Background: Cardiac disease is an important cause of maternal mortality and morbidity both in antepartum and postpartum period. The overall incidence of heart disease in pregnancy is <1%. Objective of present study was to determine maternal outcome in pregnant women with heart diseases in terms of fetal complication, maternal complication and Mode of delivery.Methods: This study was conducted in the Department of Obstetrics and Gynaecology at Government Lalla Ded Hospital, an associated of Government Medical College, Srinagar which is the sole tertiary care referral centre in the valley. 90 women with heart disease which were previously established   or diagnosed during pregnancy were enrolled in the study.Results: In 90 women pregnancies was complicated by heart disease in the study. The prevalence of heart disease amongst all pregnancies found in hospital was 4.3%. The principal cause of cardiac lesion was Rheumatic heart disease (RHD) (56.6%) while congenital heart disease was seen in 13.3%. Among the women who had RHD, mitral stenosis seen in 21 (23.3%) was most common lesion and Multiple cardiac lesions 21 (24.4%) women. Among the women with congenital cardiac disease, mitral valve prolapse was most common constituting 5 (5%) cases. Cardiomyopathy was the most common constituting 7 (7.3%). Heart failure developed in 10 (11.1%) whose NYHA class changed from class I/II to class III/IV. Majority of the women delivered by caesarean section 33 (36.7%) while (35.6%) had a normal vaginal delivery with spontaneous onset of labour. 7% had assisted instrumental vaginal delivered.  9% women had first trimester abortion. There were 4 maternal deaths. 85.6% live births were observed in these women. No baby had congenital heart disease.  72.8% babies born weighed more than 2kg.Conclusions: This study concluded that pre- pregnancy diagnosis, counselling, appropriate referral, antenatal supervision and delivery at equipped centre improve the pregnancy with heart disease outcome for both mother and baby.

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BACKGROUNDDepression is the commonest psychiatric disorder in women. Menopause is a hormone deficient state in women's life and the symptoms experienced at menopause are quite variable and affect the emotional state of women and leading to depression and poor quality of life.The study aimed to determine prevalence of depression, menopausal symptoms in perimenopausal women attending in a primary health centre in North Kerala. MATERIALS AND METHODSThis cross-sectional study was conducted in a primary health centre, North Kerala. Women in the age group of 40-55 years were included in the study. Each subject was assessed using sociodemographic data sheet and screened with PHQ-9 questionnaire. Women who scored ≥5 in PHQ-9 were further assessed using Beck's Depression Inventory. Perimenopausal symptoms were assessed by menopause rating scale. Data was entered and analysed by SPSS Version 20.0. RESULTSThe mean age of menopause was 48.5 ± 3.226 years. Most women were high school educated (38%) and belonged to rural background (89%) and low socioeconomic group (69%). 19% of women were in premenopausal phase, 43% in perimenopausal phase and 38% in postmenopausal period. 37% women was found to be depressed. The most common menopausal symptoms in the present study group were joint and muscular discomfort (77%). There was significant relationship between depression score and MRS scores in all three dimensions (P <0.001). CONCLUSIONThe menopausal transition is a time of increased vulnerability to depressive disorders. The current study highlights the presence of depressive symptoms and depressive disorders in this vulnerable age group.

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