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Background: Post-dated pregnancy may be associated with perinatal complications like fetal distress, meconium aspiration syndrome and fetal asphyxia. This study was designed to study maternal outcomes in post dated pregnancy (or beyond 40 weeks gestation). Materials & Methods: Real time ultrasound scanning was performed using (Philips EPIQ 5G, Philips EPIQ 7G and Philips affinity 50 G model) 1-5 MHz biconvex probe and general survey of foetus was done. Total 114 pregnant women beyond 40 weeks of gestation were studied. A detailed clinical history like menstrual history, marital, family history of the pregnant women included in the study was taken. For induction, cervical ripening agents like dinoprostone gel or misoprostol tablets were used. Then the patients were observed for uterine contractions and strict foetal heart rate monitoring was done. Results: In this study total 114 cases beyond 40 weeks of gestation were analyzed to know the maternal and foetal outcome in post-dated pregnancies. Majority of the postdated pregnancies 102 (89.5%) were in between 40 weeks -40 weeks 6 days. Primigravida were 55.3% while only 44.7% were multigravida. Out of total 114 patients having pregnancies beyond 40 weeks of gestation, 67.6% were delivered vaginally while 32.4% underwent lower segment caesarean section. Majority (65.8%) of patients had Bishops score <=4, Bishops score > 6 (20.2%), Bisops score in between 5-6 (14%). Incidence of meconium stained liquor was 6.1%. Conclusion: Post-dated pregnancy is a high risk pregnancy, so correct dating is done by early first trimester USG or by second trimester USG so that induction can be done at 40 weeks and timely detection of foetal distress and management can be safely introduced. [ABSTRACT FROM AUTHOR]

Background: Middle age is a link between adulthood and old age, which requires special attention. During middle age among females, changes like menopause occur, which is responsible for causing various physical, vasomotor, psychological, and social changes, which may affect overall well-being and positive mental health status. Hence, the present study has been planned to assess the prevalence of menopausal symptoms among middle-aged females. Materials and Methods: The present study was a cross-sectional study carried out in rural and urban areas of district Dehradun among 400 females. A stratified systematic random sampling technique method was used. All the females fulfilling the inclusion criteria and aged 40–60 years were included in the study. The Menopause-Specific Quality of Life (MENQOL) questionnaire was used to assess the prevalence of menopausal symptoms. Results: A total of 400 women were recruited in the study, 200 from rural and urban areas each. The mean age of the total study participants was 50.00 ± 0.32 years. Among 400 middle-aged women, 189 were premenopausal and 211 were postmenopausal. The frequencies of occurrence of menopausal symptoms were explored in 189 premenopausal and 211 postmenopausal women. The mean age of premenopausal women was 44.21 ± 2.35 and postmenopausal was 54.39 ± 4.21. Females experienced varying grades of MENQOL symptoms. Conclusions: It was found that majority of the females' quality of life were found to be affected with different grades of menopausal symptoms. With increasing age, symptoms also increase and are significantly high among postmenopausal women. [ABSTRACT FROM AUTHOR]

Introduction: Pregnancy Induced Hypertension, a life threatening complication of pregnancy is a condition that typically starts after 20th week of pregnancy and is related to increased blood pressure and protein in mother’s urine. Finding the factors about increasing the severity of blood pressure among PIH womens is very important to reduce the maternal and newborn morbidity mortality. Material and Method: Quantitative approach with Non experimental – descriptive research design was used to estimate the risk factors contributing to increase the severity of blood pressure among pregnant women with PIH. Pregnant women who diagnosed with PIH, belongs to hilly area and primigravida were included in the study. Pregnant women with convulsion and coma, with other chronic medical disorders were excluded from the study. Hundred and six (106) women with PIH were selected for study by using purposive sampling technique. Women with PIH were classified in to two groups i.e 1. women with mild BP (140/90 – <160/110) & 2. women with severe BP (≥ 160/110)2. The tools used to collect the data were 1. Demographic questionnaire, 2. Questionnaire to assess the determinants or risk factors contributing to increase the severity of Blood pressure of PIH. Results: Logistic regression Odds ratio statistics revealed that Contraceptive use (β=1.9), underwent infertility treatment (β=1.1), Family history of PIH (β= 2.0), family history of hypertension (β=2.9), physical activity (β=1.2), Sleeping hours (β=1.6), type of diet (β=1.5) and HB level (β=1.2) were the statistically proven causes for worsening of the blood pressure among PIH women. Conclusion: There are individual and multi-factors (i.e contraceptive use, infertility treatment, family history of PIH, family history of hypertension, normal activity, less sleeping hours, vegetarian and low Hb level)caused to increase the severity of blood pressure among pregnant women with PIH in Hilly Areas. [ABSTRACT FROM AUTHOR]

Decidual change is a key process required by the uterus to make itself ready for implantation. Presence of ectopic decidual tissue outside the uterine cavity is known as deciduosis.The clinical presentation can vary from being totally asymptomatic and subtle to presenting in the form of life-threatening emergencies like hemoperitoneum, recurrent pneumothorax, or even bowel perforation. Here, we present a case of ectopic deciduosis of cervix presenting in the form of severe life-threatening antepartum hemorrhage in second trimester of pregnancy. [ABSTRACT FROM AUTHOR]

Introduction: Women who experienced and survived a severe health condition during pregnancy, childbirth or postpartum are considered as 'near-miss' or severe acute maternal morbidity (SAMM) cases. Women who survive life-threatening conditions arising from complications related to pregnancy and childbirth have many common aspects with those who die of such complications. Aim: To evaluate health-care facility preparedness and performance in reducing severe maternal out comes at all levels of health care. Materials and Methods: The present study was carried out over a period of 12 months under the Department of Community Medicine. The cross-sectional study included all the women (937) attending health-care facilities, at all levels of health care i.e. Primary, Secondary & Tertiary level in Doiwala block of Dehradun district. This study was conducted as per the WHO criteria for 'near-miss' by using probability sampling for random selection of health facilities. All eligible study subjects visiting health-care facilities during the study period were included, i.e. who were pregnant, in labour, or who had delivered or aborted up to 42 days ago. Results: It was found that all women delivering at the THC received oxytocin to prevent postpartum haemorrhage. Treatment of severe post-partum haemorrhage by removal of retained products was significantly associated with levels of health care. Majority (94.73%) women who had eclampsia received magnesium sulfate as primary treatment. Conclusion: Application of WHO 'near-miss' tool indicates good quality of maternal care in rural healthcare setting in Uttarakhand, North India. The women would have otherwise died due to obstetrics complications, had proper care not been provided to them in time. [ABSTRACT FROM AUTHOR]

Introduction: Human papilloma virus (HPV) which is causative factor for cervical cancer may interact with p16 leading to malignant transformation of cervical epithelial cells. The present study was conducted to assess the immunoexpression of p16 INK4a in premalignant and malignant lesions of cervix and to correlate it with HPV 16 expression. It was also intended to study the various risk factors which may be associated with cervical cancer in this north Himalayan region of India., Material and Methods: The study included 50 cases of premalignant and malignant cervical lesions and 50 controls diagnosed on histopathology over a period of one year. All the relevant clinical details were noted and both cases and controls were subjected to HPV 16 and p16 INK4a immunohistochemical staining., Results: 67% of subjects (including cases and controls) and 94% of the cases were positive for HPV 16 expression. p16 INK4a expression was negative in all the controls, positive in 96% of invasive cancer, 66.6% in HSIL and 37.5% in LSIL., Conclusion: Cervical cancer is associated with low socio economic status, illiteracy, smoking, early age of marriage and conception in north Himalayan region of India. HPV 16 infection is positive in both cases and controls indicating high prevalence of HPV 16 in this region. Neoplastic transformation by HPV is identified by over expression of p16 INK4a in premalignant and malignant cases. The immunopositivity of p16 INK4a increases with the severity of cervical lesions and thus may play an important role in stratification of premalignant and malignant lesions., Competing Interests: There are no conflicts of interest.

Introduction: Iron Deficiency Anaemia (IDA) and β-Thalassaemia Minor (BTM) are considered to be important cause of microcytic hypochromic anaemia. Studies have evaluated various red cell parameters which are easily available on electronic cell counters for discrimination of IDA and BTM in different ethnic populations. The analysis of previously established red cell discriminative indices with new cut-off have also been done by studies which may be relevant in their set of population for differentiation., Aim: The study was conducted to propose a modified score considering the established red blood cell indices with a new cut off and to formulate index taking into consideration Red Blood Cell (RBC) and platelet parameters for early differentiation of IDA and BTM., Materials and Methods: The prospective study included cases with MCV< 80 fl and new modified score of 11 was proposed by statistically analysing the previous discriminative indices with new cut-off by giving score 0 for IDA and score 1 for BTM. The summation of all scores gave modified 11 T score. A new cut off for differentiation of IDA and BTM was proposed in the study by using ROC curve and analysing AUC which statistically corresponded to highest accuracy. An attempt to formulate a new index using the RBC and platelet parameters was also made for initial discrimination., Results: The study included 153 cases and in addition to red blood cell parameters, mean platelet volume and platelet distribution width also showed statistical significant difference between IDA and BTM (p<0.05). Modified new 11 T score was 87.6% specific for BTM while proposed index showed 80.4% negative predictive value for BTM and correctly identified 75% of cases., Conclusion: The proposed new index and modified 11T score may be used for initial discrimination of BTM and IDA especially in resource limited regions. Apart from RBC parameters, mean platelet volume and platelet distribution width may also be useful in early differentiation. It is essential to determine cut off of every index in given population for differentiation of these two conditions.