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INTRODUCTION"ONCE CAESAREAN ALWAYS A CAESAREAN" was the term given by CRAGIN in 1916. 1 That era was of classical Caesarean section. Now the scenario has been changed and today we are performing lower segment caesarean section. The lower segment cesarean section gives us the liberty to give trial of labour after cesarean.The rates of primary LSCS in increasing steadily and there is decreasing trend of vaginal birth after caesarean (VBAC), to decrease the rate of LSCS ACOG recommends that most pregnant women with previous 1 LSCS should be counselled for VBAC and trial of labour after cesarean (TOLAC). 2Appropriate clinical settings and properly selected group of patients can make the vaginal birth after caesarean (VBAC) safe and effective. Trial of labour after cesarean decreases rate of caesarean section and the morbidity associated with surgical intervention. In VBAC there is less blood loss, shorter duration of stay in hospital, less intrapartum and postpartum infections and it further decreases the economic burden on society and the individuals. Aim To evaluate safety and efficacy of trial of labour after lower segment caesarean section. Objectives ABSTRACTBackground: In recent years, there are increasing numbers of cases which report for delivery after previous LSCS. Trial of labour after lower segment cesarean section can save them from repeat LSCS and its complications. Aim of study was conducted to evaluate the safety and efficacy of trial of labour after LSCS. Methods: This is a prospective study carried out at Mahatma Gandhi Hospital. One hundred pregnant patients with previous LSCS giving informed consent for trial of labour after cesarean section (TOLAC) were enrolled. Case selection was done as per the ACOG guidelines. Continuous fetal and maternal monitoring done by WHO partograph and cardiotocography. If there appeared any indication for repeat cesarean then emergency LSCS was done. Results: In this study, 80% of the enrolled patients delivered vaginally and 20% underwent repeat emergency LSCS. 2% of the enrolled patients underwent scar dehiscence. The patients in the active phase of labour on admission had more chances of successful vaginal birth after cesarean section (VBAC). Birth weight of more than 3000 grams is associated with lower rates of successful VBAC. There was no maternal mortality but 1% intrauterine fetal death due to scar rupture was there. Conclusions: TOLAC is safe and the success rates are good. Proper selection of cases with adequate fetal and maternal monitoring is required. So, once cesarean always cesarean is not a true dictum.

AIM: Prevalence of anemia and its socio-demographic determinants in pregnant women at a tertiary care hospital in Jaipur, Rajasthan. MATERIALS AND METHODS: All the pregnant women aged 25 to 35 years, registered at antenatal clinic at Department of Obstetrics and Gynaecology, Mahatma Gandhi Medical College, Jaipur were included. A predesigned and pre tested questionnaire was used to elicit the information. Various possible causes of anaemia were considered. Data was entered on Microsoft Access and was analysed using the statistical software SPSS version 11.5 for windows vista. Chi square test was used for finding the association between degree of anaemia and various factors. p value less than 0.05 was considered to be statistically significant and p value less than 0.001 was considered to be highly significant. CONCLUSION: Prevalence of anaemia in pregnant women is still quiet high (70%), as also found in various other studies done in India. The existing health care resources should be reinforced striclly, with mandatory supply of IFA tablets to adolescent girls & pregnant women, food fortification along with correction of other nutritional deficiencies and timely interventions for reducing the burden of malaria, & other infectious diseases. Unfavourable socio demographic factors are the major barriers to the efforts in place for the prevention of anaemia during pregnancy. Socio-economic status, literacy of women & awareness related to health concerns are the major determinants that contribute to the problem of anaemia. Therefore public health education/information on reproductive health are important health care measures to be undertaken at the community level, taking care of the fact that the health care should be provided during the important years of adolescence, before marriage & child bearing. Also it is high time for realisation that health system should focus on various factors that contribute to the occurrence of anaemia & include them as an important indicator in the national health care policy.

Background: Abnormal uterine bleeding is a common problem of the women in the reproductive age group and leads to the frequent visits of women in hospitals to health care providers. In an effort to create a universally accepted system of nomenclature to describe uterine bleeding abnormalities in reproductive-aged women, an alternative classification system polyp, adenomyosis, leiomyoma, malignancy and hyperplasia, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not yet classified, known by the acronym PALM-COEIN developed.Methods: It is a retrospective study on 200 patients of abnormal uterine bleeding to categorize them on the basis of PALM-COEIN classification. Patient grouped under these categories after detailed history, examination, investigations and histopathological reports.Results: Ovulatory dysfunction was the most common cause of AUB in patients presenting to the gynecology outpatient department (n=60, 30%). It was followed by leiomyoma (n=48, 24%) and endometrial causes (n=38, 19%) and were the top three etiologies for AUB respectively. Adenomyosis (n=26, 13%), not classified (n=12, 6%), iatrogenic (n=8, 4%), polyp (n=4, 2%) and malignancy and coagulopathy each (n=2, 1%) contributing least to the PALM-COEIN classification as an etiology for AUB.Conclusions: PALM-COEIN classification is a universally accepted and consistent method of knowing exact etiology following investigations, so the proper treatment can be done for AUB.

INTRODUCTIONIndia is the second most populated country in the world after China. According to the census 2011 the population of India on 1 st March 2011 was 1,210,193,422. In spite of the availability of wide range of contraception the unmet needs of contraception for family planning is estimated to be 12.8%, the reason for the unmet needs are mainly lack of information, fear about the side effects of contraceptive methods and unsatisfactory services.The recommended birth to birth interval in India is 36 months approximately 27% of birth in India occurs in less than 24 months after the previous birth and another 34% of birth occurs between 24 to 35 months. 1 The main reason for the decreased interval of birth is lack of knowledge of contraception in post-partum period. The contraception used during this period should be safe and effective and focus on extended post-partum period.Importance of post-partum family planning is as follows:• Maternal health: Women becoming pregnant at short intervals faces problems like anemia, abortion, premature rupture of membranes and high maternal mortality • Child health: short birth interval leads to increased risk of pre-term babies, Intra uterine growth retardation (IUGR), and increased death in neonatal period • To fulfill the Unmet needs: 65% of the women in first year of delivery have unmet needs for family planning. Only 26% of the of the women in India are using any contraception in first year after delivery. 2 ABSTRACTBackground: India is the second most populated country in the world. Effective contraception with low complication rates and high continuation rate in post-partum period can check population growth.Methods: This is a prospective study carried out at Mahatma Gandhi Hospital after ethical committee approval. 100 patients giving the informed consent were taken in the study. PPIUCD inserted in patients and they were followed up at 48 hrs, 6 weeks and 12 weeks by clinical examination and USG. Results: In this study, with PPIUCD insertion during LSCS, the expulsion and removal was observed in 4% and 14% whereas in cases with FTVD 8.33% expulsion and 12.5% removal were observed. 82% and 79.2% continued the use of PPIUCD in LSCS and FTVD respectively. The most common complain of the patients with PPIUCD were irritation because of thread. No case of pelvic infection or perforation was observed. There was no expulsion of PPIUCD when the distance of PPIUCD from fundus on USG was <10 mm. Conclusion: PPIUCD have high continuation rates with low complication rate. Distance of PPIUCD from fundus on USG is not a good indicator for predicting expulsion of PPIUCD.