Development of Risk Scoring Scale Tool for Prediction of Preterm Birth.

BACKGROUND: Prediction of preterm births in the early stage during pregnancy may reduce prevalence of preterm births by appropriate interventions. AIMS/OBJECTIVE: The aim of the study is to develop an antenatal risk scoring system/scale for prediction of preterm births. SUBJECTS AND METHODS: From a cohort of 1876 and subset of 380 pregnant women attending Krishna Hospital Karad, Maharashtra, routine antenatal and in-depth information on diet, occupation, and the rest were collected and analyzed using SPSS version 16. A scoring system was developed by multivariate analysis based on the relative risk (RR) and tested on separate set of 251 mothers. STATISTICAL ANALYSIS USED: Bivariate analysis by Chi-square test, backward multivariate regression model, receiver operating characteristic curve (ROC) curve analysis, and calculation of RR for identified risk factors. Sensitivity and specificity of newly developed risk scoring scale. RESULTS: Out of six risk factors from whole cohort (n = 1876) and three risk factors from subsample (n = 380) identified by bivariate analysis. Further four and three risk factors were retained after multivariate analysis from whole and part of cohort, respectively, and risk scores of "7" and "9" were assigned based on RR cutoff levels of three and five were identified separately for whole and part data by ROC curve analyses together making it "8" with 75.5% sensitivity and 85.5% specificity when tested on 251 independent patients. Based on the prevalence of preterm births, low-, moderate-, and high-risk grading was done by identifying as second cutoff value. CONCLUSIONS: Identification of low-, moderate-, and high-risk of preterm births was possible at <8, 8, and 9 and equal to ≥10 with high sensitivity at lower cutoff and high specificity at upper cutoff.

Antenatal Risk Scoring Scale for Predication of Low Birth Weight and Its Validity.

BACKGROUND: Prediction of low birth weight (LBW) early during pregnancy may prevent LBW by appropriate interventions. AIMS/OBJECTIVE: The aim of the study is to develop an antenatal risk scoring scale for prediction of LBW. SUBJECT AND METHODS: Routine and in-depth information on diet, occupation, and rest was collected from November 1, 2013, to November 13, 2015. A cohort of 1876 and subset of 380 pregnant women attending Krishna Hospital Karad, Maharashtra, India. STATISTICAL ANALYSIS: Multivariate analysis and relative risks (RRs) were found out by SPSS version 16 and tested on a separate set of 251 mothers. RESULTS: The frequency of meals of <4, hard work <6 h of sleep and illiteracy, antenatal morbidity, <10 kg weight gain, <40 kg maternal weight, and anemia during the first trimester were the risk factors identified from subset and cohort, respectively. Based on their RRs, a new scoring system with a total score of 24 and cutoff "12" was identified by using receiver operating characteristics (ROC) curve analysis with 98.6% sensitivity and 41.1% specificity as tested on 251-independent individuals. The second cutoff of "15" score was identified based on the prevalence of LBW in babies of these 251 mothers. CONCLUSIONS: The identification of low-, moderate-, and high-risk of LBW was possible at <12, between 12 and 15, and >15 scores, respectively, with good sensitivity and specificity.

Action-oriented colour-coded foot length calliper for primary healthcare workers as a proxy for birth weight & gestational period.

BACKGROUND & OBJECTIVES: Foot length of the newborn has a good correlation with the birth weight and is recommended to be used as a proxy measure. There can be variations in the measurement of foot length. A study was, therefore, carried out to develop a foot length calliper for accurate foot length measurement and to find cut-off values for birth weight and gestational age groups to be used by primary healthcare workers. METHODS: This study was undertaken on 645 apparently healthy newborn infants with known gestational age. Nude birth weight was taken within 24 h of birth on a standard electronic weighing machine. A foot length calliper was developed. Correlation between foot length and birth weight as well as gestational age was calculated. Correctness of cut-off values was tested using another set of 133 observations on the apparently healthy newborns. Action-oriented colour coding was done to make it easy for primary healthcare workers to use it. RESULTS: There was a significant correlation of foot length with birth weight (r=0.75) and gestational age (r=0.63). Cut-off values for birth weight groups were 6.1, 6.8 and 7.3 cm and for gestational age of 6.1, 6.8 and 7.0 cm. Correctness of these cut-off values ranged between 77.1 and 95.7 per cent for birth weight and 60-93.3 per cent for gestational age. Considering 2.5 kg as cut-off between normal birth weight and low birth weight (LBW), cut-off values of 6.1, 6.8 and 7.3 were chosen. Action-oriented colour coding was done by superimposing the colours on the scale of the calliper, green indicating home care, yellow indicating supervised home care, orange indicating care at newborn care units at primary health centres and red indicating Neonatal Intensive Care Unit care for infants. INTERPRETATION & CONCLUSIONS: A simple device was developed so that the primary health care workers and trained Accredited Social Health Activist workers can identify the risk of LBW in the absence of accurate weighing facilities and decide on the type of care needed by the newborn and take action accordingly.

Correlation of Cotinine Levels with Use of Smokeless Tobacco (Mishri) among Pregnant Women and Anthropometry of Newborn.

INTRODUCTION: 'Smokeless tobacco' is the term used for the tobacco that is consumed in un-burnt form and it can be used orally or nasally. Cotinine, a nicotine metabolite, is used to quantify exposure to tobacco, which readily gains access to foetal circulation. Cotinine is invariably found in coelomic, amniotic and foetal serum when maternal serum cotinine levels exceed 25ng/ml. AIM: To estimate cotinine levels among pregnant women using and not using smokeless tobacco (mishri) and to correlate cotinine level with anthropometry of newborns. MATERIALS AND METHODS: A hospital based cohort study was conducted at Krishna Hospital, Karad, District Satara, Maharashtra, India. Pregnant women who were using smokeless tobacco (mishri) during pregnancy were analyzed for cotinine levels in blood by using ELISA kit tech and correlated with anthropometry of newborn babies and compared with non users of tobacco. RESULTS: About 480 gm reduction in Birth weight and 6.5 cm reduction in birth length of babies born to mishri users compared to non users of tobacco and also cotinine levels among users were found significantly negatively correlating with anthropometric measurement of newborn babies. CONCLUSION: A pro-active effort is essential to educate the women about adverse effects of tobacco in general and on the intrauterine growth of the baby in particular.

Field Testing of Second Generation of Colour-Coded Rings for Detecting Slow Progress of Labour at Rural Health Centres.

INTRODUCTION: An innovative appropriate technological tool of colour-coded rings based on cervicographic principles was developed to monitor deliveries. OBJECTIVES: To study efficacy, feasibility and acceptability of colour-coded rings for monitoring active phase of labour. MATERIALS AND METHODS: All consecutive deliveries occurring at selected primary health centres from Pune, Satara and Kolhapur Districts of Maharashtra, during 15 months period were included in the study and matched control groups. Training of medical officers and nurses from both study and control area was undertaken in routine natal and post-natal care. In addition, training of use of colour-coded rings was given to health workers from the study area. RESULTS: There were 6705 live births from study area and 6341 from control area. Perinatal mortality rate for study area was 15.9/1000 LB while that was 23.9/1000 LB for control area (p < 0.01). The cause-specific perinatal mortality due to birth asphyxia for the study area was 4.2/1000 LB while that was 8.5/1000 LB for control area (p = 0.0019). CONCLUSION: Higher use rate of colour-coded rings associated with reduction in cause-specific mortality rate due to birth asphyxia in study area indicated that use of colour-coded rings is effective, feasible and acceptable option to cervicography under field conditions.

Field Testing of Appropriate Technological Tool of Individualised Color Coded Any Day Neonatal Growth Monitoring Charts for Neonatal Care at Primary Health Care Level.

OBJECTIVE: To field test the Individualised Color Coded Any Day (ICCAD) growth monitoring charts at primary health care level in three districts of Maharashtra. METHODS: The present study was conducted in three districts of Maharashtra - Pune, Satara and Kolhapur and included newborns with weight ≥ 1500 g born during 1st May 2010 to 30th July 2011. Talukas were matched based on mortality and coverage indicators and put in study (ICCAD use) and control area (ICCAD non-use) from every District. Health centres were selected from each taluka where facilities of expert obstetric and pediatric services did not exist but number of deliveries conducted was high. Data was collected during neonatal period. Three patterns of ICCAD charts; 1500 g to 1999 g, 2000 to 2499 g and ≥2500 g; developed from daily weight record of 430 newborns for 30 d were used. Outcome measures were neonatal mortality rate (NMR) and weight gain in study and control groups. RESULTS: There were 6705 live births from study and 6341 from control area. The NMR of study area (6.3/1000 live births) was significantly lesser as compared to control area (10.6/1000 live births). Birth weight group specific NMR of birth weight between 1500 to <2000 g and ≥2500 g was significantly lower in study area as compared to control area. There was improvement in mean gain weight of 15 g, 43 g and 89 g for respective birth weight groups in ascending order. CONCLUSIONS: This innovative appropriate technological tool based on translational research of ICCAD neonatal growth monitoring charts appears to have benefited the decision of type of care.

Effects of blood lead level on biochemical and hematological parameters in children with neurological diseases of Western Maharashtra, India.

BACKGROUND: Lead is found in small but appreciable quantities in air, soil, drinking water, and food. Exposure to such amounts of lead does not lead to acute lead toxicity but produces subtle effects particularly in children. The aim of this study was to investigate the effects of blood lead level on biochemical and hematological parameters in children with neurological diseases in Western Maharashtra, India, and to estimate the blood lead level by liver and kidney function tests and hematological parameters in children with neurological disorders admitted to the pediatric ward and compare them with healthy controls. METHODS: In this study, 30 children with various neurological disorders admitted to the pediatric ward of Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India, were compared with 30 age- and sex-matched healthy controls. Four milliliters of venous blood was collected for estimation of blood lead level, and biochemical and hematological parameters were determined using standard methods. RESULTS: Blood lead level was significantly increased in the study group (p<0.01, 65.38%) compared to that in the control group. When different neurological conditions were grouped into three groups according to blood lead levels, there was a significant difference between the groups. All other biochemical and hematological parameters were not significantly altered in the study group as compared to the control group. CONCLUSIONS: Neurologically challenged children are more vulnerable to lead intoxication. It is imperative for the parents to take extra care of their children's food habits and limit hand-to-mouth activities to prevent lead intoxication.

Feasibility of use of color-coded rings by nurse midwives: an appropriate technology based on partographic principles.

OBJECTIVES: To study the feasibility of use of color-coded rings as a proxy for partograph for early identification of slow progress of labor. MATERIALS AND METHODS: Color-coded rings were devised as a tool using appropriate technology to translate the partographic principles into simpler, easy to understand methodology. The rings were in pairs of 4 colors i.e., red, blue, yellow, and green, ranging from 3 cm to 10 cm in diameter with a difference of 4 cm between rings of the same color. The midwife performed p/v examination of the woman in labor to assess the initial cervical dilatation and identify corresponding ring. P/V was to be repeated after 4 hours to reassess the cervical dilatation and compare it with the bigger ring of the same color indicating expected cervical dilatation. If existing cervical dilatation measured lesser, it was interpreted as slow progress of labor indicating referral. RESULTS: 44 women [23 (22.1%) primis and 21 (13%) multis] showed delayed progress of labor as judged by use of color-coded rings. 20 women (4 primis and 16 multis) showed satisfactory progress or delivered by the time arrangements for referral were made. CONCLUSION: Use of color-coded rings may serve as a valuable tool based on appropriate technology to assess slow progress of labor not only in the hands of nurse midwives but it also can serve as a training tool for TBAs to help facilitate timely referral of such cases.

Socio-demographic profile of pregnant women using mishri.

BACKGROUND: "Mishri" is one among the various smokeless tobacco products used in the central and southern part of India. The use of newer tobacco products is increasing not only among men, but also among children, teenagers, and women of the reproductive age-group. OBJECTIVES: To study socio-demographic profile of mishri users among pregnant women admitted for delivery into Krishna Hospital, Karad - Satara, Maharashtra. MATERIALS AND METHODS: All the consecutive pregnant women admitted for delivery in Krishna Hospital, Karad over a period of 6 months were enrolled and a detailed history of use of tobacco was obtained from them. A representative sample of mishri used by them for each application was collected and weighed on an electronic weighing machine. The socio-demographic information was collected among all mishri users and age-, parity-matched controls of non-mishri users during pregnancy. RESULTS: A total of 258, i.e., (12%) of the women delivering in Krishna Hospital were using mishri. The mean duration of mishri use was 2 years with a standard deviation (SD) of 1.09 years, frequency of daily application being 1.4 times with an SD of 0.55, dwell time in mouth being 10 min with an SD of 2.9 min, and the quantity of each application being 236 mg with an SD of 66.2 mg. 29% of the teenagers and 68% of the primiparas were found to be using mishri, and a majority of them were housewives, having minimum education and belonging to the middle and lower socio-economic class. It was also found that the family members played a role in influencing the habit of mishri use. INTERPRETATION AND CONCLUSION: A small but significant number of women who deliver in the hospital used mishri during pregnancy and were in need of de-addiction counseling.

Use of 'Mishri' A Smokeless form of Tobacco During Pregnancy and its Perinatal Outcome.

BACKGROUND: Use of 'Mishri' (Tobacco containing teeth cleaning powder) is common in the central and southern part of India. OBJECTIVES: To study the effects of Mishri use on the fetus during pregnancy and the perinatal outcome, and stopping its use. MATERIALS AND METHODS: All apparently healthy pregnant women were enrolled at 20 weeks of gestation from rural Maharashtra, India. Information related to use and giving up of Mishri, previous obstetrical history, current pregnancy, delivery and outcome during the perinatal period were recorded. Appropriate tests of significance were applied. RESULTS: Out of 705 enrolled pregnant women, 218 (30.9%) were using Mishri. The proportion of women with complications during the previous perinatal period, complaints and complications during the current pregnancy/delivery and the number of stillbirths were significantly more among Mishri users. A relative risk of abnormal delivery was 2.7 for the users. In spite of counseling, 153 women never stopped the use of Mishri and gave birth to babies weighing on an average 169.9 gm less (statistically significant) than babies born from the group that never used it. Babies of 28.8% who stopped/reduced consumption of Mishri were significantly benefited. CONCLUSIONS: The improvement seen in babies born to 28.8% mothers who stopped/reduced consumption of Mishri by 32 weeks during the current pregnancy is of paramount importance in the developing world for primary prevention of low birth weight.

Physical wife abuse in an urban slum of Pune, Maharastra.

The present cross-sectional study was undertaken during August-September 2004 in an urban slum area of Pune to find out prevalence & characteristics of physical wife abuse/wife beating & to ascertain women's views & behavior towards it in a social context. The prevalence of physical wife abuse/wife beating was reported to be 61.5%. The most commonly reported husband's behavior included slapping (98.8%) followed by pushing (39.8%) & kicking wives (33.7%). 17.8% women justified physical abuse by husband. The most commonly reported behavior of women included crying (85.2%) & silently bearing the physical abuse (59%).