Background: Caesarean section is the delivery of a fetus through a surgical incision on the uterine wall after 28 weeks of gestation. Objectives of present study were to determine the caesarean section rate, to analyse surgical difficulties and post-operative morbidites in caesarean deliveries and to formulate modalities to reduce morbidity and to ensure safe motherhood. Methods: Retrospective analysis of caesarean deliveries in Shri Sathya Sai Medical College and Research Institute, Ammapettai from January 2015-2017. Total number of delivery in these two year were 494.Total vaginal delivery-210, Total caesarean delivery-284. Case records of women who had cesarean deliveries were analysed for intra operative complications and post-operative morbidity within the period of their hospital stay. Results: Total no of deliveries in 2 years were 494. Vaginal delivery was 210 (42.5%). Total caesarean section is 57.5% (n=284). Primary caesarean section rate 33.1% (n=94) and secondary cesarean section rate 66.9% (n=190). 60% of our subjects were un-booked emergency admissions. Majority were between 21-30 years. Youngest is 16yr old with imminent eclampsia, oldest 35yr with previous 3 LSCS with central placenta previa. Non-closure of peritoneum in previous caesarean has increased the risk of adhesions, plastered rectus muscle and bladder adhesion which caused difficulty in reaching lower segment in 62 women. In present study, vertical incision was put on uterus in 4 cases due to adhesions. Difficulty in entering uterine cavity, extension of uterine angle due to thick lower segment and excessive bleeding was seen in cases of repeat caesarean section. Scar dehiscence has increased due to single layer closure of uterus. Scar dehiscence was noted in 41 cases. Bladder injury in 3 cases, adherent placenta over the scar was seen in 5 cases. Conclusions: Caesarean section rate is increasing. Intraoperative complications and postoperative morbidity is comparatively less in primary caesarean section. More than one morbidity was seen in 60% women who had repeat section. With the growing rate of cesarean deliveries worldwide, women should be counselled that the repeat cesarean are bound with surgical difficulties and complications. If available, it's imperative to take the senior obstetricians help for better surgical outcome. Anticipation of complications, early decision and active intervention reduces morbidity and prevent mortality as most of the women report for admissions late in labour.

Background: Vagina is the fibro muscular membrane sheath communicating with the uterine cavity and to the exterior at the vulva. Infection of female genital tract results from vaginal flora, extraneous agents and sexually transmitted diseases. The objective of the study was: a) high vaginal smear screening to find out incidence of abnormal vaginal flora of micro-organisms, b) prevalence of protozoal Trichomonas vaginalis.Methods: Rural women from in and around Ammapettai in the age group of 20-50 years attending Gynaecology OPD of SSSMC&RI for vaginal discharge and itching vulva. Exclusion criteria were age less than 20 and above 50 and pruritis vulva due to other causes the study size comprised of 50 women. After getting Institutional ethical committee’s approval and written informed consent from the patients, detailed history regarding type of discharge, odour, itching, and associated bleeding was taken. Per speculum and per vaginal examination done. High vaginal smear for aerobic bacterial profile and Trichomonas infection were taken and transported to microbiology laboratory for staining and culture. Wet mount microscopic examination of Trichomonas vaginalis and Candidiasis with saline and KOH mount done.Results: Out of 100 smears 9 were normal vaginal flora organisms, aerobic pathogens 43%, Trichomonas vaginalis (TV)  30%, and Candida albicans 5% mixed infections on 7 smears. E. coli was seen in 23 samples, Klebsiella in 14, Pseudomonas aeroginosa 4, Staphylococcus in 6 samples. Gram negative organisms were 100% sensitive to imipenem, amikacin and gentamycin and 100% resistant to cefazolin, 80% to ceftazidime, 74% to cefotaxime. Gram positive staphylococcus 50% were resistant to gentamycin, ampicillin.Conclusions: This study reflects on our responsibility to create awareness among women regarding abnormal vaginal discharge through proper health education routine screening targeted treatment to envisage healthy quality life.

Background: Hysterectomy is the removal of uterus for benign uterine tumor and uterine descent in perimenopausal women. Post hysterectomy and follow up morbidity in rural women is studied over a period of 1 year. They were reviewed during hospital stay to identify morbidity and risk factors for prolonged hospital stay and formulate modalities to reduce morbidity. Risk factors assessed were fever, wound sepsis, anemia, previous post-operative adhesions and injury to other organs. Follow up was done at 4 weeks. 72% women were morbidity free. 46% women had more than one morbidity. The aim of this study is to analyse immediate and late post hysterectomy morbidity in a rural setup and to identify risk factors for prolonged hospitalization and formulate modalities to reduce morbidity and duration of hospital stay. Method: Perimenopausal women who underwent hysterectomy for benign uterine conditions and uterine descent were studied for post-operative morbidity at SSSMCRI over a period of one year. Post hysterectomy morbidity was clinically assessed from day one of surgery till discharge, for early and late morbidity. Abdominal skin incision smear, vault smear, urine culture and USG pelvis for collection of fluid was done in woman who developed fever. Follow-up morbidity was done at 4 weeks. Hysterectomy done for malignant conditions were excluded from the study. Results: In rural women, postoperative morbidity was assessed in 81 abdominal, 32 vaginal hysterectomy. Postoperative pain was felt by all 113 women for first 3 days. Fall of hemoglobin due to haemorrhage was seen in 43 (38%) women. 33 needed post-operative blood transfusion. Surgical site infection was seen in 13, needed re-suturing in 7. Fever was seen in 50 women (44%) due to UTI (E coli 13, Klebsiella 5). Pelvic fluid collection was seen in 9 with vault infection. We had one burst abdomen, one re-laparotomy, 3 bladder injuries. Prolonged hospital stay was seen in 41 women. 46% had more than one morbidity. Follow-up at 4 weeks, 72% were morbidity-free. Prolene granuloma 2, Stitch abscess 9, vaginal discharge 14, vault granuloma 3 were observed. Vaginal smear showed 9 Staphylococcus aureus and 5 bacterial vaginosis infection. 12 women had E. coli and 6 Klebsiella infection in urine culture. Conclusion: Pre-operative risk factors for post op morbidity like anemia, urinary and vaginal infection should be properly treated prior to surgery. Awareness of risk factors for morbidity, anticipation of complications due to size, site, nature of tumour and previous surgery adhesions, timely intervention by experienced surgeons and adequate blood transfusion will reduce morbidity and prolonged hospital stay.