Indian Journal of Maternal-Fetal & Neonatal Medicine

NICU are doing the job effectively and increasing life span of neonate. There are many concepts, theories, principles and norms which define what ethical and legal medical practice is. Medical ethics defines what is ethical and legal practice, how much variation within it can be done and what lies outside of it. Decision making must be the routinely used process, requiring shared information among doctor and nurses and willingness and capability to effectively communicate with parents.

Keywords: Ethical issues; Neonatology; counseling

There are only two properties that can determine if an object is alive: metabolism and motion. Movement is the most convincing and visible indicator of life. Since fetal movement is a sign of fetal health, decreased movement is a cause of concern. Maternal perception of fetal movement is an inexpensive and non-invasive method of assessment of fetal well-being. Maternal perception of reduced fetal movements (RFM) is associated with adverse pregnancy outcomes including fetal growth restrictions, oligohydramnios, still birth. Decreased fetal movements are regarded as a marker for suboptimal intrauterine conditions. A wide range of investigations are performed for the complaint of reduced fetal movements after clinical examination. In low resource settings, maternal perception of reduced fetal movement plays vital role in early detection of fetal jeopardy. This will facilitate timely intervention and prevent adverse perinatal outcome.

Keywords: Reduced Fetal Movement; Fetal well-being; Stillbirth; Intervention.

Fetus has been given individual status and rights. Congenital malformations of fetus are diagnosed antenatally through ultrasound and prenatal testing. Congenital anomaly is defined as abnormality of structure, function or metabolism that is present at birth. The gestational age at which severe malformation is diagnosed is crucial for the further management of pregnancy. Prenatal diagnosis of congenital malformation provide information for decision during pregnancy and treatment perinatally. Decision regarding aborting a malformed fetus is challenging in view of human rights, balancing rights against each other is essential. The right to the life of mother and same right of the fetus.

Keywords: Fetus; Malformation; Ethics; Perinatal Mortality.

Objectives: To find out the perinatal outcome of pregnancies with polyhydramnios. Methods: This is a retrospective study carried out at ACPM Medical College Dhule. 100 pregnant women who were diagnosed with polyhydramnios by USG from 24 weeks onwards till 40 weeks were followed for risk factors, complications, incidence of fetal congenital anomaly, severity of polyhydramnios, mode of delivery and neonatal outcome. Result: Study showed that the incidence of polyhydramnios was higher in 20–30 years of age group. 83% were multi and 17% were primi. 65% were delivered at term, 35% were preterm labour. 63% patient delivered vaginally and 37% by C-section. 29% neonates were associated with congenital anomalies, of which 14% were associated with spina bifida, 6% with diaphragmatic hernia, 4% with hydrocephalus, 3% with anencephaly and 2% with oesophageal atresia. Perinatal death rate is 12%. Conclusion: A good clinical examination can usually identify subjects with polyhydramnios. Every case of polyhydramnios needs careful antenatal evaluation, parental counselling, individualized decision regarding timing and mode of delivery. Continuous intrapartum fetal monitoring and good neonatal care are necessary for better perinatal outcome.

Keywords: Polyhydramnios; Perinatal outcome; Preterm labor; Congenital anomalies.

Background: Amniotic fluid is an important part of pregnancy which plays a vital role in the normal growth of the fetus and, promotes muscular-skeletal development and allows for easier fetal movement, also its very crucial for the survival of the fetus. It also create hydrostatic wedge which helps in dilatation of cervix during labour. Women with oligohydramnios are more likely to have abnormal or non-reactive FHR tracings, increased incidence of fetal distress, and thus an increased incidence of caesarean sections. Oligohydramnios is also the leading indication for labor induction. Aims: (1) To know the proportion of the oligohydramnios. (2) To study the impact of amniotic fluid index on mode of delivery. (3) To study the impact of amniotic fluid index on perinatal outcome. Study design: Prospective Descriptive hospital based study. Material & methods: The study was conducted in department of obstetrics and Gynaecology, at Tertiary care center. Statistical Analysis: Data was analyzed using SPSS Ver 23. Frequencies, Descriptive, chi square test were done. Result: Out of total 384 patient, 80 patient had oligohydramnios (AFI <5 cm). oligohydramnios associated with high rate of induction of labour (86.3%), meconium stained liquor (70.1%) and fetal distress (40%), that lead to high rate of LSCS (63.8%) and NICU admission (30%) and high neonatal complication like birth asphyxia, RDS, Jaundice, MAS, Septicemia which was 23.75%, 16.3%, 25%, 6.3%, 6.3% respectively. Conclusion: 1. Determination of AFI is a valuable screening test for predicting fetal distress & neonatal outcome. 2. From study, it is suggested that antepartum evaluation of amniotic fluid volume may prove useful in reducing perinatal mortality and morbidity and improving pregnancy outcome.

Keywords: Oligohydramnios; Amniotic fluid volume; Induction of labour; Perinatal Outcome.

Introduction: Incidence of meconium stained amniotic fluid (MASF) is about 10–15% of all pregnancies which isrelated with maturation of the fetal Gastrointestinal Tract (GIT) but may also be associated with unfavorable neonatal outcome. Objectives: Aim of our study was to study the fetomaternal outcome in cases with meconium stained amniotic fluid. Materials and Methods: The present study was conducted in Maharishi Markandeshwer Medical College & Research Center, Ambala. Total 100 cases with MSAF fulfilling the inclusion criteria were included in the study. All the parameters were analyzed to identify the various fetomaternal outcome. Results: we found that the incidence of MSAF was 10.8%, thin MSAF was seen in 74% cases andthick MSAF in remaining 26%. MSAF was present frequently in primigravidas and with increase ingestational age. The incidence of abnormal FHR pattern was common in the thick meconium group (69.2%) as compared to thin meconium group (18.9%). The most common mode of delivery in cases with thin MSAF was normal vaginal delivery (51.5%) while in cases with thick MSAF was by lower segment caesarean section (LSCS) (61.5%). The incidence of NICU admission in thin MSAF group was 18.9% while in thick MSAF 46.1% required NICU admission. Conclusion: As the incidence of perinatal morbidity and mortality is more in cases with meconium stained amniotic fluid, henceforth the patients with meconium staining of amniotic fluid needs to be monitored vigorously with timely interventions and proper neonatal resuscitation.

Keywords: MSAF-Meconium Stained Amniotic Fluid; LSCS; Fetal Gastrointestinal Tract (GIT).

Background: Preeclampsia affects 2-8% of pregnancies and is a major cause of maternal and perinatal morbidity and mortality. Without intervention, the mother is at substantial risk for seizures (eclampsia), renal and liver failure, pulmonary edema, stroke, and death. Preeclampsia is also recognized as a major risk factor for cardiovascular disease later in life for both the woman and her child. HCG has many important functions during pregnancy including promotion of progesterone production, implantation and decidualization, angiogenesis, cytotrophoblast differentiation and immune cell regulation. AFP serum levels during pregnancy also have been used as an ancillary aid in the diagnosis of placental abnormalities, fetal death, growth restriction/retardation, and preterm labor. Aims and Objective: 1. To evaluate maternal serum mid-trimester human chorionic gonadotropin (HCG) and alfa-fetoprotein levels (AFP). 2. To look for correlation between maternal serum mid-trimester human chorionic gonadotropin and alpha-fetoprotein levels with development of preeclampsia. Material and Methods: Study Design: Descriptive and observational prospective study. Study Area: The study was conducted in department of obstetrics and Gynaecology, at Tertiary care center. Statistical Analysis : Data was analyzed using SPSS Ver 23. Frequencies, Descriptive, chi square test were done. Results: The mean AFP who developed severe preeclampsia was 58.84 ± 7.01 ng/ml compared to 42.85 ± 15.27 ng/ml who developed mild preeclampsia compared to 32.42 ± 8.17ng/ml who remained unaffected during study (p < 0.05). The mean β HCG who developed severe preeclampsia was 58510.00 ± 9065.68 mIU /ml compared to 42398.13 ± 13615.98 mIU /ml who developed mild preeclampsia compared to 29154.24 ± 12330.26 mIU /ml who remained unaffected during study (p <0.05). Conculsion: Elevated levels of maternal serum AFP & β hCG measured between 14 – 24 weeks of gestation have significant positive correlation with pre-eclampsia & adverse obstetric outcome. Second trimester markers (AFP & β hCG) may be used as predictor of preeclampsia.

Keywords: Preeclampsia, Alfa feto protine (AFP), Human chorionic gonadotropin (HCG)