Publications by authors named "Vatsla Dadhwal"

75 Publications

Congenital focal eventration of the left hemidiaphragm: diagnostic dilemma resolved on prenatal MRI.

BMJ Case Rep 2021 Aug 3;14(8). Epub 2021 Aug 3.

Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, Delhi, India

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http://dx.doi.org/10.1136/bcr-2021-245771DOI Listing
August 2021

Facility preparedness for an obstetric unit during the Covid-19 pandemic.

Natl Med J India 2020 Nov-Dec;33(6):349-357

Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.

Covid-19 infection has placed health systems under unprecedented strain and foresight for preparedness is the key factor to avert disaster. Every facility that provides obstetric service needs a certain level of preparedness to be able to handle at least Covid-suspect pregnant women awaiting test reports, who need to be managed as Covid-positive patients till reports are available. Thus, these facilities need to have triage areas and Covid-suspect labour rooms. Healthcare facilities can have designated areas for Covid-positive patients or have referral linkages with designated Covid-positive hospitals. Preparation includes structural reorganization with setting up a Covid-suspect and Covid-positive facility in adequate space, as well as extensive training of staff about infection control practices and rational use of personal protective equipment (PPE). A systematic approach involving five essential steps of making standard operating procedures, infrastructural reorganization for a triage area and a Covid-suspect labour ward, procurement of PPE, managing the personnel and instituting appropriate infection control practices can ensure uninterrupted services to patients without compromising the safety of healthcare providers.
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http://dx.doi.org/10.4103/0970-258X.321135DOI Listing
August 2021

Utility of fetal whole exome sequencing in the etiological evaluation and outcome of nonimmune hydrops fetalis.

Prenat Diagn 2021 Jul 24. Epub 2021 Jul 24.

Department of Pediatrics, Division of Genetics, All India Institute of Medical Sciences, New Delhi, India.

Introduction: Nonimmune hydrops fetalis (NIHF) has varied etiology. We assessed the etiological spectrum and evaluated the utility of fetal whole exome sequencing (fWES) for the diagnosis of NIHF.

Methods: In this prospective cohort study, we evaluated antenatally diagnosed fetuses with NIHF between July 2018 and December 2019 according to the routine diagnostic algorithm. Fetuses that remained undiagnosed after routine NIHF workup were subjected to fetal chromosomal microarray and/or WES. Pregnancies were followed up for clinical outcomes.

Results: Of the 45 fetuses, consanguinity and recurrent hydrops fetalis were observed in 13.3% (6/45) and 28.8% (13/45), respectively. Overall, an etiological diagnosis was possible in 75.5% (34/45) of fetuses, while the cause remained unknown in 24.4% (11/45). A genetic etiology was identified in 46.6% (21/45): aneuploidy and monogenic disorders in 28.8% (13/45) and 17.8% (8/45), respectively. fWES on 19 fetuses detected disease-causing variants in 42.1% (8/19). Nine novel variants were detected in RAPSN, ASCC1, NEB, PKD1L1, GUSB, and PIEZO1. Only 8.8% (4/45) of the cohort survived without morbidity.

Conclusions: This study describes the etiological spectrum and the disease-causing variants in an Indian cohort of hydropic fetuses.
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http://dx.doi.org/10.1002/pd.6022DOI Listing
July 2021

Pseudoamniotic band syndrome after bipolar cord coagulation in monochorionic twins complicated by twin-to-twin transfusion syndrome.

BMJ Case Rep 2021 Jul 13;14(7). Epub 2021 Jul 13.

Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, Delhi, India

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http://dx.doi.org/10.1136/bcr-2021-244471DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8278920PMC
July 2021

Perinatal outcome in monochorionic twin pregnancies after selective fetal reduction using radiofrequency ablation.

Int J Gynaecol Obstet 2021 Jun 12. Epub 2021 Jun 12.

Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.

Objective: To study the perinatal outcomes in women with complicated monochorionic twin pregnancies undergoing selective fetal reduction using radiofrequency ablation (RFA).

Methods: This retrospective study included 44 patients with monochorionic twin pregnancies, between 14 and 28 weeks of pregnancy, who underwent RFA for selective fetal reduction. Perinatal and maternal outcomes and procedure-related complications were analyzed.

Results: The procedure was technically successful in all 44 cases. Indications for selective fetal reduction included twin-to-twin transfusion syndrome (52.3%), twin reversed arterial perfusion (20.5%), twins discordant for anomaly (15.9%), and selective fetal growth restriction (11.4%). Median gestational age at procedure was 22  weeks (range 14-26 ). Live birth rate was 77.3% with three neonatal deaths; so overall survival was 70.5%. Median procedure-to-delivery interval was 12  weeks (range 2 -23). There were eight losses before 24 weeks of pregnancy, which included two co-twin deaths. Median gestational age at delivery was 35 weeks (interquartile range 32 -37 weeks). The preterm delivery rate was 66.7% (24/36) and preterm prelabor rupture of membranes (PPROM) occurred in 22.7% (10/44) of patients.

Conclusion: Selective fetal reduction using RFA is safe and effective in complicated monochorionic pregnancies. However, the rates of PPROM and preterm delivery remain high.
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http://dx.doi.org/10.1002/ijgo.13785DOI Listing
June 2021

High-altitude population neonatal and maternal phenotypes associated with birthweight protection.

Pediatr Res 2021 Jun 8. Epub 2021 Jun 8.

University College London Institute for Women's Health, London, UK.

Background: States which reduce foetal oxygen delivery are associated with impaired intrauterine growth. Hypoxia results when barometric pressure falls with ascent to altitude, and with it the partial pressure of inspired oxygen ('hypobaric hypoxia'). birthweight is reduced when native lowlanders gestate at such high altitude (HA)-an effect mitigated in native (millennia) HA populations. Studying HA populations offer a route to explore the mechanisms by which hypoxia impacts foetal growth.

Methods: Between February 2017 and January 2019, we prospectively studied 316 pregnant women, in Leh, Ladakh (altitude 3524 m, where oxygen partial pressure is reduced by 1/3) and 101 pregnant women living in Delhi (low altitude, 216 m above sea level).

Results: Of Ladakhi HA newborns, 14% were small for gestational age (<10th birthweight centile) vs 19% of newborn at low altitude. At HA, increased maternal body mass index, age, and uterine artery (UtA) diameter were positively associated with growth >10th weight centile.

Conclusions: This study showed that Ladakhi offspring birthweight is relatively spared from the expected adverse HA effects. Furthermore, maternal body composition and greater UtA size may be physiological HA adaptations and warrant further study, as they offer potential mechanisms to overcome hypoxia-related growth issues.

Impact: Reduced foetal oxygen delivery seen in native lowlanders who gestate at HA causes foetal growth restriction-an effect thought to be mitigated in native HA populations. We found that greater maternal body mass and UtA diameter were associated with increased offspring birthweight in a (Ladakh) HA population. This supports a role for them as physiological mediators of adaptation and provides insights into potential mechanisms that may treat hypoxia-related growth issues.
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http://dx.doi.org/10.1038/s41390-021-01593-5DOI Listing
June 2021

Incidental diagnosis of sad fetus syndrome in triplets.

BMJ Case Rep 2021 Feb 4;14(2). Epub 2021 Feb 4.

Pathology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India.

An unusual presentation of gestational trophoblastic disease is twin molar pregnancy, rarest in triplets with differentials being partial/complete mole, placental mesenchymal dysplasia (PMD), placental cysts or chorioangioma each with different complications. Counselling to continue pregnancy depends on diagnosis. A 37-year-old GPL, donor oocyte In vitro fertlisation (IVF) twin pregnancy was referred at 24 weeks with cystic areas in placenta. Probability of twin partial mole or PMD was assessed. The scan of fetuses showed normal growth, no structural anomalies. Biochemical markers showed high maternal beta human chorionic gonadotropin (β-hCG). Amniocentesis of molar fetus revealed normal karyotype. Likely diagnosis made as twin partial mole. The patient delivered by caesarean section at 28 weeks due to preterm labour. Twins, a male and a female baby, were delivered with three placentas, two normal and the third with molar changes and no fetal parts. Diagnosis was revised as triplet with partial mole, which was confirmed on histopathology. Serial monitoring of β-hCG became undetectable by eighth week. The male baby died on day 4. The mother and the female baby were discharged.
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http://dx.doi.org/10.1136/bcr-2020-238977DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7868267PMC
February 2021

Neurological manifestation in severe hypothyroidism in pregnancy.

BMJ Case Rep 2020 Dec 28;13(12). Epub 2020 Dec 28.

Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, Delhi, India.

Neurological manifestations of hypothyroidism include peripheral neuropathy and pituitary hyperplasia. However, these associations are rarely encountered during pregnancy. We report a case of a known hypothyroid with very high thyroid stimulating hormone (TSH) values (512 μIU/mL) in the second trimester. At 24 weeks she developed facial palsy and pituitary hyperplasia which responded to a combination of steroids and thyroxine. She had caesarean delivery at 35 weeks and 3 days gestation in view of pre-eclampsia with severe features and was discharged on oral antihypertensives and thyroxine. On follow-up at 5 months, TSH normalised and pituitary hyperplasia showed a greater than 50% reduction in size. To our knowledge, this is the first reported case of facial palsy and pituitary hyperplasia associated with hypothyroidism during pregnancy.
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http://dx.doi.org/10.1136/bcr-2020-238069DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7771221PMC
December 2020

Cerebroplacental ratio as a predictor of intrapartum fetal compromise in term pregnancy.

Int J Gynaecol Obstet 2021 Jul 22;154(1):31-38. Epub 2020 Dec 22.

Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.

Objective: To predict intrapartum fetal compromise (FC) and admission to neonatal intensive care unit (NICU) by cerebroplacental ratio (CPR) in term pregnancies.

Methods: A prospective observational study recruited women with singleton, term pregnancies. Ultrasound (US) was done for fetal biometry, umbilical and middle cerebral artery (UA, MCA) Doppler parameters, and CPR calculated. Intrapartum variables and neonatal data were recorded.

Results: Mean interval from US to delivery was 2.21 ± 2.71 days. Rate of operative delivery for FC was 17.47%. Multivariate logistic regression analysis showed that UA pulsatility index (PI) multiples of median (MoM) (P = 0.001), MCA PI MoM (P = 0.001), and CPR MoM (P = 0.001) were significantly and independently associated with operative delivery for FC. Similarly, UA PI MoM (P = 0.004), MCA PI MoM (P = 0.009), and CPR MoM (P = 0.003) were also significantly and independently associated with admission to the NICU. Rate of operative delivery for presumed FC was higher in approprate-for-gestational-age fetuses with low CPR than in small-for-gestational-age fetuses with normal CPR (43.1% and 37.5%, respectively).

Conclusion: Lower mean CPR and CPR MoM were independently associated with the need for operative delivery for presumed FC and NICU admission at term. CPR is more likely to be associated with FC due to placental insufficiency than birth weight.
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http://dx.doi.org/10.1002/ijgo.13501DOI Listing
July 2021

Aortic isthmus Doppler in normal and small-for-gestational-age fetuses and its association with prediction of adverse perinatal outcome.

Int J Gynaecol Obstet 2021 Jun 5;153(3):542-548. Epub 2021 Jan 5.

Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.

Objective: To establish reference ranges for aortic isthmus Doppler indices in appropriate-for-gestational-age (AGA) fetusesand to evaluate its association with perinatal outcome in small-for-gestational-age (SGA) fetuses.

Methods: Prospective cohort observational study in which 30 pregnant women with SGA fetuses and 60 women with AGA fetuses were recruited from the prenatal clinic of the hospital. The AGA group was eventually followed from 24 weeks by 4-weekly Doppler assessment, and the SGA group was examined as per institutional protocol. We analyzed the data using STATA version 14.0 statistical software. Continuous variables were examined for normality assumption using the Kolmogorov-Smirnov test. To develop a nomogram for appropriate gestational age, we adopted a mixed linear model analysis. For each of the variables Ao pulsatility index (PI), Ao peak systolic velocity (PSV), Ao systolic nadir (Ns), and Ao isthmic systolic index (ISI) mean predicted values, 3rd centile and 97th centile were calculated based on the parameter estimation of mixed model. Observed data for each of the variables in the SGA group were plotted in the nomogram developed for the AGA group to show the trend of SGA data in comparison to AGA data.

Results: The total number of observations made on 60 AGA and 30 SGA fetuses were 240 and 67, respectively. Nomograms for the 3rd and 97th centiles were derived for Ao PI, Ao PSV, Ao Ns, and Ao ISI. Mean Ao PI values were significantly higher in SGA group (2.37 vs 2.22; P < .05); mean Ao PSV was significantly lower in the SGA group (67.1 vs 76.3; P < .05), but mean Ao Ns and mean Ao ISI values were significantly higher in the SGA group (-5.24 vs 2.0 and -0.04 vs -0.01; P < .05).

Conclusions: Aortic Doppler assessment seems to provide beneficial information for monitoring small fetuses. Ao PI and Ao ISI, which were raised in fetuses with SGA, can be used in prognosis.
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http://dx.doi.org/10.1002/ijgo.13489DOI Listing
June 2021

Restructuring fetal medicine services in a low-resource setting during the COVID-19 pandemic: Experience from a tertiary care fetal medicine center.

Int J Gynaecol Obstet 2020 11 1;151(2):291-293. Epub 2020 Sep 1.

Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India.

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http://dx.doi.org/10.1002/ijgo.13337DOI Listing
November 2020

Intravenous Iron sucrose and change in hemoglobin, ferritin, and oxidative stress markers among moderately anemic pregnant women attending a secondary care level Hospital in Northern India.

Indian J Public Health 2020 Jan-Mar;64(1):11-16

Associate Professor, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India.

Background: Intravenous iron is associated with oxidative stress, and very few studies have assessed change in oxidative stress markers post infusion.

Objectives: The study aimed to measure the change in levels of hemoglobin (Hb), serum ferritin, and select oxidative stress markers (malondialdehyde [MDA], superoxide dismutase [SOD], and ferric reducing ability of plasma [FRAP]) 4 weeks following the administration of intravenous iron sucrose (IVIS) among moderately anemic pregnant women who were attending a secondary-level health-care facility, Haryana, North India.

Methods: An observational study was conducted (May 2016 to Jan 2018) among pregnant women receiving intravenous iron sucrose i.e., IVIS (300 mg per dose) diluted in 300 mL of normal saline over 20-45 min and were followed up for a period of 4 weeks after the last dose of IVIS (end line). The study outcomes were measured in the levels of Hb, serum ferritin, MDA, SOD, and FRAP from the baseline to the end line.

Results: The mean (95% confidence interval) change in the Hb and serum ferritin level 4 weeks after the last dose of IVIS was an increase of 2.5 (2.1-3.0) g/dL (P < 0.001) and 63.0 (44.7-81.3) ng/mL (P < 0.001), respectively. There were no significant changes (baseline to end line) in mean (standard deviation [SD]) MDA level and mean (SD) FRAP level. The mean (SD) SOD level declined significantly (2.2 [0.4] U/mL to 1.6 [0.5] U/mL [P < 0.001]). No life-threatening adverse events were encountered during the study.

Conclusion: IVIS was well tolerated and effective in treating moderate anemia in pregnancy. Body iron store was replenished following IVIS administration. There was no increase in oxidative stress following IVIS therapy.
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http://dx.doi.org/10.4103/ijph.IJPH_464_18DOI Listing
December 2020

Locally advanced cervical cancer - neoadjuvant chemotherapy followed by concurrent chemoradiation and targeted therapy as maintenance: A phase II study.

J Cancer Res Ther 2019 Oct-Dec;15(6):1359-1364

Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India.

Aim: The survival in locally advanced cervical cancer remains low. We evaluated the role of neoadjuvant chemotherapy (NACT), chemoradiotherapy (CRT), followed by gefitinib maintenance in locally advanced cervical cancer.

Materials And Methods: Twenty-five patients with locally advanced carcinoma cervix were enrolled between July 2012 and May 2013. Patients received 6 weekly doses of NACT Paclitaxel (60 mg/m) and carboplatin (AUC 2), followed by CRT and brachytherapy. The analysis of epidermal growth factor receptor (EGFR) expression was carried out by immunohistochemistry. Gefitinib (250 mg daily) was given as maintenance therapy for 1 year after completion of chemoradiation. Comparison of EGFR expression and survival outcomes was done.

Results: Twenty-four of 25 patients completed the neoadjuvant chemotherapy and concurrent chemoradiotherapy. Post-CRT, all patients were started on gefitinib maintenance, and twenty patients completed the intended 1 year of gefitinib maintenance. Nineteen (76%) patients had a radiological complete response to NACT. EGFR was moderately or strongly expressed in 86.3% of the patients. The 3-year overall survival was 69.8%, and 3-year progression-free survival was 51.4%. Expression of EGFR was not found to be a significant factor affecting overall survival or progression-free survival.

Conclusions: Weekly neoadjuvant chemotherapy is associated with a good response rate in locally advanced cervical cancer. Neoadjuvant chemotherapy, chemoradiation, followed by gefitinib maintenance gives good survival outcome in patients with locally advanced cervical cancer.
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http://dx.doi.org/10.4103/jcrt.JCRT_39_18DOI Listing
May 2020

Mifepristone Followed by Misoprostol or Ethacridine Lactate and Oxytocin for Second Trimester Abortion: A Randomized Trial.

Eurasian J Med 2019 Oct 19;51(3):262-266. Epub 2019 Aug 19.

All India Institute of Medical Sciences, New Delhi, India.

Objective: To compare two medical methods for second-trimester abortion, mifepristone followed by misoprostol versus mifepristone followed by ethacridine lactate and oxytocin for success rate, induction to abortion time and acceptability.

Materials And Methods: This is a randomized trial conducted from July 2014 to May 2016 and enrolled 120 women undergoing second trimester abortion (13-20 weeks). All patients received 200mg mifepristone orally and were randomized to receive further treatment after 36 hrs. Patients in Group M (n=60) received 400 microgram of misoprostol vaginally every 3 hours (maximum - 5 doses) and Group E (n=60) had extra-amniotic ethacridine lactate instillation followed by oxytocin infusion (max-100miu).

Results: Baseline demographic characteristics were comparable in both the groups. Success rate was 100% in group M and 98.3% in group E (p=0.31). Mean induction to abortion time was significantly shorter in group M than group E (8.2+2.3hours & 10.9+2.6 hours respectively; p=0.001). Majority of women reported side effects, 96.7% women in group M and 75% women in group E (p=0.001). Fall in hemoglobin after procedure was significantly higher in group M (0.70+0.33gram %) than group E (0.52+0.23 gram %) (p=0.001). Perception of intensity of pain was significantly more in group M but patient satisfaction in both groups was similar.

Conclusion: Both methods are comparable for success rate, induction interval was more for ethacridine lactate compared to misoprostol.
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http://dx.doi.org/10.5152/eurasianjmed.2019.18341DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6812907PMC
October 2019

NT-proBNP: A Useful Biochemical Marker for Prognosis in Rh-Isoimmunized Pregnancies.

J Obstet Gynaecol India 2019 Oct 1;69(Suppl 2):128-132. Epub 2018 Oct 1.

Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, 110029 India.

Background: Rh incompatibility sometimes results in life-threatening conditions in fetus like severe anemia and jaundice, leading to kernicterus and even death. Even after an uneventful intrauterine transfusion (IUT), fetus may not survive despite correction of the fetal anemia. Finding appropriate markers may help in determining the prognosis of such cases. The N-terminal prohormone of brain natriuretic peptide (NT-proBNP) suggests some degree of heart failure.

Objective: Present study was planned to evaluate its role in predicting the outcome of fetus in Rh-isoimmunized pregnant woman.

Methods: This prospective study consisted of total 40 pregnant patients: 10 pregnant Rh-isoimmunized women with hydropic fetuses, 10 with non-hydropic fetuses and 20 control group. If the MCA-PSV was > 1.5 MOM, cord blood sampling and IUT was done and sent for fetal hematocrit and NT-proBNP.

Results: The levels of NT-proBNP at various periods of gestation in hydropic, non-hydropic and control group fetuses showed positive correlation with the degree of fetal anemia.

Conclusion: Correlation of high levels of NT-proBNP to fetal anemia proves that hydrops fetalis is probably due to progressive high cardiac output myocardial failure, increased capillary permeability and perhaps reduced coronary flow.
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http://dx.doi.org/10.1007/s13224-018-1180-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6801230PMC
October 2019

Correlation of fetal blood vessel Doppler measurements with fetal anemia among Rhesus isoimmunized pregnancies after two intrauterine transfusions.

Int J Gynaecol Obstet 2019 Aug 7;146(2):218-222. Epub 2019 May 7.

Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.

Objective: To assess the correlation between fetal blood vessel Doppler measurements and fetal anemia among Rhesus isoimmunized pregnancies after two intrauterine transfusions as a potential guide to therapy.

Methods: A prospective observational study was conducted among 30 women who attended a single hospital in India between April 2, 2015 and October 30, 2016. The participants underwent a third intrauterine transfusion based on a middle cerebral artery (MCA) peak systolic velocity (PSV) of greater than 1.50 multiples of the median (MoM). Cordocentesis was performed before the third intrauterine transfusion and hematocrit values correlated with the blood vessel Doppler measurements.

Results: The MCA PSV MoM and fetal hematocrit MoM had a correlation coefficient of -0.43 (95% confidence interval -0.68 to 0.08; P=0.017). The sensitivity, specificity, positive predictive value, and negative predictive value were 68%, 57%, 83%, and 33%, respectively. The descending aorta PSV δ and fetal hematocrit δ had a correlation coefficient of -0.54 (95% confidence interval -0.75 to -0.23; P=0.001). An area under the curve of 0.80 (standard error 0.085; P=0.017) had 87% sensitivity and 57% specificity for diagnosing fetal anemia.

Conclusion: The descending aorta PSV could offer a useful diagnostic adjunct to MCA PSV after two intrauterine transfusions.
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http://dx.doi.org/10.1002/ijgo.12825DOI Listing
August 2019

Meditation & yoga: Impact on oxidative DNA damage & dysregulated sperm transcripts in male partners of couples with recurrent pregnancy loss.

Indian J Med Res 2018 12;148(Suppl):S134-S139

Department of Anatomy, Laboratory of Molecular Reproduction & Genetics, All India Institute of Medical Sciences, New Delhi, India.

Background & Objectives: Recurrent pregnancy loss (RPL) is one of the devastating complications of pregnancy and current focus lies in addressing the management of paternal factors. Dysregulation in selective transcripts delivered to oocyte at fertilization can result in pregnancy losses and adversely affect embryogenesis. The objective of this study was to assess the effect of yoga-based lifestyle intervention (YBLI) on seminal oxidative stress (OS), DNA damage and spermatozoal transcript levels.

Methods: The present study was a part of a prospective ongoing exploratory study and 30 male partners of couples with RPL were included from August 2016 to June 2017. Semen samples were obtained at baseline and at the end of YBLI (21 days). Gene expression analysis was performed by quantitative polymerase chain reaction on spermatozoal FOXG1, SOX3, OGG1, PARP1, RPS6, RBM9, RPS17 and RPL29. The levels of seminal OS and sperm DNA damage was assessed by measuring levels of reactive oxygen species (ROS) by chemiluminescence and DNA fragmentation index (DFI) by sperm chromatin structure assay.

Results: SOX3, OGG1 and PARP1 were observed to be upregulated, while FOXG1, RPS6, RBM9, RPS17 and RPL29 showed downregulation. A significant reduction in ROS levels, an increase in sperm motility, sperm count (done twice) and a decrease in DFI was seen after YBLI.

Interpretation & Conclusions: Adopting YBLI may help in a significant decline in oxidative DNA damage and normalization of sperm transcript levels. This may not only improve pregnancy outcomes but also improve the health trajectory of the offspring.
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http://dx.doi.org/10.4103/ijmr.IJMR_1988_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6469372PMC
December 2018

Isolated large bilateral choroid plexus cysts associated with trisomy 18.

BMJ Case Rep 2019 Mar 1;12(3). Epub 2019 Mar 1.

Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, Delhi, India.

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http://dx.doi.org/10.1136/bcr-2019-229216DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6398754PMC
March 2019

Two-dimensional fetal biometry versus three-dimensional fractional thigh volume for ultrasonographic prediction of birthweight.

Int J Gynaecol Obstet 2019 Apr 20;145(1):47-53. Epub 2019 Feb 20.

Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.

Objective: To develop and validate birthweight prediction models using fetal fractional thigh volume (TVol) in an Indian population, comparing them with existing prediction models developed for other ethnicities.

Methods: A prospective observational study was conducted among 131 pregnant women (>36 weeks) attending a tertiary hospital in New Delhi, India, for prenatal care between December 1, 2014, and November 1, 2016. Participants were randomly divided into formulating (n=100) and validation (n=31) groups. Multiple regression analysis was performed to generate four models to predict birthweight using various combinations of two-dimensional (2D) ultrasonographic parameters and a three-dimensional (3D) ultrasonographic parameter (TVol). The best fit model was compared with previously published 2D and 3D models.

Results: The best fit model comprised biparietal diameter, head circumference, abdominal circumference, and TVol. This model had the lowest mean percentage error (0.624 ± 8.075) and the highest coefficient of determination (R =0.660). It correctly predicted 70.2% and 91.6% of birthweights within 5% and 10% of actual weight, respectively. Compared with previous models, attributability for the 2D and 3D models was 0.65 and 0.55, respectively. Accuracy was -0.05 ± 1.007 and -2.54 ± 1.11, respectively.

Conclusion: Models that included TVol provided good prediction of birthweight in the target population.
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http://dx.doi.org/10.1002/ijgo.12770DOI Listing
April 2019

Paternal factors and embryonic development: Role in recurrent pregnancy loss.

Andrologia 2019 Feb 15;51(1):e13171. Epub 2018 Oct 15.

Department of Anatomy, Laboratory of Molecular Reproduction & Genetics, All India Institute of Medical Sciences, New Delhi, India.

The events occurring at the maternal-foetal interface define a successful pregnancy but the current paradigm has shifted towards assessing the contribution of spermatozoa for embryogenesis. Spermatozoa with defective DNA integrity may fertilise the oocyte but affect subsequent embryonic development. The present case-control study was conducted in male partners of couples experiencing recurrent pregnancy loss (RPL) to assess the gene expression of spermatozoal FOXG1, SOX3, OGG1, PARP1, RPS6, RBM9, RPS17 and RPL29. This was correlated with reactive oxygen species (ROS) levels and DNA Fragmentation Index (DFI). Semen samples were obtained from 60 cases and 30 fertile controls. Gene expression was done by qPCR analysis, and relative quantification was calculated by the 2 method. Chemiluminescence and the sperm chromatin structure assay were used to measure the ROS and DFI levels respectively. FOXG1, OGG1, RPS6 and RBM9 were seen to be upregulated, while SOX3 and PARP1 were downregulated. Relative expression of SOX3, OGG1, RPS6 and RPS17 showed a significant difference between patients and controls (p < 0.05). RPL patients were seen to have high ROS (>27.8; p = 0.001) and DFI (>30.7; p < 0.0001) with respect to controls. Sperm transcript dysregulation and oxidative DNA damage can be "carried over" after implantation, thus affecting embryogenesis and health of the future progeny.
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http://dx.doi.org/10.1111/and.13171DOI Listing
February 2019

Selective fetal reduction in monochorionic twins: Preliminary experience

J Turk Ger Gynecol Assoc 2019 05 9;20(2):79-83. Epub 2018 Oct 9.

Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India

Objective: In complicated mono-chorionic twin pregnancies, vaso-occlusive techniques like bipolar cord coagulation (BPCC), radiofrequency ablation (RFA), interstitial laser ablation (ILA) of cord and fetoscopy guided cord coagulation with lasers are the methods proposed for selective fetal reduction. This study brings forth preliminary data of selective fetal reduction procedures at a tertiary care center in India.

Material And Methods: This was a prospective observational study of 31 patients with complicated mono-chorionic twin pregnancies. Methods used were ILA, RFA and BPCC. Outcome measures included overall co-twin survival after selective feticide, survival rates with each method, miscarriage (defined as all fetal loss before 24 weeks), early fetal death (<24 hours after procedure) and late fetal death (>24 hours after the procedure) of co-twin.

Results: Technical success was achieved in 30/31 (96.8%) of pregnancies. Over all take home baby rate was 63.3%. Live birth rates were 50%, 71.4% and 75% with ILA, RFA and BPCC respectively.

Conclusion: Data from initial cases of selective fetal reduction in complicated mono-chorionic twins suggests that these procedures are feasible but are associated with high adverse perinatal outcome.
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http://dx.doi.org/10.4274/jtgga.galenos.2018.2018.0052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6558353PMC
May 2019

Episiotomy scar endometriosis.

Med J Armed Forces India 2018 Jul 20;74(3):297-299. Epub 2017 Aug 20.

Senior Resident (Pathology), All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.1016/j.mjafi.2017.06.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6081211PMC
July 2018

The Role of GnRH Analogues in Improving Outcome in Women Undergoing Superovulation and Intrauterine Insemination after Surgical Correction of Mild Endometriosis: A Randomized Controlled Trial.

Eurasian J Med 2018 Jun 1;50(2):105-110. Epub 2018 Jun 1.

All India Institute of Medical Sciences, New Delhi, India.

Objective: Treatment with laparoscopic surgery, gonadotropin-releasing hormone analog (GnRHa) therapy, superovulation (SO), and intrauterine insemination (IUI) have individual benefits in improving fertility outcomes in women with endometriosis. The aim of the study was to evaluate the role of GnRHa in improving outcome in women undergoing SO and IUI after surgical correction of mild endometriosis.

Materials And Methods: This was a randomized controlled trial conducted in the Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India, over a period of 2 years and 6 months. Ninety women who were diagnosed with mild endometriosis on laparoscopy using the revised American Society for Reproductive Medicine criteria were included in the study. The patients in the study group (n=45) received a single dose of 3.75 mg GnRHa subcutaneously within 48 h of the surgery, and those in the control group (n=45) did not receive GnRHa. Thereafter, patients in both arms received SO and IUI from the next menstrual cycle. Four patients in the study group and three patients in the control group were lost to follow-up before the first cycle of ovulation induction. Primary outcomes measured in our study were live birth rates and clinical pregnancy rate. Secondary outcome measures were number of follicles >18 mm, endometrial thickness, dose and days of gonadotropin stimulation.

Results: Baseline characteristics, such as age and body mass index, were comparable in both groups. The SO and IUI cycles were comparable between the two groups with regard to the secondary outcome parameters. Pregnancy rate in the first cycle was 17.1% in the study group and 19.1% in the control group (p=0.81). The overall pregnancy rate was similar in both groups (study group=21.9%, control group=23.8%; p=1). As no patient had miscarriage or any other complication during pregnancy, live birth rate was similar to the clinical pregnancy rate.

Conclusion: Adding GnRHa for the suppression of mild endometriosis has shown no significant improvement in the surgical management of women undergoing SO and IUI.
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http://dx.doi.org/10.5152/eurasianjmed.2018.17379DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6039146PMC
June 2018

What is your diagnosis?

J Turk Ger Gynecol Assoc 2018 Mar;19(1):53-55

Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.4274/jtgga.2017.0117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5838779PMC
March 2018

Pregnancy Outcomes in HIV-Infected Women: Experience from a Tertiary Care Center in India.

Int J MCH AIDS 2017 ;6(1):75-81

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.

Background And Objectives: There is conflicting data on the effect of HIV infection as well as antiretroviral therapy (ART) on pregnancy outcome. The objectives of this study were to compare pregnancy outcomes in women with and without HIV infection, and to evaluate the effect of HAART on pregnancy in HIV-infected women.

Methods: This is a prospective case record analysis of 212 HIV-infected women delivering between 2002 and 2015, in a tertiary health care center in India. The pregnancy outcome in HIV-infected women was compared to 238 HIV-uninfected controls. Women received ART for prevention of mother to child transmission as per protocol which varied during the period of study. Effect of use of ART on preterm birth (PTB) and intrauterine growth restriction (IUGR) was analyzed.

Results: HIV-infected women were more likely to have PTB, IUGR, and anemia (9.4%, 9.9%, 5.2%) compared to uninfected women (7.6%, 5%, 3.8%), this did not reach statistical significance (P-value = >0.05). The incidence of PIH, diabetes mellitus and intrahepatic cholestasis of pregnancy was similar in both groups. Mean birth weight was significantly lower in neonates of HIV-infected women (2593.60±499g) than HIV-uninfected women (2919±459g) [P-value=0.001]. neonatal intensive care unit admissions were also significantly higher in infants born to HIV-infected women (P-value=0.002). HIV-infected women on ART had decreased incidence of PTB and IUGR.

Conclusion And Global Health Implications: Good antenatal care and multidisciplinary team approach can optimize pregnancy outcomes in HIV-infected women.
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http://dx.doi.org/10.21106/ijma.196DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5547228PMC
January 2017

What is your diagnosis?

J Turk Ger Gynecol Assoc 2017 06 11;18(2):99-101. Epub 2017 May 11.

Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.4274/jtgga.2017.0009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5458444PMC
June 2017

Juvenile Cystic Adenomyoma Mimicking a Uterine Anomaly: a Report of Two Cases.

Eurasian J Med 2017 Feb;49(1):59-61

Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.

Juvenile cystic adenomyoma is a rare form of adenomyosis and described as a new type of mullerian anomaly in literature. We are presenting two cases of juvenile cystic adenomyoma which were misdiagnosed preoperatively as unicornuate uterus with haematometra in a non-communicating rudimentary horn. The mainstay of treatment is complete resection of lesion.
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http://dx.doi.org/10.5152/eurasianjmed.2017.17028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5389496PMC
February 2017

The laparoscopic management of Swyer syndrome: Case series.

J Turk Ger Gynecol Assoc 2015 2;16(4):252-6. Epub 2015 Nov 2.

Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.

Swyer syndrome, also known as 46 XY pure gonadal dysgenesis, is a rare endocrine disorder. Affected individuals are phenotypically female with female genitalia, normal Mullerian structures, absent testicular tissue, and a 46 XY chromosomal constitution. We report a series of eight cases of Swyer syndrome, of which six were managed by laparoscopic gonadectomy. The two other cases had to undergo an exploratory laparotomy in view of their presentation with adnexal masses. Two of the girls were siblings. The chief presenting complaint was primary amenorrhea. Four girls also presented with a history of poor development of secondary sexual characters. The average age at presentation was 16.19±2.85 years. The average height was 158.33 ±4.63 cm, and the average weight was 49.33±8.44 kg. Breast development was either Tanner 2 or 3 in four girls, whereas three girls had a Tanner 1 underdeveloped breasts. Axillary and pelvic hair was sparse in all the girls. The vagina was well canalized in all the girls. Hormonal evaluation revealed hypergonadotropic hypogonadism with a mean follicle-stimulating hormone (FSH) level of 95.81 mIU/L and a mean luteinizing (LH) level of 24.15 mIU/L. Imaging analysis revealed the presence of a small uterus in all the cases, except one. Bilateral ovaries were either not visualized or streak gonads were present. Adnexal mass was detected in two of the six cases with raised carcinoembryonic antigen (CA) 125 levels in one case. Genetic analysis revealed a karyotype of 46 XY in six girls, 46 XY/45 X in one, and the culture repeatedly failed in one girl. Because of the risk of malignancy, bilateral gonadectomy was performed in all cases. Histopathological analysis revealed that three of the six cases had dysgerminoma. The patients have been started on hormone replacement therapy. Laparoscopy is a minimally invasive modality for the definitive diagnosis and treatment of cases with Swyer syndrome. An early diagnosis of Swyer syndrome is possible during workup for primary amenorrhea before they present with adnexal masses.
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http://dx.doi.org/10.5152/jtgga.2015.15061DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4664218PMC
December 2015

Perinatal survival and procedure-related complications after intrauterine transfusion for red cell alloimmunization.

Arch Gynecol Obstet 2016 May 22;293(5):967-73. Epub 2015 Oct 22.

Department of Obstetrics and Gynecology and Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.

Objectives: To study the perinatal survival and procedure-related (PR)complications after intrauterine transfusions in red cell alloimmunization.

Methods: Prospective data of 102 women with Rh-alloimmunized pregnancy undergoing intrauterine intravascular transfusion for fetal anemia, from January 2011 to October 2014 were analyzed. Main outcome measures were perinatal survival and procedure-related (PR) complications.

Results: A total of 303 intrauterine transfusions were performed in 102 women. Of 102 fetuses, 22 were hydropic at first transfusion. The mean period of gestation and hematocrit at first transfusion was 26.9 ± 3.3 weeks (range 19.7-33.8 weeks) and 17 ± 7.82 % (range 5.7-30 %), respectively. Average number of transfusions was 2.97 (range 1-7) per patient. Overall survival was 93 % and mean period of gestation at delivery was 34.5 ± 1.94 (range 28.3-37.4) weeks. Mean hematocrit at delivery was 36.9 ± 8.77 % (range 10-66 %). Fetal death occurred in four cases (3PR), neonatal death occurred in three cases (2PR). Emergency cesarean delivery after transfusion was performed in four pregnancies. The total PR complication rate was 2.97 %, resulting in overall PR loss in 1.65 % per procedure.

Conclusion: Our results compare favorably with other studies published in the literature. Intravascular transfusion is a safe procedure improving perinatal survival in fetuses with anemia due to Rh-alloimmunization.
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http://dx.doi.org/10.1007/s00404-015-3915-7DOI Listing
May 2016

What is your diagnosis?

J Turk Ger Gynecol Assoc 2015 6;16(3):192-3. Epub 2015 Aug 6.

Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.5152/jtgga.2015.15023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4560481PMC
September 2015
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