INTRODUCTIONWith the sky rocketing caesarean section rates an increasing number of women face the issue of mode of delivery in their current pregnancy. The Caesarean section epidemic is a reason for immediate concern and deserves serious international attention. 1 The main concern in cases of pregnancy with scarred uterus is that it might end up in rupture, leading to severe maternal and perinatal morbidity and mortality. The presence of a CS scar affects the site of implantation and the distance between implantation site and the scar is related to the risk of spontaneous abortion, scar dehiscence and morbid adherent placenta. Apart from scar related complications there are other morbidities related to post caesarean deliveries like scar pregnancy, traumatic postpartum hemorrhage, dense abdominal adhesions, rectus sheath hematoma, UTI, cervical tear, adherent bladder and thinned lower uterine segment. In the management of patient with previous caesarean section, regular and intensive antenatal surveillance is required. Proper ABSTRACT Background: The Caesarean section epidemic is a reason for immediate concern and deserves serious international attention. The purpose of this study was to evaluate adverse maternal and fetal complications associated with pregnancies with history of previous caesarean section. Methods: A cross-sectional, observational study carried out over a period of 1 year from 1 st June 2016 to 31 st July 2017 in Medical College Kolkata. 200 antenatal patients with previous history of 1 or more caesarean sections were included. In all cases thorough history, complete physical and obstetrical examination, routine and case specific investigations were carried out and patients were followed till delivery and for 7 days thereafter. All adverse maternal and fetal complications were noted. Results: Out of 200 women, 30 candidates were tried for VBAC, of them 20 (66.66%) had successful outcome. Most common antenatal complication was APH (5.5%) due to placenta praevia followed by scar dehiscence. There were 12 cases (6.66%) of PPH and 6 cases (3.33%) of scar dehiscence in the study group. 3 cases required urgent hysterectomy due to placenta accreta. 42 out of 196 babies required management in SNCU immediately or later after birth. Conclusions: Women with a prior cesarean are at increased risk for repeat cesarean section. Vigilance with respect to indication at primary cesarean delivery, proper counselling for trial of labor and proper antepartum and intrapartum monitoring of patients are key to reducing the cesarean section rates and maternal complications.

Background: Thalassemia syndromes are autosomal recessive disorders and the most commonly inherited haemoglobinopathies in the world. HbE β is the most common type of thalassemia in eastern India. The objectives of the study include maternal outcome and complications like anemia, hypertensive disorders, gestational diabetes mellitus and also to study the neonatal outcome in terms of low birth weight, prematurity and other complications.Methods: A prospective longitudinal study carried out over a period of one year from July 2016 to June 2017 in Medical College, Kolkata. Fifty antenatal thalassemic mothers over 20 weeks of gestation during study period were enrolled in after institutional ethical clearance and consent from study subjects. All necessary investigations (complete haemogram, reticulocyte counts, Ultrasounds etc.) were done followed by statistical analysis.Results: Out of total 50 diagnosed thalassemic patients, maximum were HbE Beta Thal i.e. 54.0%. The mean level of iron in these women varied from 95.70±17.16µg/dl to 99.46±18.19µg/dl at the time of delivery and ferritin varied from 185.40±49.26µg/L vs 194.13±48.80µg/L. The mean blood transfusion done was 6.84 Units. Incidence of maternal complications were variable, PIH was found to be 26% whereas it was just 8% for GDM. The mean gestational age at delivery (Mean±SD) was 36.30±2.08 weeks. NICU admission was high (50%).Conclusions: Pregnancy with thalassemia is considered high risk, continuous pre-conceptional, antenatal and postpartum assessment should be done for favorable outcomes.

A case of cervical pregnancy managed successfully in Medical College, Kolkata by injection Methotrexate and uterine artery embolization. Cervix is a rare implantation site for ectopic pregnancy. Either during surgical management should be carefully considered due to the risk of severe hemorrhage. A 33 years old patient (P2+4 with 1 living issue) with USG diagnosed 6 weeks cervical pregnancy was admitted in Gynaecology and Obstetrics department of Medical College, Kolkata with slight bleeding per vaginum and pain abdomen. USG was repeated along with beta hCG quantification and other routine investigations. Following admission, the bleeding and pain subsided. Patient was counselled regarding the prognosis and management options available. The patient was desirous to preserve her fertility and as the patient was hemodynamically stable with low initial beta hCG of 5200 mIU/ml, we opted for a medical treatment with MTX and uterine artery embolization. Following treatment with 3 doses of weekly Methotrexate (50 mg/m2 each i.m.) and UAE the beta hCG reduced significantly. The patient was discharged with advice of weekly follow up with beta hCG report. Within 2 months of follow-up, ß-hCG level was <10 mIU/mL with TVS showing normal cervical canal and empty uterine cavity.

The two most common fetal lung lesions include Bronchopulmonary sequestration (BPS) and Congenital pulmonary airway malformation (CPAM).Their co-existence is known as a hybrid lesion. Fetal hydrops in such cases is associated with very high morbidity and mortality. Several fetal interventions have been recommended over the past years to treat the same, with varying success rates. We describe a case of a hybrid CPAM complicated by hydrops which was successfully treated by interstitial laser coagulation of the systemic feeder artery. We also review current literature on the available interventions and conclude that interstitial laser has emerged as the preferred modality of treatment over the years.