Indian Journal of Maternal-Fetal & Neonatal Medicine

Placenta is the link between mother and foetus. A healthy placenta is the single most important factor in producing a healthy baby. Placenta plays a vital role in all aspects of pregnancy from implantation to delivery. Fetal growth may be affected by changes in maternal-placentofetal transport of nutrients, energy producing substrates and oxygen. Abnormal placentation results in poor placental perfusion and placental insufficiency. Placenta is the central support organ for developing foetus.

Keywords: Placenta; Fetal Growth; Placental Insufficiency; Hormones.

Aim: The present study was undertaken to know the incidence of polyhydramnios and oligohydramnios in our hospital. Method: This prospective study conducted on 150 antenatal women between 28 to 42 weeks of gestation. 50 pregnant women with oligohydramnios, 50 women with normal amniotic fluid index (AFI) and 50 women with polyhydramnios were studied. Results: The incidence of oligohydramnios was 4% and polyhydramnios was 1%. In oligohydramnios group, 56% were primi gravida and 44% women were multigravida. In polyhydramnios group, 64% were multigravida and 36% were primigravida. Induction of labour was done in 66% of oligohydramnios women. In polyhydramnios group, 60% had vaginal delivery and 40% women underwent caesarean section. Meconium staining of liquor was seen in 16% of oligohydramnios, 14% of polyhydramnios and 14% of normal AFI women. In oligohydramnios, 8.16% of the babies had APGAR < 7 at 5 min, 26% had birth weight <2.5 kg, newborn intensive care unit (NICU) admission was seen in 20.4% and PNM was 2%. In polyhydramnios, 10.8% of the babies had APGAR < 7 at 5 min, 14% had birth weight <2.5 kg, NICU admission was seen in 21.7% and perinatal death was 16%. Congenital anomalies were seen in 2% of oligohydramnios babies, 13% of polyhydramnios and 2% of normal AFI group babies. Conclusion: Amniotic fluid assessment has become an important part of ante-partum fetal surveillance and also it has a prognostic value for fetal and new born outcome.

Keywords: Amniotic Fluid Index; Maternal outcome; sonography.

Background: Oligohydramnios is a severe and common complication of pregnancy that is associated with a poor perinatal outcome 1. Aim of this study is to identify etiological factors and to suggest measures needed to improve the perinatal outcome in pregnancies complicated by oligohydramnios. Methods: This is a descriptive prospective cross-sectional, hospital-based study, carried out at Dept of Obgy, GGH Jamnagar in the period from Sept 2017 to Aug 2018. The studied population were 100 pregnant women diagnosed as cases of oligohydramnios by sonologists using the criterion AFI less than or equal to 5 The data was collected using questionnaire, labor ward records and NICU records. The collected data were coded in a master sheet and analyzed by computer. Results: 44% participants were belonged to 23 to 27 age group and 58% participants were primigravida. 62% represented the group 13 to 26 weeks gestation. Study found FMC <10 in 51% of participants. 67% patients had c/f of PET. 47% delivery was done by vaginal route. 6% babies were still born and prematurity was the most common cause of still birth. Around 56% babies were low birth weight and congenital anomalies were present in 1% babies. APGAR score measured <7 at 1 minute was in 47% and <7 at 5 minutes was in 29% babies. 3% babies had NSAID exposure and perinatal mortality amongst those not protected by betamethasone coverage was 5%. Conclusion: Various risk factors that lead to oligohydramnios are identifiable and recognition of risk factors for oligohydramnios constitutes a part of basic prenatal and antenatal care. Routine AN corticosteroids coverage in patients of oligohydramnios and i.v. hydrotherapy can improve the perinatal outcome in pregnancies complicated by oligohydramnios. 5 min APGAR score, either alone or in combination of 1 min score instead of only 1 min score alone, is a better predictor of neonatal outcome.ELLSCS is the preferred mode of delivery and induced vaginal delivery is discouraged in cases of oligohydramnios.

Keywords: Oligohydramnios; Etiology; Risk factor; Management; Prognosis.

Background and objectives: Hyperbilirubinemia is associated with hearing impairment. This study was aimed to evaluate the incidence of hearing impairment among the term neonates with hyperbilirubinemia by using otoacostic emission (OAE) and auditory brainstem response (ABR). Methods: This one year hospital based prospective observational study was conducted from January 2017 to December 2017. A Total of 190 healthy term neonates with hyperbilirubinemia admitted at KIMS, Hubballi during the study period were studied. Most of the neonates were boys (60.53%) and boy to girl ratio was 1.53:1. History of consanguineous marriage was noted in 6.32% of the parents. The mean age was 4.73 ± 2.65 days. Majority of the neonates (97.37%) weighed between 2.5 to 3.5 Kg. The mean birth weight was 2.84 ± 0.84 Kg. The mean direct bilirubin levels were 0.88 ± 29 mg/dL and mean total bilirubin levels were 17.3 ± 2.58 mg/dL. During OAE-I, 33.16% of the neonates were advised to refer for second OAE and during OAE-II, 2.63% of the neonates were advised to undergo BERA. The incidence of hearing impairment based on BERA findings was 2.63%. 60.53% of the babies were born by LSCS while 39.47% were born through vaginal route and all the babies with hearing impairment had vaginal delivery while none of the baby with LSCS had hearing impairment (p=0.009). No association was found between hearing impairment in neonate with sex, age at admission and history of consanguineous marriage in parents and total bilirubin levels (p>0.050). Also the mean direct bilirubin, total bilirubin, birth weight, duration of NICU stay and age admission (p>0.050) were similar in babies with and without hearing impairment. Conclusion and interpretation: The present study showed incidence of hearing impairment as 33.16% based on OAE examination and 2.63% based on BERA.

Keywords: Auditory brainstem response; Hearing impairment; Hyperbilirubinemia.

Ninety six patients with respiratory distress were admitted in NICU. 62 (64.5%) were males, 34 (35.4%) were females. 33 (34.3%) had more than 34 weeks gestation age, 63 (65.6%) had less than 34 weeks gestation age. 44 (45.8%) newborn had <1500 gram body weight, 52 (54%) newborn had >1500 gram body weight. Clinical manifestation were 30 (31.2%) had nasalflaring, 24 (25%) had chest in drawing, 14 (14.5%) had cyanosis, 12 (12.5%) had grunting, 9 (9.3%) were lethargic & 7 (7.2%) had hypothermia. The etiology was 20 (20.8%) had HMD, 17 (17.7%) had BA, 15 (15.6%) had MAS, 13 (13.5%) had TEF, 5 (5.2%) had CHD, 9 (9.3%) had TTN, 11 (11.4%) had Pneumothorax & 6 (6.21%) were Anemic. 21 (21.8%) had vaginal delivery, 59 (61.4%) had elective caesarian, 16 (16.6%) had emergency caesarian. Among the culture positive (39) common organism observed were Kleibesella 16 (41%), Pseudomonas 23 (23.9%), E-coli, 19 (19.7%), S.auresis 12 (12.5) and CONS. Apart from antibiotics neonates were treated - 39 (40.6%) with oxygen, 27 (28.1%) with mechanical ventilator, 21 (21.8%) withcontinuous positive airway pressure, 7 (7.2%) with surfactant  & 2 (2%) with surgery. The discharge profile of neonates was, in 20 HMD cases 5 (25%) had deaths, in 17 BA 3 (17.6%) had death, in 15 MAS 2 (13.3%) had deaths, in 13 TEF 3 (23%) had deaths in 5 CHD, 1 (20%) had death, in 11 Pneumothorax 2 (18.1%) had deaths & in 6 anemic 2 (33.3%) had death. This practical approach to neonates with respiratory distress of different etiologies to cure will be quite helpful to guide theNeonatalogists, Pediatrician, Microbiologists and hospital personnel to handle such neonates efficiently and avoid morbidity and mortality as there is high mortality rate in neonates globally because of ambiguous clinical manifestations.

Keywords: Neonates; North Karnataka; Respiratory distress; Gestational age.

Context: Umbilical cord is the lifeline of foetus. The usual time of separation of umbilical cord is 7 to 10 days. Some studies have shown that factors like sex, birth weight and mode of delivery affect the time of separation of umbilical cord.

Aims and objectives: The aim of this study is to investigate the time of separation of umbilical cord in the neonates and its relationship with various factors like sex, birth weight, gestational age and mode of delivery. 

Methodology: Prospective study done at postnatal ward of KIMS, Hubli during May and June, 2018.

Results: A total number of 174 babies were enrolled in the study. Cord separation in order of frequency; 78 babies (44.8%) was between 4 to 6 days; for 59 babies (33.9%) between 7 to 10 days; for 21 babies (12.1%) after 10 days; for16 babies (9.2%) between 0 to 3 days. The earliest day of cord separation was 2 days on which 6 babies (3.4%) had cord fall and two babies (1.1%) had cord separation as late as 18 days. The meantime of separation of umbilical cord was 7.02 days. There was no statistical significance for cord separation between neonates of different mode of delivery, sex, gestational age and birth weight.

Conclusion: The meantime of separation of umbilical cord was 7.02 days. No relation could be established between time of cord separation and mode of delivery, sex, gestational age and birth weight.

Keywords: Umbilical Cord; Cord separation.

Context: Ovarian malignancy is a clinical entity that is diagnosed late, that is in an advanced stage of the disease. The present study highlights the correlation between the clinical and pathological features of neoplastic lesions of ovary in order to arrive at a better understanding of the disease process. The objective of study is to assess the overall incidence of various histological types of ovarian neoplasm, the pattern of occurrence of ovarian tumors in relation to age, parity and modes of presentations and to study the histopathological findings of various ovarian tumors. Aims: To study frequency and clinical presentation of ovarian malignancies and to correlate the clinical presentation of ovarian malignancies with the histopathological findings. Setting and Design: This cross sectional study was carried out at a tertiary care center catering both rural and urban population. Materials and Methods: Cases diagnosed with ovarian malignancy over a period of 4 years from April 2014 to March 2018 were included. Data was collected from the indoor files at the time of discharge. Data included detailed history of the women including history of presenting complaints, family history of malignancy, duration of symptoms to reporting to hospital, menstrual history and obstetric history. Relevant investigations like tumor markers level (CA125, inhibin, beta HCG, alpha fetoprotein, Alkaline phosphates) and USG findings were noted and CT scan reports were noted. Correlation of clinical diagnosis with histopathology was done. Statistical Analysis used: Statistical analysis was done as percentages of selected subjects and application of p value and Chi square test (wherever applicable).

Keywords: Ovarian Malignancy; Neoadjuvant chemotherapy; Tumor Marker; Histopathology.

Context: Persistent pulmonary hypertension (PPHN) is a serious neonatal illness, with significant morbidity and mortality. Limited data are available about PPHN in our set up and thus this study was done. Aims: To assess the prevalence and risk factors of PPHN in ventilated term neonates. Settings and Design: Prospective observational study conducted at NICU, JSS medical hospital, Mysuru from January 2015 to January 2016. Methods and Material: All ventilated term babies were diagnosed PPHN, provided they had right to left or bidirectional hemodynamic shunting at the ductus arteriosus or at patent foramen ovale along with tricuspid regurgitation jet >35 mm of Hg on echocardiography. The demographic, maternal, antenatal, natal and postnatal data were recorded on a predesigned proforma. Statistical analysis used: Student T test and Chi square were used to find the association between qualitative variables. Results: Out of 72 ventilated babies enrolled, 48 (66.7%) babies developed PPHN. Meconium aspiration syndrome, birth asphyxia, septicemia, polycythemia, metabolic acidosis, cesarean section, maternal gestational diabetes mellitus were associated with an elevated risk for PPHN. Conclusions: PPHN is a serious condition frequently encountered in ventilated term neonates . The prevalence of PPHN can be reduced by providing good antenatal care, regular follow up of high risk pregnancy, efficient resuscitative measures at the time of birth.

Keywords: Persistent pulmonary hypertension; Neonates; Risk factors.

Introduction: Inflammatory processes have been proposed to have a role in maintaining the patency of Ductus Arteriosus. Red cell distribution width (RDW) levels escalate in the presence of inflammation. Our aim was to evaluate the role of red cell distribution width to platelet ratio (RPR) in predicting the closure of hemodynamically significant patent ductus arteriosus (hsPDA) in response to paracetamol therapy in preterm neonates. Methods: A prospective comparative study was conducted on preterm neonates less than 37 weeks of gestation diagnosed with hsPDA after obtaining Institutional ethical clearance and detailed informed consent from the parents. All the neonates were treated with oral paracetamol for 3 days and then reassessed for closure of PDA. RDW and platelet counts were analyzed within 24 hours of life and RPR was then calculated. Preterms with sepsis, anemia, asphyxia, major congenital malformations were excluded from the study. Results: 108 preterm neonates were admitted to the NICU during the study period, of which 50 neonates were included in the study. Ductus closed in 28 preterms following treatment by day 3. Mean RPR was found to be lower in the neonates in which the ductus closed by day 3. An RPR cut off of 0.12 having AUC of 0.769 had sensitivity of 68% and specificity of 86% with PPV and NPV of 79% and 77% respectively for the prediction of Ductus Arteriosus closure. Conclusion: Our study shows that RPR can be used as a simple and effective screening tool in foreseeing the successful closure of hsPDA with pharmacotherapy.

Keywords: Ductus Arteriosus; Ductal patency; Paracetamol; Inflammation.

Context: Phototherapy treatment for hyperbilirubinemia in neonates may result in development of hypocalcaemia. The study is done to assess role of calcium prophylaxis and head cap in the prevention of phototherapy induced hypocalcemia. Aims: To compare the efficacy of head cap versus calcium supplementation in preventing phototherapy induced hypocalcemia. Settings and Design: Prospective study undertaken in NICU at JSS Hospital, Mysuru from January 2013 to June 2014. Methods and Material: This study was conducted on 150 full term neonates (50 in each group: Group A - only phototherapy, Group B - phototherapy receiving oral calcium prophylaxis, Group C - phototherapy with head cap). Serum ionized calcium levels were measured before and after phototherapy. Statistical analysis used: Statistical analysis done by SPSS software 19.0 version. Results: In control group (Group A), 28 (58.3%) neonates showed decrease in serum ionized calcium levels following phototherapy out of which, 11 (22.9%) developed hypocalcemia. Mean serum ionized calcium levels before phototherapy was 1.193 mmol/L and after phototherapy 1.06 mmol/L. In group Group B, 27 (56.3%) showed a decrease in serum ionized calcium levels following phototherapy of which, three (6.3%) developed hypocalcemia. The mean serum ionized calcium levels before phototherapy was 1.219 mmol/L and after phototherapy 1.172 mmol/L. In Group C, 30 (62.5%) neonates showed a decrease in serum ionized calcium levels following phototherapy of which, nine (18.8%) developed hypocalcemia. Mean serum ionized calcium levels before phototherapy was 1.25 mmol/L and after phototherapy, it was 1.14 mmol/L. None of the neonates in all group who showed a drop in serum ionized calcium levels below one mmol/L developed any signs of hypocalcemia. Conclusions: Neonates under phototherapy can develop hypocalcemia as a complication. Oral calcium supplementation to neonates under phototherapy would be beneficial in preventing phototherapy induced hypocalcemia.

Keywords: Hyperbilirubinemia; Phototherapy; Ionized Calcium; Hypocalcemia; Head Cap.

Background and Aim: Abnormal Uterine Bleeding (AUB) is one of the most common health problems encountered by women. It affects about 20% women of reproductive age, and accounts for almost two thirds of all hysterectomies. Present study was done with an aim to To evaluate the role of chromohysteroscopy in detection of intracavitary lesions in perimenopausal women with abnormal uterine bleeding. Material and Methods: Present study was the prospective one in subjects of 95 perimenopausal women aged >42 years who presented with complaints of abnormal uterine bleeding. Following the necessary pre-operative preparation, all women underwent diagnostic hysteroscopy, chromohysteroscopy and targeted under suitable anaesthesia, fully assembled hysteroscope. A total of 32 cases in our study group underwent hysterectomy and specimens were sent for histopathology. Histopathological examination was carried out by a clinical pathologist who was blinded regarding hysteroscopic findings. Diagnostic accuracy of hysteroscopy and chromo hysteroscopy in detection of intracavitary lesions was then studied. Results: Mean age of the study group was 42.50 ± 3.89 years, average parity was 3 and mean BMI was 25.1 ± 3.45 Kg/m2. Thirty nine percentage cases presented with menorrhagia, 36% with polymenorhagia, 8% with metrorrhagia and 5% with postmenopausal bleeding. A total of 32 cases in our study group underwent hysterectomy. In 20 of them intracavitary lesions were detected on hysteroscopy. In the rest cases, no intracavitary lesion was visualized on hysteroscopy. The diagnostic accuracy of chromohysteroscopy in detecting intracavitary lesions as unstained areas was also found to be significantly high. Conclusion: Thus it is concluded that the diagnostic accuracy of both hysteroscopy and chromohysteroscopy in detecting intracavitary made these lesions look more prominent and effortlessly identifiable to the observer, thereby minimizing inter-observer variations. A well outlined lesion is difficult to miss and less likely to involve conflicting diagnoses.

Keywords: Abnormal Uterine Bleeding; Chromohysteroscopy; Hysteroscopy; Intracavitary lesions.

Objective: To find out the various causes and their frequency in cases of intra uterine foetal death. Methods: This study is conducted at the department of obstretics and gynaecology of M.P., Shah medical college and GG hospital, a tertiary care center during the period of 9 months between 1st April 2017 to 31st December 2017. Patients presenting after 28 completed weeks of pregnancy including patients in labour were included in this study. Patients were subjected to detailed history, examination, investigations and followed up before, during and after labour to find out the causes of iufd. Results: During the time period the total number of deliveries was 5702 and the total number of patients with intra-uterine foetal death was 190 (3.33%). The most common cause of intrauterine foetal death was meconium aspiration 46 (24%)antepartum hemorrhage (APH) in 32 cases (16.84%), followed by congenital anomaly in 11 (5.78%) cases, cord prolapse in 11 (5.78%) cases, PET in 10 (5.2%) cases and no cause found in 80 cases(42.10%). Out of these 80 cases 60 were uninvestigated cases who presented for the first time in labour room. Conclusion: Encouragement of antenatal visits is the most important factor in preventing fetal death as it is the group with highest fetal deaths followed by improving intrapartum monitoring to prevent fetal deaths due to meconium aspiration syndrome by timely interventions. Also identification of high risk cases and their prevention, management can reduce iud in these cases.

Keywords: Intrauterine Death; Stillbirth.

Introduction: Low birth weight (LBW) is the global indicator of public health and is the most important determinant for neonatal and infant survival. Apart from Essential Newborn care, as mentioned in Home Based Newborn Care (HBNC) guidelines, mothers of these babies need to be aware of their special needs.Therefore, this study was conceived, to assess knowledge of mothers regarding LBW care at home. Objective: To assess knowledge regarding the readiness of mothers for home-based care of LBW babies with respect to Providing warmth, Breastfeeding, Prevention from infection, Immunization, Kangaroo Mother Care, Supplementation and Assessing the Dangersigns. Methodology: A cross-sectional, analytical, Directive open-ended questionnaire-based study over three months duration in 1498 Postnatal Mothers admitted in tertiary care institute. Questionnaire was framed and collected data was analyzed with the help of IBM-SPSS version 2016. Results & Conclusion: Considering the Inclusion and Exclusion criteria, 1498 mothers completed the questionnaire. Awareness with respect to “Providing warmth” 24.64%, “Breastfeeding” 19.02%, “Prevention from infection” 17.66%, “Immunization” 59.39%, “Kangaroo Mother Care” 18.35%, “LBW Supplementation” 20.66%, and that about the Danger signs was 10.98%. This awareness was low irrespective of Literacy, Age of Mother, Parity, Rural or Urban Status and multiple ANC Visits. HBNC programs involving community participation must insist on problems of LBW and prepare mothers for the same. 

Keywords: Low Birth Weight; Readiness; Home Based Care; Newborn