Background: Timely and prompt referral of high risk pregnancies is an integral part of emergency obstetric care and is one of the effective strategies to avoid adverse pregnancy outcomes. This study aims to assess the maternal determinants and characteristics of obstetric referrals to Travancore Medical College and Hospital.Methods: This observational study reviewed 124 obstetric referrals over 3 years. Maternal risk factors and sources of referral were looked into. Distance travelled, referral-arrival interval, mode of transport, gestational age at referral, medical co-morbidities necessitating emergency/elective transfers to this tertiary centre have been analysed.Results: Referral rate was 7.03%. Mean age was 26. Primipara and multipara went hand in hand. 95% were graduates. Materno-fetal (58%) contributed the bulk of obstetric referrals. 83.1% were from private hospitals and 64 were in-labour referrals. 71.6% had referral arrival distance of <15 kms. Mode of transport used by the referred patients was by ambulances (73.9%). Around 48% of our population had GA of 33-36.6 weeks. 73% had emergency decision among which caesarean was 83%. Anaemia (34%), HDP (30.5%), GDM (14.2%) and hypothyroidism (17.7%) were medical co-morbidities necessitating referrals. There was 1 maternal death and 4 near miss mortality cases. Mean hospital stay in private sector referrals was 10.17 days and it was 7.62 days in government referrals.Conclusions: Timely referrals with detailed referral slips imparting information regarding treatment received at the referring hospital has helped in early and optimal intervention in the study.

Background: Stress during pregnancy can have serious adverse outcomes on the mother, the foetus and the new-born. It can lead to low-birth-weight, preterm births and neuro-psychological effects such as anxiety and depression during pregnancy and puerperium. This cross-sectional research aims to assess the severity of stress among postnatal women in Kerala. This study analysed socio-demographic, obstetric, family dynamics, neonatal characteristics and psychiatric determinants of postpartum stress using perceived stress scale (PSS) among postnatal women in a tertiary hospital in Kerala state, India.Methods: 119 women between 2 to 6 weeks of postpartum period were subjected to a pre-tested pre-structured standard questionnaire. Terminal illness, still birth delivery and comorbid psychiatric illness was excluded. Screening and diagnosis of postpartum stress was done based on perceived stress scale (PSS) and graded as mild 0-13, moderate 14-26, severe 27-40.Results: Study findings indicated a statistically significant association between postpartum stress and risk factors such as unplanned/unwanted pregnancy. The mean age of women was 27±4.8 years. Support from spouse and in-laws was a negative predictor of developing both postnatal stress and depression. Family income, education of couple and husbands’ occupations were non-determinant factors (p>0.05) in this study. Psychiatric illness in the family and past history of psychiatric illness also contributed to postnatal stress. The most important variable which influenced perceived stress during pregnancy was lengthier NICU stay. Even breastfeeding problems and associated neonatal issues worsened the stress scales significantly in the immediate postnatal period.Conclusions: This research concluded that stress detection and timely counselling along with mental and physical support will mitigate stress and postpartum depression.

Background: Globally, the caesarean delivery rate is rising continuously, making caesarean one of the most common surgical procedures. The purpose was to analyse the determinants and maternofoetal outcomes in elective versus emergency caesarean sections in a tertiary care centre.Methods: All women, who gave birth by Caesarean deliveries done over a period of 1 year (January 2018-December 2018), were studied in Travancore Medical College in Kerala, India. Indications of caesarean, whether emergency or elective, medical morbidities, Gestational age at decision, birthweights and extended hospital stay and new-borns needed to resuscitate were looked into. The data was collected and analysed from the hospital registry.Results: Out of the 378 selected patients, 95 patients in group of elective and 283 emergency caesarean section were studied. The indications of emergency caesarean sections were failed induction, non-progression of labour, CPD, Previous caesarean in labour, foetal distress. The most frequent indicator for elective lower segment caesarean section (LSCS) was patient with previous LSCS not willing for vaginal birth, followed by breech presentation and high risk pregnancy ( BOH and ART). Younger mothers, gestational age remote from term, low-birth weight, and extended hospital stay were statistically significant in mothers undergoing emergency caesarean delivery. Fever, urinary tract infections, need for maternal and neonatal ventilation, blood transfusion, scar dehiscence were more common in the emergency caesarean group.Conclusions: The antenatal morbidity, low birth weights, decision taken preterm for salvaging the baby, postoperative complications and extended stay were more in the emergency caesarean when compared to elective caesarean.

Background: Pregnancy and childbirth produce a variety of physiological, psychological and social consequences. Attitudes toward pregnancy and childbirth vary from culture to culture. Prevalence estimates range from 13 to 19% in resource-rich settings and 11 to 42% in resource- limited settings PND has a significant impact on the mother, the family, her partner and mother-infant interaction. This research aims to aid the early diagnosis of postnatal depression and the socio-demographic, obstetric, family dynamics, neonatal characteristics and psychiatric determinants of depression using EPDS among postnatal women in a tertiary hospital in Kerala state, India.Methods: 119 women between 2 to 6 weeks of postpartum period were subjected to a pre-tested pre-structured standard questionnaire. Diagnosis of depression was made using the Edinburgh postnatal depression scale. Possible depression is values >13 or more are invariably associated with depression.Results: Young age at marriage (p-value 0.022), love marriage (p-value 0.040) and low social support inadequate relationship with the in-laws was significantly associated with PND (p-0.003). Low birth weight was a significant determinant of PND (p-value-0.018). Gender of the new-born, fear and preference towards any particular gender and order of female child in multiparous woman had no association in determining postnatal depression. Childcare stress (p-value-0.011), psychiatry history in family and personal history of depression and mothers with low self-esteem (p-value-0.001) had odds of developing postnatal depression in the study.Conclusions: Early screening of the women and counselling of women and their family will reduce the maternal morbidity and adverse child outcomes.

Background: Fetal Growth Restriction (FGR) is the single largest contributing factor to perinatal morbidity in non-anomalous foetuses. Synonymous with Intrauterine Growth Restriction (IUGR), it is defined as an estimated fetal weight less than the10th percentile. Obstetric Doppler has helped in early detection and timely intervention in babies with FGR with significant improvements in perinatal outcomes.  Hence, authors evaluated the maternal risk factors and diagnosis-delivery intervals and perinatal outcomes in FGR using Doppler.Methods: This research conducted in a tertiary care hospital in South Kerala included 82 pregnant women who gave birth to neonates with birth weight less than the 10th percentile over a period of1 year (Jan 1, 2017-Dec 31, 2017). Socio-demographic, maternal risk, Diagnosis- delivery interval in FGR and neonatal morbidities were studied.Results: Mean GA at diagnosis in weeks was 34.29 and 35.19 respectively for abnormal and normal Doppler respectively (p value-0.032). The mean birthweight in Doppler abnormal FGR was 272.34 g lesser than in Doppler normal group (p value-0.001). Growth restricted low birth weight neonates had Doppler   pattern abnormalities (p value-0.0009). FGR <3rd percentile and AFI <5 had abnormal Doppler (OR:6.7). Abnormal biophysical profile (OR:14) and Non-Reactive NST (OR:3.5) correlated with abnormal Doppler. Growth restricted with normal Doppler had shorter NICU stays than with abnormalities (p value-0.003). Term FGR went home early than early preterm. (p value-0.001).Conclusions: Abnormal Doppler velocimetry is significantly associated with earlier FGR detection, shorter decision- delivery interval, reduction in the mean birthweight and longer NICU stay. Hence, Umbilical artery Doppler and Cerebroplacental index is an integral part of in-utero fetal surveillance to identify impending fetal hypoxia, appropriate management, optimising the timing of delivery and improve perinatal health in FGR.