Indian Journal of Maternal-Fetal & Neonatal Medicine

Radiation is mainly of two types – ionizing and non-ionizing radiation. In pregnancy only non - ionizing radiation is used. Effects are very less in pregnancy than what is actually predicted. According to ACOG, exposure to x-rays during pregnancy is not an indication for therapeutic abortion. Fetal sensitivity to radiation depends upon – radiation dose to fetus and post conceptional period. Health effects are grouped into teratogenesis, carcinogenesis and mutagenesis. 

Keywords: Ionizing; Non- Ionizing; Post- Conceptional Period.

A 17 year old girl was admitted with lump in abdomen, dyspnoea, secondary amenorrhoea and loss of appetite since 4 months and swelling over right arm, shoulder and right aspect of neck since 15 days. Ultrasound and CT abdomen and pelvis showed malignant mass lesion of adnexa with ascites. Doppler of Right arm showed thrombus in Right subclavian vein. Her coagulation profile was altered with INR of 1.4. Considering possibility of germ cell tumor LDH, β HCG and Alpha fetoprotein were done. All these markers were raised. She was started on low molecular weight heparin in view of subclavian vein thrombosis. Neoadjuvant chemotherapy was given followed by staging laparotomy. Histopathology report was suggestive of malignant mixed germ cell tumor. Postoperatively she received 3 cycles of chemotherapy. Main aim of publishing this case is presence of Para neoplastic Syndrome.

Keywords: Adolescent Ovarian Tumor; Germ Cell Tumor; Para Neoplastic Syndrome; Subclavian Vein Thrombosis; Neoadjuvant
Chemotherapy 

 

Background: Pierre Robin syndrome (PRS) is characterised by micrognathia (undersized jaw), glossoptosis (retracted tongue), and airway obstruction. Neonates with a complete type of cleft palate, frequently present with feeding problems and aspiration is a common compliction. Presented here are two cases with Pierre Robin Syndrome. Case summary: First case is a 3 month male with feeding difficulty and aspiration pneumonia had receding chin and cleft palate on examination. He was feed by nasogastric tube initially and later a obturator was fitted. Second case is a 6 month female with bronchpneumonia and had a high arched, U shaped cleft palate and a large tongue. Conclusion: Early diagnosis for proper feeding and growth of children with Pierre Robin Syndrome is important to prevent complications like failure to thrive and repeated aspiration pneumonia.

Keywords: Pierre Robin Syndrome; Micrognathia; Cleft Palate.

 

Rickettsia are a rather diverse collection of organisms with several differences; this prohibits their description as a single homogenous group. The rickettsial diseases were believed to have disappeared from India are reemerging and they are reported from Maharashtra, Tamil nadu, Karnataka, Kerala, Jammu and Kashmir, Uttaranchal, Himachal Pradesh, Rajasthan, Assam and West Bengal. In view of low index of suspicion, nonspecific signs and symptoms, and absence of widely available sensitive and specific diagnosic test, these infections are notoriously difficult to diagnose. Knowledge of geographical distribution, evidence of exposure to vector, clinical features like fever, rash, eschar, headache and myalgia alongwith high index of suspicion are crucial factors for early diagnosis. We hereby report a patient who came to the PICU of our hospital 
Keywords: Rickettsia; Eschar; Weil-Felix Test; Antimicrobials.

 

Thrombocytopenia in pregnancy is a common hematological disorder second only to anemia. Cause of thrombocytopenia may be due to an increase in destruction or consumption of platelets, dilutional effects or lack of production of platelets. Gestational thrombocytopenia mostly found in 3rd trimester of pregnancy is most common cause of thrombocytopenia in pregnancy. Neonatal mortality rate is low with ITP mother hence normal vaginal delivery advocated. Thrombocytopenia in hypertensive disorders requires multipronged approach with component therapy and antiepileptic antihypertensive. Choosing best in all treatment modality available is challenge for obstetrician. 

Keywords: Thrombocytopenia; Pregnancy; Autoimmune; Preeclampsia; DIC; Platelet.

 

  Successful pregnancy is unique achievement in women's life. Fetal weight is interplay of maternal, genetic, environmental, placental, hormonal and fetal factors. In this article, maternal factors affecting fetal growth will be explored. Both low birth weight and macrosomia have impact on neonatal mortality and morbidity. Advanced maternal age, adolescent pregnancy, maternal height, parity, maternal weight, social economic status and nutrition affect fetal weight. Environmental factors like drugs, alcohol, smoking are determinants of low birth weight. Maternal infections, chronic medical disorders are other causes of IUGR. Maternal diabetes, obesity, previous macrosomic infant, excessive weight gain during pregnancy, prolonged gestation are risk factors for macrosomia. Prevention, early detection and timely interventions are cornerstones of optimisation of fetal weight 

Keywords: Maternal Factors; Fetal Nutrition; Low Birth Weight; Macrosomia; Environment. 

  Context: Neonatal sepsis refers to systemic bacterial infection documented by positive blood culture in the first four weeks of life and is one of the four leading causes of neonatal mortality and morbidity in India. Aims: To identify the common bacterial pathogens associated with neonatal sepsis and their antibiotic susceptibility pattern. Design: This study was a retrospective study to identify the bacterial isolates in neonatal septicaemia and their antimicrobial susceptibility in a tertiary care hospital in KBNTGH Karnataka, from March 2017 to February 2018. Methods: Blood culture in newborns with clinical sign of septicaemia was retrospectively studied. Antimicrobial susceptibility testing was performed by Kirbuay -buer disc diffusion susceptibility method in accordance to clinical laboratory standard institute guidelines (CLSI). Statistical Analysis: Chi square test was used to check the test of proportion. Results: 112 cases of septicaemia could be confirmed by blood culture. Of these Gram negative was isolated in (63.3%) of cases and (36.6%) were of gram positive isolates. Kliebsiella was the predominant pathogen (45.5%) among the gram negative pathogens followed by S. Aureus (19.6%) and CONS (16.9%) were the predominant gram positive pathogen. Polymyxin and meropenem were most effective drugs against gram negative isolates were as gram positive organisms showed maximum sensitivity to vancomycin. Conclusions: This study highlights the growing resistance to commonly used antibiotics; also highlights the importance of kleibsiella principle organism responsible for neonatal sepsis in tertiary care settings.

Kaywords: Septicaemia; Neonate; Resistance; Antibiotics; Drugs. 

  Objectives: To detect the incidence of hypoglycaemia in Small for gestateonal age (SGA) neonates. Design: Hospital based prospective study in a maternitycentre in south India. Inclusion criteria: all inborn SGA neonates without major congenital anomalies. Sampling: three hundred SGA neonates were enrolled inthe study from 1 August 2008 to 1 November 2009. ntervention/Measurement: Random blood glucose levelswere estimated by the standard glucose oxidase peroxidase method at 1,6,12,24 and 48 hours of life during the first 2 days of life. Results: The incidence of neonatal hypoglycaemia in SGA newborns in thepre-sent study group was 28%. Out of 28%,20% were asylumptomatic.during 48 hours of monitoring 70% of hypoglycaemia events occurred in first 24 hours. Conclusions: hypoglycemia incidence is very high in SGA neonates particularly asymptomatic type. So needs serial monitoring in first 48 hours. 

Keywords: Neonate; Hypoglycemia; SGA; Asymptomatic.

Background: Subset of cases of preterm birth are because of preterm onset of labour pains in mother with no obvious risk factors. The optimal mode of delivery for women with preterm onset of labour without any obvious risk factor is controversial. Aim: To assess the outcome of newborns born by caesarean delivery versus vaginal birth for women with preterm onset of labour pains with no other risk factors. Settings and design: This prospective cohort study was conducted in a level III neonatal unit of a teaching hospital. Methods and material: Infants included in the study were all preterm babies less than 37 weeks of gestation, born to mother with preterm onset of labour pains without any obvious risk factors and admitted to neonatal unit within 48 hours of life. Exclusion criteria included infants with congenital malformations, multifetal gestation and infants born to mother with any bad obstetric history apart from preterm onset of labour pains. Our primary outcome measures were incidence of birth injury to the infant and birth asphyxia. Results: Incidence of birth injury, birth asphyxia, perinatal death and neonatal mortality was more in vaginal delivery group. However, there was no significant statistical difference between the two groups. Conclusions: We believe that planned caesarean section cannot be recommended as the routine mode of delivery in cases of preterm onset of labour without any other risk factors unless there are other recognized maternal or fetal indications.

Keywords: Birth Asphyxia; Birth Injury; Planned Caesarean Section; Preterm Labour; Vaginal Delivery.   

Background: Diabetes is a very common complication seen during pregnancy. Infants born to diabetic mothers are at a higher risk for hypoglycemia. Monitoring for hypoglycemia is necessary, but the duration and the frequency has yet to be determined. Objective: To estimate the magnitude of hypoglycemia among infants of diabetic mothers and to determine how long the glucose level has to be monitored for those infants. Materials and Methods: The retrospective study was conducted in a tertiary newborn centre from January 2016 to January 2018. The inclusion criteria included all babies above 34 weeks gestation and exclusion criteria included babies admitted in NICU, with mothers on glucose infusions during delivery, on beta blockers and on anti- epileptic drugs. Total 444 infants of diabetic mothers were recruited in the present study. Descriptive analysis like mean and standard deviation were done for quantitative variables. ANOVA (Analysis of variances) test was used to compare mean capillary blood glucose values. Results: Out of 444 infant studied, only four (0.9%) had hypoglycemia in the first 6 hours of life. All babies achieved normal glucose values by 12 hours of postnatal age, yet sampling continued although none of the remaining results yielded values < 40 mg/dL Conclusion: Glucose screening can be discontinued for all babies if feeding has been initiated and the initial three pre-feed values are above the normal range. For babies that are small for gestational age/ growth restricted (SGA/IUGR), monitoring should be tailored according to the baby’s feeding pattern and growth. 

Keywords: Hypoglycemia; Diabetes.

 

  Background: Acute renal failure is recognized complication of birth asphyxia. It carries a poor immediate prognosis and may result in permanent renal damage in upto 40% of survivors. Early recognition of acute renal failure is particularly important in asphyxiated neonates with HIE, in whom a stable biochemical milieu is vital, because it facilitates the administration of appropriate fluid and electrolyte replacement. Aim: To determine the incidence of renal failure in birth asphyxia and to correlate the severity of renal failure with HIE grading of asphyxiated neonates. Materials and Methods: 100 term (37-42 wks) neonates born with Apgar score of < 7 at 5 minutes after birth were selected as cases. All asphyxiated neonates (as per WHO definition) with clinical features of HIE are staged by Sarnat & Sarnat staging. Gestational age, birth weight relevant perinatal history examination findings are recorded in predesigned proforma. After 72 hrs and before 96 hrs of life blood was collected and sent for relevant investigations and clinical condition of the baby and urine out put was monitored and were managed accordingly. esults: Incidence of ARF in our study is 50 (50.0%) Among the 50 cases which had acute renal failure, 40 (80%) had pre-renal ARF and 10 (20%) had intrinsic ARF, and based on urine out put 15 (30.0%) had oliguric ARF and 35 (70.0%) had non oliguric ARF. Comparison of blood parameters among the cases with and without ARF showed that the renal parameters were raised in cases with ARF. Incidence of ARF correlated well with HIE staging. Among the 50 ARF cases 35 improved clinically after fluid therapy, 15 did not improve clinically after fluid therapy, 10 neonates died. Among the 10 neonates who died all 10 (10.0%) had oliguric ARF. Conclusions: Perinatal asphyxia is an important cause of neonatal renal failure. ARF in birth asphyxia is predominantly pre-renal ARF and responds to fluid challenge and it is of non oliguric type. ARF in birth asphyxia correlates well with HIE staging. Mortality is more in intrinsic ARF. Early diagnosis and management of renal failure helps in prevention of intrinsic renal failure and its consequences. A simple procedure like measuring urineoutput in birth asphyxia helps to detect intrinsic renal failure thereby preventing & reducing mortality. 

Keywords: Neonates; Birth Asphyxia; Hypoxic Ischemic Encephalopathy; Acute Renal Failure. 

  Introduction: First trimester abortion is the pregnancy loss in first trimester of pregnancy, before 12 weeks of gestation. Threatened miscarriage is a relatively common complication during pregnancy, occurring in approximately 20% of all pregnancies. Vaginal bleeding during the first trimester is associated with an approximate 5.5%–42.7% risk for subsequent complete miscarriage. Previous miscarriage, increasing maternal age, teenage pregnancy, stress, pollutants, smoking, obesity, vascular diseases (such as lupus), diabetes, other hormonal problems, maternal infections especially TORCH, and abnormalities of the uterus are some of the identified risk factors. Objective: Present study was conducted to study the profile of pregnant women admitted with complain suggestive of abortion during first trimester of pregnancy and to identify the risk factors associated with it. Methodology: This was a cross sectional study done in a tertiary care hospital of Mumbai, Maharashtra. All pregnant women in first trimester with the complain of one or more of the symptoms of abortion like spotting, bleeding, passage of fleshy mass, abdominal pain and passage of grape like substance were included in the study. Their profile was recorded and possible risk factors were identified. Results: Out of total 200 patients, 95 (47.5%) patients were having threatened abortion. Out of these 95 patients, pregnancy was continued in 53 (55.8%) patients. It was observed that more than half of the patients were having presenting symptom of bleeding and spotting. Abdominal pain was also a common complain. Around 46% of patients were from age group of 21 to 25 years. Most of the pregnancies were of Gestational age 8 to 12 weeks and most of the patients were having BMI of from 18.5 to 24.9. Around 73% of patients were having no history of previous pregnancy loss. Most of the patients having mild anaemia having haemoglobin level 8 to 10 grams. Out of total 200 study participant, 50 (25%) were TORCH Ig M positive and 103(52%) were TORCH Ig G positive. Apart from idiopathic etiology most common medical risk factor was active TORCH infection which was found positive in 25% of patients. Fever, UTI and Trauma were also among common associated illnesses. onclusion: Bleeding and spotting were the most common presenting symptoms. Patients of age group of 21 to 25 years were most commonly affected. Most of the pregnancies were of Gestational age 8 to 12 weeks and most of the patients were having BMI of from 18.5 to 24.9. In around 50% of patients any of the TORCH Ig MorIgG was positive. Most common risk factor was active TORCH infection which was found positive in 25% of patients. Fever, UTI and Trauma were also among common associated illnesses 

Keywords: First Trimester Abortion; TORCH; Bleeding; Spotting

  Background and objectives: Congenital heart disease is the most common form of heart disease in children affecting 7-8 per 1000 live births. Affected babies are mostly asymptomatic at birth. Although most are not pathologic, a murmur may be the sole manifestation of the heart disease. Materials and methods: This is a prospective observational study performed on new-borns delivered, admitted in NICU, attended OPD & neonatal follow up clinics at Kamineni Hospital, L.B. Nagar, Hyderabad during 16 months period. Total of 1120 neonates were evaluated during the study period of 16 months. Once the murmur was heard, murmur was reconfirmed by senior resident/consultant pediatrician and clinical diagnosis was made based on history and clinical examination. Echocardiography was done in all neonates with murmur for confirmation of the diagnosis. Neonates with gestational age < 28 weeks were excluded from the study for PDA. Results: Out of 1120 babies examined, 48 babies (4.28%) found to have murmur. While out of 48 babies with murmur, 27 (56.25%) were male & 21 (44.75) were female babies. Out of total 817 term babies examined, 32 babies (3.91%) had murmur. Total 303 preterm babies examined, 16 babies (5.2%) were found to have murmur. History of consanguinity was present in 11 babies (22.92%) out of total 48 babies with murmur. Majority of babies (87.5%) had no significant family history. Maximum no. babies (41.66%) were presented without any maternal risk factor. The most frequently associated risk factor was polyhydramnios 20.83% (10 cases). No. of murmurs detected in the first 24 hrs of birth are least. 32 out of 48 were asymptomatic. Total 16 cases were diagnosed clinically as VSDs out of which 10 confirmed by echocardiography. Clinically 12 cases were diagnosed as PDA, but 13 was the no. diagnosed on echocardiography as PDA. The total number of ASDs diagnosed clinically were 7 in all, of these 3 were diagnosed and confirmed by ECHO. Out of 14 acyanotic congenital heart diseases 4 were diagnosed clinically. 5 out of 5 functional murmurs were detected by clinical examination. 2 out of 3 complex cyanotic congenital heart diseases were diagnosed as complex cyanotic congenital heart disease but could not specify the lesion by clinical examination. Conclusion: Although clinical evaluation could determine the presence or absence of heart disease in most neonates, the lesion-specific diagnosis was not quite satisfactory. Echocardiography is necessary for neonates with a clinically diagnosed heart disease or possible heart diseases, and may be unnecessary for those with innocent murmurs diagnosed by paediatricians. 

Keywords: Echocardiographic; Neonates; Heart Murmur.  

  Background: The incidence of intussusceptions is common in children from age between 9 months to 11 months, as described in literature. This study aimed to discuss the incidence and occurrence of intussusceptions in children less than 1 year of age. Little information is available on intussusceptions in the young infant. Here, we describethe changing trend in intussusception. Methods: The infants (<1 year of age) presenting with intussusceptions were included in the study
conducted during the period from march 2012 to april 2017. Results: An overall 55 patients were included in our study in which there were 36 boys and 19 girls. The cases were analyzed according to their age of presentation, symptoms of presentation and their duration of presentation. Conclusion: As compared to the literature we found a changing trend in the age of presentation. 

Keywords: Intussusception; 3-6 Months Of Age; Weaning Diet; Rotavirus Infection

  Objective: The aim of the study is to explore the various risk factors for uterine rupture and to evaluate the fetomaternal outcomes in this cases.Methods: This study was conducetd at a tertiary care center during the period of 4 years between 1st January 2014 to 31st December 2017. Cases of uterine rupture were studied retrospectively regarding various risk factors via relavent history and operative findings. Thereafter fetal and maternal outcome were studied retrospectively. Results: Analysis of the study suggest that out of all deliveries during 4 years, 25 cases of rupture uterus were found. Various factors were studied. Study suggests that 52% rupture occurred in age group of 24-30. 88% uterine rupture occurred during gestational age >37 weeks. Highest 56% incidence found in second gravid and least 4% incidence was in primigravida. Previous 1 cs has highest 80% and previous 2 r more CS has lowest 4% incidence of rupture uterus. 64% uterine rupture occurred when labor was induced or augmented. 66.7% incidence found in previous CS without VBAC, 19% in cases with 3 or more VBAC, 9.5% in previous CS with 2 VBAC and least 4.8% incidence found in previous CS with 1 VBAC. Incidence of rupture uterus is highest 57.1% when previous CS before <2 years and the incidence subsequently dicreases with increased duration of prior CS with least 19.1% when previous CS >4 years. There is 8% mortality occurred in cases of ruptured uterus in this study. Out of 25 cases, obstetric hysterectomy was done only in one case which is 4%.28% cases haddeveloped DIC. Out of 25 cases, 24% were stillbirths and 12% were motherside. 64% newborns were admitted to NICU. 40% newborns were discharged heathy and 24% newborns were expired. Overall fetal loss in ruptured uterus is 48%. Conclusion: Incidence is very much high in previous scar labor than in primigravida or previous normal delivery. Chances of rupture increase withearly conception after scar delivery, grand multiparity, induction or augmentation of labor, numbers of VBAC and late gestational age. Age of pregnant womenis not affecting the incidence of uterine rupture. Maternal mortality and incidence of obstetric hysterectomy is rare but fetal mortality and morbidity is high in case of ruptured uterus. 

Keywords: Rupture of Uterus; Previous CS; VBAC; Hysterectomy; Maternal Mortality