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Background: In the COVID-19 pandemic age, vaccination hesitancy also known as vaccine refusal is a cause for worry since it hinges on the five Cs of confidence, complacency, convenience, calculation, and shared responsibility. The current study was to pinpoint the elements that contribute to breastfeeding women's hesitation to receive the coronavirus disease-19 (COVID-19) vaccine. Materials and Methods: A cross-sectional observational study was carried out at the Department of Obstetrics and Gynaecology, Tertiary Care Hospital, Ranchi, Jharkhand. Result: Out of 365 nursing mothers, 242 (66.3%) were hesitant to get the COVID-19 vaccination. Those who chose not to receive the COVID-19 vaccination mostly belong to those aged 18 to 25 (38.1%), living in rural regions (44.9%), and belonging to non-tribal ethnic groups (41.1%). On application of logistic regression, it was found that rural areas had 3 times higher rate of vaccine hesitancy than urban residents, and that husbands' education levels up to the 12th grade had a 3.55 times higher rate and 5 times agriculture by husband's occupation, which was statistically significant (P value less than 0.05) The most prevalent grounds for rejection were fear of side effects (85.8%) and worry of adverse effects on newborns (83.48%). Conclusion: Both husband and wife, who had completed high school and were aware of the vaccination, were fearful of the COVID-19 vaccine. Concerns about the side effects and undesirable effects of vaccination on their newborns were the main reasons for refusal. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease was declared a global pandemic by WHO in March 2020 and since then several reports on obstetric and neonatal outcomes due to COVID-19 infection in pregnancy are showing varying results from different corners of the world. Aims and Objectives: The aim of the present study was to describe the clinical course of the disease in pregnancy and evaluation of maternal and neonatal outcomes. The secondary objective was to compare the obstetric and neonatal outcomes of COVID-19-positive mothers and COVID-19-negative mothers admitted in the same time frame. Materials and Methods: In this retrospective cohort study we included 155 COVID-positive and 310 COVID-negative pregnant women, from May 2020 to December 2020 admitted at our tertiary care hospital in West Bengal, India. Maternal and neonatal outcomes were compared in both groups. Results: Most of the COVID-positive pregnant women were asymptomatic (38%), 45.8% of patients had mild symptoms like fever and cough and only 1.9% of mothers developed severe pneumonia. Pregnancy complications like abortion, stillbirth, intrauterine fetal death, antepartum haemorrhage, pregnancy-induced hypertension, gestational diabetes mellitus were similar in both groups (P>0.05) but significantly increased incidence of preterm labor and delivery of the low-birth-weight baby was found in the COVID-positive group (P<0.05). Number of neonates with low birth weight (<2.5 kg) was significantly higher in the COVID-positive group than in COVID negative group (28% vs. 16.7%, P<0.05). Need for neonatal intensive care unit admission was similar in both groups (P>0.05). Conclusion: Significantly increased incidence of preterm labor and delivery of the low-birth-weight baby was found in the COVID positive mothers without any evidence of mother-to-child vertical transmission of SARS-CoV-2. [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]

Background: The incidence of maternal morbidity and mortality gets reduced if antenatal care (ANC) is provided since it focuses on providing birth preparedness, good health maintenance measures, and awareness regarding pregnancy complications as well as danger signs. Methodology: The present study was conducted in the selected 10 villages in the Bahadarbad block of Haridwar, Uttarakhandw. 479 out of 580 pregnant women (who had visited Antenatal Health Camps), responded to the questionnaire thus, leading to a response rate of 82.8%. Most respondents, i.e. 96% (n=461), were 21-30 years old. Result: Out of 461 pregnant women, only 45% visited antenatal health camps and 58% were found anemic. The study also indicated that of the pregnant women who visited antenatal health camps during this period, more than 72% of women gave their previous birth in less than two years. Only 15% of women obtained complete ANC (4 visits) during the study period, just half of the previous year's coverage (31%) for the same duration. The study found that home deliveries increased significantly during the lockdown period. From April to June 2020, the percentage of home deliveries was 41% while from July to December 2020 it was 24%. Conclusion: The study suggested reduced utilization of ANC services during the pandemic and significant factors were women's age, residence, educational status, repurposing of maternity healthcare services, fear of COVID-19 transmission, and transportation disruptions. Thus, efforts should be taken to enhance maternal health services. [ABSTRACT FROM AUTHOR]

Objective: To assess national and regional trends and causes‐specific distribution of maternal mortality in India. Design: Nationally representative cross‐sectional surveys. Setting: All of India from 1997 to 2020. Sample: About 10 000 maternal deaths among 4.3 million live births over two decades. Methods: We analysed trends in the maternal mortality ratio (MMR) from 1997 through 2020, estimated absolute maternal deaths and examined the causes of maternal death using nationally representative data sources. We partitioned female deaths (aged 15–49 years) and live birth totals, based on the 2001–2014 Million Death Study to United Nations (UN) demographic totals for the country. Main outcome measures: Maternal mortality burden and distribution of causes. Results: The MMR declined in India by about 70% from 398/100 000 live births (95% CI 378–417) in 1997–98 to 99/100 000 (90–108) in 2020. About 1.30 million (95% CI 1.26–1.35 million) maternal deaths occurred between 1997 and 2020, with about 23 800 (95% CI 21 700–26 000) in 2020, with most occurring in poorer states (63%) and among women aged 20–29 years (58%). The MMRs for Assam (215), Uttar Pradesh/Uttarakhand (192) and Madhya Pradesh/Chhattisgarh (170) were highest, surpassing India's 2016–2018 estimate of 113 (95% CI 103–123). After adjustment for education and other variables, the risks of maternal death were highest in rural and tribal areas of north‐eastern and northern states. The leading causes of maternal death were obstetric haemorrhage (47%; higher in poorer states), pregnancy‐related infection (12%) and hypertensive disorders of pregnancy (7%). Conclusions: India could achieve the UN 2030 MMR goals if the average rate of reduction is maintained. However, without further intervention, the poorer states will not. We estimated that 1.3 million Indian women died from maternal causes over the last two decades. Although maternal mortality rates have fallen by 70% overall, the poorer states lag behind. We estimated that 1.3 million Indian women died from maternal causes over the last two decades. Although maternal mortality rates have fallen by 70% overall, the poorer states lag behind. [ABSTRACT FROM AUTHOR]

Although seasonal variation was observed and the rate of miscarriage was higher during February-July compared to April-January in the prepandemic period, we observed a significantly higher rate of miscarriage during the same months in the second wave of the COVID-19 pandemic. The lack of reliable data on the risk of miscarriage due to coronavirus disease 2019 (COVID-19) is a concern for both patients and obstetricians. Our study demonstrates that the risk of miscarriage during the second wave of the COVID-19 pandemic was three times higher compared with the first wave of the pandemic and two times higher compared with the prepandemic period. [Extracted from the article]

Introduction: We describe the clinical characteristics, management, and short-term outcomes of SARS-CoV-2 neonates born to mothers with COVID-19 in a tertiary care hospital in Mumbai, India.Methods: The study is a retrospective analysis of 524 neonates born to mothers with COVID-19 admitted from 14th April 2020 to 31st July 2020.Results: SARS-CoV-2 infection was detected in 6.3% of the newborns of the mothers with COVID-19. No significant differences were observed between maturity at gestation, birth weight and sex of SARS-CoV-2 infected and noninfected newborns. The risk of sepsis was 4.09 [95% confidence interval (95% CI) 1.28-13.00] fold higher in the neonates with SARS-CoV-2 as compared to the noninfected group (p = 0.031). Poor feeding was significantly more common among SARS-CoV-2 infected neonates (12.1%) as compared to the noninfected neonates (2.7%) (p = 0.017). There was a total of 13 neonatal deaths, of which 3 deaths occurred in SARS-CoV-2 infected neonates (9%) while 10 (2.04%) in the SAR-CoV-2 negative group. The risk of neonatal death was higher in SARS-CoV-2 infected newborns [odds ratio (OR) 4.8; 95% CI 1.25-18.36].Conclusion: Neonatal SARS-CoV-2 infection is observed in almost 6% of neonates born to mothers with perinatal COVID-19. There is a higher risk of adverse outcomes such as neonatal sepsis and death in the SARS-CoV-2 infected as compared to the noninfected neonates. [ABSTRACT FROM AUTHOR]

Background: This retrospective review was done to gauge the preliminary experience of COVID-19 in pregnancy during first 50 days of lockdown in a tertiary care hospital of India. Methods: This was a single-centered study, wherein all the suspected women (as defined by ICMR guidelines) who were tested for SARS-CoV 2 infection by nasopharyngeal/oropharyngeal swabs, and rendered to RT-PCR, were included. Parallel evaluation was performed for women in both groups for sociodemographic and obstetric attributes, risk factors, clinical presentation and feto-maternal outcome. Categorical variables were presented in number and percentage. Qualitative variables were equated using Chi-Square test/Fisher's exact test. A P value of < 0.05 was counted as significant. Results: Amongst 112 suspected cases, seven (6.25%) were found to be positive for SARS COV2. Majority of COVID-19 positive women hailed from urban hotspot areas (57.7%) and were un-booked (57.1%). Most were mild cases, and symptomatic (85.7%), with fever (57.1%) being predominant feature in all suspects; no adverse effects seen on pregnancy and fetus, with uneventful postpartum period. Conclusion: No adverse outcome in mother and baby after acquiring SARS-COV2 infection was observed, with maximum cases being mild; fever was the predominant symptom in all suspects, with significantly higher percentage in COVID-19 positives. [ABSTRACT FROM AUTHOR]

Objective: To assess the prevalence of new-onset postpartum chronic hypertension (PPCH) after pre-eclampsia and to determine the factors are associated with it., Methods: This study was conducted in a tertiary center in south India, between June 2018 and February 2019, consisting of pre-eclamptic women who were recruited as part of an ongoing cohort and had completed at least 3 months of postpartum follow-up. Demographic, medical, and laboratory details were collected. Primary outcome was a diagnosis of new-onset PPCH at 3 months., Results: PPCH at 3 months was noted in 32 (18.1%) women. During postnatal follow-up, 2 (1.1%) women experienced hemiplegia from stroke and 19 (10.7%) had elevated serum creatinine levels (>1.1 mg/dL). On multivariate analysis, advancing maternal age (adjusted odds ratio [aOR] 1.10, 95% confidence interval [CI] 1.01-1.21), multiparity (aOR 2.79, 95% CI 1.07-7.24), and eclampsia (aOR 3.07, 95% CI 1.03-9.13) increased the risk of PPCH at 3 months postpartum., Conclusion: One in five women present with a diagnosis of new-onset PPCH within 3 months postpartum in a cohort of predominantly preterm and/or severe pre-eclampsia. A significant but weak association of PPCH with peripartum clinical characteristics was noted. The role of biochemical, hemodynamic, and echocardiographic biomarkers should be evaluated for prediction of PPCH after pre-eclampsia in future studies., (© 2020 International Federation of Gynecology and Obstetrics.)

Objective: To assess cervical dilation, fetal head station, and fetal head position by intrapartum ultrasonography and to compare the approach with digital vaginal examination (DVE)., Methods: An observational study conducted from October 2015 to January 2017 among term nulliparous women in active labor at a tertiary hospital in Delhi, India. Cervical dilation, head station, and head position were assessed by DVE, followed by ultrasonography within 10 minutes. The women's preference was also evaluated., Results: Overall, 458 observations were obtained for 215 women. Cervical dilation measured by DVE was strongly correlated with ultrasonography findings (intraclass correlation coefficient, 0.945; 95% confidence interval, 0.932-0.956; κ=0.837; P<0.001). Data for fetal head station and head position showed a fair correlation (κ=0.353 and κ=0.554, respectively; both P<0.001). The majority of women (186/215, 87%) reported a preference for ultrasonography over DVE for assessment of labor progression in a future pregnancy., Conclusion: Intrapartum ultrasonography was preferred as an objective assessment tool for labor progression among term nulliparous women and therefore should be practiced in all labor rooms. Further studies on interobserver variation are recommended to establish the reproducibility of intrapartum assessment by ultrasonography., (© 2019 International Federation of Gynecology and Obstetrics.)