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Objectives: Urinary tract infections (UTIs) are a common medical problem in both antenatal and postnatal women. Data from India on the demography of these women, microbiology and antimicrobial susceptibility of the causative bacteria, need elucidation. Material and Methods: We performed an observation study that collected data on UTI in antenatal and postnatal women between 2013 and 2017 at our tertiary care center in South India. Antenatally, urine dipstick-positive patients, high-risk, and symptomatic patients submitted urine cultures. Postnatally, all symptomatic patients had urine cultures. This was 20% of all antenatal and postnatal women resulting in 20,203 cultures. Results: Of 20,203 cultures, significant bacteriuria was seen in 9.48% of antenatal and 13.28% of postnatal women. A higher mean age was seen among those with UTI, antenatal 27 (SD 3.5) and postnatal 26.4 (SD 4.7) years versus 23.9 (SD 3.6) with no growth in culture. The mean BMI among antenatal was 28.2 (SD 3.5) and postnatal was 28 (SD 7.4). Most (60%) were primigravida. At delivery, 37% required cesarean sections while 21.2% required instrumental delivery. Recurrent UTI was seen in 25% antenatally and 10% in the postnatal period. Escherichia coli accounted for 66 and 60% of infections among antenatal and postnatal women, respectively. Enterococcus species accounted for 13% in both while Klebsiella species was 4.9 and 7.3%, respectively. Among E. coli, 68.3 and 59.2% of isolates in antenatal and postnatal period were cefpodoxime susceptible. Nearly 75% of ante- and postnatal isolates were susceptible to amoxicillin-clavulanate while 90.2% and 92.5% were susceptible to nitrofurantoin. Enterococci spp. up to 84.4 and 97.1% in ante- and postnatal isolates were susceptible to ampicillin, 64.4 and 77.4% susceptible to high-level gentamicin, and 84 and 95.5% susceptible to nitrofurantoin. Asymptomatic bacteriuria in pregnancy was documented in 2.1% of antenatal outpatients and E. coli was isolated in 74% of these cultures. Conclusion: Importance of microbiological evidence prior to administration of antimicrobials is evidenced by 79% negative cultures in this 5-year cohort. Escherichia coli accounted for 60-66% of significant bacteriuria followed by Enterococcus and Klebsiella species with 30-40% E.coli probable ESBL producers. Nitrofurantoin followed by amoxicillin-clavulanate were found to be the best oral antimicrobial options.

Background: Leishmaniasis is a multifaceted disease that is prevalent worldwide. It is an epidemic, tropical/subtropical disease caused by macrophage infection by compulsive leishmania genus intracellular parasites affecting millions of people across the globe. Methods: The demand for effective and safe molecules in the field of leishmaniasis is still an active research area. The lack of widely effective anti-leishmanial drugs, therefore, means a critical need for the production of modern, effective, affordable, and safe drugs for leishmaniasis care. In the recent past, many new pharmacophores have been synthesized and evaluated for their antileishmanial activity. Conclusion: Many important heterocycles have proved to be effective against various leishmanial strains in terms of both safety and efficacy. In this article, we have attempted to review the different pharmacophores discovered in the past few years with the potential anti-leishmanial property.

COVID-19 is an infectious disease, caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) that is rapidly spreading all over the world and responsible for the international health crisis. In an earlier period, various synthetic antiviral drugs and clinical therapies have been used to control the viral infection but at present, there is no specific treatment available for COVID-19 infection. Several approaches like ritonavir, lopinavir, hydroxychloroquine, and chloroquine have been proposed. India is a hub of medicinal plants, so there is a chance to find out the way to combat the COVID-19 pandemic. The medicinal herbal formulations may enhance the immunity and come up with a powerful antiviral drug, which is an urgent need to control the outbreak of coronavirus. In this review article, we have discussed epidemiology, clinical outcomes, treatment, and prevention of this novel epidemic coronavirus from medicinal herbal formulations perspective. We have also emphasized the reported antiviral activity and immunity-boosting property of the Indian medicinal plants. This article also suggests that the drug or formulation obtained from medicinal plant sources may have low fatal outcomes, quick response, and safe in the management and prevention of this pandemic outbreak.

Objective: The present study aimed to explore the in-vitro anticancer potential of 5-fluorouracil (5-FU) loaded PLGA nanogels coated with nerolidol sesquiterpene. Methods: The emulsification-solvent evaporation technique was used for the preparation of plain PLGA nanogels (PNGs) and 5-FU loaded PLGA nanogels (FPNGs). A surface coating of Nerolidol (2%) sesquiterpene was employed to improve the penetration efficacy of the nanogels into the stratum corneum. Results: The nanogels formulation FPNGs have the size range 220±0.25% nm obtained by dynamic light scattering. The entrapment efficiency of approx ~ 42% with a sustained-release pattern for 24 h was estimated at different pH ranges. The cell uptake and localization profile were revealed by confocal microscopy analysis using the HaCaT cell line. MTT assay demonstrated the cell compatibility of nanogels, confirmed by apoptosis assay depicting the apoptotic index of 0.87. Conclusion: This study concludes that FPNGs are a promising nanogels system against skin cancer that can be used to boost the chemo-therapeutic efficiency of bioactives with sustained and controlled release at the desired site.

Background: Naturally occurring chalcones afford diverse pharmacological activities such as anticancer, anti-malarial, anti-inflammatory, anti-tubercular, anti-hypertensive, anti-arrhythmic, antidiabetic, anti-angiogenic, anti-obesity, antiplatelet, anti-oxidant, hypolipidemic and anti-gout. They are frequently being used by the various researchers to design and develop new synthetic chalcones and many novel hybrid analogs as bioactive drugs. Many of these drugs are hybrid molecules, which are designed through molecular hybridization theory, and have displayed multiple pharmacological and medicinal aspects. This multi-effective feature of these hybrid derivatives makes them efficient and ideal drug entities for the treatment of various dreadful diseases. Methods: A structured search of published research literature from recognized standard medical databases such as PubMed, Google Scholar, Google Patents, Scopus, etc., over the defined period of 10 years (January 2009 to December 2018) have been performed. Various reported heterocyclic chalcone hybrids, their synthesis methods, plausible mechanism(s) of action(s), and probable structure-activity relationships for the therapeutic applications in cancer, malaria, tuberculosis, leishmaniasis, inflammation, diabetes, microbial infection, and cardiovascular diseases remained the centre for attraction of this article. Results: The present review article focuses on chalcone hybrids with different heterocyclic moieties and categorizing them on the basis of their pharmacology and therapeutic significance in the last ten years and has proposed their structure-activity relationships. Conclusion: Chalcone and their hybrids have largely been targeted for their anticancer, anti-malarial, anti-inflammatory, anti-tubercular, antileishmaniasis, and anti-microbial activity. This comprehensive study may assist the medicinal chemist to design and develop innovative chalcone hybrids with significant therapeutic activity.

Objective To evaluate a treponemal enzyme-linked immunosorbent assay (ELISA) as an alternative screening test for syphilis in pregnant women. Methods A cross-sectional study of diagnostic test accuracy was carried out in a large volume laboratory from a tertiary care center. A total of 416 serum samples, including 102 archived syphilis Treponema pallidum hemagglutination (TPHA)-positive samples and 314 samples from pregnant women, were used to determine the sensitivity and specificity of ELISA. All the samples were subjected to Venereal Disease Research Laboratory (VDRL), rapid plasma reagin (RPR), ELISA, and TPHA tests. Performance characteristics of VDRL, RPR, and ELISA were calculated with TPHA as a reference standard test. Results VDRL and RPR exhibited higher false positivity of 10.5% and 9.6%, respectively, compared to 2.5% by ELISA. The sensitivity and specificity of ELISA were 98% and 97.5%, of VDRL were 71.6% and 89.5%, and of RPR were 73.5% and 90.5%, respectively. Moreover, ELISA had an excellent agreement (kappa=0.9) with TPHA compared to VDRL/RPR which had a moderate agreement (kappa=0.6) only. Conclusion ELISA has the potential to replace VDRL/RPR as a screening test for syphilis in centers that can perform ELISA, especially for antenatal screening.

IntroductionIn a large developing country, with diverse population characteristics and differential access to healthcare, it is important to identify factors that influence postnatal health. This knowledge will help frame recommendations to enhance universal postnatal care.Methods and analysisA prospective cohort study will be conducted by recruiting all participants who deliver in a referral centre in South India during a 1-year period after written consent is obtained from them. In addition to clinical information pertaining to their delivery and demographics, details of physical health, mental health socioeconomic status and emotional support will also be collected. Every participant will be followed up physically and/or by telephonic consultation at 3, 9 and 18 months of their postnatal period to reassess their status and that of their babies. As there are several independent and dependent variables requiring multivariate analysis, a sample size of 10 000 is considered adequate. Any unplanned visits to a health facility will be enquired into and documented for analysis.During data analysis, the effect of Caesarean section, high-risk characteristics and gestational age of the baby at delivery on various outcome measures and postnatal status will be evaluated. Interpretation of the large volume of collected data will help frame recommendations to improve postnatal careEthics and disseminationThe study is approved by the Institutional Review Boards (Research and Ethics Committees) of Christian Medical College, Vellore, Tamil Nadu, India (IRB 12178 date 24 June 2020).Women are provided with a detailed information sheet and written consent is obtained. They are reassured that their care will not be compromised if they do not consent to the study. Data will be available on the clinical trial portal to assist in the dissemination of results after the project is published.Trial registration numberCTRI/2022/03/041343.

Background:Inflammatory bowel disease(IBD) affects women in their reproductive years with severe disease associated with maternal morbidity and adverse fetal outcomesMethodology and Results:We report our experience of managing pregnant women with IBD in South India. Of the five patients with IBD and 8 pregnancies, 2 presented with active severe disease during pregnancy and were treated with steroids and azathioprine. One developed chorioamnionitis and the other metabolic complications. All except 1 pregnancy required operative delivery by LSCS or instrumental delivery. The mean GA at delivery was 38+5 weeks with a mean birth weight of 2.93kg.Conclusion:Pregnancy outcomes in IBD are dependent on the disease activity status at conception. Diagnosis of IBD in pregnancy is a challenge as full length colonoscopy and CT imaging is not feasible. Chorioamnionitis is a complication associated with IBD, probably due to immunosuppressive drugs. There were no neonatal complications.

To examine the prevalence, etiology, and clinical outcomes of secondary hypertension in pregnancy in a high-risk tertiary care hospital. This retrospective study used data from patient records between January 2015 and July 2018. Of 52,293 pregnant women admitted during this period, those with hypertension were included. Patient demographics, diagnosis of secondary hypertension, investigations, suspected etiologies of secondary hypertension, maternal and neonatal outcomes and discharge conditions were included. The prevalence of secondary hypertension and causes were measured. Univariate followed by multivariate analyses were done to look for associated maternal and neonatal outcomes. Among patients with chronic hypertension in pregnancy, 13.7% had secondary causes, of which renal and cardiac causes were the commonest. The incidence of severe pre-eclampsia (40.5%) among patients with secondary hypertension was higher in patients with systolic blood pressures more than 140 mm of Hg than in those with systolic blood pressures lower than 140 mm of Hg (odds ratio [OR]: 4.92, confidence interval [CI]: 1.7–14.16, p: 0.002) irrespective of etiology. Pre-eclampsia predisposed to maternal acute kidney injury (OR: 1.23, CI: 1.04–1.45, p: 0.003), low birthweight (OR: 4.69, CI: 1.44–11.9, p: 0.006), preterm delivery (OR: 4.69, CI: 1.78–12.34, p: 0.001), and neonatal death (OR: 5.19, CI: 0.97–27.6, p: 0.04). The prevalence of hypertension in pregnancy was 10.3%; among them, the prevalence of secondary hypertension was 1.46%. Uncontrolled secondary hypertension was associated with poor maternal and neonatal outcomes. Strict control of blood pressure in secondary hypertension in pregnancy ensured better outcomes.

Background: Medical termination for missed miscarriage with the use of 800 μg of vaginal misoprostol as a single agent is recommended as a cheap option before 14 weeks of gestation in developing countries. A few studies have looked at its efficacy. Methods: A prospective, observational study was done on women having medical termination with up to three doses of 800 μg vaginal misoprostol at 12 hourly intervals. The number of women who needed check curettage was collected. Ultrasound findings if done were collated. Follow-up was done telephonically at the end of first week, fourth week and sixth week. Results: The cohort comprised 145 women. The primary outcome was the need for curettage after expulsion of products following medical management and this was 49/145 (37.8%) of women. The induction expulsion interval was 36 hours. The mean endometrial thickness of the 113/145 women who had an ultrasound was 11 mm. The mean endometrial thickness in women who had check curettage was 18 mm. Persistent spotting was the only significant symptom at follow-up. Resumption of cycle at the end of the sixth week was seen in 105/132 (80.15%) of women who were followed up. Conclusion: Findings of our study showed the check curettage rate of 37.8%. However, the regime which we used, that is, 800 μg vaginal misoprostol at 12 hourly intervals had a long induction to expulsion interval of 36 hours. In all, 80% of women resumed normal cycles at the end of the sixth week. No significant complications were noted on follow-up.

Takayasu arteritis (TA) is a chronic, idiopathic large-vessel vasculitis that affects women of reproductive age, and has significant maternal and fetal implications. Although there are contrasting data on the effect of TA on fertility, most studies have shown that fertility outcomes remain unaffected. The disease activity of TA usually either remains stable or decreases during pregnancy. The important fetomaternal complications are maternal hypertension, pre-eclampsia, prematurity, and intrauterine growth restriction. To reduce maternal and fetal morbidity, controlling the disease before conception is important. This review article discusses the various implications, challenges, and medical and endovascular management of TA during pregnancy.

Background: Women with Extra hepatic portal vein obstruction (EHPVO) are mostly young and belong to Asian countries. In the Indian subcontinent, 20–30% variceal bleeds are caused by EHPVO. Hence pregnancy is a concern in such patients. The objective of this study is to observe the maternal and neonatal outcomes in women with EHPVO. Materials and Method: Extra hepatic portal vein obstruction was studied retrospectively in 28 pregnancies in 20 women from Jan 2011 to July 2018 at a tertiary hospital in South India and the pregnancy outcomes were observed during this period. Institutional Review Board approval obtained. Results: The mean age of the women was 24.3 years and the mean age of diagnosis was 18.5 years. Splenomegaly, thrombocytopenia and anaemia were seen in 22 (78.5%), 17 (60.7%) and 8 (28.5%) of pregnancies, respectively. Rate of abortions and preterm deliveries were 2 (7.1%,n=28) and 10 (35.7%,n=28). There was one stillbirth (3.6%) in the study group. EHPVO was diagnosed in 25 (89.3%) women prenatally in our series. During pregnancy only one woman had variceal bleed, which was managed conservatively. Blood and blood product transfusion was required in 7(25%) of women and there was no maternal mortality. Conclusion: Pregnancies in EHPVO have good maternal and neonatal outcomes, provided they are taken care of by a multidisciplinary approach in a tertiary care centre.

BACKGROUND: In Low- and Middle-Income Countries like India, where the services and surgical care for Congenital Heart Disease (CHD) are available only in selected centres with geographical variations, it is important to detect Heart defects early and give the parents an opportunity to plan ahead for seeking appropriate care at the earliest. Several developments in recent years such as improvement of quality of ultrasound machines, sonographer’s experience, skills and better description of cardiac views have contributed to improve detection rate. METHODS: A retrospective study was done between March 2016 and December 2019, and showed ultrasound evidence of CHD was included. RESULTS: The total number of morphology scans done during study period was 50,435. The number of congenital anomalies detected was 1482, out of which CHD was detected in 334 (22.5%). Outcome of 50 pregnancies were not available while the rest (284) were available for follow up in post-natal period. There were 51 cases of CHD, missed on routine antenatal morphological screening, which were diagnosed in the post-natal period. There were 18 cases of over-diagnosed CHD on antenatal scan, but were found to have normal echo findings after birth. CONCLUSION: A systematic approach is crucial for practitioner to determine the patterns of associated defects. Use of step wise strategy helps in determining the correct diagnosis of isolated cardiac defect, associated with other system or a part of syndrome. Systematic audit of morphological scans could play an important role in improving the diagnostic accuracy, which in turn will lead to early detection.

Multiple gestations, especially monochorionic twins are associated with unique complications such as twin to twin transfusion syndrome (TTTS) and twin reversed arterial perfusion (TRAP) sequence due to preferential blood flow within the vascular communications between the two fetuses. TRAP sequence is a rare complication of monochorionic twins. The authors describe two cases of acardiac twins, one diagnosed at 17 weeks and the other at 24 weeks. While the first one was lost to follow-up, the second pregnancy was managed expectantly with close antepartum surveillance and had a term vaginal delivery of a healthy baby, along with the acardiac twin which was non-viable. The pump twin continues to be developmentally normal.

Parkinson’s disease is a widespread disease among elder population worldwide effecting approximately 6.3 million people across all genders, races and cultures. It is caused by dopamine loss, a chemical mediator that is responsible for body’s ability to control the movements. The disease reduces quality of life because of motor and non-motor complications. In this article Adaptive Boosting and Classification Tree based soft computing models are implemented to diagnose Parkinson’s disease using voice features. The soft computing models performances are evaluated on performance measures viz. true positive, false positive, false negative, true negative, accuracy, sensitivity, specificity, RMSE on training and datasets. Finally a comparison is performed to identify the most efficient model and dataset combination. Adaptive Boosting model outperformed others on reduced feature vector dataset obtained by selecting prominent 15 principal components using principal component analysis, where, it demonstrated 100% accuracy, 100% sensitivity, 100% specificity, 0.0 RMSE on training dataset and 67.00% accuracy, 67.35% sensitivity, 66.67% specificity, 0.5745 RMSE on testing dataset.

An assessment of the efficacy and satisfaction of women in active labour having digital cervical stretching compared to women who did not have this intervention. Ours was a randomised controlled trial at a tertiary centre in India. Low-risk women at term with vertex presentation in active labour with ruptured membranes and cervical dilation of 4–6 cm were included. Stretching to delivery interval was 247.5 ± 158.2 min in the intervention group and 265.5 ± 158.4 in the control group. The mode of delivery, incidence of cervical tear, and maternal, fetal and neonatal complications were similar in both groups. The Labour and Delivery Satisfaction Index (LADSI) was similar in both groups. While no significant discomfort was perceived with stretching, it does not appear to expedite labour.

OBJECTIVE To study the changes in the rates of perinatal mortality, birth asphyxia, and caesarean sections in relation to interventions implemented over the past 18 years, in a tertiary centre in South India. DESIGN Retrospective study. SETTING Labour and maternity unit of a tertiary centre in South India. POPULATION OR SAMPLE Women who gave birth between 2000 and 2018. METHODS Information from perinatal audits, chart reviews, and data retrieved from the electronic database were used. Interventions implemented during this time period were audits and training, obstetric re-organisation, and minor changes in staffing and infrastructure. MAIN OUTCOME MEASURES Main outcome measures were perinatal mortality rate, birth asphyxia rate, and caesarean section rate. RESULTS Perinatal mortality rate decreased from 44 per 1000 births in 2000 to 16.4 per 1000 births in 2018 (P

Peripartum cardiomyopathy is a syndrome of maternal heart failure with decreased left ventricular ejection fraction affecting maternal and fetal well-being. We analysed clinical profiles and outcomes in women with peripartum cardiomyopathy enrolled retrospectively from a tertiary care centre in southern India (1 January 2008–31 December 2014). The incidence of peripartum cardiomyopathy was one case per 1541 live births. Fifty-four women with a mean age of 25.5 years and mean gestational age of 35.4 weeks were recruited; 35 were primigravidae. Maternal and fetal deaths occurred in 9.3% and 24.1% of subjects, respectively. Mild-to-moderate maternal anaemia (80–110 g/L) was associated with fetal mortality (p = 0.02). Reduced left ventricular ejection fraction (

Staphylococcus bacteraemia is the leading cause of hospital acquired and community acquired bacteraemia. Complications associated are difficult to recognise. Mortality is 20 to 40%. This is a unique case discussing the metastatic spread of Staphylococcus infection following a wound infection. An informed consent was taken from the patient before publishing this case report.

To compare the efficacy of preinduction outpatient use of a single dose of 25 μg vaginal misoprostol between 381/2 and 40 weeks with that of placebo, to decrease the interval from intervention to delivery after stretch and sweep in low-risk gravid women with Bishop’s score

Background: Of all the cancers in women, about 10% manifest in the reproductive age group. These can be broadly classified as gynaecological cancers and non-gynaecological cancers; Among the non-gynaecological cancers besides haematological cancer, breast, thyroid, colon, bone and CNS are seen rarely. Clinical acumen in diagnosis and management of these rare cancers that appear during pregnancy or before pregnancy are difficult due to insufficient guidelines and rarity of the conditions.Methods: A retrospective analysis of rare cancers during a period of 10 years in this hospital was performed. Data concerning the gestational age at delivery, birth weight, mode of delivery and complications and the management of the cancers during the pregnancy were collected.Results: Among the 41 women with these rare non-gynecological, non-hematological cancers, 13 pregnancies were in women with prior history of cancers and 28 pregnancies were with current history of cancer. Majority of these cases with prior history were thyroid cancers who had uneventful pregnancies and delivered normally. Among pregnancies with current history of cancer, breast, CNS, GIT, and head and neck were the cancers with 5-6 cancers in each category. About 50% of these cancers were delivered early between 31-35 weeks to facilitate optimal treatment. Cancers with guarded prognosis diagnosed before 20 weeks had a termination of pregnancy.Conclusions: Cancers during pregnancies are rare and their care must be individualized.

Context: Studies comparing the efficacy of expectant management (EM) and immediate delivery (ID) in the management of women with preterm prelabor rupture of membranes (PPROM) between 34 and 35+6 weeks have not been done in a developing country. Although large multicentric studies show better outcomes with EM, the economic implications have not been studied. Aims: This study compared women with PPROM between 34 and 35 +6 weeks, managed expectantly with women who were delivered immediately. Settings and Design: Large tertiary center and retrospective cohort. Methods and Materials: Data of 206 women with PPROM between 34 and 35+6 weeks managed with immediate delivery in the years 2014 and 2015 were compared with seventy-five women with PPROM managed expectantly in the years 2016 and 2017. Statistical Analysis Used: Data was summarized using mean standard deviation (SD) or median interquartile range for continuous variables and frequency and percentage for categorical variables. Continuous variables were compared using independent t-test and categorical variables were compared using Chi-square statistics. Results: Neonatal sepsis was seen in 1/75 (1.3%) in the group managed expectantly and 12/206 (5.8%) in the ID group (P = 0.109). Respiratory distress was seen in 3/75 (4%) in the group managed expectantly and 22/206 (10.7%) with ID (P = 0.08). Chorioamnionitis was similar in both groups. Cesarean rate was 17.3% with expectant management and 28% with ID (P = 0.065). The mean hospital bill was ₹.33,494/- in the ED group and ₹.27,079/- in the ID group (P < 0.001). Conclusions: Expectant management was more expensive.

Introduction: Wound Dehiscence (WD) following Vaginal Delivery (VD) or Cesarean Delivery (CD) causes considerable discomfort to the woman, leading to significant physical, emotional and financial burden. The rate of Perineal Wound Dehiscence (PWD) is relatively low and more common with instrumental delivery. However, there is minimal information on the incidence and risk factors causing WD, especially for PWD. Aim: To assess the incidence and risk factors of peripartum wound dehiscence. Materials and Methods: This retrospective study was conducted in a large tertiary care centre where there were 14759 deliveries. 4671 women had caesarean deliveries and 10,088 women had the vaginal delivery. There were 86 cases (0.8%) of WD in the VD group and 95 (2%) in the CD group. These cases were compared with twice as many controls. Results: Induction of Labour (IOL) and BMI >30 kg/m2 were more common in cases compared to controls in the CD group. However, on multivariate analysis, this association was not seen. IOL, meconium stained liquor (MSAF), instrumental delivery and use of episiotomy was more common among cases than controls in the VD group. IOL did not show up as an independent risk factor on multivariate analysis. Conclusion: An association between IOL, primigravidae, instrumental delivery and MSAF was seen with peripartum WD.

Parkinson’s disease is a widespread disease among elder population worldwide caused by dopamine loss, which reduces quality of life because of motor and non-motor complications. In the current paper, nine soft computing models, i.e., Cubist, Cubist Committees, Random Forests, Kernel Support Vector Machine, Linear Regression, Naive Bayes, Artificial Neural Network, Adaptive Neuro-Fuzzy Inference System, and Hybrid Neuro-Fuzzy Inference System are implemented for Parkinson’s disease diagnosis using voice and gait features. Later, their performances are evaluated based on performance measures, viz., true positive, false positive, false negative, true negative, accuracy, sensitivity, specificity, and RMSE, and finally, a comparison is performed to identify the most efficient model and data set combination. The comparison demonstrated that Random Forest model outperformed others yielding 100% accuracy, 100% sensitivity, 100% specificity, and zero RMSE on voice and gait training data sets both; Cubist Committees model outperformed others yielding 74.00% accuracy, 69.39% sensitivity, 78.43% specificity, and 0.4582 RMSE on voice testing data set; Random Forest model once again outperformed others yielding 81.66% accuracy, 92.39% sensitivity, 66.67% specificity, and 0.4283 RMSE on gait testing data set. Furthermore, these models’ performances are also evaluated on reduced feature vector voice and gait data sets obtained by Principal Component Analysis, and compared with their performances on former data sets. The comparison exhibited that the soft computing models’ performance decreases by reducing feature vector of the data sets.

Background: Gestational hydronephrosis (GH) is result of dilatation effect of the progesterone and mechanical compression of the gravid uterus. Management during pregnancy is challenging as routine radiological investigations and surgical treatments cannot be applied due to the potential harm to the fetus. Intervention is indicated in women who fail to respond to conservative management. Acute hydronephrosis and renal colic are common etiologies for loin pain, and can lead to severe form of urinary tract infection affecting perinatal outcome. Ureteric stenting and percutaneous nephrostomy (PCN) during pregnancy are safe, requiring no intra-operative imaging, and inserted under local anaesthesia. It provides good symptom relief, low complication rate, efficient and safe modality for women with refractory symptoms.Methods: A retrospective study of pregnant women admitted under obstetric units with acute hydronephrosis requiring DJ stenting and/or PCN. Aim was to evaluate the course and pregnancy outcomes in a tertiary center of Southern India over a period of five years.Results: Descriptive statistical analysis was done in 12 women with acute hydronephrosis in pregnancy. 66.7% were nulliparous and mean gestational age at admission was 31 weeks. Diagnosis was done by USG. One-fourth had pyelonephritis and calculus being the main pathology (n=9;75%).Women requiring DJ stent and PCN were 41.6% and 58.4% respectively. 41.7% had preterm labour. 66.7% delivered vaginally, birth weight was more than 2.5kg in 50%.Conclusions: Maternal and neonatal outcome mainly depends on the early diagnosis. In this study we emphasize on the importance of multidisciplinary team approach in the management of women with acute hydronephrosis. DJ stent and PCN are efficient and safe modalities in women with refractory symptoms.

Background: Obstetric outcome in women with advanced maternal age (AMA) is not usually studied especially in India.Methods: This study was a case control study. The cases were pregnancy in 100 women at 40 years of age and beyond and there were two control arms of 100 each of ages 20-29 years and 30-39 years. The demography, maternal complications, delivery outcomes and neonatal outcomes were compared.Results: Women with AMA were mostly multipavrous and had higher Body Mass Index (BMI). Hypertensive disease in pregnancy was more common in AMA but the difference was statistically significant. Women with AMA were more likely to have gestational diabetes (p ≤ 0.011), more likely to have anemia (p = 0.038), more likely to have preterm birth (p = 0.001), other medical complications compare to the control group (p = 0.005). They were also more likely to have Lower Segment Caesarean Section (LSCS) (p ≤ 0.001) and have postpartum complications. The birth weight of the neonate was significantly decreased in the AMA group (p < 0.001). The neonates were also more likely to be admitted to Neonatal Intensive Care Unit (NICU) (p ≤ 0.006).Conclusions: Adverse maternal and neonatal outcomes were seen despite individualized and optimal obstetric care. Thus, these women need preconceptional counselling.

Inducing labour with a Foley balloon catheter rather than using oxytocin or prostaglandins is considered to be less risky if the uterus is scarred.1 It is not known if more fluid in the balloon is more effective without being more dangerous. Volumes of 80 mL and 30 mL were compared in 154 eligible women. Mode of delivery, duration of labour and delivery within 24 h were similar in both groups. However, the second group required oxytocin more frequently. Though more scar dehiscences occurred in the first group, the difference was not significant.

Objective To assess the clinical profile of pregnant/puerperal women from a semi-urban Indian population who were infected with pandemic (H1N1) 2009 virus (P[H1N1]2009v) and to evaluate their outcome. Methods In a cross-sectional study, 566 women (79 pregnant/puerperal, 487 nonpregnant) who presented to a tertiary care hospital with influenza-like illness were tested for P(H1N1)2009v by real-time reverse transcriptase polymerase chain reaction. Outcomes measures were the maternal mortality and the perinatal mortality rate (PMR). Results Twenty (25%) pregnant/puerperal and 144 (30%) nonpregnant women tested positive for P(H1N1)2009v, with 5 pregnant and 3 postpartum women requiring admission to the intensive care unit (ICU). P(H1N1)2009v-related mortality was higher in pregnant than nonpregnant women (25% versus 8%; P = 0.04). In the pregnant/puerperal cohort, factors associated with death included delayed presentation (median 6 days versus 1.5 days in survivors; P = 0.007), need for ICU admission ( P = 0.004), need for ventilation ( P = 0.001), and renal failure ( P = 0.001). The PMR was 55.5/1000 births compared with 33.5/1000 births in the hospital overall during the study period. Conclusion In a low-income country, P(H1N1)2009v infection in pregnancy is associated with considerable mortality. Delayed presentation to a tertiary care center, lack of awareness, and restricted access to treatment might have contributed to the high mortality.

Objectives The study was undertaken to determine the efficacy of routine estimation of amniotic fluid volume using the amniotic fluid index (AFI) as a means of predicting an adverse perinatal outcome in low-risk pregnancies. Materials and methods Five hundred and three singleton lowrisk pregnancies with cephalic presentation between 37 and 40 weeks and 6 days of gestation with intact or ruptured membranes had AFI estimations within 36 hours of delivery. Results The frequency of nonreassuring fetal heart patterns and perinatal outcomes among patients with oligohydramnios (8 cm) liquor were compared and not found to be different. Cesarean section for nonreassuring fetal status was also similar in the three groups. Conclusion This study suggests that AFI estimation during labor in low-risk pregnancies does not predict adverse perinatal outcomes. Further studies are needed to verify this impression. How to cite this article Jeanet J, Benjamin SJ, Mathews JE, Rathore S, Sebastian A, Thomas E. Intrapartum Amniotic Fluid Volume Estimation in Low-risk Pregnancy as a Predictor of Perinatal Outcome. J South Asian Feder Obst Gynae 2014;6(3):156-158.

Still birth continues to be one of the many challenges that an obstetrician has to face. Still births that occur in the antenatal period are more difficult to explain than that which occurs intrapartum. The latter is most often due to intrapartum asphyxia, medical complications or infections; however a cause for antenatal still birth is difficult to ascertain. A thorough examination of the case along with necessary investigations might not necessarily reveal any cause and this leads to considerable anxiety for both the mother and the treating obstetrician. In the investigation of a case of still birth a detailed examination of the placenta and cord has to be emphasised as a considerable number of still births that are thought to be unexplained may be attributable to placental or cord pathologies. Here we present one such case where an umbilical cord haematoma resulted in intrauterine foetal death.