Objectives: To assess the maternal and fetal outcomes using new screening criteria with upper serum thyroid stimulating hormone (TSH) cut off as >3mIU/L, for diagnosing hypothyroidism in pregnancy. Materials and Methods: This study was a cross sectional study, carried out in the department of Obstetrics and Gynaecology. During one year of study period from February 2016 to January 2017, pregnant women with ≤ 20 weeks gestation, attending antenatal OPD were included in the study and they were followed till delivery. On the basis of serum TSH level, women were divided into study group with serum TSH level between 3.1 to 6 mIU/L, (new range to be studied) and an equal number of ages and parity matched control group with serum TSH levels between 0.4 to 3 mIU/L. The maternal and fetal outcomes were compared between study and control groups. Results: During the study period, in study group 96 women had serum TSH between 3.1-6 mIU/L. Maternal and fetal outcomes in both the groups were comparable. Study did not find any difference in the rate of spontaneous abortion between women in study and control group [p > 0.99]. There was no significant difference in the maternal complications like preeclampsia, gestational diabetes and placental abruption in the study and control group. Vaginal delivery and caesarean section were similar in both the groups. Study shows no significant difference of foetal outcome in study and control group [p > 0.05]. Conclusion: As compared to pregnant women with serum TSH levels <3mIU/L, women with serum TSH levels between 3.1-6.0mIU/L had no significant adverse fetomaternal outcome.

Objectives: The aim of the study was to evaluate the effects of oligohydramnios on maternal and fetal outcome at term pregnancy. Methodology: A case control study on pregnancy outcome in 100 women with AFI<5cm after 37 completed weeks of pregnancy compared with 100 controls with no oligohydramnios with matched age and parity. Results: Non stress test (NST) was non-reactive in 38% of oligohydramnios and 20% of controls and was statistically significant (P<0.05). Ominous fetal heart patterns were seen in 60% of oligohydramnios and 30% of controls but it was statistically not significant. Thick meconium stained amniotic fluid was seen in 48% of oligohydramnios and 20% of the controls and was significant (P<0.001). In oligohydramnios, 54% were induced whereas in controls, only 24% and was significant (P<0.002). For fetal distress, 88% of oligohydramnios and 90% of controls underwent LSCS and was not significant. APGAR score <7 was insignificant between the two groups. LBW and NICU admission were more in oligohydramnios and was significant (P<0.05, <0.01). Perinatal mortality was not significant between the two groups. Conclusion: Oligohydramnios (AFI<5) is valuable for predicting fetal distress in labour requiring caesarean section, used as an adjunct to other fetal surveillance methods. Oligohydramnios (AFI < 5cm) detected after 37 weeks of gestation is an indicator of poor pregnancy outcome.

The World Health Organization’s Labour Care Guide (LCG) is the “next generation” partograph, designed to improve the quality of intrapartum care and enhance women’s experiences. However, the effects of the LCG on maternal and newborn outcomes have not been evaluated. We developed a novel strategy to introduce the LCG into routine intrapartum care, comprising a co-designed training program for labour ward clinicians, alongside monthly audit and feedback. We implemented the strategy and measured its effects using a stepped-wedge, randomised trial in four hospitals in India. We captured data from 26,331 women who gave birth at >=20 weeks’ gestation, over a 54-week period. Following implementation, a 5.5% crude absolute reduction in the Caesarean section rate amongst women in Robson Group 1 was observed (45.2% vs 39.7%; relative risk 0.85, 95% confidence interval 0.54-1.33). Maternal process-of-care measures were not significantly different, though labour augmentation with oxytocin was 18.0% lower with the LCG strategy. No differences were observed for maternal, fetal or newborn health outcomes, or women’s birth experiences. This “proof of concept” study provides important evidence on the effects of introducing LCG into routine practice, suggesting a 15% relative risk reduction in Caesarean section use amongst women in Robson Group 1. Larger trials are warranted, particularly in settings where urgent reversal of the Caesarean section epidemic is needed.

Objective: The aim of this study was to ascertain the presentation, diagnosis, severity and complications of HELLP syndrome and evaluation of the maternal and fetal outcome. Methods: Pregnancy induced hypertension (PIH) between 1 st February 2016 and 31 st January 2017 was included in the study. Diagnosed cases of HELLP syndrome were classified according to Tennesses criteria after assessing inclusion and exclusion criteria. The analysis of the data was done on all the patients diagnosed with HELLP syndrome. Results: The incidence of HELLP syndrome during the period was 1.14% of total deliveries and 3.82% of pregnancy induced hypertension (PIH). Majority (50%) patients belong to age group of 21 to 25 years. Mean age was 22.5 years. Most of them were primigravida (55%). Majority (52.5%) was in 36-40 weeks gestation and mean gestational age was 33.6 weeks. Head ache (56.25%) was the most common imminent symptom. Most of symptoms were nonspecific like malaise (50%), edema (45%), vomiting (20%) and epigastric pain (7.5%). Out of 80 patients of HELLP syndrome 19 delivered by LSCS and 61 delivered vaginally. Ascites (26.25%), PPH (25%) and placental abruption (22.5%) were the most common maternal complications in HELLP syndrome followed by acute renal failure (18.75%), pulmonary edema (12.5%), DIC (6.25%) and cerebrovascular accidents (6.25%). Maternal mortality in our study was 11.25%. Perinatal mortality was 41.25%. Conclusion: The reason for higher morbidity in our study is delay in identifying the problem by referring doctors. Earlier diagnosis and intervention improves maternal and perinatal outcome.

Background: Human embryo develops inside the body of the mother. One of the important part of the fetoplacental unit is the umbilical cord. The umbilical cord is the lifeline of the fetus. Objective of present study was to investigate the correlation of umbilical cord length with fetal parameters like APGAR score, sex, weight, and length, and its effect on labor.Methods: This prospective study conducted in the Department of OBG of VIMS, Bellary, from 1st February 2016 to 31st January 2017. The 1000 pregnant women of >37 weeks were studied following delivery for length of umbilical cord, any loop around neck, trunk, shoulder and number of loops of cord; knots of cord etc. Fetal parameters recorded were sex, weight, and length of the newborn and APGAR score at 1 and 5 min.Results: Cord length varied from 22 to 126 cm. The mean cord length was 66 cm (±10 cm). Maximum cases have cord length of 61and 70 cm. Lower 5th percentile and upper 5th percentile considered as short and long cord. Short-cord group was associated with significantly higher (p<0.05) incidence of LSCS cases. The incidence of all types of cord complications increases as the cord length increases (p<0.001). Nuchal cords had higher mean cord length and as the number of loops in a nuchal cord increases to two or more loops, the operative interference and fetal heart abnormalities increases. Fetal heart rate abnormalities and birth asphyxia increase with extremes of cord length (p<0.001).Conclusions: Short and long cords are associated with increased incidence of cord complications, operative interference, intrapartum complications, increased fetal heart rate abnormalities, and birth asphyxia. But cord length did not vary according to the weight, length, and sex of the baby.