Background The present observational data from the fetal medicine unit aim to identify gaps in prenatal screening modalities employed in the primary obstetric care population in coastal Karnataka. Methods A retrospective observational study of all referrals to Fetal Medicine unit is over 2 years. For each fetal abnormality, we reviewed the literature to note the range of gestational age at which the abnormality should almost always be diagnosed. Taking this as standard, the gestational age at which each of these problems was diagnosed and referred was noted down. They were compared and analysed to understand the efficiency of prenatal screening practices in the referral population. The final perinatal outcome was also noted down in order to assess the impact on perinatal mortality/morbidity. Results A total of 277 cases were referred to fetal medicine unit. Two hundred twenty-eight cases (82.31%) were low risk pregnancies. Among 277 cases, 200 (72.2%) had structural abnormalities, 7 (2.5%) chromosomal/ genetic abnormalities, 61 (22.02%) isolated soft markers, and 9 (3.2%) twin-related problems. Detection rate of structural abnormalities was 33% at 14 weeks and 52.22% at 20 weeks, considering those anomalies usually diagnosed by these gestational age windows. The primary reason for delayed diagnosis was non-performance of ultrasound “on time”, rather than missed diagnosis. Fifty-three per cent (106 out of 200) of all the fetal structural abnormalities were diagnosed beyond 20 weeks. Average gestational age at mid-trimester anomaly scan in this group was between 20 and 24 weeks. Sixty-one patients were referred due to isolated soft markers, 30 beyond 20 weeks. Eighty per cent of them did not have any aneuploidy screening in pregnancy. Conclusion Practice of fetal medicine hugely depends upon appropriate prenatal screening practices in the referral population. There is an urgent need to bring in standard protocols for Prenatal Screening across all the primary obstetric care providers, both in the public and private sectors. Considering the huge burden of delayed prenatal diagnosis in our country, the proposed revision of MTP bill is a welcome change in fast-growing field of fetal diagnosis and therapy.

Background: The current United Nations sustainable development goal 3 sets to reduce maternal mortality to less than 70 per 100 000 live births by 2030. To monitor whether India is on track to attaining sustainable development goals, it is essential to routinely assess trends of health indicators. Objectives: This study was conducted to assess trends of maternal mortality and cause-specific maternal death in tertiary care hospitals in Southern India. Methods: This is a retrospective study of hospital records and death summaries of all maternal deaths between January 1, 2009, and December 31, 2018, at the tertiary care hospital in Southern India. The demographic, clinical, and delivery details of all the maternal deaths were collected. Causes of maternal deaths were classified as direct, indirect, and nonspecific. To observe trends of maternal death, the maternal mortality ratio was calculated for each year, and Pearson’s chi-square test was used. Results: Maternal mortality ratio was 555/100000 and had a decreasing trend from its highest in 2010 of 1230/100000 to its lowest of 229/100000 in 2017 (t=7.71 p=0.02). The majority of women who died were aged 21-35 years, resided in rural, were primigravidae, and had operative delivery. Most of the maternal deaths had been referred to our facility (90.8%) from other healthcare units. Obstetric hemorrhage (27.8%) and puerperal sepsis (37.7%) among direct causes; H1N1 pneumonia (34.8%) among indirect causes were the major causes of maternal death. The number of maternal deaths due to sepsis increased from the beginning until the end of the study from 10% to 50% (t=5.9, p=0.01). On the contrary, there was a decline in maternal deaths due to obstetric hemorrhage from 50% to 25% (t=4.2, p=0.03). Conclusion: Although the maternal mortality ratio has reduced over the years, sepsis was an important cause of maternal deaths.

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.