Objective:To assess various causes of maternal mortality over a ten year periodDesign:Retrospective audit of hospital case recordsSetting:Tertiary care hospitalPopulation:Pregnant women who expired in the premises of GTB Hospital.Materials and Methods:A retrospective audit of case records of maternal deaths was conducted for a ten year period (January 2005 to December 2014).Results:There were a total of 647 maternal deaths out of 1,16,641 live births. Sixty-eight percent (n = 445) of women were aged 21-30 years, while 10.5% (n = 68) were <20 years of age. The most common direct causes of maternal mortality were preeclampsia/eclampsia in 24.4% (n = 158), obstetric hemorrhage in 19.1% (n = 124) and puerperal sepsis in 14.5% (n = 94). With regards to indirect causes, anemia accounted for 15.3% (n = 99) mortality. There was only 1 (0.1%) mortality because of HIV/AIDS. Other notable causes of maternal mortality were infective hepatitis in 7.1% (n = 46). Tuberculosis, that is a disease of tropical countries, accounted for 3.0% (n = 20) of the total deaths.Conclusion:High maternal mortality in GTB hospital can be due to it being a tertiary hospital with referrals from all neighbouring states. Accessible antenatal care can help prevent these maternal deaths. Female education can be of immense help in dealing with the problem and improving the utilization of public health facilities.Key Message:Preeclampsia/eclampsia and obstetric hemorrhage have been the main causes of maternal mortality for ages. Regular antenatal visits and the judicious training of grassroot level workers to pick-up complications early on in the pregnancy can be an effective way to deal the morbidity and mortality associated with these problems. The Janani Suraksha Yojana (JSY) and Janani Shishu Suraksha Karyakaram (JSSK) in India are pioneer steps in this direction.

Objective To evaluate materno-fetal outcomes in pregnant women with jaundice. Methods A prospective study was conducted over a period of 6 months in a tertiary care hospital of Delhi, India. 82 pregnant women with jaundice were included. The serum was screened for viral markers, liver function tests, and coagulation status. Results The mean age of women was 27.3 ± 4.3 years. 43.9 % (n = 36) women were HEV positive, 36 % (n = 27) HBsAg positive, 4 % (n = 3) HAV positive and 1.3 % (n = 1) HCV positive. Intrahepatic cholestasis was diagnosed in 10.8 % (n = 8) of women. Maternal morbidity was evaluated in terms of chorioamnionitis (5.4 %, n = 3), encephalopathy (26.8 %, n = 15), and coagulopathy (67.9 %, n = 38). There were five maternal deaths, and all were unbooked with HEV-positive status and a bilirubin [15 mg/dl with deranged coagulogram and encephalopathy and IUDs. 79 women delivered vaginally, and three had cesarean section. Of the vaginal deliveries, 59.8 % (n = 49) went into spontaneous labor, and 25.5 % (n = 21) were induced for varied reasons (BPS \ 6/10 (38 %, n = 8)) and progressive derangement of LFT (38 %, n = 8). Among the 71 deliveries, 29 (40.8 %) were IUD and 42 (59.1 %) were live born. On analyzing the morbidity data, it was found that HEV-positive women (deranged coagulogram 71.05 %, IUD 75.86 %, encephalopathy 80 %) had a poorer outcome as compared to their HBsAg positive counterparts (deranged coagulogram 10.52 %, IUD 13.79 %, encephalopathy 6.66 %).

Transabdominal amnioinfusion reduced fetal distress, early neonatal sepsis, and neonatal mortality. In the study group, more participants delivered spontaneously and there were fewer cases of postpartum sepsis, although the pPROM-delivery interval was not increased.

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Evaluation of endometrial thickness and pattern by TVS helps to identify women with a pregnancy of unknown location for close supervision.

A 24-year-old unbooked G 2 P 1 L 0 (2 nd gravida, para 1 but no living issue) presented at 6 months amenorrhea with increased Blood Pressure (BP) records. She was diagnosed Pemphigoid Gestationis (PG) in her first pregnancy after confirmation on skin biopsy and direct immunofluorescence (DIF) [Table/ Fig-1]. There were no postpartum flare-ups though she continued irregular and self medication of prednisolone. On examination, there were fresh bullous lesions along with old healed scar marks on the abdomen and limbs [Table/ Fig-2,3]. Uterus corresponded to 24-26 weeks of gestation with a single live fetus. She was started on antihypertensive drugs and dermatology review was done. Prednisolone (15 mg OD) was started. Strict maternofetal surveillance was done. Her haemogram, RFT, liver function tests, fundus and ultrasound for kidneys were normal. Due to uncontrolled BP, decision for termination was taken. Patient delivered a still birth weighing 750 gm. No postpartum flare ups of PG were noted. She was discharged on prednisolone in a satisfactory condition. DisCussionPemphigoid Gestationis (PG) also known as herpes gestationis is a rare autoimmune blistering disease with an incidence of 1/50000 pregnancies [1]. Presentation in the second or third trimester is most common and tends to recur in subsequent pregnancies Keywords: Autoimmune Pemphigoid Gestationis (PG) is a rare autoimmune blistering disease with an incidence of 1/50000 pregnancies. Presentation in the second or third trimester is most common and tends to recur in subsequent pregnancies with earlier onset and a more severe course. Direct Immunofluorescence (DIF) staining is confirmatory on skin biopsy specimen. A 24-year-old female presented at 6 months period of gestation with increased blood pressure records. On examination, there were fresh bullous lesions along with old healed scar marks on the abdomen and limbs. Termination of pregnancy was done due to high BP. Patient delivered a fresh still birth weighing 750 gm. No postpartum flare ups were seen and she was discharged on prednisolone in a satisfactory condition.

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Bony fragments in the uterus occur after second trimester termination of pregnancy following retained fetal bones. Very rarely, they can form following first trimester loss. Clinical symptoms range from pain, menstrual symptoms, and infertility. Ultrasound shows a hyperechoic shadow, and treatment is by curettage or hysteroscopic removal.