Browsing by Author "Robin Medhi"

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Does induction or augmentation of labor increase the risk of postpartum hemorrhage in pregnant women with anemia? A multicenter prospective cohort study in India
(John Wiley and Sons Ltd, 2024) Tuck Seng Cheng; Farzana Zahir; Carolin Solomi; Ashok Verma; Sereesha Rao; Saswati Sanyal Choudhury; Gitanjali Deka; Pranabika Mahanta; Swapna Kakoty; Robin Medhi; Shakuntala Chhabra; Anjali Rani; Amrit Bora; Indrani Roy; Bina Minz; Omesh Kumar Bharti; Rupanjali Deka; Charles Opondo; David Churchill; Marian Knight; Jennifer J. Kurinczuk; Manisha Nair
Objective: To investigate whether induction/augmentation of labor in pregnant women with anemia increases the risk of postpartum hemorrhage (PPH) and whether this risk varied by indications for labor induction/augmentation and by anemia severity in pregnancy. Methods: In a prospective cohort study of 9420 pregnant women from 13 hospitals across India, we measured hemoglobin concentrations at recruitment (≥28 weeks of gestation) and blood loss after childbirth during follow-up and collected clinical information about PPH. Clinical obstetric and childbirth information at both visits were extracted from medical records. Anemia severity in the third trimester was categorized using hemoglobin concentrations (no/mild anemia: hemoglobin ≥10 g/dL; moderate: hemoglobin 7 to 9.9 g/dL; severe: hemoglobin <7 g/dL), while PPH was defined based on blood loss volume (vaginal births: ≥500 mL or cesarean sections: ≥1000 mL) and clinical diagnosis. Indications for labor induction/augmentation were classified as clinically indicated and elective as per guidelines. We performed multivariable modified Poisson regression analyses to investigate the associations of anemia severity and indications for labor induction/augmentation, including their interaction, with PPH, adjusted for potential confounders. Results: PPH was associated with anemia but not with indications for labor induction/augmentation. However, there was a significant interaction between the two factors in relation to PPH (P = 0.003). Among pregnant women with severe anemia, a higher risk of PPH was associated with elective (adjusted risk ratio, 3.44 [95% confidence interval, 1.29–9.18]) but not with clinically indicated (adjusted risk ratio, 1.22 [95% confidence interval, 0.42–3.55]) labor induction/augmentation. No associations were observed among pregnant women with no/mild and moderate anemia. Conclusion: The risk of PPH is higher in women who have moderate–severe anemia in late pregnancy. Induction/augmentation of labor is generally safe for women with anemia, but it can increase the risk of PPH in women with severe anemia if performed electively. © 2024 The Author(s). International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.
Maternal and perinatal Health Research Collaboration, India (MaatHRI): Methodology for establishing a hospital-based research platform in a low and middle income country setting
(F1000 Research Ltd, 2020) Manisha Nair; Babul Bezbaruah; Amrit Krishna Bora; Krishnaram Bora; Shakuntala Chhabra; Saswati S. Choudhury; Arup Choudhury; Dipika Deka; Gitanjali Deka; Vijay Anand Ismavel; Swapna D. Kakoty; Roshine M. Koshy; Pramod Kumar; Pranabika Mahanta; Robin Medhi; Pranoy Nath; Anjali Rani; Indrani Roy; Usha Sarma; Carolin Solomi V; Ratna Kanta Talukdar; Farzana Zahir; Michael Hill; Nimmi Kansal; Reena Nakra; Colin Baigent; Marian Knight; Jenny J. Kurinczuk
Background: Maternal and perinatal Health Research collaboration, India (MaatHRI) is a research platform that aims to improve evidence-based pregnancy care and outcomes for mothers and babies in India, a country with the second highest burden of maternal and perinatal deaths. The objective of this paper is to describe the methods used to establish and standardise the platform and the results of the process. Methods: MaatHRI is a hospital-based collaborative research platform. It is adapted from the UK Obstetric Surveillance System (UKOSS) and built on a pilot model (IndOSS-Assam), which has been extensively standardised using the following methods: (i) establishing a network of hospitals; (ii) setting up a secure system for data collection, storage and transfer; (iii) developing a standardised laboratory infrastructure; and (iv) developing and implementing regulatory systems. Results: MaatHRI was established in September 2018. Fourteen hospitals participate across four states in India - Assam, Meghalaya, Uttar Pradesh and Maharashtra. The research team includes 20 nurses, a project manager, 16 obstetricians, two pathologists, a public health specialist, a general physician and a paediatrician. MaatHRI has advanced standardisation of data and laboratory parameters, real-time monitoring of data and participant safety, and secure transfer of data. Four observational epidemiological studies are presently being undertaken through the platform. MaatHRI has enabled bi-directional capacity building. It is overseen by a steering committee and a data safety and monitoring board, a process that is not normally used, but was found to be highly effective in ensuring data safety and equitable partnerships in the context of low and middle income countries (LMICs). Conclusion: MaatHRI is the first prototype of UKOSS and other similar platforms in a LMIC setting. The model is built on existing methods but applies new standardisation processes to develop a collaborative research platform that can be replicated in other LMICs. © 2020 Nair M et al.
Maternal and perinatal Health Research Collaboration, India (MaatHRI): methodology for establishing a hospitalbased research platform in a low and middle income country setting [version 3; peer review: 2 approved]
(F1000 Research Ltd, 2021) Manisha Nair; Babul Bezbaruah; Amrit Krishna Bora; Krishnaram Bora; Shakuntala Chhabra; Saswati S. Choudhury; Arup Choudhury; Dipika Deka; Gitanjali Deka; Vijay Anand Ismavel; Swapna D. Kakoty; Roshine M. Koshy; Pramod Kumar; Pranabika Mahanta; Robin Medhi; Pranoy Nath; Anjali Rani; Indrani Roy; Usha Sarma; Carolin Solomi V; Ratna Kanta Talukdar; Farzana Zahir; Michael Hill; Nimmi Kansal; Reena Nakra; Colin Baigent; Marian Knight; Jenny J. Kurinczuk
Background: Maternal and perinatal Health Research collaboration, India (MaatHRI) is a research platform that aims to improve evidencebased pregnancy care and outcomes for mothers and babies in India, a country with the second highest burden of maternal and perinatal deaths. The objective of this paper is to describe the methods used to establish and standardise the platform and the results of the process. Methods: MaatHRI is a hospital-based collaborative research platform. It is adapted from the UK Obstetric Surveillance System (UKOSS) and built on a pilot model (IndOSS-Assam), which has been extensively standardised using the following methods: (i) establishing a network of hospitals; (ii) setting up a secure system for data collection, storage and transfer; (iii) developing a standardised laboratory infrastructure; and (iv) developing and implementing regulatory systems. Results: MaatHRI was established in September 2018. Fourteen hospitals participate across four states in India – Assam, Meghalaya, Uttar Pradesh and Maharashtra. The research team includes 20 nurses, a project manager, 16 obstetricians, two pathologists, a public health specialist, a general physician and a paediatrician. MaatHRI has advanced standardisation of data and laboratory parameters, realtime monitoring of data and participant safety, and secure transfer of data. Four observational epidemiological studies are presently beingundertaken through the platform. MaatHRI has enabled bi-directional capacity building. It is overseen by a steering committee and a data safety and monitoring board, a process that is not normally used, but was found to be highly effective in ensuring data safety and equitable partnerships in the context of low and middle income countries (LMICs). Conclusion: MaatHRI is the first prototype of UKOSS and other similar platforms in a LMIC setting. The model is built on existing methods but applies new standardisation processes to develop a collaborative research platform that can be replicated in other LMICs © 2021. Nair M et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited
Relationship between anaemia, coagulation parameters during pregnancy and postpartum haemorrhage at childbirth: A prospective cohort study
(BMJ Publishing Group, 2021) Manisha Nair; Shakuntala Chhabra; Saswati Sanyal Choudhury; DIpika Deka; Gitanjali Deka; Swapna D Kakoty; Pramod Kumar; Pranabika Mahanta; Robin Medhi; Anjali Rani; Seeresha Rao; Indrani Roy; Carolin Solomi V; Ratna Kanta Talukdar; Farzana Zahir; Nimmi Kansal; Anil Arora; Charles Opondo; Jane Armitage; Michael Laffan; Simon Stanworth; Maria Quigley; Colin Baigent; Marian Knight; Jennifer J Kurinczuk
Objectives To investigate the association between coagulation parameters and severity of anaemia (moderate anaemia: haemoglobin (Hb) 7-9.9 g/dL and severe anaemia: Hb <7 g/dL) during pregnancy and relate these to postpartum haemorrhage (PPH) at childbirth. Design A prospective cohort study of pregnant women recruited in the third trimester and followed-up after childbirth. Setting Ten hospitals across four states in India. Participants 1342 pregnant women. Intervention Not applicable. Methods Hb and coagulation parameters: fibrinogen, D-dimer, D-dimer/fibrinogen ratio, platelets and international normalised ratio (INR) were measured at baseline. Participants were followed-up to measure blood loss within 2 hours after childbirth and PPH was defined based on blood loss and clinical assessment. Associations between coagulation parameters, Hb, anaemia and PPH were examined using multivariable logistic regression models. Outcomes measures Adjusted OR with 95% CI. Results In women with severe anaemia during the third trimester, the D-dimer was 27% higher, mean fibrinogen 117 mg/dL lower, D-dimer/fibrinogen ratio 69% higher and INR 12% higher compared with women with no/mild anaemia. Mean platelets in severe anaemia was 37.8×10 9 /L lower compared with women with moderate anaemia. Similar relationships with smaller effect sizes were identified for women with moderate anaemia compared with women with no/mild anaemia. Low Hb and high INR at third trimester of pregnancy independently increased the odds of PPH at childbirth, but the other coagulation parameters were not found to be significantly associated with PPH. Conclusion Altered blood coagulation profile in pregnant women with severe anaemia could be a risk factor for PPH and requires further evaluation. © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.
Risk factors for labour induction and augmentation: a multicentre prospective cohort study in India
(Elsevier Ltd, 2024) Tuck Seng Cheng; Farzana Zahir; Solomi V. Carolin; Ashok Verma; Sereesha Rao; Saswati Sanyal Choudhury; Gitanjali Deka; Pranabika Mahanta; Swapna Kakoty; Robin Medhi; Shakuntala Chhabra; Anjali Rani; Amrit Bora; Indrani Roy; Bina Minz; Omesh Kumar Bharti; Rupanjali Deka; Charles Opondo; David Churchill; Marian Knight; Jennifer J. Kurinczuk; Manisha Nair
Background: Guidelines for labour induction/augmentation involve evaluating maternal and fetal complications, and allowing informed decisions from pregnant women. This study aimed to comprehensively explore clinical and non-clinical factors influencing labour induction and augmentation in an Indian population. Methods: A prospective cohort study included 9305 pregnant women from 13 hospitals across India. Self-reported maternal socio-demographic and lifestyle factors, and maternal medical and obstetric histories from medical records were obtained at recruitment (≥28 weeks of gestation), and women were followed up within 48 h after childbirth. Maternal and fetal clinical information were classified based on guidelines into four groups of clinical factors: (i) ≥2 indications, (ii) one indication, (iii) no indication and (iv) contraindication. Associations of clinical and non-clinical factors (socio-demographic, healthcare utilisation and lifestyle related) with labour induction and augmentation were investigated using multivariable logistic regression analyses. Findings: Over two-fifths (n = 3936, 42.3%, 95% confidence interval [CI] 41.3–43.3%) of the study population experienced labour induction and more than a quarter (n = 2537, 27.3%, 95% CI 26.4–28.2%) experienced augmentation. Compared with women with ≥2 indications, those with one (adjusted odds ratio [aOR] 0.50, 95% CI 0.42–0.58) or no indication (aOR 0.24, 95% CI 0.20–0.28) or with contraindications (aOR 0.12, 95% CI 0.07–0.20) were less likely to be induced, adjusting for non-clinical characteristics. These associations were similar for labour augmentation. Notably, 34% of women who were induced or augmented did not have any clinical indication. Several maternal demographic (age at labour, parity and body mass index in early pregnancy), healthcare utilization (number of antenatal check-ups, duration of iron-folic acid supplementation and individuals managing childbirth) and socio-economic factors (religion, living below poverty line, maternal education and partner's occupation) were independently associated with labour induction and augmentation. Interpretation: Although decisions about induction and augmentation of labour in our study population in India were largely guided by clinical recommendations, we cannot ignore that more than a third of the women did not have an indication. Decisions could also be influenced by non-clinical factors which need further research. Funding: The MaatHRI platform is funded by a Medical Research Council Career Development Award (Grant Ref: MR/P022030/1) and a Transition Support Award (Grant Ref: MR/W029294/1). © 2024 The Author(s)
The complex relationship between iron status and anemia in pregnant and postpartum women in India: Analysis of two Indian study cohorts of uncomplicated pregnancies
(John Wiley and Sons Inc, 2023) Manisha Nair; Saswati S. Choudhury; Anjali Rani; Carolin Solomi; Swapna D. Kakoty; Robin Medhi; Sereesha Rao; Pranabika Mahanta; Farzana Zahir; Indrani Roy; Shakuntala Chhabra; Gitanjali Deka; Bina Minz; Rupanjali Deka; Charles Opondo; David Churchill; Samira Lakhal-Littleton; Elizabeta Nemeth
Low hemoglobin is widely used as an indicator of iron deficiency anemia in India and other low-and-middle income counties, but anemia need not accurately reflect iron deficiency. We examined the relationship between hemoglobin and biomarkers of iron status in antenatal and postnatal period. Secondary analysis of uncomplicated singleton pregnancies in two Indian study cohorts: 1132 antenatal women in third trimester and 837 postnatal women 12–72 h after childbirth. Associations of hemoglobin with ferritin in both data sets, and with sTfR, TSAT, and hepcidin in the postnatal cohort were examined using multivariable linear regression. Multinomial logistic regression was used to examine the association between severity of anemia and iron status. Regression models were adjusted for potential confounders. Over 55% of the women were anemic; 34% of antenatal and 40% of postnatal women had low ferritin, but 4% antenatal and 6% postnatal women had high ferritin. No evidence of association between hemoglobin and ferritin was observed (antenatal: adjusted coefficient [aCoef] −0.0004, 95% confidence interval [CI] −0.001, 0.001; postnatal: aCoef −0.0001, 95% CI −0.001, 0.001). We found a significant linear association of hemoglobin with sTfR (aCoef −0.04, 95% CI −0.07, −0.01), TSAT (aCoef −0.005, 95% CI −0.008, −0.002), and hepcidin (aCoef 0.02, 95% CI 0.02, 0.03) in postnatal women. Likelihood of low ferritin was more common in anemic than non-anemic women, but high ferritin was also more common in women with severe anemia in both cohorts. Causes of anemia in pregnant and postpartum women in India are multifactorial; low hemoglobin alone is not be a useful marker of iron deficiency. © 2023 The Authors. American Journal of Hematology published by Wiley Periodicals LLC.