Objectives: Primary objective was to compare screening accuracy of fetal growth assessment by conventional fundal height assessment by palpation with plotting of symphysio-fundal height (SFH) measurement on 21 st Intergrowth charts for detecting small for gestational age (SGA) foetuses. Secondary objective was to find an agreement between these two methods. Design: Prospective observational analytic study Setting: Lady Hardinge Medical College and associated hospitals, Delhi, India Population: Five hundred low risk pregnant women with singleton pregnancy, with reliable dates at ≥28 weeks from Antenatal Clinic of Lady Hardinge Medical College and associated hospitals from November 2019 to October 2021. Outcome measures: Assessment of fundal height in weeks by palpation and a lag of ≥3 weeks, suggested SGA fetus. SFH measured in centimetres and plotted on Intergrowth 21 st foetal growth charts. SFH of less than 10 th centile suggested SGA. Birthweight of new-born was plotted on Intergrowth 21 st Estimated Foetal Weight Chart. Birthweight of less than 10 th centile was classified as SGA. Results: Thirteen percent women delivered new-borns with birthweight below 10 th centile. Fundal height palpation had 98.6 % specificity and 69.9% sensitivity compared to 99.5% specificity and 83.3% sensitivity by SFH measurement for detecting SGA neonates. Conclusions: SFH measurement plotted on Intergrowth 21 st chart is more sensitive and specific for detecting SGA neonates compared to conventional fundal height palpation. Agreement between the methods measured by Cohen’s Kappa Statistic was 0.804, indicating substantial agreement between the methods. SFH measurement is a more accurate and practical tool, for use in low resource settings.

Objective: To study the impact of COVID 19 pandemic on the prevalence, clinical profile, and pregnancy outcomes of women with severe anaemia. Design: Retrospective Case Control study Setting: Department of Obstertrics ,Tertiary care hospital of Delhi Population:Antenatal women >26 weeks and Hemoglobin<7 gm% Methods: After satisfying inclusion and exclusion criteria, cases were taken for a duration of six months during COVID pandemic, covid cases and controls from period six months post covid. Main outcome measures: Prevalence of anemia, Anemia indices and maternofetal outcome. Results: Total 4031 women delivered in study period compared to 6659 in control period. 74.7% and 51.6% were anaemic in study and control groups respectively (p < 0.001). Mean hemoglobin level was significantly lower in cases compared to the controls. Microcytic hypochromic anemia was most common morphological type of anemia in both groups. Serum ferritin, serum iron, serum B12 and folic acid levels among cases were significantly (p<0.05) lower as compared to controls. Odds of foetal growth restriction was 48% higher among cases as compared to controls. The odds ratio of new-born complications such as low birth weight 2.49 (95%CI: 1.04-5.91) and need for nursery or NICU admission 4.84 (95%CI: 0.48-48.24) was higher in cases as compared to controls. Low birth rate was higher in cases and was found to be statistically significant. Conclusion: India needs to focus on minimizing the indirect effects of the pandemic on the maternal and perinatal outcomes. Funding: none

In a pandemic, where it is impossible to distinguish a pauci-symptomatic/asymptomatic patient, all must be regarded as potentially infected. The symptoms of COVID-19 are non-specific and cannot alone be used for screening. On detecting significant positive women in Non-covid suspect obstetric population led to change in strategies. Application of Truenat test for Covid screening in these asymptomatic obstetric patients on admission led to appropriate segregation of infective patients and avoided extra burden on RT-PCR lab. Our experience may be informative in re-adjusting the existing policies for other healthcare systems while setting up a mixed Covid- obstetric setting.