Early feeding in preterm IUGR neonates with AREDF on antenatal UA Doppler allowed earlier discontinuation of PN, allowing birth weight to be regained earlier and did not increase the incidence of NEC and FI.

Acute appendicitis is the most common extra-uterine surgical emergency requiring immediate surgical intervention during pregnancy [1]. Six young female patients presented with appendicitis during May 1996 to May 2001 in different service hospitals. Five patients underwent emergency appendectomy successfully. Gestational age at presentation included first trimester in 4 patients, second trimester in 2 patients and none in third trimester. 84% had pathologically proven acute appendicitis. One patient presented with appendicular lump in first trimester, proved on ultra sonography examination, which was treated by Oshner Sherren regime and subsequently interval appendectomy was done in second trimester. No long term adverse maternal morbidity or mortality was reported. One patient had premature onset of labour and delivered. Natural history of acute appendicitis is not changed during pregnancy while gestational physiological changes obscure the accurate diagnosis of acute appendicitis.

Second stage of labour has been often neglected leading to increased maternal and perinatal morbidity. Recognising and managing prolonged second stage is a challenge even to an experienced obstetrician. This article reviews the changes in the definition of prolonged second stage over the years. It discusses the causes, recognition and management options along with the difficulties in delivering a patient with prolonged second stage of labour. Though adding an extra hour to the definition of second stage in patients may reduce the rate of caesarean section but some studies also show a rise in maternal and perinatal morbidity. Obstetricians are familiarized to the different techniques of delivery of the impacted head. Once diagnosis of prolonged second stage is confirmed, causes should be identified and addressed, and treatment should be individualised, and timing and mode of intervention planned.

Original ArticleIntroduction L abour and delivery results in severe pain for many women. The McGill Pain Questionnaire ranks labour pain in the upper part of the pain scale between cancer pain and amputation of a digit [1]. The goal of maternal labour analgesia is relief of pain without compromising maternal safety, progress of labour and foetal well-being. Epidural analgesia is the most effective and least depressant method of intrapartum pain relief in current practice [2]. Low concentration of bupivacaine combined with fentanyl, results in analgesia with minimal side effects [3]. The aim of the study, was to develop a safe dosing regime to provide satisfactory pain relief with minimal side effects. Material and MethodsIt was a prospective open label study. We studied 45 primiparous and five second gravida women with singleton foetus in vertex position admitted for parturition in the age group of 18-30 years. Parturients with obstetric complications like pre-eclampsia, preterm labour, previous caesarian, abnormal lie and placenta previa were excluded from the study. Once the parturient is in active phase of labour i.e. cervix is 3-4 cms dilated, anaesthesiologist was called for lumbar epidural block.After explaining the procedure, 500 ml of ringer lactate was infused as preload. Pre-epidural pulse, blood pressure (BP), SpO 2 and pain score (using Visual Analogue Scale-VAS) were checked. Foetal heart rate (FHR) was continuously monitored using cardiotocograph. All the parturient were kept fasting, but clear fluids were allowed till delivery. Epidural space was identified in L2-3 / L3-4 interspinous space using loss of resistance to saline and multiorifice epidural catheter inserted. Initial bolus of 10 ml of drug solution (0.1% bupivacaine and 0.0002% fentanyl) was injected in two aliquots, five ml in left lateral and five ml in right lateral position at an interval of five minutes. Maternal pulse, BP, SpO 2 and FHR were monitored every five minutes for the first 30 minutes. After 30 minutes pain score using VAS and motor blockade using modified Bromage Score (Table 1) was checked. If pain relief was satisfactory (VAS <5) and there were no motor block or evidence of significant hypotension an epidural infusion (with syringe infusion pump) of the same drug solution was started at the rate of 5ml /hour. Patient was assessed at 30 minutes interval for pain relief (objective assessment using VAS on 1-10 scale and subjective assessment by mother as excellent/good/fair/poor), maternal haemodynamics, foetal heart rate, motor block, duration of second stage of labour, incidence of caesarian section, instrumental delivery, side effects, complications (sedation, nausea, vomiting, itching, urinary retention) and total dose of bupivacaine and fentanyl used.

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We discuss the reprogramming of CD34 cells isolated from UCB of a healthy female child of Indian ethnicity. The CD34cells were nucleofected using episomal vectors expressing Oct4, Sox2, L-Myc, Klf4, Lin28 and p53DD (negative mutation in p53). The colonies were stained for alkaline phosphatase and evaluated for pluripotency marker expression by PCR, immunofluorescence and flow-cytometry. The safety of cells was confirmed by absence of plasmid in subsequent passages by PCR. G-banded karyotype demonstrated a stable genome. The ability of tri-lineage differentiation was confirmed by specific marker expression by immunofluorescence invitro and teratoma formation invivo.

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