Antenatal Outpatient Department Research Articles

PAP Smear in Pregnant Women: A Hospital Based Study

Introduction: Pregnancy provides an important opportunity to screen the cervix for neoplastic and infectious diseases and to spread awareness. A Papanicolaou(Pap) smear is simple, cost effective and safe during pregnancy. In low resource countries, this may be the only opportunity when woman visits a health care centre. Objective of this study is to use Pap smear as a cervical cancer screening test in pregnant women and to determine the prevalence of abnormal Pap smear among pregnant women attending the antenatal outpatient department. Methods: A prospective study conducted in the department of Obstetrics and Gynaecology of Shree Birendra Hospital for a period of 12 months from September 2020 to August 2021. Inclusion criteria was pregnant women in the first trimester. Exclusion criteria were pregnancy greater than 12 weeks, symptoms of vaginal infection, history of sexual intercourse or vaginal medication or bleeding in the last 48 hours or normal Pap smear in last 3 years. Ayre’s spatula was used to conduct smear test in this study. All the smears were immediately fixatived in 95% ethanol and sent to the department of pathology. The cytological result were reported on the Bethesteda classification system 2014. Results: Out of 300 pregnant women enrolled in the study, the Pap smear report revealed that 28.3% of the study subjects had inflammatory smear 65.7% of the subjects showed negative for intraepithelial lesion or malignancy and only 0.3% of subjects had Atypical Squamous Cells of Undetermined Significance (ASCUS). No satisfactory sample was reported in 5.7% of the subjects. Conclusions: The antenatal period should be utilized as an opportunity to screen women for cancer cervix. Pap smear during pregnancy not only gives the opportunity to screen but also helps to create awareness.

A study to assess the awareness and utilization regarding government scheme “Janani Suraksha Yojana” (JSY) among general public in New Delhi

Maternal health remains a pressing public health challenge in India, with high maternal and neonatal mortality rates influenced by poverty, limited healthcare access, and cultural barriers. To address these issues, the Government of India introduced the Janani Suraksha Yojana (JSY) in 2005, a conditional cash transfer program promoting institutional deliveries to reduce mortality rates. Despite its significance, awareness and utilization of the scheme remain low among the public. So, in this concern an quantitative and descriptive research was conducted, the aim of the study aimed to evaluate the awareness and utilization of JSY among attendees of the antenatal outpatient department at Lal Bahadur Shastri Hospital, New Delhi with 112 participants selected through convenient sampling. Data were gathered using a structured questionnaire distributed via a Google Form link and Bar Code. The data were analyzed using descriptive statistics, including frequencies, percentages, means, and chi-square tests. The results revealed that 57.1% of respondents were unaware of JSY, and 77.7% had not utilized the scheme. No significant association was found between demographic factors and awareness levels. Knowledge regarding Janani Suraksha Yojna was disseminated through charts, posters, pamphlets and nukkad natak among the general public. The study highlights the need to increase awareness and utilization of JSY among the general public in New Delhi. Health education programs and awareness campaigns can be implemented to promote the scheme and improve maternal and child health outcomes.

Gestational Diabetes Mellitus Prevalence and Risk Factors - A Study from a Tertiary Care Centre in North India

Introduction: Type 2 diabetes mellitus (T2DM) and gestational diabetes mellitus (GDM) pose significant global health challenges. The increasing global prevalence of GDM and its associated complications underscores the need for proactive screening and management. The study aimed to evaluate the prevalence of GDM and its associated risk factors in a tertiary care hospital in North India Methodology: A prospective cross-sectional study conducted at Max Super Speciality Hospital, New Delhi, during 2016-2017, enrolled 900 pregnant women (aged 18-50 years) from the antenatal outpatient department (OPD). Primary objective: To assess impaired oral glucose tolerance prevalence (IADPSG criteria) at 24th-28th weeks. The data covered demographic, socioeconomic, obstetric, and medical details. Descriptive statistics were used to summarize the variables. Chi-square or Fisher's tests were applied to categorical data, while continuous data were analysed using independent t-tests. Multiple regression analysis was conducted to identify risk factors. Results: GDM was diagnosed in 7.4% of participants. Prevalence was highest in the age group >35 years (36.2%, p=0.000), and a significant association was found between increasing body mass index (BMI) and GDM (p=0.04). Adverse obstetric history, including previous abortions and GDM in prior pregnancies, increased the risk of GDM. Complications during pregnancy, such as macrosomia (present in 1 patient with GDM and none in non-GDM), foetal distress (9.09% in GDM), and preeclampsia (4.7% in GDM), were higher in women with GDM. Vaginal delivery prevalence was higher in non-GDM, while GDM had a higher rate of caesarean section delivery (p<0.005). Conclusion: The study discloses a 7.4% GDM prevalence in North Indian tertiary care, accentuating rising diabetes trends. Identified risk factors inform antenatal screening, highlighting the need for early GDM management to mitigate complications and prevent future diabetes. Single-centre limitations emphasise the necessity for broader population studies for accurate prevalence rates.

An exploratory study to assess gender preference and its factors among primigravida women attending antenatal outpatient department in selected hospital of district Mohali, Punjab

An exploratory study to assess gender preference and its factors among primigravida women attending antenatal outpatient department in selected hospital of district Mohali, Punjab

Association of Placental Umbilical Cord Insertion Site with Maternal and Fetal Outcomes: A Prospective Study

Abstract Introduction Adequate fetal growth during pregnancy depends upon the normal development and insertion of the umbilical cord. Central/paracentral placental cord insertion is considered normal, while marginal/velamentous cord insertion is considered abnormal. Although the location of placental umbilical cord insertion can be determined by ultrasound (US), it is not included in the routine protocol of a targeted anomaly scan. Through this study, we determined different placental umbilical cord insertion sites by US and categorized them as normal and abnormal, identified the risk factors involved, and evaluated the outcome of pregnancies using standard protocols. The rationale of this study was to identify pregnancies that require frequent monitoring and surveillance for an optimal perinatal outcome. Methods A prospective cohort study was conducted in a tertiary care hospital for 18 months. A total of 345 pregnant women who attended the antenatal outpatient department between 18 and 22 weeks for targeted imaging for fetal anomalies scan were included in the study after informed consent. Detailed history followed by US documentation of the cord insertion site on the placenta was done and women were followed up throughout pregnancy to look for development of complications including hypertensive disorders, antepartum hemorrhage (APH), and fetal growth restriction (FGR). Intrapartum adverse events like fetal distress and intrapartum hemorrhage were assessed. Confirmation of US findings was done by macroscopic examination of the placenta and measuring the distance between the placental cord insertion and the edge of the placenta. The weight of the placenta was also documented. Newborns were evaluated for adverse outcomes like preterm birth, low birth weight, need for resuscitation, and neonatal intensive care unit (NICU) admission. Follow up of neonates and mothers was done till discharge. Results Placental cord insertion was accurately determined at the anomaly scan with 100% sensitivity and specificity. The study showed 44 abnormal placental cord insertions (ACIs)—42 had marginal and 2 had velamentous cord insertions. There was a high incidence of ACI noted in women aged more than 28 years, with body mass index of more than 26.38, multiparity, previous history of myomectomy, first trimester miscarriage, and conceived by assisted reproductive technology. Women with ACI had an increased risk of small for gestational age/FGR and APH and had an average baby weight of 2.7 kg, which was 200 g less than babies with normal cord insertion. They also had lower mean Apgar scores at 5 minutes and required resuscitation and NICU admission. Conclusion Our study concluded that it will be a good practice to document the placental cord insertion during the mid trimester anomaly scan so that we can identify the subset of pregnant women who are prone to develop complications, thereby providing adequate surveillance for an optimal perinatal outcome.

Role of soluble fms-like tyrosine kinase-1/placental growth factor ratio along with uterine artery Doppler for the prediction of pre-eclampsia – A case–control study

Role of soluble fms-like tyrosine kinase-1/placental growth factor ratio along with uterine artery Doppler for the prediction of pre-eclampsia – A case–control study

Fraser syndrome with limb reduction defect: a rare and unique anatomic variation.

Fraser syndrome, named after George Fraser, is an autosomal recessive disorder showing a highly variable interfamilial phenotypic variation, with malformations ranging from minor symptoms to lethal anomalies like renal agenesis, incompatible with survival. Limb reduction defects have not been reported to be associated with it. A 21-year-old primigravida presented to the antenatal outpatient department with a level two targeted anomaly scan report suggestive of severe oligohydramnios with suspected renal agenesis. The cranial vault bones were compressed, and orbital globes and lenses could not be visualized. Renal agenesis was confirmed due to sleeping adrenals sign, non-visualization of the urinary bladder, and Doppler of renal arteries. A detailed examination of the fetal head in the sagittal section showed the absence of an eye globe and lens, arousing suspicion of Fraser syndrome. After pregnancy termination, a complete fetal autopsy was done to look for any additional findings. Patients who have a syndromic mix of acrofacial and urogenital abnormalities with or without cryptophthalmos should be evaluated for Fraser syndrome, which can be diagnosed by clinical examination and perinatal autopsy.

Self-care Behaviour of Pregnant Women with Gestational Diabetes Mellitus at a Tertiary Care Hospital in Lucknow, India: A Quasi-experimental Study

Introduction: India is now the diabetes capital of the world. The rising burden of Gestational Diabetes Mellitus (GDM) adds to the existing diabetes burden. Euglycemia is achieved once the baby is delivered. The first line of management of GDM is mainly through lifestyle modification with diet and physical activity. There is a dearth of information from Lucknow city about how well pregnant women with GDM adhere to dietary changes and exercise recommendations, or how counselling helps them deal with their GDM. Aim: To assess the self-care behaviour related to diet, physical activity, and Self-Monitoring of Blood Glucose (SMBG) of pregnant women diagnosed with GDM. Materials and Methods: A total of 188 pregnant women diagnosed with GDM were selected for present quasiexperimental study. The study participants were recruited from the antenatal Outpatient Department (OPD) at the Department of Obstetrics and Gynaecology of Queen’s Mary Hospital, King George Medical University (KGMU), Lucknow, India. The total study duration was from November 2019 to November 2022. Pregnant women diagnosed with GDM according to Diabetes in Pregnancy Study Group in India (DIPSI) criteria, up to 28 weeks of gestation, who gave their written consent to participate in the study and were living within a 15-kilometer radius of the study Institute, were included in the study. One group of the study participants received one-to-one counselling, an individualised diet plan, along with usual GDM care, and the other group received usual GDM care during their antenatal visits. The summary of diabetes self-care was adapted to assess adherence to the recommended dietary and physical activity modifications, as well as self-monitoring of blood glucose. Data were analysed using R software version 4.1.1 (R Core Team, 2021). All categorical data were presented using frequency and percentages. The comparison of baseline demographic and clinical parameters of pregnant women between the two groups was done using the Chi-square test or Fisher’s-exact test for categorical observations based on the expected frequency. The independent sample t-test or Mann-whitney U test for continuous measurements was used after checking the normality assumption using the Shapiro-wilk test. The change in scores of general diet, specific diet, physical activity, and SMBG throughout all follow-ups was assessed by repeated measures Analysis of Variance (ANOVA). The change from the first follow-up visit to subsequent follow-up visit was compared using a mixed linear model with follow-up visits. The p-value was considered significant at a 5% level of significance for all comparisons. Results: The mean age of the pregnant women with GDM was 27.6±3.7 years in the intervention group and 27.9±3.9 years in the control group (p=0.451). The pregnant women with GDM in the two groups did not show significant differences in terms of socio-demographic variables such as age, religion, education, socio-economic status, occupation, type of family, and family history of diabetes mellitus. A significant difference was observed in the dietary and physical activity scores between the two groups of pregnant women with GDM. However, no difference was observed in the case of self-monitoring of blood glucose scores of the two groups. Conclusion: The study concluded that counseling plays an important role in helping pregnant women with GDM adhere to the recommended dietary modifications and physical activity.

Diagnostic Accuracy of Gestosis Score in Comparison to multi-marker Screening as a Predictor of Preeclampsia at 11-14 Weeks of Pregnancy: A Cohort Study.

Pre-eclampsia is a pregnancy-specific multisystemic disorder associated with adverse feto-maternal outcomes. Low-dose Aspirin therapy started in early pregnancy in high-risk women, has significantly reduced the chances of developing PE. Therefore, screening and identification of at-risk mothers are crucial. The present study was planned to study the predictive ability of gestosis score in predicting early-onset pre-eclampsia by comparing it with the multi-marker model. One hundred sixteen women, more than 19 years of age, with live singleton pregnancy at 11-13 weeks of gestation were recruited from the antenatal outpatient department and formed the study cohort. After a detailed history, screening for pre-eclampsia was performed both by multi-marker screening and by gestosis score. Diagnostic accuracy was compared for the two methods of screening. The incidence of pre-eclampsia in the present study cohort was 26.7%. The sensitivity of gestosis score >/= 3 was 84.38% (67.21-94.72) and specificity was 93.18% (85.75-97.46 %). The positive predictive value was 81.82% (67.2%-90.81%), and the negative predictive value was 94.25 (87.98 - 97.35%). The diagnostic accuracy of the gestosis score was 90.83%. Gestosis scoring is a potential tool that can be used as a cost-effective screening method for pre-eclampsia at 11-14 weeks of gestation in low-resource settings. The sensitivity and negative predictive value of the gestosis score is comparable to multi-marker screening using maternal factors, MAP, Uterine artery PI, PAPP-A, and PlGF.

Effect of Group Psycho-Educational Interventions on Child birth fear and Child birth Self-efficacy among Primiparous women.

Child birth related fear and low self-efficacy for child birth found common among primiparous women. Antenatal group psycho-educational interventions have been used as important strategies to address child birth fear and self-efficacy. Thus, this study aimed to find out the status of child birth fear among antenatal women and effect of group psycho-educational interventions among primiparous women. One group pretest-posttest design was adopted. Total 307 primigravida women attending antenatal outpatient department of two hospitals within Kathmandu valley were selected through purposive sampling technique. Data was collected from March to July 2020. Child birth fear was assessed by using validated tool i.e.Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) and Child birth self-efficacy was assessed by using childbirth self- efficacy tool. Primigravida women with moderate level of child-birth fear, were intervened for group psycho-education based on PRIME Model by nurses who were research team members. Paired t-test was used to compare differences in mean scores on child birth fear and child birth self-efficacy before and after intervention. Moderate level of child birth fear was found among 24.8% of participants. Low child-birth self-efficacy was found among 42.0% participants. The overall mean score before providing group psycho-educational interventions to experimental group on child-birth fear was 54.0±2.09 and on child birth self-efficacy was 78.0±28.64 with p<0.001 and after providing group psycho-educational interventions child-birth fear was reduced to 47.8±2.44 and child birth self-efficacy was 105.2±19.6 with p<0.001. Group psycho-educational interventions based on PRIME approach led by nurses have significant effects in reducing child-birth fear and increasing child-birth self-efficacy. Therefore, provision of group psycho-educational interventions along with routine antenatal service need to be considered in clinical settings in Nepalese context.

IMPACT OF CORTICOSTEROIDS ON PERINATAL OUTCOME

Objective: The study’s main aim was to demonstrate the efficacy of antenatal corticosteroids (betamethasone) to prevent respiratory distress syndrome (RDS) and other related complications in premature babies and to study the outcomes of neonates whose mothers received corticosteroids during the antenatal period. Methods: A total of 50 pregnant women with a risk of preterm delivery admitted to the labor ward of Prathima Institute of Medical Sciences were included in the study. It is a prospective, hospital-based, and longitudinal study. All women coming to the antenatal outpatient department of Prathima Institute of Medical Sciences who are at risk of preterm delivery were selected. The follow-up component of the study involved women identified as at high risk for premature delivery and who had received betamethasone. The neonatologist diagnosed the neonatal complications was taken as an outcome. Results: Of the 50 babies that were enrolled in the study, 27 (54%) were delivered by spontaneous vaginal delivery, 1 by assisted breech (2%), 1 by instrumental delivery (2%), and 18 (36%) were delivered by cesarean section. The occurrence of RDS among babies with low APGAR was 4 (44.44%). Only one intraventricular hemorrhage occurred among the category, with a low APGAR score (11.11%). Out of 19 cases, ten deaths were identified, and nine were alive within 24 h due to the action of steroids. Among 31 cases, two cases were death, and 29 were alive after 24 h of the duration of action of steroid. Even though mothers of all babies in this study admitted to the neonatal unit had received corticosteroids, there was still 24% mortality by 28 days. The results suggest that once admitted to NICU, having only received a single dose of corticosteroids &lt;24 h previously (as opposed to more than 24 h), gestational age &lt;34 weeks, and having any listed neonatal complications were associated with mortality by 28 days. Conclusion: Even though 50% of the neonates suffered complications, over 40% of the subjects were delivered before betamethasone could take effect. Several other factors, apart from betamethasone, influenced the outcome of neonates. The present study showed that the use of ANCS administration is the single most intervention to prevent complications of prematurity which can be done at a public health center or by a private practitioner, even in rural areas.

Gestational glucose intolerance (GGI) and gestational diabetes mellitus (GDM) among antenatal women attending urban community health centers of Lucknow: A cross-sectional study.

Gestational diabetes mellitus (GDM) is an emerging public health concern in India, which has detrimental effects on both the mother and the baby. The data on prevalence of GDM was unavailable at secondary urban health facilities, from where a majority of pregnant women seek antenatal services, and the following study identifies this burden. A cross-sectional study was conducted from May 2019 to June 2020 among pregnant women attending the antenatal outpatient department (OPD) at secondary level health facilities in urban Lucknow. A semi-structured interview schedule was administered to the study subjects for collecting the relevant information and 75 g of oral glucose tolerance test was performed irrespective of the meal. The cut-off points taken for the diagnosis of GDM and gestational glucose intolerance (GGI) was as per the guidelines of the Ministry of Health and Family Welfare for diagnosis of GGI/GDM. The overall prevalence of GDM and GGI in the study was 11.6% and 16.8%, respectively. Three-fourth of the women (22/29) were diagnosed with GDM in the second trimester of pregnancy. The prevalence of GDM (16.7%) was significantly higher in pregnant women aged more than 25 years and in those who were overweight. Mean birth weight (3.2 ± 8.1 kg) of the babies was significantly higher in the women with GDM. Among the fetal complications was respiratory distress observed among 28 pregnant women and 31% of them had GDM and this was statistically significant. The prevalence of GGI and GDM was found 16.8% and 11.6%, respectively. Gestational age, pre-pregnancy weight, pre-pregnancy BMI, weight gain during the pregnancy, family history of diabetes. PCOS, macrosomia and GDM in prior pregnancies was found to significant with GDM in the study.

Effect of nursing intervention on anxiety during labour among primigravida mothers in JIPMER, Puducherry: Randomized control trial

Background: Childbirth is universally celebrated and significant moment in women’s life. More than 90% of prenatal anxiety and stress is related to the process of labour. Understanding the suffering of mother and providing safe labour with less pain and anxiety is one of the fundamental principles of modern obstetrics. This study aimed to assess the effectiveness of nursing intervention to reduce the anxiety during labour among primigravida mothers.Methods: A Randomized control trial was carried out among 66 primigravida mothers in Antenatal outpatient department, Labour room in tertiary care hospital, Puducherry by simple random sampling with computerised random numbers and divided into experimental and control group, 33 in each. Pre-test anxiety level was assessed by using modified anxiety scale to both the groups and nursing intervention was given to experimental group and control group were received routine care.Results: The result showed that in terms of comparing the pre-test and post-test level of anxiety during labour after giving nursing intervention shows statistically highly significant (p<0.001) in experimental group and no significant difference in control group p value (0.052). Conclusions: Mothers especially primigravida mothers experience anxiety during labour (p<0.001). Thus, the study concluded that nursing interventions were effective in reducing the anxiety level of primigravida during labour.

Maternal and Perinatal Outcomes in Pregnancies Associated with HIV Infection: A Prospective Cohort Study

Introduction: Human Immunodeficiency Virus (HIV) has persisted as the world’s leading infectious killer disease. Globally, around 19.3 million women in the reproductive age group are suffering from HIV, and most of these women are capable of transmitting this infection to their babies. Although pregnancy does not have an adverse effect on the natural history of HIV infection in women, Acquired Immunodeficiency Syndrome (AIDS) has become a leading cause of maternal and perinatal morbidity and mortality in some areas as the epidemic progresses. Aim: To assess the impact of HIV infection on maternal health, the risk of vertical transmission, and neonatal complications. Materials and Methods: This prospective cohort study was conducted at the Department of Obstetrics and Gynaecology, RG Kar Medical College and Hospital, Kolkata, West Bengal, India between March 1, 2021, and August 31, 2022. The study population comprised all pregnant patients with a known positive HIV status or those diagnosed newly during routine antenatal screening at the antenatal Outpatient Department (OPD) and Prevention of Parent to Child Transmission of HIV (PPTCT) clinic, or attending obstetric emergency. After registering in the antenatal clinic, they underwent all routine investigations, including baseline CD4 count, husband’s HIV status, screening for other sexually transmitted diseases, and initiation of Antiretroviral Therapy (ART). Maternal and perinatal outcomes, such as maternal complications, risk of vertical transmission, gestational age at birth, and birth weight of the baby, were assessed throughout the antenatal period and up to six weeks post-delivery. Data were entered into a Microsoft Excel datasheet and analysed using Statistical Packages for Social Sciences (SPSS) version 22.0 software. Categorical data were represented in the form of frequencies and proportions. Chi-square test was used for significance testing, with a p-value &lt;0.05 considered statistically significant. Results: Out of a total of 15,087 deliveries during the study period, 55 were HIV-positive cases, with a prevalence of 0.36%. Both vaginal delivery and cesarean section showed almost similar vertical transmission rates in the newborns, i.e., 4 (14%) and 4 (17%), respectively. Opportunistic infection rates were significantly higher in mothers with lower CD4 counts (&lt;200). Mothers receiving regular ART treatment showed a lower incidence of perinatal complications, such as neonatal sepsis, perinatal asphyxia, convulsions, or perinatal death, i.e., 6 (13.63%), compared to those not on treatment, 8 (72.72%) (p-value=0.005475). Higher rates of vertical transmission were observed in patients with significantly lower Cluster of Differentiation 4 (CD4) counts, 5 (71%) versus 3 (6.8%) (p-value=0.00001). Conclusion: Pregnancy outcomes in terms of maternal risks of infection, risk of vertical transmission, preterm births, foetal deaths, and neonatal complications can be significantly improved by early diagnosis and treatment of HIV infection. Proper antenatal care, early detection, initiation of antiretroviral drugs, and patient compliance with the multidrug regimen are the mainstay of feto-maternal well-being.

Nomogram of Nasal Bone Length in Euploid Fetus at 18-22 Weeks of Gestation in Bangladeshi Population

Introduction: Down syndrome (DS) is the most common chromosomal aneuploidy to result in a live birth. Prenatal diagnosis of the affected fetuses can be performed using variety of sonographic features. Within the 11 to 14 weeks gestational age (GA) window, increased nuchal translucency has been the hallmark for identifying fetuses with Down syndrome. Objective: To estimate the Nasal Bone Length (NBL) of fetuses at 18 to 22 weeks GA in Bangladeshi population and establish the Nomogram of it and finally compare it with that of Caucasian population. Materials and Methods: The prospective observational study was conducted in Aklima General Hospital Limited, Mirpur, Dhaka, Bangladesh in the Feto-maternal Medicine Unit under Obstetrics and Gynaecology Department for tenure from February 2014 to June 2019. After considering the inclusion and exclusion criteria, 500 antenatal subjects married to Bangladeshi partners with singleton pregnancies attending the routine antenatal outpatient department for an anomaly scan (18-22 weeks) were included and followed up in the study. The nasal bone length was measured from the base of the nose closest to the frontal bones to the farthest extent of ossification on the nose. Results: The nasal bone lengths of the fetuses at 18 to 22 weeks were measured in 500 cases where for 19 cases of 18 weeks of GA fetuses have a mean NBL of 4.6 mm, 75 cases of 19 weeks of GA fetuses have a mean NBL of 4.8 mm, 161 cases of 20 weeks of GA fetuses have a mean NBL of 5.1 mm, 169 cases of 22 weeks of GA fetuses have mean NBL of 5.8 mm and 76 cases of 22 weeks of GA fetuses have mean NBL of 6.2 mm which is significantly shorter than those of Caucasian population. Conclusion: The nasal bone lengths of the fetuses at 18 to 22 weeks were significantly shorter to those of the Caucasian population. JAFMC Bangladesh. Vol 18, No 1 (June) 2022: 48-50

Effectiveness of nurse-led educational intervention package on back pain and activity of daily living in primigravidae women with back pain

Background: The primigravida women often have more complaints of back pain during pregnancy. Pregnant women reported that back pain might affect the activities of daily routine e.g. walking, climbing stairs, sitting, and women may expect help from family members.Methods: A quasi-experimental study was directed on primigravidae women visiting antenatal outpatient department (OPD) of All India Institute of Medical Sciences (AIIMS) Jodhpur. An absolute of 60 primigravidae women (30 in each experimental and control group) were incorporated through the non-probability consecutive sampling method.Results: The pre-test score uncovered that the majority of the women (70%) in the experimental group and (60%) in the control group revealed moderate pain. The post-test score uncovered that (56.6%) in the experimental group detailed mild pain and 53.3% of women in the control group reported severe pain. When compared with the pre-test, the pain score of members in the experimental group was diminished and in the control group, the pain score was increased in post-test (p≤0.000). No critical contrast was found in the activity of daily living in the experimental and control group. For analysis, paired and unpaired t-test, x2, and Fisher exact tests were used.Conclusions: The majority of primigravidae women had back pain during pregnancy and participants recognized prolong sitting as the most well-known aggravating factor. It was discovered that there was a significant distinction in pain scores between pre-test and post-test in the experimental and control group.

Impact of Corona Virus Disease in Pregnancy and Newborn

Background: The novel corona virus has made the world standstill. In India COVID first and second wave has created dramatic fear among the pregnant mothers and the treating obstetricians. Objectives: To study the impact of COVID-19 in pregnancy, newborn and to compare the maternal and neonatal outcome among COVID-19 negative and COVID-19 positive pregnant women during the first and second COVID wave. Materials and Method: This was a prospective study done over one year from July 2020 to July 2021 in a tertiary care hospital in South India. 400 pregnant women attending antenatal outpatient department during COVID willing to participate in the study were included. Nasopharyngeal RT-PCR was done. Socio-demographic profile, maternal and neonatal outcome were compared between non COVID and COVID positive pregnant women. Results: A total of 400 pregnant women were screened for corona virus. 75 pregnant mothers turned positive for COVID-19 and 325 were negative. Among them, 10 were positive during first wave and 65 during second wave. Of them, 20 (26.7%) were asymptomatic and 55 (73.3%) were symptomatic. During the second COVID wave, there was a rise in missed miscarriage (21.5%), intrauterine growth restriction (46.15%), oligohydramnios (53.8%) and intrauterine demise (4.6%). The rate of caesarean and neonatal intensive care unit admission also increased to 70.3% and 59.5% respectively. Conclusion: This study has found increased maternal and neonatal adverse effects associated with COVID second wave. Hence vaccine should be recommended for all pregnant women.

The Spectrum of Mucocutaneous Manifestation during Pregnancy: An Observational Study of 170 Pregnant Women Visiting a Tertiary Care Hospital

ABSTRACT Background: Pregnancy is characterized by myriad of temporary alteration in endocrine, metabolic, and immunological factors. These alterations result in multiple mucocutaneous manifestations. The various skin changes may be either physiological or changes in preexisting skin diseases, or development of new pregnancy-specific dermatoses. Pregnancy-specific skin dermatoses include atopic eruption of pregnancy (AEP), polymorphic eruption of pregnancy, pemphigoid gestationalis, and intrahepatic cholestasis of pregnancy. Aims: The aim of the study was to study the frequency and pattern of mucocutaneous manifestations in pregnant women attending the tertiary care hospital. Settings and Design: A descriptive observational study. Subjects and Methods: A total number of 170 pregnant women attending antenatal outpatient department from October 2017 to March 2019 were included in the study. Detailed history, clinical examination, and relevant investigations were done. Patients not willing to give informed consent were only excluded from the study. Results: In this study, 58.23% (99) were primigravida and 41.77% (71) were multigravida. Most of the cases presented during third trimester (73%). In this study among the 170 pregnant women, the incidence of skin changes observed was 790 physiological entities, nonspecific dermatoses of pregnancy were 95, and 42 cases of specific dermatoses of pregnancy. The most common physiological changes noted were pigmentary changes 46.96% out of all physiological changes. All pregnant women showed pigmentary changes. Most common pigmentary change was linea nigra and melasma. Other changes were striae distensae 14.55%, vascular changes 10.37%, mucous membrane changes 5.19%, pruritus 17%, hair changes 1.51%, and nail changes 1.13%. Tinea corporis was most common infection 48.6% out of all infections, followed by candidal vaginitis 10.8%. Acne vulgaris was most common inflammatory disorder seen in 12.35%, followed by urticaria and psoriasis, seen in 7.05% and 1.76%, respectively. Polymorphic eruption of pregnancy and AEP was seen in 14.70% and 10%, respectively. No cases of intrahepatic cholestasis of pregnancy and pemphigoid gestationalis were noted. Conclusions: This study brings into focus prevalence of various mucocutaneous changes during pregnancy. Thorough knowledge about pregnancy dermatoses is essential to arrive at a specific diagnosis which is a mandate for counseling and management.

Physical Activity and Pelvic Girdle Pain in Pregnancy- A Cross-sectional Study

Introduction: Physical Activity (PA) is an important component of a healthy pregnancy, for both the mother and her child. Sedentary lifestyle during pregnancy may increase development of pregnancy related musculoskeletal discomforts. Studies show that 25% of women experience severe Pelvic Girdle Pain (PGP) during pregnancy and 8% are severely disabled due to PGP. Aim: To analyse the association between the PA and PGP during pregnancy. Materials and Methods: This cross-sectional study was conducted at antenatal outpatient department, Sri Ramachandra Hospital, Chennai, Tamil Nadu, India from November 2019 to March 2020. Total 250 mothers were screened and finally 150 participants were selected. They were asked to fill-up the Pregnancy Physical Activity Questionnaire (PPAQ), Pregnancy Musculoskeletal Dysfunction Scale (PMDS) to assess the PA level and musculoskeletal dysfunction. Mothers who complaints of PGP were clinically diagnosed and were asked to fill the Pelvic Girdle Questionnaire (PGQ). Data was analysed using Statistical Package for the Social Sciences (SPSS) version 20.0. Results: A total of 26 (17.33%) pregnant women in this study had PGP. The association between the total PA and PGP showed that the risk of PGP decreased as the PA increased which was statistically significant (p=0.03). PGP was also significantly associated with increased body weight (p=0.014). Conclusion: It was found that there was an association between total PA and PGP in pregnancy. Increased PA is associated with reduction in PGP. Hence, moderate PA is recommended during pregnancy

Factors affecting the consumption of iodized salt by pregnant women in Karachi.

Background and Objective:Globally iodine deficiency disorder (IDD) is a major preventable cause of cognitive impairment in new born. In developing countries, every year 38 million newborn develop cognitive impairment as a result of iodine deficiency. Iodine consumption by pregnant women is affected by many factors. Hence, we conducted this study to identify factors associated with IDD. To know the effects of different factors on use of iodized salt by pregnant women visiting antenatal outpatient department (OPD) at a public sector tertiary care hospital of Karachi.Methods:Pregnant women (n=360) visiting antenatal OPD at public sector tertiary care hospital of Karachi were interviewed using a structured questionnaire. Systematic random sampling method was employed. Data was collected from March 2017 to January 2018. Chi-square test was applied to identify factors associated with IDD.Results:Thirty one (31% ) of pregnant women were consuming iodized salt in their homes. The percentage of participants who heard about iodized salt for the first time was 24%. Twelve percent (12%) reported that price of iodized salt is more than that of normal salt. Ninety eight (98%) of pregnant women replied that they were not informed about the importance of iodine or iodine requirement during pregnancy by their doctor or health care provider. A statistically significant association was observed between educational status (p=0.001) and household income (p<0.001) with the use of iodized salt.Conclusion:Low education, low income of study participants are identified as factors related to limited consumption and incorrect practices related to the use of iodized salt. In order to address iodine deficiency, there is a need to not only sensitize the expectant mothers about the adverse outcome of maternal iodine deficiency for their unborn child but also to introduce an awareness program at the antenatal clinics by the Health Professional for the antenatal care seeking women. There is also an immense need of support from Government side as well to make strategies and policy changes at the national level to ensure the availability, accessibility and affordability of iodized salt.