Background: The Robson system is the most widely accepted classification system available for analysing characteristics of delivering women worldwide. Several authors have tried modifications in the existing system. The objective of this study was to modify the existing system with relevance to caesarean section rates in various obstetric population and to identify major factors contributing to it.Methods: This study was performed in Government Medical College, Thrissur from January 2017 to June 2017. All women delivered during this period were classified according to the modified system consisting of 8 groups using their maternal characteristics and obstetric history. Each major group were sub classified into 3: women who went into spontaneous labour/ induced labour/ CS done before labour. For each group, we calculated the contribution to overall CS and Primary CS separately. Women with Previous CS were analyzed as a separate group. This classification was intended to directly estimate primary as well as repeat CS rates and indirectly the VBAC rates. Results: Out of total 1337 women delivered, 413 underwent CS (30.8%). The contribution made by previous CS group to overall CS was 61.5%, and the repeat section rate was 91.3%. The primary CS rate was 15% and the maximum contribution was made by term induced primigravida followed by Primigravida with Breech presentation. VBAC rate was 8.6%.Conclusions: Our modified Robson system can be effectively utilized in analysing delivering women and provide valuable information regarding the delivery characteristics with particular relevance to Caesarean sections.

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Background: Early detection of cervical cancer is possible with Pap smear tests. The proportion of women who undergo Pap smear testing ranges from 68% to 84% in developed countries as compared to India where the rates range from 2.6% to 6.9% among women in communities. This study is to assess the knowledge of women about cervical cancer, its screening, role of doctor and source of information.Methods: Cross-sectional study – observational study of Women attending gynecology camps/op clinics held in rural areas of Ernakulam and Thrissur who are between 25 and 65 years of age Non-random sampling with Sequential inclusion of the women who met the study criteria. A questionnaire devised collecting Basic sociodemographic profile like age, parity, educational qualification, Questions to assess knowledge about symptoms of cervical cancer Questions to assess the knowledge about cervical cancer screening and prevention doctor as Source of knowledge from the subjects. Correct response for questions carried score of 1 mark. So, the maximum was 6 and minimum was 0. The knowledge was graded as: <2 being poor knowledge; 2-5 being satisfactory knowledge and ≥5 being good knowledge.Results: 32.9% of women identified discharge per vaginum as the most common symptom. When 50.9% thought multiparity was a risk factor 30% identified early sexual activity. 2.3% women knew that pas smear screening has to be done repeatedly. 8.3% of participants already had screening done. Only 8.3%of doctors advised pap screening during their consultations. Uptake of pap smear after awareness program was 100%.Conclusions: Awareness classes are needed for increasing the coverage for pap smear screening. The women should be educated about cervical cancer, its screening methods and the facilities available for screening in the hospitals. An Information Leaflet has to be provided to these women in the local language. Training programs should be conducted for general practitioners and gynecologists to conduct awareness classes for the public and also to motivate women to undergo screening at every possible opportunity.

INTRODUCTIONStress urinary incontinence is a symptom or sign indicating that the woman has involuntary loss of urine associated with exertion in the absence of detrusor contraction. It has a significant impact on quality of life. It's prevalence varies from 4% to 35% depending upon the variation in population studied. 1 The treatment options include initial conservative therapies (i.e., lifestyle interventions, pelvic floor muscle training, and bladder training), followed by surgery, which is an option for women whose quality of life is still impaired after a diagnosis of genuine stress incontinence. In transobturator tape (TOT) procedure, a small incision is placed in the groins and in the vagina under the urethra. The mesh is placed under the urethra in the correct position without having to pass needles blindly through the retropubic space, as in transvaginal tape (TVT). The ABSTRACT Background: Stress urinary incontinence is a symptom or sign indicating that the woman has involuntary loss of urine associated with exertion in the absence of detrusor contraction. It has a significant impact on quality of life. TOT insertion is a popular procedure being done now. Studies related to quality of life assessment following Trans obturator tape (TOT) insertion is sparingly reported. Objectives of present study were to evaluate the quality of life following TOT insertion in patients with stress urinary incontinence and to assess the post operative complications. Methods: This is a prospective study done in the Department of Obstetrics and Gynecology, Government Medical College, Thrissur from January 2015 to December 2016. 48 women with Stress urinary incontinence who underwent TOT insertion were included in the study, out of which 30 patients were followed up. The King's Health Questionnaire was used for assessment. Data was analyzed using Epi Info 7 and Microsoft Excel. The statistical analysis was done using student t-test. Results: At 6 months follow up 86.66% (26) of patients had significant improvement in quality of life. 2 patients (6.66%) had postoperative voiding dysfunction, required recatheterisation, discharged after relief of symptoms. 2 patients (6.66%) had urge incontinence, advised medical management and was sent home, showed no improvement even after 6 months. 2 patients (6.66%) had continuous incontinence, fistula ruled out. Now they were lost to our follow up. Most common late post operative complication was groin pain. None had mesh erosion, bladder and bowel injuries. Conclusions: TOT is a safe and effective procedure for the treatment of stress urinary incontinence (SUI) which significantly improves the quality of life.

Background: With no systematic national screening programme, the rates of cervical epithelial cell abnormalities as reported by various studies range from 1.32% to 25% in India. Majority are epithelial squamous cell abnormalities that include atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesion (LSIL). Worldwide incidence of adenocarcinoma and its precursors have increased over past few decades. Objectives were to study the clinical and cervical cytological profile among women attending camps in rural areas of Thrissur district of Kerala.Methods: A cross sectional study was conducted in 214 women in the 25-65 years age group who attended cancer screening camps in rural areas of Thrissur district. Papanicolaou (Pap) smear was done using standard technique and reported using latest Bethesda classification. Pap smear results were considered as abnormal when the report was ASCUS, atypical glandular cells of undetermined significance, LSIL, high grade squamous intraepithelial lesion or invasive lesion.Results: Of all the smears, 41.6% were negative for intraepithelial lesion or malignancy. Inflammatory smears (nonspecific and specific infection associated) were seen in 57%. Glandular cell abnormality was found in 1.4% and these women were in 31-50 years age group. Among patients with glandular cell abnormality most common symptom was discharge per vaginum.Conclusions: The results of this study may be a pointer to an increase in glandular cytological abnormalities in our population and needs further large-scale studies to confirm. Current screening methods of Pap smear alone may not be adequate to pick up these lesions.