Aims and objectives:To classify the cesarean section (CS) in different groups of Robson's ten-group classification system (TGCS) and comparing the rate and relative size of groups with that of previous year at the tertiary hospital. . The data collected included parity, mode of previous delivery, gestational age, onset of labor-spontaneous or induced, delivery notes of labor ward, and operative notes of CS. This data was then applied to the Robson's TGCS for the year 2014 and compared with that of 2013. Results:The total deliveries during 2014 were 12,930 and in 2013 were 15,182. The number of CSs during 2014 was 3,793 and in 2013 it was 3,917. Cesarean section rate in 2014 was 29.33% while in 2013 it was 25.8%.The CS rate has come down to half in group I (nulliparous, single, cephalic ≥ 37 weeks, in spontaneous labor) and to onefourth in group III [multiparous (excluding previous CS) single, cephalic ≥ 37 weeks, in spontaneous labor] in 2014. Conclusion:Robson's TGCS is easy to classify. Clinical significance:The study showed reduction in CS rate by half in group I and by one-third in group III in 2014 in our institution. This was probably due to the increased awareness among the staff of the institute by the previous year study about higher CS rate.

Background: Episiotomy is the surgical enlargement of the vaginal orifice by an incision on the perineum during the last part of the second stage of labour or delivery. Episiotomy, incision of the perineum at the time of vaginal childbirth, is a common surgical procedure experienced by women. This study is done to compare use of restrictive episiotomy and routine episiotomy in primigravidae undergoing vaginal birth.Methods: This is a prospective cohort study designed to analyse the outcome of the restrictive use of episiotomy in comparison to routine use of episiotomy. Total 100 primigravidae women reporting to labour room in spontaneous labour/induction of labour were included and two cohorts were formed. Both the cohorts were evaluated during labour, immediate postpartum period and first postnatal day and data was tabulated and analysed.Results: Vaginal and paraurethral tears were noted in 14% primigravidae in the routine episiotomy group and 22.22% in the restrictive episiotomy group with no statistically significant association. Number of cases sustaining perineal tear in restrictive group was 15.55% and extension of episiotomy in the routine group was 26% with no statistically significant association. Requirement of suturing was far less in restrictive group (20%) as compared to routine group (100%), as 64.45% of the patients in restrictive group delivered with an intact perineum. The restrictive use of episiotomy does not prolong the second stage of labour and has requirement of significantly less pain relief compared to the routine group. Complication rate was higher in the routine group and perineal laceration and pain severity, was less in restrictive episiotomy group. However, neonatal complications were similar in the two groups.Conclusions: This study identified fair to good evidence suggesting that immediate outcomes following routine use of episiotomy are no better than those of restrictive use. Indeed, routine use is harmful to the degree that some proportion of women who would have had lesser injury instead had a surgical incision.

Background: With the advent of electronic foetal monitoring, a relationship between foetal movement and foetal heart rate was observed and that relationship formed the basis for non-stress test (NST). Doppler USG plays an important role in foetal growth restriction (FGR) pregnancies where hemodynamic rearrangements occur in response to foetal hypoxemia. It is now proved that significant Doppler changes occur with reduction in foetal growth at a time when other foetal well-being tests are still normal. This study was done to find out the comparative usefulness of Doppler and NST in the management of FGR and severe preeclampsia and subsequent correlation with perinatal outcome. Methods: This prospective study was conducted on pregnant women with severe preeclamsia and/or FGR beyond 30 weeks of gestation at AHRR Delhi. 50 pregnancies complicated with severe preeclampsia and/or FGR beyond 30 weeks of gestation were selected. Patients meeting the inclusion criteria were subjected to NST. Umbilical arterial Doppler flow was obtained at weekly or twice weekly interval depending on the severity by pulsed wave color doppler indices were measured during foetal apnea by the same examiner at the free loop site where the clearest waveform signal could be visualized. Of 3 measurements, the mean average of S/D ratio was recorded and followed up with serial Doppler assessment and non-stress test. Data was collected and statistical analysis was carried out. Results: The Doppler showed changes earlier than NST giving a significant lead time of up to 20 days with an average of 4.94 days. The UA S/D had the highest sensitivity (88%) and diagnostic accuracy (94%) in predicting the adverse perinatal outcome. The sensitivity and specificity of Doppler as compared to NST was 82.6% and 63.0% respectively with a diagnostic accuracy of 72%. The Doppler has negative predictive value of 80.95% and positive predictive value of 65.5%. Color Doppler has diagnostic accuracy of 72%. The mortality rate in reversal of diastolic flow was 77.77% and in absent UA flow was 16.66%. 12% foetuses were found to have AEDV in UA and among them 66.66% had both FGR+PE as maternal complication. There was 83.33% rate of LSCS, 16.66% neonatal mortality rate, 83.33% NICU stay rate and 66.66% complication rate in neonates. Whereas 18% had REDV and among that 88.88% had both FGR+PE as maternal complication, a similar rate of LSCS, 77.77% rate of neonatal mortality, 100 % NICU stay and 66.66% complication rate in the neonates. Conclusions: Combined foetal testing modalities such as Doppler, NST and biophysical profile provide a wealth of information regarding foetal health. Integrated foetal testing would be ideal for individualized care of the preterm compromised foetuses for timed intervention.

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Background: Generalised Peritonitis is a common surgical emergency and its treatment remains a challenge despite advances in surgical techniques, antimicrobial therapy and intensive care support. The commonest etiological factors are perforation of hollow viscus and appendicitis. The aim was to study the most common cause of perforation peritonitis, associated risk factors, modes of clinical presentation, management, postoperative complications, and comorbid conditions influencing the morbidity and mortality in rural set up.Methods: 50 patients of peritonitis of over 10 years of age managed in our institution from July 2015 to November 2016 were studied and followed up on a three-monthly basis for a period varying from 12 months to 2 years with an average of 18 months.Results: Appendicular perforation was the most common cause of peritonitis followed by peptic ulcer perforation. Perforation peritonitis constituted 26% of total emergency operations performed with a male to female ratio of 2.84:1 and age between 41-50 years. Patients presenting within 24 hours of perforation had an uneventful recovery whereas those presenting after 24 hours had significant postoperative complications. The serum CRP levels provided as good prognostic marker. It remained high in complicated cases. Out of 56% complication rate, wound infection was the commonest.Conclusions: Early diagnosis and surgical intervention plays a crucial role in early recovery, though the end result depends on many factors like age of the patient, degree of peritoneal contamination and presence of comorbid diseases. This study also highlights the role of CRP as a serum prognostic marker.

Background: Gestational diabetes mellitus(GDM) is defined as carbohydrate intolerance of variable severity with onset or first recognition during pregnancy. This study aims at determining the efficacy of the glibenclamide versus insulin in achieving the adequate glycemic control and to analyze the maternal and fetal outcomes and to determine the failure rate of glibenclamide, patient compliance and overall cost of the treatmentMethods: This study was carried out for a period of 22 months at Command Hospital Air Force, Bangalore in Dept. of OBG. Women with GDM whose glycemic control was not achieved with medical nutrition therapy with fasting blood sugar (FBS) values >105mg/dl and 2hour post prandial blood sugar (PP) value >140mg/dl were selected and randomized for treatment either glibenclamide or insulin (50 in each group).Results: The age of the patients in this study ranged from 23 to 33 years. The mean age in glibenclamide group was 27.32 (SD ± 2.84) where as in insulin group was 26.30 (SD ± 3.01). The mean plasma glucose level achieved with glibenclamide was fasting -87.62 mg/dl, post prandial -116.44 mg/dl, before lunch - 95.62mg/dl, after lunch -115.80 mg/dl, before dinner-91.96 mg/dl, after dinner - 116.64 mg/dl, 3AM - 84.42 mg/dl and next day fasting - 86.30mg/dl in comparison with insulin where fasting- 85.54 mg/dl , post prandial -114.14 mg/dl, before lunch - 87.08, after lunch -112.82 mg/dl, before dinner-86.76 mg/dl and after dinner - 114.18 mg/dl, 3AM - 81.16 mg/dl and next day fasting was 86.72mg/dl which is statistically significant. The incidence of maternal and neonatal morbidities was comparable in both the group. 4 % percent of patient treated with glibenclamide had treatment failure. The cost of the treatment and compliance was better with glibenclamide.Conclusions: It has been concluded that glibenclamide is effective as insulin in achieving adequate glycemic control with no significant maternal and fetal morbidity and mortality.

Background: The importance of fetal monitoring during labour has been realized since long. The stress of uterine contractions may affect the fetus adversely especially if the fetus is already compromised, when the placental reserves are suboptimal, or when cord undergoes compression as in those associated with diminished liquor amnii or iatrogenic uterine hyperstimulation due to injudicious use of oxytocin. Even a fetus which is apparently normal in the antenatal period may develop distress during labour. Hence fetal monitoring during antepartum and intrapartum periods is of vital importance for timely detection of fetal distress so that appropriate management may be offered. Methods: This study was a prospective observational study included 100 patients of more than 34 weeks period of gestation were divided into two groups. Patients in labour were analyzed on an Electronic Monitor. Delivery conducted was either by vaginal route, instrumental or by caesarean section depending upon the fetal heart rate tracings and their interpretations as per the case. At the time of delivery umbilical cord blood was taken for the pH analysis. All new born babies were seen by the paediatrician immediately after the delivery and 1 and 5 minute APGAR score assessed for the delivered baby. The various EFM Patterns obtained were compared with the neonatal status at birth using the parameters already mentioned. The false positives and false negatives if any were tabulated. Data so obtained was analyzed statistically thereafter. Statistical Package for Social Sciences (SPSS) Version 13.0 was used for the purpose of analysis. Results: Results revealed that among the 50 subjects of the case group, 7 subjects showed the absence of the beat to beat variability, 12 subjects showed early deceleration, 32 subjects showed late deceleration, and 6 subjects showed the presence of variable deceleration. No significant association of beat to beat variability, early and variable deceleration could be established with meconium staining/NICU admissions/low APGAR. A significant positive association between persistent late deceleration with MSL, APGAR <7 at 1 min, and Instrumental/LSCS delivery was seen. A significant positive association between any CTG abnormality and APGAR at 1 min, type of delivery, and meconium staining was seen. Conclusions: EFM should be used judiciously. Cardiotocography machines are certainly required in the labour room. Equally important is the proper interpretation of the CTG tracings so that unjustified caesarean sections can be minimized, at the same time picking up cases of fetal distress in time which is likely to improve fetal outcome.

Background: The management of cT3 laryngeal cancers remains controversial, with studies recommending surgical or non-surgical approaches. Despite the many papers that have been published on the subject, there is a lack of studies showing which treatment has better results in terms of survival. Objective: To determine the difference in survival outcomes following total laryngectomy (TL), concurrent chemoradiation (CRT) or radiation therapy (RT) alone in T3 laryngeal cancers. Methods: Search of PubMed, Scopus, and Google Scholar databases from 1995 to 2023 employing specific keywords and Boolean operators to retrieve relevant articles. Statistical analysis was conducted using a random-effects model, and heterogeneity was evaluated using the Q-test and I2 statistic. Funnel plot asymmetry was assessed using rank correlation and regression tests. Results: The qualitative data synthesis comprised 10,940 patients from 16 included studies. TL was performed in 2149 (19.4%), CRT in 6723 (61.5%), RT in 295 (2.7%), while non-surgical treatment was not specified in 1773 (16.2%) patients. The pooled 2-year overall survival (OS) rates were TL = 73%, CRT = 74.7%, RT = 57.9%, 3-year OS rates were TL = 64.3%, CRT = 62.9%, RT = 52.4%, and 5-year OS rates were TL = 54.2%, CRT = 52.7%, RT = 40.8%. There was a significant heterogeneity in the included studies. There was no statistically significant difference in 2-year OS (logOR= −0.88 (95% confidence interval (CI): −1.99 to 0.23), p = 0.12), 3-year OS (logOR = −0.6 (95% CI: −1.34 to 0.15), p = 0.11), and 5-year OS (logOR = −0.54 (95% CI: −1.29 to 0.21), p = 0.16) between TL and CRT. Instead, there was significant difference in 2-year OS (logOR= −1.2383 (95% CI: −2.1679 to −0.3087), p = 0.009), 3-year OS (−1.1262 (95% CI: −1.6166 to −0.6358), p < 0.001), and 5-year OS (−0.99 (95% CI: −1.44 to −0.53)), p < 0.001) between TL and RT alone. Conclusions and Significance: TL followed with adjuvant (chemo)radiation on indication and CRT with salvage surgery in reserve appear to have similar OS outcomes. Both resulted in better OS outcomes compared to RT alone in the treatment of T3 laryngeal cancers. If patients are unfit for chemotherapy, making CRT impossible, surgery may become the choice of treatment.