Indian Journal of Maternal-Fetal & Neonatal Medicine

Background: Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality, particularly in low-resource settings. Uterine atony is the most common etiology, marked by inadequate uterine contraction following delivery. Emerging evidence suggests a role for inflammatory cytokines, including interleukin-6 (IL-6) and interleukin-1 beta (IL-1β), in regulating uterine contractility and vascular remodelling. Aim: This study aimed to evaluate maternal plasma levels of IL-6 and IL-1β in women with PPH due to uterine atony compared to controls, to assess their potential as predictive biomarkers and explore their clinical utility in risk stratification. Materials and Methods: A case-control study was conducted involving 88 pregnant women—44 with PPH secondary to uterine atony and 44 matched controls without PPH. Blood samples were collected antepartum and within 24 hours postpartum, and cytokine levels were measured using enzyme-linked immunosorbent assay (ELISA). Demographic, obstetric, hematologic, and clinical management data were recorded. Statistical analyses included t-tests, chi-square tests, and receiver operating characteristic (ROC) curve analysis. Results: IL-6 levels were significantly higher in cases than controls (45.58 ± 29.83 vs. 13.83 ± 5.86 pg/mL; p < 0.0001), as were IL-1β levels (25.01 ± 15.44 vs. 8.39 ± 4.02 pg/mL; p = 0.01). IL-6 showed superior diagnostic accuracy (AUC = 0.812), with 100% sensitivity and 70% specificity for severe PPH. Elevated cytokines were associated with greater blood loss, increased transfusion needs, adverse maternal outcomes, longer hospital stays, and higher rates of surgical intervention. Conclusion:IL-6 is a promising biomarker for predicting PPH severity and identifying high-risk patients early. Its incorporation into postpartum risk assessment protocols could enhance maternal care. Further multicenter studies are warranted to validate these findings and explore targeted anti-inflammatory therapies.

Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality globally. Despite advancements in pharmacological interventions, mechanical tamponade remains a cornerstone of conservative management for uterine atony and refractory bleeding. This article examines the clinical efficacy, technical application, and comparative advantages of the Bakri Postpartum Balloon (BPB) and the emerging “Butterfly” vacuum-induced uterine tamponade (VIUT) devices. By evaluating recent clinical data and standardized obstetric protocols, this paper argues that the transition from passive hydrostatic pressure (Bakri) to active vacuum-assisted suction (Butterfly/Jada) represents a paradigm shift in the management of refractory PPH, potentially reducing the need for invasive surgical interventions such as hysterectomy.

Introduction: Costello Syndrome (CS) is a rare RASopathy caused by germline activating variants in the HRAS gene. The disorder presents with multisystem involvement and overlaps phenotypically with other RASopathies, making prenatal diagnosis challenging. Case Report: We describe a gravida 2 woman referred for evaluation after a first-trimester scan revealed increased nuchal translucency (NT) and nasal bone hypoplasia. Subsequent ultrasound showed progressive fetal abnormalities including generalized edema, bilateral pleural effusion, redundant skin folds, tachycardia, echogenic bowel, and unilateral talipes equinovarus. Microarray analysis from chorionic villus sampling was normal. Whole exome sequencing detected a pathogenic HRAS variant (c.37G>T; p.Gly13Cys), confirming Costello Syndrome. Following counselling, the couple opted for medical termination. Posttermination examination correlated with ultrasound findings. Conclusion: This case highlights the importance of integrating detailed fetal imaging with advanced genomic testing for the prenatal diagnosis of single-gene disorders such as Costello Syndrome. Early diagnosis facilitates informed decisionmaking and targeted counselling.

Maternal mental health has gained increasing attention as a critical component of maternal and child well-being. Depression, anxiety, and other mood disorders during pregnancy and the postpartum period can adversely affect both mother and child. This review explores the prevalence, risk factors, screening tools, and intervention strategies related to maternal mental health, with a special focus on low- and middle-income countries (LMICs). Despite the growing wareness, gaps remain in the integration of mental health services into maternal healthcare. The review recommends culturally appropriate and scalable mental health interventions to enhance maternal outcomes.