Key takeaways from the FMFI Research webinar on fetal growth and monitoring

Fetal growth and monitoring has always been a subject of tremendous interest
for the obstetricians ,Fetal medicine specialists, neonatologists and not to forget
-the parents!

Research from various parts of the world has provided  the much needed insight
in this aspect however published work from Indian quarters has always been a
sore point.This is especially when we have some researchers arguing that
growth is ethnicity specific with an equally vociferous disagreement.

We were however fortunate to have Dr Uma Ram and Dr Seneesh KV for the
FMFI Research Webinar on 15.01.21 who have initiated work in this field.

Dr Uma Ram presented her work on how the Diabetic foetuses have increased
subcutaneous fat at the midtrimester scan, predating the clinical diagnosis of
GDM. She also shared that these studies are now being validated as prospective
studies.

An interesting discussion by the chairpersons- Dr S Suresh, Dr Ashok
Khurana and Dr Anita Kaul was whether these findings could be integrated in
an algorithm to initiate early maternal nutrition therapy.

Dr Seneesh showcased his study, prospectively comparing different available
antenatal and postnatal growth charts.

The concluding remarks by the chaipersons emphasised the need of following up every fetus by the
drop/increase in their centiles irrespective of the growth charts that are used. In
addition, multivessel Dopplers added significant value in the decision of
delivery of a fetus that shows declining centiles.

It was a stimulating session and pushed us to think beyond the routine where a
simple additional measurement from a standard fetal plane could potentially
change the course of maternal complications. The hard work put in a
prospective study whilst doing routine clinical work to answer questions that we
come across daily but brush aside due to lack of time was equally invigorating.

We hope to collate many more such research work by Indian authors in the
times to come.

Key takeaways from the FMFI webinar on Rh isoimmunization

 – 25th September 2020.

FMFI Webinar on Rh Isoimmunization

  1. 1. Whichever lab is used for titration of Rh antibody titres, once ICT comes positive, check whether the titres are verified by Tube agglutination method rather than column method.
    Most labs have facilities for both but prefer to do the initial screening on the column method. An antibody screening panel test should be done straight away.
    Best would be that as soon as ICT comes positive to refer to a fetal medicine unit
  2. 2. The follow -up for ICT positive women is 2 weekly scans in a fetal medicine unit for MCA PSV.
    The follow-up for Rh negative, but ICT negative is ICT blood checks every 4 weeks from 20 weeks onwards, apart from the booking bloods ICT . This will avoid late referrals for blood transfusion when the fetus is already in heart failure.
  3. 3. Timing of subsequent transfusion after the initial in utero transfusion will be monitored by the cut-off of MCA PSV >1.5 MoM or rate of fall of hematocrit. Increasing the threshold to 1.69 MoMs (as suggested by a few papers) will miss a significant number of anaemic fetuses.
  4. 4. A lot of cases of isoimmunization happen even in women who have received prophylactic Anti-D injections. This could be secondary to inadequate doses, incorrect timing of prophylactic doses or faulty storage.
  5. 5. All Rh negative women who are ICT negative at 28 weeks, should receive full dose prophylaxis between 28-30 weeks and then at delivery in Rh positive babies.
  6. 6. Ideally a Kleihauer -Betke should be checked post delivery and additional doses be given if feto-maternal haemorrhage is deemed to be beyond the neutralization effects of the standard dose.
  7. 7. In peripheral areas, please check that your supplier has maintained the cold chain for Anti-D procurement and storage.