General anaesthesia for obstetric surgery has distinct characteristics that may contribute towards a higher risk of accidental awareness during general anaesthesia. The primary aim of this study was to investigate the incidence, experience and psychological implications of unintended conscious awareness during general anaesthesia in obstetric patients. From May 2017 to August 2018, 3115 consenting patients receiving general anaesthesia for obstetric surgery in 72 hospitals in England were recruited to the study. Patients received three repetitions of standardised questioning over 30 days, with responses indicating memories during general anaesthesia that were verified using interviews and record interrogation. A total of 12 patients had certain/ probable or possible awareness, an incidence of 1 in 256 (95%CI 149-500) for all obstetric surgery. The incidence was 1 in 212 (95%CI 122-417) for caesarean section surgery. Distressing experiences were reported by seven (58.3%) patients, paralysis by five (41.7%) and paralysis with pain by two (16.7%). Accidental awareness occurred during induction and emergence in nine (75%) of the patients who reported awareness. Factors associated with accidental awareness during general anaesthesia were: high BMI (25-30 kg.m -2 ); low BMI (<18.5 kg.m -2 ); out-of-hours surgery; and use of ketamine or thiopental for induction. Standardised psychological impact scores at 30 days were significantly higher in awareness patients (median (IQR [range]) 15 (2.7-52.0 [2-56]) than in patients without awareness 3 (1-9 [0-64]), p = 0.010. Four patients had a provisional diagnosis of post-traumatic stress disorder. We conclude that direct postoperative questioning reveals high rates of accidental awareness during general anaesthesia for obstetric surgery, which has implications for anaesthetic practice, consent and follow-up.

Introduction: Ruptured ectopic pregnancy is a life threatening obstetrical emergency and presents in various ways. The aim was to evaluate predisposing factors associated with development of ectopic pregnancy in current scenario and evaluation done for association between ectopic pregnancy and constellation of signs/ symptoms.

Background: Caesarean section (CS) is a surgical intervention for safe delivery other than natural vaginal route. World Health Organization (WHO) has recommended ten group classification systems of Robson criteria which we have used to analyse CS at our center. The objective of the study to analyse the lower section caesarian section (LSCS) data under Robson criteria for implementation in regular practice in tertiary care center and to understand the need of it for future practice.Methods: A prospective analysis done for deliveries in Obstetric Department of Shalby Multispecialty Hospital of central India by Robson ten group classification criteria. The study was carried out for the period of two year from April 2016 to April 2018 including antenatal women attending labour room with high risks or referred cases from other centers.Results: The study reflected overall 196 live birth of high risk cases which were having other co morbidities like pre-eclampsia, eclampsia, hypothyroidism, diabetes, acute viral hepatitis. The data compared with Robsons guidelines and reflected that the centre is dealing with high risk primigravida (47.51%, 35-42% Robson criteria) cases with high CS rate (16.8%, group 5). There was multiple pregnancy, group 8, (2.32 %, >1.5-2% Robson Criteria) and preterm births as in group 10, 18.02 % (5% in Robson Criteria), exclusively high.Conclusions: The Robson criteria help to classify the population handled by the canter to develop the strategies for betterment of services. It has limitation in view of qualitative assessment of the data for comorbidities and severity of the disease.

Background: Hepatitis E has poor prognosis in pregnancy and leads to 20-30% mortality in term cases. The Aim of the study was to observe the trend of maternal and perinatal outcome in acute viral hepatitis E.Methods: A prospective study conducted in two high risk obstetric center of Jabalpur district in January 2015 to December 2017. The inclusion criteria were all antenatal women diagnosed with acute viral Hepatitis E entering to the Intensive care unit of any gestational age who later delivered in the same center. Other than acute hepatitis E all acute hepatitis cases and women missed in follow up in delivery were excluded from the study. The data collected on demographic, clinical and biochemical variables in excel sheet and descriptive analysis done by SPSS system.Results: There were 72 antenatal women enrolled with mentioned criteria in study duration. Out of these only 67 were in follow up and alive till their delivery in the same set ups. Out of these 70.14% were Primigravida of median age 27 year. The mean gestational age at detection of hepatitis E was 30.3week. The maternal mortality observed was 17.9% (12/67) in the total study population. The high grade of mortality was significantly associated with high grade of disease. There were 19.4% (13/67) perinatal (mortality seen which included intrauterine (14.9%) and neonatal (4.4%).Conclusions: The severity of Hepatitis and high grade of hepatic encephalopathy following poor primary care in the beginning of disease results in poor perinatal and maternal outcome.