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Here, we present three cases of women with interstitial pregnancy who were managed with local instillation of potassium chloride. These women were in their 20s–30s and presented in stable condition. Of them, two had a history of previous ectopic pregnancy. Interstitial pregnancy was diagnosed by transvaginal sonography which showed an empty uterine cavity with a gestational sac 1 cm away from the lateral edge of the uterine cavity, with <5 mm myometrium surrounding it in all planes. Two of the three cases failed to respond to methotrexate injection. Due to the presence of high-end ultrasound machine and technical expertise, local instillation of potassium chloride was offered as an alternative to surgical treatment, which is definitive, and all three patients had a successful outcome. One patient returned with pain in the abdomen, which required inpatient monitoring and was later diagnosed with urinary tract infection and was given appropriate antibiotics.

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Background: Every year there are 15 million babies who are born too soon. The objective of this study was to analyze the neonatal morbidity and mortality of preterm neonates at birth. Methods: This was a prospective study conducted in the department of obstetrics and gynecology and neonatology. We included all preterm deliveries from 26 weeks to 36 weeks 6 days period of gestation in one year. Neonatal morbidities and mortalities at birth were noted. Results: The rate of preterm birth was 8.49%. Spontaneous preterm labor accounted for 52% of the causes of preterm. Hyperbilirubinemia was the commonest neonatal morbidity affecting 53.2% of the neonates. Respiratory distress syndrome (RDS) and sepsis was highest in neonates of 26 weeks to 28 weeks gestation. This group saw a mortality of 90%. Conclusions: Prematurity is associated with high mortality and long-term morbidity. Low APGARS might be good predictors of neonatal/ infant mortality. In the extremely preterm neonate, it may prove worthy to weigh the risks and benefits and thereafter counsel the mother and concerned relatives accordingly to help with decision making.

Background: Objective of this study was to audit the cases of maternal sepsis and analyze their maternal and fetal outcomes.Methods: A retrospective analysis of cases of maternal sepsis was undertaken for one year. Cases were taken as infection with fever, tachycardia, tachypnea, low oxygen saturation, high or low white blood counts and clinical or laboratory evidence of organ dysfunction and were analyzed. Demographic profile, gestational age at the time of diagnosis, organisms & their sources of infection was noted. Maternal outcomes of abortion, preterm delivery, need for intensive care unit (ICU) / high dependency unit (HDU) stay, blood and blood products, surgical interventions for the control of infection, culture-positive rate, source of organism, antibiotic usage and maternal mortality were analyzed. Fetal outcomes of early fetal demise, preterm birth, intrauterine death, stillbirth and term birth were studied.  Results: There were a total of 2327 deliveries, with 2333 live births during the study period. Twenty-two cases were diagnosed with sepsis, of which 17 survived, and five died. The incidence of maternal sepsis was 9.4/1000 live births & maternal deaths were 22.7%. Ninety percent were in the age group of 21-39 years, 68% were referred, 59% were post-delivery. Fifty nine percent of women who survived, and none of the women who died had medical co-morbidities. Respiratory tract followed by genitourinary tract were the most common source of infection, though culture was negative in 54.5% of the cases. The organisms grown were varied, with Escherichia coli (3/10) contributing to 30% of the culture positive cases. Spontaneous abortion and preterm delivery were 18% each, 36% required surgical intervention, 81% required ICU and 64.7 HDU stay. Seventy-seven had live birth.Conclusions: Maternal sepsis is an evolving preventable health burden. Early recognition requires a high index of clinical suspicion, even in the absence of risk factors. Mortality to morbidity ratio is very high in maternal sepsis. The timing of sepsis determines the fetal outcomes.

Background: The purpose of intrapartum fetal monitoring by cardiotocograph (CTG) is to identify early signs of developing hypoxia so that appropriate action can be taken to improve the perinatal outcome. Although CTG findings are well known to monitor the progress of the labor due to the paucity of recommendations, there has always been a clinical dilemma as the term fetuses respond differently than a preterm fetus. However, umbilical cord blood pH can distinguish the infant at high risk for asphyxia and related sequel. Therefore, because of differences in fetal physiology in term and preterm fetuses, CTG findings vary, and hence the validity of CTG to determine fetal acidosis should be different. Aims and Objectives: This study aimed to correlate abnormal intrapartum CTG findings with umbilical cord blood pH in term and preterm labor and thus evaluate the success of CTG in predicting fetal acidosis during labor. Methods: The present study included 210 women in labor (70 preterm and 140 term) with abnormal intrapartum CTG that was classified as per 2015 revised International Federation of Gynecologists and Obstetrician (FIGO) guidelines. Immediately after delivery 2 ml Umbilical artery cord blood sample was taken in a pre-heparinized syringe for analysis, pH <=7.2 was taken as acidosis and pH >7.2 was taken as normal. The measured data were maternal general characteristics which included gravida status, associated comorbidities, method of induction and character of liquor, the intrapartum CTG tracings recorded the cord arterial blood pH and the neonatal characteristics such as APGAR score and neonatal outcome. Results: Data from 70 preterm labor was compared with 140 term labor. In this study, 20.9 % of the babies had acidosis. Suspicious CTG due to decreased variability were more common in the preterm group than in the term group (21.4% vs. 8.6% p<0.05). Positive predictive value (PPV) of abnormal CTG for fetal acidosis in the preterm group was found to be higher than that in term group, PPV of pathological CTG being even higher than suspicious CTG. Women with suspicious CTG had 82 % less risk of fetal acidosis as compared to pathological CTG. Women with Bradycardia had 5.9 times the risk of fetal acidosis as compared with normal and tachycardia. Conclusion: Abnormal CTG should be managed appropriately without any delay to prevent acidosis and cord blood pH should be done in all labors with abnormal CTG. However, our findings of a higher incidence of lower cord blood pH and suspicious CTG due to decreased variability alone, highlight the limitation of criteria currently used for interpretation of CTG in preterm labors.

Background: The best method of estimation of amniotic fluid volume is a matter of ongoing debate. Objectives: To determine the perinatal & maternal outcomes in pregnant patients when the amniotic fluid volume was assessed by the amniotic fluid index (AFI) in comparison to the single deepest vertical pocket (SDVP). Methods: We studied abnormal Cardiotocograph, meconium stained amniotic fluid, birth weight <2.5kg, Apgar score at 5 min <7, cord blood pH <7.2 & necessity for NICU admission as perinatal outcomes. Rate of diagnosis of oligohydramnios, induction of labor for oligohydramnios & mode of delivery were observed in maternal outcomes. Results: Of the 697 pregnant patients recruited, 353 were in the AFI and 344 in the SDVP group. Perinatal outcomes were similar in both. In the AFI group, the number of women diagnosed with oligohydramnios was higher (p = 0.0333) & the rate of induction was also higher (p = 0.003378). Vaginal deliveries were more in the SDVP group. The Receiver Operating Characteristic curves showed statistically significant correlation with NICU stay, birth-weight, and mode of delivery. While an AFI of >5cm and SDVP of >1.9cm had good sensitivity in predicting babies with a birth weight of ≥ 2.5kg and avoiding NICU admissions, an AFI of > 5.8cm and an SDVP of > 1.9 cm had a sensitivity of around 80% in predicting successful vaginal deliveries. Conclusion: The SDVP method has a slight edge over the AFI in terms of lower inductions and higher vaginal deliveries with comparable perinatal outcomes.

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. How to cite this article Paladugu S, Mundkur A, Yedlapalli S, et al. 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.