How to cite this article:
Mundkur A, Paladugu S, Yedlapalli S, Vasudeva A, Shivananda RP, Hegde N. Performance of Fetal Renal Artery Doppler Compared with Umbilical Artery Doppler in Mild and Moderate Fetal Growth Restriction: An Observational Study in a Tertiary Care Hospital. Int J Infertil Fetal Med 2020; 11 (1):1-4.
Background: Fetal growth restriction (FGR) and oligoamnios are one of the major reasons of preterm delivery and low birth weight contributing to almost two-third of neonatal mortality. Fetal kidney, in addition to placenta, acts in controlling and regulating physiology of the fetus. Doppler ultrasound has become a part of routine antenatal care in monitoring such high-risk pregnancies. However, renal artery was the least studied.
Aim and objective: To compare the relationship of perinatal outcomes with renal artery Doppler and umbilical artery Doppler indices.
Materials and methods: A prospective observational study carried out among women attending an antenatal clinic and who have undergone delivery in Department of Obstetrics and Gynecology, in a tertiary care hospital between August 2016 and May 2018. Regular ultrasonography was done at 28–31 weeks; they were followed up 4 weeks later and Doppler indices were noted.
Results: In the 394 patients studied, 13.1% were having FGR, 12.2% were oligoamnios, and 12.2% had preterm delivery. The p values of the pulsatility index and the resistivity index of the renal artery in FGR, oligoamnios, preterm delivery, and low birth weight were more significant than umbilical artery Doppler indices.
Conclusion: Renal artery Doppler indices were significantly more reliable in predicting adverse perinatal outcomes in cases of mild uteroplacental insufficiency. Additionally, renal artery Doppler indices were able to pick up these changes earlier than umbilical artery Doppler, hence a potential early indicator, and the pulsatility index being more specific and sensitive.
Limitations: Sample size of the study is limited with only mild cases of FGR. Larger studies are required. In addition, patients at a higher risk of FGR in comparison with low-risk cases should be studied with more sample size as this study did not show any significant association with comorbidities.
Nayana D Hiremath,
Introduction: Hysterolaparoscopy often brings to light the hitherto unexpected pathology. The objective of this study was to evaluate various etiological factors in infertility by hysterolaparoscopy and to evaluate therapeutic interventions done during hysterolaparoscopy.
Materials and methods: Women posted for hysterolaparoscopy for infertility workup in JSS hospital during the period from November 01, 2014, to October 31, 2016, were included in the study. First hysteroscopy was performed. In hysteroscopy, endocervical canal was visualized for any growth or polyps. Diagnostic laparoscopy was performed using a 30-degree deflection angle telescope powered with a fiber-optic cable for light source.
Results: On hysteroscopy, out of 90 cases, 68 (75.6%) had normal findings, 10 (11.1%) had endometrial polyps, 5 (5.6%) had septate uterus, 3 (3.3%) had hyperplastic endometrium, and there was 1 case each of submucous fibroid, atrophic endometrium, intrauterine adhesions, and hypoplastic uterus. Laparoscopic interventions were performed in the form of ovarian cystectomy in 17 (18.8%), paraovarian cystectomy in 3 (3.3%), adhesiolysis in 2 (2.2%) cases, drilling of polycystic ovaries in 26 (28.8%) cases, fulguration or excision of endometriosis nodules in 4 (4.4%), myomectomy in 7 (7.7%) cases), fimbrial cystectomy in 2 (2.22%), and unilateral salpingectomy done in 2 (2.22%).
Conclusion: Hysterolaparoscopy is an effective and safe tool in comprehensive evaluation of infertility to diagnose and treat the various pathological conditions in a single sitting.
Background: Vitamin D deficiency is a common endocrinological problem. Maternal vitamin D insufficiency during pregnancy has been associated with many pregnancy-related complications like preeclampsia, gestational diabetes (GDM), preterm labor, and low birth weight (LBW). Maternal vitamin D deficiency can lead to poor skeletal growth and reduced bone mineral density in children.
Aims and objectives: To study the prevalence of vitamin D deficiency in antenatal women and to study an association between vitamin D deficiency and maternal and neonatal complications.
Materials and methods: A prospective study of 100 antenatal women presenting to obstetrics and gynaecology OPD at GSMCH, Banur. Out of these, data from 94 women were finally analyzed. For the rest of the women, follow-up and intrapartum and neonatal details were not available, so they were excluded from the study.
Results: The prevalence of vitamin D deficiency in the present study was 79.8%. The rate of small for gestational age babies (SGA) and oligohydramnios was significantly higher in the study group. There was no significant difference in the incidence of GDM, preterm labor, and preterm premature rupture of membranes (PTPROM).
Conclusion: Antenatal vitamin D deficiency is associated with hypertensive disorders of pregnancy (HDP), SGA, oligohydramnios, and LBW. So, routine vitamin D supplementation should be recommended in the antenatal period.
Background: Infertility has been identified as a health issue worldwide and it is of great concern among married couples in our society. Scientifically, it has been established that both males and females can contribute to infertility. However, in most cases, women are held responsible for the same without proper diagnosis. Statistically, female factors contribute to about 40–60% of infertility cases, whereas 20–40% of infertility cases are due to factors contributed by males, of which, deficiency in semen quality is the major cause which accounts for 40–50% of infertility cases. A decrease in semen quality has been reported which can be due to lifestyle changes, occupational exposures to chemicals, heat, and stress.
Aims: To study the prevalence of infertility, distribution of sperm abnormalities, and the impact of occupation on men visiting a tertiary clinic.
Settings and design: Male partners of infertile couples who visited the fertility center were considered for the study.
Materials and methods: Seminal fluid was analyzed for volume, sperm concentration, motility (progressive motility), and morphology.
Results: In this study conducted in our center, we found that 55.8% of the patients had sperm abnormalities, among which teratozoospermia was the commonly observed anomaly.
Conclusion: Male factors equally contribute to infertility as female factors. Semen analysis is the crucial diagnostic test for infertility assessment of the male partner.
Key messages: The incidence of male infertility has been increasing recently and the evaluation and prognosis of male subfertility are challenging. Although semen analysis is the primary test for the assessment of infertility in males, it does not recognize the abnormality in idiopathic infertility. Thus, new techniques and methods need to be developed to improve accuracy and reduce variation.
Background: To discuss a series of complex non-immune fetal anemia cases, including etiology, investigations, workup, diagnosis, and management.
Materials and methods: Five complex non-immune cases of fetal anemia seen in our department are presented.
Results: Of the five cases presented, all are live births with follow-up least up to 1.5 years of age. They are cases of hereditary spherocytosis, congenital dyserythropoietic anemia, MCDA twins—twin-twin transfusion syndrome (TTTS) post-laser co-twin demise-fetal anemia, placental chorioangioma, and massive fetomaternal hemorrhage.
Conclusion: Non-immune causes of fetal anemia can be difficult to diagnose its etiology and hence complex to manage. Repeated intrauterine transfusions may be the only perinatal management. The perinatal morbidity/mortality and preterm delivery rates are increased, and some cases require long-term treatment including regular transfusions. We present our experience of a series of complex non-immune fetal anemia managed in a tertiary unit, review the literature, and suggest appropriate management.
Choledochal cysts (CCs) are rare congenital anomaly with characterized dilatation of intra- or extrahepatic biliary duct or both. Prenatal diagnosis is increasing due to high resolution of ultrasound (US) and ultrafast sequences of magnetic resonance imaging (MRI) showing better delineation of the cyst to the adjacent structure. Considering the additional value of the fetal MRI report is still infrequent to confirm the CC case, we therefore report the type I of CC, which was previously diagnosed as a cystic biliary atresia (CBA) from US result. Postnatal MRI and histopathology prove it.
Umbilical vein varix is an uncommon vascular anomaly. The varix may be the initial presentation of an underlying congenital portosystemic shunt adversely affecting the fetus as we demonstrate in this case. To be able to label a varix as an isolated finding necessitates a thorough evaluation of the fetal venous system as well. Serial ultrasound of the fetus can help in detecting changes in the varix, thrombosis, growth restriction, as well as heart failure if there is another underlying venous anomaly. Early postnatal imaging is essential to exclude other associations to optimize the neonatal outcome. The prognosis is good if it is an isolated finding.