Summary At the onset of the global pandemic of COVID‐19 (SARS‐CoV‐2), guidelines recommended using regional anaesthesia for caesarean section in preference to general anaesthesia. National figures from the UK suggest that 8.75% of over 170,000 caesarean sections are performed under general anaesthetic. We explored whether general anaesthesia rates for caesarean section changed during the peak of the pandemic across six maternity units in the north‐west of England. We analysed anaesthetic information for 2480 caesarean sections across six maternity units from 1 April to 1 July 2020 (during the pandemic) and compared this information with data from 2555 caesarean sections performed at the same hospitals over a similar period in 2019. Primary outcome was change in general anaesthesia rate for caesarean section. Secondary outcomes included overall caesarean section rates, obstetric indications for caesarean section and regional to general anaesthesia conversion rates. A significant reduction (7.7 to 3.7%, p < 0.0001) in general anaesthetic rates, risk ratio (95%CI) 0.50 (0.39–0.93), was noted across hospitals during the pandemic. Regional to general anaesthesia conversion rates reduced (1.7 to 0.8%, p = 0.012), risk ratio (95%CI) 0.50 (0.29–0.86). Obstetric indications for caesarean sections did not change (p = 0.17) while the overall caesarean section rate increased (28.3 to 29.7%), risk ratio (95%CI) 1.02 (1.00–1.04), p = 0.052. Our analysis shows that general anaesthesia rates for caesarean section declined during the peak of the pandemic. Anaesthetic decision‐making, recommendations from anaesthetic guidelines and presence of an on‐site anaesthetic consultant in the delivery suite seem to be the key factors that influenced this decline.

The association of gonadal dysgenesis and Mayer-Rokitansky-Kuster-Hauser syndrome is very rare. We report a 21-year-old phenotypical female who presented with primary amenorrhea and underdeveloped secondary sexual characteristics. Hormonal evaluation revealed hypergonadotropic hypogonadism. Her karyotype was 46XX. Laparoscopy of pelvis revealed absent uterus, normal fallopian tubes and bilateral streak ovaries, which were biopsied and histopathology was consistent with the findings of gonadal dysgenesis. We searched PubMed for similar reports in the literature and details of all the cases were analyzed and reported here.

Cesarean section is the most common surgery performed with over 30% of deliveries occurring via this route. This number is likely to increase given decreasing rates of vaginal birth after cesarean section (VBAC) and primary cesarean delivery on maternal request, which carries the inherent risk for intraoperative complications. Previous C-section delivery was a major indication for a repeat C-section delivery. The present study aims knowing the intra-operative difficulties encountered by an obstetrician, in this highly evolved surgical procedure called C-section especially in a repeat C-section. It was a Prospective observational study conducted on 60 cases of repeat cesarean section in c/o previous one cesarean section. Difficulties encountered while operating on cases of previous one cesarean section were noted. The intraoperative complications were compared with respect to adhesions (peritoneal, bladder, bowel, omental etc), blood loss, extension of tears over uterus, bladder injury, scar dehiscence, uterine rupture, need for hysterectomy. In present study, following intraoperative morbidities were encountered- adhesions 38.33%, advanced bladder 20%, excess blood loss 10%, placenta accrete was found in 1.67%,thinned out scar seen in 5% . Bladder injury seen in 1.67% patients. No cases of uterine rupture & bowel injury were noted. None of the patient needs caesarean hysterectomy. In modern obstetric practice, objective is safe motherhood and healthy baby by proper management. From present study, it can be concluded that repeat caesarean sections in c/o previous one cesarean section are associated with increased complications which lead to increased maternal morbidity Keywords:  Primary Cesarean section , Repeat Cesarean section ,  Caesarean Section Difficulties.

Background: Postdated pregnancy is gestation longer than 40 weeks or 280 day. Prolonged pregnancy is defined as any pregnancy that last 294 days or more. Reported frequency of post term pregnancy range from 3 - 1 4 percent with an average of about 10 percent. Several studies have concluded that these pregnancies are accompanied by a rise in perinatal morbidity and mortality. The presumed etiology for this rise is placental insufficiency. Abnormalities such as congenital anomalies, oligohydramnios, meconium aspiration, fetal asphyxia, fetal dysmaturity, macrosomia and shoulder dystocia are commonly observed in these pregnancies Materials and Methods: This study was conducted in the Department of Obstetrics and Gynecology, after approval from the Ethics Committee, from January 2019 to September2020 on 150 patients in the department of Obstetrics and Gynaecology, willing to participate and fulfilling the inclusion and excliusion criteria in the study period. Results: Of the total 150 women, 122 (81.34%) were in 40 weeks group; 28 (18.66%) in 41 weeks group and 0 (0%) were in > 42 weeks group. Most women (89.3%) were between 20-35 years of age. Among 150 women, 40 (26.6%) went into spontaneous labor, 87(8.0%) were induced andn23 (15.34%) was taken for caesarian section. Misoprostol, Dinoprostone gel and oxytocin were the different modes of induction (Table 7). Misoprostol was used in the majority of inductions followed by Dinoprostone gel. The success rate between these two is almost similar (92.45% & 95.1%).Lscs rate was 15.33%.Most of the newborn had weight between 2.5-3.5kg in 68.25% of women in gestational age >40 weeks. Conclusions: The present study, we conclude that postdated pregnancy can be considered as a high risk factor from the point of fetal outcome as there is more fetal morbidity. Keywords: High risk pregnancies, maternal mortality, Outcomes, Perinatal mortality, postdated pregnancy.

Background: Mother is the pillar of the family and maternal deaths during pregnancy and delivery are great loss to baby, family, society and country too. Objective: This study was design to evaluate the mortality rate in our hospital, to assess the epidemiological aspects and cause of maternal mortality, types of delay and to suggest recommendations for improvement. Method: was obtained from Sir T hospital record in form of maternal death review form which was filled by Gynec department after every maternal mortality in Sir T Hospital. From Year 2011 to 2020, data were collected and reviewed and exclude those deliveries in which accidental, incidental and non-obstetrics causes were found. Result and conclusion: On basis of this study thus we know the common cause of maternal mortality and with what it may associated, so we can overcome it and reduced the mortality. Keyword: Maternal mortality, Anaemia, Postpartum haemorrhage, Eclampsia.

Background: Many countries have seen a two-wave pattern in reported cases of coronavirus disease-19 during the 2020 pandemic.  Empirical data show that the characteristics of the effects of the virus do vary between the two periods. Differences in age range and severity of the disease have been reported, although the comparative characteristics of the two waves still remain largely unknown. This study helps in the comparison between the characteristics and severity between first and second wave. Methods: This study is prospective and comparative study based on compiled clinical and outcome data for pregnant women infected with COVID-19 between April 2020 to October 2020 and March 2021 to July 2021  at our tertiary level hospital. A laboratory confirmed case of COVID-19 is defined as a positive result by quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) assay of maternal pharyngeal and nasopharyngeal swab specimen. Results: In our hospital, a total of 89 pregnant women were admitted in our tertiary hospital, out of which 53 of the patients were antenatal women of which 15 of the women died, 32 patients were admitted during third trimester and labour and 4 patients were delivered outside and referred here. This study, the most common age group affected was only between 20-30 years same as that of the first wave, preterm deliveries was found to be higher. The second wave had higher incidence and severity of cough (40%), fever (43%), diarrhea (28.12%) and dyspnea (38%).It also suggests that the caesarian rates(62%) were found to be higher in covid 19 patients and maternal mortality rate(25%) was also found to be higher thereby indicating the need for vaccination to reduce the severity and mortality in the upcoming waves. Conclusion: The result of the present study suggests that the second wave among the pregnant women was found to be more severe when compared to the first wave because of the new variants. Because of this we as obstetricians and health care workers has to insist upon the vaccination during pregnancy thereby preventing the severity of the disease and reducing the maternal mortality. Key words: covid 19, fetomaternal outcome, maternal mortality.

Background: This paper presents the findings of a qualitative assessment aimed at exploring knowledge, attitudes and practices regarding family planning and factors that influence the need for and use of modern contraceptives. Educational interventions can help increase knowledge of available contraceptive methods, enabling individuals to make informed decisions and use contraception more effectively .This systematic review evaluated contraceptive education interventions to guide national recommendations on quality family planning services. Material and method: This descriptive study using Cross-sectional survey was carried among reproductive age group women of 15-45 year in sir t hospital bhavnagar. Results: This study shows most common contraceptive method used by patients is cupper –t (33.33%) followed by oc pills (19.16%), barrier method (15.83%), behavioral method (14.16%), and sterilization method (13.33) Least method used by patients is injectable DMPA (4.16%)

In India about 6.7 million abortions takes place every year of which 4 million are induced and 2 millions are spontaneous. WHO estimates that unsafe abortion kills about 70,000 women annually, many more suffer serious injuries and permanent disability. In spite of legalization of medical termination of pregnancy in India, the incidence of illegal abortion is at time more common than legal abortion. Unsafe abortion is major cause of mortality among women in India accounting for 12% of all maternal death. One way of reducing mortality and morbidity associated with unsafe abortion is early decision by women for termination of pregnancy by use of combination of mifepristone and misoprostol for termination of pregnancy up to 9 weeks. So the present study aims to study the efficacy of mifepristone and misoprostol  for medical termination of pregnancy up to 9 weeks of pregnancy. This is a prospective randomized study undertaken in 100 patients seeking MTP, in the reproductive age group with a history of less than or equal to 9 weeks gestation, attending Obstretic and Gynace OPD of Sir Takhsinhji Hospital attached to Govt. Medical College, Bhavnagar from March 2018 to August 2019. They were administered 200 mg of mifepristone followed by oral misoprostol 400 ug after 48 hours and another 400ug misoprostol after 24 hours. Results show Overall success rate of 92% abortion failure rate of 8% were achieved. This treatment regimen was more effective in earlier gestational age group. Keywords: Abortion, MTP, Mifepristone ,  Misoprostol