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.

A pilot study on CD4 & CD8 cell counts in healthy HIV seronegative pregnant women.

CD4 and CD8 counts are widely used prognostic markers to assess the degree of immune impairment in HIV seropositive individuals and to monitor anti-retroviral therapy (ART). Pregnancy is considered as a physiologically immunocompromised state, hence alterations in T lymphocyte subsets may occur during pregnancy. There is a need to establish base-line values of these counts, especially in healthy pregnant women. One hundred healthy HIV seronegative pregnant women (mean age 22.5 +/- 2.99 yr) in their third trimester of pregnancy and 30 non-pregnant women (mean age 22.7 +/- 3.01 yr) were tested for their CD4 and CDS counts. In pregnant women, the CD4 and CD8 cell counts/microl were 764 +/- 249 and 547 +/- 196 and the CD4 and CD8 per cent were 56.49 +/- 8.3 and 38.03 +/- 7.2 respectively. In the non-pregnant women CD4 and CD8 counts/microl were 965 +/- 267 and 639 +/- 211 whereas the CD4 and CD8 per cent were 55.27 +/- 5.99 and 36.17 +/- 6.44 respectively. Absolute counts were significantly lower (P < 0.05) in the pregnant group as compared to the controls. A wide variation was seen in the CD4 and CD8 counts in both the groups. However, the variations in the mean CD4 and CD8 per cent were much smaller. Thus CD4 and CD8 per cent may be considered as a useful indicator of immune function rather than absolute counts, in pregnant women.

Admission test: a predictive test for fetal distress in high risk labour.

OBJECTIVE: To study predictive utility of admission test (AT) for perinatal outcome in high risk labours. METHOD: A hundred patients at risk of fetal jeopardy due to uteroplacental insufficiency were screened by admission test. The traces were classified as per the criteria suggested by Ingemarsson and Arulkumaran (1986). The perinatal outcome was correlated with the initial FHR pattern and Chi square test was applied to the results. RESULTS: Fifty-eight patients had reactive, 35 had equivocal and 7 had ominous tracing. The incidence of operative delivery for fetal distress showed a progressive rise from reactive (5.17%) to ominous (28.5%) pattern group. The perinatal morbidity also showed a rise from 6.89% in the reactive to 31.42% in the equivocal (p < 0.01) and 85.71% in the ominous group (p < 0.02). The reactive pattern was assuring of the fetal well being for next 5 hours. Presence of late decelerations and decelerations of 60 beats or more below the baseline were additional ominous characteristics, associated with a significant increase in perinatal morbidity. CONCLUSION: Reactive AT appears to be predictive of fetal well being in high risk labours also. Repeat tracing 4 to 5 hours apart may improve the predictive accuracy. Equivocal and ominous patterns require vigilant monitoring.

Infant mortality in rural India: a strategy for reduction.

PIP: A risk-approach-strategy project sponsored by WHO was undertaken in 22 villages of Surur, Pune, by BJ Medical College. All births in the study population of 47,000 were followed, comparing the 3 cohorts born between January 1981 to December 1983. Female village health guides were trained in screening for 11 maternal risk factors, infant risk factors, infant monitoring, and basic health support such as maternal nutrition, rest, breastfeeding and home cleaning, heating, humidifying and infant isolation. There were 123, 97 and 87 infant deaths in the 1981, 1982, and 1983 cohorts, giving infant mortality rats of 91.2, 72.3 and 67.3 respectively. The proportion of neonatal deaths remained at 61 to 62.1% over the period. The most common risk factors seen were illness, low birth weight and growth retardation, often associated with illness. Incidence of low birth weight and prolonged labor both decreased significantly over the duration of the program. Mortality was high among infants with feeding problems and prematurity. 40% of deaths were due to infections, 28% to low birth weight and prematurity, and 9% to birth asphyxia. The lower infant mortality rate achieved here is comparable to urban levels reported in India. These results show that primary health workers are capable of referring and managing risks, and risk management could be applied on a larger scale.^ieng