Appraising LaQshya's potential in measuring quality of care for mothers and newborns: a comprehensive review of India's Labor Room Quality Improvement Initiative.

BACKGROUND: Poor intrapartum care in India contributes to high maternal and newborn mortality. India's Labor Room Quality Improvement Initiative (LaQshya) launched in 2017, aims to improve intrapartum care by minimizing complications, enforcing protocols, and promoting respectful maternity care (RMC). However, limited studies pose a challenge to fully examine its potential to assess quality of maternal and newborn care. This study aims to bridge this knowledge gap and reviews LaQshya's ability to assess maternal and newborn care quality. Findings will guide modifications for enhancing LaQshya's effectiveness. METHODS: We reviewed LaQshya's ability to assess the quality of care through a two-step approach: a comprehensive descriptive analysis using document reviews to highlight program attributes, enablers, and challenges affecting LaQshya's quality assessment capability, and a comparison of its measurement parameters with the 352 quality measures outlined in the WHO Standards for Maternal and Newborn Care. Comparing LaQshya with WHO standards offers insights into how its measurement criteria align with global standards for assessing maternity and newborn care quality. RESULTS: LaQshya utilizes several proven catalysts to enhance and measure quality- institutional structures, empirical measures, external validation, certification, and performance incentives for high-quality care. The program also embodies contemporary methods like quality circles, rapid improvement cycles, ongoing facility training, and plan-do-check, and act (PDCA) strategies for sustained quality enhancement. Key drivers of LaQshya's assessment are- leadership, staff mentoring, digital infrastructure and stakeholder engagement from certified facilities. However, governance issues, understaffing, unclear directives, competency gaps, staff reluctance towards new quality improvement approaches inhibit the program, and its capacity to enhance quality of care. LaQshya addresses 76% of WHO's 352 quality measures for maternal and newborn care but lacks comprehensive assessment of crucial elements: harmful labor practices, mistreatment of mothers or newborns, childbirth support, and effective clinical leadership and supervision. CONCLUSION: LaQshya is a powerful model for evaluating quality of care, surpassing other global assessment tools. To achieve its maximum potential, we suggest strengthening district governance structures and offering tailored training programs for RMC and other new quality processes. Furthermore, expanding its quality measurement metrics to effectively assess provider accountability, patient outcomes, rights, staff supervision, and health facility leadership will increase its ability to assess quality improvements.

Clinical outcomes in higher-order multiples reduced to dichorionic diamniotic (DCDA) twins compared with primary twins and singletons: A prospective observational study.

OBJECTIVE: To compare outcomes in higher-order multiple pregnancies reduced to dichorionic diamniotic (DCDA) twins with primary DCDA twins and singleton pregnancies. METHODS: This prospective observational study included all higher-order multiple pregnancies that underwent ultrasound-guided transabdominal fetal reduction at 11-13 weeks of gestation from January 2018 to June 2020. Outcomes were compared with 100 primary DCDA twins and 1078 singletons. RESULTS: Sixty-four higher-order multiples underwent reduction at mean gestational age of 11.46 weeks. Of the reduced pregnancies, 3.12% resulted in miscarriage before 24 weeks compared with 2% (2/100) of primary twins and 0.74% of singletons (P = 0.09). The mean gestational age at delivery was 33.48 weeks for reduced twins, 34.52 weeks for primary twins (P = 0.10) and 38.14 weeks for singletons (P < 0.001). Compared with primary twins, the adjusted odds of preterm delivery before 34 weeks and before 36 weeks for reduced twins were 0.56 (95% confidence interval [CI] 0.48-3.54, P = 0.62) and 0.84 (95% CI 0.78-8.85, P = 0.08), respectively. There was no significant difference in rates of pre-eclampsia, Cesarean delivery, birth weight below the 10th and 3rd centiles, and perinatal mortality among primary and reduced twins. All risks were significantly lower in singleton pregnancies. CONCLUSION: Reduced twins have similar obstetric and perinatal outcomes as primary twins, but adverse outcomes are significantly higher in both groups when compared with singleton pregnancies.

Comparison of Ribbond and Everstick Post in Reinforcing the Re-attached Maxillary Incisors Having Two Oblique Fracture Patterns: An In Vitro Study.

AIM AND OBJECTIVE: This study aims to compare the resistance to fracture in maxillary incisors which were fractured in two different oblique patterns and then were re-attached and reinforced using anatomic fiber-reinforced composite (FRC) post. MATERIALS AND METHODS: Sixty extracted and intact human maxillary incisors were obtained and divided into two groups (A and B; n = 30). "Labiopalatal" and "palatolabial" fractures were induced in group A and group B, respectively. These two groups were further subdivided into two subgroups (n = 15). In subgroup I Ribbond fiber (Ribbond Inc., Seattle, WA, USA) and in subgroup II Everstick post (everStick Post™, GC Corporation, Tokyo, Japan) were used. Fractured fragments were re-attached using resin and tested for fracture resistance in universal testing machine. Statistical analysis was done with ANOVA one-way test and post hoc test. RESULTS: The labiopalatal fracture pattern of group A showed significantly increased resistance to fracture than the palatolabial fracture pattern of group B in both the subgroups. Similarly, subgroup II with Everstick post exhibited significantly higher fracture resistance than subgroup I with Ribbond in both groups A and B (p value < 0.05). CLINICAL SIGNIFICANCE: The study simulates a clinical scenario of coronal fracture of a tooth and focuses on the techniques and materials which can be used for successful management of such cases. HOW TO CITE THIS ARTICLE: Khurana D, Prasad AB, Raisingani D, et al. Comparison of Ribbond and Everstick Post in Reinforcing the Re-attached Maxillary Incisors Having Two Oblique Fracture Patterns: An In Vitro Study. Int J Clin Pediatr Dent 2021;14(5):689-692.

Revisiting absent nasal bone in the second trimester.

PURPOSE: To evaluate the outcomes of fetuses diagnosed with absent nasal bone in the second trimester. METHODS: This prospective, observational study included all fetuses who were diagnosed at or referred to our fetal medicine center with an absent nasal bone from 16 weeks onwards from November 2017 to December 2019. Amniocentesis for fetal karyotype and microarray was offered to all women. Women who opted not to undergo invasive testing were also followed up and neonatal outcome noted. RESULTS: 26 fetuses were eligible for inclusion in the study. 8 (30.8%) out of these were diagnosed with aneuploidy: 7 with trisomy 21 and one with trisomy 18. All fetuses with aneuploidy had additional ultrasound abnormality and/or high risk on biochemical screening. CONCLUSIONS: Isolated absent nasal bone in the second trimester with prior low risk on combined screening performed by certified sonographers is unlikely to be associated with Down syndrome.

Infant Hearing Screening in India: Current Status and Way Forward.

Loss or impairment of auditory sense is the most prevalent deficit of all the sensory organs. With virtually no mortality, hearing impairment causes huge impact on one's social, educational and economic well-being. There are 5-6 infants who are hard of hearing out of 1000 neonates. They will not be identified till they attain 2 or more years of age, by then irreversible damage would have been done. Universal screening for hearing of new-borns is the only way to decrease the burden of deafness in our society. There are tools available which can be administered by health workers after initial training for screening the infants for hearing impairment. Under the aegis of National Programme for Prevention and Control of Deafness (NPPCD) of India universal screening can and should be applied. The programme would entail additional financial burden for the initial purchase of screening machines and rehabilitating the identified children.