Objective: To evaluate the accuracy of Dare's formula in estimating fetal birth weight in pregnant women.Methods: A prospective study was conducted at a tertiary care hospital in New Delhi after institutional ethical committee clearance. In all, 175 pregnant women with singleton pregnancies of 37 weeks or more were included. The aim was to assess fetal birth weight by Dare's formula and ultrasonography. This estimated fetal weight (EFW) was compared with actual birth weight (ABW) of newborn.Results: Estimated fetal birth weight by Dare's formula was within 10% of ABW in 77 (44.00%) cases. Meanwhile in the majority (98; 56.00%), EFW by Dare's formula was not within 10% of ABW. The proportion of EFW by ultrasonography within 10% and not within 10% of ABW were comparable (50.29% [88] and 49.71% [87], respectively).Conclusion: Dare's formula can be used by medical personnel as a clinical method in routine prenatal care to estimate fetal weight, for better management of women in labor to decrease the maternal and neonatal mortality and morbidity.

Objective To study the impact of COVID-19 pandemic on maternal mortality ratio, aetiological and modifiable factors for maternal mortality and key interventions performed. Method Retrospective exploratory study evaluating maternal mortality between April to November 2020 (study group) and 2019 (control group). Results Demographic variations existed in the two groups. Increased maternal age and illiteracy were significantly more in the study group. Maternal mortality ratio (MMR) was significantly high in the study group (792 vs. 296 p value = 0.0). Hemorrhage accounted for 20% and COVID-19-related maternal deaths accounted for 15% deaths in the study group. Level 3 delay (delay in receiving care/inadequate care) was observed in 35% in the study group and 28% in control group ( p value = 0.349). 17.5% of mothers in the study group as compared to 8% of control group were dead on arrival to hospital though not statistically significant (p value = 0.28). Significantly more women in study group died within 24 h of admission (45% vs. 20%, p value 0.04). Among the key interventions, the use of supplemental oxygen was significantly high in study group ( p value = 0.02). Conclusion Maternal mortality ratio was high in the pandemic year because of a significant decline in hospital delivery rate. The lesson learnt from this pandemic needs to be documented to guide better planning in the future to face similar situations.

Background: Development of pre-eclampsia (PE) at less than 34 weeks of gestation is known as early onset PE (EOPE) and is commonly associated with more severe adverse maternal and fetal outcomes. The purpose of this study was to study Doppler parameters of uterine, umbilical and fetal middle cerebral arteries exclusively in women with EOPE and its correlation with perinatal outcomes. This study was a hospital-based observational prospective study.Methods: 60 patient of early onset PE with singleton live pregnancy were included in the study and followed up. The results of sonographic and Doppler examination were analysed and correlated with perinatal outcomes.Results: Adverse perinatal outcomes were seen in 66.66% cases of early onset PE. To predict adverse perinatal outcomes, umbilical artery (Umb A) RI, PI were found to be most sensitive, cerebroplacental ratio (CPR) was most specific indicator with highest positive predictive value (PPV). Absent end diastolic flow /reverse end diastolic flow (AEDF/REDF) were ominous signs.Conclusions: Early onset PE is recently considered a more severe disease with different etiopathogenesis. Doppler study is the primary imaging modality for fetomaternal surveillance for follow up and prediction of perinatal outcome, thus allowing planning of timely management in early onset PE patients, as these patients are at higher risk of adverse perinatal outcomes.

Agrawal, Swati MBBS, MD; Puri, Manju MBBS, MD; Aggarwal, Kiran MBBS, MD; Singh, Lata MBBS, MD; Singh, Abha MBBS, MD; Nangia, Sushma MBBS, MD, DM Author Information

OBJECTIVE:To investigate the factors associated with late stillbirth among women with hypertensive disorders of pregnancy (HDP). MATERIAL AND METHODS:The clinical details of women with HDP having late stillbirth were compared with controls having livebirth. RESULTS:Total 208 cases and 288 controls were included in the study. Inadequate antenatal visits (p < 0.001, OR-5.92). birth weight < 2000 gms (p < 0.001, OR 10.3) and BW/PW ratio > 8 contributed significantly (p = 0.0001, OR-5.6) to stillbirth. CONCLUSION:Poor antenatal care, birth weight below 2000gms and high BW/PW ratio was associated with a higher risk of stillbirth.

Background: Maternal near miss (MNM) is now widely accepted as a better indicator of maternal health than maternal death and reflects the quality of obstetric care in a particular institution.Methods: This is a retrospective study conducted at Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital over a period of 12 months (April 2016-March 2017), of all cases of maternal death and near miss maternal deaths due to major obstetric haemorrhage(MOH).Results: During the period reviewed, there were 13,083 deliveries, 12,958 live births and 37 maternal deaths. There were 30 cases of near miss maternal deaths and 2 maternal mortalities due to MOH. The mortality index was 6.25%. Severe maternal outcome ratio (SMOR) was 2.46.Among the near miss cases (n=30), morbidly adherent placenta was the cause in 26.6% of cases(n=8), postpartum hemorrhage in 23% of cases(n=7); rupture uterus in 13% cases(n=4); massive abruption in 13% of cases(n=4) and placenta praevia with antepartum haemorrhage in 3% of cases(n=1). Early obstetric haemorrhage due to ruptured ectopic pregnancy and incomplete abortion resulted in MNM in 16% (n=5) and 3.3% (n=1) cases respectively.It was observed that in 40% (n=12) of MNM cases (8 cases of morbidly adherent placenta plus 4 cases of rupture uterus), previous cesarean section was the single most important causative factor for the morbidity of the patient.Conclusions: Reduction in cesarean section rates is imperative to reduce morbidity and mortality associated with MOH.

Objective: To explore the factors associated with hypertensive disorders of pregnancy (HDP) in women experiencing stillbirth (SB). Material and methods: It was an observational, analytical case-control study, done as part of the World Health Organization South-East Asian Region Office SB project. The epidemiological profile, history, clinical features, and investigations of stillborn cases having HDP were noted, an equal number of age and parity matched subjects with HDP having livebirth were taken as controls. Results: Out of 46,816 deliveries, 1239 (26.2/1000) were stillborn. The maternal causes contributed 374/1239 (30.2%) stillbirths according to the CODAC classification, HDP was the most common maternal cause (304/1239, 24.9%). Subjects with HDP were included as cases. On comparing the cases with controls it was found that significantly more number of cases had inadequate antenatal visits (p < .001, OR -4.8), two or more abortions (p < .001, OR -1.9), early onset of hypertension (p < .0001, OR -5.6) and complications such as fetal growth restriction (FGR) (p < .001, OR -2.3) and abruption (p < .001, OR -4.0). Women with preeclampsia were less likely to have SB compared to those with gestational or chronic hypertension (p = .0001, OR -2.3). The birth weight/placental weight ratio of more than eight had the highest odds ratio regarding contribution to SB among hypertensive women (p = .0001 OR -6.7). Conclusion: In women with HDP, adequate antenatal care would lead to the prevention of complications such as anemia, abruption, and FGR, and thus prevent SB. The high BW/PW ratio is a potential marker of risk of SB.

Introduction: The Osteoprotegerin (OPG) cytokine network has been found to control bone homeostasis and is implicated in increased skeletal resorption, including several forms of osteoporosis. Aim: To establish the relationship of Bone Mineral Density (BMD) with serum Osteoprotegerin levels and the biophysical profile (waist to hip ratio and body mass index) and also to correlate it with menopausal status and risk of osteoporosis. Material and Methods: A case-control study was conducted on 110 non-pregnant subjects: 40 perimenopausal, 40 post-menopausal women and 30 women in the reproductive age group. Bone mineral densitometry by Quantitative Computerized Tomography (QCT) at lumbar spine, Waist-to-hip (W:H) ratio and Body Mass Index (BMI) were computed. Results: Independent student’s t-test and Karl Pearson’s correlation coefficient analyzed the parameters under study. Standard unimodal distribution curve determined the cut-off value of Osteoprotegerin for screening of osteoporosis risk. In the peri-menopausal age group (40-55 years), there were significant correlations of BMD with age and BMI (p=0.0857; p=0.458). The postmenopausal group (50-70 years) had significant correlations of OPG with age (p=0.030), W:H ratio (p=0.002) and BMI (p=0.005). An OPG concentration of 17.9 pmol/L could predict osteoporosis in postmenopausal women. BMD detected the maximum number of osteoporotic and osteopenic subjects within the postmenopausal group while least were encountered in the normal group. Conclusion: Osteoporosis was encountered in 60% of post-menopausal and 40% of peri-menopausal patients due to low oestrogen levels. Maximum derangement of BMD, waist to hip ratio and BMI were seen in overweight women. The significant correlations of BMD with BMI may be utilized for assessing osteoporosis in menopausal women.

BACKGROUND:Over 98% of the world's total stillbirths are believed to occur in developing countries and still have received very little research, programmatic or policy attention.AIMS AND OBJECTIVE:To collect data on epidemiological profile of cases experiencing stillbirths, to assess the associated antenatal high risk factors present and to find out the probable cause of stillbirth.MATERIALS AND METHODS:This was a cross-sectional, observational study, which was done as part of WHO SEARO project after ethical clearance. The study included all stillbirths which occurred in the hospital during the study period August 2015-February 2017. Antenatal records were reviewed; maternal investigations were done. Baby was examined after delivery. Pre-structured pro forma was filled for every case. Finally, the relevant condition found was classified under CODAC system of stillbirth classification.RESULT:Out of 20,580 deliveries, 600 (2.9%) were stillborn. Maternal cause was noted in 145/600 (24.2%) cases, fetal cause was noted in 181/600 (30.2%), and placental and cord origins were suspected in 128/600 (21.3%) and 12/600 (2%) cases, respectively. In 72/600 (12.0%) cases the reason for stillbirth was unknown and unclassifiable. Among the maternal causes the most common was hypertension (89/600, 14.8%) followed by infection including fever (5.7%); the most common infection was hepatitis. Among the fetal causes birth defect was the most common (106/600, 17.7%) followed by extreme prematurity in 42/600 (7.0%).CONCLUSION:Birth defects were the most important fetal cause of stillbirth; hypertension in pregnancy and fetal growth restriction were important associated factors.

Background: To study the role of serum homocysteine and serum folate levels in prediction of materno-fetal outcome in preeclamptic women, especially in early onset preeclampsia.Methods: This prospective study was conducted in a tertiary care teaching hospital in India. 60 preeclamptic women (Group A) that were matched with 60 normotensive pregnant women (Group B), with singleton pregnancy and gestational age between 24-32 weeks attending antenatal clinics were included in the study. Maternal blood was collected twice first at time of enrolment and second at delivery. Serum homocysteine and serum folate levels were analyzed using enzymatic assay and chemiluminescent immunoassay. Mean rise in serum homocysteine and folate levels were calculated individually in all patients.Results: Mean homocysteine levels were significantly higher in Group A as compared to Group B both at enrolment and delivery (p <0.05). Women with higher rise in mean homocysteine levels were associated with an increased risk of adverse maternal complications (p <0.05). Mean rise in homocysteine levels were significantly higher in women who developed abruption and perinatal death (p <0.05) while no correlation was found with the mean change in serum folate levels (p >0.05).Conclusions: Serum homocysteine can be used as a reliable marker for predicting the severity of preeclampsia and adverse pregnancy (both maternal and fetal) outcome thus helps in reducing maternal and fetal morbidity and mortality, especially in women with early onset preeclampsia.

Objective: To determine the value of placenta growth factor (PlGF) for predicting hypertensive disorders of pregnancy (HDP) in a low-risk population when used either alone or in combination with other markers. Methods: A prospective observational cohort study was conducted among women with singleton pregnancy in the first trimester in New Delhi, India, between October 1, 2013, and September 30, 2016. First-trimester measures included maternal history, body mass index (BMI), mean arterial pressure (MAP), Doppler uterine artery pulsatility index, and serum levels of biomarkers (including PlGF). Results: Among 1725 women, 208 (12.1%) developed HDP; 74 (35.6%) of these cases were early onset. Mean PlGF levels were significantly lower among cases than among controls (30.42 +/- 10.22 vs 37.31 +/- 13.28pg/mL; P<0.001). As a biomarker for prediction of HDP, PlGF fared better than pregnancy-associated plasma protein A (PAPP-A): area under the curve 0.685 (95% confidence interval [CI] 0.620-0.750; P<0.001) versus 0.659 (95% CI 0.593-0.726; P<0.001). The highest odds ratio was found for MAP (8.369, 95% CI 5.752-12.215). The combination of PlGF, PAPP-A, BMI, MAP, and Doppler uterine artery pulsatility index provided an area under the receiver operating characteristic curve of 0.876 (95% CI 0.833-0.919; P<0.001). Conclusion: Combining PlGF concentration with biochemical and biophysical markers provided a good screening test for HDP during the first trimester.

The current management of intrauterine growth restriction (IUGR) being empirical and aimed at selecting a safe time for delivery. Acknowledging the beneficial effects of l-arginine on endothelial vasculature the present study was designed to evaluate efficacy of l-arginine on bioavailability of nitric oxide (NO) with respect to fetal outcome. With l-arginine supplementation, mean NO levels were significantly increased and a significant mild reduction in systolic/end-diastolic velocity ratio (S/D ratio) was observed on doppler blood flow study, also neonatal outcome improved and incidences of complications were lowered. A deficiency in NO may play an important role in the causation of asymmetric fetal growth restriction. l-Arginine can be used to increase maternal NO levels, enhancing birth weight and decreasing neonatal morbidity. The ideal candidate for arginine therapy according to our study would be IUGR cases with S/D ratio less than 4.96 ± 0.49 and NO levels below 33 μmol/L with minimum of 3 weeks duration of arginine supplementation.

The role of transcatheter arterial embolization in the management of obstetric emergencies is relatively new and not so commonly used. In the following series, the efficacy of this technique in situations such as scar site ectopic pregnancy, antepartum and postpartum obstetric hemorrhage, especially in the presence of coagulation derangement is presented.

Background: Gestational diabetes mellitus (GDM) has been observed to be associated with increased perinatal morbidity and mortality. GDM is becoming a public health concern globally as well as in India with fast increasing trend. It affects approximately 14% of all pregnancies. Studies on the association of food items having high glycaemic index with GDM risk are sparse. Most of the literature has focused on typical risk factors like advanced maternal age, family history of diabetes mellitus, history of abortions, previous history of GDM. Objective: To assess the risk of developing GDM in pregnant women consuming food items with high glycemic index. Material and Methods: A hospital based case control study was conducted in Lady Hardinge Medical College and associated hospital with a sample size of 104 (52 cases & 52 controls). For dietary history a validated quantitative food frequency questionnaire was used. The usual pattern of eating during days, weeks and months were asked. The data was compiled and analysed in SPSS version 12. Results: Total 30.8% cases and 13.5% controls gave history of consuming food items having high glycaemic index more frequently (at least once daily). The odds ratio of developing GDM was 2.86(CI -1.06-7.70) among the cases who were taking high glycaemic foods more frequently in comparison to those who were taking occasionally. Conclusions: Risk of developing GDM in high glycemic foods consumers is high. Simple measures like changing dietary patterns, consuming food items with low glycaemic load can contribute significantly in prevention of GDM.

BACKGROUND:Fetal autopsy is included in the basic protocol of investigating a perinatal death, parental refusal is the main reason for its low rate.AIM:To increase acceptance of fetal autopsy and to provide better counselling to the couple regarding risk of recurrence in future pregnancies.MATERIALS AND METHODS:All cases with antenatally diagnosed congenital anomaly resulting in stillbirth or termination before 20 weeks were offered fetal autopsy and it was performed in labor room itself by the fetal medicine specialist after consents. External and internal examination, photograph, infantogram and karyotyping were done, and relevant tissue was sent for histopathology. Correlation between the ultrasound and autopsy finding was done.RESULTS:Total 674 cases of antenatally detected major congenital anomaly were included in the study. Out of 403 cases of stillbirth and abortion, consent for autopsy was given in 312. Most common defect was cranio-vertebral defect followed by genitourinary anomaly. The autopsy finding correlated with USG findings fully in 63.5% cases, there were additional findings altering diagnosis in 24.7% cases, the diagnosis completely changed in 11.8% cases.CONCLUSION:Autopsy if done in labor room increases its acceptance by the couple. Additional findings on autopsy helped in reaching at diagnosis and counseling accordingly.

Objective. To investigate association between maternofoetal complications and the amount of proteinuria measured by spot urine protein creatinine ratio in patients with preeclampsia. Methods. 200 consecutive patients with preeclampsia were recruited in the study. The complications like first episode of severe hypertension, renal insufficiency, raised level of aspartate transaminase, signs of neurological involvement, thrombocytopenia, eclampsia, and need to shift in intensive care units were studied. The maternal outcome was studied in terms of type of labour, outcome of pregnancy, mode of delivery, indication of cesarean section, and maternal mortality. The foetal complications and outcome parameters were birth weight, Apgar score at the time of birth and at five minutes, need of high dependency unit care, and perinatal mortality. Result. The frequency of various maternal and foetal complications was between 14–53% and 22–92%, respectively. Maternal mortality was 3%, whereas perinatal mortality was 23%. Statistically significant association was found between the frequencies of various complications in mother and newborn and spot UPCR. Conclusion. The rate of various maternofoetal complications in preeclampsia is higher in developing countries than in developed world. Maternofoetal complications and outcome correlate with maternal spot UPCR.

ABSTRACT Objective This study aimed to determine the postnatal outcome of congenital malformations in a tertiary care hospital of India. Material and methods This was a prospective study of all women with prenatally detected major congenital malformations. Postnatal follow‐up of live born babies was carried out for 1 year. Results There were 574 cases with major congenital anomalies, 523 of which were fully followed. Only 69 women (13.6%) had the initial scan before 20 weeks of gestation. Craniospinal defects were the most common (42.7%), followed by genitourinary anomalies (28%). There was no live birth in cases such as anencephaly, iniencephaly, bilateral renal agenesis, gastroschisis, and cystic hygroma. Survival at 1 year was less than 25% in spina bifida, bilateral cystic kidneys, complex cardiac disease, and non‐immune hydrops fetalis. In cases with mild hydrocephalus or unilateral and mild renal disease, the survival was over 75%. Conclusion In India, the majority of congenital anomalies present late in gestation. Although fetal outcome is invariably poor for severe defects, existing legislation in the country leaves pregnancy continuation as the only option. © 2013 John Wiley & Sons, Ltd.

24-h urine protein is traditionally used as a gold standard method for protein estimation. Because of the operational difficulty, there is the necessity to use rapid, convenient, and reliable method of proteinuria estimation.

Rupture of uterus is a serious obstetric complication. Consequences can be more dangerous if it remains undiagnosed. Spontaneous rupture of a scarred uterus is an uncommon event but it is rare for it to be followed by vaginal delivery and to be diagnosed postpartum period is still rare. We report a case of spontaneous uterine rupture which was followed by a vaginal delivery which was diagnosed postpartum. A tender uterus after delivery was the only consistent sign present.

OBJECTIVEThe aims of the study were to find out the maternal and perinatal outcome of early onset severe preeclampsia (PE) in a tertiary care center in a developing country like India and to determine whether expectant management in such a setup improves the perinatal outcome.MATERIALS AND METHODSIt was a retrospective study. All women with early PE were admitted stabilized and evaluated. Expectant management was given whenever there was no indication for eminent delivery. The perinatal outcome of the expectant group was compared with that of the aggressive group, and appropriate statistical analysis was carried out.RESULTSA total of 106 women were admitted with severe PE, 61 were treated aggressively, and 45 were stable enough to receive expectant management. The total days gained on expectant management was 7 days. Perinatal mortality was 31.13%. Perinatal outcome of the expectant and aggressive management groups did not differ (P = 0.141); there was no increase in maternal complications on expectant management. There were 2 cases of maternal mortality in the aggressively managed group.CONCLUSIONPerinatal mortality in severe PE is high. There was no increase in maternal morbidity on expectant management; however, there was no difference in perinatal mortality on expectant management.