Who needs prenatal counselling with a pediatric surgeon? Experience from a large tertiary care university hospital

Objectives To describe our experience with prenatal counselling for surgical anomalies in a large volume center. The secondary aim is to suggest a list of prenatal abnormalities warranting counselling by a pediatric surgeon. Methods We reviewed all prenatal counselling consultations performed by the pediatric surgery team between January 1st, 2015 and December 31st, 2016. Results A total of 169 patients or couples had a prenatal consultation with a pediatric surgeon. Prenatal work-up included a fetal MRI in 26% of cases, mainly for digestive and thoracic pathologies (56.1% of cases). Consultation with the pediatric surgeon led mainly to recommendations concerning the place of delivery. Induction for reasons related to the fetal anomaly occurred in 22.2% of cases. Most children were surgically treated within the first year of life (63.5%). Correlation between predicted prognosis and actual status at four years of life was 96.9%. Correlation between prenatal and postnatal diagnosis was 87.4%. Conclusions Prenatal counselling by a pediatric surgeon allows couples to obtain clear information on the pathology of their unborn child, giving them greater autonomy in their decision to continue the pregnancy.

Symptomatic haemophilia A: management during pregnancy and the postpartum period

As an X linked disorder, the presence of severe symptomatic haemophilia A is an extremely rare disorder in women. Therefore there are no high-level evidence-based guidelines when it comes to pregnancy. Although there have been advances in the fields of prenatal counselling and maternal-fetal care, the management of these gestations continues to embody a challenge for any medical team. We report the successful management of a pregnant woman with symptomatic haemophilia A, from pregnancy to the postpartum period. Our aim is to enhance knowledge on this topic, and further improve outcomes for these mothers and their offspring.

Knowledge and Anxiety Level on Labour Process among Primigravida Mothers in a Selected Hospital, Kamrup (M), Guwahati, Assam: A Descriptive Study

Introduction: Many Indian women are unaware about the changes that occur in their body during pregnancy and labour, as a result many mothers suffer physiologically and psychologically, hence education is needed for mother especially to primigravida mothers. Aims and Objectives: The aim of the study is to assess the level of knowledge and level of anxiety on labour process among primigravida mothers who are attending antenatal OPD at a selected hospital. Methods and materials: A descriptive survey research design was used and purposive sampling technique was used for obtaining sample for the study. Study was undertaken on 100 sample primigravida mothers at Maternity and Child welfare Hospital of Guwahati, Assam. Results: The finding shows that majority i.e. 53% had inadequate knowledge, 44% had moderately adequate knowledge and only three (3%) had adequate knowledge on labour process ,majority of the respondents i.e 58% had moderate anxiety and 42% had severe anxiety.There was association between the knowledge level and selected demographic variables such as age ,education, trimester of pregnancy and any prenatal counselling given. Also with anxiety and selected demographic variables such as education, occupation and any types of prenatal counseling attend. There was moderate negative correlation (-0.310) between knowledge and anxiety scores on labour process among primi gravida mothers. Conclusion: This study shows that primigravida mothers had lack of knowledge and moderate anxiety on labour process. Therefore health personnel need to conduct the education programmes to improve the level of understanding as to reduce the level of anxiety on labour process. Key words: Primigravida, labour process, anxiety, delivery, childbirth, pregnancy.

Impact of structured pre-natal counselling on early initiation of breast feeding and adherence to exclusive breast feeding: a comparative interventional study

Background: The importance of early initiation of breast feeding (EIBF) and exclusive breastfeeding (EBF) is widely recognized, but the optimum rates have not been attained due to several factors. One of the important factors is the lack of adequate knowledge of women regarding breastfeeding.Methods: This comparative intervention study was conducted in the obstetric OPD and postnatal wards of tertiary care hospital of central Gujarat. This study included antenatal women between gestational age of 28 to 38 weeks who are visiting obstetric OPD at our institute and wanted to deliver at the same as cases (356 participants) and postpartum women who were delivered at this institute who have not taken antenatal care and counselling at this institute as control.Results: This study concluded that prenatal counselling regarding breast feeding had significant impact on the improvement of knowledge of women regarding EIBF and Exclusive breast feeding. Rate of EIBF and EBF was 91.85% and 86.52% in case group which was significantly higher compared to the control group.Conclusions: Prenatal structured counselling helps to raise the rate of EIBF and EBF.

Recommendations of the AGG (Task Force for Obstetrics, Section Maternal Diseases) on the Management of Maternal Hepatitis B, C and D Infection in Pregnancy

These statements and recommendations should provide appropriate information about maternal and fetal routes of infection, screening, detection of risk factors, diagnostic procedures, treatment, birth planning and peripartum and postpartum management of maternal hepatitis infection and offer pointers for prenatal counselling and routine clinical care on delivery wards.

Association of prenatal counselling and immediate postnatal support with early initiation of breastfeeding in Uttar Pradesh, India

Background Timely initiation of breastfeeding, also known as early initiation of breastfeeding, is a well-recognized life-saving intervention to reduce neonatal mortality. However, only one quarter of newborns in Uttar Pradesh, India were breastfed in the first hour of life. This paper aims to understand the association of community-based prenatal counselling and postnatal support at place of delivery with early initiation of breastfeeding in Uttar Pradesh, India. Methods Data from a cross-sectional survey of 9124 eligible women (who had a live birth in 59 days preceding the survey) conducted in 25 districts of Uttar Pradesh, India, in 2018, were used. Simple random sampling was used to randomly select 40 Community Development Blocks (sub district administrative units) in 25 districts. The Primary Sampling Units (PSUs), health service delivery unit for frontline workers, were selected randomly from a linelisting of PSUs in each selected Community Development Block. Bivariate and multivariate logistic regression analyses were performed to assess the association of prenatal counselling and postnatal support on early initiation of breastfeeding in public, private and home deliveries. Results Overall 48.1% of mothers initiated breastfeeding within an hour, with major variation by place of delivery (61.2% public, 23.6% private and 32.6% home). The adjusted odds ratio (aOR) of early initiation of breastfeeding was highest among mothers who received both counselling and support (aOR 2.67; 95% CI 2.30, 3.11), followed by those who received only support (aOR 1.99; 95% CI 1.73, 2.28), and only counselling (aOR 1.40; 95% CI 1.18, 1.67) compared to mothers who received none. The odds of early initiation of breastfeeding was highest among mothers who received both prenatal counselling and postnatal support irrespective of delivery at public health facilities (aOR 2.49; 95% CI 2.07, 3.01), private health facilities (aOR 3.50; 95% CI 2.25, 5.44), or home (aOR 2.84; 95% CI 2.02, 3.98). Conclusions A significant association of prenatal counselling and postnatal support immediately after birth on improving early initiation of breastfeeding, irrespective of place of delivery, indicates the importance of enhancing coverage of both the interventions through community and facility-based programs in Uttar Pradesh.

Prenatal Imaging Features and Postnatal Outcome of Short Corpus Callosum: A Series of 42 Cases

<b><i>Objectives:</i></b> Our goal was to provide a better understanding of isolated short corpus callosum (SCC) regarding prenatal diagnosis and postnatal outcome. <b><i>Methods:</i></b> We retrospectively reviewed prenatal and postnatal imaging, clinical, and biological data from 42 cases with isolated SCC. <b><i>Results:</i></b> Prenatal imaging showed SCC in all cases (<i>n</i> = 42). SCC was limited to rostrum and/or genu and/or splenium in 21 cases, involved body in 16 cases, and was more extensive in 5 cases. Indirect imaging features included typical buffalo horn ventricles (<i>n</i> = 14), septal dysmorphism (<i>n</i> = 14), parallel lateral ventricles (<i>n</i> = 12), and ventriculomegaly (<i>n</i> = 4), as well as atypical features in 5 cases. SCC was associated with interhemispheric cysts and pericallosal lipomas in 3 and 6 cases, respectively. Aneuploidy was found in 2 cases. Normal psychomotor development, mild developmental disorders, and global developmental delay were found in 70, 15, and 15% of our cases, respectively. <b><i>Conclusions:</i></b> SCC should be investigated to look for pericallosal lipoma and typical versus atypical indirect features of corpus callosum agenesis (CCA). Prenatal counselling should be guided by imaging as well as clinical and genetic context. Outcome of patients with SCC was similar to the one presenting with complete CCA.