European Journal of Molecular & Clinical Medicine

Objective: To compare the neonatal morbidity rates in early term versus full term born neonates.
Study design: This was a prospective study of 220 deliveries from 37 0/7 to 40 6/7 weeks of gestation from September 2020 to September 2022. After excluding anomalies, twin gestation, malpresentation, and stillbirth in parturating women in the study. Labour was monitored and newborns were assessed at birth. Neonatal morbidities of babies compared for each week of delivery.
Results: Neonatal morbidity, in the early term babies when compared with full term babies was 24.5% and 6.3% respectively. Neonatal intensive care unit admission and respiratory morbidity were lowest at or beyond 39 weeks of gestation when compared with the early term babies. Statistically significant differences in morbidity were noted between 37 and 39 weeks of gestation. Respiratory morbidity was higher at 37 than 39 weeks regardless of the route of delivery.
Conclusion: This was a prospective comparative study between early and full-term babies. We observed that the neonatal outcome was poorer in the early term group in terms of birth weight, neonatal morbidity, NICU admission rate, and respiratory distress with a statistically significant difference in comparison to full term babies.

Background: To assess asymptomatic bacteriuria in pregnant women and treatment effect on outcome of pregnancy.
Materials and Methods: One hundred five pregnant women of age group 18 – 45 years were involved. Collection of clean catch, mid- stream urine sample was done. Urine routine and microscopy was done. Maternal and fetal outcomes was recorded.
Results: Significant bacteriuria was seen in 25, insignificant growth in 10 and negative in 70 cases. There were 10%, 6% and 0 pre- term, 81%, 90% and 100% term and 9%, 90% and 100% post- term birth in patients with significant bacteriuria, insignificant growth and negative bacteriuria. In significant bacteriuria patients, 86% patients had >2.5 kg weight and 14% had <2.5 kg weight. In insignificant growth patients, 91% had >2.5 kg weight and 9% had <2.5 kgs weight. 100% in negative growth patients had >2.5 kgs weight of babies. 91%, 93% and 100% patients had APGAR score between 9-10 at 1 minute and 95%, 99% and 100% had between 9-10 respectively. 10%, 5% and 0 required NICU admission respectively.

Conclusion: Significant bacteriuria was seen in 25 patients. Maximum were term and normal vaginal delivery. Maximum babies were with birth weight of >2.5 Kg and APGAR score of 9 and 10 was seen in patients with significant bacteriuria with minimum NICU admission

Background: To assess asymptomatic bacteriuria in pregnant women and treatment effect on outcome of pregnancy.
Materials and Methods: One hundred five pregnant women of age group 18 – 45 years were involved. Collection of clean catch, mid- stream urine sample was done. Urine routine and microscopy was done. Maternal and fetal outcomes was recorded.
Results: Significant bacteriuria was seen in 25, insignificant growth in 10 and negative in 70 cases. There were 10%, 6% and 0 pre- term, 81%, 90% and 100% term and 9%, 90% and 100% post- term birth in patients with significant bacteriuria, insignificant growth and negative bacteriuria. In significant bacteriuria patients, 86% patients had >2.5 kg weight and 14% had <2.5 kg weight. In insignificant growth patients, 91% had >2.5 kg weight and 9% had <2.5 kgs weight. 100% in negative growth patients had >2.5 kgs weight of babies. 91%, 93% and 100% patients had APGAR score between 9-10 at 1 minute and 95%, 99% and 100% had between 9-10 respectively. 10%, 5% and 0 required NICU admission respectively.

Conclusion: Significant bacteriuria was seen in 25 patients. Maximum were term and normal vaginal delivery. Maximum babies were with birth weight of >2.5 Kg and APGAR score of 9 and 10 was seen in patients with significant bacteriuria with minimum NICU admission

Heart disease is a major cause of maternal mortality and morbidity during both the
antepartum and postpartum periods. Heart disease occurs less frequently than 1% of the time during pregnancy. Cardiovascular disorders complicate about 1% of all pregnancies.A thorough evaluation of the patient throughout the entire pregnancy may result in the early detection of heart disease. So, the present study was conducted with an aim to assess the effect of heart disease in pregnancy and its outcome.
Methods: This study was a cross-sectional study of the maternal-fetal outcomes of cardiac disease-related pregnancies over the last five years that were followed at tertiary care hospitals in North India. The study was carried out for three months after receiving institutional review board ethical approval. The study comprised pregnant patient files with pre-existing or newly diagnosed heart illness during pregnancy. Maternal age, parity,York Heart Association (NYHA) functional class, and materno-fetal outcome were among the variables that were recorded. The collected data was entered in the MS excel sheet. The variables were presented as frequency and percentages.
Results: In our study, a prevalence of 1.5% of heart disease was observed among pregnant women. Four fifth of pregnant women (80.0%) with heart disease were primigravida.Among enrolled pregnant women four fifth of the women were having rheumatic heart disease (84.2%). Among pregnant women with rheumatic heart disease (RHD), the single valvular lesions were seen in 28.7% of pregnant women (20.3% of mitral stenosis and 5.1% of mitral regurgitation).52.9% of pregnant women were having grade II functional class as per NYHA. Congestive cardiac failure as complication was observed in 15.7% of pregnant women. Among alive neonates, 29.2% of neonates were preterm, and 7.7% of neonates were having IUGR, 15.4% needed NICU admission
Conclusion: In underdeveloped nations, maternal and perinatal morbidity from rheumatic heart disease is high and accounts for a large portion of cardiac disease in pregnancy. When congenital heart disease is treated early in life, morbidity and mortality are reduced.

Background: Respiratory distress (RD) is a challenging problem and is one of the most common causes of admission in neonatal intensive care unit (NICU). The common causes of RD in neonates includes transient tachypnea of the newborn (TTN), hyaline membrane disease (HMD), birth asphyxia, pneumonia, meconium aspiration syndrome (MAS), and other miscellaneous causes.Present study was aimed to clinical profile of neonates admitted in NICU with respiratory distress in a tertiary care hospital.
Material and Methods: This study was prospective, observational study, conducted in neonates admitted to NICU with respiratory distress.
Results: In present study, majority neonates were male (56.38 %), had birth weight 1.5 – 2.5 kg (46.28 %), were term gestational age (41.49 %) & delivered vaginally (52.13 %). Symptoms and signs of respiratory distress noted were tachypnea (86.17 %), flaring of alae nasi (84.04 %), chest in drawing (82.45 %), grunting (47.34 %) & cyanosis (42.55 %). Premature rupture of membranes (13.83 %), meconium‑stained amniotic fluid (11.17 %), hypertension (9.04 %), maternal pyrexia (5.85 %), foul smelling liquor (2.66 %) & diabetes mellitus (2.13 %) were maternal risk factors observed among neonates with respiratory distress. Among neonates admitted with respiratory distress common diagnosis were transient tachypnea of newborn (34.57 %), sepsis (20.74 %), respiratory distress syndrome (11.17 %), meconium aspiration syndrome (9.04 %), hyaline membrane disease (8.51 %) & birth asphyxia (5.85 %). Majority neonates were discharged uneventfully (86.71 %) & mortality was observed among 16 neonates (8.51 %).
Conclusion: Common diagnosis observed in neonates with respiratory distress were transient tachypnea of newborn, sepsis, respiratory distress syndrome, meconium aspiration syndrome, hyaline membrane disease & birth asphyxia.

Background: Respiratory distress (RD) is a challenging problem and is one of the most common causes of admission in neonatal intensive care unit (NICU). The common causes of RD in neonates includes transient tachypnea of the newborn (TTN), hyaline membrane disease (HMD), birth asphyxia, pneumonia, meconium aspiration syndrome (MAS), and other miscellaneous causes.Present study was aimed to clinical profile of neonates admitted in NICU with respiratory distress in a tertiary care hospital.
Material and Methods: This study was prospective, observational study, conducted in neonates admitted to NICU with respiratory distress.
Results: In present study, majority neonates were male (56.38 %), had birth weight 1.5 – 2.5 kg (46.28 %), were term gestational age (41.49 %) & delivered vaginally (52.13 %). Symptoms and signs of respiratory distress noted were tachypnea (86.17 %), flaring of alae nasi (84.04 %), chest in drawing (82.45 %), grunting (47.34 %) & cyanosis (42.55 %). Premature rupture of membranes (13.83 %), meconium‑stained amniotic fluid (11.17 %), hypertension (9.04 %), maternal pyrexia (5.85 %), foul smelling liquor (2.66 %) & diabetes mellitus (2.13 %) were maternal risk factors observed among neonates with respiratory distress. Among neonates admitted with respiratory distress common diagnosis were transient tachypnea of newborn (34.57 %), sepsis (20.74 %), respiratory distress syndrome (11.17 %), meconium aspiration syndrome (9.04 %), hyaline membrane disease (8.51 %) & birth asphyxia (5.85 %). Majority neonates were discharged uneventfully (86.71 %) & mortality was observed among 16 neonates (8.51 %).
Conclusion: Common diagnosis observed in neonates with respiratory distress were transient tachypnea of newborn, sepsis, respiratory distress syndrome, meconium aspiration syndrome, hyaline membrane disease & birth asphyxia.

Background: To evaluate the risks to mother and the baby when pregnancy is associated with obesity.
Materials and Methods: A Prospective Comparative study conducted at Government medical college attached to Government General Hospital, Kadapa, affiliated to Dr. NTRUHS from October 2019 to September 2020 for a period of 1 year.
Results: In the study group 100 obese women with BMI≥30 kg/m2 and in the control group normal BMI between 18.5-24.9 Kg/m² were included in the study.  28% belonged to age group of 25-30 years in the study group as compared to 17% in the control group. Obese women were older than non-obese women.  45% of the obese women and 53% women in the control group belonged to low socio economic class V.  31% obese women and 35% non-obese women were primigravida. 69% women in the study group were multigravida. As the parity increases, Obesity tends to increase.  The percentage of women in the study group belonged to class I, class II and class III obesity was 81%, 18%,1% respectively. The Incidence of Gestational Diabetes Mellitus in the study group is 14% and 2% in control group, with a statistically significant p value of 0.008. The incidence of Gestational Hypertension in the study group was 39% and in the control group was 11%. The incidence of preeclampsia in obese women was 17% and in control group was 2%. The incidence of Antepartum Haemorrhage; abruptio placenta in the study group and control group was 0%,1% respectively; whereas incidence of placenta previa was 1% and 0% in study group and control group respectively, which is not statistically significant.  PPROM seen in 2% of women in study group and 5% of women in the control group which has no statistical significance.  The main indication for primary caesarean section in the study group was Cephalopelvic Disproportion (20%). Majority of newborns in study group (58%) belonged to birth weight of 3-3.9kgs. Macrosomia was seen in 4% in study group as compared to 0% in control group. The rates of NICU admissions were 8% in the study group and 2% in the control group.
Conclusion: We conclude that, Pre conceptional counseling is the best time to create awareness regarding the complications of obesity in pregnancy and therefore dietary interventional measures to be started at this period.  Awareness among reproductive age group women about the importance of normal weight before pregnancy to be done.

Background: To find complications associated with teenage pregnancies. To find the effects on maternal and fetal outcomes.
Materials and Methods: It was a Quantitative, observational, analytical, prospective cross-sectional study. 100 Study populations were taken by randomization, after applying exclusion criteria. The study was carried out during the year from October 2019 – September 2021 At GGH, Kadapa.
Results: In the present study, 2% of total deliveries conducted in our institution are of teenagers. 74% of pregnant teenage women were 19 years and 18 years old, 4% were under 15 years, and 22% were in the 15-18 years age group. 85% belong to primigravida in our study, and the remaining were high order pregnancies. In our study, 1% is pregnant out of wedlock. The mean age of marriage is 17 years in our study. Only 7% had an occupation in our study.  All pregnant teenage women in our study belong to low socioeconomic status. 95% of our study had poor knowledge regarding pregnancy and delivery. 31% of teenage pregnancies were booked. 2% came directly during labour, remaining 67% registered late in pregnancy.  Only 4% are short-statured in our study.  4% are undernourished in our study, and 12% are overweight.  73% are anaemic in our study according WHO guidelines. 26% of our study has PIH disorders.  26% had oligohydramnios as a risk factor in our study population . There was a 1% antepartum haemorrhage. In addition, 1% had twins as a risk factor. Malpresentation was seen in 5% of cases. CPD was noted in 19% of the study population. 8% of our study group had premature rupture of membranes.  60% of our study population underwent LSCS,1% had instrumental deliveries. 39% had a vaginal delivery.  Indications for c-section are CPD, which is 19%, followed by oligohydramnios, malpresentation and prior LSCS. 15% of babies in our study were below 2.5 kg. 1% had a congenital anomaly.7% of babies admitted in NICU.
Conclusion: Teenage pregnancy is a severe social problem prevalent in rural India. Educating on STDs and measures to prevent them together can reduce teenage pregnancies, by which complications of teenage pregnancy can be prevented.

Background: This study was undertaken to estimate the incidence, etiological factor, time of onset & clinical types of neonatal seizures in our setup and to study the biochemical abnormalities among the different types of neonatal seizures in our setup.
Methods: This is a hospital based prospective observational study conducted in neonatal ICU, department of paediatrics, BMCRI during period of January 2020 to March 2022.
Results: Total number of patients which developed neonatal seizures were 82 in our study. The proportion of neonatal seizures among NICU admission of inborn patients were 10.8%. Out of 82 babies of neonatal seizures, 45 (54.8%) were males and 37(45.12%) were females in the ratio of 1.2:1, with male preponderance. Out of 82 babies who developed neonatal seizures, it was found that 50(60.9%) were pre-term babies, 28(34.14%) were term babies and 4(4.87%) were post-term babies. In this study out of 82 babies, 45 neonates (54.8%) were LBW babies and 37 (45.12%) were of >=2.5kg birthweight. Out of 82 neonates, in 35 (42.6%) neonates seizure occurred between 24-72hrs whereas in 28 (34.14%) neonates seizure occurred in <24hrs and in 19 (23.17%) babies seizure occurred in >72hrs which shows that most of seizures were observed between 24-72hrs of life. In this study, out of 82 cases, neonates with subtle seizures were 40(48.78%), neonates with tonic seizures were 32(39.02%), neonates with focal clonic were 8(9.75%) and the multifocal clonic seizures were 2(2.43%). This shows that subtle seizures were most common followed by tonic seizures. It was found that out of 82 cases of neonatal seizures in this study, maximum cases 35(42.6%) were of birth asphyxia, followed by 15 cases of isolated hypoglycemia, (18.29%),
10(12.19%) cases were of neonatal meningitis/septicemia, 9(10.9%) cases were of isolated hypocalcemia, 10(12.19%) cases were of ICH (intracranial haemorrhage). There were 3(3.65%) cases of unknown causes of neonatal seizures. 2Out of 82 cases, 24 (29.26%) babies expired in spite of taking all efforts, and 58 (70.7%) babies were discharged successfully.
Conclusion: Neonatal seizures were more common in preterm, LBW. Birth asphyxia was the most common cause of all neonatal seizures followed by hypoglycemia. Subtle seizures were the commonest type of seizure observed followed by tonic. Subtle seizures were more common in 24-72 hours of life. Most common biochemical abnormality found in neonatal seizures is hypoglycemia followed by hypocalcemia.

Background: Sepsis and septic shock cases in the Neonatal intensive care unit (NICU)
and Pediatric intensive care unit (PICU) remain one of the most significant causes of
morbidity and mortality in pediatric patients. Therefore, studying and comparing the
clinical features and outcomes of pediatric patients with sepsis in ICUs are important,
especially in developing countries.
Methods: From 1st July 2021 to 31st December 2021, we have collected data from both of
our pediatric ICU and neonatal ICU of Shyam Shah Medical College using a preformed
proforma. Complete blood count, C - reactive protein and culture sensitivity reports
were used to diagnose or screen sepsis. We compared clinical features, laboratory data,
microbiologic results, and final outcome for patients with sepsis in both NICU and
PICU.
Results: A total 1509 and 236 cases with sepsis from both NICU and PICU respectively
are included in the study (mean duration of stay in NICU 8.9 days±4.3; in PICU 12.5
days±5.3). Among these cases, culture positive cases with sepsis were 66% and 28% in
NICU and PICU respectively. Common pathogens isolated from blood cultures were E.
coli and pseudomonas in NICU and E.coli and S. aureus in PICU. Mortality, discharges,
refers and Left against medical advice cases were compared as outcomes in our study.
Comparing with NICU (n=24, 10.1%), mortality due to sepsis in PICU (n=111, 7.3%)
was less.
Conclusion: Sepsis in children both in NICU and PICU is associated with high mortality
despite aggressive treatment strategies, but more in NICU. Early recognition and
prompt treatment is the key to improve outcome of sepsis.

Background:Second stage caesarean is technically more difficult due to deep
engagement of fetal head, and this is associated with increased risk of maternal
morbidity such as surgical injuries and intra operative excessive haemorrhage as well as
fetal morbidity such as asphyxia and fetal injury. A Prospective study was done to
compare the maternal and neonatal complications of caesarean sections performed in
second stage compared to first stage of labour. Objective: To determine the maternal
and perinatal outcome associated with caesarean sections performed in second stage
versus first stage of labour.
Materials and Methods: It is an observational cross-sectional study where 7033 women
were enrolled in the study, out of them 1272underwent C- section in first stage of labour
where as rest152 underwent caesarean section in second stage of labour for various
indications.
Results: It was found that the women who underwent caesarean section in second stage
of labour had a higher risk of maternal morbidity than those who underwent caesarean
in first stage of labour The rate of intraoperative bleeding is>1000ml,uterineatony,
longer duration of surgery,adhesions, fetalhypoxia, neonatal admissions toNICU,
neonatal sepsis and early neonatal death were more common in second stage of labour
as compared to first stage.
Conclusion: In conclusion, Present study suggests that women undergoing c-section in
second stage of labour have increased chance of Uterineatony, rate of excessive
bleeding, postoperative fever, wound infection, fetal hypoxia compared to first stage of
labour and therefore require special care and should be handled and operated by
experienced obstetricians’ The rate of complications can be avoided by proper antenatal
care, proper usage of partograph, pelvic assessment in early labour and timely
intervention.

Background:The aim is to compare the spot urine protein/creatinine ratio with 24hour
urinary protein in hypertensive disorders of pregnancy.
Materials and Methods: A prospective correlational study was conducted on 100
hypertensive pregnantwomen during the study period. The objective of the study was to
know if a spot protein/creatinine ratio would provide an accurate quantification of
proteinuria and whether it can replace the use of the 24 hours urine protein in
preeclamptic women. Ethical clearance and informed consent were obtained. Urine
samples were collected for visual dipstick, spot urine P/C ratio and 24hours urinary
protein estimation.
Results: A fair degree of correlation existed between the two variables with r =
0.842with a highly significant p value <0.01 when all the observations were considered.
The correlation at lower level of proteinuria was less r = 0.72 compared to higher levels
of proteinuria,but is statistically significant. The area under the ROC curve - 0.739
(95% CI: 0.628, 0.849) with p value < 0.01 (significant). The optimal cut off point was
0.5, which yielded a sensitivity of 92% and specificity - 66%. Even though the results
were known to clinicians the values were not taken for clinical decision, only by the
ratio alone. However the 24 hour urine protein values were considered for the patient
management. The perinatal outcome in women with higher levels of proteinuria were
poor with increased incidences of IUGR, prematurity, low birth weight and the need for
NICU care was increased in such babies.
Conclusion: The present study indicates that this method for quantification of
proteinuria, when properly interpreted, can provide valuable information, that for
clinical purposes is a satisfactory substitute for the determination of protein excretion in
a 24 hour collection.