Background: Expressed breast milk is a healthy feeding option as compared to formula milk for working postnatal mothers. Objective of present work was to study the knowledge, attitude and practice regarding expressed breast milk feeding among working postnatal mothers and to identify and explore the barriers against it.Methods: A double blinded cross sectional study was conducted at a tertiary care centre in Hyderabad city, India. 100 working breastfeeding postnatal mothers with infants upto 1 year were identified. A validated questionnaire in English and Hindi was used for data collection. It constituted personal characteristics, knowledge regarding expressed breast milk feeding, attitude towards it and presently followed practices by working mothers.Results: A total of 100 working mothers with infants less than one year were selected who attended the postnatal clinics at our hospital, a tertiary care centre in Hyderabad city. Overall, the knowledge regarding expressed breast milk feeding was unsatisfactory in 64% of women. Only 36% of them had satisfactory knowledge. Positive attitude towards expressed breast milk feeding was seen in 60% of them and 40% of them had negative attitude. Expressed breast milk feeding was practised by 11% of them, formula milk by 53%, mixed feeding by 10% and cow milk by 26% as a substitute to breast feeding in their absence. Univariate analysis revealed no statistically significant determinant of their knowledge, attitude and practices.Conclusions: Knowledge about expressed breast milk feeding in Indian working breastfeeding mothers is suboptimal. Imparting adequate knowledge can improve feeding practices.

Introduction: Mullerian Anomalies are known to disturb the reproductive life of women immensely and adversely affect their obstetric outcomes too. Therefore, they get identified either during pubertal, early reproductive or antenatal period. Ultrasound diagnosis in pregnancy after first trimester is also very difficult Very few anomalies get diagnosed after a successful term pregnancy incidentally during delivery. Their actual incidence varies from 1-10% but little is known about incidence of unidentified cases in successful term pregnancies Aim: To determine the incidence of incidental finding of Mullerian Anomalies in successful term pregnancies Methods: Over 3 year study period at a tertiary care centre we observed all women who delivered both by vaginal route and cesarean section for any Mullerian Anomaly. Results: Of the total 5124 women who delivered at our institute at term gestation, 3 women were excluded, as they were known cases of Mullerian anomalies on regular follow up at our institute. 11 women were identified with Mullerian Anomalies incidentally during delivery at term.9 of them were referral cases. 5 cases of Arcuate Uterus, 2 cases of septate uterus, 2 cases of Unicornuate uterus, 1 case of bicornuate uterus and 1case of agenesis of fallopian tube were found. Conclusion: Mullerian Anomalies are seen occasionally incidentally in successful term pregnancies during delivery. They can be asymptomatic, silent and can have positive pregnancy outcomes. These incidences are crucial for counseling of patients and their families. Also, we must be on a look out for these diagnoses not only to identify co existing urological disturbances but also to help us improve their subsequent obstetric performances.

Longitudinal vaginal septum is a well-known anomaly of the female genital tract. It is usually diagnosed in early reproductive life due to symptoms like difficulty inserting tampons, dyspareunia and apereunia. Most other cases get diagnosed and treated during delivery. Those who surpass all these stages usually remain asymptomatic thereafter. We report a parous woman who approached us four years after her second delivery with a prolapsed longitudinal vaginal septum with a broad base into which cystocele and rectocele were invaginating but was not associated with uterocervical prolapse. Usually their correction is a simple surgery involving only excision of the septum. But our case demanded longitudinal splitting of the vaginal septum, performing anterior and posterior colpoperineorrhaphy followed by approximation of the normal vaginal mucosa. To the best of our knowledge no other case of isolated prolapsed longitudinal vaginal septum with such tailored surgical management has been reported.

INTRODUCTIONPregnancy is a delicate stage in a woman's life where her nutritional demands completely change. She has to keep up to the increased requirement of several nutrients. Of a special mention is iron which plays a pivotal role in maintaining the health of both mother and the fetus. The daily iron requirement for an antenatal woman is 4-6mg/day in second trimester and that in third trimester is 10-12mg/day. 1 This high requirement is difficult to meet ABSTRACT Background: A large number of antenatal women have difficulty consuming oral iron due to its well-known side effects. A simple alternative for it needs to be found. Aim and objective was to study the efficacy of parenteral iron prophylaxis as an alternative for antenatal women who are not able to consume oral iron. Methods: A prospective case control study was conducted at a tertiary care centre in Hyderabad city, India from March 2016-March 2017. 73 non-anemic antenatal women between 14-24 weeks who were not taking oral iron supplementation were identified. 39 of them were willing for parenteral iron supplementation were included in Cases group and 34 who were not taking iron supplementation in any form were controls. Cases were administered three doses of IV Iron sucrose 200mg in 100 ml normal saline between 24-28 weeks, 28 -32 weeks and 35-37 weeks Hemoglobin was checked again at 32weeks, 36 weeks, just prior to and on 3 rd day post-delivery. Data obtained was analyzed using SPSS software. Results: 67% of antenatal women discontinued oral iron due to its gastric side effects. No bias took place during selection of cases and controls. 7.69% of the 'cases group' developed anemia despite parenteral prophylaxis. All of them were diagnosed as mild anemia. 70.59% of the 'controls group' developed anemia eventually of which 8 were mild, 13 were moderate, 3 were severe and none were very severe. Mostly women became anemic after delivery. About 59% of antenatal women in cases group had no adverse effects with Iron Sucrose Injections, 8 of them had itching or rash and 9 of them complained of brownish discoloration of urine.11 of them had pain at the infusion site and only 1 of them had fever on administering parenteral therapy. None of these were severe enough to cause discontinuation of parenteral iron administration. No statistically significant difference could be found in maternal and perinatal morbidity and mortality between the two groups. The mean cost of parenteral iron prophylaxis was Rs. 1650. Conclusions: Women who do not take oral Iron supplementation in pregnancy are more prone to develop anemia subsequently. The commonest cause of non-compliance to oral iron is gastric intolerance. 3 doses of Intravenous Iron Sucrose 200mg prevents anemia in antenatal women who do not take oral iron supplementation. Hence, it can now be considered a convenient option for them.

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