Indian Journal of Maternal-Fetal & Neonatal Medicine

 Macrocephaly-capillary malformation (M-CM/ MCAP) was formerly known as Macrocephaly-cutis marmorata telangiectatica congenita. It is a multiple congenitial syndrome , which was first described in 1997 and it was renamed as “ Macrocephaly – capillary malformation” in 2007. It is a multiple malformation syndrome which involves body and head overall abnormal growth, abnormalities of skin , vascular abnormalities and neurological problems ( seizures, hypotonia), cortical brain malformations, most distinctively polymicrogyria. This disorder is attributed to PIK3CA gene mutation. Till now, There are only 130 reported cases of M-CM, there are likely many more affected individuals who have been misdiagnosed, are unrecognized or have not been published in the medical literature.

Keywords: Macrocephaly; Neonatal; Congenitial syndrome

 Introduction: Torsion of ovarian cyst is defined as total or partial rotation of adnexa around its vascular axis or pedicle. We may get difficulty in diagnosis in term gestation patient because of gravid uterus and symptoms of onset of labour mimicks the symptoms of twisted ovarian cyst. Method: Case Report 32 year G3P2L2 with 38 weeks of gestation with complain of pain in abdomen and nausea since previous day. H\O same complains twice in last month which was diagnosed as preterm labour pain and treated accordingly in other hospital. She presented herself in latent phase of labour. During monitoring, she was having continuous abdominal pain and episodes of vomiting twice. Decision of emergency L.S.C.S taken in view of fetal distress and non progress of labour. But while exploring the abdominal cavity, twisted ovarian cyst of size 10 x 8 cm in right adnexa found. Right sided Salpingoophorectomy done without untwisting the pedicle. Conclusion: Twisted ovarian cyst is usually symptomatic in pregnancy. but here because of Gravid Uterus, It remained undiagnosed till term gestation and required right salpingoophorectomy during L.S.C.S.

Keywords: Twisted Ovarian Cyst; Torsion; Term Gestation.

 Sirenomelia (mermaid syndrome) is a rare congenital anomaly with characteristic feature of complete or partial fusion of lower limbs. Although, this syndrome is incompatible with life due to the association of several congenital visceral abnormalities; however, there are few reports of surviving infants [1]. Here, we are reporting a case was a live born, normally delivered at term by a 27-year-old third gravida of lower socioeconomic status. Examination of the baby revealed caudal dysgenesis having fusion of lower limbs, single leg with 1 foot and 5 toes. There was no identifiable external genitalia and anus.

Keywords: Sirenomelia; Caudal Regression Syndrome; Mermaid Syndrome; Potter’s Facies.

 Gastroschisis is a rare congenital anterior abdominal wall defect, which involves herniation of the small bowel with no membranous sac covering it [1]. It is usually present just to the right of a normal insertion of the umbilical cord into the body wall. There is an increased risk of intra uterine growth retardation (IUGR), fetal death, and premature delivery [2]. We hereby report a patient with this condition who came to the Neonatal Intensive Care Unit of our hospital.

Keywords: Gastroschisis; Anterior Abdominal Wall Defect; IUGR.

 Pregnancy is a wonderful experience. But not always is the experience as picturesque as we would plan it to be. Often times unexpected complications arise that can foul up from trying to have pregnancy to actually having a healthy pregnancy. We report a 35 year old nullipara presented with history of 2 year infertility with polycystic ovary syndrome (PCOS). Ovulation induction done with gonadotrophins and intrauterine insemination done. Moderate ovarian Hyperstimulation syndrome (OHSS) developed that was conservatively managed. In same cycle patient became pregnant. Bed rest and progesterone support advised in view of threatened abortion in early pregnancy. At around 28 weeks betamethasone coverage and tocolysis started due to preterm labor pains, continued up to 35 weeks. At 36 weeks emergency caesarean section done in view of absent diastolic flow in fetal umbilical artery. A live healthy male baby weighing 2.4 kg delivered. On post operative day 7, symptoms of congestive cardiac failure appeared and diagnosis of Peripartum cardiomyopathy (PPCM) was made, admitted in ICU and managed actively by multidisciplinary team.

Keywords: Ovulation Induction; Gonadotrophins; Ovarian Hyperstimulation Syndrome; Peripartum Cardiomyopathy

 Syphilis is an infectious disease presenting stages associated with specific orallesions. Therefore, health professionals should be familiar with the different syphilis oral manifestations at each stage and be prepared to refer any suspected patient for further evaluation. Congenital syphilis is a very rare clinical entity,and its early diagnosis and treatment is essential. Dental findings often provide valuable evidence for the diagnosis of late congenital syphilis. It occurs due to the transmission of the disease from an infected mother to her fetus through placenta. This long forgotten disease continues to effect pregnant women resulting in perinatal morbidity and mortality. Congenital syphilis is a preventable disease, and its presence reflects a failure of prenatal care delivery system, as well as syphilis control programs. Although oral manifestations of syphilis are most likely to be observed during secondary disease, all stages of the disease can give rise to oral lesions. Since the prevalence of infective syphilis in heterosexuals has been increasing, there has now been a gradual rise in the number of children born with congenital syphilis. Consequently, the congenital disease gives rise to dental anomalies as well as bone, skin, and neurological anomalies of the face. This review describes the various stages of syphilis, along with its diagnosis and further management.

Keywords: Syphilis; Pregnancy; Congenital.

Fetal Therapy is defines as a therapeutic intervention for the purpose of correcting or treating a fetal anomaly or condition. Medical fetal therapy describes any therapy in which a pharmacological agent is administered to a woman or her fetus in order to avoid or alleviate fetal disease. Treatment of the fetus with blood products or injection of other agents can also be considered to be medical fetal therapy. In almost every case, the fetus is at risk of intrauterine death from the abnormality [1]. It is the “operative branch” of fetal medicine. It includes a series of interventions performed on the “sick” fetus with the aim of achieving fetal well being. These interventions include medical (i.e. non-invasive) and surgical procedures [2]. The field of medical fetal therapy has been extremely exciting and continues to evolve at a rapid pace. No doubt, future advances involving genetic manipulation or the use of molecular genetic techniques for diagnosis will continue to keep this field at the forefront of treatment and prevention of fetal disorders.

Keywords: Fetal Therapy; Fetal disorders; Intrauterine death.

 Background: Premenstrual syndrome is a psychosomatic disorder of unknown etiology often noticed just prior to menstruation. Premenstrual symptoms are a group of symptoms linked to the menstrual cycle. Premenstrual symptoms occur 1 to 2weeks before the period (menstruation or monthly bleeding) starts. Aim: The aim of the present study was to assess the prevalence of premenstrual syndrome and coping behavior among higher secondary school girls. Methods: The research design selected for this study was non experimental descriptive research design. The study was conducted in Government Higher Secondary School at Nellikupam, Kancheepuram district, Tamil Nadu. The study sample consisted of 110 higher secondary school girls, those who fulfilled the inclusion criteria. Standardized 5 point rating scale was used to assess the prevalence of premenstrual syndrome and 3 point rating scale was used to assess the coping behavior of the higher secondary school girls. Results: The analysis revealed that, majority 79 (71.8%) of higher secondary school girls had mild level of symptoms, 27 (24.6%) of girls had moderate level of symptoms, 4 (3.6%) of girls had no premenstrual symptoms and no one had severe level of premenstrual symptoms. Regarding the coping behavior, majority 103 (93.6%) of higher secondary school girls sometimes used coping behavior, 7 (6.4%) of higher secondary school girls always used coping behavior and no one never used any coping behavior for their premenstrual symptoms. Conclusion: Most women experience some form of premenstrual symptoms whether mild or severe at some time in their life. Many treatments have been tried in premenstrual syndrome. Reducing salt intake, caffeine and stress along with increasing exercise are some of the ways to manage premenstrual syndrome.

Keywords: Prevalence; Premenstrual Syndrome; Coping Behavior.

 Background: The term Kangaroo Mother Care (KMC) is derived from practices similar to marsupial care. It is an alternative to conventional neonatal care for LBW babies. Main components of KMC are- Skin to skin contact between mother and baby, exclusive breast feeding, early discharge and follow up. The advantages of KMC are, it reduces the overall mortality of the baby, increases the confidence and self-esteem in mother and bondage between mother and baby. Aim and Objective: To assess the weight gain in low birth weight babies with KMC care. Methodology: It is a prospective observational study conducted in a tertiary care hospital. All new born babies less than 1800 grams weight, accepting oral feeds are included in the study. After initiation of KMC, mother was instructed to record the duration of KMC practiced. Baby’s weight is monitored at the time of enrolment, daily in the morning and at time of discharge. During this study period baby is also monitored for complications like hypothermia, apnea, sepsis and jaundice. If any complications arise baby is withdrawn from the study and necessary intervention is done. KMC is continued till discharge of baby. Results: Significant weight gain is observed in babies with proportionate to the duration of KMC practice. Conclusion: Kangaroo mother care for low birth weight babies is the need of the hour for better survival and better quality of life.

Keywords: Marsupial care; Kangaroo Mother Care (KMC); Hypothermia; Apnea; Sepsis; Jaundice.

 Background: Building on the momentum generated by Millennium Development Goal 5, the Sustainable Development Goals (SDGs) establish a transformative new agenda for maternal health is to reduce the global MMR to less than 70 per 100 000 deliveries by 2030. At the country level, India estimated 15% maternal deaths worldwide in 2015. Among the major complications, high blood pressure during pregnancy (pre-eclampsia and eclampsia) is one of them. As incidence of eclampsia is influenced by the availability and quality of antenatal care, eclampsia mortality remains important in settings of high maternal mortality. The present study carried out to analyze the trend and assess socio demographic characteristics of maternal deaths associated with eclampsia. Methods: The present retrospective record based study was carried out at an Obstetrics and Gynecology Department of a tertiary care hospital located at Northern Maharashtra region. The study extracted the information from the records during the period from 2010 to 2015.The variables like age, education, income, registration status, parity, etc. were also obtained from the records of deaths due to Eclampsia. All the collected data analyzed using MicrosoftTM Excel 2010. Descriptive analysis and calculations of indicators were done. Results: Maternal mortality rate was 255 per 100000 deliveries for the period of 2010- 2015. Eclampsia contribution in maternal deaths is decreased from 66.6 % in 2010 to 43.48% in 2015. Overall Eclampsia incidence was 26.9 per 1000 deliveries and the case fatality rate 3.76 per 100 cases. Age group of 18-22 yrs 31(60.8%), 35 cases i.e.68.6% rural area of residence, 68.6% primigravida,78.4% unregistered pregnancies & Antepartum eclampsia (70.5%) were common factors present in eclampsia deaths. Conclusion: Better antenatal care including effective identification of high risk cases for preeclampsia/eclampsia, evidence based protocols for management of hypertension in pregnancy at all levels of health care and robust referral systems are required for better maternal outcome.

Keyword: Eclampsia; Antenatal; Maternal; Maternal mortality rate

 Introduction: Neonatal sepsis is one of the major causes of neonatal morbidity and mortality. It is responsible for about 30-50% of the total neonatal deaths in developing countries. Delay in diagnosis and treatment of sepsis can have devastating consequences in a neonate. So, surveillance is necessary to identify common signs and the bacterial pathogen as well as its antibiotic sensitivity pattern in a particular area. Methodology: This was a retrospective study conducted in Government Medical College and Hospital, Aurangabad from October 2013 to September 2015. Data was collected retrospectively by analyzing case sheet papers of neonates admitted to Neonatal Intensive Care Unit (NICU), GMCH Aurangabad during the study period. Results: Out of 3217 babies admitted to NICU, 523 (16%) developed culture positive sepsis. Females and preterm babies were more affected. Gram negative isolates were more common with Enterobacter aerogens being the most common organism followed by Klebsiella pneumoniae. Staphylococcus aureus was the most common gram positive isolate. There was wide spread resistance to cephalosporins among gram negative organisms. Conclusion: Early onset sepsis was more common in our set up. Gram negative organisms were predominant. Enterobacter aerogens was the most common isolate followed by Klebsiella pneumoniae. All gram negative organisms were resistant to cephalosporins. Staphylococcus aureus was most common gram positive isolate.

Keywords: Neonate; Sepsis; Culture; Antibiotic Sensitivity

 Introduction: The neonatal period is regarded as first 28 days of extra uterine life. Various cutaneous manifestations are commonly seen during this period, most of which are benign, transient and physiological. Nevertheless these conditions often cause anxiety and serious concern to the parents leading to significant psychological stress and sometimes suffer from unnecessary treatment by over-consiousness or by lack of knowledge. Aims and objectives: to study the prevalence of transient cutaneous manifestations in neonates. Material and Methods: A prospective case series study comprising of 200 neonates during the first 28 days of life in the post natal wards or attending outpatient department of pediatrics at Sri Adichunchanagiri hospital and research centre, BG Nagara. Results: Out of 200 newborns examined, 153(76.5%) had one or more cutaneous lesions, 103(67.3%) having multiple and 50(32.3%) with single type of lesion. Female babies, LBWýÿs and post term babies had higher incidence with 94% of cases presenting in the first week of life. Erythema toxicum constituted the maximum of 62(40.5%) followed by Mongolian spot, lanugo hair with 47(30.7%) cases and milia 39(25.4). Miniature puberty constituted 36(23.5%) followed by caput succecaneum with 21(13.7%) and physiological scaling 19(12.4%) cases. The least number of manifestation observed was accessory nipple and transient pustular melanosis with 01(0.6%) and 02(1.3%) cases respectively. Conclusion: Cutaneous manifestations are very common especially during the first 7 days of life. Thorough knowledge of these transient conditions is essential to avoid unnecessary investigations and treatment and to alleviate the parental concerns.

Keywords: Neonate; Transient; Cutaneous; Dermatoses.

 Introduction: Prediction of fetal weight has been a subject which has interested many workers. It is useful for the prevention of prematurity by avoiding delivery of small babies through induction or caesarean section. Aims and Objectives: To Study of assessment of fetal weight in term pregnancy by abdominal girth and symphysiofundal height and comparison with actual birth weight of baby. Methodology: This was a Prospective Study carried out at medical college and hospital from January 2009 to October 2010 in the department of obstetrics and gynecology. Two hundred women at term were studied. The fetal weight was estimated at the time of admission.The statistical analysis done by SPSS version 17. Result: Mean age of mothers was found to be 22.67 years. 59% babies were normally delivered and 24.5% babies were delivered by LSCS. Actual birth weight (Grams) was 2643.00 ±331.14 (Range 2000-3615), while SFHAG (grams) was 2721.45 ± 360.01 (Range 1806 -3534). Error by SFHAG was 78.5 ± 365.4 and (Range -1090.0 to 1398.0). Percent SFHAG Error by SFHAG was 3.9 ± 14.5 (Range -36.9 to 67.9). The SFHAG significantly differed from the Actual birth weight (P<0.05). Birth weight determined by SFHAG in 57% babies had an error of more than 200gms. Birth weight by SFHAG was overestimated in 58% babies; of them 35.5% babies were estimated to have birth weight more than 200 gms. In 42% babies birth weight was underestimated and in 21.5% babies had weight determined less than 200gms. Conclusion: Clinical palpation is a subjective methodology that must be employed at or near the data of delivery but this method is having much errors in measurement so should be accompanied with other methods of estimation like USG.

Keywords: Symphysio Fundal Height (SFHAG); Mcdonald’Smeasurement, Intrauterine Growth Retardation (IUGR).

 Background: In mullerian anomalies uterine anomalies are most common.They areassociated with normal as well as adverse reproductive outcomes.This study aims to evaluate different types of uterine congenital anomalies and its impact on maternal and fetal outcome. Setting & Design: The present study is carried out in the Dept of OBGY in tertiary care hospital and medical college. It is a retrospective observational study done among patients who have various types of mullerian anomalies with pregnancies. Methods: The study was conducted from April 2008 to March 2015. Universal sampling done. Data of 21 patients collected and analysed using MS Excel software. Statistical Analysis: Frequency analysis done for study variables using MS Excel 10.0. Results: During this period 21 patients with various uterine anomalies with pregnancy were studied. 19.4% patients had bicornuate uterus, 23.8% had septate uterus & 14.28% had unicornuate uterus, 9.52% had uterus didelphus, 23.80% patients had arcuate uterus and 4.76% patient of transverse vaginal septum and longitudinal vaginal septum each. Malpresentation was found in bicornuate, unicornuate, didelphys, arcuate uterus. Bad pregnancy outcome was seen in bicornuate, septate and unicornuate uterus. Conciusion: Mullerian anomalies have a significant adverse impact on obstetric outcomes. High suspicion index should be kept with all patients coming with infertility,recurrent pregnancy loss, preterm labor, malposions and malpresentations and bad obstetric history. Favorable outcome can be achieved by early diagnosis with the help of advanced modality and possible surgical interventions.

Keywords: Maternal and Fetal Outcome; Mullerian Anomalies; Malpresentation; Recurrent Pregnancy Loss.

 Introduction: India is facing a demographic nightmare in terms of gender imbalance, The worrying fact is the child sex ratio in Nashik district is 890 which is much lower than the national average of 919. This rate of decline is alarming. Though government has implemented PC & PNDT Act to prevent pre-natal sex determination, it seems not to be reflected in practice. Aims & Objectives: To assess the Knowledge, Attitude and Practice of Gender Preference & Pre-natal sex determination in population visiting ANC OPD in a tertiary care hospital in Nashik district. Materials and Methods: This is a cross sectional prospective study carried out at a tertiary care hospital involving 100 Married women of reproductive age group and have not completed their family visiting ANC OPD. Analysed using SPSS software 20. Results: Out of 100 women, 71% knew about the PC PNDT act but only 38% have knowledge about the sex ratio and 85% of them preferred a male child in their subsequent pregnancy. This study suggest that those who have preferred more males, desired to know the sex of the child during pregnancy 34.20%. This is statistically significant, as well they could induce abortion if by chance they get to know the gender of foetus and it is of opposite sex to what they had desired, it is also statistically significant (0.000238 i.e. p < 0.05 ). Conclusion: The existence of son preference is at an alarming high rate in our society and is the most important – the root cause of imbalanced sex ratio.Thus apart from the legislative measures, people also needs to be educated about the ethical issues related to female foeticide.

Keywords: Attitude; Gender Preference; PC & PNDT Act; Sex Ratio; Female Foeticide.

 Background: Obstetric hemorrhage is major cause of maternal mortality worldwide. In India obstetric hemorrhage constitutes 38% of maternal deaths. BIAL is advocated as effective means of controlling severe obstetric hemorrhagepreventing maternal mortality and morbidity. Aims: To study effectiveness and outcome of BIAL IN severe obstetric hemorrhage as therapeutic measure. Setting & Design: The present study is carried out Dept of obs/gynae, Govt medical college. It is a retrospective observational study done among patients who have undergone BIAL as therapeutic measure to control severe obstetric hemorrhage. Methods: The study was conducted from January 2011 to January 2016. universal sampling done. Data of 25 patients collected in prestructured questionnaire, collected data analysed using MS Excel software. Statistical Analysis: Frequency analysis done for study variables. Results: During this 5 yr period BIAL was done in 25 patients. 40 % of the patients were from the age group of 25-29 yrs,36% patients were primipara and 28% patients were grand multipara. In Maximum no of patients BIAL was done patients for atonic PPH (32%), followed by for rupture uterus (20%). The effectiveness of BIAL was 92% & uterus conservation was 72%,with no major complication encountered. Conclusion: Early & prompt decision of BIAL in severe obstetric hemorrhage is very effective as therapeutic measure to save life as well as to preserve fertility of the patients.

Keywords: BIAL; Severe Obstetric Haemorrhage; North Maharashtra