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OBJECTIVESTo compare maternal morbidity in routine versus selective episiotomy in primigravidae. STUDY DESIGNProspective case control study. SETTING AND DURATION OF STUDYObstetrics and gynaecology ward of Krishna Institute of Medical Sciences, Karad, from November 2013 to June 2015. METHODOLOGYDeliveries managed with routine use of episiotomy formed the Control Group, while those managed with restricted use of episiotomy formed the Study Group. Exclusion Criteria of our study was multigravida, multiple pregnancies, assisted breech deliveries, non-vertex presentations including malposition, instrumental deliveries and associated systemic diseases, maternal exhaustion, preterm deliveries, foetal macrosomia, PROM and VBAC. Perineal Pain Score was measured in the post-partum period by 100 mm VAS (visual analog scale). The main outcome measures which causes maternal morbidity was severe perineal trauma (3rd and 4th degree tears). Other outcomes which cause the maternal morbidity in terms of 1st and 2nd perineal tears, presence of perineal pain, haematoma formation and wound dehiscence were also recorded on proforma. RESULTSThis study included 200 patients of routine episiotomy and 200 patients of restricted episiotomy. In the study group, 75% of women had first degree of tear and 22.5% women had second degree tear without any post-partum haemorrhage and in the control group; 95% pregnant women had episiotomy without any extension, 10 pregnant women had third degree of tear. During followup, only 2 patients reported dyspareunia in study group, while 3 patients reported faulty wound healing, 1 patient each reported urinary incontinence and anorectal incontinence, also 4 patients reported dyspareunia among control group. CONCLUSIONAs perineal pain, perineal tears and wound dehiscence and infections were all less frequent in study group, as compared to routine group, also pelvic muscle strength was better in study group, so overall maternal morbidity was less among study group.

BACKGROUNDEctopic pregnancy is a significant cause of morbidity and mortality in the first trimester of pregnancy. Treatment with Methotrexate (MTX), an antimetabolite chemotherapeutic agent that binds to the enzyme dihydrofolate reductase, which is involved in the synthesis of purine nucleotides. This interferes with DNA synthesis and disrupts cell multiplications, achieves results comparable to surgery for treatment of appropriately selected ectopic pregnancies. Surgery is specifically indicated in ruptured ectopic and when MTX is contraindicated. Aim-To evaluate the medical management of Ectopic pregnancy in tertiary care hospital.

BACKGROUND HELLP is a rare life-threatening obstetric syndrome. It is a multisystemic complication of preeclampsia occurring in 0.1 to 0.8% of all pregnancies and in 10% to 20% of those with severe preeclampsia/eclampsia. This dreaded condition was traditionally associated with high rates of perinatal mortality over 70% and maternal mortality over 25%. However recent trends in early recognition and diagnosis, effective assessment and the rapid initiation of medical and obstetric critical care, all offer significant improvement in maternal and foetal prognosis. Aims and Objectives-To analyse the incidence, maternal and neonatal outcome of HELLP syndrome in a tertiary care teaching hospital serving a semi urban and rural population and to study management solutions to reduce maternal and perinatal mortality.

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