Indian Journal of Maternal-Fetal & Neonatal Medicine

The risk of number of chronic diseases in adulthood may have their origins before birth search diseases include non-insulin dependent Diabetes, hypertension and coronary heart disease. Alteration in fetal nutrition and endocrine status may result in adaptations that permanently change the structure physiology and metabolism of the offspring predisposing individuals to metabolic endocrine and cardiovascular diseases in adult life. The developmental origin of adult disease hypothesis is called Barker hypothesis. Under nutrition is programming stimulus when events during critical period of development and change structure and function of the organism. Insulin resistance is early feature of metabolic syndrome and is associated with fetal effects. Adverse events during pregnancy can affect not only the offspring of that pregnancy but also the next generation, women on growth, diet and body composition before and during pregnancy play a major role in programming the future health of her children.

Keywords: Fetus; Adult; Barkar; Programming; Thrifty Phenotype; Diabetes. 

Regulation of fetal growth is complex and still poorly understood. It involves genetic, nutritional, environmental, placental, hormonal and fetal factors. Weight of the child at birth is critical determinant of neonatal morbidity and mortality and the risk of metabolic diseases throughout the life span. Contributing fetal factors for low birth weight are multifaceted and include factors such as: maternal age, poor fetal genome, fetal infections, hormones, fetal malformations, multiple fetuses, amino acids, glucose, lipids. Risk factors for macrosomia are maternal diabetes, high pre- pregnancy BMI, excessive weight gain during pregnancy, multiparity, parental height, prolonged gestation. Nutritional insult during a critical period of gestation may leave permanent ‘memory’ throughout life. Early antenatal screening for chromosomal abnormalities and congenital malformations will ensure continuation of healthy pregnancy.

Keywords: Fetus; Low Birth Weight; Macrosomia; Genetic; Fetal Infections; Malformations.

APS in pregnancy is one of the important cause of recurrent pregnancy loss, preclampsia and IUGR. Treatment to be started after confirmation of APS with the help of laboratory and clinical criteria. With the imperfect data that are currently available it is impossible to give evidence based recommendations on how patients with APS should be treated in pregnancy. It is wise to regard pregnancies as being at high risk. Treatment to be started with prepregnancy councelling followed by follow up during pregnancy and treatment.

Keywords: APS; Antiphospholipid Antibody (aPL); Recurrent prgnancy loss; Preclampsia. 

Background: Seizures are the most frequent sign of neurological dysfunction in the neonatal period. We studied the incidence, clinical types and etiological factors in neonatal seizures and change/s in the epidemiology of neonatal seizures in the last 2 decades by comparing data from a study done 20 years earlier.

Methods: It was a prospective observational cohort study conducted in a tertiary care teaching hospital in north India from November 2016 to October 2017. 7303 neonates were recruited and of these, 66 (0.9%) had clinical seizures at the time of presentation. Complete demographic details, relevant clinical information and investigations were recorded in the pretested Performa and analysed.

Results: The overall incidence of neonatal seizures was 0.9% (66/7303). The incidence of seizures was 0.44% (29/ 6589) among Inborn and 5.1% (37/714) among Out born neonates. Incidence in ELBW, VLBW, LBW and normal birth weight was 2.5%, 4.4%, 0.62% and 0.84% respectively. Male preponderance was observed with a male to female ratio of 1.44:1. Forty-five (68.18%) neonates had seizures in the first 96 hours of life. Out of 142 seizure episodes in 66 neonates, subtle seizure 68 (47.9%) were the most common clinical type followed by focal clonic 27 (19%) and multifocal clonic 27 (19%). Etiological profile revealed perinatal asphyxia in 14 (21.2%), meningitis in 13 (19.7%), hypocalcemia in 12 (18.2%), hypoglycemia in 8 (12.1%), intracranial bleed in 6 (9.1%), hypernatremia in 4 (6.1%) and acute bilirubin encephalopathy in 4 (6.1%). IEM (1.5%) and CNS malformation (1.5%) were observed in 1 patient each. Cause of seizures could not be ascertained in 3 (4.5%) patients.

Conclusions: Perinatal asphyxia and HIE still remains the commonest cause of neonatal seizures despite significant advancements in perinatal and neonatal care although incidence has decreased when compared to the statistics 20 years back. Biochemical abnormalities still are an important and manageable cause of neonatal seizures.

Keywords: Neonatal Seizures; Perinatal Events; HIE; Biochemical. 

Introduction: Any pregnancy which has passed beyond the expected date of delivery is called a prolonged pregnancy & which have passed 42 weeks, 294 days is called postmaturity or post term pregnany [1], these are at an increased risk for fetal postmaturity syndrome, macrosomia, fetal intolerance of labor, oligohydramnios, meconium-stained amniotic fluid, and cesarean delivery [2]. The clinical evidence of an increased potential for these poor perinatal outcomes has triggered a movement toward increased antenatal testing between 37- 42 weeks of gestation, and cervical ripening with labor inductions at or before 42 weeks of gestation. While a ripe cervix is usually suggestive of fetal maturity to find an unripe cervix does not exclude maturity. Induction of labor is one of the most common procedures in obstetrics and is carried out in approximately 20% of pregnancies [3]. Mechanical and biochemical means have been used to affect cervical ripening and to induce labor. Methods of induction include amniotomy, membrane stripping or sweeping, prostaglandins, laminaria and oxytocin. Membrane stripping or sweeping is a commonly use procedure aimed at preventing the post term pregnancy and avoid the application of formal method of induction of labour.

Aims and Objectives: 1. to determine the effectiveness & safety of membrane stripping at term pregnancy as a OPD procedure weekly which can reduce the incidence of Post term pregnancy, labour induction and its complication. 2. To determine what factors occurring after digital separation of the chorionic membranes from the lower uterine segment (membrane stripping) are involved in observed clinical changes compared with patients not so treated.

Material and Methods: Study Design: This was a prospective study conducted at department of Obstetrics and Gynaecology at our hospital. Study Duration: Study was conducted during the period of duration September 2014 to September 2016.

Results: After documenting the confirm gestational dating criteria and obtaining inform consent 200 patients at 37 complete week of gestation were randomly selected for the study. Data were collected from findings at 1,2,3 week and during labour, which is compaired by pearson chi-square and fischer exact test.

Conclusion: Stripping of membranes is a very old procedure. This causes the release of plasma prostaglandin F2, Increase in endocervical phospholipase A activity and oxytocin release have also been observed. This will initiate uterine contraction and onset of labour. It is safe, cheap, effective and even an out patient procedure. It is associated with earlier delivery and decreased incidence of posterm gestation and hence maternal and fetal complication related to post maturity.

Keywords: Iron Deficiency Anemia; Iron Sucrose; Iron Ferric Carboxymaltose. 

Introduction: Dysfunctional uterine bleeding (DUB) usually presents as heavy menstrual bleeding without any underlying cause. Norethisterone is the most frequently prescribed drug for dysfunctional uterine bleeding serving 38% of the patient population the reason being cost effectiveness and absence of side effects.

Aim and Objectives: To study the efficacy and safety of Norethisterone in the management of Dysfunctional uterine bleeding.

Material and Methods: A total of50 women between 20 to 50 years of age presenting with abnormal or dysfunctional uterine bleeding during a period of one year included in the study. During each visit a detailed menstrual history was taken and Pictorial Blood Assessment Chart (PBAC) score was calculated. All patients of Dysfunctional uterine bleeding under study treated with Norethisterone and the treatment outcome measured. Results: Among a total of 50 patients, there were 24 (48%) patients belonged to 31-40 years age group with 35.40 years to be a mean of all ages. The mean Haemoglobin level recorded was 7.5gm%. The mean Pictorial Blood Assessment Chat (PBAC) score prior to treatment was 274 which was found to be decreased upto188 after treatment of 3 months with Norethisterone. A total of 32% patients suffered from side effects out of which 20% had nausea as most common.

Conclusions: Norethisterone when used in patients with Dysfunctional uterine bleeding (DUB), it suppresses endometrial development, re-establishes predictable bleeding patterns, decreases menstrual flow and lowers the risk of iron deficiency anaemia.

Keywords: Dysfunctional Uterine Bleeding (DUB); Pictorial Blood Assessment Chart (PBAC).

Introduction: Dysfunctional Uterine Bleeding (DUB) is excessive, erratic, or irregular bleeding usually associated either with hormonal disturbance or intrauterine pathology. It has remained one of the most frequent indications for hysterectomy in developing countries but 40% of cases were not associated with any definitive organic pathology. Aim and Objectives: To study Clinical profile of patients with dysfunctional uterine bleeding at a tertiary care hospital.

Material and Methods: It’s a cross-sectional, observational type of study carried out at tertiary care centre from September 2015 to August 2016 including 100 women between 20 to 50 years of age presenting with abnormal or dysfunctional uterine bleeding without any organic, systemic or iatrogenic cause. After obtaining an approval from institutional ethics committee, a detailed history and clinical examination was done.

Results: Ahighest proportions of patients were in the age group of 31 – 40 years (49%) followed by 20-30 years (26%). A maximum of 31% patients attained the age of menarche at 12 years. Among all 71% were multiparous, 24% were grand multiparous. The most common bleeding pattern was menorrhagia (64%) followed by polymenorrhoea (28%), while pain in abdomen was the most common complaint encountered.

Conclusions: DUB had serious impact on women’s life. It is recommended that, training program is recommended for women in order to enhance their knowledge and skills regarding Dysfunctional uterine bleeding.

Keywords: Dysfunctional Uterine Bleeding.

Background: Neonatal infections still forms a significant burden to the health system of low and middle income countries (LMIC), as it increases hospital stay, number of interventions and poor Neuro developmental outcome. The burden of neonatal sepsis in our country from a hospital based study is 30%. We try study the burden and contribution of various risk factors for neonatal sepsis in a tertiary care referral centre in south India.

Methodology: We collected retrospective perinatal data of all neonates admitted in our unit from 01 Jul 2016 – 30 Jun 2017 who had a discharge or death diagnosis of sepsis. We classified our data based on predetermined case definitions for our study.

Statistics Analysis: Descriptive and inferential statistical analysis has been carried out in the present study. Results on continuous measurements are presented on Mean±SD (Min-Max) and results on categorical measurements are presented in Number (%). Chi-square/ Fisher Exact test has been used to find the significance of study parameters on categorical scale.

Results and Conclusion: Our sepsis rates are 41.6 per 1000 live births.Our study had predominantly EONS of 30.8 per 1000 live births. Male Gender, Low Birth Weight, Preterm, babies born to mothers with risk factors are important risk factors for sepsis and related mortality. 38.3% babies from our study cohort were culture positive, contributing 48.5% of sepsis related mortality. Klebsiella species predominates both EONS & LONS. Ultra rapid horizontal spread might be the main cause of neonatal sepsis. Prevention is the key to combat Neonatal Sepsis.

Keywords: Neonatal Sepsis; Early Onset Neonatal Sepsis; Klebsiella Sepsis; Culture Positive.

Introduction: Preterm births are increasing globally, estimated at an annual incidence of 15 million. Of these, about 80% are moderate and late preterm births occurring between 32-37 weeks of gestation. Though large in size they have much more morbidity and mortality compared to their term counterparts.

Methods: Retrospective case control study conducted in a referral perinatal centre in South India during the period January 2011 to June 2013. Inborn late preterms (LPT) were cases and term babies born during the same period were controls. Maternal and neonatal demography, morbidity and mortality data were collected. Means and standard deviations were used to compare numerical variables between case and control groups using Student’s t test and the Mann-Whitney test; Pearson’s chi-square was used for categorical variables.

Results: A total of 1933 babies were included in the study of which 233 (12%) were late preterms. Elderly mothers, conceived with ovulation induction, multiple gestation and with antenatal complications had significantly higher number of LPT births. There were more CS and PROM noted. Parity and newborn gender did not show significant differences. There were larger numbers of small and large for gestational age babies among the late preterms. NICU admissions, phototherapy, sepsis treatments, respiratory distress, hypoglycemia, duration of hospital stay and cost of stay, mortality and readmission rates were higher among the LPT babies.

Conclusion: Late preterms had a longer and more morbid course after delivery as compared to their term peers. They represent a high risk group which may go unrecognized.

Keywords: Late Preterms; Morbidity. 

Aims and Objectives: 1. to study prevalence of various etiological factors involved in late pregnancy haemorrhage.  2. To find out relative frequency of various causes of bleeding during late pregnancy.  Materials and Methods: 1. this is observational retrospective study performed within span of 1 year (August 2014 to july 2015) in Department of Obstetrics and Gynaecology in ACPM Medical College, Dhule.  2. Total number of 200 women with bleeding per vaginum during pregnancy were enrolled in the study.  The patients who presented with vaginal bleeding were divided into:  1. Early pregnancy bleeding < 20 weeks  2. Late pregnancy bleeding > 20 weeks  In this article, since the demographic profile, etiology, risk factors involved, maternal & perinatal morbidities and mortalities associated with early and late pregnancy group are drastically different, so the cases in this study are divided into two groups- EARLY (< 20 weeks) & LATE (>20 weeks), and late pregnancy group studied separately in terms of all variables.  Results: In this study, 66% patients presented with early pregnancy bleeding and 34% with late pregnancy bleeding. Late pregnancy bleeding due to abruption was 59%, 29.32% was due to placenta previa, 1.47% was due to vasa previa, 2.9% due to uterine rupture, 2.9% due to abnormal placentation and rest 4.41% constitutes causes due to distal genital tract/ gynaecological bleeding.  Conclusion: When pregnant women have bleeding, it may cause stress and anxiety for the mother-to-be about the outcome of pregnancy. So, it is necessary to diagnose and manage obstetric hemorrhage to prevent maternal or fetal mortalities and morbidities. 

Keywords: Hemorrhage; Abruptio Placentae; Placenta Previa; Etiological Factors.

Objectives: The present study aims at advantages of ferric carboxymaltose therapy over iron sucrose in iron deficiency anaemia of ante natal and postnatal patient.

Methods: A prospective observational study was carried out at ACPM medical college during January 2017 to December 2017 for 50 antenatal and 50 postnatal women, total 100 women. Diagnosis of iron deficiency anemia done by proper history taking, examination, peripheral blood smear and blood indices. Baseline haemoglobin and serum ferritin levels were noted on first, eighth, fifteenth and thirtieth day of treatment with iron sucrose or ferric carboxymaltose for randomly selected 50 antenatal and 50 postnatal women.

Results: The mean rise of haemoglobin value was 4.3 g/ L for ferric carboxymaltose and 4.0 g/L for iron sucrose in pregnant women. For postpartum women mean rise of haemoglobin was 4.9 g/L after treatment with ferric carboxymaltose and 4.4 g/L for iron sucrose.

Conclusion: For the treatment of iron deficiency anaemia in pregnancy as well as postnatal women ferric carboxymaltose is safe, efficient and having many advantages over iron sucrose.

Keywords: Iron deficiency anaemia; Iron sucrose; Iron ferric carboxymaltose 

Background: In modern era obesity has become a serious issue. Worldwide increase in obesity has been noticed among children. Child obesity is associated with various risk factors and the key to prevention is identification of the risk factors.

Aim: The aim of this study is assess obesity in 4 to 12 years old children and associated risk factors.

Materials and Methods: 400 school going children aged between 4 to 12 years were selected for the current study. Samples were selected from both public and private school. Self-administered questionnaire was provided to the children. Childs height, weight, age were recorded.

Results: Of the 400 children 200 were males and 200 females. Only 30% fathers and 23% mothers were post graduated. 38% children they never consume vegetables. Children who sleep less than 8 hours were more prone to obesity. Obese parents were more likely to have obese children (50%).

Conclusion: Obesity is an alarming situation and should not be ignored. Proper attention, care and motivation can help to prevent obesity. Risk factors like excess sleep duration, lifestyle, parents BMI should not be ignored.

Keywords: Obesity; Overweight; School Children; Risk Factors. 

This is a retrospective study on antenatal mothers with chronic hypertension detected either preconceptionally or before 20 weeks of gestation, carried out during a period of 6 months from February 2017 to July 2017 at Government Rajaji Hospital, Madurai. During that period a total of 198 mothers with hypertension were seen. Among them, 32 patients had chronic hypertension (16.2%). One patient was detected in previous pregnancy and continued antihypertensive medication postpartum as she was diagnosed to have chronic hypertension. All other patients were newly diagnosed before 20 weeks of gestation (96.8%). 5 patients out of 32 patients had superimposed preeclampsia (15.6%) among which 3 patients (60%) had super added proteinuria alone, one patient had HELLP syndrome (20%) and one patient had imminent eclampsia (20%). Objective: To study the incidence, associated risk factors, co-morbidities, complications and pregnancy outcome in antenatal mothers with chronic hypertension.

Keywords: Chronic Hypertension; Proteinuria; Preeclampsia. 

Context: Meconium stained amniotic fluid occurs as a result of foetal stress and therefore is considered to predict adverse foetal outcome, thus resulting in increased rate of operative deliveries.

Aims: To determine immediate foetal and neonatal outcome and associated maternal obstetric factors. Settings and

Design: Prospective observational study conducted in the Department of Obstetrics and Gynaecology and the Neonatology Unit in a tertiary care centre in Southern India. Methods and Material: Hundred pregnant mothers with meconium stained amniotic fluid delivered 102 babies. Maternal demographic details were noted and newborns were followed up tilldischarge. Their progress, complications and interventions were studied. Statistical analysis used: Frequencies and percentages of the various factors studied were determined.

Results: Among the 100 mothers, 66% were primigravida and 73% of mothers belonged to the younger age group of 21 – 30 years. Only 4% of the mothers were post term, but 73% delivered towards term (38 + to 40 weeks). The mode of delivery was mainly by Caesarean (64%). Among the babies, a majority (81.4%) were asymptomatic while only 18.6% required any respiratory support. Among the sick babies, 89.5% improved with oxygen therapy alone. Only two babies required endotracheal intubation in the delivery room and required further ventilatory support, and one was treated for shock. Only 27.4% of these babies required prolonged stay (> 72 hours) in the Neonatal Intensive Care Unit and majority (47.6%) required only short term antibiotics (3 days). Sepsis was suspected in 41.2% babies of which C Reactive Protein was positive in 16.6% while Blood culture positivity was there in 9.5 % of those screened for sepsis. Only 26.2% required antibiotics for longer than 5 days.

Conclusions: Meconium stained liquor is in itself, always not a determinant for adverse neonatal outcome. Other associated factors in a mother like hypertension complicating pregnancy, Intrauterine Growth Restriction and gestational diabetes also contribute to poor foetal outcome. Meticulous monitoring during labour and timely intervention for the mother by the obstetrician and immediate expert resuscitation results in better foetal outcome and brings down the perinatal morbidity in MSAF.

Keywords: Meconium Stained Amniotic Fluid (MSAF); Foetal Outcome; Neonatal Outome. 

Introduction: Dysfunctional Uterine Bleeding is the most common cause of abnormal vaginal bleeding during a woman’s reproductive years. ‘Ormeloxifene’ a nonsteroidal selective estrogen receptor modulator (SERM), is currently undergoing clinical evaluation for the treatment of heavy menstrual bleeding. It normalizes the bleeding from the uterine cavity by regularizing the expression of estrogen receptors on the endometrium.

Aim and Objectives: To study the efficacy of Ormeloxifene in the management of dysfunctional uterine bleeding.

Material and Methods: A total of 50 women between 20 to 50 years of age presenting with abnormal or dysfunctional uterine bleeding during a period of one year included in the study. During each visit a detailed menstrual history was taken and PBAC score was calculated. All patients of DUB under study treated with Ormeloxifene and the treatment outcome measured.

Results: Among a total of 50 patients, there were 25 (50%) patients belonged to 31-40 years age group with 37.9 years to be a mean of all ages. The mean Hb level recorded was 7.3gm%. The mean PBAC score prior to treatment was 274 which was found to be decreased upto 91.7 after a treatment of 3 months with Ormeloxifene.

Conclusions: DUB is considered to be caused because of the hormonal imbalance, eventually leading to hyperestrogenic state, which can be quite successfully treated by the medical management, like Ormeloxifene.

Keywords: Dysfunctional Uterine Bleeding. 

Introduction: The accurate dating of pregnancy is critically important for pregnancy management from the first trimester to delivery, and is particularly necessary for determining viability in premature labour and in post-dated deliveries. Prior to the widespread use of ultrasound, caregivers relied on a combination of history and physical examination to clinically determine gestational age.

Objective: To compare the Gestational Age in Third Trimester determined by Using Fetal Femur Length Versus Biparietal Diameter.

Materials and Method: In the present study total 100 pregnant female attending antenatal clinic of the study institute in third trimester were enrolled. Detailed demographic profile including age, address etc was obtained. Detailed history regarding the exact knowledge of her LMP, cycle regularity and duration of cycle was taken. All patients then underwent detailed examination i.e. general and systematic examination. The gestational age at time of scanning was confirmed by LMP, and abdominal examination. All the women in the study underwent ultrasonoghraphy. The ultrasound was done by a single operator to avoid bias in observations. All the fetal parameters were assessed and special attention was given to the femur length and biparietal diameter. The collected data was entered in Microsoft excel. Primary analysis was conducted by using Epi Info statistical software.

Results: The mean gestational age calculated from LMP was 33.53±3.37 weeks. The mean gestational age was calculated by using BPD and femur length on ultrasonoghraphy was 35.87±2.96 weeks and 34. 15±3. 40 weeks respectively. When the gestational age calculated from LMP and BPD was compared it was observed there was statistically significant difference in the two methods. While the gestational age calculated by LMP and FL showed no statistically significant difference. Thus the gestational age calculated from femur length was more accurate as compared to BPD. Similarity of GA in LMP with BDP was observed in 13 patients while similarity with FL observed in 74 patients. The Correlation coefficient between GA by LMP and GA by BDP was 0.9268 and correlation coefficient between GA by LMP and GA by FL is 0.9603. The coefficient between GA by BPD and GA by FL was 0.9099.

Conclusion: The gestational age estimated from Biparietal diameter and fetal femur length were statistically significantly correlated with the gestational age calculated from the LMP. But the gestational age calculated from femur length was more accurate as compared to BPD.

Keywords: Ultrasonography; Gestational Age; BPD; Femur Length.