Background: Neonatal Hyperbilirubinemia is one of the most common reasons for NICU admissions. The frequency of neonatal jaundice has been on an increase since the last decade. Is the increase due to changes in obstetric practice or drugs? There is no definite reason. This study was undertaken to find out any obstetric characteristics which may contribute to the development of Neonatal Hyperbilirubinemia and which is modifiable.Methods: Record review data from 140 singleton deliveries at the Institute of Maternal & Child Health ,Govt. Medical College, Kozhikode, Kerala were analyzed to determine the relationship between neonatal hyperbilirubinemia (>10mg/dl) and maternal characteristics. Confounding variables were controlled by multiple logistic regression analysis.Results: There was statistically significant relationship between hyperbilirubinemia and LBW, preterm delivery, PPROM, breast feeding, neonatal infection, instrumental delivery and presence of GDM and IUGR.Conclusions: By identifying these obstetric characteristics, we may be able to modify them and reduce the need for NICU admissions for Neonatal Hyperbilirubinemia.

Objectives: To assess the efficacy of self-collected vaginal samples compared with physician-collected cervical samples for the detection of HPVDNA. Methods: A hospital-based cross-sectional study was carried out among patients with newly diagnosed cervical cancer attending . Consenting patients collected their vaginal samples, followed by cervical sample collection by the clinician. The paired samples were transported at 4-8 °C to the laboratory. Amplification of LCR/E6/E7 regions of the HPV genome was done by polymerase chain reaction (PCR). The agreement level between paired samples was assessed by the Kappa index.Results: Among the 114 cervical cancer patients enrolled in the present cross-sectional study, the prevalence of HPV DNA was 78.1% (95% confidence interval [CI] 69.2%-85%) in cervical samples and 77.2% in vaginal samples (95% CI 68.7%-83.9%). The overall agreement between the two sampling methods was 93.9% and the kappa value was 0.82 (P<0.001). The sensitivity of HPV detection using vaginal samples was 98.9% (95% CI 93.9%-99.8%) and the specificity was 100% (95% CI 86.7%-100%) with cervical sampling as the gold standard. By Kappa index, an almost perfect agreement for HPV DNA detection between self-collected and physician-collected samples was observed. Conclusion:Self-collection of vaginal samples ensures equity of cervical cancer screening in low-income countries such as India. K E Y W O R D S

Background:WHO has recommended Visual Inspection with Acetic acid (VIA) or Human Papillomavirus (HPV) DNA testing if feasible, for cervical cancer screening in low income countries. However, the number of women undergoing screening is very low as a result of limited information, inadequate infrastructure and invasive nature of sampling. Methods:A cross sectional study was carried out comparing HPV DNA detection by Polymerase Chain Reaction (PCR) in paired cervical and urine samples procured from histologically confirmed cervical cancer cases. Results:Amongst the samples collected from 114 cervical cancer cases, HPV DNA was tested positive in cervical samples of 89 (78.1%) and urine samples of 55 (48.2%) patients. The agreement between the two sampling methods was 66.7% and the kappa value was 0.35 indicating a fair agreement. The sensitivity of HPV detection using urine samples was 59.6% (95% confidence interval 49.16%-69.15%) and the specificity was 92% (95% confidence interval 75.0%-97.8%). Conclusion:Even though not acceptable as an HPV DNA screening tool due to low sensitivity, the urine sampling method is inexpensive and more socially acceptable for large epidemiological surveys in developing countries to estimate the burden.

BACKGROUND Doppler velocimetry is a non-invasive method of measuring changes in blood flow. (1,2,3) Randomised Control Trials (RCTs) have shown that using Doppler indices in the management of Intrauterine Growth Restriction (IUGR) cases leads to a significant reduction in perinatal mortality rate. Deterioration of various Doppler indices precedes abnormal Biophysical Profile (BPP) by 1-2 weeks. (1,2,3,4) Umbilical artery indices only reflect the placental status. Fetal response to this increasing placental insufficiency can be deduced from studying the Cerebroplacental Ratio {CPR}, which gives us an idea of the fetal response to the placental status and is potentially more advantageous in predicting fetal outcome. OBJECTIVES To compare CPR in predicting fetal outcome with UA and MCA indices. MATERIALS AND METHODS Prospective cohort study of cases of IUGR-January 2013 to December 2013. 180 cases of clinically diagnosed IUGR were selected. Obstetric USG and Doppler was performed. The S/D ratio, RI, PR values were obtained and CPR calculated. All cases were managed as per the protocol then in place using U/A SD ratios for determining the timing & mode of termination RESULTS Of 180 cases of IUGR were selected most women were primigravidae, 20-34 years, and from low socioeconomic status. (3) 25 women (13.8%) had oligohydramnios (AFI <5). Of these women, 24 had an abnormal CPR, 1 normal CPR. 47% with abnormal CPR had caesarean for fetal distress. Birth weight was <1.5 kg in 14.4% of patients all of whom were in the abnormal CPR group. 7.5% had an Apgar <7; all these babies were in the abnormal CPR group. 43.9% of babies from the abnormal CPR group needed resuscitation. 79% of the abnormal CPR group babies needed NICU admission. CONCLUSION Utilization of only UA and MCA indices may cause unnecessary early intervention in some cases. (1,5) CPR can help triage pregnancies in need of termination while prolonging those which are relatively stable so as to gain more time fetal maturity and cervical ripening. CPR can predict the perinatal outcome of IUGR pregnancies.