Assessing the Role of Fetal Doppler in High-Risk Obstetrics: Evidence From a Comprehensive Study.

Background Colour Doppler ultrasound is pivotal in modern obstetrics for evaluating maternal and fetal health, especially in high-risk pregnancies. It enhances fetal oxygenation and nutrient delivery assessment, aiding in the early detection of adverse outcomes. However, its effectiveness is influenced by operator skill and the potential for interpretative variability. Aim This study aims to assess the utility of Doppler ultrasound in evaluating fetal status in high-risk pregnancies at Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, India. Materials and methods A hospital-based observational study was conducted from September 2022 to July 2024, including 145 high-risk pregnant women, of whom 120 delivered at the institute. The study included thorough maternal and fetal assessments, with regular Doppler studies starting at 28 weeks of gestation. The frequency of these studies was adjusted according to the changes and severity observed in the indices. Detailed documentation of both maternal and neonatal outcomes was meticulously maintained. Statistical analyses were performed using MS Excel (Microsoft® Corp., Redmond, WA, USA) and RStudio, Version 2023.08.0-daily+170 (RStudio, Inc., Boston, MA, USA), with a significance threshold of p < 0.05. Results The majority of participants were aged 21-30 years, with multigravida constituting 63.33%. Pregnancy-induced hypertension (PIH) and preeclampsia were the most common high-risk factors (28.33%). Abnormal umbilical artery (UA) flow patterns were observed in 58.33% of cases. Abnormal UA and middle cerebral artery (MCA) Doppler indices correlated significantly with adverse outcomes. Most deliveries were via caesarean section (82.5%), and 63.33% of neonates required Neonatal Intensive Care Unit (NICU) admission. Neonates with abnormal antenatal Doppler studies had significantly lower APGAR (appearance, pulse, grimace, activity, and respiration) scores and higher NICU admission rates. Discussion The study highlights the critical role of Doppler ultrasound in managing high-risk pregnancies, providing essential data for early interventions. Consistent with other studies, abnormal Doppler patterns were significantly associated with adverse neonatal outcomes, necessitating timely caesarean deliveries. Conclusion Fetal Doppler ultrasonography is essential for managing high-risk pregnancies, enabling timely therapeutic interventions and improving perinatal outcomes. Despite its limitations, Doppler technology remains invaluable in identifying at-risk foetuses and guiding clinical decisions for optimal pregnancy management.

Genetic Insights Into Early Pregnancy Loss: A Case Study of Trisomy 22 and an Enlarged Yolk Sac.

The first trimester of pregnancy is crucial for organ development but also carries a high risk of complications, with early pregnancy loss being the most common. Anomalies in the yolk sac, the first extra-embryonic structure seen by ultrasonography, can indicate severe fetal growth abnormalities and are linked to higher rates of first-trimester loss. This case report details a 38-year-old woman with a history of recurrent pregnancy loss (RPL) who presented with per vaginal bleeding and mild abdominal pain. Transvaginal ultrasonography revealed a yolk sac larger than 10 mm, prompting further genetic investigation. Chromosomal microarray analysis confirmed Trisomy 22. The presence of an enlarged yolk sac, correlated with Trisomy 22, highlights the importance of early detection through sonography and genetic testing. This approach aids in managing RPL by identifying genetic causes, thereby informing pre-conception counseling and future pregnancy management. An abnormal yolk sac size necessitates thorough evaluation, including cytogenetic microarray testing and quantitative fluorescent-polymerase chain reaction analysis, to guide clinical decisions and improve pregnancy outcomes.

From Diagnosis to Delivery: Navigating Pregnancy With an Isthmocele.

Isthmocele is a myometrial defect in the uterine isthmus, often resulting from previous caesarean sections. With rising cesarean rates globally, including a significant increase in India, the prevalence of isthmocele has become a noteworthy clinical concern. Isthmocele can lead to symptoms such as abnormal uterine bleeding, dysmenorrhea, and secondary infertility, often detected through transvaginal ultrasound or MRI. Additionally, it can lead to caesarean scar pregnancy, a serious complication. The condition necessitates treatment, particularly in symptomatic cases or those planning future pregnancies. Early diagnosis and appropriate management are crucial for preventing complications and ensuring positive pregnancy outcomes. Here, we report a case that underscores the potential for successful pregnancy outcomes despite the presence of isthmocele, highlighting the need for tailored management strategies in such high-risk cases.

An Ominous Case of Uterine Rupture in an Unscarred Womb and Its Subsequent Management.

Uterine rupture is a rare but critical obstetric complication that demands a swift and decisive intervention to ensure the well-being of the mother and fetus. We present a case report detailing the surgical management of a bizarre uterine rupture in a multigravida female with two previous vaginal deliveries and a previously unscarred uterus. This case highlights the challenges of treating and diagnosing, particularly in the Indian setting, an antenatally unregistered patient with rare obstetrical complications. Emphasizing the clinical challenges faced and the multidisciplinary approach employed for optimal outcomes, this report underscores the importance of a high degree of suspicion, early diagnosis, timely intervention, and comprehensive intraoperative and postoperative care in addressing this rare obstetric catastrophic event. This article's main focus is multicentric, aiming to showcase the obstacles to maintaining low maternal mortality and morbidity, the presence of inadequate awareness in society, and the importance of multimodal treatment and planning.

Ambulatory Hysteroscopy: Evaluating Pain and Determining Factors.

Study objective: To measure pain using a visual analogue scale (VAS) and analyse its relationships with variables such as menopausal status, parity, uterine and cervical pathology, procedure length, and anxiety in patients undergoing ambulatory hysteroscopy (AH). Design: Prospective observational study. Setting: Dr DY Patil Medical Hospital and Research Centre, Dr.D.Y. Patil Vidyapeeth, Pimpri, Pune. Patients: Seventy-five women. Intervention: Ambulatory hysteroscopy(AH). Methodology: AH was performed in seventy-five patients using vaginoscopic approach. At the end of the procedure, the intensity of pain was assessed using the visual analogue scale (VAS), from the score of 0 (no pain) to 10 (intolerable pain). The factors determining pain were assessed. Results: Patients who underwent AH reported mild pain in 66% of cases, moderate pain in 22%, and severe pain in 12% of cases. The most frequent reason for referral was abnormal uterine bleeding (AUB).In the moderate pain group, the bivariate analysis was statistically significant for menopausal status (P values < 0.001), cervical pathology (< 0.001), and duration of procedure (0.001) and in multivariate analysis nulliparity (0.001) and menopausal status (0.001) were the significant determining factors.In severe pain group, the bivariate analysis was statistically significant for cervical pathology (P value = 0.001) and in multivariate analysis cervical pathology (0.003) and uterine pathology (0.002) were the significant determining factors. Conclusion: Hysteroscopy is a safe, painless and a gold standard procedure. Pain experienced during AH was significantly influenced by cervical pathology. Gynaecologists in practise should receive training and start using AH to assess the endometrial cavity.