Background: In populations with a high incidence of low birth weight, a macrosomia index (ratio of head /chest circumference) may better detect infants of diabetic mothers rather than a birth weight of ≥4000g. The objective of this study was to correlate Macrosomia Index ≤1 (MI) with maternal HbA1c at delivery.Methods: Prospective cross-sectional study in a Medical College Hospital in South India from November 2012 to March 2014.  Study subjects were 715 term consecutive, mother/neonate pairs, booked, inborn and singleton deliveries. Birth weight, head and chest circumference of neonates, and maternal HbA1c at delivery were measured. The calculated macrosmia index (MI) was correlated with maternal HbA1c. Pearson correlation and odd’s ratio were calculated.Results: Of 715 mothers, 68.3% (488/715) had HbA1c >5.4% (range 4.2 to 10.5%), although only 32.7% (234/715) were categorized as gestational diabetics in pregnancy. Odds of Macrosomia Index ≤1 in neonates with maternal HbA1c > 5.4% was 7 times (95%CI: 3.2-15.4) as compared to that of neonates of mothers with HbA1c ≤ 5.4 (p<0.001). 13.4% (96/715) of neonates had MI ≤1 but only 1.4% (10/715) had birth weight of ≥4000g.Conclusions: MI ≤1 correlated with an HbA1c of >5.4% at delivery. Hence, in addition to birth weight ≥4000g, MI ≤1 should also be used to detect macrosomia in infants of diabetic mothers.

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A 24 yr old Primigravida who conceived spontaneously came with two months amenorrhea for confirmation of pregnancy and routine checkup. Her 1st trimester scan, showed a single intra -uterine viable pregnancy of 8-9 weeks, with a right adnexal mass of about 10.7x7.7x10.3 cm with solid and cystic areas with internal echoes. In view of the size of the tumor and its varying echogenicity, pathological condition of the ovary was suspected. She reported at 24 weeks with abdominal pain. Partial torsion was suspected and Laprotomy was done. Right ovary was enlarged to 10 cm with varying consistency. Right ovariotomy was done. Postoperative period was uneventful. Histopathological examination showed extensive decidual changes in the ovary, forming tumor like lesions in the cystic areas. The pregnancy progressed without any complication. At term, she delivered a healthy female baby. The case is being presented for its extreme rarity.

It has been estimated that 30% of births have some type of umbilical cord abnormalities. Disruption of the umbilical cord supply line is a major source of harm to the developing foetus. It is estimated that every third to fourth delivery has an identifiable umbilical cord abnormality or anomaly. What is unknown is how these findings affect the foetus and to what extent. Hence, the placenta and umbilical cord needs to be evaluated. AIM OF THE STUDY To study the correlation between the foetal outcome and the different types of abnormalities of placenta and umbilical cord. METHODS AND MATERIALS This descriptive study was done during the period October 2010 to December 2011 in a tertiary care centre. All consecutive patients who delivered at the institution during this period were included in the study. Those placentas where the anatomy of the cord could not be clearly identified were excluded from the study. RESULTS 26.6% of the placentas examined showed some abnormality. Abnormalities of the cord was present in 78 cases (7.8%). One cord had five vessels-four arteries and one vein. Foetal abnormalities were more common in those who had a placental or cord anomaly also. CONCLUSIONS No significant correlation between placental abnormalities and foetal anomalies could be obtained. There was a higher incidence of adverse foetal outcome with cord abnormalities. An accurate antenatal evaluation could be of help in anticipating adverse perinatal outcomes in selected cases.

BACKGROUNDThe rising caesarean section rates can be curtailed by increasing the rates of Vaginal Birth After Caesarean (VBAC). Ability to predict vaginal birth after caesarean with certainty may enable better counselling and decision making regarding mode of delivery for pregnant women with a previously scarred uterus. AIMTo assess the accuracy of a simple validated vaginal birth after caesarean score in predicting the mode of delivery in pregnant women with previous one caesarean section. MATERIALS AND METHODSData for all patients who delivered at this institution between November 2011 and October 2013 were reviewed. Data of women who delivered after one caesarean section were analysed and details of the index pregnancy, labour and mode of delivery were noted. A vaginal birth after caesarean prediction model was applied to all women who underwent a Trial of Labour After Caesarean (TOLAC) using data at admission. Women who delivered after two or more caesarean sections were excluded from the study. The primary outcome assessed was the mode of delivery. SETTINGS AND DESIGNRetrospective Cohort study at a 650-bedded tertiary care hospital in South India. STATISTICAL ANALYSISFor categorical variables, data was compiled as frequency and percent. For continuous variables, data was calculated as mean±SD. Performance of the vaginal birth after caesarean score was assessed by receiver operating characteristic curve analysis. RESULTSSix hundred and eighty-seven women were delivered by caesarean section. Among them, 280 women who had a previous caesarean section were included in the study. Vaginal birth after caesarean scores were computed for 82 women who underwent a trial of labour after caesarean. 57.3% had a successful vaginal birth after caesarean and the remaining had a repeat caesarean section after a failed trial of labour. The score performed fairly well with an area under receiver operating characteristic curve of 0.75. CONCLUSIONThe vaginal birth after caesarean score maybe useful tool in counselling eligible women in favour of a trial of labour after caesarean thereby reducing the number of elective repeat caesarean sections. KEYWORDSVaginal Birth After Caesarean, Prediction Score, Trial of Labour, Repeat Caesarean. HOW TO CITE THIS ARTICLE: Tahmina S, Kuruvila SK, Daniel M. Usefulness of a simple prediction model for vaginal birth after caesarean section in a low resource setting.