Indian Journal of Maternal-Fetal & Neonatal Medicine

The estimation of gestational age (GA) is important in planning appropriate treatment for the infant and to modify details of care. The development of many neonatal issues in the immediate postnatal period is dependent on gestational age. Hence its accurate assessment is essential for perinatal practice. The best estimate of GA is based on sonography if it is performed before 22 weeks of gestation. When a consistent date of last menstrual period (LMP) or an early sonographic report is not available, postnatal assessment methods of newborn maturity is required. Widely used Expanded new Ballard Score with physical and neurologic criteria is complex and needs trained personnel to execute. Scores using physical criteria alone are easy to perform, less time consuming and has good interobserver reliability. These can be performed reliably even by non-pediatricians compared to score containing both physical and neurological criteria.

Keywords: Gestational Age; Ultrasonography; New Ballard Score; Eregie Score; Parkin Score.

Screening in pregnancy is of surveying a population of women with markers to identify those at higher risk of particular disorder. Biochemical markers are building blocks for screening tests. Alphafetoprotein is used to identify pregnancies at high risk of neural tube defects. Its implication extended beyond NTDs screening to detection of other anatomic malformations, multiple pregnancy, Down’s syndrome, other aneuploidies and placental disease. There are variables affecting serum AFP. Estimation of maternal serum alpha- fetoprotein is found to be one of the cost effective and non-invasive screening method.

Keywords: Alpha Fetoprotein; Screening Tests; Biochemical Markers; Neural Tube Defects.

Background: Premature rupture of membranes (PROM) has an incidence of about 5-10% of all pregnancies and is a significant event as it can cause maternal complications, neonatal morbidity and mortality. Some believe that the expectant management of PROM at term reduces the perinatal and maternal morbidity, and immediate induction of labour leads to high rate of caesarean section. Some authors reported a significant increase in the rates of neonatal, maternal infection and foetal distress if delivery occurs over 24 hours after PROM. Thus, a data is required to manage the cases of PROM to effect safe delivery for both mother and baby. The objective of the study was to compare the neonatal and maternal outcomes between immediate and delayed induction with tab misoprostol in term PROM. Methods: This study was conducted in Department of Obstetrics and Gynaecology, Command Hospital Air Force, Bangalore as a randomized comparative interventional study on 60 patients with confirmed PROM at term 37 to 40 weeks gestation. These patients were randomly divided into two groups by using computer generated random system of allocation after fulfilling the inclusion and exclusion criteria. Group A (immediate) received misoprostol within 6 hours of PROM and Group B (delayed) received misoprostol after 6 hours of PROM. history was elicited regarding age, menstrual and obstetric history with enquiry regarding the time of rupture of membranes, duration and amount of leaking with general, systemic and detailed obstetric examination. Augmentation of labour if required was done with oxytocin infusion. Results: The number of misoprostol tablets needed for induction varied between the two groups. There was difference in maternal and neonatal morbidity and which was statistically significant (p value <0.05). Among delayed group, 6 (20%) subjects had maternal morbidity (intrapartum fever, GIT symptoms, PPH, LSCS) and 6 (20%) neonatal morbidity (foetal distress, meconium aspiration syndrome, neonatal sepsis, NICU admission) was recorded. No maternal complication among immediate induction group whereas one case of respiratory distress observed in neonates.

Keywords: Labour Induction; Oral Misoprostol; Premature Rupture of Membranes; Immediate and Delayed.

Aim: To study rebound hyperbilirubinemia in post-phototherapy neonates. Methods: A prospective observational study was conducted in pediatric tertiary care hospital. 156 neonates were recruited in the study and phototherapy was given according to guidelines. After consent, detailed history was taken and clinical examination were carried out for both groups. They were subsequently estimated for rebound hyperbilirubinemia usually 24±6 hrs after cessation of phototherapy. Serum bilirubin (total and direct) was measured at the end of phototherapy, after 24±6 hours of stopping phototherapy. Results: Statistically significant association found with risk factors include gestational age <35 weeks (p value 0.004), low birth weight (<2000gms) (p =0.047),, haemolytic causes(p value <0.001), age at onset of jaundice, duration of primary phototherapy <72 hrs(p value of 0.034). 50% neonates recovered within 24-48hours of phototherapy & 44.4% required phototherapy for ≥48 hours. This result bears significant statistical correlation (p value 0.002).The mean duration of hospital stay is 5.32 ± 1.85 days and it was observed that majority of babies (56.4%) with significant post-phototherapy rebound hyperbilirubinemia had stayed for 5-8 days in the hospital before discharge. Conclusion: In this study it is found that rise of serum bilirubin to a significant level after phototherapy cessation is present in 11.5% of cases. The etiological risk factors include gestational age <35 weeks, low birth weight (<2000gms), haemolytic causes, age at onset of jaundice, duration of primary phototherapy <72 hrs. Retreatment with phototherapy was found to be an effective therapy for neonates with significant post phototherapy rise of serum bilirubin.

Keywords: Phototherapy; Rebound Hyperbilirubinemia; Serum Bilirubin.

Background: Premature rupture of fetal membranes (PROM) occurs in approximately 5-10% of all pregnancies, of which approximately 80 % occur at term (Term PROM). If active management of term PROM is supported with induction, then it is associated with reduced maternal infective morbidity without increasing the caesarean section or operative vaginal birth rates. Objective: To compare the time of onset of labour among immediate versus delayed administration of oral misoprostol for induction of labour in premature rupture of foetal membranes at term gestation. Material and Methods: This study was conducted in Department of Obstetrics and Gynaecology, Command Hospital Air Force, Bangalore as a randomized comparative interventional study on 60 patients with confirmed PROM at term 37 to 40 weeks gestation. These patients were randomly divided into two groups by using computer generated random system of allocation after fulfilling the inclusion and exclusion criteria. Group A (immediate) received misoprostol within 6 hours of PROM and Group B (delayed) received misoprostol after 6 hours of PROM. Augmentation of labour if required was done with oxytocin infusion. Results: The present study showed that mean time interval from PROM to delivery was 14.2±3.30 hours in immediate group of induction and 23.04±5.44hrs in delayed group of induction and p value is 0.00 (p value <0.001) which is highly significant. Early induction of labour with oral low dose misoprostol 25 microgram in term PROM patients is always better than expectant management for better obstetric outcome. There were no maternal complications in the immediate group of induction, 2 cases with intrapartum fever, 2 cases with GIT symptoms and one case had PPH, and one patient underwent LSCS in delayed group.

Keywords: Immediate and Delayed; Misoprostol; PROM.