undergoing vaginal hysterectomy who were randomly assigned to receive pre-operative intra cervical vasopressin or no intra cervical injection. SETTINGS

BACKGROUND:Amniotic fluid is an indicator of placental function on the fetal development. The AFI is the most commonly used method of measuring amniotic fluid. AIMS: We aimed to study the amniotic fluid volume in pregnancies beyond 34 weeks of gestation and to evaluate the predictive value of amniotic fluid index (AFI <5cm) for adverse perinatal outcome in terms of labour inductions, fetal heart rate pattern, meconeum staining, caesarean section, Apgar score and NICU admissions. SETTING AND DESIGN: This was a non-randomized comparative study carried out in the Department of Obstetrics and Gynaecology at Kamla Raja Hospital, Gwalior (M.P.). METHODS: This study was conducted on 100 antenatal patients with gestational age 34 weeks and above with a singleton, non-anomalous fetus who were divided into two groups based on their AFI as group A (AFI<5cm) and group B (AFI>5cm) during one year from August 2013 to July 2014. The women's history, clinical examination recorded and AFI were measured using the Phelan's technique and the perinatal outcome compared between the two groups i.e. AFI<5cm and >5cm. STATISTICAL ANALYSIS USED: Chi-square test was carried out at 5% (=0.05) level of significance to analyze the collected data for final outcome. RESULTS: Labour was induced in 30% in group A as compared to 18% in group B. Induction of labour was significantly less in cases with AFI>5 cm of same gestational age group. The non-reassuring fetal heart rate were recorded more often in group A i.e. AFI<5 cm. The incidence of meconium staining in caesarean section and low 5 min Apgar score was higher in patients with oligohydramnios i.e. AFI<5cm (p=0.015, 0.012, 0.027 respectively). There was no significant difference in NICU admissions and perinatal death between the two groups. CONCLUSION: Amniotic fluid index is a helpful tool in determining the high risk patients during labour and AFI<5 cm is one of the indicators of comparatively poor perinatal outcome.

Background: Adnexal masses are one of the most common pathologies among women of all age groups. Ovarian tumors, alone, represent two thirds of these cases. Malignant ovarian tumors are the fourth most common cause of death in women. Accurate diagnosis is required foremost for proper treatment and management of the patients.Methods: A prospective study done on 100 patients with adnexal masses presenting to Department of Obstetrics and Gynecology at Kamla Raja Hospital, G.R.M.C, Gwalior from February 2015 to August 2016. Firstly, the cases were studied by ultrasonography then intraoperatively and simultaneous sampling for HPE done. The study included women with clinical symptoms of pain abdomen/ discomfort, bleeding per vaginum, abdominal mass was subjected to ultrasonography, diagnosed with adnexal mass. 100 indicated patients were taken for surgery and intraoperative tissue and fluid samples were taken and sent for HPE.Results: No discordance found regarding laterality of adnexal masses between ultrasonographical findings and surgical findings. 69% cases were devoid of any septation/locules/nodules. Most common pathology found to be ectopic pregnancy. Most common benign ovarian mass encountered was serous cystadenoma (31.1%) and malignant mass was serous adenocarcinoma (12.7%). Apart from 13 malignant adnexal masses, 2 adnexal masses had malignant changes found on histopathological examination. 11 cases were found to be of advanced stage on surgical findings, which then confirmed by HPE.Conclusions: There is positive correlation between ultrasonographical and surgerical evaluation of adnexal masses. Correlation of the lesion’s location and appearance at imaging with the surgical findings will aid in the detection of potential pathology reporting errors.

Background: Pregnancy poses unique consideration for critical care and it is imperative that obstetrician and other members of health care team have a working knowledge of these factors because these are women are usually young and in good health, their prognosis should be better than that of many other patients admitted to an intensive care.Methods: The present study was conducted in the Department of Obstetrics and Gynaecology, Gaja Raja Medical College and associate Kamla raja Hospital, Gwalior in the ICU from Oct. 14 to Oct. 15.Results: 678 obstetric women were admitted into the ICU of Kamla Raja Hospital, over a period of 1 year study period. Maximum number of patients belong to age group 21-25 years (54.8%), 398 (58.7%) patients were uneducated, 343 (50.59%) came directly to Kamla Raja Hospital. 362 (53.39%) belongs to urban area. The mean length of stay in ICU was 3 days. Maximum number of patients were postpartum 580 (85.55%). According to mode of delivery maximum number of patients 348 (51.33%) underwent LSCS. Most common obstetric indication for admission in ICU was hypertensive disorder of pregnancy 472 (69.61%). Most common medical indication was severe anaemia 128 (18.87%). Various type intervention like pulse oxymetry, O2 inhalation, BT, nebulisation and ventilation were done in ICU according to patients need. 43 maternal death happened during the study period with most common cause was cardiorespiratory arrest 9 (1.32%) and pulmonary edema 8 (1.17%).Conclusions: Establishment of a dedicated obstetric ICU at tertiary care centre with knowledge familiarity, experience and expertise of an obstetrician and a special team would be best place to monitor and treat the critically ill obstetric patients which will reduce the maternal morbidity and mortality.