Genetics in prenatal diagnosis

The options for prenatal genetic testing have evolved rapidly in the past decade, and advances in sequencing technology now allow genetic diagnoses to be made down to the single-base-pair level, even before the birth of the child. This offers women the opportunity to obtain information regarding the foetus, thereby empowering them to make informed decisions about their pregnancy. As genetic testing becomes increasingly available to women, clinician knowledge and awareness of the options available to women is of great importance. Additionally, comprehensive pretest and posttest genetic counselling about the advantages, pitfalls and limitations of genetic testing should be provided to all women. This review article aims to cover the range of genetic tests currently available in prenatal screening and diagnosis, their current applications and limitations in clinical practice as well as what the future holds for prenatal genetics.

A systematic review on hydroxyurea therapy for sickle cell disease in India

Background & objectives: Sickle cell disease (SCD) constitutes frequently inherited haemoglobin disorders and poses a significant health burden in India. Hydroxyurea (HU), the most commonly used drug, has shown promising results in the clinical management of SCD. The present systematic review was undertaken to assess the efficacy and toxicity of HU in Indian sickle cell patients. Methods: A systematic review of studies on HU therapy was conducted to identify the application of HU and its outcome(s) across India. PubMed, Scopus and Cochrane Library was used as data sources for various studies on the efficacy and toxicity of HU therapy for treatment for SCD in India published between January 2001 and October 2021. Two authors independently extracted the data on study design, patient characteristics and therapeutic outcomes of HU in order to determine the study quality of the present review. Results: Overall, 14 studies were included for a systematic analysis. Of these 11 were prospective, two cross-sectional and one double-blind randomized controlled trial. Low-dose HU (10 mg/kg/day) was found to reduce the rates of vaso-occlusive crisis and hospitalization as well as decreased the requirement of blood transfusion in SCD patients. The foetal haemoglobin (HbF) level was recorded in 13 (80%) studies all of whom reported an elevation in the HbF levels, with a mean increase in per cent HbF from 15.8 to 21.4 per cent across studies. The common adverse events were reversible, mild-to-moderate cytopenia and anaemia. Interpretation & conclusions: The findings of the present review suggest that there is still insufficient information presently to determine the long-term or major adverse effects on organ damage, fertility as well as pregnancy on the use of HU therapy for SCD. Long-term multi-centric studies are thus required to address these problems.

Relationship between estimated foetal weight and maternal renal volume in normal pregnant women in Bayelsa state, South-South Nigeria

Background: The weight of the foetus is an important factor to consider when determining the outcome of pregnancy. The birth weight is reliable in predicting perinatal outcome. Excessive and low weights of the baby are associated with increased risk of newborn complications during labour, delivery and postpartum. The objective of the study was to determine the relationship between estimated foetal weight and maternal renal dimensions and volume in normal pregnant women in Bayelsa State, Nigeria.Methods: This prospective, descriptive, cross-sectional study was conducted at the Obstetrics and Gynaecology, and Radiology Departments of the two tertiary hospitals in Bayelsa State, Nigeria, from July to December, 2021. Sonographic assessments of estimated foetal weight and the maternal renal dimensions and volume in 400 consecutive normal pregnant women in both tertiary institutions were done, after obtaining written informed consent from them. Data were entered into a pre-designed proforma, and analysed using Statistical Product and Service Solutions for windows� version 25, (SPSS Inc.; Chicago, USA). Results were presented in frequencies and percentages for categorical variables and mean and standard deviation for continuous variables.Results: A total of 400 pregnant women were scanned. There was a valid relationship between right renal antero-posterior diameter (?= 0.32; p �010), right renal width (?= 0.32; p �007), right renal volume (?= 0.32; p �007) and estimated foetal weight. The left renal width and renal volume showed the same trend as the right parameters with slight differences in values.Conclusions: This study revealed that estimated foetal weight increased with increase in maternal renal volume and dimensions.

The Medical Termination of Pregnancy (Amendment) Act, 2021: A step towards liberation

Reform of the abortion laws in favour of the well-being of pregnant women is one aspect of the removal of gender discrimination. The Medical Termination of Pregnancy Act (MTP Act) 1971, was a breakthrough legislation in this regard, as it reduced the number of unsafe illegal abortions. With advancements in ultrasonography and genetic technologies, many foetal malformations and genetic disorders were being diagnosed after 20 weeks of gestation. The fact that termination of pregnancy was not legally permitted beyond 20 weeks of gestation caused great distress to such women, and highlighted the need to increase the upper limit of termination of pregnancy. Concurrently, there has been greater awareness around the world on the rights of women to take decisions regarding their own bodies. The MTP Bill, 2020, has come as a breath of fresh air extending the term limit for legal abortions to 24 weeks for certain categories of women, and removing the limit for abortion in the presence of a significant foetal abnormality. The amendments were recently approved by Parliament and the President of India, and have become law as of March 25, 2021. This paper presents the amendments made and their implications for obstetric, ultrasonographic and foetal medical practice. It also presents a critique of the various Acts and suggests further amendments that would enhance the value of the Act.

MATERNAL AND FOETAL OUTCOMES IN SPONTANEOUS VERSUS INDUCED LABOUR- A CROSS SECTIONAL STUDY

Introduction: Induction of labour is the artificial initiation of labour before its spontaneous onset for the purpose of delivery of the foetoplacental unit. The purpose of this study was to determine whether the current practice of elective labour induction was associated with differences in mode of delivery, demand for pain relief and foetal outcomes when compared with labour of spontaneous onset. Methods And Materials: This cross-sectional study carried out on 100 pregnant women with singleton pregnancy between 37 and 41 weeks of gestation with cephalic presentation delivering in labour room. This study included two groups: Electively induced (50) and spontaneous group (50). Results: In electively induced group 44% had normal vaginal delivery and 6% had instrumental delivery. With spontaneous labour, 78% had normal vaginal delivery and 4% had instrumental delivery. Postpartum hemorrhage (PPH) was 20% in electively induced group and 6% in the spontaneous group (p-0.038).Apgar scores, mean birth weights were comparable. Analgesia demand was 22% in the electively induced group when compared to 6% in the spontaneous group. Conclusion: The present study emphasizes that elective induction of labour in nulliparous women with a single cephalic presentation is associated with increased risk of caesarean section, which is predominantly related to an unfavorable cervix. Hence, elective induction is safe and efficacious. Caesarean delivery rate was more due to nulliparity or unfavorable cervix not due to elective induction itself.

Factors associated with reduced foetal movements in Iringa, Tanzania

Introduction: Maternal perception of foetal movement ensures foetal wellbeing. Reduced foetal movement is associated with foetal hypoxia, stillbirths, and intrauterine foetal growth restriction (IUFGR). This study aimed at assessing factors that are associated with maternal perception of reduced foetal movements. Method: This was a cross-sectional study that was conducted at Iringa Regional Referral Hospital from 1st January ­ 30th June 2022. A purposive sampling technique was used, and SPSS version 25 software was used for data analysis. Results: 41.3 % of study participants were aged 24 ­ 34 years, with a mean and SD of 29.08 ±7.53. 75% were not employed, 52.8 % of study participants delivered from 37 ­ 42 weeks of gestational age, 66.1% had a posterior placenta and only 24.0 % had an anterior placenta. Women who delivered at 28 ­ 36 weeks of gestational age were about 4 times more likely to experience reduced foetal movement compared to those who delivered at 37 ­ 42 weeks of gestation (AOR=4.162, 95% CI 2.174 - 7.966, p= =0.0067). Conclusion: Reduced foetal movements are associated with lower gestation age at delivery and decreased antenatal clinic attendance in Iringa, Tanzania. All pregnant women should be encouraged to make early antenatal clinic attendance and should attend adequate visits. Healthcare providers should educate and create awareness on methods of assessing foetal movements.

Obstetric Referrals to a Tertiary Hospital in Northern Uganda- A One Year Experience

Delay in referral adversely affects maternal and neonatal outcome. We wanted to review the obstetric referrals, source of referrals, appropriateness of referrals and document the maternal and perinatal outcomes in a tertiary hospital in northern Uganda. MethodsThis is a secondary data analysis from case records. A descriptive study of 780 eligible obstetric referrals, with ≥28 week’s gestation, referred to the hospital for a period of 12 months were analysed with SPSS version 23. ResultsObstetric referrals accounted for 16.3% (780/4799) of the total admissions in 2018, 43.8% were from CEMNOC sites and 32.3% from HC IVs, while 57% from without Lira District, showing lacunae in the emergency obstetric care given at the HC IV levels and the districts hospital in the region. Majority or 93.5% (729) were intrapartum admissions and 98.1% (715) of these had labour outcome recorded, showing the nature of referrals. Most common diagnosis at referral was labour or complications of labour and only 4.6% had other diagnoses. The diagnoses at the time of admission were normal labour (31.0%); obstructed labour (25.1%); prolonged labour (7.1%). About 29.9% presented with more than one medical/obstetric complications, and the most common one was obstructed labour, preeclampsia, IUFD and previous caesarean section scars. The outcome of the referred cases included 45.1% (327) vaginal delivery (either spontaneous or augmented), 54.4% (396) caesarean section, 0.5% (4) Caesarean hysterectomy, 3.1% (24) transferred out undelivered, 1.2% (09) missing outcome while the 3.6% (28) with medical conditions were managed and discharged. There were ten (10) maternal deaths among the referrals, during the study period and 3 were due to obstetric haemorrhage; and behind these there were many near misses which would provide valuable information on the quality of care at the peripheral facilities. 80.4% (627) were live babies, 10.5% (82) were FSB/MSB and 10% had APGAR score ≤5 at 5 minutes of birth while 13.2% were of low birth weight. ConclusionsA wide spectrum of complicated and uncomplicated obstetric cases was referred to this hospital and majority were unjustifiable as majority of the referred conditions could be managed at the lower CEMONC sites. Unavailability of Comprehensive Emergency Obstetric Care (CEMONC) was the most common reason for referrals, even where infrastructure and human resource where known to be available. Most common diagnosis at the time of referral was prolonged/obstructed labour. Even today, obstetric haemorrhage is the leading cause of maternal mortality while prolonged/obstructed labour contributed to the high neonatal mortality.

Study of Intrauterine Foetal Death in Government Medical College in Tribal Area of Bastar.

IUFD is a major obstetrical complication and is an important indicator of perinatal health in a given population. Literally, intrauterine foetal death (IUFD) is considered as all foetal deaths weighing 500 g or more occurring both during pregnancy and during labour. We wanted to asses maternal and foetal factors associated with intrauterine death, and formulate effective strategies for prevention of IUFD. MethodsThis was a prospective study carried out in a GMC Jagdalpur from July 2019 to mid-November 2019. All the admitted patients of our department with gestational age >28 weeks (confirmed by LMP or by USG) diagnosed as having IUFD (confirmed by USG) were included in the study. ResultsTotal number of deliveries during the study was 1455 and total number of IUFD was 109. Incidence of intrauterine death was 7.49%. Majority of the cases were of age group 26-30 years that is 39.44% (43/109) while teenager (16-20 years) pregnancies were only 11.92%. Most of the cases were preterm (67/109) around 61.46% and only 2.75% cases were post term. In 22.01% (24/109) cases, causes were not identified while in 77.99% cases (85/109) causes were identified. Hypertensive disorder was the major cause of IUFD (27.5%) followed by unknown aetiology (22.01%), infection (14.67%) and rupture uterus (10.09%). Rural population was 66.97% and urban population was only 33.02%. Most of the cases were primipara 43.11% (47/109) while least number of cases 8.25% (9/109) was of grand multipara. ConclusionsDespite being a tertiary center, incidence of IUFD is much higher than other areas of our country. Cause may be attributed to lack of awareness, illiteracy, and poor infrastructure in periphery, and this being a referral centre for a large area.

Emergency obstetric care among referrals in more than 24 weeks gestation at a tertiary care teaching institution in Kerala, India

Background: One of the biggest barriers confronting efforts to reduce maternal mortality through increased skilled delivery is access to emergency obstetric care. This study aimed to look into the profile of emergency obstetric referrals. Referral-decision interval, reasons and morbidities of referral were analysed and their neonatal outcomes assessed.Methods: This observational study reviewed 90 emergency obstetric referrals over 3 years from June 2013 to February 2016.Results: In-labour referrals constituted the majority of emergency obstetric referrals. Preterm obstetric referrals needed emergency interventions in view of medical/obstetric indications and it was statistically significant. Referral- decision and referral-arrival interval was significant in emergency group (p-value-0.001). Babies born to mothers who were obstetric emergency referrals had extended NICU stay (p-value-0.001). There was a maternal death and four near-misses in this research.Conclusions: Timely decisions taken during interhospital emergency referrals resulted in better perinatal outcomes by prompt maternal interventions.

A study of hypertensive disorders of pregnancy and the fetal outcome in a tertiary care hospital: a prospective study

Background: Pregnancy induced hypertension is one of the major causes of feto maternal morbidity and mortality in pregnancy. The exact cause of PIH is unknown certain factors are known to increase the risk of PIH such as risk factor includes that young women with first pregnancy.Methods: The objective of this study was to assess the socio-demographic and clinico-pathological profile of the patients with hypertensive disorders of pregnancy and its associated fetal outcomes. A prospective study was conducted in department of obstetrics and gynecology Shri B. M. Patil Medical College, Hospital and Research Centre, BLDE (Deemed to be University), Vijayapura Karnataka from 15th July to 15th December 2018. All women admitted to labour ward with diagnosis of hypertensive disorders of pregnancy were included in the study after ruling out the exclusion criteria and thorough history, examination and laboratory evaluation were done and followed till delivery.Results: A total of 123 pregnant women with hypertensive disorder of pregnancy were enrolled in the study. Most of the participants were in the age group of 20 to 30 years. The PIH was seen mostly in primigravida, lower socioeconomic status and with lower educational levels. Emergency LSCS is the most common mode of delivery.Conclusions: The hypertensive disorder in pregnancy affects the majorly younger age group. It is most commonly seen in low socio-economic and uneducated population. Hence, there should be provided with proper antenatal care, early detection of hypertensive disorders for better feto-maternal outcome.

Effectiveness of forceps delivery in modern day obstetrics

Background: There has been an alarming rise in number of caesarean sections all over the world. Instrumental delivery plays an important role to reduce this trend globally. Forceps delivery though proper training and expertise can definitely reduce the rising caesarean section rates in the modern-day obstetrics. The aim of this study is to study the effectiveness of forceps delivery in modern obstetrics.Methods: In the present observational study, 20 cases of forceps delivery were studied for maternal and foetal outcomes including postpartum hemorrhage, perineal tears, Apgar score, NICU admissions, birth injury, and mortality.Results: The most common indication for forceps application was maternal exhaustion (80%) followed by foetal distress. All the cases of forceps application in the present study were associated uneventful vaginal delivery. No any adverse maternal outcomes including perineal tears, post-partum hemorrhage was observed in this study. Average birth weight in the present study was 3.2 kgs and Apgar scores at birth and five minutes was within normal limits. No any birth injury was noted in any of the newborns.Conclusions: Forceps delivery is a safe and effective option in modern day obstetrics to reduce the alarming rise in rates of caesarean section globally. Training should be encouraged to develop the expertise of this art of forceps delivery.

Association of Foetal Outcome with Maternal Body Mass Index (BMI)

Background:The worldwide obesity epidemic continues to be a major public health challenge, particularly in women of childbearing age. There is a need to understand the associations between maternal BMI and perinatal outcome.Objectives: To evaluate recent trends in maternal body mass index (BMI) and to quantify its association with foetal outcome.Methodology: It is a cross sectional study including a total of 384 pregnant women who were primi gravida and carry singleton pregnancy admitted at term in the department of Obstetrics and Gynaecology of DMCH for the management of labour. All the mothers were chosen by purposive sampling. The study populations were classified into four groups according to BMI. Group-I stands for 44 mothers who are underweight, Group-II consists of 234 mothers who are normal weight, Group III represents to 81 mothers who are overweight and Group IV signifies for 25 mothers who are obese. The women with multiple pregnancies, preterm labour and hypertension or diabetes were excluded from the study. Data regarding socio demographic, clinical, obstetrical and foetal outcome were recorded, afterwards the data were edited, managed and analyzed. The observations were plotted into tabular and figure form. The categorical variable was analyzed by chi square test and the quantitative variables were analyzed by ANOVA test. At all level 95% confidence interval & level of significance was p <0.05. The statistical analysis wasdone by SPSS version 23.Results: The mean BMI of mothers in different groups (Group I, Group II, Group III and Group IV) were 18.37±1.06kg/m2, 23.77±2.03kg/m2, 26.54±2.47kg/m2and 32.15±1.17kg/m2respectively. The average BMI of total 384 mothers was 22.75±4.56kg/m2. The highest 84% newborn had birth weight >2.5kg in Group IV whereas 72.7% had ≤2.5kg birth weight in Group I. Maximum (57%) mothers underwent NVD in Group I as long as the paramount (71%) mothers endured LSCS in Group III. Out of 384, total 180(46.9%) mothers had NVD and 204(53.1%) mothers deferredLSCS. APGAR score ≤7 was found 31.8%, 12.8%, 38.3% and 20% in Group I, Group II, Group III and Group IV independently. The P-value showed statistically significant of the groups (P=0.00016). Among 204 LSCS, 167(81.9%) mother sustained emergency and 37(18.1%) undertook elective LSCS. 52.9% of mothers went through LSCS were due to meconium staining liquor in Group IV which was subsequently followed by 46.6% in Group-III. 25.0%, 9.8%, 32.1% and 16% neonates required NICU admission in Group I, Group II, Group III and Group IV severally. There was a moderately positive significant correlation between maternal BMI and neonatal birth weight (r=+.383, p<0.001). All the statistics of requirements of NICU between one another group showed statistically significant difference.Conclusion: Our study shows that maternal BMI has an effect on foetal outcome. Low BMI is associated with adverse perinatal outcome in terms of low birth weight while high BMI is associated macrosomia, LSCSand neonatal NICU admission. Regarding NICU requirements overweight mothers had more association with foetal outcome rather than obese. Therefore, definitely there is a role of pre pregnancy counseling regarding maintenance of weight of women especially during reproductive age group to maintain normal BMI as to have better perinatal outcome

Study of caesarean section at tertiary care centre: a retrospective study

Background: Caesarean section (C-section) is one of the most widely performed surgical procedure in obstetrics worldwide. The WHO guidelines revised in 1994 states that the proportion of C-section birth should range between 5-15% but both in developed and developing countries C-section rate is on the rise. This study was conducted to analyse the frequency and indications for C-section and associated maternal morbidity and mortality.Methods: This retrospective study was conducted over a period from January 2018 to May 2019 at the department of obstetrics and gynecology, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Hingna, Nagpur, Maharashtra, India. Data of patients who delivered by C-section in our hospital during the defined study period were studied and statistically analysed according to various parameters namely, the frequency of caesarean section, its indications, age, parity and gestational age of the patient.Results: The total number of women delivered over the study period were 2811. Out of which C-sections were done in 1461 women (51.97%). Previous C-section was the leading indication in 35.72% women followed by fetal distress 14.09%, failure of induction 12.93%, arrest of labour 7.93%, PIH 7.18%, oligo/IUGR 6.50%, breech 4.44%, refusal of vaginal birth 4.24%, CPD 1.71%, bad obstetrics history (BOH) 1.43%, malpresentation 1.30%, prematurity 1.23%,  and multifetal gestation in 1.09% women. Two women had classical C-section 0.07. 14.09% women had various complications. There was no maternal mortality.Conclusions: A high rate of caesarean deliveries was observed. Individualization of the indication and careful evaluation, following standardized guidelines can help us to limit C-section. Audit and feedback are the best way to judge clinical practice and to reduce the frequency of caesarean section in any tertiary setup.

Voxelotor: novel drug for sickle cell disease

Sickle cell disease (SCD), is an autosomal recessive disorder caused by mutation in the ??chain of haemoglobin (Hb) that leads to production of sickle haemoglobin (HbS). The disease has a profound negative impact on health-related quality of life with increased propensity for complications. Current treatment options include drugs like hydroxyurea and L-glutamine that are currently on the market. However, none of these therapies target the underlying mechanism and have potential safety concerns. As oxygenated Hb is a potent inhibitor of HbS polymerization, increasing the proportion of oxygenated HbS may provide a disease?modifying approach to SCD. Voxelotor is a novel therapy developed for the treatment of SCD by modulating the Hb affinity for oxygen. By forming a reversible covalent bond with the N?terminal valine of the ??chain of Hb, the drug results in an allosteric modification of Hb and thereby leading to an increase in oxygen affinity. Moreover, voxelotor prevents sickling of red blood cells (RBCs) and possibly interrupts the molecular pathogenesis of the disease. The drug is available in oral formulation with a recommended dosage of 1500 mg once daily. The onset of voxelotor is fast, shows rapid absorption and linear pharmacokinetics. Most common adverse reactions seen are headache, diarrhea and abdominal pain. Clinical trials for voxelotor have been positive, and results suggest that the drug may be a new safe and effective option for SCD treatment. With global blood therapeutics having already received US FDA approval in November 2019, voxelotor may soon be an addition to the mounting armoury of drugs against SCD.

A rare case of abdominal pregnancy: diagnostic and therapeutic challenges

Abdominal pregnancy refers to a pregnancy that has implanted in the abdominal cavity, the estimated incidence being 1 per 30,000 births. A 36-year-old primigravida with term pregnancy with fetal demise was referred to us. Examination was suggestive of single foetus of 30 weeks’ gestation with longitudinal lie and cephalic presentation with absent foetal heart sounds. The cervical os was closed, uneffaced. Ultrasound done at 18 weeks’ gestation had reported pregnancy in a bicornuate uterus. Present ultrasound revealed intrauterine foetal demise of 28.4 weeks. Cervical ripening, done using prostaglandins, mechanical dilation with Foley’s catheter and oxytocin, had failed, and thus patient was taken up for surgery. Findings revealed an abdominal pregnancy with a macerated fetus of 1070 grams (severely growth restricted). Placenta was found to be implanted on multiple areas of both small and large intestine and posterior peritoneum. Placenta was left in situ. Postoperative recovery was uneventful. She was given higher antibiotics, 4 doses of tablet mifepristone 200 mg and monitored regularly with ultrasound/ MRI and bHCG which showed slow placental resorption. Conclusion- Abdominal pregnancies, associated with a high maternal and perinatal morbidity and mortality, are diagnosed preoperatively only in 45% of cases. Thus, a high index of suspicion and improvement in diagnosis is the need of the hour. Successful management includes prompt intraoperative recognition and management of the placenta (we advocate leaving the placenta in situ), multidisciplinary approach with involvement of surgeons and interventional radiologists, access to blood products, meticulous postoperative care and close observation during the subsequent delayed reabsorption.

Study of early perinatal outcome in lower segment caesarean section in severe foetal distress at tertiary care centre

Background: For asphyxia, the fetus reacts with a series of responses. First there is redistribution of blood flow to vital centres to limit the deleterious effects of oxygen limitation in the brain, heart and adrenal glands. A further compensatory response is that overall fetal oxygen consumption declines to values as low as 50% of the control.Methods: This was a prospective study. Early perinatal outcome of newborns delivered through Caesarean section due to clinical foetal distress in labour was compared with a group of newborns similarly delivered via Caesarean section without a diagnosis of clinical foetal distress. Data collected and analysed using appropriate standard statistical methods i.e. Chi-square (X2) test and ‘Z’ - test.Results: Most common indication for NICU admission in study group was MAS (Meconium Aspiration Syndrome 14%) followed by MAS with perinatal asphyxia (5.33%), MAS with Hypoxic ischaemic encephalopathy (HIE) - stage III (3.33%) paerintal asphyxia (2.66%), severe PNA with HIE - III (0.66%) and TTN (0.66%) meconium gastritis (0.66%) respectively.Conclusions: Clinical foetal distress (study group) was found to be significantly associated with low 1 min and 5 min. Apgar score. There was no significant difference in immediate NICU admission whether D-D (i.e. detection fetal detection to delivery interval) time interval <30 minutes or >30 minutes. But rate of mortality was high when D-D (i.e. detection fetal detection to delivery interval) was >30 minutes.

Feto-maternal outcome in human immunodeficiency virus seropositive mothers in co-relation with CD4 count

Background: To study the effect of human immunodeficiency virus (HIV) infection on pregnancy outcomes and new born as mother to child transmission of HIV is a major route on new infections in children and compare it with HIV uninfected pregnancies.Methods: Prospective comparative study conducted on 40 HIV seropositive and 40 HIV seronegative pregnant women attending ANC and delivering in the department of obstetrics and gynecology, S. M. S. Medical College, Jaipur, Rajasthan, India.Results: CD4 count had no effect on birth weight of baby or term of delivery. HIV seropositive pregnancies were more prone to IUD, still birth and preterm birth (p=0.029). Mother to child transmission was 2.7%.Conclusions: HIV infection increases the risk of adverse foetal outcome in terms of intrauterine demise, still birth and preterm labour.

Comparative evaluation of continuous epidural infusion of 0.0625% Bupivacaine + 0.0002% Fentanyl and 0.1% Ropivacaine + 0.0002% Fentanyl for labour analgesia

Aim& Objectives: To compare the total dose of Fentanyl and Bupivacaine with total dose of Ropivacaine and fentanyl in terms of total volume delivered-loading, infusion and top ups. Also, to compare Analgesic efficacy (VAS score) and adverse events if any. Methods: 60 ASA physical status I or II parturients in labour who were either primigravidae or gravida 2 were included in a randomized, single blind, prospective study. After a bolus dose of 0.125 % Bupivacaine and 25 mcg Fentanyl, the group BF received a continuous epidural infusion of 0.0625% Bupivacaine and 0.0002% Fentanyl whereas the group RF received a bolus of 0.2% Ropivacaine and 25 mcg Fentanyl followed by an infusion of 0.1% Ropivacaine and 0.0002% Fentanyl. Results: The Group BF and Group RF were comparable with respect to their physical parameters. It was seen that the pain relief in the group BF was excellent for 8 out of 30 patients (26.67%) whereas for the group RF it was excellent for 9 of 30 patients (30%). After that till delivery, both the groups had a comparable mean maternal pulse rate (p value >0.05). None of the parturient in study or control group ever had an episode of bradycardia. Throughout the remaining period of analgesia, the mean foetal heart rate was comparable between the two groups. In the present study groups only 2 parturients from group BF and only one parturient from group RF underwent caesarean section due to foetal distress. 6 parturients (20%) from group BF and 5 parturients (16.67%) from group RF developed hypotension. Conclusion: Continuous infusion of 0.1% Ropivacaine + 0.0002 % Fentanyl provides equipotent labour analgesia and maternal satisfaction as 0.0625% Bupivacaine + 0.0002% Fentanyl infusion can provide.

Acute kidney injury in obstetrics: a five-year study in a tertiary centre

Background: Pregnancy Related Acute Kidney Injury (PRAKI) is a major cause of maternal and foetal morbidity and mortality in developing countries. The incidence has declined due to improvements in reproductive health but it is still associated with significant perinatal mortality and maternal morbidity. It may be due to decrease in renal perfusion or ischemic tubular necrosis from a variety of conditions encountered during pregnancy. Our study aims at determining the predisposing factors and causes of AKI during pregnancy and its impact on maternal and foetal outcome.Methods: A retrospective cohort study over a period of 5 years was conducted on pregnant women with AKI as per inclusion and exclusion criteria. The detailed history, events, mode of delivery, cause leading to AKI, management, hospital stay, maternal and foetal outcome were studied in detail and evaluated. These patients were classified according to RIFLE criteria and were followed up for hospital stay and residual morbidities.Results: The incidence of PRAKI in the study was 0.07% (36 out of 50,735 deliveries) and among obstetric ICU patients, it was 6.8%. Most of the majority of the cases were unbooked (66.7%) and multipara (61.1%). Maternal morbidity was seen in 66.7% and mortality was 27.8%. Poor foetal outcome was seen in 44.4%.Conclusions: Haemorrhage is the most common cause of PRAKI, followed by toxaemia of pregnancy and sepsis. Early detection and meticulous management of haemorrhage, hypertension and sepsis reduce the incidence of PRAKI and associated maternal mortality.