Vasudeva Akhila

Manipal Academy of Higher Education | MAHE · Department of Obstetrics and Gynaecology

Cardiospondylocarpofacial syndrome (CSCF; MIM#157800) is a rare condition caused by monoallelic variants in the MAP3K7 gene. The characteristic features of CSCF include growth retardation, facial dysmorphisms, carpal-tarsal fusion, dorsal spine synostosis, deafness, inner ear malformations, cardiac septal defects and valve dysplasia. We present her...

Gestational diabetes mellitus is a common medical disorder of pregnancy. Diabetic ketoacidosis is a complication that may affect both maternal and perinatal wellbeing adversely. It is rare, most often involving women with type 1 or type 2 diabetes, but occasionally can be seen in gestational diabetes mellitus. Here are two cases of ketoacidosis see...

Background : Doppler studies performed on uteroplacental/ fetal circulation have proven useful in diagnosing FGR, appropriately timing the delivery, and improving perinatal morbidity and mortality. There has been an extensive search to find an ideal vessel to identify fetuses between the compensatory and acidemic phase that is in the “pre-acidemic...

The fetal echocardiogram is useful for monitoring and diagnosing cardiovascular diseases in the fetus in utero. Importantly, it can be used for assessing prenatal congenital heart disease, for which timely intervention can improve the unborn child’s outcomes. In this regard, artificial intelligence (AI) can be used for the automatic analysis of fet...

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 d...

Background Ultrasound has become an invaluable tool in our daily practice. Its role in screening for adhesions has been tested since the 1990s. Objective This study aims to determine the role of the visceral slide test as a screening method to predict abdominal wall adhesions in women undergoing gynecological surgery. Methods We conducted a prosp...

Multiple studies have demonstrated that obtaining standardized fetal brain biometry from mid-trimester ultrasonography (USG) examination is key for the reliable assessment of fetal neurodevelopment and the screening of central nervous system (CNS) anomalies. Obtaining these measurements is highly subjective, expertise-driven, and requires years of...

Quality assessment of prenatal ultrasonography is essential for the screening of fetal central nervous system (CNS) anomalies. The interpretation of fetal brain structures is highly subjective, expertise-driven, and requires years of training experience, limiting quality prenatal care for all pregnant mothers. With recent advancement in Artificial...

Introduction Offspring of diabetic mothers have five times higher risk of cardiovascular abnormalities than in normal pregnancies. These cardiac anomalies involve fetal cardiac morphological and functional changes. Here, we investigate subclinical cardiovascular abnormalities, including structural and functional changes among infants of diabetic mo...

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 literat...

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...

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 m...

In the presence of gestational diabetes mellitus (GDM), the fetus is exposed to a hyperin-sulinemia environment. This environment can cause a wide range of metabolic and fetal cardiac structural alterations. Fetal myocardial hypertrophy predominantly affecting the interventricular septum possess a morphology of disarray similar to hypertrophic card...

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...

There is sparse Indian data on whether fetal echocardiography among pregnant diabetics would be useful to predict adverse perinatal/neonatal outcome. Objectives To study fetal cardiac changes in diabetic mothers and non-diabetic controls from 24 weeks gestation until the neonatal period; correlate them with maternal glycemic control; study their i...

Context: The rising incidence of endometriosis may be due to improvisation in the diagnostic techniques. Transvaginal sonography has proven to be very useful in the diagnosis of complexity of the disease and in turn to predict the intraoperative findings on laparoscopy. Aims: The aim was to study the use of sliding sign for detecting the status...

Background Predicting spontaneous preterm birth (SPTB) during mid-trimester would be very useful. We used a multimodality screening approach mainly focusing on urogenital infections among unselected obstetric population between 18 and 24 weeks in a tertiary center. Method Diagnosis of lower genital tract infection (LGTI) was attempted among 228 pr...

Background: The majority of women who undergo induced abortion are young and of low parity. Hence, it is desirable to look for any association effects of induced abortion with future reproductive outcomes. In this study, we aim to compare ultrasound measured cervical length in pregnant women with previous induced abortion versus those who have not...

Background Screening of lower genital tract infection (LGTI) in mid-trimester prevents preterm birth (PTB). There is no consensus on best screening methods for LGTI-symptoms, speculum findings, a point of care tests or high vaginal swab microscopy. Aim To know diagnostic accuracy of screening of lower genital tract infection (LGTI) in mid-trimeste...

Background: Mother-infant bonding has tremendous implications for the child's future development. The difficulties that some mothers have in establishing an emotional bond with their newborns often referred to as impaired bonding or bonding failure are an essential focus in the postpartum period. Therefore, it is important to identify predictive fa...

Intra Uterine Contraceptive Device (IUCD) is the most popular method of reversible contraception in India because of their high efficacy for fertility regulation, low-risk, low-cost, and lack of required maintenance. Uterine perforation remains one of the most serious complications, with an incidence 0.87 per 1000 insertions. The IUCD strings are u...

Once the recommended 5-year recurrence-free follow-up is achieved for cervicalcancers regular annual pelvic examination is mandatory. The main aim of presenting this short report is to emphasize the difficulties in the collection and interpretation of cytology samples from stenosed cervix or vault after pelvic irradiation. Radiotherapy can induce c...

Abstract Once the recommended 5-year recurrence-free follow-up is achieved for cervical cancers regular annual pelvic examination is mandatory. The main aim of presenting this short report is to emphasize the difficulties in the collection and interpretation of cytology samples from stenosed cervix or vault after pelvic irradiation. Radiotherapy ca...

Background: GDM cases go unidentified with inadequate screening methods in first trimester which in turn increases the maternal and neonatal morbidity which is preventable. The purpose of the study was to find out a cut off level for HbA1c and RBS at first trimester for screening Gestational diabetes mellitus (GDM).Methods: Observational study on p...

Background: Congenital heart defects (CHD) remain the most prevalent congenital malformations, with an estimated prevalence of 6-8 per 1000 live births. Routinely, fetal echo is performed around 18-22 weeks among high risk cases. A dedicated early fetal echo (EFEC) performed by experts between 11-16 weeks is emerging as an excellent screening tool...

Background: Reduced maternal perception of fetal movements allows early identification, timely evaluation and intervention for fetuses at risk of adverse outcome. The primary objective of this study was to assess the pregnancy characteristics and outcomes of pregnant women presenting to hospital with reduced fetal movements (RFM).Methods: Prospecti...

Visual symptoms in pregnancy are ominous. The spectrum of ocular symptoms seen in pre-eclampsia includes blurring of vision, scotoma, hemianopia and even total cortical blindness. Diplopia, though rare has also been reported in cases of pre-eclampsia and occurs due to pathological changes affecting the 6th cranial nerve. Ocular symptoms of pre-ecla...

Objectives Elective cesarean deliveries (ECD) are still performed prior to 39 weeks. This study aimed to identify risk of neonatal respiratory morbidity (NRM) following ECD near term, in a South Indian population. Specifically, study aimed to measure the additional healthcare burden due to large number of ECDs performed prior to 39 weeks, in this l...

Background Present study carried out in a tertiary referral hospital in South India attempts to determine the predictive value of integrated screening at 11–14-week antenatal visit. Objectives To determine the detection rate of fetal abnormalities at 11–14 weeks and also to predict the placental dysfunction disorders based on early integrated evalu...

Vaginal foreign bodies retained for long duration are uncommon in present day scenario. When a female presents with recurrent foul smelling vaginal discharge, foreign body should be suspected. Here is a report of foreign body in the vagina of a postmenopausal lady.

A 27-year-old primigravida at 19 weeks of gestation with suspected hydrops fetalis. There were characteristic ultrasonographic features like hyper inflated and enlarged lungs, flattened diaphragm, small centrally displaced heart, and hydrops suggestive of CHAOS. Congenital high airway obstruction syndrome is a rare fetal anomaly causing nonimmune h...

Neuroendocrine carcinomas (NECs) are rare malignancies that originate from the hormone-producing cells of the body’s neuroendocrine system. Rectal high grade NEC (HG-NEC) constituting less than 1% of colorectal cancers can cause large ovarian metastasis that may be the initial presenting complaint. Ovarian Krukenberg tumor from a primary rectal HG-...

Middle Interhemispheric variant (MIH) is a rare subtype of holoprosencephaly (HPE), also known as syntelencephaly. We present a case of MIH, which was diagnosed as an interhemispheric cyst on antenatal sonography at 19 weeks, but later diagnosed as MIH variant of holoprosencephaly after a postabortal MRI and perinatal autopsy.

Prenatal diagnosis of intracranial tumors generally implies a poor prognosis. We present three such cases, where prognostication was difficult. We attempted to correlate our prenatal counseling with postnatal follow-up/postabortal diagnosis. In the first case, tumor was diagnosed at 37 weeks. Ultrasound and fetal/neonatal MRI suggested a malignant...

We aimed to analyze the utility of fetal autopsy in terms of its contribution to establishing a definitive diagnosis and its impact on genetic counseling. Detailed fetal autopsy was carried out in fetuses referred for examination. Clinical utility of fetal autopsy and impact on counseling were measured by adapting previously published parameters. W...

Introduction: Fetal growth abnormality is associated with changes in the soft tissue mass, which is decreased in growth restricted fetuses and increased in macrosomia. Objective: To correlate fetal abdominal subcutaneous tissue thickness (FASTT) measured by ultrasound at term and birth weight and to obtain a cut-off value of FASTT to predict large...

Background: The damage to ovarian reserve inflicted by surgery for endometriosis represents a major concern in the balance between reproductive benefits and risks. Aim: To evaluate the ovarian reserve in sub fertile women after laparoscopic endometriotic cystectomy. Settings and design: Prospective study, done in Department of Obstetrics and G...

To assess the efficacy, complication rates and outcomes for complex monochorionic pregnancies undergoing selective fetal reduction using radiofrequency ablation (RFA). In this prospective observational study, one hundred consecutive cases of selective fetal reduction using RFA were analysed. All cases were managed at the Centre for Fetal Care at Qu...

Introduction: Endometrioma is a common form of endometriosis and it is represented by endometriotic deposits within the ovaries which accounts for upto 17-44% of cases. Laparoscopic stripping of ovarian endometriotic cysts is an accepted technique owing to low recurrence rates. Decrease in residual ovarian tissue volume was noted in many studies f...

Placental site trophoblastic tumour (PSTT) is the least common form of gestational trophoblastic neoplasia accounting for only 1-2% of trophoblastic tumors. Approximately 200 cases are reported in English literature. PSTT presenting as a cervical growth is even less common. Differentiation of PSTT from other types of GTN, non-neoplastic gestational...

We aimed to measure early fetal growth velocity and to correlate this with the birth weight, gestational age at delivery, and with the incidence of adverse pregnancy outcomes specifically preeclampsia and perinatal mortality.MethodsA data based prospective observational study, wherein sonographic biometry data and specific pregnancy outcome related...

Acute respiratory distress syndrome (ARDS) is common among women admitted to obstetric intensive care units, and it contributes significantly, both directly and indirectly, to maternal deaths. We present a case series of ARDS in pregnant women caused by non-obstetric causes. The women were treated at a tertiary hospital in southern India. The strik...

Ovarian pregnancy is a rare form of ectopic pregnancy following ICSI-ET, and the diagnosis depends on the physicians suspicion and experience. Preservation of ovarian tissue during surgery is of utmost importance to preserve fertility. We present a case of ovarian pregnancy who had a successful treatment preserving the ovary.

We present a case of recurrent pregnancy loss associated with unusual constellation of utoimmunity-related features such as hypertension, severe hrombocytopenia, hypothyroidism and persistent high titers of perinuclear antineutrophilic cytoplasmic antibodies. Her clinical features did not fit into a particular diagnosis of vasculitides, systemic lu...

To compare clinical efficacy, side effects and continuation rates using oral hormone therapy (HT), percutaneous gel, and transdermal patch. Eighty-eight symptomatic menopausal women were allocated into 3 groups (oral, gel, patch); the patch group was further subdivided to be given either reservoir or matrix patch. After one year of follow up, sympt...