Intra-uterine growth restriction (IUGR) is an important perinatal problem giving rise to increased morbidity and mortality in the growth restricted fetus. The aim of fetal medicine today, is to prevent the mere occurrence of IUGR in high risk pregnancies and to deliver the fetuses already afflicted with growth restriction, before they have suffered from the effects of hypoxia. The use of Doppler provides this information, which is not readily obtained from the other conventional tests of fetal well being. The Doppler patterns follow a longitudinal trend in the arterial and venous circulation of the fetus as well as the placental vasculature guiding management decisions regarding the appropriate time of delivery. Progressive knowledge of the fetal circulation and its adaptation when the fetus is subjected to hypoxia, has helped us recognize the early signs of IUGR thereby improving the prognosis of these complicated pregnancies. It has therefore become the gold standard in the management of the growth-restricted fetus.
Intra uterine growth restriction, Fetal circulatory changes in IUGR, Doppler based management in IUGR Aortic IsthmusObjective(s): To evaluate the role of triple vessel (umbilical, middle cerebral and uterine artery) color Doppler study in normal and high risk pregnancy in relation to perinatal outcome.
Method(s): Aprospective study was done including fifty women with high risk pregnancy and 50 normal pregnant women during the year 2006-2007. Doppler examination was done after recording patients’ history, clinical examination and ultrasound. Mode of delivery, perinatal outcome including birth weight, perinatal death, Apgar score at 1 and 5 minutes and admission to nursery were compared.
Result(s): There was significant difference between the Doppler indices of the three vessels in the study and the control group. In women with abnormal Doppler indices, there was high incidence of cesarean section (78%), low birth weight babies, lowApgar score, higher admission rate to nursery (36%) and high incidence of neonatal deaths as compared to that of the control group.
Conclusion(s): Triple vessel color Doppler sonography is very useful in high risk pregnancy diagnosis and in predicting perinatal outcome.
high risk pregnancy, triple vessel color Doppler, perinatal outcome.Objectives: The study was done to assess the tricuspid and mitral valve velocities in 45 fetuses between 18 and 28 weeks and to compare these findings with reported values from literature.
Methods: The study was conducted on 45 women referred to the clinic for sonography examination. They were between 18 and 28 weeks gestation. They had no past history of any medical disorder, no history of drug exposure, and no family history of congenital heart disease. They had undergone 1st trimester screening and the NT was reported as normal. The fetuses were otherwise normal with respect to sonographic findings. Fetal echocardiography was done using 2D and color Doppler. Standard views of the heart were obtained and were confirmed to be satisfactory and normal. When these conditions were satisfied, the patients were included in the study. The mitral and tricuspid velocities were assessed with Pulsed Wave Doppler. Peak “A” wave velocities across both valves were measured. From the data, mean velocity, minimum and maximum values and 95% confidence limits were calculated.
Results: The mitral valve peak “A” wave velocity observations were, mean mitral valve velocity = 45.67 cm/sec, maximum mitral valve velocity = 75.81 cm/sec, minimum mitral valve velocity = 31.00 cm/sec, standard deviation = 10.20, maximum 95% confidence limit = 66.08 cm/sec and minimum 95% confidence limit = 25.27 cm/sec. The tricuspid valve peak “A” wave velocity observation were Mean Tricuspid velocity = 46.61 cm/sec, Max velocity = 76.39 cm/sec, Min velocity = 33.97 cm/sec, sd = 8.44, higher 95% confidence limit = 63.50 and lower 95% confidence limit 29.72 cm/sec.
Conclusions: The results showed that the velocities obtained in the Indian population were similar to those obtained in the western literature.
mitral velocity, tricuspid velocityObjectives: To determine whether difference in the S/D ratio of both sides of uterine arteries was significantly associated with the development of IUGR
Methods: One hundred and ten women attending the antenatal clinic of our hospital were included in the study. At the time of anomaly scan at 20 weeks doppler assessment of both uterine arteries was done. Systolic diastolic ratio of both sides was calculated. Clinical outcome was recorded at the time of birth. Statistical analysis was performed using chi-square test, regression curve, and Fischer test, using SPSS software.
Results: The correlation coefficient between the average S/D ratio and the difference between the right and left s/d ratio (δ) was 0.67 which was highly significant (p<.001). Abnormal S/D ratio difference defined as more than1 was significantly associated with IUGR. (p<.001). The placenta on histopathology examination showed significantly lesser number of vessels per tertiary villus in those with abnormal S/D ratio difference (p=.045).
Conclusion: Abnormal S/D ratio difference in uterine arteries is a significant pathophysiological event which results in decreased placental perfusion and it appears that it is the resultant placental ischemia which is responsible for intrauterine growth retardation and low birth weight at delivery.
uterine arteries, divergent flows, pre-eclampsia, IUGR, placental perfusionObjectives: Intrauterine insemination with or without controlled ovarian hyperstimulation is a viable treatment option for male factor, cervical factor and unexplained infertility.We enumerate our 10 year experience in performing intrauterine insemination at a government teaching hospital setup.
Study Design: Retrospective observational study.
Results: Nine hundred eighty nine couples were observed for 3104 treatment cycles. Male factor and anovulation were the two common causes of infertility in this cohort. Out of the 232 pregnancies that occurred during the study, 34.05% resulted in live birth. Highest cycle fecundity was seen in cases of idiopathic infertility (16%) followed by male factor infertility (15%). 91.8% conceptions occurred in the 1st cycles of intrauterine insemination.
Conclusion: In the resource deprived Indian scenario controlled ovarian hyperstimulation with intrauterine insemination is an effective, less invasive, feasible & financially acceptable modality for the treatment of sub-fertility.
intrauterine insemination, male factor, idiopathic infertility, ovarian, hyperstimulation.Objective: To review whether detailed videolaparoscopic evaluation of so called unexplained infertility can find out certain causes and laparoscopic corrective techniques can alleviate them.
Methods: From 1998 to 2007, 1726 cases of unexplained infertility were investigated by laparoscopy at Repose Fertility Clinic, Kolkata. 846 minor tubal defects were detected.
Results: According to our observation tubal defects were classified into six categories. Most of them belonged to combined aetiology.
Conclusion : Different laparoscopic surgical techniques to restore structural and functional integrity of fallopian tubes may be useful in achieving pregnancy in many cases of so called unexplained infertility.
