DOI: 10.5005/jp-journals-10065-0020 |
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Neel S, Swaminathan E, Neel PB, Lazar J, Gireesh E, Pande P, Pawar BP. Study of Integrated Approach of Antenatal Care to improve the Gestational Age at Birth. World J Anemia 2018; 2 (1):1-10.
Aim and objective: Study of integrated approach of antenatal care (ANC) to improve the gestational age (GA) at birth.
Materials and methods: A total of 532 women attending the antenatal clinic at Neel clinic in Panvel, Navi Mumbai, India, were enrolled between 18 and 28 weeks of pregnancy from April 2015 to March 2017, in prospective nonrandomized, matched, interventional study.
A total of 254 women were enrolled in the study group; 278 women were enrolled in the control group. Women were matched for age, gravida, parity, educational, religion, and residential area.
Integrated approach of ANC:
• Stress management through Rajyoga meditation (Brahma Kumaris).
• Nutritious and satwik food.
• Antenatal physical and breathing exercises.
Exercises, walking, and meditation were practiced by the study group from date of entry into the study until delivery. The control group walked ½ an hour twice a day (standard obstetric advice) during the study period. Compliance in both groups was ensured by frequent telephone calls and maintenance of a daily activity charts.
Result: Preterm labor was significantly lower (<0.02) in the study group.
Conclusion: Stress management through meditation and nutritional management may contribute to decreased risk of premature delivery or low birth weight (LBW) babies, and eventually would decrease problems in the infant, children, adolescent, and fetal origin of adult diseases. Exercise during pregnancy would reduce the risk of cesarean delivery.
Integrated approach of ANC is safe, relatively cheap to implement, and would reduce the costs of long-term health care.
Thalassemia is a congenital and hereditary disease and comprises a “group” of hematological phenotypes. The most common form of thalassemia is due to a defective beta gene. India has a huge burden of many patients with a β-thalassemia syndrome and sickle cell disease, but few among them are optimally managed, and allogeneic stem cell transplant is unaffordable for the majority of families. Thalassemia was considered by Caffey to be the best example of skeletal dwarfism and infantilism caused by chronic anemia. Transfusion therapy, which is the mainstay of treatment, allows for normal growth and development and suppresses ineffective erythropoiesis. Hematopoietic stem cell transplantation is the only available treatment with the high cost and scarcity of human leukocyte antigen (HLA)-matched, related donors. Prevention and control of beta-thalassemia disease require the accurate diagnosis of carriers and proper genetic counseling. Prenatal diagnosis can be performed in the first or second trimester of pregnancy by deoxyribonucleic acid (DNA) analysis using polymerase chain reaction (PCR). Since there are 17 mutations as well as rare ones causing beta-thalassemia in Asian Indians, the point mutation detection by reverse dot blot (RDB) allele-specific oligonucleotide hybridization for common mutations along with amplification refractory mutation system (ARMS) techniques has been developed for prenatal diagnosis. The author has tried to explain all the important facts regarding thalassemia in an Indian perspective in this article to help the readers.
Transfusion of blood and blood components is a common practice in obstetric wards but it is not without risk. The incidence of transfusion reactions varies from 4 in every 100 transfusions for nonhemolytic reactions to 1 in every 40,000 for hemolytic transfusion reactions. Appropriate and rational use of blood/components is essential for ensuring availability for the needy as well as preventing risks of transfusion-transmitted diseases and saving resources. Rational use means providing the right blood or products, in the right quantity, to the right patient and at the right time, bridging demand, and supply gap. The safety, adequacy, and effectiveness can only be achieved if unnecessary transfusions can be prevented. This article discusses the physiological basis of transfusion as well as the blood components involved.
Hemolytic anemia caused by blood group incompatibility is an important cause of neonatal morbidity and mortality. Hemolytic disease of the fetus and newborn (HDFN), which is also termed as alloimmune HDFN or erythroblastosis fetalis, occurs due to destruction of red blood cells (RBCs) of the fetus or neonate by maternal immunoglobulin G antibodies. Under the conditions of anemia, the fetal bone marrow initiates production of immature erythroblasts into the fetal peripheral circulation, resulting in various manifestations of erythroblastosis fetalis, including conditions, such as hydrops fetalis, icterus gravis neonatorum, and congenital anemia of the newborn. Different approaches are being employed for the treatment of fetal anemia, such as intrauterine blood transfusion and exchange transfusion that takes place after birth. Recently, use of intravenous immunoglobulin (IVIg) has also been considered for the management of jaundice in newborns associated with hemolytic diseases.
Anemia, defined as a hemoglobin level two standard deviations below the mean for age, is prevalent among infants and children as well as adults worldwide. The evaluation of an individual with anemia should begin with a thorough history and risk assessment. Characterizing the anemia as microcytic, normocytic, or macrocytic based on the mean corpuscular volume (MCV) will aid in the work-up and management. Microcytic anemia due to iron deficiency is the most common type of anemia in children. Iron deficiency anemia, which can be associated with cognitive issues, is prevented and treated with iron supplements or increased intake of dietary iron. This review article discusses the clinical evaluation of different types of anemias based on the findings of clinical examination (i.e., pallor, pedal edema, nail changes, and epithelial changes) as well as the results of various investigations such as routine blood investigations (hemoglobin, mean cell hemoglobin concentration [MCHC], packed cell volume, etc.), peripheral smear examination, bone marrow examination, etc. Management options for various types of anemia are different and have been briefly discussed in this article.
Conjoint twins (CTs) are a very rare entity since it occurs only once in 50,000 to 2 lakh births. Female:male CTs are 3:1. Conjoint twins are monozygotic twins. In this sense, they share the same zygote where the twinning is initiated after 12 days of fertilization of egg. It may be due to genetic or environmental factors; 40% of CTs are stillborn and an additional one-third die within 24 hours of birth. We report an undiagnosed case of ischiopagus-tetrapus CTs delivered vaginally, with difficulty needing bilateral episiotomy. The bodies of two fetuses were fused laterally from mid-abdomen to pelvis along with single umbilical cord. There were two heads, four separate limbs, with fusion at pelvic region, and partially fused male external genitalia. The CTs were cyanosed and stillborn. Postnatal period was uneventful.
Bell's palsy affects pregnant women three times more often than nonpregnant women, with majority of cases occurring in the third trimester (71%) and early postpartum period (21%). Bell's palsy during pregnancy has been associated with preeclampsia, with 22% of these women developing preeclampsia. A 26-year-old G3P1L1A1 presented at 33 weeks period of gestation with chief complaint of progressive bilateral pedal edema since a week, blood pressure (BP) 150/100 mm Hg, dipstick urine 3+. Labetalol 100 mg 12 hourly was commenced for control of BP. Laboratory screening of HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome was normal. Six days later she had an episode of generalized tonic–clonic convulsion, magnesium sulfate was given and emergency laboratory investigations revealed partial HELLP syndrome [platelet 80,000, serum glutamic oxaloacetic transaminase (SGOT)/serum glutamic pyruvic transaminase (SGPT) 281/222 U/L] with normal coagulation profile. Lower segment cesarean section was done under general anesthesia with delivery of a 2 kg baby with Apgar score of 7/10 and 9/10 at 1 and 5 minutes respectively. Postoperative day 3, all laboratory reports including magnetic resonance imaging (MRI) brain were normal. Blood pressure was stabilized and she was discharged on third postnatal day, with some right-sided residual facial weakness. All obstetricians must be aware of association of Bell's palsy with hypertensive disorders of pregnancy and aggressive screen for the same as soon as diagnosed, in order to prevent complications like eclampsia and HELLP. Since Bell's palsy is not associated with adverse perinatal outcomes, it should not prompt obstetricians for unnecessary preterm inductions.
Placenta accreta syndrome is any placental implantation with abnormally firm adherence to myometrium because of partial or complete absence of decidua basalis and imperfect development of fibrinoid and Nitabuch's layers. We report a case of densely adherent placenta in a 21-year-old primipara without any other risk factor. She was referred from CHC Barnala following preterm vaginal delivery at 36 weeks 3 days with two failed attempts of manual removal of the placenta (MROP) where only a few bits of placenta could be removed. The ultrasonography (USG) confirmed retained adherent placenta with increased vascularity on color Doppler. Patient was managed conservatively with 50 mg inj methotrexate intramuscularly, single dose given followed by placental expulsion 10 days later. Repeat USG confirmed normal empty uterus. Patient was discharged in satisfactory condition.
Introduction: Bicytopenia in pregnancy is a rare entity that poses as a diagnostic challenge. It may present as a combination of anemia, leukopenia or thrombocytopenia. Though bone marrow failure is the commonest cause, nutritional deficiencies need to be ruled out. We report a case of Bicytopenia in pregnancy due to Vitamin B12 deficiency.
Case report: A 22 year old primigravida with 29 weeks of gestation presented with severe anemia. On evaluation her haemoglobin was 5.1gm/dl and blood picture showed a mixed population of normocytes, hypochromic red blood cells with macrocytes; normal neutrophil count with hypersegmented neutrophils and diminished platelets. Iron studies were normal and her serum Vitamin B12 levels were low. She was given blood transfusions to improve her hemoglobin. Post transfusion, she set into spontaneous labor and delivered a dead female baby of wt 1kg. Treatment with injectable cyanocobalamin followed by oral multivitamin led to a sustained improvement in the haematological parameters.
Discussion: This case demonstrates that B12 deficiency could be a rare cause of bicytopenia in pregnancy. Failure to diagnose and treat could lead to fatal maternal and fetal complications. Early diagnosis of B12 deficiency and supplementation is warranted.