Comparing difference in mean total protein, albumin and globulin based on severity of rhesus isoimmunization: a prospective study

Background: Maternal RBC alloimmunization results from exposure and response to a foreign RBC antigen. Transplacental fetal to maternal hemorrhage is the most common cause of alloimmunization. Rh incompatibility can lead to either fetuses with hydropic features or non-hydropic. The precise mechanism leading to the development of hydrops is uncertain. Biochemical markers have the potential to be used to assess the severity of problem. But of the mechanisms proposed none have been able to totally explain the phenomenon or predict the prognosis. Objective of this study wads to compare the difference in mean total protein, albumin and globulin bases on severity of isoimmunization and comparing it with normal controls.Methods: A Total of 40 pregnant patients were enrolled which included 10 hydropic fetuses of Rh isoimmunised mothers, 10 non hydropic fetuses of Rh isoimmunized mothers. Control group included 18 Rh positive women without any fetal complication and 2 fetuses in women undergoing cordocentesis. Blood sampling was done at time of intrauterine transfusion and sent for estimation of total proteins, albumin, globulin in fetal blood. Pregnancies were followed up till delivery and fetal outcome noted.Results: Mean total protein, albumin and globulin between hydropic, non hydropic group and control group (3.25, 2.17 and 1.18 g/dl) in hydropic, (4.14, 2.70 and 1.44 g/dl) in non hydropic and (4.42, 2.95 and 1.47 g/dl) in control group respectively. Mean total protein, albumin and globulin between mild hydropic (3.43, 2.30 and 2.10 g/dl) and severe hydropic group (2.59, 1.6 and 1.3 g/dl) respectively.Conclusions: There was significantly lower levels of serum total proteins, albumin and globulin in hydropic fetuses as compared to non hydropic fetuses. Thus, hypoproteinemia can be considered a strong marker for development of hydrops in Rh isoimmunized fetuses.

Study of perinatal outcomes in normal and borderline oligamnios

Background: Oligamnios is a common cause of perinatal mortality and morbidity, but the outcome of borderline oligamnios, defined as Amniotic Fluid Index (AFI) between 5 and 8, is less clear. This study aims to find out the effect of borderline oligamnios on perinatal outcomes in pregnancies beyond 37 weeks.Methods: An observational prospective study of 131 antenatal mothers with AFI between 5 and 8, after 37 weeks of gestation was conducted in Sree Gokulam Medical College and Research Foundation from October 2017 to September 2019. These observations were compared with that of 131 antenatal mothers with normal AFI beyond 37 weeks of gestation. The observations according to fetal heart rate abnormalities, meconium staining of amniotic fluid, mode of delivery, low birth weight babies, APGAR score, the need of neonatal intensive care unit (NICU) admissions due to neonatal complications were statistically analysed.Results: Both groups were comparable with respect to age, parity and gestational age. In those with borderline oligamnios, fetal heart rate abnormality was seen in 21% (28), meconium stained amniotic fluid in 18% (23), 70% (91) delivered vaginally and 30% (40) underwent caesarean section, 31% (41) babies weighed below 2.5 kg and 21% (27) neonates needed NICU admissions. In those with normal AFI, none showed fetal heart rate abnormality, 2% (3) showed meconium staining, 93% (122) delivered vaginally and 7% (9) underwent caesarean section, 11% (14) babies weighed below 2.5 kg and 3% (4) neonates needed NICU admissions.Conclusions: Borderline oligamnios is associated with poor perinatal outcome. AFI can be used as an adjunct to other fetal surveillance methods. It helps to identify those infants at risk of poor perinatal outcome.

A clinical study of McIndoe vaginoplasty in vaginal agenesis

Background: The aim of this study is to determine the effectiveness of McIndoe Vaginoplasty in the creation of a neovagina for patients with vaginal agenesis.Methods: this is a retrospective study of 50 cases of vaginal agenesis, who underwent McIndoe Vaginoplasty over a period of 8 years (2004-2012) by using skin graft in 25 cases and amnion as graft in the remaining.Results: McIndoe Vaginoplasty was performed successfully in all 50 patients and post-surgical result was acceptable to the patient psychologically, sexually and aesthetically.Conclusions: McIndoe Vaginoplasty is a safe and effective procedure for providing a satisfactory and functional vagina in patients with MRKH syndrome.

Management of stillbirths: an observational analysis at a rural tertiary care centre in Kerala, India

Background: Stillbirth is a distressing event, both for the expecting mother and the obstetrician. Several maternal, social and circumstantial factors influence its occurrence. These women with intrauterine fetal death need to be treated in a considerate manner. Our aim was to analyse different methods   of induction, management of labour and their outcomes in women with antepartum fetal demise.Methods: All women admitted to a tertiary care centre with intrauterine fetal death after 22 weeks during the study period of 24 months were recruited. Maternal sociodemographic characteristics and relevant investigations were studied. Induction of labour was achieved with mechanical and pharmacological methods.  Stillborn babies, placentae and umbilical cord were examined after delivery.Results: There were 175 women with IUFD   admitted during the study period. The stillbirth rate was 38.6 per1000 live births.148 women (84.57%) required induction of labour while16 women had spontaneous onset of labour. Among the 44 women with previous Cesarean section, 11 underwent elective Cesarean section. 19 women (57.6%) out of 33 cases of trial of labour after Cesarean had a successful vaginal delivery. There were 2 cases of rupture uterus and 10 women required ICU admissions. Intrauterine growth restriction was the leading cause of stillbirth (41.8%) followed by hypertensive disorders (27.7%).Conclusions: Present study has shown that vaginal birth can be achieved in most women with mechanical and pharmacological methods of induction within a reasonable period of time.

Audit into stillbirths: a tertiary hospital experience.

Background: The objective of the study was to evaluate the prevalence, risk factors and causes of stillbirth. Methods: A retrospective cohort study was conducted from January 2014 until December 2014 in a tertiary referral teaching hospital in Punjab. The 2014 birth register from the department of Obstetrics and Gynecology was reviewed and the data was collected. The results were tabulated and data was analyzed as frequencies, percentages and descriptive statistics. Results: During the one-year study period, there were 1528 registered pregnancies in the hospital and 64 pregnant women were diagnosed to have stillbirth resulting in a stillbirth rate of 40.63 / 1000 live births. More than 75% of the stillbirths were noted in women between 21 to 30 years of age. Pregnant women who were unbooked (72.5%) had higher rates of stillbirths. More than 80% of the stillbirths were preterm. Anaemia (41.93%), pre-eclampsia (25.8%) and antepartum hemorrhage (24.19%) were the most common maternal risk factors noted in these patients. Maternal factors contributed to 37.5% of the causes of stillbirths. The other causes for stillbirths were placental factors (32.8%) and fetal factors (6.2%). In 23.43% of the cases the cause was unknown. Conclusions: India shares a high burden of stillbirths with priority gaps in reporting and recognizing at the health policy level. Better counting of stillbirths and improved cause-of-death data can advocate child survival strategies.

The use of mycotoxin binders in reducing contamination of swine diets by feed borne fusarium mycotoxins and its effects on metabolism and reproduction in first parity gilts.

In an experiment to determine the effects of feed-borne fusarium mycotoxins on metabolism and reproduction in first parity gilts, a total of 36 first parity Yorkshire gilts (3 diets with 12 gilts per diet) were housed in individual stalls for 21 days before farrowing and 21 days after farrowing in the first experiment and a total of 32 first parity gilts (4 diets with 8 gilts per diet) were used in the 2nd experiment. Experimental conditions were similar in the 2 experiments. Diets included a control diet, a diet with contaminated grains and a diet with contaminated grains + 0.2% mycotoxin binder in the 1st experiment. In the 2nd experiment a 4th diet was included. There were no significant (P>0.05) effects of diet on average daily feed intake of gilts during gestation. Weight gain and feed: gain ratios however were reduced by contaminated grains. The percentage of stillbirths was higher and total piglets born were lower for gilts fed contaminated grains compared with those fed contaminated grains plus mycotoxin binders. During lactation, feed intake and weight gain were reduced by diets containing contaminated grains. Blood chemistry, milk composition and piglet weights at weaning were not affected by diet.

Still Births in a Tertiary Hospital, Niger Delta Area of Nigeria; Less Than a Decade to the Millennium Developmental Goals.

Aims: To determine the prevalence and associated factors of stillbirths in the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt, south-south Nigeria. Study Design: Retrospective study. Place and Duration of Study: Data were obtained from the delivery registers in the theatre, labour and isolation wards and the records department of the UPTH between 1st January 2005 and 31st December 2010. Methodology: We included 580 stillbirths (316 males and 264 females) whose data were analyzed using Epi-Info software version 6.04 and SPSS version 11. Results: The prevalence of stillbirths was 45 per 1000 births. Fresh stillbirths (SB) (50.9%) were not significantly more than macerated SB (49.1%) p=0.792. Preterms (47.8%) were insignificantly more than term SB (41.5%) p=0.765. Unbooked mothers (86.7%), age 25-34 years (70%) and lower parities 1, 2 and 0 (43.4% and 29% respectively) were significantly associated with stillbirth delivery p<0.05. Places of antenatal supervision of the unbooked mothers were primary health centre (27%), traditional birth attendants’ (25%), churches, (22.3%), private maternities, (21.1%). Predominant pregnancy and labour complications associated with SB were prolonged labour (23.1%) abruptio placentae (14.1%), retained second twin (21.8%). Significantly more SB were delivered vaginally (66.9%) than abdominally (33.1%) p=0.026. Conclusion: Lack of booking, inadequate pregnancy and labour supervision, avoidable delays are major contributors to high prevalence of stillbirths in Nigeria.

Challenge of Reducing Perinatal Mortality in Rural Congo: Findings of a Prospective, Population-based Study.

Each year, an estimated six million perinatal deaths occur worldwide, and 98% of these deaths occur in low- and middle-income countries. These estimates are based on surveys in both urban and rural areas, and they may underrepresent the problem in rural areas. This study was conducted to quantify perinatal mortality, to identify the associated risk factors, and to determine the most common causes of early neonatal death in a rural area of the Democratic Republic of the Congo (DRC). Data were collected on 1,892 births. Risk factors associated with perinatal deaths were identified using multivariate analysis with logistic regression models. Causes of early neonatal deaths were determined by physician-review of information describing death. The perinatal mortality rate was 61 per 1,000 births; the stillbirth rate was 30 per 1,000 births; and the early neonatal death rate was 32 per 1,000 livebirths. Clinically-relevant factors independently associated with perinatal death included: low birthweight [odds ratio (OR)=13.51, 95% confidence interval (CI) 7.82-23.35], breech presentation (OR)=12.41; 95% CI 4.62-33.33), lack of prenatal care (OR=2.70, 95% CI 1.81-4.02), and parity greater than 4 (OR=1.93 95% CI 1.11-3.37). Over one-half of early neonatal deaths (n=37) occurred during the first two postnatal days, and the most common causes were low birthweight/prematurity (47%), asphyxia (34%), and infection (8%). The high perinatal mortality rate in rural communities in the DRC, approximately one-half of which is attributable to early neonatal death, may be modifiable. Specifically, deaths due to breech presentation, the second most common risk factor, may be reduced by making available emergency obstetric care. Most neonatal deaths occur soon after birth, and nearly three-quarters are caused by low birthweight/prematurity or asphyxia. Neonatal mortality might be reduced by targeting interventions to improve neonatal resuscitation and care of larger preterm infants.