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Aim: Maternal morbidities present a major burden to the health and well-being of childbearing women. However, their impacts on women's quality of life (QoL) are not well understood. This work aims to describe the extent to which the morbidities women experience during pregnancy and postpartum affect their QoL and identify any protective or risk factors., Methods: This qualitative study included pregnant and postpartum women in Kenya, Ghana, Zambia, Pakistan, and India. Data were collected between November 2023 and June 2024. Participants were selected via purposive sampling, with consideration of age, trimester, and time since delivery. A total of 23 focus group discussions with 118 pregnant and 88 late (≥6 months) postpartum participants and 48 in-depth interviews with early (≤6 weeks) postpartum participants were conducted using semi-structured guides developed by the research team. Data was analyzed using a collaborative inductive thematic approach., Results: Four overarching themes were identified across pregnancy and the postpartum period: (1) physical and emotional challenges pose a barrier to daily activities; (2) lack of social support detracts from women's QoL; (3) receipt of social support mitigates adverse impacts of pregnancy and postpartum challenges on QoL; and (4) economic challenges exacerbate declines in women's QoL during pregnancy and postpartum., Conclusions: Bodily discomfort and fatigue were near-universal experiences. Physical and emotional morbidities related to childbearing limited women's ability to complete daily tasks and adversely impacted their perceived QoL. Social and financial support from the baby's father, family and/or in-laws, community members, and healthcare providers are important to mitigate the impacts of pregnancy and postpartum challenges on women's health and well-being., Competing Interests: COMPETING INTERESTS STATEMENT The authors declare no competing interests.

Background: As Indian states consider HPV testing for cervical screening, there is a need to review evidence from prior studies to inform program design and evaluate implementation research gaps., Design: We conducted a systematic review of original articles in Medline, Embase, Global Health and Web of Science, published from 2000 to May 4, 2024. Articles describing use of HPV as a primary cervical screening test in India, in either community-based programs for the general population, or among women living with HIV, were included. We describe approaches to invitation, education, screening, and follow-up, and map determinants and outcomes to the RE-AIM and the Consolidated Framework for Implementation Research frameworks., Results: Of 71 included articles (51 unique studies), 19 reported on screening among women living with HIV, while 52 were community-based (general population of women). Self-collection was offered by 15 studies and was acceptable to most screened women. Community-based programs were mainly facility or outreach-based, with three studies offering only home-based self-collection, including one that integrated with cardiovascular risk screening. Studies from northeastern and tribal populations were scarce. Only one self-collection study used a screen and treat (at second visit) approach, but did not report follow-up, while none offered immediate treatment following a point-of-care test., Conclusions: Community-based HPV testing, including self-collection, is feasible in India, with more research needed among underrepresented populations. Further implementation research is needed on integrating HPV screening with existing health systems, feasibility of HPV test and treat models and genotyping triage, to improve follow-up in low resource settings., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Julia ML Brotherton reports a relationship with Australian Centre for the Prevention of Cervical Cancer that includes: employment. JMLB was previously employed by the Australian Centre for the Prevention of Cervical Cancer (ACPCC). ACPCC/VCS Pathology has received equipment or supplies from Abbott, AusDiagnostics, BD, Cepheid, Copan, Hologic, Microbiologics, MicroBix, NRL, Qiagen, Rovers, Roche, and Seegene for research and validation studies. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Breast cancer and cervical cancer are the leading causes of cancer-related mortality in Indian women. As part of the Indian national guidelines for population-based cancer screening, village-level accredited social health activists (ASHAs) are the key mobilizers for encouraging women to undergo cervical and breast cancer screening. Assessing screening rates in these health workers themselves, can improve implementation of the national program by identifying some of the facilitators and barriers for screening., Methods: A cross-sectional study was conducted among ASHAs in Puri, Odisha, in eight primary health centers (PHCs) randomly selected from 10 blocks. Of all 291 ASHAs in these PHCs, 242 (83.2%) who consented, were given a self-administered questionnaire to assess screening and its associated factors., Results: The screening rates for cervical and breast screening in ASHA workers were 9.1% (95% CI: 5.4%-12.8%, 22/242) and 14.9% (95% CI: 10.3%-19.5%, 36/242), respectively. Having undergone screening themselves, was associated with referring others for screening (83.3% of those screened for breast cancer had referred others vs 37.4% of those never screened; 86.4% of those screened for cervical cancer had referred others vs 34.1% of those never screened)., Conclusions: ASHAs reported low rates of screening for breast and cervical cancer. History of screening significantly influenced the referral of others for screening. ASHAs need to be empowered with both educational exposure as well as motivation for health-promoting activities for themselves, in order to increase population-wide screening coverage., (Copyright © 2025 Indian Journal of Cancer.)

Objective: To evaluate the patterns of weight gain in pregnancy and the outcomes of pregnancy in overweight and obese mothers., Materials and Methods: A retrospective cohort study was performed on 1,352 mothers between October 2020 and August 2021. All pregnant women who presented for antenatal checkups from 20 weeks or earlier, with a singleton pregnancy, were included in the study. Details such as comorbidities, total duration of labor, complications during labor, and neonatal complications were included., Results: At the first antenatal visit, 16% of mothers were underweight, 51% of mothers were normal weight, and 33% of mothers were overweight or obese. Women with poor weight gain were two times more prone to give birth to a child with low birth weight than those with adequate weight gain. Excess weight gain in pregnancy in women with a normal body mass index (BMI) had an association with the development of pre-eclampsia. The odds of overweight/obese pregnant women developing gestational diabetes mellitus (GDM) were 2.1 times higher than in pregnant women with normal BMI. The odds of pregnant overweight/obese women undergoing cesarean section were 1.6 times higher than in pregnant women with normal BMI., Conclusion: Overweight/obese pregnant women had increased odds of developing GDM and undergoing a cesarean section. Excess weight gain was also seen in overweight/obese women. It is therefore important for physicians to educate women on acceptable weight gain during their pregnancy., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Family Medicine and Primary Care.)

Purpose: To determine the incidence of covert and overt postpartum urinary retention after vaginal delivery and the associated risk factors for postpartum urinary retention. To determine how well clinical examination by abdominal palpation correlates with ultrasound findings of urinary retention., Methods: Patients after delivery were screened with ultrasound and examined clinically to check for retention of urine after voiding., Results: A total of 822 of women were recruited in the study of which 86 (10.5%) women had significant post-void residue of urine. 33 (38.4%) had overt retention, while 53 (61.6%) had covert retention. Duration of labour and an increased VAS score were found to be significantly higher among those with urinary retention. Using clinical examination to diagnose postpartum urinary retention had a sensitivity of 66.1%, specificity of 88.6%, positive predictive value of 76.5% and negative predictive value of 82.3%., Conclusions: Clinical examination by abdominal palpation is not a very sensitive test in diagnosing PPUR., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: In order for low and middle income countries (LMIC) to transition to Human Papilloma Virus (HPV) test based cervical cancer screening, a greater understanding of how to implement these evidence based interventions (EBI) among vulnerable populations is needed. This paper documents outcomes of an implementation research on HPV screening among women from tribal, rural, urban slum settings in India., Methods: A mixed-method, pragmatic, quasi-experimental trial design was used. HPV screening on self-collected cervical samples was offered to women aged 30-60 years. Implementation strategies were 1) Assessment of contextual factors using both qualitative and quantitative methods like key informant interviews (KII), focus group discussions (FGDs), pre-post population sample surveys, capacity assessment of participating departments 2) enhancing provider capacity through training workshops, access to HPV testing facility, colposcopy, thermal ablation/cryotherapy at the primary health care centers 3) community engagement, counselling for self-sampling and triage process by frontline health care workers (HCWs). Outcomes were assessed using the RE-AIM (Reach, Effectiveness, adoption, implementation, maintenance) framework., Results: Screening rate in 8 months' of study was 31.0%, 26.7%, 32.9%, prevalence of oncogenic HPV was 12.1%, 3.1%, 5.5%, compliance to triage was 53.6%, 45.5%, 84.6% in tribal, urban slum, rural sites respectively. Pre-cancer among triage compliant HPV positive women was 13.6% in tribal, 4% in rural and 0% among urban slum women. Unique challenges faced in the tribal setting led to programme adaptations like increasing honoraria of community health workers for late-evening work and recalling HPV positive women for colposcopy by nurses, thermal ablation by gynaecologist at the outreach camp site., Conclusions: Self-collection of samples combined with HCW led community engagement activities, flexible triage processes and strengthening of health system showed an acceptable screening rate and better compliance to triage, highlighting the importance of identifying the barriers and developing strategies suitable for the setting., Trial Registration: CTRI/2021/09/036130., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Oommen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: A large proportion of pregnant women in lower and middle-income countries (LMIC) seek their first antenatal care after 14 weeks of gestation. While the last menstrual period (LMP) is still the most prevalent method of determining gestational age (GA), ultrasound-based foetal biometry is considered more accurate in the second and third trimesters. In LMIC settings, the Hadlock formula, originally developed using data from a small Caucasian population, is widely used for estimating GA and foetal weight worldwide as the pre-programmed formula in ultrasound machines. This approach can lead to inaccuracies when estimating GA in a diverse population. Therefore, this study aimed to develop a population-specific model for estimating GA in the late trimesters that was as accurate as the GA estimation in the first trimester, using data from GARBH-Ini, a pregnancy cohort in a North Indian district hospital, and subsequently validate the model in an independent cohort in South India., Methods: Data obtained by longitudinal ultrasonography across all trimesters of pregnancy was used to develop and validate GA models for the second and third trimesters. The gold standard for GA estimation in the first trimester was determined using ultrasonography. The Garbhini-GA2, a polynomial regression model, was developed using the genetic algorithm-based method, showcasing the best performance among the models considered. This model incorporated three of the five routinely measured ultrasonographic parameters during the second and third trimesters. To assess its performance, the Garbhini-GA2 model was compared against the Hadlock and INTERGROWTH-21st models using both the TEST set (N = 1493) from the GARBH-Ini cohort and an independent VALIDATION dataset (N = 948) from the Christian Medical College (CMC), Vellore cohort. Evaluation metrics, including root-mean-squared error, bias, and preterm birth (PTB) rates, were utilised to comprehensively assess the model's accuracy and reliability., Findings: With first trimester GA dating as the baseline, Garbhini-GA2 reduced the GA estimation median error by more than three times compared to the Hadlock formula. Further, the PTB rate estimated using Garbhini-GA2 was more accurate when compared to the INTERGROWTH-21st and Hadlock formulae, which overestimated the rate by 22.47% and 58.91%, respectively., Interpretation: The Garbhini-GA2 is the first late-trimester GA estimation model to be developed and validated using Indian population data. Its higher accuracy in GA estimation, comparable to GA estimation in the first trimester and PTB classification, underscores the significance of deploying population-specific GA formulae to enhance antenatal care., Funding: The GARBH-Ini cohort study was funded by the Department of Biotechnology, Government of India (BT/PR9983/MED/97/194/2013). The ultrasound repository was partly supported by the Grand Challenges India-All Children Thriving Program, Biotechnology Industry Research Assistance Council, Department of Biotechnology, Government of India (BIRAC/GCI/0115/03/14-ACT). The research reported in this publication was made possible by a grant (BT/kiData0394/06/18) from the Grand Challenges India at Biotechnology Industry Research Assistance Council (BIRAC), an operating division jointly supported by DBT-BMGF-BIRAC. The external validation study at CMC Vellore was partly supported by a grant (BT/kiData0394/06/18) from the Grand Challenges India at Biotechnology Industry Research Assistance Council (BIRAC), an operating division jointly supported by DBT-BMGF-BIRAC and by Exploratory Research Grant (SB/20-21/0602/BT/RBCX/008481) from Robert Bosch Centre for Data Science and Artificial Intelligence (RBCDSAI), IIT Madras. An alum endowment from Prakash Arunachalam (BIO/18-19/304/ALUM/KARH) partly funded this study at the Centre for Integrative Biology and Systems Medicine, IIT Madras., Competing Interests: The authors declare the following competing interests. HS, RT, and SB are inventors of the Garbhini-GA2 formula (Indian Patent Application no: 202341061748), submitted by the Indian Institute of Technology Madras., (© 2024 The Author(s).)

Background: In vitro studies with human fetal islets of different gestational ages (GA) would be a great tool to generate information on the developmental process of the islets as this would help to recontextualize diabetes research and clinical practice. Pancreatic islets from human cadavers and other animal species are extensively researched to explore their suitability for islet transplantation procedure, one of the upcoming treatment strategies for insulin-dependent diabetes mellitus. Although human fetal islets are also considered for islet transplantation, ethical issues and limited knowledge constraints their use. The fetal islets could be explored to address the information lacunae on the maturity process of pancreatic islets and the endocrine-exocrine signaling mechanisms., Aim: This study aimed to assess the feasibility of isolating viable islets and study the cytoarchitecture of the fetal pancreas of GA 22-29 weeks, not reported otherwise., Methodology: Pancreas obtained from the aborted fetuses of GA 22-29 weeks were subjected to collagenase digestion and were further cultured to determine the viability in vitro. Parameters assessed were expression of markers for endocrine cell lineages and insulin release to glucose challenge., Results: Islets were viable in vitro and islets were shown to maintain cues for post-digestion re-aggregation and expansion in culture. The immunofluorescent staining showed islets of varying sizes, homogenous cell clusters aggregating to form heterogenous cell clusters, otherwise not reported for this GA. On stimulation with different concentrations of glucose (2.8 and 28 mM), the fetal islets in the culture exhibited insulin release, and this response confirmed their viability in vitro., Conclusion: Our findings showed that viable islets could be isolated and cultured in vitro for further in-depth studies to explore their proliferative potential as well as for the identification of pancreatic progenitors, a good strategy to take forward., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Rout et al.)

Background: In view of the WHO's call for the elimination of cervical cancer as a public health problem, and current low screening coverage, Indian policy makers need evidence on how to effectively implement cervical screening programmes, ensuring equity in access. Our study will follow the INSPIRE implementation framework to co-design and test HPV-based screening approaches in two states of India with different health system organisation, based on understanding the status of screening as currently implemented, readiness and challenges to transition to HPV-based screening, and preferences of key stakeholders. Here, we describe our protocol for the formative phase of the study (SHE-CAN)., Methods: The study population includes women from vulnerable populations, defined as residents of tribal areas, rural villages, and urban slums, in the states of Mizoram and Tamil Nadu. The baseline assessment will use mixed methods research, with desktop reviews, qualitative studies, and surveys. A capacity assessment survey of screening and treatment facilities will be done, followed by interviews with healthcare providers, programme managers, and community health workers. Interviews will be conducted with previously screened women and focus group discussions with under and never-screened women and community members. Stakeholder workshops will be held in each state to co-design the approaches to delivering HPV-based screening among 30-49-year-old women., Discussion: The quality and outcomes of existing screening services, readiness to transition to HPV-based screening, challenges in providing and participating in the cervical cancer care continuum, and acceptability of screening and treatment approaches will be examined. The knowledge gained about the current system, as well as recognition of actions to be taken, will inform a stakeholder workshop to co-design and evaluate implementation approaches for HPV-based screening through a cluster randomised implementation trial., (© 2023. The Author(s).)

The occurrence of microplastics in drinking water has drawn increasing attention due to their ubiquity and unresolved implications regarding human health. Despite achieving high reduction efficiencies (70 to >90%) at conventional drinking water treatment plants (DWTPs), microplastics remain. Since human consumption represents a small portion of typical household water use, point-of-use (POU) water treatment devices may provide the additional removal of microplastics (MPs) prior to consumption. The primary objective of this study was to evaluate the performance of commonly used pour-through POU devices, including those that utilize combinations of granular activated carbon (GAC), ion exchange (IX), and microfiltration (MF), with respect to MP removal. Treated drinking water was spiked with polyethylene terephthalate (PET) and polyvinyl chloride (PVC) fragments, along with nylon fibers representing a range of particle sizes (30-1000 µm) at concentrations of 36-64 particles/L. Samples were collected from each POU device following 25, 50, 75, 100 and 125% increases in the manufacturer's rated treatment capacity, and subsequently analyzed via microscopy to determine their removal efficiency. Two POU devices that incorporate MF technologies exhibited 78-86% and 94-100% removal values for PVC and PET fragments, respectively, whereas one device that only incorporates GAC and IX resulted in a greater number of particles in its effluent when compared to the influent. When comparing the two devices that incorporate membranes, the device with the smaller nominal pore size (0.2 µm vs. ≥1 µm) exhibited the best performance. These findings suggest that POU devices that incorporate physical treatment barriers, including membrane filtration, may be optimal for MP removal (if desired) from drinking water.

Iron deficiency anemia is associated with maternal morbidity and poor pregnancy outcomes. Heme and non-heme iron transport proteins expressed in the placenta help in adequate iron supply from anemic mother to fetus. Here we examined the expression of placental iron trafficking molecules and their association with maternal and neonatal iron status in pregnant women with iron deficiency anemia (IDA). Pregnant women who received prenatal care at Christian Medical College, Vellore, India for childbirth were recruited. Pregnant women who were 18-35 years old with gestational age (GA) of ≥36 weeks were eligible to participate in the study. In a prospective cohort of pregnant women, 22 % were iron deficiency anemia and 42 % were iron replete. Samples were collected (Maternal blood, placental tissue, and cord blood) from pregnant women with a gestational age of ≥38 weeks at the time of delivery. The mean gestational age at the first visit and delivery was 12.8 ± 2.72 weeks and 39 ± 1.65 weeks, respectively. Hemoglobin (9.3 ± 0.9 g/dl) and ferritin (15.4(0.8-28.3) ng/ml) levels at delivery were significantly decreased in IDA as compared to controls. The fetal hemoglobin and ferritin levels were in the normal range in both groups. There was no correlation between maternal and cord blood hepcidin with fetal iron status in IDA. We further analyzed the expression of iron transport genes in the placenta of controls and the IDA group. Under maternal iron insufficiency, the expression of placental iron transporters DMT1, FPN1, and GDF15 was upregulated at the protein level. In IDA, placental GDF15 and ferroportin protein had an association with fetal iron status. These findings confirm that placental iron traffickers respond to maternal iron deficiency by increasing their expression and allowing sufficient iron to pass to the fetus., Competing Interests: Declaration of competing interest The authors declare no competing financial interests., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Hypertension is one of the most common medical disorders complicating pregnancy. In India, high blood pressure contributes to 7.1% of maternal deaths. This study was carried out to describe the characteristics and pregnancy outcomes of patients presenting with eclampsia or pre-eclampsia to a secondary care hospital in rural India., Methods: Patients diagnosed with pre-eclampsia or eclampsia between January 2018 and April 2021 were identified and included in the study. Medical records were searched and general patient characteristics, obstetrical history, information about the antenatal period, mode of delivery and outcomes were documented and analysed., Results: Among the 3651 women who delivered in this hospital during this time period, 2.3% ( n = 83) presented with eclampsia and 1.9% ( n = 71) with pre-eclampsia. More than 50% of the women delivered by lower segment caesarean section among both the eclamptics and pre-eclamptics. The stillbirth rate among those with either pre-eclampsia or eclampsia was 1 per 1000. The number of low birth weight babies born to those presenting with eclampsia (66.7%) was significantly more than those presenting with pre-eclampsia (48.6%). Eclampsia/pre-eclampsia accounted for 21% of all maternal deaths with a case fatality rate of 2.6%., Conclusions: This study identified that in this setting the patients presenting with eclampsia were much higher than those presenting with pre-eclampsia which is in stark contrast to the status even in developing countries. This could be an important finding indicating poorer health-seeking behaviour among the population and will need more studies on various interventions to change this status., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Family Medicine and Primary Care.)

Objectives: The frequent association between malformations and chromosomal abnormalities is now well-established. This study looks at the incidence and type of chromosomal abnormalities detected by conventional cytogenetic analysis in women undergoing invasive tests following detection of fetal anomalies on antenatal scans as well as incidence of other genetic abnormalities detected by DNA analysis of fetuses with congenital anomalies that had a normal karyotype., Materials and Methods: A retrospective, observational study of pregnant women undergoing invasive testing following identification of fetal anomalies by ultrasonography was carried out in a tertiary care facility, Vellore, India, between 2011 and 2018., Results: 169 women underwent an invasive diagnostic procedure following detection of fetal anomalies. The most common indication for doing fetal karyotype was the presence of major fetal structural anomalies (142/169, 84%) with over a third (48/142, 34%) having multisystem involvement. Fetal hydrops was the next most common indication, detected in 18/169 (10%) fetuses. Aneuploidy was seen 19 of 25 fetuses (76%) with an abnormal karyotype with autosomal aneuploidy accounting for 13 (68%) and sex chromosome aneuploidy for seven (37%) of the fetuses. One fetus had double aneuploidy. In fetuses with normal karyotype, no additional information was obtained from further genetic testing., Conclusions: The overall detection rate of chromosomal abnormalities in our study using conventional cytogenetic analysis was 14.8%, the majority (72%) being associated with structural malformations, 20% with non-immune hydrops and 4% with soft markers. Abnormal karyotypes were seen in 12.7% of fetuses with structural malformations., Competing Interests: Conflict of interestThe authors have no conflicts of interest to disclose., (© Federation of Obstetric & Gynecological Societies of India 2022.)

Objectives: To determine the occurrence of MTHFR gene polymorphisms and to study their association with vitamin B12 deficiency and adverse perinatal outcomes among a cohort of pregnant women from Kaniyambadi block, Tamil Nadu., Methods: 120 consecutive pregnant women who were ≤20 weeks of gestational age from the 82 villages of Kaniyambadi block were recruited. Genomic DNA was isolated from the peripheral blood. PCR amplification was done followed by Sangers sequencing. Maternal and neonatal outcomes were extracted. Data was entered and analysed., Results: Our study found the occurrence of c.1298A>C variant in homozygous state in 14.2% and c.677C>T heterozygous state in 15%. Sanger sequencing of exon 7 identified another pathogenic variant c.1262G>T in heterozygous state in two of them. Both the mothers who harboured that variant had preterm delivery and one of them gave birth to a low-birth-weight neonate. In the entire cohort, 5% of the mothers had abortion, 4.2% of them had preterm delivery and 8.8% of the neonates had low birth weight. Presence of c.1298A>C or c.677C>T variants were associated with vitamin B12 deficiency [Pearson Chi squared value (χ 2 )=7.9 and 7.6 respectively; p=0.02]. Heterozygous pathogenic variant c.1262G>T was associated with both adverse maternal [χ 2 =11.5; p=0.001] and neonatal [χ 2 =18.3; p=0.009] outcomes., Conclusions: MTHFR gene polymorphisms could be associated with several adverse perinatal outcomes and vitamin B12 deficiency. Further larger studies are needed to prove the pathogenicity of c.1262G>T variant on pregnancy., (© 2022 Walter de Gruyter GmbH, Berlin/Boston.)

Objective: To assess the effectiveness in preventing cesarean section for failed induction by using Foley catheter for cervical ripening in comparison to Foley catheter with a weight attached to it., Methods: A randomized control trial conducted between November 2018 and July 2020, which looked at induction of labor with 30-ml Foley catheter in one arm and the Foley placed with a 500 ml weight attached to it in the other arm. Primary outcome was the cesarean section rate., Results: We randomized 399 women. Modes of delivery were similar in both groups. Numbers undergoing cesarean section for failed induction were higher in the group that underwent induction with Foley with weight but this was not statistically significant (45.7% vs 26.5%, P = 0.1). There was a shorter time to expulsion of the Foley with weight attached (mean ± standard deviation: 2.6 ± 3.3 h vs 10.9 ± 3.2 h, P < 0.001) but this did not translate into a difference in time to active labor or time to delivery., Conclusion: Placing a weight at the end of the Foley catheter for induction of labor does not affect the time to delivery or the rate of cesarean deliveries, although there is faster expulsion of the Foley., Clinical Trial Registration No: CTRI/2018/10/016154., (© 2021 International Federation of Gynecology and Obstetrics.)

Background: Globally, over 130 million babies are born every year, and almost 8 million die before their first birthday. Data on perinatal mortality (PM) and its various causes are lacking in many parts of the world including India., Objectives: This study aimed to estimate stillbirth (SB), early neonatal, and PM rates and its causes over the last decade in a rural development block, India., Materials and Methods: This is a nonconcurrent cohort study, analyzing the births, SBs, and early neonatal deaths between January 2008 and December 2017. The World Health Organization-PM classification was used to allocate causes of death as well as maternal risk factors. Birth weights were classified using standard growth charts., Results: There were 20,704 births after 28 weeks gestation and where the fetus weighed more than 1000 g of which 285 were SBs. There were 20,419 live births with 229 early neonatal deaths. There was a significant decline in PM rate from 32 per 1000 to 11 per 1000. There was a decrease in the small for gestational age fetuses from 20% to 12.5%. The main cause for SBs was antepartum hypoxia (34.4%) and fetal growth disorders (26.3%). Complications of intrapartum events contributed to 32.8% of the early neonatal deaths., Conclusion: Steady decline in PM rate and in the number of small for gestational age fetuses over 10 years was seen. Pregnancy registration and follow-up help in giving us a better understanding of the causes of PM., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Indian Journal of Community Medicine.)

Background: Early detection of breast and cervical cancer by organized screening has been found to reduce mortality rates in trials, but documentation of programme results and challenges is rarely done from non-trial settings. This study reports results of a population-based cancer control programme in a rural block in Vellore, Tamil Nadu, population size (116,085), targeting a population of 18,490 women aged 25-60 years, between November 2014 and March 2018., Methods: Village-based health education sessions were conducted by social workers, using trained volunteers and health workers to motivate eligible women. Screening was done at a secondary level hospital, by trained general physicians using visual inspection with acetic acid and clinical breast examination, followed by colposcopy, radiological imaging (breast) and biopsy as required., Results: A total of 8 volunteers and 17 health workers motivated women for 93 health education and screening sessions, in 46 out of 82 villages. While 1,890/18,490 (10.2 per cent) were screened for breast cancer, 1,783 (9.6 per cent) were screened for cervical cancer, with a yield of 3.4/1,000 for cervical pre-cancer/cancer. The main challenges were creating time for screening activities in a busy secondary hospital and difficulty in ensuring treatment completion of screen-detected cases., Conclusions: Population-based cancer screening programs can be offered by secondary hospitals that also run primary care services, to increase screening rates. Clear referral systems need to be established, bearing in mind that social factors, especially poor family support, may pose a threat to treatment, in spite of easy availability of cure., Competing Interests: None

Background: India attributes to about 15% of the maternal mortality globally. Many a time poor maternal and neonatal outcomes occur unanticipated during intrapartum and postpartum period. An efficient referral system identifies the indications necessitating prompt referrals besides ensuring patient friendliness and continuity of care., Methodology: The descriptive, retrospective study was done in a secondary care hospital of a teaching institution in South India, run by primary care physicians, obstetricians and pediatricians. It describes the referrals from labour room in a year, identifying the referral rate, indications, maternal and neonatal outcomes., Results: The referral rate was found to be 3 per cent. The most common indication for the referrals was hypertensive disorders of pregnancy (54.5 percent). Among the women referred, there were no maternal deaths and majority had uncomplicated postpartum period. Eleven women developed postpartum hemorrhage. Neonatal outcome reflected a good trend as 83 per cent had an uneventful hospital stay. There were eight early neonatal deaths., Conclusion: The hospital could reduce the referral load to its tertiary care due to adequate training of primary care post graduates in basic obstetrics and anaesthesia skills, establishing standardized referral protocol and monitoring with regular clinical audits. Patient experience could be improved with inter referral unit communication and linking the health information system., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Family Medicine and Primary Care.)

Congenital long QT syndrome [LQTS] is a channelopathy characterized by QT prolongation and polymorphic VT. LQTS however need not be a purely electrical disease. Defects in ion channels may cause myocardial architectural disruption leading to ventricular non compaction [VNC]. It is defined as the presence of prominent ventricular trabeculations and deep intertrabecular recesses within the endomyocardium. We describe the in-utero management of a foetus who was later found to have LQTS with VNC. The detection of ventricular tachycardia and complete heart block in utero should arouse the suspicion of LQTS. It would be wise to avoid QT prolonging antiarrhythmics in this subset of patients., Competing Interests: Declaration of competing interest The authors declare no conflict of interests., (Copyright © 2021 Indian Heart Rhythm Society. Production and hosting by Elsevier B.V. All rights reserved.)

Objective: Breech presentation is the most common fetal malpresentation at term, with an incidence of 3-4%. External cephalic version (ECV) is a procedure that can be offered to women with breech presentation beyond 36 weeks of gestation to convert it to cephalic presentation, reducing the risks of a vaginal breech delivery and the morbidities associated with caesarean section., Material and Methods: We retrospectively reviewed the records of women who underwent ECV between October 2012 and June 2020 with the objectives of determining the success rate of the procedure, the mode of delivery, the maternal and neonatal outcomes, periprocedural complications and their management., Results: Among the 200 women who underwent the procedure with a 64% success rate (128 women), there were 110 vaginal deliveries (56.7%) including five vaginal breech deliveries, and 84 women (43.2%) underwent caesarean section, which included 24 women who had successful ECV but needed emergency caesarean for other indications. There was no significant difference in the neonatal APGAR scores in those who had a successful ECV and those who did not. Only three women (1.5%) experienced any significant periprocedural complication., Conclusion: These results suggest that ECV improves the possibility of a vaginal delivery with an overall low complication rate, reducing the neonatal risks associated with vaginal breech delivery and the maternal morbidity of a caesarean section. It may thus contribute to reducing the primary caesarean section rate, making it a useful intervention, especially in limited resource settings.

Introduction: Vitamin B12 is essential for the normal functioning of the nervous system and for the formation of red blood cells. Vegetarian diet, low socioeconomic status, and social and religious reasons are known risk factors of its deficiency. Pregnant women, children, and the elderly are vulnerable groups. Indians have the highest prevalence, but the data among pregnant women in the rural setting is lacking., Objectives: The objective of this study is to assess the prevalence of Vitamin B12 deficiency and its associated factors among pregnant women of rural South India., Materials and Methods: A cross-sectional study was conducted to recruit consecutive 120 multigravida women with ≤20 weeks of gestation, attending the mobile doctor run clinic of Kaniyambadi block, Vellore. A structured questionnaire was administered, and blood samples were collected., Results: The prevalence of Vitamin B12 deficiency (<200 pgm/ml) and anemia (Hb ≤10.5 g/dL) was 55% and 17.5%, respectively. Only 11.7% were B12 deficient and anemic. Past history of abortion (odds ratio [OR] = 0.5), fatigue (OR = 0.4), and low B12 intake (OR = 2) was associated only in the bivariate analysis. First trimester (OR = 3.9) and obesity (OR = 9.6) were found to be independent risk factors of Vitamin B12 deficiency., Conclusion: Our study showed a high prevalence of Vitamin B12 deficiency in pregnancy in rural India. Some risk factors were identified. However, studies with a higher sample size will be beneficial to study the associated risk factors better., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Indian Journal of Community Medicine.)

Context: Domestic violence in Indian setting has five major components: emotional abuse; physical violence; sexual violence; honor killing; dowry-related abuse; and death., Aims: The aim of the study was to estimate the prevalence of domestic violence and 3 of its components - emotional abuse, physical violence, and sexual violence among women in the age group of 15-49 years in Kaniyambadi block, rural Vellore, Tamil Nadu and to determine the risk factors of domestic violence., Settings and Design: A community-based cross-sectional study among women between the ages 15 and 49 years at the rural setting of Kaniyambadi block, Tamil Nadu., Results: Prevalence of all forms of domestic violence among women was 77.5%, and forty percent women were classified as having ever been subjected to severe domestic violence. Prevalence of physical violence was 65.8%, sexual abuse was 17.5%, and emotional abuse was 54.2%. Alcohol consumption by husband (adjusted odds ratio [AOR] 4.37; 1.35, 14.18), controlling behavior by family member (AOR 8.07; 2.47, 26.37), and woman's employment (AOR 4.33; 1.27, 14.77) were statistically significant determinants of domestic violence. Three-fourth (73.1%) of the women felt that being subjected to domestic violence has affected their physical and mental health., Conclusions: The high prevalence of domestic violence in our community needs to be addressed as it has tacit implications on socioeconomic well-being, physical and mental health of a woman, her family, and thereby, society as a whole., Competing Interests: There are no conflicts of interest., (Copyright: © 2019 Indian Journal of Community Medicine.)

Background and Objectives: Gestational Diabetes Mellitus (GDM) has been well documented to be associated with significant mortality and morbidity among both mother and their offspring. Prevalence of GDM in India varies between regions and has been documented to be on the rise over the last two decades which is a public health concern and reflects an increase in the frequency of type 2 diabetes mellitus in these populations. This study aimed at estimating the prevalence of GDM among antenatal women attending a rural secondary care hospital in southern India and attempts to study associations between anthropometry, parental history, physical activity of pregnant women and GDM., Methods: A hospital based cross sectional study was done among 630 pregnant women who were screened with oral glucose tolerance test between 24 and 28 weeks of gestation based on IADPSG criteria. Risk factors for developing GDM were assessed by conducting home visits to 75 women diagnosed to have GDM and 150 randomly selected women without GDM., Results: Hospital based prevalence of GDM was 14% (95 % CI: 11.3% to 16.7%) and a significant rise in prevalence levels was noted with age. Women with family history of diabetes mellitus, women with body fat of more than 23% had 2.65 and 2.89 times significantly higher odds of developing GDM. Interpretation and conclusion: Family history of diabetes and excess body fat are risk factors associated with GDM. Among them excess body fat could be an independent risk factor without the influence of foetal weight and preventive measures could be directed towards it., (© Journal of the Association of Physicians of India 2011.)

Background: India, with its large number of migrant workers, had a large number of people affected by HIV. This included antenatal women who are a vulnerable population. The Government of India along with nongovernmental organizations worked on a large number of programs to screen and decrease mother-to-child transmission. This in turn has brought down the prevalence of HIV., Materials and Methods: Retrospective analysis of data from the block being provided with healthcare was carried out over a period of 14 years from January 2002 to December 2016., Results: The observed HIV prevalence was 5.9 per 1000 in 2002 and showed a declining trend to 1.2 per 1000 in 2016., Conclusion: Consistent work at health education and preventive methods has helped bring down the prevalence of HIV over the years., Competing Interests: There are no conflicts of interest.

Background: Carcinosarcoma is a rare malignancy, and reports are often mixed along with other sarcomas. The literature on uterine carcinosarcoma per se is sparse., Aims: This study aims to evaluate the demography, survival, and optimal treatment strategy of uterine carcinosarcoma., Settings and Design: A tertiary care center in India. The study design was descriptive with survival analysis., Materials and Methods: The medical records of all 18 patients admitted with uterine carcinosarcoma between January 2011 and December 2015 were reviewed. Baseline characteristics and outcomes were studied. Survival analysis was done using the Kaplan-Meier method and compared between treatment groups using the Log-rank test., Results: The total number of uterine malignancies operated in our center over this time period was 311 of which 18 were carcinosarcomas (5.7%). Median age of presentation was 61 years (36-77 years). Most women (94%) were postmenopausal and 67% of them presented with postmenopausal bleeding. Over half of the patients (56%) presented late (Stage III or IV). Only 11 (61%) had adjuvant treatment and 7 patients had expired at the time of follow-up. The median survival was 284 days (95% confidence interval 107-461). Patients who received adjuvant therapy did better compared to those who did not ( P = 0.036)., Conclusions: Carcinosarcomas are aggressive tumors of postmenopausal women who present with bleeding or discharge per vaginum. In spite of adequate surgical staging followed by adjuvant therapy, survival remains poor. Improvements in early detection and optimal therapy need to be made., Competing Interests: There are no conflicts of interest.

Mesenchymal stem cells (MSCs) are derived from Wharton's jelly tissue of the human umbilical cord. Given appropriate culture conditions, these cells can self-renew and differentiate into multiple cell types across the lineages. Among the properties exhibited by these cells, immunomodulation through secretion of trophic factors has been widely exploited in a broad spectrum of preclinical/clinical regenerative applications. Moreover, the extracellular matrix is found to play a major role apart from niche cells in determining stem cell fate including that of MSCs. Therefore, the currently employed technique of two-dimensional culture expansion can alter the inherent properties of naïve MSCs originally residing within the three-dimensional space. This limitation can be overcome to some extent by using native extracellular matrix scaffold culture system which mimics the in situ microenvironment. In this chapter, we have elucidated the protocol for the preparation of a native extracellular matrix scaffold by decellularization of the MSC sheet and thereof culture expansion and characterization of human Wharton's jelly-derived MSCs.

Objective: To study the prevalence and types of congenital anomalies that present at birth in a secondary-level hospital in South India and its contribution to perinatal mortality., Materials and Methods: A total of 36,074 births over 10 years, from 2003 to 2013, were studied for the prevalence of gross congenital malformations at birth. It was a descriptive, cross-sectional study using data from the birth register and available medical records., Results: The incidence of birth defects was 12.5 per 1000 live births, with musculoskeletal disorders being the commonest, followed by craniovertebral anomalies. The prevalence of anomalies over the past 10 years has not shown any significant change (p= 0.555)., Discussion: The high prevalence of neural tube defects indicates the need for periconceptional folic acid supplementation and early detection of anomalies, which would help in timely management. Detection of musculoskeletal anomalies would help in counseling patients antenatally., (© The Author [2016]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Background: During delivery, drugs being prescribed cause concerns due to their harmful effects on lactation as well as potential adverse reactions on the mother. This retrospective study was performed to evaluate the drug prescribing pattern during normal delivery in a secondary care hospital in India., Materials and Methods: This cross-sectional retrospective study included 3 months of patient's medical records., Results: A total of 2222 drugs, comprising 51 different types of drugs were prescribed to 313 mothers undergoing normal delivery. Most of these drugs are safe in lactation. Ten types of drugs would have been better avoided, but they possibly did not cause harm because of their limited short-term use only during the intranatal period., Conclusion: This study reflects a good, safe, and rational medication practice during normal delivery for various common ailments in a secondary care hospital and can be cited as an example for similar settings., (© The Author(s) 2016.)

Background: Hypertensive disorders in pregnancy are one of the common causes for perinatal and maternal morbidity and mortality in developing countries. Pre-eclampsia is a condition which typically occurs after 20 weeks of gestation and has high blood pressure as the main contributing factor. The aim was to study the effects of pre-eclampsia on the mother and the fetus in rural South Indian population., Materials and Methods: This was a descriptive study conducted in a secondary level hospital in rural South India. A total of 1900 antenatal women were screened for pre-eclampsia during the period August 2010 to July 2011 to study the effects on the mother and fetus., Results: Of the 1900 women screened 93 were detected with pre-eclampsia in the study. Among these, 46.23% were primigravida, 30.1% belonged to socio-economic class 4 and 48.8% were among those with BMI 26-30. The incidence of severe pre-eclampsia was higher in the unregistered women. The most common maternal complication was antepartum hemorrhage (13.9%) and the most common neonatal complication was prematurity (23.65%)., Conclusions: Treating anemia and improving socioeconomic status will improve maternal and neonatal outcome in pre-eclampsia. Antenatal care and educating women on significance of symptoms will markedly improve perinatal morbidity and mortality. Prematurity, growth restriction and low birth weight are neonatal complications to be anticipated and dealt with when the mother has pre-eclampsia. A good neonatal intensive care unit will help improve neonatal outcomes.

Our institution has devised a low cost method of banding oesophageal varices by loading cut Foley catheters on to a banding apparatus.

The activities of alkaline phosphatase, aspartate aminotransferase and creatine kinase in sera of 1,033 children and adolescents aged 5 to 20 years were measured. The results showed significant deviation from the gaussian distribution. Because of differences between sexes and nonlinear relationship to age, sex- and age-related values for the 95th, 90th, and 5th percentiles are presented. Alkaline phosphatase activity increased markedly between 5 and 14 years of age in male subjects and 5 and 12 years of age in female subjects. The peak at puberty was more pronounced in boys than in girls. After puberty, activities decreased toward adult values. Aspartate aminotransferase activity showed a gradual significant decrease between 5 and 17 years of age in male subjects and 5 and 16 years of age in female subjects; then it remained steady until 20 years of age. Creatine kinase activity remained constant in male subjects between 5 and 12 years old, then rose to a maximum at 15 to 16 years of age before declining rapidly toward adult values. In female subjects, creatine kinase activity remained stable from 5 to 12 years of age, then decreased gradually in early adulthood.

We describe a method for automatic computation of "methylene unit" retention-time indices in real time on a computer-controlled gas chromatograph/mass spectrometer system. The calculation is based on the exponential relationship between the methylene unit values of hydrocarbon reference standards and the oven temperature at their elution. Using this mathematical relationship, we calculated calibration factors, which eliminates the need to include a set of methylene unit reference standards with each run and simplifies and speeds identification of unknown peaks in chromatograms. Long-term stability and good precision of the calibration factors were observed during the six-month period of study.

We automated the Jendrassik-Grof method for measurement of bilirubin with the Greiner Selective Analyzer GSA II D. Comparison with the manual Jendrassik-Grof method showed a highly significant correlation coefficient of 0.994 for total and 0.980 for "direct" bilirubin measurement. The automated method showed good precision and was linear to 667 mu mol/L, the highest concentration tested. Addition of hemolysate caused a greater effect on the measurement of direct bilirubin than on total bilirubin. The inhibitory effect on measurement of total bilirubin, though small, was statistically significant at hemoglobin concentrations greater than 2 g/L. Comparison with the method involving diazotized 2,4-dichloroaniline showed the Jendrassik-Grof method to be relatively less affected by hemolysis and turbidity in the measurement of total bilirubin.

The measurement of creatinine by two Jaffé-based procedures is described. In comparing the Beckman Creatinine Analyzer II and the Greiner Selective Analyzer GSA IID, better between-day precision was observed with the former. Percentage recovery of creatinine added to serum was quantitative for the Beckman Creatinine Analyzer II and 92-95% for the Greiner Selective Analyzer. The Greiner Selective Analyzer employs a serum blank and for this reason interference produced by pseudo-Jaffé chromogens in the measurement of creatinine was far less significant than the corresponding interferences observed with the Beckman Creatinine Analyzer II. Comparison of results obtained on 100 sera and 40 urine samples provided correlation coefficients of 0.998 and 0.997 respectively.

The concentrations of 14 chemical constituents in sera of 1,062 children and adolescents aged 4 to 20 years were measured and their 5th and 95th percentiles were calculated. The distribution of values for all constituents showed significant deviation from the gaussian when the results were combined, regardless of age and sex, except for magnesium. Although certain chemical constituents showed statistically significant relationships with age and sex, two additional criteria based upon the coefficient of variation of the method employed were utilized to judge the effectiveness of computing stratified reference values. After applying these corrections the reference values established were classified into three categories, viz. (1) those where the relationship to age and sex remained significant (inorganic phosphorus and creatinine); (2) those where the relationship to age only remained significant (total protein); (3) those where no significant relationship to age and sex was obtained (all other constituents).

After noting rises in measured serum billirubin in premature infants undergoing parenteral nutrition, a series of experiments was designed to ascertain the effect of the presence of Intralipid on the actual laboratory analysis. It has been shown that the most commonly used spectrophotometric analysis of bilirubin and the estimation of direct bilirubin by micromethods are affected by the presence of Intralipid in the specimens. Centrifugation of the blood samples at 15,000 rpm for 10 minutes and analysis of the aqueous layer overcomes, in both methods, the interference and error introduced by the presence of Intralipid chylomicrons in patient sera. Alternatively spurious bilirubin measurements due to hyperlipidemia may be avoided by using a bilirubinometer equipped with a filter which eliminates the effect of Intralipid interference.

A new sweat test (CF Indicator; Medtronic, Inc.) for cystic fibrosis (CF) features a compact, portable configuration of electrodes that dispense pilocarpine for iontophoresis. A disposable chloride sensor patch absorbs a specified volume of sweat, in which the chloride concentration is immediately determined as less than 40, 40-60, or greater than 60 mmol/L. We assessed the performance of the system in a five-center study, in relation to the clinical diagnosis and to the Gibson-Cooke sweat test (GCST) as a control test. With sweat chloride concentrations of less than or equal to 40 mmol/L defined as normal and greater than 40 mmol/L as indicating persons at risk for CF, the new system showed 91% specificity and 100% sensitivity for CF, as compared with 92.8% and 100%, respectively, for the GCST. When we used sweat chloride concentrations of less than or equal to 60 mmol/L as probably normal and greater than 60 mmol/L as probably indicative of CF, the new system showed a 99.1% specificity and 98.6% sensitivity, vs 97.8% specificity and 97.9% sensitivity for the GCST test. In both procedures, occasionally insufficient sweat was collected, and this appeared related to the age of the subject. We conclude that the new sweat test system is potentially useful in physicians' offices, in clinics, and similar settings.

We evaluated the performance characteristics of the Coulter Kem-O-Lab for the measurements of calcium, inorganic phosphate, total protein, albumin, glucose and urea nitrogen in serum. The precision on replicates agreed with those claimed by the manufacturer. All methods showed acceptable total precision measured over a four-week period, except for urea nitrogen. There was significant correlation between the Kem-O-Lab and routine methods, but the slope was significantly different from unity for calcium, total protein and urea nitrogen indicating a bias in their determinations. While turbidity and hemoglobin significantly interfered with measurements in all methods, bilirubin interference was observed only for total protein and glucose. There were no interferences due to any of the nine drugs tested.