To study the prevalence, causes, treatment and outcome of thrombocytopenia in pregnancy. Methods: 15,721 antenatal women were screened for thrombocytopenia using automated blood counter. Women with thrombocytopenia were further evaluated using history, clinical examination & investigations to diagnose the cause of thrombocytopenia. These women were treated appropriately according to the cause and followed up to know the outcome of thrombocytopenia in pregnancy. Results: Out of 15,721 patients screened, 1,212 patients had thrombocytopenia (7.7%). 949 patients found to have gestational thrombocytopenia accounting for 78.3% of all thrombocytopenic patients. Hypertension complicating pregnancy was the second major cause (15.01%). 1.60% of thrombocytopenic women had ITP. Other causes were fever complicating pregnancy (50 patients), Bone marrow disorders (2 patients), and Jaundice complicating pregnancy (9 cases). Platelet count normalized within 2 weeks of delivery without treatment in gestational thrombocytopenia patients. All the patients with ITP and Aplastic anaemia responded well to steroids. Patients with fever and liver disease complicating pregnancy were treated supportively. Platelets transfused in all patients with severe thrombocytopenia to avoid hemorrhagic complications during delivery. Maternal morbidity and mortality was high in hypertension complicating patients. Regarding perinatal outcome only 2 neonates of ITP mothers had platelet count < 50,000/cumm (one delivered by vaginal and other by LSCS) but none of them developed hemorrhagic complications. Conclusion: Prevalence of thrombocytopenia in pregnancy is 7.7%. Gestational thrombocytopenia is the major cause of thrombocytopenia in pregnancy (78.9%). Platelet count > 1lakh/cumm and without past h/o thrombocytopenia should rise the doubt of Gestational thrombocytopenia. ITP should be considered in patients with past history of low platelets. Caesarean deliveries should be reserved for obstetric indications alone. For gestational thrombocytopenia normalization of platelet count after delivery is necessary.

Sumathy, V. and Baucom, K. (Dept. of Obstetrics and Gynecology, University of Missouri‐Kansas City School of Medicine, Kansas City, Miss., USA). Prolapse of the Fallopian tube following abdominal hysterectomy. Report of three cases. Int J Gynaecol Obstet 13: 273–276, 1975. Three cases of prolapse of the Fallopian tube are presented. Probable predisposing factors for this clinical entity include post‐operative pelvic infection, failure to secure separate closure of the peritoneum and vaginal vault following abdominal hysterectomy. Unfortunately symptoms of tubal prolapse are very vague and misleading. Initial diagnosis is usually that of granulation tissue. A biopsy should be taken of any lesion within the vaginal vault which is sensitive to touch, bleeds easily and persists despite cauterization. Treatment of prolapsed tube is that of high ligation and excision. Cauterization of the prolapsed tube does not usually result in permanent cure. It is highly possible that there are more undiagnosed cases than one would imagine.

A partograph is a composite graphical record, of progress of labour and silent condition of mother and foetus the partograph was not created for the convenience of doctors; infact it was created as a tool for all health professionals including midwives and traditional birth attendants. It serves as an early warning system and assists in early decision on transfer, augmentation and termination of labour. In under resourced setting, prolonged labour and delay in decision-making and late referrals are important causes of adverse obstetric outcome owing to resource constraints in such settings, it is usually not possible to monitor each woman continuously throughout the duration of the labour. In such setting, the partograph serves a simple and inexpensive tool to monitor labour in a cost-effective way. Thus labour a simple natural process which can take a turn making it lethal for any patient. The role of obstetric caregiver is to avoid unnecessary intervention in this natural physiological process but at the same time to identify problems when things start going amiss. so the early recognition of any deviation from normal progression of labour will help to prevent or reduce undesirous maternal and fetal outcome, which brings in the importance of partogram Aim 1) To recognise abnormal labour at an early stage using WHO partogram in relation to the alert line and action line. 2) To evaluate the role of partogram in preventing prolonged labour 3) Toasses the maternal and perinatal morbidity and mortality. Materials and Methods Study design: comparative prospective clinical study No of cases: 200 cases each at term in labour Sampling technique: Random selection of subjects meeting the inclusion and exclusion criteria. The WHO modified partogram is attached to the mothers case record when the patient is admitted in the labour room. Labour in 200 patients (control group) is monitored without using partogram. Outcomes are stratified in terms of duration of labour, mode of delivery, maternal and neonatal outcome. Results  The mean duration of first stage labour-9.6 hours  The mean duration of second stage of labour-21.77 minutes  The mean total duration of labour-10.2 hours  Lscs-60% in control, 40% in test group. Conclusion 1. Abnormal labour patterns can be identified earlier by partogram. 2. The difference in outcomes like mode of delivery, augmentation of labour and neonatal outcome was significant and can be predicted by partogram. 3. Maternal and perinatal outcomes can be predicted with use of partogram.

Background:The second most leading cause for maternal mortality is hypertensive disorder of pregnancy, which accounts for 15% of total deaths and still births. Preeclampsia is a complex disorder affecting about 5-10% of the obstetric population, resulting from deficient placental implantation during the first half of pregnancy and hypertensive disorders after 20 th week of gestation in a previously normotensive woman. Periodontal diseases are plaque induced infections and pathological changes of the periodontium, divided into two categories: gingivitis and periodontitis. Preeclampsia and periodontitis have been found to be associated with high circulating levels of tumor necrosis factor-alpha (TNF-α), interleukin (IL)-10, and IL-6 resulting in inflammatory vascular damage leading to placental endothelial alterations. Periodontal microbiota plays a significant role in systemic diseases directly through a pro-inflammatory effect or indirectly through the host-mediated destruction. The similarities in their pathophysiologies have led to the hypothesis of periodontal disease being a risk factor for preeclampsia. Aim of the study: 1. The aim of the present study was to evaluate the association between maternal periodontitis and preeclampsia. 2. Also the association of periodontitis and preeclampsia after matching for primi Parity. Materials and Methods: The present study was conducted at Institute of at Madras Medical College, Chennai Tamilnadu during the academic year 2017. The study was done in 200 patients for duration of 8 months. Participants were informed about the aims of the study and a written informed consent was obtained from them. An eligible sample was selected based on the following criteria. Results: Of the 200 patients analysed 92 were found to have periodontitis, which accounts for 46% of study population. Out of the 92 patients having periodontitis 67 patients were preeclamptic. The study showed no significant association between age, parity, socioeconomic status and place of residence to periodontitis. There is significant association between maternal periodontitis and preeclampsia. Conclusion: Delaying treatment may result in more complex problems. Counseling should include reinforcement of routine oral health maintenance, such as limiting sugary foods and drinks, brushing twice a day with fluoridated toothpaste, flossing once daily, and dental visits twice a year. Dental providers often recommend the use of chlorhexidine and fluoridated mouth rinses, and xylitol-containing chewing gum to decrease oral bacteria. No adverse effects have been reported with these products during pregnancy.

Induction of labor is the artificial initiation of labor before its spontaneous onset by means of various interventions. Now a days, about 10-30% obstetric cases required induction due to various indications. There are many surgical and medical methods available for induction of labor/cervical ripening. Of these cervical ripening using Prostaglandin Gel intracervically is most common practice in modern times. Prostaglandin gel is not only effective in cervical ripening, but also effective in activating myometrial contractility. There are many formulations available for Prostaglandin E2 for local administration, including vaginal tablets, endocervical gels, and vaginal gels and also in the form of slow release dinoprostone vaginal insert forms. Prostaglandin E2 gel is an organic acid which has low solubility in aqueous solution with low pH. The aim of this study is to evaluate whether vaginal PH has any effect on Dinoprostone gel used for cervical ripening in labor induction. Aim 1. The influence of vaginal PH on the efficacy of PGE2 gel which we commonly use for cervical ripening in labor induction. So it might improve patient selection and we can predict those cases which might go into failed induction with PGE2. 2. I will also try to study the changes in vaginal pH because of various factors e.g. age of the patient, gestational age, parity, draining per vagina etc. Materials and Methods: This study was conducted on patients who were undergoing induction of labor with Dinoprostone (PGE2) gel at The Institute of social obstetrics, Government Kasturba Gandhi Hospital, Madras Medical College, Triplicane, Chennai, and Tamil Nadu during the academic year 2016-17. The study was done in 100 patients for duration of 1 year. Study Designs: Prospective observational study. Sample size: 100 Results: 60% of the study populations are in the age group of 21 to 28 year. 33% pregnant women had vaginal pH >4.5. 66% women were primigravidae, while the remaining 34% are multigravidas. Among 32 cases of draining P.V. vaginal pH >4.5 is seen in 20 cases, i.e. 62.5%.Among 100 cases of PGE2 gel induction, 83.7% cases show positive Bishops score changes after 6 hour of induction in pregnant women with higher vaginal pH of >4.5.If vaginal pH is >4.5, it was found that the time interval between gel to delivery is reduced to <12 hours in 77% of cases. Conclusion: we can see that assessing vaginal pH before induction can be an useful parameter in predicting the outcome of labour in pregnant women who are undergoing labour induction with PGE2 gel. However further research with a well designed pharmacological study with bigger study population is necessary to study the role of vaginal pH in absorption and overall efficacy of Dinoprostone gel which in future could increase the efficacy and reduce unwanted outcomes.