Incidence of intrapartum stillbirth and associated risk factors in tertiary care setting of Nepal: a case-control study

Background: Each year, 1.2 million intrapartum stillbirths occur globally. In Nepal, about 50% of the total number of stillbirths occur during the intrapartum period. An understanding of the risk factors associated with intrapartum stillbirth will facilitate the development of preventative strategies to reduce the burden of death. This study was conducted in a tertiary-care setting with the aim to identify the risk factors associated with intrapartum stillbirth. Methods: A case-control study was completed from July 2012 to September 2013. All women who had an intrapartum stillbirth during the study period were included as cases, and 20% of women with live births were randomly selected on admission to make up the referent population. Information from the clinical records of case and referent women was retrieved. In addition, interviews were completed with each woman on their demographic and obstetric history. Results: During the study period, 4,476 women with live births were enrolled as referents and 136 women with intrapartum stillbirths as cases.  The following factors were found to increase the risk for intrapartum stillbirth: poor familial wealth quintile (Adj OR 1.8, 95% CI-1.1-3.4); less maternal education (Adj OR, 3.2 95% CI-1.8-5.5); lack of antenatal care (Adj OR, 4.8 95% CI 3.2-7.2); antepartum hemorrhage (Adj OR 2.1, 95% CI 1.1-4.2); multiple births (Adj. OR-3.0, 95% CI- 1.9-5.4); obstetric complication during the labor period (Adj. OR 4.5, 95% CI-2.9-6.9); lack of fetal heart rate monitoring per protocol (Adj. OR-1.9, 95% CI 1.5-2.4); no partogram use (Adj. OR-2.1, 95% CI 1.1-4.1); small weight for gestational age (Adj. OR-1.8, 95% CI-1.2-1.7); premature birth (Adj. OR-5.4, 95% CI 3.5-8.2); and being born premature and with small weight for gestational age (Adj. OR-9.0, 95% CI 7.3-15.5). Conclusion: Inadequate Fetal heart rate monitoring and partogram use are risk factors associated with intrapartum stillbirth and increasing the adherence to the interventions that can reduce the risk of intrapartum stillbirth. Preterm birth and small weight for gestational age were the factors that had the highest risk for intrapartum stillbirth, which indicates that adequate antenatal care can improve the health and growth of the baby and prevent premature death

Efficacy of maternal B-12 supplementation in vegetarian women for improving infant neurodevelopment: protocol for the MATCOBIND multicentre, double-blind, randomised controlled trial

INTRODUCTION: Vitamin B12 deficiency is widely prevalent across many low- and middle-income countries, especially where the diet is low in animal sources. While many observational studies show associations between B12 deficiency in pregnancy and infant cognitive function (including memory, language and motor skills), evidence from clinical trials is sparse and inconclusive. METHODS AND ANALYSIS: This double-blind, multicentre, randomised controlled trial will enrol 720 vegetarian pregnant women in their first trimester from antenatal clinics at two hospitals (one in India and one in Nepal). Eligible mothers who give written consent will be randomised to receive either 250 mcg methylcobalamin or 50 mcg (quasi control), from enrolment to 6 months post-partum, given as an oral daily capsule. All mothers and their infants will continue to receive standard clinical care. The primary trial outcome is the offspring's neurodevelopment status at 9 months of age, assessed using the Development Assessment Scale of Indian Infants. Secondary outcomes include the infant's biochemical B12 status at age 9 months and maternal biochemical B12 status in the first and third trimesters. Maternal biochemical B12 status will also be assessed in the first trimester. Modification of association by a priori identified factors will also be explored. ETHICAL CONSIDERATIONS AND DISSEMINATION: The study protocol has been approved by ethical committees at each study site (India and Nepal) and at University College London, UK. The study results will be disseminated to healthcare professionals and academics globally via conferences, presentations and publications. Researchers at each study site will share results with participants during their follow-up visits.Trial registration numberCTRI/2018/07/015048 (Clinical Trial Registry of India); NCT04083560 (ClinicalTrials.gov)

Outcome of fallopian tube recanalization

Objective: To find out the fertility outcome of tubal surgery. Method: This was a hospital based descriptive study conducted at Om Hospital, Bharatpur. Forty-one women who were operated in this hospital during the period of 6 years. (Jan 2002- December 2007). Results: esults: Of 41 patients who underwent tuboplasty, 34 (82.9%) cases were available for follow-up. Out of these 34 cases, 14 (41.2%) became pregnant. Among them 9 (64.3%) had viable births, 3 (21.4%) ectopic pregnancies and 2 (14.3%) spontaneous miscarriages. Conclusion: Fallopian tube recanalization has been established as an effective, useful and novel treatment of infertility due to tubal occlusion. Key ey words: Infertility, fallopian tube, tuboplasty, pregnancy

Severity of Hyperemesis Gravidarum and Associated Maternal factors

Background: Hyperemesis gravidarum is the most severe form of nausea and vomiting in pregnancy. It is one of the most common cause of early pregnancy admissions and associated with various maternal risk factors . Very few studies have been conducted among Nepalese women with hyperemesis gravidarum. This study aims to identify various maternal risk factors among Nepalese women and its severity using pregnancy unique quantification of emesis scoring. Methods: This is a cross sectional observational study conducted at Paropakar Maternity and Women’s Hospital. Total duration of the study period was for one year from February 2018 to Janurary 2019. A total of 144 patients meeting the inclusion criteria were included in the study.The severity of the hyperemesis gravidarum was assessed and classified using pregnancy unique quantification of emesis scoring. Various maternal demographic, obstetric and personal factors were studied in relation to the incidence and severity of hyperemesis gravidarum.Results: Moderate (49.30%) to severe(50.69%) hyperemesis gravidarum were admitted in the hospital. Most women were nulliparous from 20-24 years age group. Among all categories of BMI, underweight had more severe hyperemesis gravidarum (63.63%) and overweight patient had increased incidence of moderate hyperemesis gravidarum (66.66%). Women with previous dysmenorrhea had severe hyperemesis gravidarum (54.05%) and non-smoker had severe hyperemesis gravidarum (52.03%) while smoker had moderate hyperemesis gravidarum (57.14%).Conclusions: Pregnant women of age group of 20-24 years, nulliparity and underweight were associated with severe hyperemesis gravidarum. Keywords: Hyperemesis gravidarum; maternal factors ; pregnancy unique quantification of emesis.</jats:p

Comparison of urine protein creatinine ratio and 24 hours urine protein in detecting preeclampsia

Aim: To assess the diagnostic accuracy of spot urine protein-creatinine ratio for detection of proteinuria in Preeclampsia.&#x0D; Methods: Cross Sectional Descriptive Study was conducted in a total of 38 pregnant women in Paropakar Maternity and Women’s Hospital in study period of 3 month. The correlation between protein- creatinine ratio in spot urine samples and urinary protein excretion in 24-hour collections were analyzed.&#x0D; Results: Comparison of 24 hours urinary protein and protein- creatinine ratio in women with preeclampsia shows a significant correlation (r=0.911, p&lt;0.0001). The cut-off protein-creatinine ratios which gave maximum area under the curve for 300mg protein for 24hrs was 0.27 (sensitivity: 94.6%, specificity: 100%, PPV: 100%, NPV: 33.3%); 2000 mg urine protein excretion was 2.1 (sensitivity and specificity of 100%); 3000mg protein excreted for 24hours was 3.0 (sensitivity: 83.3%,&#x0D; specificity: 92.3%, PPV: 83.3%, NPV: 93.3%. Area under the ROC for 24hours urine total protein of &gt;300mg, &gt;2000mg and &gt;3000mg/day were 0.946 (95%CI 0.873-1.019), 1 (95% CI 1.00-1.00) and 0.957 (95%CI 0.897- 1.016) respectively.&#x0D; Conclusions: Spot urine protein-creatinine ratio is as accurate as to 24 hours urine protein determination of proteinuria in Preeclampsia.</jats:p

Heterotopic Pregnancy Following Ovulation Induction With Successful Pregnancy Outcome: A Case Report

ABSTRACT Heterotopic pregnancy (HTP) is a rare, life‐threatening condition in which both extrauterine and intrauterine gestation co‐occur. It presents diagnostic and therapeutic challenges for physicians, often being missed or overlooked. A heterotopic pregnancy must always be considered if a patient presents with pelvic pain, especially when pregnancy is aided with ovulation‐inducing agents or assisted reproductive technologies (ARTs)

Effect of early versus delayed cord clamping in neonate on heart rate, breathing and oxygen saturation during first 10 minutes of birth : randomized clinical trial

Background: Delayed cord clamping (DCC) after 180 s reduces iron deficiency up to 8 months of infancy compared to babies who received Early Cord Clamping (ECC) at less than 60 s. Experimentally DCC has shown to improve cardio-vascular stability. To evaluate the effect of delayed (≥180 s) group versus early (≤60 s) cord clamping group on peripheral blood oxygenation and heart rate up to 10 min after birth on term and late preterm infants. Methods: We conducted a single centred randomized clinical trial in a low risk delivery unit in tertiary Hospital, Nepal. One thousand five hundred ten women, low risk vaginal delivery with foetal heart rate (FHR) ≥ 100 ≤ 160 beats per minute (bpm) and gestational age (≥33 weeks) were enrolled in the study. Participants were randomly assigned to cord clamped ≤60 s of birth and ≥ 180 s. The main outcome measures were oxygen saturation, heart rate from birth to 10 min and time of spontaneous breathing. The oxygen saturation and heart rate, the time of first breath and establishment of regular breathing was analysed using Student t-test to compare groups. We analysed the range of heart rate distributed by different centiles from the time of birth at 30 s intervals until 10 min. Results: The oxygen saturation was 18% higher at 1 min, 13% higher at 5 min and 10% higher at 10 min in babies who had cord clamping in delayed group compared to early group (p &lt; 0.001). The heart rate was 9 beats lower at 1 min and3 beats lower at 5 min in delayed group compared to early group (p &lt; 0.001). Time of first breath and regular breathing was established earlier in babies who had cord clamping at 180 s or more. Conclusion: Spontaneously breathing babies subjected to DCC have higher oxygen saturation up to 10 min after birth compared to those who have undergone ECC. Spontaneously breathing babies with DCC have lower heart rates compared to ECC until 390 s. Spontaneously breathing babies receiving DCC have early establishment of breathing compared to ECC. Trial registration: ISRCTN, 5 April 2016