Background: Heavy menstrual bleeding (HMB) is defined as prolonged (>7 days) or excessive menstrual blood loss greater than or equal to 80 ml per menstrual cycle. The objective of the study was to assess the efficacy, acceptability and side effects of LUS IUS in women with heavy menstrual bleeding.Methods: 42 women with heavy menstrual bleeding with or without associated dysmenorrhoea or chronic pelvic pain and had no contraindication to IUS insertion were included in the study. Patients having active genital tract infection, suspicion of pregnancy, uterine fibroids >2.5 cm in size or sub mucosal distorting the uterine cavity, uterine size >12 weeks, atypical endometrial hyperplasia or malignancy, abnormal cervical cytology, coagulopathy or liver disease were excluded from the study. Preliminary endometrial biopsy was done to rule out malignancy and LNG IUS was inserted under anaesthesia. Women were followed for 3,6,12 and 24 months post insertion.Results: In first 3 months, 20% patients achieved normal menstrual cycle, and at 6 months 44.44% had scanty menstrual flow and after 1 year of use 81.5% achieved amenorrhoea. In initial 3 months 37.5% patients had irregular heavy bleeding, which reduced to 13.89% at 6 months and 0% at 1 year follow up. Irregular spotting was second most complaint in 32.5% patients in initial 3 months that persisted in 7.4% patients at 1year follow up. In 5.0% patients, there was spontaneous expulsion of the device in first 3 menstrual cycles. After 3 months of use 57.5% patients were satisfied with the device and at the end of 1 year 92.5% were satisfied.Conclusions: LNG IUS is highly effective in controlling blood loss, well tolerated and better alternative for hysterectomy with higher user satisfaction in all age group of women.

The perimenarcheal onset of polycystic ovarian syndrome (PCOS) has long been recognized, through both its pathophysiology and the frequent onset of hirsutism and menstrual irregularities in this age group. However, there is often a delay in diagnosing PCOS in adolescence because menstrual irregularity is frequently thought to be normal in the first 2 or 3 years after menarche, particularly if clinical signs of hyperandrogenism such as hirsutism or acne are mild or absent. This was a Cross-sectional Study consisting of 102 adolescent girls, aged 12 to 19 years, selected from patients attending the Gynecology Outpatient Clinic. In present study, level of insulin resistance along with markers of PCOS was assessed and compared in adolescent women with (cases) or without (controls) menstrual irregularities, a hall mark of PCOS. 18(35.29%) cases versus 01(1.96%) controls the Rotterdam criteria of PCOS. Clinical manifestations of hyper androgenism were not yet present in all cases who met Rotterdam criteria of PCOS, suggesting menstrual irregularity, especially oligomenorrhoea (83.3% of all PCOS (cases), as the most precocious marker of PCOS. CONCLUSIONS: Adolescents with persistent menstrual irregularities 2 years after menarche frequently have PCOS and elevated HOMA-IR values than controls, indicating a high probability of developing insulin resistance and metabolic syndrome later in life.

Introduction Vaginal discharge is the most frequent complaint during pregnancy, leading to numerous complications in both the mother and fetus. Aim The goal of this study was to determine the prevalence of vaginal discharge, investigate its common infectious causes and associated symptoms during pregnancy. Methods This hospital-based cross-sectional study performed over one year evaluated 200 expectant mothers with vaginal discharge at any trimester in the Department of Obstetrics and Gynecology, in cooperation with the Microbiology section, of Indira Gandhi Institute of Medical Science, Patna. Results The mean age of the mothers was 26.84±5.51 years (range 19-42 years). Most of the patients (47.5%) were in the age group of 26-35 years, belonged to the lower socioeconomic class (67.5%), gravida 3 or more (43.5%), and presented in the third trimester. The prevalence of pathological discharge in pregnancy was 148/308 (48.05%). A positive culture was obtained in 105 (52.5%), and negative culture was obtained in 95 (47.5%). Vaginal candidiasis was diagnosed in most cases (37.5%), followed by aerobic vaginitis (15%), trichomoniasis (13.0%), and bacterial vaginosis (8.5%). The non-pathological discharge was diagnosed in 26.0%. Dysuria was the most common symptom (32.5%), followed by itching (27.5%) and urinary tract infection (UTI; 10.0%). The following variables were significantly associated (P<0.05) with discharge: age (in years), age group, gravida, culture, organism isolated on culture, UTI as a symptom, and diagnosis. Conclusion Expectant mothers presenting with vaginal discharge need to be evaluated to identify the etiology and allow timely treatment, which might be helpful in preventing complications.

Background: Obstetric emergencies can occur suddenly and unexpectedly. Obstetrics is unique in that there are two patients to consider and care for, a mother and a baby or fetus. Identification and referral of high risk pregnancies are an integral part of maternal and child health services. Timeliness and appropriateness can reduce the incidence of obstetric emergencies. Present study was carried out to know the incidence, nature and outcome of obstetric emergencies.Methods: Retrospective study of obstetric emergencies admitted to Obstetrics and Gynaecology department of Indira Gandhi Institute of Medical science, Patna from March 2015 to September 2017.Results: The common clinical presentation was Ectopic Pregnancy (19.64%), Heart Disease (16.64%), Abortion (13.69%), Severe Anaemia (16.66%), Purpureal Sepsis (9.52%), Sever pregnancy induced hypertension (3.57%), Eclampsia/ HELLP Syndrome (2.38%), Multiple Pregnancy (1.19%) Malignancy Disorder with Pregnancy (2.97%) and HIV in pregnancy (0.59%). Intervention done include Dilation and evacuation (13.69%), Caesarean section (28.57%), Vaginal delivery (22.62%), Caesarean Hysterectomy (2.38%), Exploratory Laparotomy (20.83%) and conservative management in (11.90%) of patients. Maternal outcome include shock due to rupture ectopic and post-partum (16.68%), Blood Transfusion done in (27.99%), Septicaemia (15.48%), ICU admission (8.92%), HDU (12.5%), Pulmonary oedema (6.54%), DIC (4.16%), CCF (3.57%), Ventilatory Support (1.78%) and Maternal Mortality (2.38%). Fatal outcome includes live birth (58.8%), NICU Admission (27.45%), Ventilatory Support (7.84%) and Neonatal mortality (5.88%).Conclusions: High risk pregnancy identification and proper antenatal, intranatal and postnatal care will reduce the incidence of obstetrical emergencies. Peripheral health care system need to be strengthen and early referral need to be implemented for better maternal and fetal outcome.

Introduction: Pregnancy-related acute kidney injury (AKI) is a common occurrence and is associated with substantial maternal morbidity and mortality in developing countries. It may comprise up to 25% of the referrals to dialysis centers in developing countries. Acute kidney injury in pregnancy bears a high risk of bilateral renal cortical necrosis and consequently chronic renal failure. Study aimed to evaluate the contributing factors responsible for pregnancy-related Acute kidney injury and to assess the outcome of patients with pregnancy-related Acute kidney injury. Material and methods: The present study is a prospective study of patients with obstetric complications leading to Acute kidney injury admitted in Obs and Gynae Deptt and nephrology deptt of IGIMS for a period of one year. Pregnant women who are included in the study are those who were healthy previously and had developed Acute kidney injury-oliguria (Urine output <400 ml/d) and azotemia (Serum creatinine >2 mg%) due to pregnancy related complications. Results: Pregnancy related complications was present in 38 patients admitted in our hospital with acute kidney injury in one year period. Out of these 37% (14) of patients were in early stage of pregnancy while 63% (24) were in later stage of pregnancy and puerperium. Causes of AKI was post abortal sepsis in 23.6%, puerperal sepsis in 26.3%, haemorrhagic shock in 23.6%, eclampsia/pre-eclampsia/HELLP syndrome in 21%, IUD in 2 nd trimester with sepsis in 2.6% and acute fatty liver of pregnancy in 2.6% of cases. Sepsis was the major cause accounting upto 52.6% of cases. Approximately 52.6% (20) of patients improved on treatment and dialysis, 21% did not improve (8), 13.15% (5) died and 13.15% (5) left against medical advice. Cause of death in 80% (4 out of 5) of patients was sepsis. Renal biopsy was performed on 62.5% of patients who did not improve (5 out of 8 patients). Renal transplant was done in 1 patients. Conclusion: Obstetric AKI is still a critical situation in developing countries and rare entity in developed countries. Maternal mortality has decreased but sepsis still accounts for majority of cases. Therefore early diagnosis and treatment is the need of the hour.

BACKGROUNDPost-dated pregnancy is defined as one which has crossed expected date of delivery. Incidence is up to 10% of all pregnancies and carries increased risk to mother and foetus. Prolonged pregnancy has always been regarded as a high-risk condition because perinatal morbidity and mortality is known to rise. The interest in postdatism has been recent and the management is controversial. We wanted to analyse the perinatal and maternal outcome of post-dated pregnancies. METHODSData was collected retrospectively from hospital records of all patients delivering after 40 weeks of gestation in our hospital and was collected till the sample size of 100 was reached. Details including demographic profile, booking status, period of gestation in weeks, method of induction of labour (if done), mode of delivery, maternal and neonatal complications if any, were noted. RESULTSThe incidence of post-dated pregnancy was 9.22% at our centre. Majority of the patients (87%) were ≤30 years age. 71% patients were primigravida. Most of the patients (64%) were unbooked. As the gestational age increased from 40-41 weeks to 41 weeks 1 day and above, the percentage of patients undergoing LSCS increased. More number of patients had to be induced as the gestational age crossed 41 weeks. Rate of LSCS was higher in the group where induction of labour was done. Common indications being failure of induction, non-progress of labour and foetal distress. Complications included increased NICU admission rates, birth asphyxia, macrosomia, shoulder dystocia, increased LSCS rates, oligohydramnios, etc. CONCLUSIONSPostdated pregnancy is associated with both, maternal and foetal complications. Timing of induction has to be decided carefully, as early induction leads to failure and increased rates of LSCS, while late induction leads to increased foetal complications.

INTRODUCTIONToday there is an increased trend in the incidence of caesarean section (CS) rate worldwide particularly in middle-and high income countries, even with the lack of evidence supporting considerable maternal and perinatal benefits with CS rates higher than a certain threshold.The ideal CS rate should be between 10-15% as WHO recommended and was an accepted norm until 2014. 1Although CS is a life saving procedure for both mother and baby, the incidence of neonatal mortality and morbidity did not decrease with the increase in CS rates.The following reasons have been designated for the rise of CS rates include fear of medico-legal issues, increasing maternal request, increasing malpractice pressure, convenience of scheduled deliveries as well as economic, cultural and organizational factors.However, ICMR task force study stated after considering data from 30 teaching institutions that the most frequent ABSTRACT Background: Today, there is an increased trend in the incidence of caesarean section (CS) rate worldwide particularly in India, even with the lack of evidence supporting considerable maternal and perinatal benefits with higher CS rates. The main objective of our study was to find the incidence of CS rate, auditing the data on the basis of modified Robson criteria, factors responsible for the most common group, to know the changing trends of CS and finally put forth the strategies to reduce CS rate. Methods: This is a retrospective study of 472 CS cases carried out in a tertiary care hospital during the year 2016. All the cases were grouped according to the modified Robson criteria and the data was analyzed. The data were grouped into 3 different slots of 4 months each (FF = first four months; MF = middle four months and LF = last four months of the year 2016). Results: A significant increasing trend was observed in the groups of 2B and 5C where as a significant decreasing trend was noticed in 6C and 7C. The most common indications for caesarean delivery were cephalo-pelvic disproportion (CPD) (28%) and fetal distress (22%) in group 1 whereas in group 2A CPD, fetal distress and failed induction were found to be 12%, 24% and 30% respectively. Conclusions: The change in trend has been noticed in the last few months particularly in 2B and 5C groups suggesting that there is a change in the attitude of obstetricians in conducting caesarean deliveries before the onset of labour rather than performing CS after the onset of labour. Targeting 2B along with 5C would help our efforts in reducing the CS rate.

Objective The aim of this study was to determine the perinatal outcome of pregnant patients complicated with meconium-stained amniotic fluid (MSAF) compared with clear amniotic fluid. Methodology This prospective cross-sectional study was conducted in the Department of Obstetrics and Gynecology in collaboration with the Department of Pediatrics at Indira Gandhi Institute of Medical Sciences, Patna, India, from September 2016 to January 2018. A total of 200 patients were included in the study after taking their written consent. Out of these 200 patients, 100 patients had MSAF, and the other 100 patients with clear liquor were taken as controls after fulfilling the inclusion and exclusion criteria. These two groups of patients were compared regarding various maternal and neonatal parameters. These parameters were compared and tested statistically for significance. Results Among the 100 patients with MSAF, 20 patients had grade 1 meconium (X), 22 patients had grade 2 meconium (Y), and 58 patients had grade 3 meconium (Z). The majority of patients in the MSAF group were primigravida and more than 25 years of age. In addition, 47% of patients in the MSAF group had some associated high-risk factors and 50% of patients had non-reassuring fetal heart rate patterns, and among these, 39 patients had grade 3 MSAF (X). In the MSAF group, 49% of patients had undergone lower segment cesarean section (LSCS), whereas in the non-MSAF group, it was 37%. Also, 30% of babies in the MSAF group and 13% in the non-MSAF group had neonatal intensive care unit (NICU) admission; 22% of babies in the MSAF group and 12% of babies in the non-MSAF group had an adverse neonatal outcome. Meconium aspiration syndrome was present in 14% of the patients in the MSAF group, and among these, two babies had neonatal death and both had severe birth asphyxia. In the non-MSAF group, there was one neonatal death due to neonatal sepsis. However, after statistically analyzing the neonatal outcome in both the groups, there was no statistical difference between the two groups (p<0.001). Conclusion MSAF is associated with increased frequency of operative delivery, poor neonatal outcomes, and increased NICU admission. Management of labor with MSAF requires appropriate intrapartum care with continuous fetal heart rate monitoring, and this can reduce unnecessary cesarean sections in patients with MSAF.