A REVIEW ON FETAL BIOMETRY: MODERN AND AYURVEDIC PERSPECTIVE

The measurements of embryo/fetus are referred to as fetal biometry. Fetal biometric measurements reflect the growth and wellbeing of the fetus during the antenatal period. These parameters aid not only in detecting fetal anomalies but also in estimating the correct gestational age as well as to calculate the estimated date of delivery. The main biometric measurements available in a routine scan report are Crown Rump Length in the first trimester; Bi-parietal Diameter, Head Circumference, Abdominal Circumference, Femur Length in the second and third trimesters. Apart from these primary biometric measurements, secondary fetal parameters can also be assessed on demand. Measurement of parts of human body is referred to as Pramana (measurement) in Ayurveda. The Pramana (measurement) of adult human anatomy is well explained in the Ayurvedic classics under the topic of Pramana Shareera (Anthropometry) but that of Garbha (embryo/fetus) is very vague or almost nil. Details about the stages of growth and development of Garbha (embryo/fetus), it's anomalies, signs and symptoms for the assessment of fetal gender etc. have been vividly narrated in the Ayurvedic classics but the parameters to assess the measurement of Garbha is not at all sufficient to come to a satisfactory conclusion. Here an attempt has been made to explore the Ayurvedic aspects of fetal biometry apart from it's modern review.

A CRITICAL ANALYSIS OF GARBHAVRIDHI (GROWTH OF EMBRYO/FETUS) IN THE THREE TRIMESTERS

The union of Sukra (sperm) and Sonita (ovum) along with Atma (soul) in Garbhashaya (uterus) is termed as Garbha (embryo/fetus). It is formed as a result of combination of Panchamahabhutas (five elements) and Chetana (soul). Further these Panchamahabhutas (five elements) play an important role in Garbhavridhi (growth of embryo/fetus). Almost all Acharyas (scholars) of Ayurveda has similar opinion regarding the formation of Garbha (embryo/fetus). Four Garbhotpadakabhavas (factors responsible for the formation of embryo/ fetus) and six Garbhavridhikarabhavas (factors responsible for the development of embryo/fetus) aid in the formation and growth of Garbha (embryo/fetus). The developmental stages of Garbha (embryo/fetus) have been vividly narrated in Ayurveda as well as modern science. Almost all ancient scholars have described the month wise development of Garbha (embryo/fetus) but Harita has keenly observed the changes happening in weeks or a couple of days at a few instances. The concept of Garbhavridhi (growth of embryo/fetus) was of great interest to the Ayurvedic scholars; the developmental changes happening in the embryo during pregnancy is given much importance in modern parlance too. As per modern view the whole period of pregnancy can be divided into three trimesters each of which comprises of three months. Each trimester has its own milestones in the developmental aspect of embryo/fetus. The knowledge regarding the developmental events help in preventing various fetal anomalies thus aids in the formation of healthy individuals and thereby a healthy society. The basic facts pertaining to the growth, differentiation, specialization and development of an individual starting from fertilization till birth forms the core concept of this review. A keen study of both Ayurvedic and modern aspects of the developmental events during the gestational period has been attempted for a better understanding.

Sonomorphology and colour flow Doppler studies in differentiating between benign and malignant ovarian masses

Background: Ovarian cancer is the most frequent cause of death from Gynaecological malignancies in the world. Most patients with epithelial ovarian cancer are asymptomatic in early stage disease and usually present with stage III or IV disease. There are various screening methods for detection of ovarian cancer like bimanual pelvic examination, ultrasound examination (TVS and TAS) with or without color Doppler flow imaging and measurement of various circulating proteins like CA 125. The Purpose of a study is to determine optimal cut off point for a morphological scoring system and color flow directed Doppler values to differentiate benign and malignant ovarian masses.Methods: This study was done at Department of obstetrics and Gynaecology, Government Rajah Mirasudhar Teaching Hospital attached to Government Thanjavur Medical College, Thanjavur, Tamilnadu, India during the period of June – 2011 to October – 2012. This study consisted of 73 patients, 3 patients were not operated as they were not fit for surgery for medical reasons. Hence 70 patients were included in the study. A note was made of their main symptoms at admission, Parity, menopausal status, family history of carcinoma. Patients admitted with diagnosis of ovarian masses and clearly ovarian by sonomorphology and surgery were only included in this study. Morphological Score, RI and PI were calculated. All patients underwent exploratory laparotomy with surgical removal of the tumor. The final diagnosis obtained based on HPE were classified as either benign or malignant. The score of each mass and the Doppler values were assessed individually and in combination with regard to its relationship to final diagnosis.Results: In summary the resistance to flow measurement obtained by Doppler had a higher sensitivity and specificity compared to the morphological scoring system in differentiating benign and malignant ovarian masses. The combination of morphological score and Doppler Measurements improved the specificity positive predictive value for differentiating benign and malignant ovarian masses. Conclusions: The combination of ultrasound and Doppler values is better in differentiating benign from malignant ovarian masses. The cut off point for ultrasound guided morphological scoring system was 4 and Doppler velocimetry for differentiating benign and malignant ovarian masses was a RI of 0.55 and PI of 0.8

Transvaginal sonographic cervical length assessment in predicting the outcome of induction of labor

Background: The aim of the study was to assess Bishop Score in women undergoing induction of labor followed by cervical length measurement by transvaginal sonography and to study the role of transvaginal sonographic cervical assessment in predicting outcome of induction of labor.Methods: This was a prospective observational study carried out in 300 pregnancy women undergoing induction of labor. In all the women, Bishop score was calculated by per vaginal examination and cervical length assessed by transvaginal ultrasound, both prior to induction of laborResults: This study has demonstrated that in singleton pregnancies undergoing induction of labor at 37-41 weeks of gestation, successful vaginal delivery within 24hrs of induction occurred in 66.8%. The study has also demonstrated that induction to delivery interval is significantly associated with both the preinduction Bishop score and sonographically measured cervical length, higher the Bishop score and lesser the cervical length, better the likelihood of vaginal delivery within 24 hrs of induction. The best cutoff point for successful induction was ≥3 for Bishop score and ≤2.5 cm for cervical length, which was obtained from the ROC curve.Conclusions: Cervical length assessment by transvaginal ultrasound was a better predictor of successful induction of labor.

Organic metabolites produced by Vibrio parahaemolyticus strain An3 isolated from Goan mullet inhibit bacterial fish pathogens

Identification and action of several antibacterial metabolites produced by a fish pathogen Vibrio parahaemolyticus strain An3 from marine ecosystem of Goa has been demonstrated. Antibacterial activity of the crude cell extract of the test bacterium has been evaluated against indicator pathogenic bacterial strains such as Acinetobacter sp. An2, Aeromonas hydrophila strain An4, Staphylococcus arlettae strain An1 and Alteromonas aurentia strain SE3 by agar well diffusion method which clearly demonstrated comparatively more significant inhibitory effect on indicator bacteria as compared to several commonly used antibiotics. Gas chromatography mass spectrometry (GC-MS) analysis of crude cell extract of the test organism interestingly revealed presence of indole, phenyl acetic acid, n-(3- methyl-1, 2, 4-oxadiazol-5-yl) - 1- pyrrolidine carboximidamide, pyrrolopyrazines, tetramethyl pyrazine and other important phenolic compounds which may be responsible for antibacterial activity against indicator microorganisms tested. It has been clearly demonstrated that V. parahaemolyticus strain An3 produced several medically important organic metabolites during cultivation suggesting it as a potential candidate for production of several antibacterial metabolites to control pathogenic bacterial strains causing serious fish and human diseases.Key words: Antibacterial, gas chromatography mass spectrometry, metabolites, pathogenic bacteria, welldiffusion

Maternal outcomes among emergency obstetric admissions at a tertiary care teaching hospital in Chitradurga, South India

Background: The maternal mortality is a vital index of the quality and efficiency of obstetric services prevailing in a country. The obstetric emergencies are unexpected occurrences during pregnancy or puerperium requiring immediate attention. Obstetric emergencies can either happen suddenly or they can develop as a result of complications that are not properly identified, monitored or managed. These emergencies, to a large extent, are preventable. The purpose of this study was to understand the contributing factors of obstetric emergencies, their clinical presentation, management and maternal outcomes.Methods: A cross sectional study was conducted among obstetric emergency admissions during October 2016 to September 2017, at a tertiary care hospital in urban area of central Karnataka.Results: A total of 100 emergency admissions were observed in the study period. A 41% of were un-booked antenatal cases. A 13% of patients reached with the longest delay of 10-12 hours duration. A 31% of emergency admissions were in compromised condition. The majority of the cases were delivered by LSCS (55%).Conclusions: In the study, nearly half of the pregnancies were unbooked. There were teenage pregnancies reported in the study. More than half of obstetric emergencies were from rural areas. In nearly 50% of admissions a delay of more than 5 hours in reaching this hospital was noted. Ignorance was a major factor which impeded the access of antenatal health care services. Health education to pregnant women about importance of accessing maternal health services, early ANC booking and regular checkups, identification of high-risk pregnancy and timely referral, availability of fully functional first referral units and transport facilities for these emergency patients. Availability of skilled medical professionals round the clock in these FRU’s are the need of the hour

A Study on Fetal Biometry in Third Trimester in Relation to Maternal Prakruti

Fetal biometry refers to the various measurements obtained from sonography which denotes the development of the fetus in a particular period of growth. These measurements describe normal growth of fetal structures and are used to estimate the age and to monitor fetal growth. The biometric measurements attain an optimum value in the third trimester and any abnormality in the range of the values in this particular period can predict fetal anomalies as well.[1] Prakruti (constitution) is the inborn character reflected on the individual which forms the basis of one’s personality.[2] It is a group of characters inherited by an individual depending on the predominance of Dosha (humor) prevailing at the time of conception and which remains with him or her throughout life.[3] Out of the many factors which influence the growth and development of fetus, Prakruti has an important role to play. Hence an effort has been made to know the influence of maternal Prakruti on fetal biometry in the third trimester of pregnancy

AN ANTIMICROBIAL PHTHALATE DERIVATIVE FROM BACILLUS CEREUS, THE SYMBIOTIC BACTERIUM ASSOCIATED WITH A NOVEL ENTOMOPATHOGENIC NEMATODE, RHABDITIS (OSCHEIUS) SP

Objective: To isolate and identify the bioactive metabolites from the culture filtrates of a bacterium (Bacillus cereus) symbiotically associated with a novel entomopathogenic nematode Rhabditis (Oscheius) species.Methods: The bacterium was cultured in three different media and the antimicrobial activity was determined by the well diffusion assay. The ethyl acetate extract of the cell free culture filtrate was then purified by silica gel column chromatography and thin layer chromatography. Identification of the active metabolite was done with HPLC, GC-MS and LC-MS.Results: The cell free culture filtrate of a nematode symbiotic bacterium showed both antibacterial and antifungal activities. Fermentation conditions were standardized and optimum antibacterial activity was observed in tryptic soy broth at 72 h of incubation at 30 °C. When the ethyl acetate extract was purified by silica gel column chromatography and thin layer chromatography, an active fraction was obtained which was subjected to HPLC analysis along with GC-MS and LC-MS leading to the identification of a major compound Bis (2-ethyl hexyl) phthalate. The compound was active against Gram positive bacteria Bacillus subtilis MTCC2756, Staphylococus aureus MTCC902, Gram negative bacteria Escherichia coli MTCC 2622 and fungi such as Aspergillus flavus MTCC277, Candida albicans MTCC183, Fusarium oxysporum MTCC 284, Rhizoctonia solani MTCC 4634.Conclusion: Bis (2-ethyl hexyl) phthalate was identified as one of the metabolites produced by a nematode symbiotic bacterium associated with a novel entomopathogenic nematode Rhabditis (Oscheius) species. Thus similar compounds isolated from novel entomopathogenic bacteria would pave the way for identifying new drugs for the pharmaceutical and agricultural sector.Â