Pregnancy outcome after antepartum diagnosis of oligohydramnios at or beyond thirty seven completed weeks in rural India

Background: Amniotic fluid volume abnormalities may reflect a problem with fluid production or its circulation, such as underlying fetal or placental pathology. These volume extremes may be associated with increased risks for adverse pregnancy outcome. Some studies show that amniotic fluid index is a poor predictor of adverse outcome and some authors have not confirmed the association of adverse perinatal outcome with oligo-hydramnios. Thus this study is conducted to find out the value of oligohydramnios in perinatal outcome and maternal outcome in pregnancies beyond 37 completed weeks.Methods: This study was done at department of Obstetrics and Gynaecology, NIMS hospital, Jaipur, Rajasthan, India, from January 2013 to January 2015 for a period of 24 months. Our analysis included a total of 200 antenatal women; both booked and unbooked were included in this study. In this study 100 women with AFI <5 cm were allotted into the study group and another 100 women with normal AFI were included into the control group. Labour was either spontaneous or induced in both study and control group . During labour intermittent auscultation of fetal heart rate was done to detect any signs of fetal distress. Artificial rupture of membranes was done in active phase of labour to notice the grade of liquor and progress of labour was monitored on a partogram. Mode of delivery and intrapartum complications were noted. At birth neonate was assessed using 5 minute APGAR score , birth weight was recorded and neonate who were admitted into NICU were followed until discharge.Results: Oligohydramnios i.e., AFI <5 cm measured by ultrasonography in term pregnancies is associated with adverse perinatal outcome. The risks of meconium staining of liquor, intrapartum fetal distress,operative delivery and perinatal mortality are significantly higher in patients with AFI <5 cm , compared to those with normal AFI.Conclusions: Determination of AFI can be used as an adjunct to other fetal surveillance methods. It helps to identify those infants at risk of poor perinatal outcome. Determination of AFI is a valuable screening test for predicting fetal distress in labour requiring cesarean section

A two-year retrospective study of infants with Erb-Duchenne's palsy at a tertiary centre in Rajasthan, India

Background: Brachial plexus injury (BPI) has prevalence of between 0.5 and 4.4/1000 live births. It is commonly believed to be attributed to extensive lateral traction during difficult neck delivery. This paper aims to look at one aspect of birth injuries, Erb-Duchenne palsy, its incidence and contributing factors.Methods: All infants sustaining Erb-Duchenne palsy during birth were identified at Department of OBGY, NIMS Hospital, Jaipur. The notes of the infants and mothers were reviewed. Special attention was given to the known risk factors for birth trauma such as ethnicity, parity, antenatal care, history of diabetes etc.Results: During the two-year period 2013 to 2015, there were 6 infants diagnosed with Erb-Duchenne palsy, giving an incidence of 0.79 in 1000 live births. Out of six, four were primigravidae. All pregnancies were singleton, cephalic/vertex undergoing vaginal deliveries; none required forceps or ventouse deliveries. The mean infant birthweight was 4.378 kg with a median value of 4.48 kg (range 3.51-4.78). Four infants were classified as macrosomic i.e. birthweights greater than 4 kg, four infants had birthweights of 4 kg to 5 kg; none weighed over 5 kg. Three of the deliveries were documented as difficult shoulder delivery/shoulder dystocia. Five of the infants had APGAR scores that were less than seven.Conclusions: This study suggested that Erb-Duchenne palsy is strongly associated with fetal macrosomia and shoulder dystocia. Diabetes was not significant in causing macrosomia as only single mother was found diabetic. Fetal macrosomia contributed to shoulder dystocia in the majority of cases

A two-year retrospective study of infants with Erb-Duchenne's palsy at a tertiary centre in Rajasthan, India

Background: Brachial plexus injury (BPI) has prevalence of between 0.5 and 4.4/1000 live births. It is commonly believed to be attributed to extensive lateral traction during difficult neck delivery. This paper aims to look at one aspect of birth injuries, Erb-Duchenne palsy, its incidence and contributing factors.Methods: All infants sustaining Erb-Duchenne palsy during birth were identified at Department of OBGY, NIMS Hospital, Jaipur. The notes of the infants and mothers were reviewed. Special attention was given to the known risk factors for birth trauma such as ethnicity, parity, antenatal care, history of diabetes etc.Results: During the two-year period 2013 to 2015, there were 6 infants diagnosed with Erb-Duchenne palsy, giving an incidence of 0.79 in 1000 live births. Out of six, four were primigravidae. All pregnancies were singleton, cephalic/vertex undergoing vaginal deliveries; none required forceps or ventouse deliveries. The mean infant birthweight was 4.378 kg with a median value of 4.48 kg (range 3.51-4.78). Four infants were classified as macrosomic i.e. birthweights greater than 4 kg, four infants had birthweights of 4 kg to 5 kg; none weighed over 5 kg. Three of the deliveries were documented as difficult shoulder delivery/shoulder dystocia. Five of the infants had APGAR scores that were less than seven.Conclusions: This study suggested that Erb-Duchenne palsy is strongly associated with fetal macrosomia and shoulder dystocia. Diabetes was not significant in causing macrosomia as only single mother was found diabetic. Fetal macrosomia contributed to shoulder dystocia in the majority of cases