International Journal of Infertility & Fetal Medicine

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2022 | September-December | Volume 13 | Issue 3

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EDITORIAL

Kamini A Rao

EDITORIAL

[Year:2022] [Month:September-December] [Volume:13] [Number:3] [Pages:1] [Pages No:00 - 00]

   DOI: 10.5005/ijifm-13-3-iv  |  Open Access |  How to cite  | 

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RESEARCH ARTICLE

Chandrakala Magudapathi, Sumangali Thirunavukkarasu, Sowmya Ravikumar

Umbilical Artery Doppler Flow Velocimetry in Intrauterine Growth Restriction and its Relation to Perinatal Outcome

[Year:2022] [Month:September-December] [Volume:13] [Number:3] [Pages:4] [Pages No:87 - 90]

Keywords: Intrauterine growth restricted, Preterm, Ultrasonography, Umbilical Doppler

   DOI: 10.5005/jp-journals-10016-1297  |  Open Access |  How to cite  | 

Abstract

Materials and methods: A retrospective data analysis was conducted on antenatally detected intrauterine growth restricted (IUGR) fetuses born between 26 and 38 weeks of gestational age with high resistance Doppler flow (HRDF) and absent or reversed end-diastolic flow (AREDF), excluding multiple gestations. The data was collected using an obstetric information management system and evaluated. About 152 cases were identified over a 5-year period in our tertiary referral center. The patients were divided into two groups: those with elevated systolic/diastolic ratio group of 95th or more percentile (n = 123, 81%) and those with absent/reversed end-diastolic flow (n = 38, 19%). Maternal characteristics and perinatal outcomes of these groups were comparatively analyzed. Results of umbilical artery Doppler showed a significant correlation with the perinatal outcome. The poor perinatal outcome was 26% in those with absent or reversed diastolic flow in Doppler, as compared to only 1% in those with increased Doppler flow. Using Fischer’s exact test, the result is statistically significant (p < 0.05). Predictors of nonsurvival were the presence of reversed end-diastolic flow and preterm <30 weeks of gestation. Nonsurvivors had a significantly lower gestational age at diagnosis and delivery. Conclusion: Antenatal umbilical artery Doppler is shown as a significantly efficient marker in predicting perinatal outcomes in IUGR fetuses. Severely abnormal umbilical artery blood flow poses a significant risk for pregnancy, while perinatal mortality is also dominated by gestational age at diagnosis and delivery.

185

RESEARCH ARTICLE

R Aishwarya, Shanthi Ethirajan

Gestational Age at Booking for Antenatal Care in a Tertiary Healthcare Facility: A Glance

[Year:2022] [Month:September-December] [Volume:13] [Number:3] [Pages:5] [Pages No:91 - 95]

Keywords: Antenatal visit, Care, Early booking, Late booking, Pregnancy outcome

   DOI: 10.5005/jp-journals-10016-1295  |  Open Access |  How to cite  | 

Abstract

Background: Perinatal care is important to improve the outcome of the pregnancy and reduce associated morbidity and/or mortality to the pregnant mother and the developing fetus. Ideally, preconception counseling and preparedness for conception are necessary for an optimal pregnancy outcome. But this is not practiced by everyone due to various reasons. In such a scenario, an early antenatal visit will provide an opportunity for early screening and prepare a plan of care that will result in a better outcome of the pregnancy. In many countries, pregnant women still start their first antenatal visit late. Hence this study aims to determine the mean gestational age at booking, the magnitude and the factors associated with late booking for antenatal care in a tertiary care referral hospital. Objectives: (1) To assess the gestational age of booking for antenatal care in a tertiary referral healthcare facility. (2) To assess the prevalence of late booking and factors contributing to it. Materials and methods: This is a prospective study conducted on pregnant women visiting the outpatient Obstetrics and Gynaecology Department at Saveetha Medical College and Hospital from February 2020 to July 2020. A total of 203 pregnant mothers, who consented to the study, were interviewed at the antenatal clinic by using a structured questionnaire. The data was compiled and assessed using Microsoft Excel. The mean gestational age at booking and prevalence of late booking visit and their causes are assessed. Bivariate and multivariate data analysis was performed using Statistical Software for the Social Sciences (SPSS) for Windows version 16.0. Result: This study showed that 203 pregnant women who participated in the study were between 19 and 40 years of age. A total of 121 patients were nulliparous, and 82 were multiparous. The mean gestational age at booking was found to be approximately 11 weeks of gestation in the study group. Around 83 were late for their booking visit (40.89%). Lack of knowledge of early booking and its benefits was the most common cause of increased gestational age at the first antenatal visit (28.92%). The recent COVID-19 outbreak this year has caused a delay in the booking of 12 patients (14.46%).

122

RESEARCH ARTICLE

Prasanth Gunasekaran, Madhukar Hemamalini, Rajakannan Venkatachalam

Structure Prediction and Binding Site Analysis of Human Sperm Hyaluronidases

[Year:2022] [Month:September-December] [Volume:13] [Number:3] [Pages:5] [Pages No:96 - 100]

Keywords: Acrosome reaction, Homology modeling, Hyaluronic acid binding, Molecular docking, Sperm hyaluronidases

   DOI: 10.5005/jp-journals-10016-1280  |  Open Access |  How to cite  | 

Abstract

Background: Sperm cell hyaluronidases are important class of enzymes which play a prominent role in hydrolyzing hyaluronan during sperm penetration through the layer of cumulus and zona pellucida of egg. Clinically sperm hyaluronidases play important role in analyzing sperm binding quality during IVF treatments by hyaluronan binding assay. The functions of sperm hyaluronidases such as penetrating the hyaluronan matrix of cumulus layer, inducing hyaluronan-based acrosome reaction were directly related to substrate binding efficiency of these enzymes. Though hyaluronidases were confirmed to play the hyaluronan hydrolyzing role in fertilization, there is no structural evidence to prove their difference in molecular weight-based substrate specificity and their multifunctional activity in fertilization. This work presents the evidence on the binding modes of hyaluronan with sperm cell hyaluronidases using homology modeling and molecular docking methods. Materials and methods: The different isoforms of human sperm hyaluronidases were modelled using human hyaluronidase 1 (PDB code 2PE4) and the optimized structure of hyaluronan from the crystal structure of bee venom hyaluronidase complexed with HA tetramer (PDB Code: 1vcz) was docked using AUTODOCK TOOLS. The results are evaluated based on the complex binding energy and interaction with substrate binding residues. Results: The molecular docking results confirm the binding of hyaluronan with HYAL-2 in the deep substrate-binding groove, which was absent in HYAL-3 and HPH-20 hyaluronan complex. The binding of hyaluronan with HPH-20 and HYAL-3, involved in neutral-active domain and residues present in perpendicular beta sheets. The binding mode of HYAL-2 is more on acid-active region of the enzyme which was considered to induce hyaluronan-dependent cell signaling and AR activation. Conclusion: The results conclude that the substrate accommodation pattern of HYAL-2 was differed from HYAL-3 and HPH-20 where the acid active domain of HYAL-2 may predominantly involve in AR activation and zona pellucida penetration apart from cumulus HA degradation.

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RESEARCH ARTICLE

Mounika Kachakayala, Suseela Vavilala

Stage-based FGR (Barcelona Protocol): Perinatal Outcome in SGA and FGR

[Year:2022] [Month:September-December] [Volume:13] [Number:3] [Pages:10] [Pages No:101 - 110]

Keywords: Fetal growth, Fetal growth restriction (FGR), Multivessel fetal Doppler, Perinatal outcome, Small for gestational age (SGA)

   DOI: 10.5005/jp-journals-10016-1294  |  Open Access |  How to cite  | 

Abstract

Objective of the study: To identify adverse perinatal outcomes, these include stillbirth, neonatal death, hypoxic-ischemic encephalopathy, need for mechanical ventilation, or severe metabolic acidosis in small for gestational age (SGA) and in all stages of fetal growth restriction (FGR) based on Barcelona Protocol. To evaluate the demographic variables, maternal risk factors, mode of delivery, birthweight, and indications of operative delivery in SGA and all stages of FGR. Materials and methods: It is a prospective observational study underwent from January 2019 to June 2019 at the Department of Fetal Medicine, Fernandez Hospital. All mothers with singleton pregnancies, who came for fetal growth scan, it’s mandatory to have expected delivery date (EDD) confirmed in first trimester itself and estimated fetal weight (EFW) < 10th percentile were included in the study. Multiple pregnancies, structurally abnormal fetuses, first scan >20 weeks (GA not accurate) were excluded from the study. Mothers with EFW < 10th percentile underwent serial sonographic evaluation of estimated fetal weight at 2-weekly intervals including multivessel Doppler assessment based on staged-based protocol. If the EFW 3–10th percentile, multivessel Doppler findings are within normal range the fetus is termed as SGA fetus and is followed up every 2 weeks. If the EFW < 3rd percentile or any of the multivessel Doppler findings show features of placental insufficiency, the fetus is termed as FGR, and management is based on the stage-based Barcelona Protocol. Maternal, fetal, and neonatal characteristics, neonatal morbidity, and adverse perinatal outcome were recorded. Results: Among 6,240 mothers who underwent growth scans during the study period, 14% (n = 858) with EFW < 10th percentile were taken as the study population. A total of 768 pregnant women were included in the study. Based on Barcelona protocol, 68% (n = 521) and 32% (n = 247) were termed FGR and SGA, respectively. FGR fetuses were classified into four stages —488 (95%), 23(14.4%), 10(2%), I, II, III, and IV, respectively. Among 247 pregnant women with SGA fetuses, 42% required induction of labor, FGR stage I (488), 40% required induction of labor. FGR stage II & III fetuses (25) 27% required induction of labor. Fetuses grouped under stages II & III have 61% admissions into NICU, compared to 12% in FGR stage I and 2% SGA group fetuses. There are no adverse perinatal outcomes in SGA group. In FGR stage I group, adverse perinatal outcomes in terms of metabolic acidosis, 5 minutes APGAR < 7, hypoxic ischemic encephalopathy (HIE), need for mechanical ventilation are 1.8%, 0.6%, 0.6%, 0.8%, respectively. In FGR stage II & III, metabolic acidosis was diagnosed in five (15%) neonates, two neonates (6%) required mechanical ventilation with four (12%) of stillbirths. There is one neonatal death (NND) in the entire cohort, classified under FGR stage I. Conclusion: Incorporation of Barcelona protocol as a structured antenatal surveillance protocol discriminates between SGA fetuses and stages of FGR. Prenatal recognition of FGR allows for close monitoring and timely delivery. There is a higher risk for adverse perinatal outcomes in FGR II & III compared to FGR stage I and SGA fetuses.

393

RESEARCH ARTICLE

Devendra Arora, Madhusudan Dey, Sanjay Singh, Abhijeet Kumar, Vinod G Nair

Management of Rh-negative Alloimmunized Pregnancy Optimizing Perinatal Mortality and Morbidity: A Single-center Study

[Year:2022] [Month:September-December] [Volume:13] [Number:3] [Pages:5] [Pages No:111 - 115]

Keywords: Exchange transfusion, Fetal anemia, Indirect Coombs test, Intrauterine transfusion, Perinatal mortality, Rhesus isoimmunization

   DOI: 10.5005/jp-journals-10016-1291  |  Open Access |  How to cite  | 

Abstract

Objective: The aim of the study was to report pregnancy and fetal outcomes of Rhesus (Rh)-negative pregnancy at a tertiary care teaching hospital. Materials and methods: Prospective observational study was carried out on all Rh-negative women over 3 years period. On the basis of the evolution of indirect Coombs test (ICT), titer and middle cerebral artery peak systolic velocity (MCA-PSV) value, women were categorized into five groups. In the group with ICT >1:32 and MCA-PSV >1.5, multiple of median (MOM) or any features of hydrops underwent intrauterine transfusion (IUT). Pregnancy outcomes, neonatal outcomes, and procedure-related adverse events were analyzed. Results: A total of 496 women were recruited, out of which 411 were non-alloimmunized, and 85 were alloimmunized. Out of 85 alloimmunized pregnancies, 47 fetuses underwent 148 IUT. The overall perinatal mortality was 1/47, while adverse procedure-related complication was nil in fetuses who underwent IUT. In the IUT group without hydropic fetuses, there was no mortality, but 100% of newborns underwent phototherapy, and 30% underwent exchange transfusion, which was better than the previous studies. In the IUT group with hydropic fetuses, one fetus had mortality out of seven has a cumulative perinatal loss rate of 14%. The procedure-related complication rate was 4.7%. Conclusion: In the absence of fetal hydrops, IUT has a good prognosis with 100% fetus survival in our center. Advancement in neonatal management [concomitant use of phototherapy and intravenous immunoglobulin (IVIG)] of IUT-received fetuses has significantly reduced morbidity related to hemolytic disease of the fetus and newborn (HDFN). Early detection of pregnancy at risk of fetal anemia using ICT titer and MCA-PSV trend and timely management of fetus at risk of anemia using IUT at fetal medicine center leads to a favorable outcome.

209

RESEARCH ARTICLE

Jyothi G Seshadri, Vanshika Balani, Sujani B Kempaiah

Fetomaternal Complications of In Vitro Fertilization Pregnancies in a Tertiary Center

[Year:2022] [Month:September-December] [Volume:13] [Number:3] [Pages:5] [Pages No:116 - 120]

Keywords: Dichorionic diamniotic, In vitro fertilization, Low birth weight, Monochorionic diamniotic, Neonatal intensive care unit, Pulmonary embolisms

   DOI: 10.5005/jp-journals-10016-1300  |  Open Access |  How to cite  | 

Abstract

Introduction: Over the past decade, the use of assisted reproductive technology (ART) has increased dramatically. In vitro fertilization (IVF) is the most frequently practiced ART procedure. There has been an increasing trend in a number of pregnancies in IVF conception since it was first introduced in 1981. Multifetal gestation and its outcomes are the greatest risks of IVF pregnancy. There is an increased risk of prelabor rupture of membranes (PROM), preterm labor, low birth weight (LBW), and small for gestational age infants. It is also associated with increased maternal complications during pregnancy, including gestational diabetes mellitus (GDM), preeclampsia, intrahepatic cholestasis of pregnancy, placental abruption, placenta praevia, adherent placenta, polyhydramnios, and postpartum hemorrhage. Thus, pregnancies after IVF conception require more vigilant monitoring. Objective: Assess maternal and fetal complications of IVF pregnancies and IVF conception. Study design: Retrospective single-arm analysis of pregnancies with IVF complications over a period of 3 years from September 2014 to August 2017. Results: A total of 104 women underwent IVF conception, with the highest incidence in women of age more than 30 years (56.73% of the cases). There were eight cases of abortion. Among the total cases who underwent IVF conception, 73 (70%) women were primigravidae, and 31 (30%) were multigravidae. The risk of maternal complications was 87.5%. Multifetal gestation was the most common maternal complication (39.4%), with an incidence of twin pregnancy of 37.5%, out of which 32.7% were dichorionic diamniotic (DCDA) twins and 4.8% were monochorionic diamniotic (MCDA) twins, followed by preterm labor (17.3%). The total number of viable newborns delivered was 140, with 43.2% being LBW (<2.5 kg). A total of 45 babies (32.1%) required neonatal intensive care unit (NICU) admissions, out of which three babies (2.1%) succumbed. Conclusion: There is a need for more vigilant monitoring of IVF pregnancies in view of a higher rate of maternal and fetal complications.

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RESEARCH ARTICLE

Suvrati Bansal, Anjali Mundkur, Prashanth Adiga, Pratap Kumar, Vidyashree Poojary, Shaweez Faizi, Durgesh Shukla

The Effect of Body Mass Index on Semen Quality

[Year:2022] [Month:September-December] [Volume:13] [Number:3] [Pages:4] [Pages No:121 - 124]

Keywords: Obesity, Oligospermia, Prospective observational study, Sperm motility and physically fit

   DOI: 10.5005/jp-journals-10016-1293  |  Open Access |  How to cite  | 

Abstract

Introduction: Obesity is a major public health problem. Its impact on male infertility is controversial. We aimed to explore the relationship between increasing male body mass index (BMI) and the change in semen parameters and recognize the ones most affected. Objectives: Explore the relationship between the male BMI and their semen parameters & recognize the most affected parameter. Materials and methods: It is a prospective study involving 221 men who were distributed into groups according to the BMI (kg/m2)—underweight (<18.5), normal (18.5–22.9), overweight (23.0–24.9), and obese I (25–29.9) obese II (>30). Their semen analysis was done as a part of the routine evaluation, and that was correlated with the BMI. The statistical significance was determined using the p-value, obtained by analysis of variance (ANOVA) testing. p-value <0.05 was considered statistically significant. Results: The pairs: normal vs obese I, normal vs obese II, and overweight vs obese I have statistically significant mean differences for the volume. The pairs: normal vs obese I and normal vs obese II have statistically significant mean differences for progressive motility. The pairs: normal vs obese I have a statistically significant mean difference for total motility while using a family error rate of 0.05. Conclusion: Obese men had significantly reduced semen volume, progressive, and total motility. The sperm concentration and morphology also showed abnormal values with increasing BMI, but the relationship was not statistically significant. Oligospermia in the underweight group was incidentally noted. We concurred that maintaining a normal BMI augments a man’s fertility potential.

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RESEARCH ARTICLE

Pragya Gupta, Smriti Agrawal, Anjoo Agarwal, Amita Pandey, Namrata Kumar, Wahid Ali

Comparison of Endocrine and Metabolic Profile of Obese and Lean PCOS Women with Infertility

[Year:2022] [Month:September-December] [Volume:13] [Number:3] [Pages:4] [Pages No:125 - 128]

Keywords: Metabolic syndrome, Obesity, Polycystic ovary syndrome

   DOI: 10.5005/jp-journals-10016-1290  |  Open Access |  How to cite  | 

Abstract

Background: Polycystic ovary syndrome (PCOS) has been associated with endocrine and metabolic abnormalities. The study’s objective was to compare the endocrine and metabolic parameters of lean and obese PCOS women with infertility. Materials and methods: After satisfying the inclusion and exclusion criteria, infertile women with PCOS were enrolled in the study. Women were divided into two groups according to their body mass index (BMI); group I with BMI <23 kg/m2 (lean and underweight) and group II with BMI ≥ 23 kg/m2 (obese and overweight) according to the Indian Council of Medical Research (ICMR) guidelines. Physical characteristics like the presence of acne, hirsutism, acanthosis nigricans (AN), and waist–hip ratio (WHR) were noted in all. The endocrine profile included serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), anti-Müllerian hormone (AMH), thyroid-stimulating hormone, prolactin, estradiol, and testosterone, while the metabolic profile included lipid profile, oral glucose tolerance test (OGTT) (fasting and 2 hours), fasting insulin. Results: A total of 80 women were enrolled. Obese PCOS had hypertriglyceridemia (15% vs 0% in lean group, p = 0.011) and hypercholesterolemia (20% vs 2.5%, p = 0.011). AN, acne, hirsutism, hormonal profile (LH/FSH ratio, AMH, serum testosterone), fasting insulin, and OGTT were similar in both groups. Conclusion: Increased BMI in PCOS women is associated with increased WHR and altered lipid profile with no difference in endocrine parameters.

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CASE REPORT

Iryna Tsikhanenka, Pavel Kamandzirchyk

Is Prenatal Diagnosis of Duplicated Inferior Vena Cava Really Feasible?

[Year:2022] [Month:September-December] [Volume:13] [Number:3] [Pages:4] [Pages No:129 - 132]

Keywords: Case report, Duplication, Fetal anomalies, Inferior vena cava, Prenatal diagnosis

   DOI: 10.5005/jp-journals-10016-1281  |  Open Access |  How to cite  | 

Abstract

Aim: The aim is to describe ultrasound features of duplicated inferior vena cava in fetus in order to make a challenging detection of fetal venous anomalies more feasible. Background: Duplication of inferior vena cava (IVC) is well-known and thoroughly described by adult anatomists entity. Meanwhile, there are few publications available concerning prenatally detected inferior vena cava anomalies though they are of great importance for surgeons and radiologists. Case description: We presented two cases of double IVC diagnosed in fetuses during routine ultrasound examination. Typical sonographic visualization of two venous vessels on both sides of the aorta in the transverse view of the fetal abdomen during assessment of kidneys with the same blood flow direction makes feasible the diagnosis of dual IVC. Conclusion: Visualization of two venous vessels on both sides of the aorta in the transverse view of the fetal abdomen is typical for dual IVC. Color Doppler, demonstrating the same blood flow direction in these vessels, may prove the diagnosis. Thus, though venous assessment is not currently included in standard screening protocol, it is possible to detect this venous anomaly during mandatory ultrasound assessment of fetal kidneys. Clinical significance: The inferior vena cava anomalies may be asymptomatic, but influence the adult life being of great importance during surgery, so antenatal diagnosis is crucial. During ultrasound assessment of kidneys in the transverse view of the fetal abdomen, which is done routinely, visualization of two venous vessels on both sides of the aorta should raise the suspicion of dual IVC. The duplication of IVC can be confirmed by color Doppler demonstrating the same blood flow direction in these infrarenal segments of IVC, opposite to that of the aorta. Though venous assessment is not currently included in standard prenatal screening protocol, it is possible to detect this venous anomaly during mandatory ultrasound assessment of fetal kidneys.

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