Severe Haemolytic Disease of Foetus and Newborn due to Anti-c Alloimmunisation in a Multiparous Malay Woman: A case study

Severe haemolytic disease of foetus and newborn (HDFN) is commonly caused by anti-D, anti-c and anti-K alloimmunisation. However, anti-c associated HDFN are infrequent because the majority of infants are relatively often c-negative. This case report describes a severe HDFN due to anti-c alloimmunisation in a multiparous Rhesus D positive mother. The baby was delivered prematurely at 32 weeks of gestation and unable to survive due to hydrops foetalis. Failure to detect anti-c alloimmunisation at the early antenatal period and unknown previous RBC alloimmunisation status were the main reasons for poorly suspicion of HDFN, which lead to improper foetal management and end up with foetal loss. Thus, routine antenatal RBC antibody screening during the early antenatal period is recommended for every pregnant woman with a history of HDFN or at risk for alloimmunisation for early detection and management of HDFN to prevent severe related morbidity or mortality.

Intermittent auscultation in obstetric practice in tertiary health facilities in Nigeria. Are we doing it correctly?

Background: Intermittent auscultation (IA) was the main method of foetal monitoring in Nigeria, with the pinard stethoscope more in use than the hand-held Doppler. Aim of the study to produce a guideline on IA, conduct an audit on its use and to give a recommendation for future practice. Methods: A mixed-method design-observational-descriptive, review and an audit carried out in tertiary centres in Rivers State, Nigeria. The WHO 2018, FIGO 2015 and other guidelines on IA were reviewed. Good practice points were extracted from the literatures and used to produce a guideline. 17 review criteria for the audit were chosen from the guideline and used to test 150 doctors, midwives and nurses. Data were analysed with Epi. info 2020. Results: A guideline on IA was created. Out of the 150 participants, correct answers to the questions were given as follows: foetal movements over the preceding 24 hours before IA, determination of foetal lie, assessment of presentation and position before IA and identification of point of application of foetal stethoscope on maternal abdomen by 121 (80.67%), 17 (11.33%) and 34 (22.67%) respectively; frequency of IA in the antenatal period, duration of IA and maternal pulse palpation during IA for 13-98 (8.67-65.33%), 121 (80%) and 0 (0%) respectively; in labour, questions on timing of IA, ruling out hypoxia in early labour, determination of the baseline FHR and recording of the findings on IA for 61-130 (40.67-86.67%); interval and duration of IA and management of abnormal findings in the antenatal period and in labour, interval and duration of IA at 2-18 (1.33-12%).Conclusions: The performance of IA by obstetric practitioners was poor; that may account for some of the wrong management plan in the antenatal and intra-partum periods. A quarterly or yearly drills on IA were therefore recommended.

Antenatal Emergency Department and Inpatient Use Among Massachusetts Deaf and Hard of Hearing Women: A Retrospective Cohort Study

Background Hearing loss is increasingly prevalent among younger adults and significantly impacts health and health care use. Deaf and hard of hearing (DHH) women have a significantly higher risk of chronic diseases, pregnancy complications and adverse birth outcomes compared to hearing women. The mechanisms, including health care utilization patterns during the perinatal period, remains not well understood. Methods We conducted a retrospective cohort study design to analyze 2002–2013 Massachusetts Pregnancy to Early Life Longitudinal data to compare antenatal inpatient and emergency department use between DHH (N=925) and hearing (N=2895) women with singleton deliveries. Matching was done based on delivery year, age at delivery and birth parity in 1:3 case-control ratio. Demographic, socioeconomic, clinical and hospital characteristics were first compared for DHH mothers and the matched control group using chi-squared tests and t-tests. Multivariable models were adjusted for socio-demographic and clinical characteristics. Results Among DHH women (N=925), 49% had at least one emergency department visit, 19% had an observational stay, and 14% had a non-delivery hospital stay compared to 26%, 14%, and 6%, respectively among hearing women (N=2895) during the antenatal period (all p<0.001). The risk of non-delivery emergency department visits (RR 1.58; p<0.001) and inpatient stays (RR 1.89; p<0.001) remained higher among DHH women compared to hearing women even after adjustment for relevant variables. Having four or more emergency department visits (7% vs. 2%), two or more observational stays (7% vs. 3%) and two or more non-delivery hospital stays (4% vs. 0.4%) prior to delivery were more common among pregnant DHH women compared to their controls (all P<0.001). Conclusion(s): The study findings demonstrate that DHH women during the use emergency departments and inpatient services at a significantly higher rate than their hearing controls during the antenatal period. A systematic investigation of the mechanisms for these findings, including healthcare-, patient- and provider-based factors, are needed. Health care providers should be aware of potentially heightened risk for pregnancy and birth complications among DHH women which are in part due to persistent social and healthcare barriers, including communication and language.

COMPARATIVE ASSESSMENT OF MICROALBUMINURIAAND EARLY UTERINE ARTERY DOPPLER INDICES AS A PREDICTOR OF DEVELOPING PREECLAMPSIA.

BACKGROUND : As we know hypertensive disorders in pregnancy is always a deadly threat to mothers and fetus. Mothers will be in large benet if we predict it earlier. Easy reproducible non cumbersome screening test are needed for it. METHODS: This is a Prospective longitudinal study. Patients were studied from rst trimester to late trimester in the department of g & o for 1 year who fullled the inclusion and exclusion criteria. They were observed through out the time period. All the data were studied by chi – square test . Ap value of <.05 was considered statistically signicant. RESULTS : Out of 150 antenatal mothers 12 developed pre-eclampsia (including 1 eclampsia) among which 8 had microalbuminuria during their antenatal period. 10 mothers had microalbuminuria but did not develop pre-eclampsia, 4 of them developed pre-eclampsia but they did not have microalbuminuria during antenatal period. 128 mothers did not have microalbuminuria and they did not develop pre-eclampsia When RI of >0.58 was used as cut off value at 18weeks of POG. In our study of 150 antenatal mothers 12 developed pre-eclampsia (including 1 eclampsia) among which 4 had RI of > 0.58 during their antenatal period. 6 of them had RI of >0.58 but did not develop pre-eclampsia, 8 of them developed pre-eclampsia but did not have increased RI value. 132 mothers did not have raised RI value and they did not develop pre-eclampsia. CONCLUSION Both the screening tools are easy to done. Microalbuminuria and early uterine artery doppler indices can be used as predictor of detecting preeclampsia. Mothers with no microalbuminuria and uterine artery RI value of < 0.58 would have less chance of developing pre eclampsia in late pregnancy.

Risk factor for gestational diabetes mellitus and impact of gestational diabetes mellitus on maternal and fetal health during the antenatal period

Background: Gestational diabetes mellitus (GDM) is defined as any degree of dysglycaemia that occurs for the first time or is first detected during pregnancy. The adverse effects of GDM on pregnant women are pre-eclampsia, PIH, PPH, polyhydramanios, PROM, meanwhile, there would be an increase in dystocia, birth injury, and cesarean sectionMethods: This retrospective study was conducted in a Gynecology clinic in District Shivpuri to find out the various risk factors for GDM and to evaluate the impact of GDM on maternal and fetal health during the antenatal period. 84 patients who were diagnosed with GDM were included in the study. Results: Among risk factors; BMI >25 kg/m2 before pregnancy was found in 15.47% of the case, family history of diabetes mellitus 8.33%, Previous history of macrosomia 17.85%, Poor reproductive history 17.85%, baby with congenital malformation 8.33%, H/o unexplained IUFD 11.90%. H/o polyhydramnios 15.47%. History of PCOS 13.09% and preeclampsia was found in 17.85% of cases. In antenatal complications; miscarriages was found in 15.47%. polyhydramnios in 17.85%. Oligohydramnios in 8.33%, preterm labor in 11.90%, PROM in 9.52%, pre-eclampsia in 17.85%, sudden IUFD in 8.33% and congenital malformation was found in 4.76% of cases. On USG; IUGR was found in 7.14% of cases. Large for date fetus in 16.66% of cases and the normal growth was found in 76.19% of cases.Conclusions- In conclusion appropriate and timely diagnosis and treatment of GDM will result in decreased maternal and neonatal adverse outcomes comparable to general population rates, therefore, early diagnosis is important.

An interesting case of intrauterine torsion of ovarian cyst in a female fetus

Fetal ovarian cysts are usually benign and managed conservatively. We report an interesting case of fetal ovarian cyst diagnosed in the antenatal period. Post-delivery, neonate was operated for torsion of the ovarian cyst. The baby recovered well.

A mixed-methods evaluation of hepatitis B knowledge, attitudes, and practices among migrant women in Thailand

Background Globally 90 % of transmission of Hepatitis B virus (HBV) is from mother-to child and occurs predominantly in resource limited countries where the prevalence of HBV is high. Transmission could be interrupted by timely vaccinations but coverage remains problematic in these areas. Low knowledge or awareness of HBV may play a part in low vaccination coverage. This study examines the provision of antenatal care counselling with a focus on HBV in two different regions of northern Thailand, Sarapee Hospital (SH), Chiang Mai, and Shoklo Malaria Research Unit (SMRU), Tak Province. Methods A mixed-methods sequential explanatory study design was used to evaluate antenatal services for migrants. Cross-sectional knowledge, attitude and practice (KAP) surveys were conducted immediately after counselling at first ANC contact, at 3–6 months after first ANC contact and at delivery. Surveys provided quantitative data, and qualitative methods included observations, focus group discussions (FGD) and in-depth interviews (IDI); analysed thematically to explore concepts of knowledge and understanding, attitude and practice of pregnant women and providers. Results Between September-2019 and May-2020, 757 women participated to KAP surveys, and 31 observations of counselling, 16 FGD and 9 IDI were conducted. KAP surveys showed in spite of low knowledge about HBV transmission, infection, or vaccination (correct response: SH 5.7 %, 9/157; SMRU 34.0 %, 204/600), most women (≥ 93 %, either site) understood they were screened for HBV and were willing to vaccinate infants for HBV. In explaining KAP survey results, qualitative analysis suggests counselling should: use the appropriate language; be tailored to the local health literacy level, provide only pertinent information, be repeated over the antenatal period; and attempt to ensure patient privacy (where possible). Programme effectiveness benefits from positive attitudes to screening and vaccinations and a high level of trust in the providers nevertheless participants provided good suggestions for improvements of the service. Conclusions Limited knowledge of HBV among migrant women can be improved by counselling that emphasizes actionable knowledge such as vaccination schedule. Key improvements to the counselling process include training counsellors to conduct interactive counselling sessions in the woman’s language, using appropriate visual aids and timely repetition over the course of the antenatal period.