Indian Journal of Maternal-Fetal & Neonatal Medicine

Preterm birth is caused by multiple etiologiesas individual and environmental factors which makes the prediction and prevention of preterm birthschallenging process in antenatal care. As underlying etiology of preterm labour is not completely clear, identification of risk factors and determining the individual risk for pregnant women have importance in obstetric management of women who may benefit from current treatment strategies, current screening tests for prediction of spontaneous preterm labour can bedivided into three categories : Risk factor assessment, cervical measurement and biochemical markers. Early interventions may be effective in reducing the risk of preterm birth.
 

Background: Cervical septum, a rare congenital uterine anomaly, can occasionally be acquired following surgical procedures on the cervix or in the uterus. While most cases are diagnosed incidentally during evaluation for infertility or recurrent miscarriage, acquired cervical septa have been rarely reported following cervical interventions such as hysteroscopy, conization. The impact of such abnormality on subsequent pregnancy outcomes still remains largely unexplored.

Aim: Here, we report the case of a 28-year-old female, gravida 3, abortion 2, at 37+4 weeks, with gestational hypertension, who presented for safe confinement and was found to have a cervical septum.

Discussion and conclusion: This anomaly is believed to have developed following a hysteroscopic cervical polypectomy performed. The clinical course and management of this patient underscore the need for heightened awareness of potential complications following such interventions on labour.

Ethics is derived from the word ‘ethos’. There are distinctive attitudes pervading the culture of a group of persons, with adherence to certain values. It includes a definite tradition, and sharing in customs and experiences. Ethics deals with the right conduct. It helps in the distinction between what is considered right or wrong at a given time, in a given culture, with the moral consequences of the action. Obstetrics is a specialty dealing with two lives, closely linked, whose interests may not always coincide. Abortion raises a lot of ‘heat and dust’ during policy discussions. Hippocrates considered termination of pregnancy as unethical. Times have changed and abortion has been accepted by many societies, the health of the mother being the most important consideration. However, by all the criteria of modern molecular biology, life is present from the moment of conception. Thus, abortion is one of the most controversial issues in today’s world.
 

Context: Respiratory Distress Syndrome (RDS) is a significant cause of morbidity and mortality in preterm neonates due to pulmonary immaturity and lack of endogenous surfactant. This study evaluates the effect of early and prophylactic surfactant therapy in preterm neonates in a tertiary care setting.

Aims: To assess the clinical outcomes of early and prophylactic surfactant therapy in preterm neonates.

Settings and Design: A prospective observational clinical trial conducted over 24 months at the Neonatal Intensive Care Unit (NICU) of VMGMC Solapur.

Methods and Material: The study included preterm neonates up to 28 days old who received surfactant therapy. Neonates with severe congenital anomalies were excluded. Surfactant was administered using the Intubation-surfactant-Extubation (InSurE) technique without sedation. Bovine lipid extract surfactant (NEOSURF) was administered, followed by non-invasive positive pressure ventilation (NIPPV). Data was collected using a pre-designed questionnaire and analysed using IBM SPSS version 21.0.

Statistical analysis used: Descriptive statistics was used to describe the data. Chisquare test was applied for qualitative data, and Student's t-test for quantitative data. A pvalue of <0.05 was considered statistically significant.

Results: Out of 97 neonates, 67.01% had a gestational age of 28-32 weeks, and 62.88% had low birth weight. Clinical presentations included nasal flaring (97.93%) and grunting (63.91%). The majority of surfactant administrations occurred within the first 6 hours (53.6%). Postsurfactant arterial blood gas normalization was achieved in 88% of the cases. Complications included acute desaturation (12.37%) and apnea (12.37%). Mortality was 10.67%, with the majority being discharged after an average NICU stay of 17.6 days.

Conclusions: Early and prophylactic surfactant therapy significantly improved clinical outcomes in preterm neonates, reducing morbidity and mortality with manageable complications.

A major cause of maternal and perinatal morbidity and mortality, Preeclampsia (PE) is predominantly thought to be a consequence of impaired placentation. PE can be subdivided into early onset PE and late-onset PE. Early identification of pregnancies at high risk of early onset PE is a major challenge in modern obstetrics and undertaking measures to improve placentation and reduce the prevalence of the disease is the need of the hour. Large number of potential biochemical and biophysical markers have been identified which may help in predicting the risk of developing pre-eclampsia. Numerous clinical tests have been done to establish a reliable method to predict pre-eclampsia.
 

Every pregnant women has a right to get respectful maternal care, positive pregnancy experience and best possible health services during her antenatal period. It has been established that by implementing timely and appropriate evidence-based practices, antenatal care reduce maternal mortality by 20% if given of good quality and regular attendance. Clients’ satisfaction is a measure of the quality of care of health system performance.1 Global evidence has shown that the introduction of midwifery care has historically translated into the increased availability of quality maternal and newborn health services, and significantly aided the reduction of maternal and newborn mortality and morbidity. Therefore, this study aimed to assess maternal satisfaction among pregnant women regarding midwife led antenatal care services in Public health facility of Dehradun.

Methods: A facility based cross-sectional study was conducted among pregnant women attending midwife led antenatal care services in public health facility of Dehradun. 145 low risk pregnant women were selected using a non probability purposive sampling method. Data was collected using a self structured satisfaction rating scale andanalysed using SPSS software. The level of significance was determined at a p-value of less than 0.05.

Results: Overall, 62.8% of pregnant women were satisfied with antenatal care services provided by midwives in public health facility. Most of the respondents were satisfied with skills and competency of midwives, respect and dignity provided, care approaches, cleanliness and hygiene. Initiating ANC services within 1sttrimester, frequency of antenatal visits, educational status of partner, number of previous pregnancy have shown significant association with the maternal satisfaction.

Conclusion: Majority of the respondents were satisfied with the service. It concludes that pregnant women expressed positive satisfaction with antenatal care provided by midwives. Midwives can provide women centered care which promotes positive pregnancy experience and thus provides high quality of antenatal care.