Indian Journal of Maternal-Fetal & Neonatal Medicine

 Periodontal diseases arethe most common chronic disorders with a reported prevalence varying between 10 and 60% in the population, involving gingivitis and periodontitis.Periodontitis is an inflammatory disease of a multifactorial origin with anaerobic gram-negative organisms involved in the etiopathogenesisand may result in local and systemic inflammation, so a possible association between periodontitis and adverse pregnancy outcomes has been suggested. Adverse pregnancy outcomes have been linked to periodontal disease, that include preterm birth, low birthweight, miscarriage or early pregnancy loss, and preeclampsia. Preterm birth and low birth
weight are world wide leading perinatal problems having evident public health implications. Due to the fact that their incidence doesn’t decrease in spite of the many attempts at their prevention,pre-eclampsia and preterm births are the major causes of maternal and perinatal morbidity and mortality. This review is to understand the relationship between periodontal diseases and pregnancy related conditions affecting the overall health of the patient and its outcome. 

Keywords: Periodontal Disease; Pregnancy; Inflammation.

 Improvement of obstetric services has lead to smaller preterm babies presenting in the NICU (Neonatal Intensive Care Unit). There are many problems faced by preterm babies and the severity increases with less weight and gestational age. Prebiotics, Probiotics and also postbotics appear to present a new hope for these babies. Many studies and trials have shown benefits in conditions like Necrotizing enterocolitis, Feeding intolerance, Neonatal sepsis and in overall morbidity and mortality. The benefits in these areas leads to better neuro-developmental outcome in later life. Present article presents the review of literature about status of proiotics, prebiotics and post biotics use in preterm babies.

Keywords: Prebiotics; Probiotics; Postbiotics; Preterm Babies.

 Ceasarean section on maternal request is defined as a ceasarean delivery for a singleton pregnancy on maternal request in absence of medical or obstetrical indication. Obstetrics is a speciality dealing with two lives, closely linked whose interest may not always coincide. Ceaesarean section is a major surgical procedure with potential risk to mother and neonate. Intense psychological fear of childbirth is termed as tocophobia. This fear is expressed as fear of pelvic floor injury, of requiring emergency caesarean section, of loosing the baby. Such factors lead to ceasrean section on demand. In India, the family sometimes demand that baby is born on auspicious date and time. Physician must decide according to principles of autonomy, beneficence, non-malificence and distributive justice. Physician’s perspective is from legal, financial, ethical aspects. Caesarean section on maternal request has social, cultural, psychological facets. Obstetritian should explain risk-benefits of the procedure to the patient and take the decision on ethical guidelines. 

Keywords: Caesarean Section; Maternal Request; Ethics; Vaginal Delivery; Autonomy; Justice.

 An increased prevalence of cardiovascular disease (CVD ) has been found in women of reproductive age group. Pregnancy is associated with substantial physiologic changes that require adaptation of cardiovascular system. In this article we describe the changes in cardiac physiology encountered during pregnancy, and its effect on pre-existing cardiac disease. Important cardiac , maternal as well fetal assessment is elaborated. We outline the main cardiac pathology that can affect women during pregnancy and labour and provide a summary of the available evidence to guide management. Aspects of obstetric care that require adjustment in the presence of cardiac disease are highlighted. Pre-conceptional counselling is very important in patients with known cardiac disease. A team approach is needed to manage a pregnancy with cardiac disease to improve the outcome. It includes obstetrician, cardiologist, intensivist, anaesthetist, neonatologist. 

Keywords: Cardiovascular Disease ( CVD ); Pre-Conceptional Counselling; Oral Anticoagulant ( OAC ); Low Molecular Weight Heparin ( LMWH ); Unfractionated Heparin ( UFH ); Fetal Assessment.

 High risk neonate is at risk for neonatal mortality and morbidity. Short term outcome are predicted by combination of BPD, PDA, IVH, PVL, RDS, NEC etc. For better neonatal long term outcome recognition of high risk pregnancy, prevention of preterm births, increase transport facilities and multidisciplinary early intervention is necessary. 

Keywords: High Risk Neonate; Predictors of Outcome; Early Intervention; Prevention of Preterm Birth; Transport to Level 3 Prenatal Centre; Multidisciplinary Team.

 Meconium appearing in liquor which had clear earlier in labor is perhaps the most absolute sign of fetal distress. Meconium term derived from the Greek word “Meconium arion” meaning substance that resembles poppy juice or opium which is greenish in color. It is the first intestinal discharge from the newborn. Mechanism of passage meconium ma be – (a.) Physiological due to spontaneous gastrointestinal tract motility (b.) Due to direct hypoxic bowel stimulation. (c.) Due to sporadic and repetitive cord compression causing vagal stimulation .Factors influencing meconium staining are Gestational age, Gravid and Parity, Postdatism, Oligohdramnios, Intrauterine growth restriction(IUGR), Gestational hypertension, Preclampsia. Grading of MSAF by subjective assessment . Meconium aspiration syndrome (MAS) occurs due to aspiration of meconium during delivery with the initial braths of the baby. Factors associated with MAS: neurological complications, Birth asphyxia etc. This concluds prediction of the meconium staining of amniotic fluid can be attempted which would be of invaluable help in reducing the perinatal morbidity and mortality Presence of thick meconium should be viewed seriously as it may pose a potential danger for baby.

Keywords: Meconium; Hypoxia; Gestational Age; Oligohydramnos; Pneumonia

 Introduction: More than half of all maternal deaths occur within 24 hours of delivery; most commonly from postpartum hemorrhage (PPH). Uterine atony is the most common cause of PPH. Majority of the cases respond to medical measures. However, few cases are refractory to medical measures and need further interventions. The present study was conducted to highlight uterus preserving management options for refractory cases of atonic PPH. Material and Methods: A retrospective review of all cases of atonic PPH refractory to medical measures was carried out in the department of Obstetrics and Gynecology, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India from January 2014 to June 2015. Results: Out of 446 cases of PPH, uterine atonicity was responsible for 300 cases (67.26%). Of these 300 cases, 62 (20.67%) were refractory to medical measures and required further interventions. Foleys condom tamponade (FCT) was used in 34 patients, uterine compression sutures were used in 18 cases, and uterine devascularization was opted for in 7 cases. The success rate of FCT, uterine compression sutures and devascularization for controlling refractory atonic PPH was 85.29%, 94.44%, and 85.71% respectively. Conclusion: oleys condom tamponade should be tried to manage refractory atonic PPH following vaginal delivery. It is technically simple, easily available and highly effective modality. Doctors and health workers posted in peripheral health centres should be trained for uterine tamponade. So that referred patients do not reach higher centre in moribund state. In cases of refractory atonic PPH following cesarean section, both uterine compression sutures and FCT can be used depending on expertise of the operating person. The technique of compression sutures can be easily taught to senior residents and consultants. In cases of placenta previa with uterine atonicity, the preferred modalities are uterine devascularization with or without FCT.

Keywords: Atonic PPH; Intrauterine Tamponade; Uterine Compression Sutures, Uterine Devascularization.

 Background: The greatest risk of childhood death occurs during the neonatal period, which extends from birth through the first 28 days of life. About 60 percent of all deaths to children under age 5 and nearly two-thirds of infant deaths (birth to 12 months) occur during the neonatal period. About two-thirds of all neonatal deaths occur during the first week of life. Objectives: To study the incidence of neonatal morbidity in NICU, causes of neonatal morbidity in NICU, find out complications of neonatal morbidity, and find out number of home deliveries and hospital deliveries in NICU. Study Design: Retrospective Study. Material and Methods: A convenient sampling technique will be used whereby; all the patients who presented to NICU during study period would be included. An informed consent will be obtained and assessed clinically and laboratory investigation. The data analysis will be done using the Excel program. result : Prematurity, low birth weight, birth asphyxia, hypoxic ischemic encephalopathy and sepsis are the major causes of morbidity and mortality to the neonatal intensive care unit. The high neonatal mortality warrants an urgent need to identify and reduced the risk factors with emphasis on prematurity, low birth weight, birth asphyxia and sepsis. onclusion: according to this study RDS, birth asphyxia and neonatal sepsis are leading causes of morbidities in newborn babies. In spite of many advances in neonatal care above factors still continue to be the leading causes of morbidity in neonates.

Keywords : NICU; Prematurity; Sepsis; Low Birth Weight

 Objectives: To compare the efficacy and safety of oral nifedipine and parenteral isoxsuprine in suppression of preterm labour. Methods: This is a prospective trial. 100 antenatal cases with 28- 36 weeks of gestation with threatened or early preterm labour were selected and divided in 2 groups. Group A received oral nifedipine, while group B received parenteral isoxsuprine. Outcome was analyzed with respect to prolongation of pregnancy, maternal and fetal side effects. Conclusion: Nifedipine is preferred tocolytic agent than isoxsuprine in arrest of early preterm labour with lesser maternal side effects.

Keywords: Preterm Labour; Nifedipine; Isoxsuprine.