Normal Term Delivery Research Articles

Early prediction of spontaneous preterm birth before 34 gestational weeks based on a combination of inflammation-associated plasma proteins.

In order to identify and possibly offer prophylactic treatment to women at risk for preterm birth (PTB), novel prediction models for PTB are needed. Our objective was to utilize high-sensitive plasma protein profiling to investigate whether early prediction of spontaneous PTB (sPTB) before 34 gestational weeks (gw) was possible in a low-risk population. A case-control study was conducted on 46 women with sPTB before 34 gw and 46 women with normal pregnancies and term deliveries. Prospectively collected plasma sampled at gw 11 (range 7-16) and gw 25 (range 23-30) was analyzed with a high-sensitivity Proximity Extension Assay for levels of 177 inflammation-associated proteins, and statistically processed with multivariate logistic regression analysis. In the first trimester, higher levels of hepatocyte growth factor (HGF) were associated with sPTB <34 gw (OR 1.49 (1.03-2.15)). In the second trimester, higher levels of interleukin (IL)-10 (OR 2.15 (1.18-3.92)), IL-6 (OR 2.59 (1.34-4.99)), and the receptor activator of nuclear factor κB (RANK) (OR 2.18 (1.26-3.77)) were associated with sPTB <34 gw. The area under the curve for the prediction models including these proteins was 0.653 (0.534-0.759) in the first trimester and 0.854 (0.754-0.925) in the second trimester. A combination of inflammation-associated plasma proteins from the second trimester of pregnancy showed a good predictive ability regarding sPTB before 34 gw, suggesting it could be a valuable supplement for the assessment of the clinical risk of sPTB. However, although a high number (n=177) of plasma proteins were analyzed with a high-sensitivity method, the prediction of sPTB in the first trimester remains elusive.

Assessment of Second Trimester Genetic Amniocentesis: A Review of 6 Years of Experience at Sanpatong Hospital, A Mid-level Secondary Hospital Setting

OBJECTIVE This study aims to assess the indications, complications, and outcomes of second-trimester genetic amniocentesis performed at Sanpatong Hospital, Chiang Mai, Thailand. METHODS A cross-sectional descriptive study analyzed data collected from high-risk pregnant women who underwent second-trimester genetic amniocentesis at Sanpatong Hospital between October 1st, 2016 and September 30th, 2022. The data include indications for the procedure, complications, and pregnancy outcomes. RESULTS A study of 451 women with high-risk pregnancies who underwent amniocentesis found that the most common indications for second trimester genetic amniocentesis were advanced maternal age (49.4%) and a high-risk Quad test (49.4%). Abnormal chromosomes were detected in 3.1% of cases, with aneuploidy the most common type (2.1%), primarily trisomy 21 (1.3%). The overall aspiration success rate was 100%. The only complications related to the procedure were pelvic pain (0.6%) and placental hematoma (0.2%). There were no fetal losses within 30 days after amniocentesis. The culture failure rate was 1.1%. Pregnancy outcomes included preterm delivery (12.3%) and normal term delivery (87.7%). CONCLUSIONS Performing second trimester genetic amniocentesis at Sanpatong Hospital, a mid-level secondary hospital, over a six-year period resulted in no fetal losses.

Characteristics and outcomes of COVID-19 in pregnant women during the COVID-19 pandemic

Abstract Background: Pregnant women with severe acute respiratory syndrome coronavirus-2 disease 2019 [COVID-19] appear to be at greater risk of morbidity and mortality complications in pregnancy. Objective: This prospective analysis aimed to assess maternal and neonatal outcomes among hospitalized pregnant women with COVID-19. Methods: The present prospective study included COVID-19-positive pregnant women referred to our tertiary care centre. Data related to demographics, clinical characteristics, diagnosis, laboratory parameters, histopathological findings, procedure, treatment regimen and clinical outcomes were recorded. and analysed. We studied maternal and neonatal outcomes among hospitalised pregnant women with COVID-19. Results: During the period from April 2020 to April 2022, we studied 83 women clinically diagnosed with COVID-19. Placenta previa (n = 3), decrease in foetal movement (n = 2) and premature rupture of membranes (n = 1) were observed among pregnant women with COVID-19. A total of 31 women had pre-term delivery (&lt;37 weeks gestation), 33 had normal term delivery (&gt;37–&lt;40 weeks gestation) and two had post-term delivery (&gt;40 weeks gestation). Of these 83 patients, 17.6% had pneumonia, 14.7% had hypothyroidism, 8.8% had gestational diabetes mellitus and 5.9% had gestational hypertension. Elevated baseline C-reactive protein (21.6 mg/dL) and interleukin-6 (16.6 pg/mL) levels were observed. Mother-to-child COVID-19 transmission was observed in one neonate. The length of hospital stay had ranged from 2 to 77 days in COVID-19 positive mothers. Eighty two patients (98.8%) were managed conservatively and were successfully discharged. Conclusions: Our observations suggest that pregnant women with COVID-19 have a significant impact on maternal health and pregnancy outcomes.

Efficacy of Marham-e-Dakhilyun Ointment and Alum Perineal Wash for Perineal Wound Healing and Pain Intensity in Postpartum Women: A Self-control Clinical Trial

Background and Objective:: Episiotomy, worldwide, is the most frequently performed obstetric surgical procedure. Delayed wound healing potentially amplifies the risk of wound infection, structural muscular alterations, and ultimately contributes to the loss of muscle tone. In addition, rapid and complete repair of the episiotomy or perineal tear is very important as the pain and discomfort of episiotomy wounds may affect the quality of life of postnatal mothers. Therefore, we aimed to determine the efficacy of Marham-e-Dakhilyun ointment and alum perineal wash on perineal wound healing and pain intensity in postnatal mothers. Materials and Methods:: A single-arm self-controlled study was conducted on postnatal mothers aged 18 to 40 years, who underwent full-term normal cephalic singleton vaginal delivery with episiotomy and/or 1st, 2nd, or 3rd-degree perineal tears. The recommended external care regimen for a period of 10 days involved perineal wash with a solution of alum powder (2 gm/500ml), followed by the application of Marham-e Dakhilyun ointment twice daily to the perineal wound. For the primary evaluation of wound healing, the REEDA (redness, edema, ecchymosis, discharge, and approximation) scale has been utilized, while the secondary assessment involved the use of the VAS (visual analog scale) pain intensity scale. The therapeutic outcome was determined based on the grading of REEDA scores on days 10-14 and VAS scores. Results:: We observed our trial medicine showed complete wound healing in 86.4% on days 10- 14. The mean pain reduction percentage (PR %) was 96.85% on days 10-14 from baseline. The REEDA score was 2.41±0.81 and 0.23±0.61 at one hour and day 10-14, respectively, with significant differences (p &lt; 0.001). The VAS score was 2.86±1.08 and 0.09±0.29 at one hour and day 10-14, respectively, with significant differences (p &lt; 0.001). Therefore, the trial ointment and alum have demonstrated beneficial effects in promoting perineal wound healing and alleviating pain in postnatal mothers. Conclusion:: The potential efficacy of Marham-e-Dakhilyun can be attributed to its composition of various phytoconstituents, such as oleuropein, phenolic acids, flavonols, flavones, linoleic acid isovitexin, vitexin vanillic acid, salicylic acid, beta-D-glucopyranoside, olanigroside Y1, solasonine, gallic acid, aucubin, scopoletin, and lantamajoside. These constituents have been proven in research studies to possess anti-inflammatory, wound healing, antimicrobial, analgesic, and antioxidant properties. The investigators have optimized the use of these Unani medicines to provide clinical evidence supporting their effectiveness in the wound-healing process and in reducing pain intensity.

BRCA Mutation Patients: Are There Other Predisposing Factors for Ovarian Cancer Occurrence? A Multicenter Retrospective Study

Objectives: The objective of this multicenter retrospective study aimed to evaluate the association of clinical variables and the incidence of ovarian cancer in patients with BRCA 1–2 mutation carriers who underwent risk-reducing salpingo-oophorectomy (RRSO). Design: Patients with a pathogenic mutation of BRCA 1–2 genes and with no evidence of disease are considered eligible. The exclusion criterion was the refusal to undergo the surgery. The retrospective study included all RRSO performed from May 2015 to April 2022 in the three gynecological Institutions of Southern Italy for were included in this retrospective study. Participants/Materials, Setting, Methods: Age, menarche age, BMI, menopause at time of RRSO, breast cancer first- and second-degree relatives, ovarian cancer first- and second-degree relatives, estroprogestin use, pregnancy normal full-term delivery, history of endometriosis, previous breast cancer and histologic type, previous abdominal/pelvic surgery, BRCA 1 or BRCA 2 status, preoperative serum CA-125 levels (IU/mL), age at time of RRSO and histological analysis were collected. Results: 184 were recruited. One was excluded. To assess cancer risk, the outcome variable was classified into three classes: no event, cancer, and other conditions excluding cancer. 14 women presented ovarian cancer and tubal intraepithelial carcinoma (STIC) on histopathologic final report. Ovarian cancer was found in 8 patients, whereas the presence of STIC was found in 6 of them. Limitations: The low incidence of patients diagnosed with ovarian cancer or STIC compared with the total number of patients undergoing RRSO is a potential bias. Conclusions: Our study did not demonstrate a correlation between clinical features and the occurrence of precancerous or cancerous lesions in BRCA mutation carrier patients.

An Ayurvedic management for repeated pregnancy loss (Putraghni Yonivyapada): A case report

The loss of a pregnancy is a loss that affect the couple both mentally and emotionally. In Ayurveda, this condition is coined as Putraghni (habitual abortion), Vamini (profluvium seminis), Asrija (gestational bleeding), and Yonivypada (vaginal diseases). These conditions usually result in pregnancy loss. A 29-year-old female with her husband aged 31 years residing at Jamnagar reported to the outpatient department of Prasuti Tantra evam Striroga, Institute of Teaching and Research in Ayurveda, Jamnagar with complaints of loss of pregnancy twice in the past 12 months. She had associated complaints of Yoni Daha (burning at vagina), Yoni Vrana (cervical erosion), Yoni Pidaka (eruptions in vagina), Maithuna Asahishnutva (dyspareunia), burning during sexual intercourse, and weakness. Her menstrual history revealed excess menstrual flow for 5–7 days with an interval of 25 days. The patient had a past history of high-grade fever, followed by mild fever for 20 days, 4 years ago, followed by which she had multiple episodes of fever and heavy menstrual flow. Her reports showed TORCH infection positive. Semen analysis report of her husband was within normal limits. According to Ayurveda, the patient was diagnosed with a case of Putraghni Yonivypad and was treated with Virechana (therapeutic purgation), followed by oral medication, Pitta Shamaka (Pitta alleviating drugs), Jwaraghna Chikitsa (principle of fever management), Brimhana (nourishment), and Garbha Sthapaka Yoga (preventive measures for abortion and promotive measures for fetal health and quality). The patient conceived in the 3rd menstrual cycle. She was advised to follow Garbhini Paricharya (pregnancy regime). The patient had a full-term normal delivery and was blessed with a female child weighing 2600 g, with no obvious abnormalities detected at the time of birth.

Misplaced of Intrauterine Devices: The Endoscopic Management

Intra uterine device migration is a relatively rare event. The migration of the IUD in the surrounded viscera can be managed by endoscopy approach. Objectives: We reported our experience to determine the epidemiologic characteristics of patients that presented migrated IUD, to report clinical aspects and describe the laparoscopic management. Method: The study includes 10 patients reported to obstetrics and Gynecology I department of UHC Hassan II FES in the last 4 years (2018-2021). In all the patients a gynecological examination, ultrasound evaluation abdomen and pelvis were done to locate the misplaced IUD. If the device was found to be intrauterine, hysteroscopy was done to locate and retrieve device. In those patients in whom the IUD was confirmed to be extrauterine diagnostic laparoscopy was done. Results: The average of age was 34.5 years. Majority of patients were primipara (53.3%) and 46.6% were multipara. As far as timing of insertion is concerned 6 (60%) were postpartum, 4 (40%) were postmenstrual. The average of time interval between insertion and removal is 3, 12 years. Of the 10 misplaced intrauterine devices 4 were found partially embedded in uterine wall and 6 of the misplaced 1UD’s were found deeply embedded in the uterine cavity. After their location they were removed hysteroscopically One patient reported with 8 weeks pregnancy and misplaced IUD. The device was confirmed to be intrauterine on transvaginal sonography. She had full term normal delivery and IUD was removed after 6 weeks hysteroscopically. None of our patient had an extra uterine migration that required a laparoscopy.

Placental Mesenchymal Dysplasia Co-existing with High Grade Villitis of Unknown Aetiology (VUE): A Very Rare Case Report and Literature Review

The present case study reports about Placental mesenchymal dysplasia co-existing with high grade villitis of unknown aetiology (VUE). Placental Mesenchymal Dysplasia (PMD) is a rare placental lesion characterized by unusual abnormality of the stem villi of the placenta that could be mistaken for hydatidiform mole due to the presence of both cysts and normal-appearing parenchyma. A 30-year-old G2 P1 (full-term normal delivery) seen in fetal medicine clinic at 20 weeks within view of high risk on combined screening (low PAPP-A and high HCG). An ultrasound scan showed an appropriately grown baby with an abnormal placenta consisting of multiple lacunae more than 50% of the placental mass with increased thickness. A second opinion at tertiary care hospital confirmed the presence of prominent lakes on the placenta. Growth scans also showed IUGR with increasingly abnormal Doppler scans as the pregnancy progressed. At 35 weeks, EFW was &lt; 3rd centile with static growth and patient had Induction of labour at 35 +4 weeks with vaginal delivery of a live male neonate weighing 2325g admitted to the neonatal intensive care unit (NICU) admission due to prematurity. The baby was discharged from NICU at day 5, achieving developmental milestones at the age of 23 weeks post-delivery. On microscopic histological examination, the chorionic plate showed no significant abnormality. The villous architecture was highly abnormal, and some villi were markedly enlarged with myxoid stroma and central degeneration. There were very occasional foci of apparent trophoblastic proliferation with villous architecture abnormalities seen in the form of clusters of large, immature intermediate villi. These features were in keeping with mesenchymal dysplasia. A highly unusual finding in this context was a florid infiltrate of CD3 positive T cells consistent with high-grade villitis of unknown aetiology concluding very rare co-existence of both conditions.

A rare case of multiple deformities with idiopathic cause

A 26 year old female patient came to physiotherapy OPD with multiple deformities in upper and lower limb. Patient is full term normal delivery, cried after birth weight was 2.5 kg.

Correlation between transcutaneous bilirubin levels and total serum bilirubin levels in postnatal period in a tertiary care center

Background: Neonatal jaundice is generally a benign condition seen during the postnatal period. The non-invasive methods including transcutaneous bilirubinometry have been developed for assessment of neonatal jaundice, transcutaneous bilirubin TcB) meters noninvasively estimate the bilirubin levels by measuring light transmission through the skin of neonates this value is then to be plotted against a chart in order to look for hyperbilirubinemia. Aim was to determine the efficacy of measuring the transcutaneous bilirubin as a screening tool for clinically significant hyperbilirubinemia. Methods: Study was a cross sectional study conducted under pediatric department of SMBT IMS and RC at tertiary care center after taking the approval from the ethical committee. Total of 110 neonates that appear to be clinically suffering from neonatal jaundice were considered for study after consent from respective parent/ guardian. Neonatal TCB levels and serum bilirubin levels were done. If bilirubin levels lie in phototherapy range, then baby was shifted to NICU and phototherapy treatment was given, and once levels came within normal range after the phototherapy treatment, again serum bilirubin levels were measured in order to compare pre-and post-treatment levels. Results: Present study showed male preponderance. 64 were male and 46 were female. Majority 61% were full term normal delivery and 39% were LSCS. Mean TCB level was 8.5±2.8. Statistical significance was seen for TCB and sever hyperbilirubinemia. Conclusions: Present study concluded that hyperbilirubinemia is commonly seen among males. Newborn delivered had hyperbilirubinemia. Statistical significance was seen between TCB level and severity of the disease. Thus, neonatal TCB levels can be used as a screening test for detecting hyperbilirubinemia in neonates. As TCB is a noninvasive and cost effective it can be used widely as predictor of the disease.

Hysteroscopy for retained products of conception: a single-institution experience

BackgroundRetained products of conception can occur with induced abortion during early-term pregnancy, induction of labor during mid-term pregnancy, drug-induced abortion, miscarriage, cesarean delivery, or full-term normal delivery. Compared with traditional dilation and curettage, hysteroscopy is a safer and more effective treatment method for retained products of conception. This study aimed to report the efficacy of hysteroscopy for treating retained products of conception and to share our new clinical perspectives.MethodsThis retrospective, single-center study was conducted at a tertiary hospital in Chengdu, China. We included 36 patients with retained products of conception who underwent hysteroscopy at our hospital.ResultsOur study reported a complete removal rate of 80.5% (29/36) with one procedure. The normal menstruation recovery rate during 1 year of follow-up was 91.6% (33/36). A low rate of postoperative intrauterine adhesions (2.8% [1/36]) was also reported.ConclusionOur retrospective study elucidated the use of hysteroscopy for retained products of conception. We also shared new perspectives regarding hysteroscopy and optimal surgical methods for treating retained products of conception as well as our experience treating residual products with hysteroscopy. To our knowledge, no other study has shared similar experiences.

Endometrial Stromal Nodule with Intense Decidual Changes. Findings during Delivery of the Placenta

Background: Endometrial stromal nodules involving the placental membranes are exceptionally rare. Only two cases have been described in the literature. We report a new case of endometrial stromal nodule with intense decidual changes as an incidental finding during delivery of the placenta. Case: A 31-years-old female patient with no history of interest presented after a normal term delivery, a 3.5 x 2.6 x 1cm well circumscribed nodule independent of the placenta and not attached to it. The tumor was asymptomatic and was not identificated ultrasonographically. Microscopically, the neoplastic nodule was composed of spindle and epithelioid cells with extensive eosinophilic cytoplasm with a decidualized appearance without associated glands, except for minimal epithelial remnants in the periphery. Characteristic features of endometrial stromal tumor were identified, such as CD10, WT-1, and progesterone receptor positivity, and an expanding noninfiltrating linear pushing rim. There were also pregnancy-related changes, such as decidualization and myxoid change. The lesion was considered a endometrial stromal nodule with an unusual morphology and increased proliferation rate due to the hormonal stimuli of pregnancy. Conclusion: We report a rare case of an incidental endometrial stromal nodule during delivery of the placenta, representing only the third such case reported in the world literature. In all likelihood, this neoplasm originated from the decidua of the free membranes

A Case Report of Cushing's Disease Presenting With Psychosis and Muscle Weakness Postpartum.

Cushing's syndrome is a condition leading to overproducing of cortisol by the adrenal glands. If the pituitary gland overproduces cortisol, it is called Cushing's disease. Cushing's syndrome and even Cushing's disease during and after pregnancy are rare events. There is not enough literature and guidance for managing and treating these patients. The diagnosis of Cushing's syndrome in pregnancy is often delayed because the symptoms overlap. We presented a thin 31-year-old woman, admitted 2 months after a normal-term delivery, with an atypical presentation of Cushing's disease, unusual clinical features, and a challenging clinical course. She had no clinical discriminatory features of Cushing's syndrome. Given that the patient only presented with psychosis and proximal myopathy and had an uncomplicated pregnancy, our case was considered unusual. The patients also had hyperpigmentation and severe muscle weakness which are among the less common presentations of Cushing's syndrome. Our findings suggest that an early diagnosis of Cushing's disease is important in pregnancy period for its prevalent fetal and maternal complications, and it should be treated early to optimize fetal and maternal outcomes as there is an increasing trend toward live births in treated participants.

The serotonin reuptake inhibitor fluoxetine induces human fetal membrane sterile inflammation through p38 MAPK activation

Serotonin Reuptake Inhibitors (SRIs) are often used as first line therapy for depression and other psychiatric disorders. SRI use during pregnancy is associated with preterm premature rupture of membranes (PPROM) and subsequent preterm birth. The objective of this study was to investigate the mechanism(s) responsible for SRI-associated PPROM. Putative mechanisms underlying PPROM include fetal membrane (FM) inflammation, increased apoptosis, and/or accelerated senescence, the later which may be reversed by statins. Human FM explants from normal term deliveries without labor, infection, or antidepressant use were treated with or without the SRI, fluoxetine (FLX), either alone or in the presence of a p38 MAPK inhibitor or the statins, simvastatin or rosuvastatin. FMs were also collected from women either unexposed or exposed to FLX during pregnancy. FLX significantly increased FM p38 MAPK activity and secretion of inflammatory IL-6. Inhibition of p38 MAPK reduced FM IL-6 secretion in response to FLX. Statins did not reduce the SRI-induced FM IL-6 production. FMs from women exposed to FLX during pregnancy expressed elevated levels of p38 MAPK activity compared to matched unexposed women. FMs exposed to FLX did not exhibit signs of increased apoptosis and/or accelerated senescence. These results indicate that the SRI, FLX, may induce sterile FM inflammation during pregnancy through activation of the p38 MAPK pathway, and in the absence of apoptosis and senescence. These findings may better inform clinicians and patients as they weigh the risks and benefits of SRI antidepressant treatment during pregnancy.

Associations Between Rurality, pre-pregnancy Health Status, and Macrosomia in American Indian/Alaska Native Populations.

To examine the relationships between pre-pregnancy diabetes mellitus (DM), gestational diabetes mellitus (GDM), pre-pregnancy body mass index (BMI) and county-level social determinants of health, with infant macrosomia within a sample of American Indian/Alaska Native (AI/AN) women receiving Indian Health Service (IHS) care. The sample included women-infant dyads representing 1,136 singleton births from fiscal year 2011 (10/1/2019-9/30/2011). Data stemmed from the IHS Improving Health Care Delivery Data Project. Multivariate generalized linear mixed models were fitted to assess the association of macrosomia with pre-pregnancy health status and social determinants of health. Nearly half of the women in the sample were under age 25 years (48.6%), and most had Medicaid health insurance coverage (76.7%). Of those with a pre-pregnancy BMI measure, 66.2% were overweight or obese. Although few women had pre-pregnancy DM (4.0%), GDM was present in 12.8% of women. Most women had a normal term delivery (85.4%). Overweight, obesity, pre-pregnancy DM, and county-level rurality were all significantly associated with higher odds of infant macrosomia.

Optimal duration of cardiotocography assessment using the iPREFACE score to predict fetal acidemia

Cardiotocography (CTG) applicability to improve fetal outcomes remains controversial. This study aimed to determine the clinically optimal CTG assessment duration using the integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring (iPREFACE score). This single-center, retrospective observational study included 325 normal full-term singleton vaginal deliveries at the Toho University Omori Medical Center, from September 2018 to March 2019. The iPREFACE(10), iPREFACE(30), and iPREFACE(60) scores were calculated at 10, 30, and 60 min immediately before delivery. The primary outcome was fetal acidemia (umbilical artery blood pH < 7.2). The secondary outcome was the correlation between all iPREFACE scores and the umbilical artery blood pH, base excess (BE), and lactate values. Patients without accurate CTG findings or with failure of umbilical artery blood sampling immediately after birth were excluded, leaving 145 patients in the final analysis. Of these, 16, three, and two had umbilical artery blood pH of < 7.2, < 7.1, and < 7.0, respectively. All iPREFACE scores significantly correlated with umbilical artery blood pH, BE, and lactate values. iPREFACE(30) had the highest predictive capacity for fetal acidemia, suggesting that 30 min immediately before delivery may be a useful scoring time in clinical practice.

APLA Syndrome in Pregnancy and its Outcome: A Case Report

Antiphospholipid antibody syndrome is a heterogenous autoantibody mediated acquired thrombophilia, which is associated with severe life threatening complications during pregnancy and most important treatable cause of recurrent pregnancy loss. It was described in 1980s by E Nigel Harris and Aziz Gharavi. It is also called as Hughes syndrome. Clinician should have high index of suspicion of APLA in patient with history of recurrent abortions, Intra uterine death with unexplained cause. We are presenting a case of 27yr old G2A1 with 38 wks. of POG with history of pulmonary thromboembolism and pulmonary hypertension and deep vein thrombosis 2 years ago, she was diagnosed with APLA syndrome. Patient was followed up to term and she was asymptomatic throughout the pregnancy. She had full term normal delivery. Both mother and baby were stable and healthy. She was asymptomatic in her postpartum period

Postpartum Use of Shavari Bar® Improves Breast Milk Output: A Double-Blind, Prospective, Randomized, Controlled Clinical Study.

Background and objectivesAppropriate nutrition, along with the establishment of lactation, is of paramount importance for the feeding mother and the growing neonate. Asparagus racemosus, a common name for Shatavari, is a well-known herb that has been used as a galactagogue in traditional Indian culture. It is also referenced in Ayurvedic medicine. Despite multiple formulations available, palatability has been a concern always as Shatavari is very bitter. We have devised a palatable and nutritionally rich formulation of Shatavari with no artificial ingredients. To understand the efficacy, we have conducted this double-blind, prospective, randomized, controlled study to evaluate the effect of oral Shatavari formulation (Shavari Bar®) on breast milk output in postpartum women.MethodsA prospective, randomized, parallel-group, double-blind, placebo-controlled study was conducted at two centers in women with gestational age 37 weeks or more who intended to breastfeed. Hundred and four women were screened, of which 78 were randomized to receive either bar containing Shatavari and oats (n=39, study) or an identical placebo bar (n=39, control). All 78 women completed the study, 61 delivered by a lower segment Caesarean section (LSCS), and 17 had a full-term normal vaginal delivery. Time to first noticeable breast fullness was measured and expressed milk volume measurements were done 72 hours after delivery or after consumption of four bars, whichever was later using a standardized breast pump. Comparison between the two groups was analyzed using a t-test.ResultsDemography and baseline data of patients enrolled were similar in the two groups. The mean total milk volume expressed was higher (p=0.008) with Shavari (64.74 ml) compared to placebo (49.69 ml). The time to breast fullness was shorter (p=0.024) with Shavari (30.49 hours) compared to placebo (38.09 hours). No adverse events were noted in either of the study groups. Global assessment of the satisfaction of mothers with lactation, the well-being of the child, taste, and ease of use was better in the treatment arm than in the placebo arm.ConclusionThe use of the Shavari bar can be an effective option in postpartum women to establish early lactation and build confidence in breastfeeding along with nonpharmacological intervention.

Occurrence of urinary tract infection and asymptomatic bacteriuria during pregnancy and its association with maternal outcome

: The pregnancy increases the possibility of the case progressing from asymptomatic bacteriuria (ABU) to urinary tract infection (UTI) with symptoms, which may further lead to pyelonephritis and obstetric outcomes. The adverse outcome may result in premature delivery, low weight at birth, and increased foetal mortality. The present study was proposed to assess the occurrence of Symptomatic UTI and asymptomatic bacteriuria, the microorganisms causing UTI in pregnancy, to assess the socio-demographic characteristics involving the risk factors of UTI and the maternal outcome. A total of 152 pregnant women with and without symptoms of urinary tract infection were included as a study subject from January 2011 to April 2011. Midstream urine samples were collected and processed following standard bacteriological tests. In the present study 85 (55.9%) cases were symptomatic UTI and 67 (44.1%) cases were having asymptomatic bacteriuria. was the predominant organism isolated in 61 (49.6%) cases followed by in 24 (19.5%) cases, in 16 (13.0%) cases, CONS 12 (9.7%) cases and in 10 (8.1%) cases. The lower socio-economic status has contributed in 65 (42.8%) cases and the education status of the most of the cases was either high school (47.4%) or primary school (38.8%). Out of 118 cases of vaginal delivery, 101 (85.6%) cases had full term normal delivery, but among 17(14.4%) preterm delivery, 12 (10.2%) were having symptomatic UTI and 05 (4.2%) cases were having asymptomatic bacteriuria.. Our study findings showed that low socioeconomic status and education background were predominant factors associated with increased symptomatic UTI and ABU. There was no significant difference in the prevalence of UTI and ABU with respect to gestational age. It was concluded in the study that the prompt treatment of ABU early in pregnancy significantly reduces the chances of adverse pregnancy outcome. Thus, screening for ABU should ideally be done in the pre-conceptional period. It was also found in our study that higher incidence of UTI was found in third trimester. Hence all pregnant women should be checked for the presence of ABU in the 1st trimester, treated aggressively with suitable antibiotics and promptly followed up.

Gut Microbiome Characteristics in Mothers and Infants According to the Presence of Atopic Dermatitis.

Objective The role of the gut microbiome in the onset and development of atopic dermatitis (AD) has been postulated. Thus, we investigated the gut microbial compositions in infants with and without AD and compared the gut bacterial flora of their mothers. Methods The prospective and cross-sectional study participated in 44 pairs of mothers and children. We selected infants born via full-term normal vaginal delivery and no history of antibiotic or probiotic use and infection during the first three months of life. The 15 pairs, consisting of nine healthy infants and six AD infants, were included in this study. Fecal samples of mothers and infants were analyzed within 30 days of delivery and at 12 months, respectively. Microbes in the fecal samples of mothers and infants were subjected to analysis of 16S rRNA amplicon sequencing. Results The abundance of specific taxonomic groups was notably different, but microbial diversity and phylogenetic distances were not significantly different in either maternal or infant groups according to the presence of infant AD. A total of 12 species were selected as differential species in infants with AD compared to healthy infants. Six species were significantly different in the mothers of infants with AD compared to the mothers of healthy infants. Akkermansia muciniphila was only detected in healthy infants and their mothers. Conclusion The presence of Akkermansia muciniphila in mothers and children after vaginal delivery is associated with the onset and development of AD.