Wilson's disease is an autosomal recessive genetic disorder affecting copper transport leading to hepatic and/or neuropsychiatric manifestations. Changes in pregnancy can mimic certain clinical features of chronic liver disease such as spider naevi, and constraints for the use of various investigation for diagnosis pose a challenge to physicians. A high index of suspicion, multi-disciplinary team approach, use of correct non-invasive testing including viral serology, autoantibodies and copper studies and ultrasonography help to diagnose most of the pre-existing, de novo or pregnancy-specific hepatological conditions. We report a case of Wilson's disease diagnosed during pregnancy and discuss the challenges in diagnosis and treatment in pregnancy.

Objective: The study was conducted to see the maternal and neonatal outcomes of the women with placenta praevia. Methods: All women with the diagnosis of placenta praevia admitted in the hospital were included in the study. The maternal and fetal outcomes were recorded from January 2012 to August 2017, over a period of 5 years. Results: A total of 63 patients were included in the study, after radiological confirmation. The period of gestation for the first presentation was predominantly in 28 weeks of gestation, for central placenta praevia. The mean blood loss intraoperative was 3000 ml, ranging to as much as 5500 ml in central placenta praevia and more so in posterior than anterior placenta. The need of additional procedure like uterine artery ligation was needed in 26 (41.2%), internal iliac artery ligation 8 (12.6%), B lynch in 12 (19.04%) and peripartum hysterectomy was performed in 3 (4.7%). The mean requirement of blood transfusion was 500ml of packed cell. The need of ICU care was in 5 (7.9%) and serious morbidity was seen in 3 (4.7%). Maternal mortality was not seen in any case. Fetal outcomes were studied by recording the fetal weight, Apgar and need of NICU care which was for 23 (36.5%). Conclusion: The need for early diagnosis and multispecialty approach to a patient is greatly associated with reducing the blood loss, lesser need of additional procedure and lower maternal and fetal mortality and morbidity.Keywords: Placenta praevia, accreta, antepartum hemorrhage, maternal complication.Placenta praevia means the placenta located in the lower uterine segment which is less than 2.5 cms from the cervical os 1 . This condition is complicating about 0.3 to 0.8% of all pregnancy 2-5 . The risk factors for developing placenta praevia are previously scarred uterus, grand multiparty, maternal age of more than 35 years, recurrent abortion and intrauterine curettage 6-9 .Maternal morbidity in the form of abnormal placentation, increased risk of section and additional procedure, need for blood transfusion and ICU care and fetal morbidity in the form of preterm, low birth weight, low Apgar and need for NICU care makes it a must for care in a higher center and with available advanced resources [10][11][12][13] . The most frequent management in the form of section which is on the rise in today's era more so increases the risk of placenta praevia in the next RESEARCH ARTICLE

Aim and objective: To find the incidence of surgical site infections following cesarean section and to assess the associated risk factors and the common pathogens involved in these wound infections. Materials and methods:The study was conducted from November 2014 to June 2016. A total of 548 women were included. Data were collected from patients and medical records in a semi-structured proforma and wound site examined till discharge of the patients. After discharge, patients were followed by telephone on day 14 and 30. Results: The mean age of the women was 26.20 ± 4.385 years. The mean BMI was 25.965 ± 4.18 kg/m 2 . Forty women out of the total 548 developed surgical site infections with an incidence rate of SSI of 7.3%. Only three cases in them were deep SSI. Gram-negative organisms were the most isolated organisms in the infected cases with Escherichia coli being the most common organism. The key risk factors for infections found significant by multiple logistic regression analysis were obesity, severe anemia, prolonged rupture of membranes, multiple vaginal examinations, emergency basis, extended duration of surgery, and skin closure by mattress sutures with silk sutures. Conclusion:The infection rate is significantly associated with severe anemia and obesity, prolonged rupture of membranes, multiple vaginal examinations, emergency procedures, prolonged duration of surgery, and silk as a suture material for skin closure with mattress suture.

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Lymphedema of filarial origin affecting the vulva is extremely rare. It is a dilemma if seen in a pregnant woman as there are no guidelines regarding excision and the mode of delivery. With the World Health Organization‐driven global program to eradicate filaria, it is unfortunate to see such cases. We report of a woman who had massive lymphedema of both the labia majora following filarial infection with a small secondary ulcer. She presented to our outpatient department in early pregnancy. After detailed counseling with the couple, a decision was taken for excision. The same was carried out. The wound healed well but the lymphedema recurred after 6 weeks. She was thereafter managed symptomatically. Pregnancy advanced without any complication. Her intrapartum management for a successful vaginal delivery is outlined in the report.