Research Interests:
The corpus callosum is the principal supratentorial cerebral commissure, which connects the two cerebral hemispheres in the midline. It is divided into rostrum, genu, body, and splenium. Affected patients may develop mental retardation,... more
The corpus callosum is the principal supratentorial cerebral commissure, which connects the two cerebral hemispheres in the midline. It is divided into rostrum, genu, body, and splenium. Affected patients may develop mental retardation, dysmorphic features, spasticity, ataxia, or epilepsy. Corpus callosal abnormalities may be isolated or be associated with other anomalies such as sulcal abnormality, ventriculomegaly, cerebellar hypoplasia or cerebellar vermian hypoplasia. Magnetic resonance imaging (MRI) plays a major role in the diagnosis of fetal corpus callosal developmental abnormalities when they are suspected on sonography. This pictorial essay shows the MRI findings in fetal corpus callosal developmental abnormalities in a very systematic manner.
Research Interests:
Objective: The aim of this study is to compare the images obtained from standard ultrafast magnetic resonance (MR) imaging sequences with gradient (GRE) sequence images in identifying fetal intracranial hemorrhage (ICH). Materials and... more
Objective: The aim of this study is to compare the images obtained from standard ultrafast magnetic resonance (MR) imaging sequences with gradient (GRE) sequence images in identifying fetal intracranial hemorrhage (ICH). Materials and Methods: MR images of fetal brains with ICH done between October 2012 and September 2015 were reviewed. The images obtained from four ultrafast MR sequences– Turbo Fast Low Angle Shot (Turbo FLASH) T1-weighted images, Half Fourier Acquisition single-shot turbo spin echo (HASTE) T2-weighted images, b0 images of diffusion-weighted imaging (DWI) and b800 images of DWI were compared with images obtained from GRE sequence in depicting fetal ICH. Results: Out of the 212 fetuses during the study period, 15 fetuses had ICH. In the 15 fetuses with ICH as detected on GRE, Grade1 germinal matrix hemorrhage was seen in 5 fetuses, Grade 2 in 4 fetuses, Grade 3 in 3 fetuses, and Grade 4 in two fetuses. Subdural hemorrhage was seen in 1 fetus. In comparison to GRE se...
Human cytomegalovirus (HCMV) and Rubella virus (RV) are common causes of intrauterine viral infections . The incidence of fetal infection and the risk of congenital deformities are particularly high after RV infection in pregnant women.... more
Human cytomegalovirus (HCMV) and Rubella virus (RV) are common causes of intrauterine viral infections . The incidence of fetal infection and the risk of congenital deformities are particularly high after RV infection in pregnant women. Despite the availability of specific vaccine, RV infection during pregnancy is still a problem and surprisingly, in several countries RV vaccination is still optional. The exact prevalence of viral infections in pregnant women or congenital infections in fetuses or neonates in India remains unknown owing to lack of a standardized approach and to the lack of standardized reference laboratories ISSN: 2319-7706 Volume 4 Number 12 (2015) pp. 343-351 http://www.ijcmas.com
Research Interests:
Positive anti-Ro/SSA and anti-La/SSB antibodies in pregnant mothers are strongly associated with fetal congenital heart block (CHB). Increased echogenicity of fetal endo-myocardium is one of the lesser known manifestations of maternal... more
Positive anti-Ro/SSA and anti-La/SSB antibodies in pregnant mothers are strongly associated with fetal congenital heart block (CHB). Increased echogenicity of fetal endo-myocardium is one of the lesser known manifestations of maternal autoimmune disease. In this retrospective analysis of data from the last ten years (2010–2019) at our fetal medicine unit, we identified nine fetuses presenting in the second trimester with isolated increased echogenicity of the endo-myocardium without CHB. In three cases, mothers had a pre-existing autoimmune disease. The others were diagnosed with positive autoimmune antibodies following evaluation for the echogenic fetal heart. One fetus developed a first-degree heart block at 33 weeks and another had a second-degree heart block three weeks after presentation. There was no fetal mortality. All were live-born. One fetus with tachycardia and ventricular dysfunction died within a few days of birth. Both babies with heart block are stable and on medical follow-up, while others remain asymptomatic with a normal rhythm. There seems a spectrum of fetal disease caused by maternal auto-antibodies affecting the endo-myocardium but sparing the conduction system. In fetuses with echogenic hearts, evaluation of maternal autoimmune status should be part of the protocol for optimal fetal and maternal care.
Research Interests:
Research Interests:
Agnathia/Otocephaly is a rare lethal syndrome characterised by mandibular hypoplasia/aplasia, ventromedial malposition or fusion of ears, microstomia and microglossia/aglossia. We present 26 cases of prenatally diagnosed... more
Agnathia/Otocephaly is a rare lethal syndrome characterised by mandibular hypoplasia/aplasia, ventromedial malposition or fusion of ears, microstomia and microglossia/aglossia. We present 26 cases of prenatally diagnosed agnathia/otocephaly, the largest published series so far, with a broad review of available literature and updated concepts on the etiopathogenesis. This is a retrospective case series identified between May 2000 and April 2018 in a tertiary fetal medicine centre in South India where we evaluated the ultrasound features of agnathia/ otocephaly and assessed the associated anomalies and syndromes. Out of 26 cases identified, 42% were isolated and 58% were associated with other anomalies. The most common associations were skeletal (7) followed by central nervous system anomalies (4) and genitourinary anomalies (2). Syndromes identified were Nager acrofacial dysostoses, Treacher Collins, Al Awadi Raas Rothschild and Femoral Facies syndrome. A simple method of observing the mandibular dot in-line with the maxilla in the sagittal view and the absence of the same would help to raise the suspicion of agnathia/severe micrognathia. The difference between these two and syndromic associations may not be brought out in ultrasound. Postnatal clinical assessment or pathologic diagnosis is mandatory as it helps in the counselling process and in the guidance of subsequent pregnancies.
Research Interests:
The fetal adrenal gland plays a pivotal role in perinatal survival. Because imaging the fetal adrenal gland is not part of routine antenatal ultrasonography (US), there is a paucity of available data about imaging techniques. The purpose... more
The fetal adrenal gland plays a pivotal role in perinatal survival. Because imaging the fetal adrenal gland is not part of routine antenatal ultrasonography (US), there is a paucity of available data about imaging techniques. The purpose of this study was to construct gestational age-wise data for fetal adrenal gland size and volume (2D US measurements) for 20, 21, 22 and 32 weeks of gestation and define a technique to measure the gland ultrasonographically. One year prospective study, at a single centre. 87 consecutive pregnant women with uncomplicated singleton pregnancy were included. Exclusion criteria were multiple pregnancy, maternal complications, congenital anomalies or fetal growth abnormality and a previous child suffering with Congenital Adrenal Hyperplasia (CAH). All measurements were made in 2 dimensional ultrasonography. In coronal sections of the fetal abdomen, fetal adrenal glands were identified just above the upper pole of the kidney to measure length and breadth. With the fetal spine in an anterior position, fetal adrenals were identified on either side of the spine and the width was measured. The gestational age included was 20, 21, 22 and 32 weeks. Both fetal adrenal glands could be visualised and identified in all cases (100%). Length, breadth, width and volume of both the glands for the above gestational ages with 95% confidence limit have been calculated. Antenatal imaging of the fetal adrenal gland can be done by 2D US if indicated.
Research Interests:
Background Congenital abnormalities of the diaphragm cause impairment of lung development and are an important cause of post-natal morbidity and mortality. Congenital diaphragmatic eventration (CDE), a less sinister diaphragmatic anomaly... more
Background Congenital abnormalities of the diaphragm cause impairment of lung development and are an important cause of post-natal morbidity and mortality. Congenital diaphragmatic eventration (CDE), a less sinister diaphragmatic anomaly compared to the more common congenital diaphragmatic hernia (CDH), often tends to mimic CDH on prenatal imaging. This study evaluates the role of fetal magnetic resonance imaging (MRI) in differentiating these two entities. Results This was a retrospective study which included fetal MRI studies done in patients with ultrasound diagnosis of fetal diaphragmatic anomaly. MRI exam was performed with a 1.5 T superconducting system with eight-element torso array coil. The images were studied by two radiologists experienced in fetal imaging in consensus. Diagnosis of CDE was made if the dome of the diaphragm was visualized as a thin hypointense line separating the lung from abdominal structures on coronal and sagittal MRI sequences. If this thin hypointens...
Research Interests:
Aim To study the trend in referral patterns for fetal echocardiography (FE) and the outcome Methods Retrospective study of fetuses referred to a single fetal imaging center for FE from Jan 2008 to Dec 2017. The study group was divided... more
Aim To study the trend in referral patterns for fetal echocardiography (FE) and the outcome Methods Retrospective study of fetuses referred to a single fetal imaging center for FE from Jan 2008 to Dec 2017. The study group was divided into group 1 (2008–2012) and group 2 (2013–2017). Indications were categorized into ‘low-risk’, ‘maternal-risk’ and ‘fetal-risk’. Detection of cardiac defect (CHD) was noted as abnormal outcome and it was analysed in relation to the referral indication. Results The study group had 32,679 cases, 11,468 in group 1 and 21,211 in group 2. Total number of referrals showed an increase of 84% between first and second half of study. ‘Low-risk’ referrals were the most common in both groups but high risk referrals had shown an increase of 24.5% over years. Maternal diabetes was the most common ‘maternal-risk’ factor and abnormal cardiac finding in obstetric scan was the common ‘fetal-risk’ indication. Incidence of CHD increased from 4.6 to 10.2% during the study period. CHD was seen more in ‘fetal-risk’ indications (65%) compared to other risk groups ( p < 0.05). Maternal-risk indications individually did not show a significant relationship to CHD. Abnormal cardiac findings in scan, extra-cardiac anomaly, aneuploidy screen positivity, single umbilical artery, growth and liquor abnormality showed a higher risk for CHD. Among low-risk 22.5% showed CHD. Conclusion Referral of high-risk cases for FE has increased recently. Abnormal fetal findings in scan or screening tests was significantly associated with fetal CHD. A significant percentage of CHD was detected in the low-risk group. Strengthening fetal cardiac screening is needed to optimise appropriate risk stratification as well as to increase detection of cardiac anomalies.
Research Interests:
Research Interests:
Abstract Idiopathic arterial calcification of infancy is a rare autosomal recessive disease, characterized by deposition of calcium along the internal elastic membrane of arteries, accompanied by fibrous thickening of the intima which... more
Abstract Idiopathic arterial calcification of infancy is a rare autosomal recessive disease, characterized by deposition of calcium along the internal elastic membrane of arteries, accompanied by fibrous thickening of the intima which causes luminal narrowing. We hereby report a series of 20 cases seen over a period of 10 years. Nineteen cases were reported as idiopathic arterial calcification and one was reported as arterial calcification in a twin reversed arterial perfusion sequence. The sites of calcification were mainly aortic valve and root of aorta which was involved in 100% of cases followed by pulmonary artery up to its branches in 18 (90%) cases. There was recurrence in the subsequent pregnancies in three of the cases. Genetic association with ENPP1 was proved in one case. There was no survival in all the cases. Thus, the prognosis of idiopathic arterial calcification is very poor with very few long-term survivors.
Research Interests:
Research Interests:
To establish normative ultrasound data for thyroid gland volume in South Indian neonates and infants and compare with abnormal sonological features of thyroid in congenital hypothyroidism (CH) to explore thyroid ultrasound utility as a... more
To establish normative ultrasound data for thyroid gland volume in South Indian neonates and infants and compare with abnormal sonological features of thyroid in congenital hypothyroidism (CH) to explore thyroid ultrasound utility as a supportive screening tool to newborn screening programs for early detection of CH. In view of impact of geo ethnic factors, varying growth velocities and body mass indices of human population worldwide, specific regional, age and gender related reference data for thyroid gland size and volume are vital. This study was an offshoot of ICMR pilot New Born Screening (NBS) project for CH. Formula used for thyroid volume estimation was ellipsoidal formula D1 x D2 x D3 × 0.523. It was a prospective observational study. The neonates who screened negative for Thyroid Stimulating Hormone (TSH) with repeat normal serum TSH and free thyroxine were selected. One hundred fifty seven infants were enrolled which included 99 boys and 58 girls. The study population inc...
Research Interests:
AbstractBackground Objective assessment of posterior fossa landmarks such as the measurement of brain stem width or intracranial translucency have not been consistently shown to be predictive of future posterior fossa abnormalities, other... more
AbstractBackground Objective assessment of posterior fossa landmarks such as the measurement of brain stem width or intracranial translucency have not been consistently shown to be predictive of future posterior fossa abnormalities, other than the Arnold–Chiari II malformation.ObjectiveTo study the association between the objective and subjective assessments of the posterior fossa landmarks at the 11–14 weeks’ scan and the posterior fossa abnormalities detected at the second-trimester anomaly scan.MethodsDesign—Blinded retrospective case–control study. Setting—Tertiary level multioperator fetal medicine center. Cases-fetuses with one of the second trimester diagnoses of posterior fossa abnormalities (Blake’s pouch cyst, mega cisterna magna, vermian agenesis, Dandy–Walker malformation, cerebellar hypoplasia) that had a 11–14 weeks’ examination at our center; Controls-fetuses with normal second trimester anatomy that had a 11–14 weeks’ examination at our center. Main outcome measures: measurements of the posterior fossa landmarks and subjective assessment of the landmarks.ResultsSignificant inter-rater agreement existed for three out of four measurements of posterior fossa landmarks. No significant difference was noted in the measurements between cases and controls, in fetuses with measurable landmarks. Abnormal landmarks were more in cases than controls (brainstem OR 4.2 (95% CI 1.5–11.8); intracranial translucency OR 3.7 (95% CI 1.3–10.1); any landmark OR 3.1 (95% CI 1.2–7.9).ConclusionAbnormal posterior fossa landmarks at the 11–14 weeks’ examination is associated with threefold risk of posterior fossa malformation.
Research Interests:
Research Interests:
ObjectiveTo analyse the distribution and determinants of the first trimester screening risk for the detection of trisomy 21 in the population in and around Chennai, a south Indian metropolitan city.MethodsA cross-sectional analysis of... more
ObjectiveTo analyse the distribution and determinants of the first trimester screening risk for the detection of trisomy 21 in the population in and around Chennai, a south Indian metropolitan city.MethodsA cross-sectional analysis of 27,647 singleton pregnancies that underwent the first trimester combined screening test (FTS) was carried out. For the screen positive cases, karyotype reports or postnatal phenotype outcome were available. The distribution of the various components of risk assessment in the screen positive cases and screen negative cases formed the main outcome measures.ResultsOf the 27,647 cases, 4.6% (1270) of cases had unossified nasal bone; 1.8% (499/27,647) had risk more than 1:250 (screen positive). Fifteen (3.2%) of the screen positive cases had confirmed Down syndrome while 46 had termination of pregnancy and 8 had fetal loss.ConclusionsWith the current screening protocol, the screen positive rate and the odds of being affected given a positive result (OAPR) for a threshold of 1:250 are 1.8% and 1 in 25 respectively.
Research Interests:
A 28-week-old fetus was detected to have a single left atrial mass in prenatal ultrasound. Postnatal echocardiography showed an aneurysm between the anterior mitral leaflet and aortic valve, to the left of atrioventricular junction and... more
A 28-week-old fetus was detected to have a single left atrial mass in prenatal ultrasound. Postnatal echocardiography showed an aneurysm between the anterior mitral leaflet and aortic valve, to the left of atrioventricular junction and communicating with the left ventricle through a narrow mouth. It probably originated from the mitral-aortic intervalvular fibrous tissue and an inherent weakness at this site might be the cause. Reported cases of pseudoaneurysm of mitral-aortic intervalvular fibrosa and subvalvular ventricular aneurysms seen following infective endocarditis, surgery, or trauma seem to have a similar anatomical background. This case explains the possibility of congenital aneurysm in this location which needs to be considered a differential diagnosis in similar cases.
Research Interests:
Transposition of great arteries (TGA) is more commonly associated with D-malposition of great arteries where anterior aorta produces characteristic "I" sign in the three-vessel view (3VV) in fetal heart imaging. We describe two... more
Transposition of great arteries (TGA) is more commonly associated with D-malposition of great arteries where anterior aorta produces characteristic "I" sign in the three-vessel view (3VV) in fetal heart imaging. We describe two cases with TGA and L-malposition of aorta where 3VV imaging showed an apparently normal arrangement of vessels while outflow tract imaging proved vital in diagnosing transposition anatomy. Apparently, normal 3VV in the presence of disproportionate vessel caliber and inability to produce normal outflow images should raise the suspicion. Attempts should be made to produce views to show great arteries originating from respective ventricles to rule out ventriculoarterial discordance and to complete segmental analysis.
Research Interests:
To review fetal autopsy reports with persistent left superior vena cava (PLSVC) and identify its associations. Autopsy reports of all fetuses diagnosed with PLSVC in our center from January 2011 to December 2015 were reviewed. Fetuses... more
To review fetal autopsy reports with persistent left superior vena cava (PLSVC) and identify its associations. Autopsy reports of all fetuses diagnosed with PLSVC in our center from January 2011 to December 2015 were reviewed. Fetuses less than 15 weeks gestational age along with autolyzed and damaged hearts were excluded from the study. The study group was compared with controls during this period. Prenatal ultrasound detection rate of PLSVC was 13.06%. All the cases had associated anomalies of which 96% had extra cardiac anomalies and 67% had intrinsic cardiac defects among which septal defects were most common (39.6%). Anomalies of cardiovascular, respiratory, genitourinary and musculoskeletal, hypoplastic thymus and single umbilical artery were significantly higher in the study group. This study emphasizes on the importance of improving the technical skill for imaging the three-vessel view as PLSVC seems to have significant associations.
Research Interests:
Research Interests:
Blomstrand osteochondrodysplasia (BOCD) is a rare autosomal recessive sclerosing skeletal dysplasia characterized by accelerated chondrocyte differentiation. In this article, we discuss three cases where lethal skeletal dysplasia was... more
Blomstrand osteochondrodysplasia (BOCD) is a rare autosomal recessive sclerosing skeletal dysplasia characterized by accelerated chondrocyte differentiation. In this article, we discuss three cases where lethal skeletal dysplasia was suspected and Blomstrand dysplasia was diagnosed by autopsy. Antenatal ultrasound findings include increased nuchal translucency, tetramicromelia and polyhydramnios. Radiological hallmark is advanced skeletal maturation and bone sclerosis. Histology of long bones revealed narrow cartilagenous cap and changes in the physeal growth zone which showed severe hypoplasia and disorganization of proliferative phase and hypertrophic phase. Homozygous and compound heterozygous mutations in PTHR1 gene have been implicated in the pathogenesis of this chondrodysplasia.
Research Interests:
Research Interests:
OR 1.16, CI OR: 1.03–1.33). Regression analysis revealed that the odds of failure increased as size of ectopic increased (P = 0.045, OR 1.85, CI OR 1.01–3.39). Conclusions: Similar results to previous studies were found regarding failure... more
OR 1.16, CI OR: 1.03–1.33). Regression analysis revealed that the odds of failure increased as size of ectopic increased (P = 0.045, OR 1.85, CI OR 1.01–3.39). Conclusions: Similar results to previous studies were found regarding failure rate of methotrexate therapy. The odds of failure of methotrexate therapy and need for surgical intervention increased by 16% for every 500 iu increase noted in pretreatment βhCG level. Size of ectopic pregnancy also played an important role with failure of therapy almost doubling as size of ectopic increased. Cutoff levels for size and βhCG at which risk of failure was considered clinically significant were calculated.
Research Interests:
Research Interests:
We report three cases of Restrictive dermopathy from unrelated families. All were small for gestational age with small eyes and open mouth. Taut, stretched skin caused restriction of movements. Clavicular hypoplasia was a consistent... more
We report three cases of Restrictive dermopathy from unrelated families. All were small for gestational age with small eyes and open mouth. Taut, stretched skin caused restriction of movements. Clavicular hypoplasia was a consistent radiological feature. Molecular diagnosis in the parents facilitated prenatal diagnosis from chorionic villous sample (CVS) in the subsequent pregnancy.
Research Interests:
Research Interests:
Research Interests:
Research Interests:
OR 1.16, CI OR: 1.03–1.33). Regression analysis revealed that the odds of failure increased as size of ectopic increased (P = 0.045, OR 1.85, CI OR 1.01–3.39). Conclusions: Similar results to previous studies were found regarding failure... more
OR 1.16, CI OR: 1.03–1.33). Regression analysis revealed that the odds of failure increased as size of ectopic increased (P = 0.045, OR 1.85, CI OR 1.01–3.39). Conclusions: Similar results to previous studies were found regarding failure rate of methotrexate therapy. The odds of failure of methotrexate therapy and need for surgical intervention increased by 16% for every 500 iu increase noted in pretreatment βhCG level. Size of ectopic pregnancy also played an important role with failure of therapy almost doubling as size of ectopic increased. Cutoff levels for size and βhCG at which risk of failure was considered clinically significant were calculated.
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
An antenatal referral for fetal echocardiography at 20 weeks of gestation with the suspicion of a cyst in the right atrium led to the diagnosis of an aorta to right atrial communication in a fetus. It was considered to be right coronary... more
An antenatal referral for fetal echocardiography at 20 weeks of gestation with the suspicion of a cyst in the right atrium led to the diagnosis of an aorta to right atrial communication in a fetus. It was considered to be right coronary to right atrial fistula by fetal echocardiography. There was no other fetal anomaly and the cardiac hemodynamics remained stable throughout pregnancy. Postnatally, there was a progressive enlargement of the tunnel that led to a decision for intervention. Aortography showed an anterior aorta to right atrial tunnel, which was occluded in the catheterization laboratory. We describe in this report, the antenatal findings noted in ultrasound imaging along with the postnatal presentation and management of this rare congenital anomaly.
Research Interests:
A case report of a child with partial tri-somy of 11q'due to inherited translocation is being presented for its rarity and microstigmata in the carrier. ... The prepositus was the second born, at term, by caesarian section, for... more
A case report of a child with partial tri-somy of 11q'due to inherited translocation is being presented for its rarity and microstigmata in the carrier. ... The prepositus was the second born, at term, by caesarian section, for oblique lie, to non consanguineous couple - aged 25 years and ...