Background: Perinatal autopsy is the most definitive method for establishing the cause of stillbirth and provides valuable insights for risk assessment and counseling in future pregnancies. Despite its clinical significance, the acceptance and uptake of perinatal autopsy in India remain limited due to multiple barriers. Aim: To assess healthcare professionals’ perceptions and attitudes toward perinatal autopsy, identify challenges to its acceptance, and explore factors influencing its utilization. Methods: A prevalidated, semi-structured questionnaire was administered to healthcare workers involved in the care of women with stillbirth. The survey evaluated knowledge of autopsy procedures, the extent of communication with families, and the willingness of providers to recommend post-mortem examination. Results: None of the respondents reported formal training in counseling families about perinatal autopsy. Awareness of procedural and prognostic aspects was generally limited, with uncertainty surrounding costs, reporting timelines, and clinical value. Misconceptions among providers, along with concerns about religious sensitivities and financial burdens, further restricted acceptance of the procedure. Conclusion: Significant gaps exist in healthcare providers’ knowledge and counseling practices regarding perinatal autopsy. Improving training and communication skills may help improve acceptance and utilisation of perinatal autopsies.

BACKGROUND:Anemia in pregnancy is traditionally attributed to iron deficiency, but emerging evidence highlights the contribution of other trace elements to hematopoiesis and oxidative defense. Limited studies from India have systematically evaluated their multivariate interactions. AIM:This study assesses serum concentrations of eight trace elements in anemic and non-anemic pregnant women and identifies latent clustering patterns using principal component analysis (PCA). METHODS:This hospital-based cross-sectional study enrolled 100 pregnant women (< 14 weeks gestation) at a tertiary care center in Lucknow, India. Serum concentrations of iron (Fe), zinc (Zn), copper (Cu), selenium (Se), magnesium (Mg), manganese (Mn), cobalt (Co), and chromium (Cr) were measured using inductively coupled plasma mass spectrometry. Data were analyzed using independent t-tests, Pearson's correlation, and PCA with exploratory factor analysis. RESULTS:Anemic women had significantly lower serum Fe (43.10 ± 26.47 μg/dL) compared to controls (77.88 ± 37.71 μg/dL, P < 0.001). Hemoglobin correlated positively with Fe (r = +0.590, P < 0.01) and weakly, negatively with Cu (r = -0.201, P < 0.05). PCA revealed four clusters explaining 70.7% of variance: Fe-Zn-Se, Mn-Cr, Mg-Co, and Cu. These clusters suggest synergistic and competitive roles of trace elements in red cell metabolism beyond iron deficiency alone. CONCLUSION:Iron deficiency remains the predominant cause of anemia in pregnancy. However, PCA underscores the collective influence of trace element clusters, highlighting potential secondary modulators of anemia risk. Broader micronutrient-based strategies, alongside iron supplementation, might improve maternal anemia outcomes in India.

Stillbirth Society of India conducted its third national conference in Lucknow, India, bringing together oral presentations and abstracts from diverse regions. Evidence from these presentations and workshops was synthesized into a narrative review highlighting emerging policy and programmatic perspectives on stillbirth in India. The review demonstrated substantial heterogeneity in stillbirth burden and identified major medical causes, including hypertensive disorders of pregnancy, anemia, fetal growth restriction, preterm birth, and congenital anomalies. Vulnerable populations included young multiparous women, women with inadequate antenatal care, rural populations, and those from lower socioeconomic backgrounds. Emerging innovations included physiological interpretation of cardiotocography, early pregnancy biomarker panels, predictive ultrasound parameters, angiogenic markers in preeclampsia, third-trimester group B streptococcus screening, and phone-based follow-up of high-risk pregnancies, alongside emphasis on respectful maternity services, bereavement support, placental examination, and clear communication with families.

Background: Bereavement care plays an essential role in helping mothers cope with the psychological and emotional burden of stillbirth. In India, however, such care remains poorly defined, inconsistently delivered, and unsupported by formal guidelines. The lack of structured systems leaves mothers vulnerable and healthcare providers uncertain in how to respond. Objective: To examine existing bereavement care practices following stillbirth, explore the challenges faced by healthcare providers, and identify strategies for improvement. Methods: A qualitative study was conducted using in-depth interviews with healthcare providers. A semi-structured, validated questionnaire was used to assess current practices, provider awareness, barriers to offering support, and opportunities for strengthening bereavement care at institutional and systemic levels. Results: Healthcare providers commonly reported limited awareness of bereavement care and discomfort in providing support, largely due to insufficient training and professional inexperience. Formal institutional protocols were lacking, and no systems were in place to address the emotional toll on providers themselves, many of whom described experiencing secondary trauma and distress when caring for bereaved families. Conclusion: Bereavement care after stillbirth in India remains underdeveloped. Strengthening this area will require raising awareness, developing standardised guidelines, and integrating bereavement training into medical and nursing education. Embedding structured, compassionate bereavement support within routine maternity care can ensure dignity for mothers and provide much-needed support for healthcare providers.

Competency-Based Medical Education (CBME) in India has shifted medical training towards outcomes that emphasise self-directed lifelong learning as a core attribute of a competent physician. Self-Directed Learning (SDL) encourages learners to identify gaps in knowledge, access and evaluate relevant resources, reflect on their learning needs, and integrate knowledge into clinical practice. This paper aims to review the conceptual foundations, implementation strategies, benefits, and challenges of SDL within the CBME framework in undergraduate medical education in India. This narrative review is based on the National CBME guidelines of India, and published literature on SDL in medical education. Key themes included learner readiness, faculty roles in facilitating SDL, assessment methods aligned with SDL, and institutional strategies for integration. SDL improves learner engagement, critical thinking, and adaptability by promoting reflective practice and autonomous learning behaviours. CBME tools such as reflective portfolios, formative feedback, and workplace-based assessments provide opportunities for SDL; however, effective implementation is constrained by limited faculty training, traditional reliance on teacher-centred instruction, and variable student readiness for autonomous learning. SDL is integral to CBME and requires structured approach, faculty development, and institutional support to fulfil its potential in producing reflective, competent, and lifelong learners in medical practice. International Journal of Human and Health Sciences Vol. 10 No. 02 Apr’26 Page: 78-81

Background: The umbilical coiling index (UCI), defined as the ratio of vascular coils to cord length, has been proposed as an indicator of fetal well-being. Deviations from normal coiling—whether reduced (hypocoiling) or excessive (hypercoiling)—have been linked with unfavorable maternal and neonatal outcomes. However, its routine clinical use remains limited, particularly in low-resource environments. Objective: To evaluate the relationship between umbilical coiling patterns and perinatal outcomes in uncomplicated term singleton pregnancies. Methods: A cross-sectional observational study was carried out on women with term, cephalic, singleton gestations. The umbilical cord was examined immediately after delivery, and UCI was calculated based on length and number of vascular coils. Cases were grouped into hypocoiled, normocoiled, and hypercoiled categories according to percentile-based cutoffs. Maternal and fetal outcomes—including operative delivery, fetal distress, meconium-stained liquor, neonatal condition at birth, and need for NICU admission—were compared across groups. Associations with maternal comorbidities were also analyzed. Results: Cords with normal coiling formed the majority, while both under-and over-coiling patterns were associated with adverse pregnancy outcomes. Abnormal UCI correlated with higher rates of fetal compromise, low neonatal weight, increased NICU admissions, and growth restriction. Maternal complications, including hypertensive disorders and gestational diabetes, were also more frequent among abnormal coiling groups. Operative interventions, particularly cesarean deliveries, were more common in such cases. Conclusion: Umbilical coiling abnormalities serve as important predictors of perinatal risk. Incorporating UCI evaluation into obstetric assessment—postnatally and potentially during antenatal sonography—could enhance risk identification and support timely clinical decision-making, thereby improving maternal and neonatal outcomes.

BackgroundBereavement care plays a crucial role in reducing the stress response in mothers who experience stillbirth. However, in India, the delivery of such care remains unregulated and inconsistent and lacks clear protocols and standards. The significant unmet need for bereavement care leads to dissatisfaction among both grieving mothers and caregivers. This study was conducted to assess existing bereavement care practices following stillbirth, identify the challenges faced by healthcare providers, and suggest possible solutions.MethodsThe present study is a qualitative analysis using the medium of in-depth interviews. We used a semi-structured, validated questionnaire and audio-video recording of the interviews. The questions pertained to the existing practices, awareness, challenges faced by healthcare providers and suggestions for improvement at micro- and macrolevel.ResultsUsing purposive sampling, we conducted 31 in-depth interviews of doctors and nursing staff involved in caring for women with stillbirth. Most of the subjects demonstrated lack of bereavement care awareness, discomfort in caring due to professional inexperience and the absence of training. There is no provision for care and counseling of healthcare providers who themselves undergo psychological trauma and mental stress when caring for such women.ConclusionBereavement care after stillbirth is in its primitive stages in most of the care settings in India. Increasing awareness about stillbirth and bereavement care, making guidelines, conducting mandatory training for healthcare providers, and introducing "Bereavement companionship" model as a pilot project can provide initial steps toward betterment in care.

Antenatal Care Bundle” presents evidence-based antenatal care interventions aimed at reducing stillbirths, developed by the Stillbirth Society of India. The interventions are designed to complement WHO recommendations, focusing on risk assessment, maternal and fetal monitoring, and management of fetal growth restriction, particularly in low-resource settings. They are intended to be adopted by all the practitioners to provide standard care to every pregnant woman for optimal outcomes. Each section of this bundle has undergone extensive discussion followed by consensus. The recommendations have been graded according to the level of evidence-based as recommended by NICE guidelines.

Background: Anemia in pregnancy is a significant global health concern, often associated with adverse maternal and fetal outcomes. Objective: This study aims to examine the hematological profiles of pregnant women with nutritional anemia, focusing on diagnostic challenges and clinical implications. Methods: This retrospective study was conducted at Jawaharlal Nehru Medical College and Hospital (JNMCH), Uttar Pradesh, India, to analyze hematological parameters in pregnant women unresponsive to routine iron and folic acid therapy. Case records of anemic patients who had received at least four weeks of oral iron and folic acid supplementation without significant improvement in hemoglobin levels were included. Patients with known hematological disorders, chronic diseases, or incomplete records were excluded. Hematological parameters analyzed included hemoglobin levels, total leukocyte count (TLC), platelet count, and general blood picture findings. Patients were categorized into microcytic hypochromic anemia and dimorphic anemia groups. Results: Microcytic hypochromic anemia was the most prevalent type, though a significant proportion of cases exhibited dimorphic anemia. Dimorphic anemia was associated with higher TLC values, indicating a potential inflammatory or immune response, and lower platelet counts, suggesting a possible risk of thrombocytopenia. The findings highlight the heterogeneity of dimorphic anemia and its implications for treatment strategies. Conclusion: The study underscores the diagnostic complexities of anemia in pregnancy, particularly in differentiating between iron deficiency anemia and mixed nutritional deficiencies. Routine hematological screening, supplemented by biochemical assays for vitamin B12 and folate levels, is crucial for accurate classification and management. Improved screening protocols and targeted supplementation strategies are essential in resourcelimited settings to optimize maternal and fetal health outcomes.International Journal of Human and Health Sciences Vol. 09 No. 02 Apr’25 Page: 107-112

Objective This prospective observational study aimed to explore the epidemiology, causes, and outcomes of Pregnancy-Related Acute Kidney Injury (PRAKI) in a tertiary care center in North India and identify risk factors for mortality. Methods We enrolled adult obstetric patients with PRAKI according to Kidney disease improving global outcomes criteria between February 2021 and April 2022. Data on demographic characteristics, clinical features, causes of PRAKI, and outcomes were collected. Univariate and multivariate analyses were conducted to identify factors associated with mortality. PRAKI prevention bundles for patients and obstetricians were proposed on the basis of key findings of the study. Results Of the 89 patients included, pre-eclampsia/eclampsia/HELLP syndrome, hemorrhage, and sepsis were the primary causes of PRAKI. Maternal mortality was alarmingly high at 24.7%. Factors independently associated with mortality were the need for vasopressor support and renal replacement therapy. Conclusion This study highlights the urgent need for preventive and therapeutic interventions to reduce maternal mortality related to PRAKI. On the basis of the key findings, PRAKI prevention bundles were proposed. The PRAKI prevention (patient) bundle included regular BP measurement during ANC visits, healthcare check-up if there is fever or drop in urine during pregnancy or immediate postpartum. The PRAKI prevention (obstetrician) bundle included regular BP measurement, urine culture, avoidance of nephrotoxic agents and hourly urine output monitoring during delivery and immediate postpartum. Implementing preventive measures, enhancing obstetric intensive care units, and improving antenatal care compliance may help mitigate the devastating impact of PRAKI.

Background Birth companion (BC) has been globally recognised as an essential component of childbirth care. As our institution did not allow BC in labour, this study was planned as a quality improvement (QI) project to introduce the concept. We aimed to achieve birth companionship from existing 0 to 100% over a period of six months. Intervention QI team was constituted, and an initial brainstorming session conducted. A fishbone diagram was drawn to analyse issues that need addressal before implementation of the initiative. The framework was defined, and team members assigned their roles and responsibilities. A series of five successive Plan-Do-Study-Act (PDSA) cycles were carried out over a period of six months, which included introduction of the concept, dissemination of information, infrastructural changes in labour room and introducing column for documentation in birth register. To achieve sustainability, comprehensive group counselling sessions were started for women during antenatal period, and sensitisation classes were regularly conducted for newly inducted trainees and faculty. Result Birth companionship was achieved in 98% of cases. Conclusion The QI tools helped in preparation and planning of changes by breaking down a large problem into smaller sections and covering all aspects of challenges in a systematic manner using team-based approach. National directives and recommendations, sensitisation of leadership and training of stakeholders were found to be important facilitators. Robust systems of monitoring and successive PDSA cycles were needed for continuous improvement and sustainability of the idea.

Background Surgical site infections (SSIs) are a substantial cause of maternal morbidity and are associated with a significant increase in hospital stay and cost. The prevention of SSI is complex and requires the integration of a range of measures before, during, and after surgery. Jawaharlal Nehru Medical College (JNMC), Aligarh Muslim University (AMU) is one of the referral centers of India with a huge influx of patients. Methods The project was undertaken by the Department of Obstetrics and Gynaecology, JNMC, AMU, Aligarh. Our department was sensitized to the need for quality improvement (QI) through Laqshya, a Government of India initiative for labor rooms in 2018. We were facing problems like a high surgical site infection rate, poor documentation and records, no standard protocols, overcrowding, and no admission discharge policy. There was a high rate of surgical site infections, leading to maternal morbidity, increased days of hospitalization, more usage of antibiotics, and increased financial burden. A multidisciplinary quality improvement (QI) team was formed comprising obstetricians and gynecologists, the hospital infection control team, the head of the neonatology unit, staff nurses, and multitasking staff (MTS) workers. Results The baseline data were collected for a period of one month and it was found that the rate of SSI was around 30%. Our aim was to decrease the rate of SSI from 30% to less than 5% over a period of six months. The QI team worked meticulously, implemented evidence-based measures, regularly analyzed the results, and devised measures to overcome the obstacles. The point-of-care improvement (POCQI) model was adopted for the project. The rate of SSI decreased significantly in our patients and the rates are around 5% persistently. Conclusion The project not only helped in decreasing the infection rates but also led to vast improvements in the department with the formulation of an antibiotic policy, surgical safety checklist, and admission-discharge policy.

Cesarean section (CS) is increasingly replacing vaginal delivery, which is concerning due to associated complications. World Health Organization (WHO) recommends robust classification such as Modified Robson's criteria for decision making to minimise non indicated CS. This study was planned to see the applicability of Modified Robson's criteria in assessing causes of CS. To classify and compare indications of CS using the WHO modified Robson’s criteria. The present study was a retrospective study conducted at Era's Lucknow Medical College over 24 months. Due approval was obtained from ethics committee before commencing the study. All cases who underwent CS from 1st January 2018 to 31st December 2019 were analysed, data classified in accordance with the WHO Modified Robson's criteria and analysed. Parameters used for analysis included gestational age, parity, number of foetuses, history of previous CS, fetal lie and presentation, induced or spontaneous labour, indication of CS and any associated high risk factors. Of 1929 deliveries, 621(32.2%) had CS. A total 500 CS were evaluated. The major contributor to overall CS rate was Group 5 [30%], 10 [17.4%] and 1 [16.4%]. Modified Robson's classification could be easily applied to our data set and helped in identification of the main groups which contributed majorly to the overall CS rate viz. previous CS, nulliparity, prematurity and induced labours. It also helped us in identifying the subgroups which require more surveillance and monitoring. It is important to focus on Group 5, 10 and 1 which constitute 63.8% of total CS being done.

COVID-19 which was followed by the lockdown all over the world is seriously affecting the lives of students with visual impairment, especially their academic activities. The aim of the study is to understand the current situation of special schools and explore the academic challenges of students and the ways of academic success for students with visual impairment during COVID-19. The study will aid in raising awareness for the government, decision-makers, and policymakers to consider initiatives to reduce the challenges faced by students with visual impairment during this pandemic. This study is based on semi-structured interviews with teachers that included the epistemological nature of research questions. A total of 15 teachers were selected by using a purposive sampling technique. The current research paper provides a pragmatic approach by using a type of thematic content analysis. The study's findings revealed that COVID-19 has a negative impact on the interactional and online learning, emotional state, and behavior of students with visual impairment. It is recommended that future studies may be conducted with parents and children with visual impairment, and it may investigate the other life challenges that are being faced by visually impaired students during this pandemic.

A24 year old female P1L1 presented to our hospital on first post operative day of emergency caesarean delivery with complaint of fever with chills and rigors. The per-operative notes showed the presence of thick pinkish maternal blood when compared to cord blood, which turned opaque white while sampling. On examination she had pallor and raised blood pressure. Her lipid levels were very high and ultrasound showed bilateral mild pleural effusion with minimal ascites with increase echogenicity of peripancreatic fat. She was started on injectable antibiotics following which she improved in symptoms. She was also started on fenofibrate and orlistat following which her lipid profile improved and the blood stopped turning opaque white and she was then discharged against medical advice due to financial constraints.

Background: India has seen a rise in the incidence of cesarean deliveries (CD) especially in the last decade. The present national average stands at 17.2%, which if taken as a stand alone figure represents an almost ideal statistical measurement. However, the country has widespread regional variations in the CD rate, ranging from 4.4% to 35.9%. Auditing individual CD rates by each institution, and exploring reasons for high incidence remains an essential component of maternal care. Aim of the study: The present study was done to find out the incidence of CD at our facility, compare it with the national average and explore reasons for high incidence of CD. Methodology: It is a partially mixed concurrent quantitative and qualitative study including retrospective analysis of one year data and filling up of questionnaire from resident doctors. Data extraction was done from Maternity Ward, for all women who delivered during the aforementioned period in our facility, including socio-demographic profile, number of births, mode of delivery, reasons for induction of labour and any complications during childbirth. Statistical analysis was done using appropriate tests. Results: A total of 621 deliveries were studied, out of which 44.6% delivered vaginally and 55.3% had CD. Conclusion: The incidence of CD in the present study is 55.3% . The main reasons for high incidence of CD are high risk pregnancies, previous CD, fear of litigation and logistical delays in performing Category I cesarean section, prompting early decision for CD. Bangladesh Journal of Medical Science Vol. 21 No. 02 April’22 Page : 284-290