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Introduction: Over the years, continuous efforts have been made for improving reproductive health status of women. In India, Ministry of Health and Family Welfare (MoHFW) has set Maternal Near Miss (MNM) review operational guidelines. Aim: Analysis of the incidence and causes of MNM cases in tertiary care hospital. Materials and Methods: This retrospective observational study was undertaken at a tertiary care hospital from January 2010 to September 2018. MNM cases were identified according to the criteria given by MoHFW, MNM review operational guidelines. Following parameters (variables) were noted viz., age, parity, obstetric haemorrhage, severe anaemia, sepsis, therapeutic interventions, etc., and analysed. Quantitative data was analysed by calculating means, ratios and proportions, using SPSS software (Version 21.0). Results: There were total 36,366 deliveries during the study period. A total of 315 Maternal Near Miss cases were noted. Hypertensive disorders n=133 (42.2%) in pregnancy was the leading cause of MNM events at the hospital. This was followed by obstetric haemorrhage n =97 (30.79 %), and severe anaemia constituting n=36 (11.42%), and Sepsis n=30 (9.52%). Mortality index was highest in the sepsis group n=5 (14.28%) followed by severe anaemia n=3 (7.69%). Conclusion: Hypertensive disorders were most common cause of near miss cases followed by obstetric haemorrhage. Sepsis was commonest cause of maternal mortality. Early identification of hypertensive disorders in pregnancy, obstetric haemorrhage, severe anaemia and sepsis; and prompt treatment of these causes may help in reducing near miss and maternal mortality.

Background: Due to technical advances in the field of laparoscopy, there has been an increase in total laparoscopic hysterectomies all over the world in last decade. This study was conducted to analyse the technique and surgical outcome of total laparoscopic hysterectomy in tertiary care hospital Methods: This is a retrospective cohort (observational) study, which included all patients who underwent Total Laparoscopic Hysterectomy (TLH) for benign conditions from January 2012 to December 2017 at the tertiary Care Hospital. The data so obtained was analysed for various parameters like indication for surgery, mean operating time, length of hospital stay, complications and conversion to abdominal route. Results: Total number of 2307 hysterectomies were performed over a period of 5 years. Of these, TLH were 270 (11.70%). Amongst those undergoing TLH, the mean age was 45±7.84 years. The most common indication for the surgery was fibroid uterus (38.14%), followed by dysfunctional uterine bleeding (28.88%), and adenomyosis (15.1%). The mean estimated blood loss was 106±4.34 ml. Hemorrhage (n = 2) and bladder injury (n = 4) were most common surgical complications. Conclusions: TLH is safe and effective procedure for most of the benign pelvic conditions. With adequate training TLH can be used more widely in tertiary care hospital and teaching institute.

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Background and objective:The technological advancement in endoscopic instruments has revolutionized the management of female infertility. Our objective was to compare the diagnostic and therapeutic efficacy of Hysterolaparoscopy over Hysterosalpingography in infertile patients and also to assess is there any needfor doing HSG ininfertility evaluation. Methods:100 infertile women who wereconfirmed to have normal ovulatory cycles, hormonal assays, and husband semen analysis were enrolled.HSG was performed as a basic test for the evaluation of tubes and the uterine cavity. All 100 women were also subjected to combine laparoscopic and hysteroscopy, and comparative evaluation done. Results:A total of 100 subjects were analyzed in this study. 81% of subjects had primary infertility and 19% had secondary infertility. 89%of patients had normal uterine cavity on HSG whereas 19 % patients had abnormal findings on Hysteroscopy. Hysteroscopy operative procedureswere done among 21% cases.In our study, 40 % patients had abnormal findings on laparoscopy, and corrective surgeries were performed in 23 % patients in the same setting. Laparoscopic operative procedures involved adhesiolysis in 7.0% of cases, PCOD ovarian drilling in 6.0% of patients, myomectomy in 2.0% of cases, Tubal reconstructive surgery in 2.0% of cases, ovarian cystectomy in2.0%of cases and ablation for endometriosis was done in eight (8.0%) cases. Conclusion: See and treat the infertility factors shall be the reality and future argument in modern Gynecology within the limitations of this study. We conclude that hysterolaparoscopy should be offered as the first- line gold standard modality for the evaluation of infertility wherever the procedure is available.