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Recently Cabinet has passed the proposed Medical Termination of Pregnancy (Amendment) Bill, 2020. In current bill certain changes has been made regarding the upper limit of gestational age for termination of pregnancy under MTP Act, 1971. Through this paper researcher will discuss about the drawback of the MTP (Amendment) Bill, 2020 in terms of gestational age with the help of the various judicial pro-announcement. [ABSTRACT FROM AUTHOR]

BACKGROUND: High quality personal exposure data is fundamental to understanding the health implications of household energy interventions, interpreting analyses across assigned study arms, and characterizing exposure–response relationships for household air pollution. This paper describes the exposure data collection for the Household Air Pollution Intervention Network (HAPIN), a multicountry randomized controlled trial of liquefied petroleum gas stoves and fuel among 3,200 households in India, Rwanda, Guatemala, and Peru. OBJECTIVES: The primary objectives of the exposure assessment are to estimate the exposure contrast achieved following a clean fuel intervention and to provide data for analyses of exposure–response relationships across a range of personal exposures. METHODS: Exposure measurements are being conducted over the 3-y time frame of the field study. We are measuring fine particulate matter [PM < 2.5 μm in aerodynamic diameter (PM2.5)] with the Enhanced Children’s MicroPEM™ (RTI International), carbon monoxide (CO) with the USB-EL-CO (Lascar Electronics), and black carbon with the OT21 transmissometer (Magee Scientific) in pregnant women, adult women, and children < 1 year of age, primarily via multiple 24-h personal assessments (three, six, and three measurements, respectively) over the course of the 18-month follow-up period using lightweight monitors. For children we are using an indirect measurement approach, combining data from area monitors and locator devices worn by the child. For a subsample (up to 10%) of the study population, we are doubling the frequency of measurements in order to estimate the accuracy of subject-specific typical exposure estimates. In addition, we are conducting ambient air monitoring to help characterize potential contributions of PM2.5 exposure from background concentration. Stove use monitors (Geocene) are being used to assess compliance with the intervention, given that stove stacking (use of traditional stoves in addition to the intervention gas stove) may occur. CONCLUSIONS: The tools and approaches being used for HAPIN to estimate personal exposures build on previous efforts and take advantage of new technologies. In addition to providing key personal exposure data for this study, we hope the application and learnings from our exposure assessment will help inform future efforts to characterize exposure to household air pollution and for other contexts. [ABSTRACT FROM AUTHOR]

Aim: To synthesize the existing literature and determine the efficacy of occupational therapy intervention, starting in the neonatal intensive care unit (NICU), on the motor, cognitive, and behavioural outcomes of Indian infants born pre-term. Method: Databases were searched for randomized controlled trials, quasi-randomized controlled trials, pre and post studies etc of occupational therapy early intervention for infants with a gestational age of less than 37 weeks, initiated in the NICU and delivered by a therapist or parent with therapist support. Quality was evaluated using the Cochrane standardized risk of bias assessment tool. Recommendations were made using the Grading of Recommendations, Assessment, Development and Evaluations approach. Results: Ten studies met the inclusion criteria. Studies were categorized into four intervention categories: (1) nesting, positioning and diaper sizing; (2) multi-sensory stimulation; (3) KMC (skin to skin care) (4) oral-motor intervention. Risk of bias varied from low to high or was unclear. Interpretation: Preliminary support indicates that occupational therapy improves motor and cognitive outcomes in the short-term and possibly long-term. Occupational therapy intervention programmes for pre-term infants have a positive influence on cognitive and motor outcomes during infancy. A great deal of heterogeneity between studies was due to the variety of early developmental intervention programmes tested and to gestational ages of included pre-term infants; thus, comparisons of intervention programmes were limited. Further research is needed to determine which early developmental interventions are most effective in improving cognitive and motor outcomes, and to discern the longer-term effects of these programmes. [ABSTRACT FROM AUTHOR]

Iodine nutrition status amongst neonates can be assessed by estimating thyroid stimulating hormone (TSH). According to WHO, if more than 3 % of the neonates have TSH levels of 5 mlU/l and more in a population, it indicates presence of iodine deficiency (ID). Iodine deficiency is an endemic health problem in Solan district, Himachal Pradesh (HP) state. ID leads to mental retardation, deaf mutism, squint, dwarfism, spastic diplegia, neurological defects and congenital anomalies. The aim is to determine iodine nutrition status of neonates of Solan district. In Solan district, six hospitals/community health centers providing obstetric services and conducting more than 100 deliveries per annum were identified and enlisted. Two hospitals were selected keeping in view of operational feasibility. A total of 683 umbilical cord blood samples of neonates were collected on filter paper and analyzed for TSH. It was found that 63.2 % of the neonates had TSH levels of more than 5 mlU/l indicating iodine deficiency in the Solan district. Iodine deficiency was a public health problem in Solan district, HP. [ABSTRACT FROM AUTHOR]

Objectives In low-income settings, neonatal mortality rates (NMR) are higher among socioeconomically disadvantaged groups. Institutional deliveries have been shown to be protective against neonatal mortality. In Gujarat, India, the access of disadvantaged women to institutional deliveries has increased. However, the impact of increased institutional delivery on NMR has not been studied here. This paper examined if institutional childbirth is associated with lower NMR among disadvantaged women in Gujarat, India. Methods A community-based prospective cohort of pregnant women was followed in three districts in Gujarat, India (July 2013-November 2014). Two thousand nine hundred and nineteen live births to disadvantaged women (tribal or below poverty line) were included in the study. Data was analyzed using multivariable logistic regression. Results The overall NMR was 25 deaths per 1000 live births. Multivariable analysis showed that institutional childbirth was protective against neonatal mortality only among disadvantaged women with obstetric complications during delivery. Among mothers with obstetric complications during delivery, those who gave birth in a private or public facility had significantly lower odds of having a neonatal death than women delivering at home (AOR 0.07 95% CI 0.01-0.45 and AOR 0.03, 95% CI 0.00-0.33 respectively). Conclusions for Practice Our findings highlight the crucial role of institutional delivery to prevent neonatal deaths among those born to disadvantaged women with complications during delivery in this setting. Efforts to improve disadvantaged women's access to good quality obstetric care must continue in order to further reduce the NMR in Gujarat, India. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Electronic fetal monitoring (EFM) is used to identify early signs of fetal deterioration. However, caution is advised when interpreting cardiotocographic parameters. A promising alternative is umbilical cord blood sampling. The analysis of blood gases and lactate levels in the cord within the initial minutes of life is a recommended approach. STUDY DESIGN: This prospective cohort study, conducted over eighteen months from June 2021 to December 2022, enrolled 70 patients with non-reactive and 70 with reactive cardiotocograph (CTG) patterns. APGAR scores were recorded at 1 and 5-minute intervals. 1 ml of umbilical artery blood was assessed in an arterial blood gas machine and fetal acidosis was defined as pH <7.0 and a lactate concentration exceeding 4 mmol/L. RESULTS: In the non-reactive CTG group, 35.7% had early decelerations, 37.1% had variable decelerations, and 17.1% had late decelerations (p<0.001). The mean cord blood lactate was 5.220±1.970 mmol/L in the non-reactive CTG group and 3.400±0.228 mmol/L in the reactive CTG group. Similarly, the mean cord blood pH was 7.030±0.007 in the non-reactive CTG group and 7.170±0.076 in the reactive CTG group (p<0.001). 14.3% of cases in the non-reactive CTG group had a 5-minute APGAR <7, with a higher APGAR score in the reactive group. CONCLUSION: The study suggests that abnormal or indeterminate CTG readings are linked to a higher risk of intrapartum fetal acidosis. Non-reactive CTG results were associated with higher mean cord blood lactate and pH levels and more number of Neonatal Intensive Care Unit (NICU) admissions. There is a definite correlation between abnormal CTG patterns and poorer neonatal outcomes. [ABSTRACT FROM AUTHOR]

Aim: The aim was to examine the outcomes of pregnant women admitted to intensive care unit with coronavirus disease-2019 (COVID-19) infection during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in India. The primary outcome of the study was maternal mortality at day 30. The secondary outcomes were the intensive care unit (ICU) and hospital length of stay, fetal mortality and preterm delivery. Materials and methods: This was a retrospective multicentric cohort study. Ethical clearance was obtained. All pregnant women of the 15--45- year age admitted to ICUs with SARS-CoV-2 infection during 1st March 2020 to 31st October, 2021 were included. Results: Data were collected from nine centers and for 211 obstetric patients admitted to the ICU with a confirmed diagnosis of COVID-19. They were divided in to two groups as per their SpO2 (saturation of peripheral oxygen) level at admission on room air, that is, normal SpO2 group (SpO2 > 90%) and low SpO2 group (SpO2 < 90%). The mean age was (30.06 ± 4.25) years and the gestational age was 36 ± 8 weeks. The maternal mortality rate was10.53%. The rate of fetal death and preterm delivery was 7.17 and 28.22%, respectively. The average ICU and hospital length of stay (LOS) were 6.35 ± 8.56 and 6.78 ± 6.04 days, respectively. The maternal mortality (6.21 vs 43.48%, p < 0.001), preterm delivery (26.55 vs 52.17%, p = 0.011) and fetal death (5.08 vs 26.09%, p = 0.003) were significantly higher in the low SpO2 group. Conclusion: The overall maternal mortality among critically ill pregnant women affected with COVID-19 infection was 10.53%. The rate of preterm birth and fetal death were 28.22 and 7.17%, respectively. These adverse maternal and fetal outcomes were significantly higher in those admitted with low SpO2 (<90%) at admission compared with those with normal SpO2. [ABSTRACT FROM AUTHOR]

To compare risk factors, biochemical parameters, maternal and fetal health parameters of Early onset preeclampsia and Late onset preeclampsia in Central India at tertiary care centre. Methods: At a tertiary care institute in Central India, a prospective study was conducted. 75 women in each, EOP and LOP, were studied based on development of preeclampsia before and after 34 weeks of gestation respectively. Risk factors, biochemical parameters, maternal and perinatal outcomes were compared between the groups to get a better idea in understanding etiopathogenesis and its implications on Indian Population. Results: The results concluded that Mean Gestational age in EOP was 31.8 weeks than 37.9 in LOP. 50.67% and 37.3% ICU admissions were seen in EOP and LOP respectively due to more incidence of maternal morbidities in EOP. In EOP and LOP still births were 21.3% and 9.3% respectively. More number of NICU admissions were seen in EOP than LOP; 30.7% and 8% respectively. Conclusion: The results concluded that Early onset preeclampsia is comparatively associated with more severe maternal and perinatal outcomes, which was statistically significant. Biochemical parameters were more deranged in Early onset preeclampsia. Inconclusive results were found on comparison of known risk factors of preeclampsia between both groups. [ABSTRACT FROM AUTHOR]

Introduction: Congenital heart diseases (CHD) are among the most common form of birth defects. The fetal cardiac screening by ultrasound can detect a high proportion of cases of CHD. Detection of cardiac anomalies can be challenging and is typically done by fetal cardiac ultrasound performed between 18 and 22 weeks. A transvaginal scan can detect anomalies even at 12-13 weeks. Early and precise detection of CHD can direct appropriate management. Objectives: To detect the incidence of congenital heart diseases at a tertiary care centre and to detect cardiac anomalies early, accurately, and help avail all the benefits of early prenatal diagnosis. Methods: A descriptive cross-sectional study, where 5,000 patients were screened over a period of 10 months who came for routine second trimester (16 to 24 weeks) obstetric evaluation. The fetal heart was evaluated and sequential segmental analysis was done using ultrasonography. Detailed biometric and structural evaluations of all fetuses were undertaken. In high-risk cases (17%), or in cases with positive cardiac findings, the extended fetal echocardiographic examination was performed at 16-20 weeks(850 cases). Follow-up scans were done at 24 weeks and post-natal periods to confirm the diagnosis. Out of 5,000 screened cases, 25 fetuses had CHD. The most common indication for extended fetal echo was maternal (59.2%) followed by fetal (40.2%). In maternal indications, the most common was advanced maternal gestational age (>35 years), followed by bad obstetric history and gestational diabetes. In fetal indications, the most common was abnormal obstetric Doppler findings favouring IUGR. Results: Of 5,000 cases examined by us, at 16 - 24 weeks using Color Doppler, and a high-end ultrasound machine, we could diagnose VSD in 3 cases, ASD in 2 cases, TOF in 2 cases, Transposition of great vessels in 2 cases, Hypoplastic left heart syndrome in 2 cases, Ebstein's anomaly in 1 case and severe fetal hydrops with bradycardia in 1 case. On follow-up scan at 24 weeks, 2 additional VSD cases, 2 additional ASD cases, 2 new cases of TOF, and 1 new case of TGA were diagnosed. However, the number of cases of other pathologies remained the same. On post-natal scan additional cases of VSD, TOF and TGA diagnosed were 2, 1, and 2. Conclusion: An apparently normal appearance at any stage of pregnancy does not exclude a major heart defect, and it seems likely that some defects may be amenable to diagnosis only after birth. Hence follow-up scans with minute observation and technical expertise are need of the hour. Most of the CHDs in our region are missed, primarily because of poor socioeconomic status, lack of availability and awareness of diagnostic echocardiography. Spreading awareness and skill of fetal echocardiography is need of the hour. [ABSTRACT FROM AUTHOR]

Background: Neonatal mortality rate accounts for 20.3 per 1000 live births in India. One of the significant predictors of neonatal mortality is low birth weight. Weight is the most extensively used parameter. However, there are alternate anthropometry parameters, such as mid-arm circumference, mid-thigh circumference, and mid-calf circumference, which can be used to assess newborns' growth and identify the newborns at risk. The current study aimed to determine the correlation between limb anthropometric measurements and gestational age and to derive the mean and standard deviation for all limb anthropometric measurements of the newborn with gestational age. Methods: The study included 400 live newborn babies admitted to the NICU/PNW at the Aarupadai Veedu Medical College and Hospital for routine observation from December 2020 to October 2022. Within 48 hours after birth, newborns were evaluated for anthropometric measures using standard techniques. Results: All limb anthropometric measurements increased as gestational age increased to 39-40 weeks, which began to decline after 40 weeks. There was a strong correlation between limb anthropometric measurement with gestational age (p < 0.001), with mid-thigh circumference exhibiting the highest correlation (r=0.652). Conclusion: The findings of the current study suggest that besides birth weight, other basic anthropometric parameters, such as limb anthropometry (e.g., mid-thigh circumference), can be effectively used to quantify prenatal development and identify infants at risk. Conducting an analysis of anthropometric measures after delivery allows for a rapid assessment of infants with atypical growth patterns, making them more susceptible metabolic complications. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Omicron was declared as a variant of concern by WHO on 26 Nov 2021. Omicron is highly transmissible, but the disease severity and morbidity were lesser compared to the Delta variant. However, COVID-19 Vaccine efficacy was reduced for the Omicron variant whereas it was highly efficacious for the Delta variant. Hence, for evidence-based counseling in pregnant patients about expected outcomes depending on their vaccination status, this prospective cohort study was conducted. STUDY DESIGN: This study was conducted in Base Hospital Delhi Cantt, New Delhi, India during the third wave of SARS-CoV-2 i.e. from Jan 2022 to Mar 2022. All COVID-19-positive patients who were admitted for delivery were followed up till discharge from the hospital. The outcomes in terms of severity of COVID-19 infection, period of gestation at the time of delivery, intrapartum/postpartum complications, fetal distress, meconium staining of liquor, the requirement of neonatal intensive care unit admission were documented and data was analyzed to assess clinical severity of the disease in fully/partially vaccinated+unvaccinated women. RESULTS: During the specified period, 22.32% was the positivity rate among the delivered patients. Of 61.78% were fully vaccinated and 24.39% were either not vaccinated or partially vaccinated. The risk of symptomatic COVID-19 illness, the requirement of supportive management, and maternal and neonatal outcomes in both groups were comparable. CONCLUSION: Unvaccinated or partially vaccinated parturient had no increased risk of symptomatic COVID-19 illness or requirement of supportive management in terms of oxygen inhalation or ventilation as compared with fully vaccinated pregnant women. The study also reported comparable maternal and fetal outcomes in vaccinated and unvaccinated/partially vaccinated pregnant women. Further studies are required to ascertain whether the comparable outcomes were due to the decreased severity of the disease caused by the omicron variant. [ABSTRACT FROM AUTHOR]

Aims: The International Association for Diabetes in Pregnancy Study Group (IADPSG) criteria recommend a single-step diagnostic oral glucose tolerance test (OGTT) for diagnosis of gestational diabetes mellitus (GDM). The aim of this study was to examine the association between the number of abnormal glucose values and levels of FPG with pregnancy outcomes. Methods: Pregnant women (n=1,044) were screened for GDM at maternity centers in South India using IADPSG criteria. OGTTs were classified based on the number of abnormal glucose values (any one value or more than one value high) and fasting plasma glucose (FPG) values (<92mg/dl,92-100mg/dl,>100mg/dl) and correlated with pregnancy outcomes. Odds ratio were adjusted for age, BMI, gestational week at diagnosis, family history of diabetes, previous history of GDM, gestational week at delivery and birth weight. For macrosomia and large for gestation age, birth weight was excluded from the model. Results: Risk of caesarean section was significantly higher in women with any one abnormal glucose value (OR: 1.49; 95%CI: 1.07–2.09). This further increased in those with >1 value (OR: 1.35; 95%CI: 0.87–2.10), when compared to women with all values normal. Risk of large for gestation age (LGA) was higher in women with FPG 92–100mg/dl (OR: 1.37; 95%CI: 0.80–2.35) and in those with FPG >100mg/dl (OR: 1.87; 95%CI: 1.04–3.35), compared to those with FPG <92mg/dl. Conclusions: The risk for poor pregnancy outcomes starts in those with one abnormal value in the OGTT or with FPG >92mg/dl but becomes significantly higher in those with higher abnormal values. [ABSTRACT FROM AUTHOR]

Maternal iodine (I) status is critical in embryonic and foetal development. We examined the effect of preconception iodine supplementation on maternal iodine status and on birth outcomes. Non‐pregnant women in Guatemala, India and Pakistan (n ~ 100 per arm per site) were randomized ≥ 3 months prior to conception to one of three intervention arms: a multimicronutrient‐fortified lipid‐based nutrient supplement containing 250‐μg I per day started immediately after randomization (Arm 1), the same supplement started at ~12 weeks gestation (Arm 2) and no intervention supplement (Arm 3). Urinary I (μg/L) to creatinine (mg/dl) ratios (I/Cr) were determined at 12 weeks for Arm 1 versus Arm 2 (before supplement started) and 34 weeks for all arms. Generalized linear models were used to assess the relationship of I/Cr with arm and with newborn anthropometry. At 12 weeks gestation, adjusted mean I/Cr (μg/g) for all sites combined was significantly higher for Arm 1 versus Arm 2: (203 [95% CI: 189, 217] vs. 163 [95% CI: 152, 175], p < 0.0001). Overall adjusted prevalence of I/Cr < 150 μg/g was also lower in Arm 1 versus Arm 2: 32% (95% CI: 26%, 38%) versus 43% (95% CI: 37%, 49%) (p = 0.0052). At 34 weeks, adjusted mean I/Cr for Arm 1 (235, 95% CI: 220, 252) and Arm 2 (254, 95% CI: 238, 272) did not differ significantly but were significantly higher than Arm 3 (200, 95% CI: 184, 218) (p < 0.0001). Nominally significant positive associations were observed between I/Cr at 12 weeks and birth length and head circumference z‐scores (p = 0.028 and p = 0.005, respectively). These findings support the importance of first trimester iodine status and suggest need for preconception supplementation beyond salt iodization alone. [ABSTRACT FROM AUTHOR]

Objective: To construct international ultrasound-based standards for fetal cerebellar growth and Sylvian fissure maturation.Methods: Healthy, well nourished pregnant women, enrolled at < 14 weeks' gestation in the Fetal Growth Longitudinal Study (FGLS) of INTERGROWTH-21st , an international multicenter, population-based project, underwent serial three-dimensional (3D) fetal ultrasound scans every 5 ± 1 weeks until delivery in study sites located in Brazil, India, Italy, Kenya and the UK. In the present analysis, only those fetuses that underwent developmental assessment at 2 years of age were included. We measured the transcerebellar diameter and assessed Sylvian fissure maturation using two-dimensional ultrasound images extracted from available 3D fetal head volumes. The appropriateness of pooling data from the five sites was assessed using variance component analysis and standardized site differences. For each Sylvian fissure maturation score (left or right side), mean gestational age and 95% CI were calculated. Transcerebellar diameter was modeled using fractional polynomial regression, and goodness of fit was assessed.Results: Of those children in the original FGLS cohort who had developmental assessment at 2 years of age, 1130 also had an available 3D ultrasound fetal head volume. The sociodemographic characteristics and pregnancy/perinatal outcomes of the study sample confirmed the health and low-risk status of the population studied. In addition, the fetuses had low morbidity and adequate growth and development at 2 years of age. In total, 3016 and 2359 individual volumes were available for transcerebellar-diameter and Sylvian-fissure analysis, respectively. Variance component analysis and standardized site differences showed that the five study populations were sufficiently similar on the basis of predefined criteria for the data to be pooled to produce international standards. A second-degree fractional polynomial provided the best fit for modeling transcerebellar diameter; we then estimated gestational-age-specific 3rd , 50th and 97th smoothed centiles. Goodness-of-fit analysis comparing empirical centiles with smoothed centile curves showed good agreement. The Sylvian fissure increased in maturation with advancing gestation, with complete overlap of the mean gestational age and 95% CIs between the sexes for each development score. No differences in Sylvian fissure maturation between the right and left hemispheres were observed.Conclusion: We present, for the first time, international standards for fetal cerebellar growth and Sylvian fissure maturation throughout pregnancy based on a healthy fetal population that exhibited adequate growth and development at 2 years of age. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Aim: Prediction of length of stay (LOS) among preterm neonates is important for counselling of parents and for assessing neonatal intensive care unit (NICU) census and economic burden. The aim of this study is to evaluate perinatal and postnatal factors that influence LOS in preterm infants (25-33 weeks of gestation) admitted to participating NICUs of Indian National Neonatal Collaborative (INNC).Methods: From the INNC database, the data which were prospectively entered using uniformed pre-defined criteria were analysed.Results: A total of 3095 infants were included from 12 centres. Every week decrease in gestation increased LOS by 9 days. The median LOS for infants with gestational age of 25, 26, 27, 28, 29, 30, 31, 32 and 33 weeks were 86, 70, 62, 52, 40, 30, 23, 16 and 10 days, respectively. On multivariate analysis, abnormal antenatal umbilical artery doppler, severe small for gestational age (SGA), requirement of resuscitation, respiratory distress syndrome (RDS), seizures, sepsis, necrotising enterocolitis (NEC), major malformations and bronchopulmonary dysplasia (BPD) increased LOS by 5.4 (3.5-7.4), 21.6 (19-23.9), 4.7 (3.3-6.1), 3 (1.7-4.3), 15.2 (8.5-22.1), 11.2 (9.1-13.2), 9.8 (5.2-14.4), 8.8 (4.4-13.3) and 5.6 (0.5-10.7) days, respectively.Conclusions: Apart from lower gestation and birth weight, abnormal antenatal umbilical artery doppler, severe SGA, resuscitation need, major malformations, RDS, seizures, sepsis, NEC and BPD influenced LOS in preterm infants. In comparison with other networks or data from developed countries, LOS in our network was comparatively less for similar gestational age infants. [ABSTRACT FROM AUTHOR]

This study aimed to examine the association between breastfeeding and childhood obesity. A multinational cross‐sectional study of 4,740 children aged 9–11 years was conducted from 12 countries. Infant breastfeeding was recalled by parents or legal guardians. Height, weight, waist circumference, and body fat were obtained using standardized methods. The overall prevalence of obesity, central obesity, and high body fat were 12.3%, 9.9%, and 8.1%, respectively. After adjustment for maternal age at delivery, body mass index (BMI), highest maternal education, history of gestational diabetes, gestational age, and child's age, sex, birth weight, unhealthy diet pattern scores, moderate‐to‐vigorous physical activity, sleeping, and sedentary time, exclusive breastfeeding was associated with lower odds of obesity (odds ratio [OR] 0.76, 95% confidence interval, CI [0.57, 1.00]) and high body fat (OR 0.60, 95% CI [0.43, 0.84]) compared with exclusive formula feeding. The multivariable‐adjusted ORs based on different breastfeeding durations (none, 1–6, 6–12, and > 12 months) were 1.00, 0.74, 0.70, and 0.60 for obesity (Ptrend =.020) and 1.00, 0.64, 047, and 0.64 for high body fat (Ptrend =.012), respectively. These associations were no longer significant after adjustment for maternal BMI. Breastfeeding may be a protective factor for obesity and high body fat in 9‐ to 11‐year‐old children from 12 countries. [ABSTRACT FROM AUTHOR]

Introduction: Peak systolic velocity (PSV) of the middle cerebral artery (MCA) shows 100% sensitivity for predicting fetal anemia before the first intrauterine transfusion (IUT). However, its ability to predict subsequent transfusions has remained mostly controversial.Objectives: To assess if there is a need to change the threshold of MCA-PSV from 1.5 to 1.69 multiples of the median (MoM) to predict fetal anemia and the need for subsequent IUT.Methods: This is a retrospective audit, wherein case records of mothers who underwent IUT at the Bangalore Fetal Medicine Centre between April 2008 and May 2017 were reviewed; 86 cases were included, and the data were analyzed using MS Excel. The MCA-PSV and pretransfusion Hb were converted into MoM. 40 fetuses that had more than 1 IUT were included in the analysis. -Results: 31/40 fetuses that had >1 IUT had an MCA-PSV >1.5 MoM, of which 29 were anemic according to the post-IUT Hb MoM. 20/29 (69%) had an MCA-PSV >1.69, whereas 9/29 (31%) had an MCA-PSV between 1.5 and 1.69 MoM. Our study shows that changing the MCA-PSV threshold from 1.5 to 1.69 MoM will reduce the detection of fetal anemia and hence the need for repeat IUT by 31%.Conclusions: Increasing the fetal MCA-PSV threshold from 1.5 to 1.69 will miss out one-third of the fetuses that will require a 2nd, 3rd, or 4th IUT. This is more relevant in geographical areas where the parents must travel long distances for IUTs, which are performed in tertiary fetal care centers. [ABSTRACT FROM AUTHOR]

Context: High perinatal mortality in India may be caused by inaccurate dating of pregnancy resulting from suboptimal uptake of antenatal care and ultrasound services during pregnancy. Aim: To determine the discrepancy in the last menstrual period (LMP) assigned expected date of delivery (EDD) and ultrasound assigned EDD in pregnant women in a rural district of central India. Methods: Data from an ongoing cross-sectional screening program providing fetal radiology imaging in Guna district of Madhya Pradesh from 2012–2019 was analyzed for recall of LMP and discordance between LMP and ultrasound assigned EDD. The discrepancy was present when EDD assigned by ultrasound differed by 3 or more days at gestational ages less than 8+6 weeks, 5–7 days at gestational ages 8+6 weeks till 14 weeks, and 7–10 days at gestational ages 14–20 weeks. Results: The program screened 14,701 pregnant women of which 4,683 (31.86%, 95% CI: 31.11, 32.61) could not recall LMP. EDD assigned by LMP and ultrasound matched in 7,035 (70.22%, 95% CI: 69.32, 71.12) of the remaining 10,018 pregnant women. EDD was overestimated by LMP for 26.06% (95% CI: 25.21, 26.93) women; these foetuses were at risk of being misclassified as a term fetus. In 2018, the project had no maternal deaths, infant mortality rate of 24.7, low birth weight rate of 9.69%, and 100% antenatal coverage. Conclusion: Accurate dating of pregnancy and systematic follow-up integrating radiology imaging and obstetrics care for appropriate risk-based management of pregnant women can significantly improve perinatal statistics of India. [ABSTRACT FROM AUTHOR]

Background: The incidence of neonatal sepsis in India is the highest in the world. Evidence regarding its risk factors can guide clinical practice and prevention strategies. Objective: To review, assess and synthesize the available literature from India on the risk factors of sepsis among neonates. Methodology: A systematic review was conducted. We searched PubMed, CINAHL, Scopus, Web of Science, Popline, IndMed, Indian Science Abstracts and Google Scholar from inception up to March 23, 2018 to identify observational analytical studies reporting on risk factors of laboratory-confirmed neonatal sepsis in India. Two authors independently screened studies (title, abstract and full-text stages), extracted data, and assessed quality. A random-effects meta-analysis was performed as substantial heterogeneity was anticipated. Subgroup and sensitivity analyses were additionally performed. Effect size in our review included odds ratio and standardized mean difference. Results: Fifteen studies were included from 11,009 records, of which nine were prospective in design. Birthweight and gestational age at delivery were the most frequently reported factors. On meta-analyses, it was found that male sex (OR: 1.3, 95% CI: 1.02, 1.68), out born neonates (OR: 5.5, 95% CI: 2.39, 12.49), need for artificial ventilation (OR: 5.61; 95% CI: 8.21, 41.18), gestational age <37 weeks (OR: 2.05; 95% CI:1.40, 2.99) and premature rupture of membranes (OR:11.14, 95% CI: 5.54, 22.38) emerged as risk factors for neonatal sepsis. Included studies scored lowest on exposure assessment and confounding adjustment, which limited comparability. Inadequacy and variation in definitions and methodology affected the quality of included studies and increased heterogeneity. Conclusions: Male neonates, outborn admissions, need for artificial ventilation, gestational age <37 weeks and premature rupture of membranes are risk factors for sepsis among neonates in India. Robustly designed and reported research is urgently needed to confirm the role of other risk factors of neonatal sepsis in India. [ABSTRACT FROM AUTHOR]

Objective: To determine whether oral clindamycin reduces the risk of preterm birth (PTB) in women with abnormal vaginal microflora as evidenced by a vaginal pH ≥5.0.Design: Randomised double-blind placebo-controlled trial.Setting: Rural southern India.Population: Pregnant women with a singleton fetus between 13+0/7 weeks and 20+6/7 weeks.Methods: Pregnant women were recruited during prenatal visits in Karnataka, India, from October 2013 to July 2015. Women were required to have a singleton fetus between 13+0/7 weeks and 20+6/7 weeks and an elevated vaginal pH (≥5.0) by colorimetric assessment. Participants were randomised to either oral clindamycin 300 mg twice daily for 5 days or an identical-appearing placebo.Main Outcome Measures: The primary outcome was the incidence of PTB, defined as delivery before 37+0/7 weeks.Results: Of the 6476 screened women, 1727 women were randomised (block randomised in groups of six; clindamycin n = 866, placebo n = 861). The demographic, reproductive, and anthropomorphometric characteristics of the study groups were similar. Compliance was high, with over 94% of capsules being taken. The rate of PTB before 37 weeks was comparable between the two groups [clindamycin 115/826 (13.9%) versus placebo 111/806 (13.8%), between-group difference 0.2% (95% CI -3.2 to 3.5%, P = 0.93)], as was PTB at less than 34 weeks [clindamycin 40/826 (4.8%) versus placebo group 37/806 (4.6%), between-group difference 0.3% (95% CI -1.8 to 2.3%, P = 0.81)]. No differences were detected in the incidence of birthweight of<2500 g, <1500 g, miscarriage, stillbirth or neonatal death.Conclusion: In this setting, oral clindamycin did not decrease PTB among women with vaginal pH ≥5.0.Tweetable Abstract: Oral clindamycin between 13+0/7 and 20+6/7 weeks does not prevent preterm birth in women with a vaginal pH ≥5.0. [ABSTRACT FROM AUTHOR]

Background: Several low-cost methods are used in resource-limited settings to provide therapeutic hypothermia in asphyxiated neonates. There is inadequate data about their efficacy and safety. This is a retrospective study comparing two low-cost cooling methods-frozen gel packs (FGP) and phase changing material (PCM).Results: There were 23 babies in FGP and 45 babies in the PCM group. Induction time was significantly shorter with FGP than PCM (45 vs. 90 minutes; p -value < 0.001). Proportion of temperature readings outside the target range was significantly higher (9.8% vs. 3.8%; p -value < 0.001) and fluctuation of core body temperature was wider (standard deviation of target temperature 0.4 °C vs. 0.28 °C) in the FGP group, compared with PCM group.Conclusion: Both FGP and PCM are effective and safe, comparable with standard servo-controlled cooling equipment. PCM has the advantage of better maintenance of target temperature with less nursing input, when compared with FGP. [ABSTRACT FROM AUTHOR]

Background: : Infant body mass index (BMI) peak has received much interest recently as a potential predictor of future obesity and metabolic risk. No studies, however, have examined infant BMI peak in Asian populations, in whom the risk of metabolic disease is higher.Methods: : We utilized data among 1020 infants from a mother-offspring cohort, who were Singapore citizens or permanent residents of Chinese, Malay or Indian ethnicity with homogeneous parental ethnic backgrounds, and did not receive chemotherapy, psychotropic drugs or have diabetes mellitus. Ethnicity was self-reported at recruitment and later confirmed using genotype analysis. Subject-specific BMI curves were fitted to infant BMI data using natural cubic splines with random coefficients to account for repeated measures in each child. We estimated characteristics of the child's BMI peak [age and magnitude at peak, average pre-peak velocity (aPPV)]. Systolic (SBP) and diastolic blood pressure (DBP), BMI, sum of skinfolds (SSF) and fat-mass index (FMI) were measured during a follow-up visit at age 48 months. Weighted multivariable linear regression was used to assess the predictors (maternal BMI, gestational weight gain, ethnicity, infant sex, gestational age, birthweight-for-gestational age and breastfeeding duration) of infant BMI peak and its associations with outcomes at 48 months. Comparisons between ethnicities were tested using Bonferroni post-hoc correction.Results: : Of 1020 infants, 80.5% were followed up at the 48-month visit. Mean (SD) BMI, SSF and FMI at 48 months were 15.6 (1.8) kg/m 2 , 16.5 (5.3) mm and 3.8 (1.3) kg/m 2 , respectively. Mean (SD) age at peak BMI was 6.0 (1.6) months, with a magnitude of 17.2 (1.4) kg/m 2 and pre-peak velocity of 0.7 (0.3) kg/m 2 /month. Compared with Chinese infants, the peak occurred later in Malay {B [95% confidence interval (CI): 0.64 mo (0.36, 0.92)]} and Indian infants [1.11 mo (0.76, 1.46)] and was lower in magnitude in Indian infants [-0.45 kg/m 2 (-0.69, -0.20)]. Adjusting for maternal education, BMI, gestational weight gain, ethnicity, infant sex, gestational age, birthweight-for-gestational-age and breastfeeding duration, higher peak and aPPV were associated with greater BMI, SSF and FMI at 48 months. Age at peak was positively associated with BMI at 48 months [0.15 units (0.09, 0.22)], whereas peak magnitude was associated with SBP [0.17 units (0.05, 0.30)] and DBP at 48 months [0.10 units (0.01, 0.22)]. Older age and higher magnitude at peak were associated with increased risk of overweight at 48 months [Relative Risk (95% CI): 1.35 (1.12-1.62) for age; 1.89 (1.60-2.24) for magnitude]. The associations of BMI peak with BMI and SSF at 48 months were stronger in Malay and Indian children than in Chinese children.Conclusions: : Ethnic-specific differences in BMI peak characteristics, and associations of BMI peak with early childhood cardio-metabolic markers, suggest an important impact of early BMI development on later metabolic outcomes in Asian populations. [ABSTRACT FROM AUTHOR]

Aim: Jaundice may cause auditory toxicity (auditory neuropathy and hearing loss). However, total serum bilirubin (TSB) does not discriminate neonates at risk for auditory toxicity. We compared TSB, bilirubin:albumin molar ratio (BAMR), and unbound bilirubin for their association with auditory toxicity in neonates with severe jaundice (TSB ≥342μmol/L, or that met exchange transfusion).Method: Neonates greater or equal to 34 weeks gestational age with severe jaundice during the first 2 postnatal weeks were eligible for prospective cohort study, unless they had craniofacial malformations, chromosomal disorders, toxoplasmosis, other infections, rubella, cytomegalovirus, herpes simplex infections, surgery, or family history of congenital deafness.Results: Twenty-eight out of 100 neonates (mean gestational age 37.4wks; 59 males, 41 females) had auditory toxicity. Peak unbound bilirubin, but not peak TSB and BAMR, was associated with auditory toxicity (p<0.05) in neonates with severe (TSB <427.5μmol/L) and extreme hyperbilirubinemia (TSB ≥427.5μmol/L). Area under the receiver operating characteristic curve for unbound bilirubin (0.78) was significantly greater (p=0.03) than TSB (0.54) among neonates with severe but not extreme hyperbilirubinemia.Interpretation: Unbound bilirubin is more strongly associated with auditory toxicity than TSB and/or BAMR in greater or equal to 34 weeks gestational age neonates with severe jaundice. Unbound bilirubin is a better predictor than TSB in neonates with severe hyperbilirubinemia. [ABSTRACT FROM AUTHOR]

Objectives: To assess the spectrum of Magnetic Resonance Imaging (MRI) abnormalities among preterm babies at term equivalent age using objective scoring and to study the association among MRI variables.Methods: Ninety-four preterm babies born at ≤32 wk of gestation and / or birth weight ≤ 1500 g at term equivalent age who underwent cranial MRI between April 2011 and August 2012 and the MRI interpreted by experienced radiologists were studied. In 2014, the MRI was retrospectively re-interpreted by the same radiologists using an objective scoring system described by Kidokoro. Spectrum of MRI abnormalities, their association with perinatal variables and correlation among white matter (WM), grey matter and cerebellar scores were analyzed.Results: MRI abnormalities observed were WM signal abnormality (24 %), lateral ventricular dilatation (16 %), WM cystic abnormality (13 %), deep grey matter signal abnormality (9 %), cerebellar volume reduction (9 %) and deep grey matter volume reduction (8 %). Sepsis was significantly associated with occurrence of WM and cerebellar abnormalities (p < 0.05). WM scores did not show significant correlation with cortical grey matter and deep grey matter scores while cerebellar scores showed a weak positive correlation with WM (r = 0.33), cortical grey matter (r = 0.27) and deep grey matter scores (r = 0.22).Conclusions: MRI abnormalities are common in preterm infants, with 60 % showing some abnormality at term equivalent age. Among perinatal characteristics, sepsis was identified as risk factor for WM and cerebellar injury. Grey matter abnormality occurs independent of WM abnormality. Cerebellar abnormalities appear to coexist with either WM or grey matter changes. [ABSTRACT FROM AUTHOR]

Background: Antenatal corticosteroids are commonly used to reduce neonatal mortality, but most research to date has been in high-resource settings and few studies have evaluated its impact on stillbirth. In the Antenatal Corticosteroids Trial (ACT), a multi-country trial to assess impact of a multi-faceted intervention including antenatal corticosteroids to reduce neonatal mortality associated with preterm birth, we found an overall increase in 28-day neonatal mortality and stillbirth associated with the intervention. Methods: The ACT was a cluster-randomized trial conducted in 102 clusters across 7 research sites in 6 countries (India [2 sites], Pakistan, Zambia, Kenya, Guatemala and Argentina), comparing an intervention to train birth attendants at all levels of the health system to identify women at risk of preterm birth, administer corticosteroids and refer women at risk. Because of inadequate gestational age dating, the <5th percentile birth weight was used as a proxy for preterm birth. A pre-specified secondary outcome of the trial was stillbirth. Results: After adjusting for the pre-trial imbalance in stillbirth rates, the ACT intervention was associated with a non-significant increased risk of stillbirth (aRR 1.08, 95 % CI, 0.99-1.17, p-0.073). Additionally, the stillbirth rate was higher in the term births (1.20 95 % CI 1.06-1.37, 0.004) and among those with signs of maceration (RR 1.18 (1.04-1.35), p = 0.013) in the intervention vs. control clusters. Differences in obstetric care favored the control clusters and maternal infection was likely more common in the intervention clusters. Conclusions: In this pragmatic trial, limited data were available to identify the causes of the increase in stillbirths in the intervention clusters. A higher rate of stillbirth in the intervention clusters prior to the trial, differences in obstetric care and an increase in maternal infection are potential explanations for the observed increase in stillbirths in the intervention clusters during the trial. Trial registration: clinicaltrials.gov (NCT01084096) [ABSTRACT FROM AUTHOR]

Background: Neonatal mortality continues to be a significant problem in the Indian setting, especially in very low birth weight (VLBW) neonates. Selenium (Se) has been shown to possess antioxidant properties, and some recent studies have shown a reduction in the sepsis-attributable neonatal mortality with its use. India is a Se-deficient country. Blood Se concentrations in newborns are lower than those of their mothers and lower still in preterm infants.Objective: To evaluate the efficacy of Se in preventing the first episode of late-onset sepsis in VLBW preterm neonates.Methods: Ninety neonates weighing <1500 g and period of gestation <32 weeks, asymptomatic at birth and admitted to the neonatal intensive-care unit (NICU) in the first 12 h of birth with no maternal risk factors for sepsis were analyzed in the study. Se or placebo was supplemented orally once daily from 1st to 28th day of life to the test (n = 45) or control (n = 45) groups, respectively, followed by daily clinical assessment for signs or symptoms of sepsis in the hospital and weekly after discharge.Results: Preterm VLBW neonates (mean birth weight 1464.22 ± 50.14 g and mean gestational age 221.75 ± 4 days) are Se deficient at birth, with mean (SD) Se levels 31.1 ± 14.8 µg/l. Se supplementation at 10 µg/day increased serum Se levels significantly (63.9 ± 13.9 µg/l on Day 28 in Se vs. 40.9 ± 17.3 on Day 28 in placebo; p < 0.01). The incidence of the first episode of culture-proven late-onset sepsis was significantly lower in the Se than in the placebo group. [0/45 (0%) in Se vs. 6/45 (13.3%) in placebo; p = 0.033]. The incidence of probable sepsis was found to be significantly lower in the Se group [7/45 (15.55%)] than in the placebo [16/45 (35.55%)]; p = 0.02. The total incidence of any late-onset sepsis (i.e. culture-proven plus probable sepsis) was also significantly reduced by Se supplementation. [7/45 (15.55%) in Se vs. 22/45 (48.88%) in placebo; p = 0.001].Conclusion: Preterm VLBW neonates are Se deficient at birth. Se supplementation at 10 µg/day resulted in getting the Se levels into the acceptable normal level and reduced the incidence of the first episode of late-onset sepsis in these neonates. [ABSTRACT FROM AUTHOR]

Background: The Antenatal Corticosteroid Trial assessed the feasibility, effectiveness, and safety of a multifaceted intervention to increase the use of antenatal corticosteroids (ACS) in mothers at risk of preterm birth at all levels of care in low and middle-income countries. The intervention effectively increased the use of ACS but was associated with an overall increase in neonatal deaths. We aimed to explore plausible pathways through which this intervention increased neonatal mortality. Methods: We conducted a series of secondary analyses to assess whether ACS or other components of the multifaceted intervention that might have affected the quality of care contributed to the increased mortality observed: 1) we compared the proportion of neonatal deaths receiving ACS between the intervention and control groups; 2) we compared the antenatal and delivery care process in all births between groups; 3) we compared the rates of possible severe bacterial infection between groups; and 4) we compared the frequency of factors related to ACS administration or maternal high risk conditions at administration between the babies who died and those who survived 28 days among all births in the intervention group identified as high risk for preterm birth and received ACS. Results: The ACS exposure among the infants who died up to 28 days was 29 % in the intervention group compared to 6 % in controls. No substantial differences were observed in antenatal and delivery care process between groups. The risk of pSBI plus neonatal death was significantly increased in intervention clusters compared to controls (2.4 % vs. 2.0 %, adjusted RR 1.17, 95 % CI 1.04-1.30, p = 0.008], primarily for infants with birth weight at or above the 25th percentile. Regarding factors related to ACS administration, term infants who died were more likely to have mothers who received ACS within 7 days of delivery compared to those who survived 28 days (26.5 % vs 17.9 %, p = 0.014), and their mothers were more likely to have been identified as high risk for hypertension and less likely for signs of preterm labor. Conclusions: These results suggest that ACS more than other components of the intervention may have contributed to the overall increased neonatal mortality. ACS may have also been involved in the observed increased risk of neonatal infection and death. Further trials are urgently needed to clarify the effectiveness and safety of ACS on neonatal health in low resource settings. [ABSTRACT FROM AUTHOR]

Aim The aim of our study was to examine the association of low pregnancy-associated plasma protein- A ( PAPP-A) with adverse pregnancy outcome. Material and Methods A total of 1640 consecutive pregnant women between 9+5 and 13+6 weeks of pregnancy were recruited. One hundred and thirty women with PAPP-A levels < 0.4 multiple of median were followed till delivery and the outcome information was obtained for fetal loss, birthweight, growth restriction, preterm birth, reduced liquor and development of pre-eclampsia. Results During the study period, 130 (7.92%) women had low PAPP-A and were considered as cases and 200 women with normal PAPP-A were controls. Intrauterine growth restriction was observed in 28 (21.54%) cases as compared to 10 (5%) controls. Pre-eclampsia presented in 24 (18.46%) cases and in 18 (9%) controls. Twenty (15.38%) cases had preterm delivery compared to 12 (6%) controls. Fifty-six (43.08%) cases delivered low-birthweight babies compared to 22 (11%) controls. Thus, the incidence of intrauterine growth restriction, preterm birth and low birthweight was significantly more in the cases as compared to the control group. Conclusions PAPP-A is a valuable analyte for predicting risk of adverse pregnancy outcome and women with low serum PAPP-A levels would benefit from closer surveillance. [ABSTRACT FROM AUTHOR]

Over the past decade, India has attracted would-be parents from around the globe, many seeking to build their families through gestational surrogacy. Through extensive ethnographic fieldwork in India, I found that issues of nationality and citizenship for babies born via gestational surrogacy were among the most pressing concerns for commissioning parents. In this article, I consider the ways in which states and institutions define parents and make citizens, as well as how families created through surrogacy in India challenge these processes in new ways. By closely interrogating the ways that families, states, and global and local institutions define parenthood and citizenship within the context of transnational surrogacy, I show that while transnational surrogacy may challenge conventional understandings of kinship and family, it simultaneously renaturalizes state definitions of citizenship and motherhood. [ABSTRACT FROM AUTHOR]

The food frequency questionnaire (FFQ) was validated against multiple 24-hour dietary recalls (24-HDRs) and for a few blood biomarkers in 154 pregnant women at the obstetrics and gynecology department of St John’s Medical College Hospital, Bangalore, India. Absolute nutrient intakes from the FFQ correlated positively with the average 24-HDR during pregnancy. Energy-adjusted nutrients from the FFQ in all trimesters, except proteins, carbohydrate, folate intake, and vitamin B6 in the third trimester, correlated positively with average 24-HDR. Overestimation by the FFQ compared with the 24-HDR ranged from 9% to 41%. Vitamin B12 status in the first and second trimesters positively correlated with energy-adjusted and absolute vitamin B12 intakes from the FFQ. The Bland Altman plots showed a pattern such that a trend was seen toward underreporting of intakes through the FFQ, with increasing mean intakes by the 2 methods, considering 24-HDR as the reference tool. We conclude that the FFQ is a valid tool to measure dietary intakes during pregnancy. [ABSTRACT FROM PUBLISHER]

Objectives: To evaluate growth and neurodevelopmental outcome of very low birth weight infants (VLBW) and compare with term normal birth weight infants (NBW) till 12 months corrected age. Design: A prospective cohort study Setting: Tertiary care neonatal unit in northern India Subjects: 37 VLBW infants and 35 NBW infants born between January 2007 and December 2007. Interventions: Anthropometric measurements were recorded and Z-scores were computed serially at birth, discharge, 40 weeks post menstrual age (PMA), and at 1,3,6 and 12 months of corrected age. Developmental quotient (DQ) at 12 months corrected age was assessed. Results: Z-scores for weight, length and head circumference (HC) at birth were -1.21(±0.92), -0.98(±1.32) and -0.70(±1.14),respectively for VLBW infants and -0.37(±0.72), -0.11(±0.96) and 0.05(±0.73) respectively for NBW infants. VLBW infants had a significant drop in all Z-scores by discharge (P<0.001). There was a catch up to birth scores by 12 month age. VLBW infants had significantly lower Z-scores for weight, length and HC at one year corrected age as compared to NBW infants (P =0.01, 0.04 and 0.001, respectively). DQ at 12 months was significantly lower in VLBW infants (91.5+7.8) than NBW infants (97.5±5.3) (P O.001). DQ of small for gestational age (SGA) and appropriate for gestational age (AGA) VLBW infants was comparable. Conclusion: VLBW infants falter in their growth during NICU stay with a catch-up later during infancy. In comparison to NBW infants, they continue to lag in their physical growth and neurodevelopment at 1 year of corrected age. [ABSTRACT FROM AUTHOR]

Objective To determine population-based neonatal mortality rates in low- and middle income countries and to examine gestational age, birth weight, and timing of death to assess the potentially preventable neonatal deaths.Methods A prospective observational study was conducted in communities in five low-income countries (Kenya, Zambia, Guatemala, India, and Pakistan) and one middle-income country (Argentina). Over a 2-year period, all pregnant women in the study communities were enrolled by trained study staff and their infants followed to 28 days of age.Results Between October 2009 and March 2011, 153,728 babies were delivered and followed through day 28. Neonatal death rates ranged from 41 per 1000 births in Pakistan to 8 per 1000 in Argentina; 54% of the neonatal deaths were >37 weeks and 46% weighed 2500 g or more. Half the deaths occurred within 24 hours of delivery.Conclusion In our population-based low- and middle-income country registries, the majority of neonatal deaths occurred in babies >37 weeks' gestation and almost half weighed at least 2500 g. Most deaths occurred shortly after birth.With access to better medical care and hospitalization, especially in the intrapartum and early neonatal period, many of these neonatal deaths might be prevented. [ABSTRACT FROM AUTHOR]

The article highlights the role of poor maternal nutrition as a key factor responsible for much low birthweight in India. Several papers published in "Nutrition and Health" about maternal nutrition and pregnancy outcome are stressing that nutrition is an independent risk factor in the prevention of small for gestational age births and low birthweight.

A total of 100 women with gestational ages of 34-42 weeks requiring induction of labour were consecutively recruited in a prospective study at the Medical College and Hospital, Baroda, India. The aim of this study was to determine the value of transvaginal measurement of cervical length in the prediction of successful vaginal delivery within 24 h. Induction of labour was carried out with Tab Misoprostol (25 μg). A Bishop's score and sonographic cervical assessment were performed prior to induction. Univariate and logistic regression analyses was used. A pre-induction cervical length measurement on TVS was an independent predictor of successful vaginal delivery. At ≤3 cm cervical length, the probability of a LSCS was <30%, while with 4 cm cervical length, the probability became >75%. One unit increase in cervical length increased the probability of LSCS by 45%. The cervical length measurement by TVS is therefore an independent predictor of successful labour induction and performs better than Bishop's score as a method of pre-induction cervical assessment. [ABSTRACT FROM AUTHOR]

Background and Objective We looked at the two most commonly used methods for prenatal diagnosis, cordocentesis and chorionic villus sampling for prenatal diagnosis of haemophilia A in an Indian setting. Material and Methods The study sample included 16 families which reported to us for prenatal diagnosis of haemophilia A at All India Institute of Medical Science, New Delhi, India. Prenatal tests were done on chorionic villus samples or on cord blood (cordocentesis). Molecular work-up included the use of indirect mutation analysis in the form of linkage markers like CA-13, CA-22, Xba1 and Bcl1 as well as direct mutation analysis in the form of inversion 1 and 22 detection. Non-molecular work-up included primarily factor VIII assays. Result Chorionic villus sampling was performed in eight mothers. Of the other eight mothers, six underwent cord blood factor VIII assays because these had absence of family history and were negative for linkage and inversion 1 and 22. One patient had a female child and another had a fetus that showed congenital abnormalities. Conclusion We found that the choice of either technique, chorionic villus or cordocentesis, is not really an alternative, but rather dependent on the gestational age of presentation. [ABSTRACT FROM AUTHOR]

TABRAP (TArget Birth Rate Acceptor Program) is a computer programmed model that provides a direct solution to the problem of determining the total annual numbers of contraceptive acceptors required to achieve a prescribed crude birth rate target path. Applied to an initial population for which age structure, the fertility schedule, and expected trends in life expectancy and age-specific proportions of females married are known, TABRAP incorporates the following factors: age at acceptance, with acceptors drawn from currently married nonusers; age-method-specific attrition rates of users; a potential fertility schedule of acceptors that allows for aging and sterility; and allowance both for postpartum anovulation and nine months for gestation to time properly the averted births. TABRAP generates annual data on acceptors, couple-years of use, births averted and age-specific fertility rates that meet the crude birth rate target. Resulting changes in population size, age structure and crude vital rates, also yielded, are invariant with respect to acceptor age and method mix. Assuming a target to reduce the crude birth rate from 45 to 30 in ten years, TABRAP is illustrated for seven mixes of acceptor age-method combinations applied to a population approximately that of Thailand, circa 1965. [ABSTRACT FROM AUTHOR]

Background: The prevalence of early pregnancy loss through miscarriage and medically terminated pregnancy (MTP) is largely unknown due to lack of early registration of pregnancies in most regions, and especially in low- and middle-income countries. Understanding the rates of early pregnancy loss as well as the characteristics of pregnant women who experience miscarriage or MTP can assist in better planning of reproductive health needs of women. Methods: A prospective, population-based study was conducted in Belagavi District, south India. Using an active surveillance system of women of childbearing age, all women were enrolled as soon as possible during pregnancy. We evaluated rates and risk factors of miscarriage and MTP between 6 and 20 weeks gestation as well as rates of stillbirth and neonatal death. A hypothetical cohort of 1000 women pregnant at 6 weeks was created to demonstrate the impact of miscarriage and MTP on pregnancy outcome. Results: A total of 30,166 women enrolled from 2014 to 2017 were included in this analysis. The rate of miscarriage per 1000 ongoing pregnancies between 6 and 8 weeks was 115.3, between 8 and 12 weeks the miscarriage rate was 101.9 per 1000 ongoing pregnancies and between 12 and 20 weeks the miscarriage rate was 60.3 per 1000 ongoing pregnancies. For those periods, the MTP rate was 40.2, 45.4, and 48.3 per 1000 ongoing pregnancies respectively. The stillbirth rate was 26/1000 and the neonatal mortality rate was 24/1000. The majority of miscarriages (96.6%) were unattended and occurred at home. The majority of MTPs occurred in a hospital and with a physician in attendance (69.6%), while 20.7% of MTPs occurred outside a health facility. Women who experienced a miscarriage were older and had a higher level of education but were less likely to be anemic than those with an ongoing pregnancy at 20 weeks. Women with MTP were older, had a higher level of education, higher parity, and higher BMI, compared to those with an ongoing pregnancy, but these results were not consistent across gestational age periods. Conclusions: Of women with an ongoing pregnancy at 6 weeks, about 60% will have a living infant at 28 days of age. Two thirds of the losses will be spontaneous miscarriages and one third will be secondary to a MTP. High maternal age and education were the risk factors associated with miscarriage and MTP. Trial registration: The trial is registered at clinicaltrials.gov. ClinicalTrial.gov Trial Registration: NCT01073475. [ABSTRACT FROM AUTHOR]