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.

Muzaffarpur Outreach programme

Muzaffarpur Obstetrics and Gynecological Society Joint Programme

Date: 18th November 2018
Venue: CME at Hotel Chandra Palace, Live Demo at Ayushman Hospital

Dr. Anita Kaul
HOD, Fetal Medicine, Apollo Centre for Fetal Medicine, New Delhi.
Dr. Rachna Gupta
Director Sonepat Fetal Medicine & Genetic Centre, Visiting Consultant at Indraprastha Apollo Hospital, New Delhi.
Dr. Punam Dixit
Consultant PMSC, Patna.
Dr. Prachi Singh
Consultant Ayushman Hospital and Endoscopy Centre, Ashirwad IVF Centre, Muzaffarpur.

9:15 am – 9:30 am Welcome Address by Prof. Dr. Rangila Sinha FRCOG
9:30 am – 10:00 am First trimester screening and current concepts: Dr. Anita Kaul
10:10 am – 10:30 am Role of Biochemistry in screening – Quadruple marker in the 2nd Trimester: Dr. Prachi Singh
10:35 am – 10:55 am Doppler in 3rd Trimester: Dr. Rachna Gupta
11:00 am – 11:20 am Tea break
11:20 am- 11:45 am Screening and Prevention of pre-eclampsia an overview: Dr. Punam Dixit
11:50 am – 12:10 pm Early vs late fetal growth restriction: Dr. Rachna Gupta
12:15 pm- 12:45 pm Group Discussion : Difficulties faced doing USG by Obstetricians in general practice.
12:45 pm – 1:45 pm Lunch
2:00 pm – 4:00 pm Live Demonstration of cases:
4:00 pm Vote of Thanks: Dr. Pallawi Roy President MOGS

Registration is free for CME.
Registration fee of Rs 1500 for those who want to attend live demonstration workshop.

Rajpura Outreach Programme

Date: 5th August 2018 9.00 – 1.00 pm
Venue: Neelam Hospital, NH64, Opp. Chitkara University, Rajpura. Punjab


Dr Anita Kaul
HOD, Fetal Medicine, Apollo Center For Fetal Medicine, New Delhi
Dr Rachna Gupta
Consultant. Sonepat Fetal Medicine and Genetic Center,
Visiting Consultant, Apollo Center For Fetal Medicine



  • 09.15-09.30 am Welcome address – Dr Shikha Gupta
  • 09.30-10.00 am First Trimester Screening – current concepts – Dr Anita Kaul
  • 10.05-10.25 am Role of Biochemistry in Screening: Quadruple marker in the second trimester – Dr Gurika Aggarwal
  • 10:30-10.50 am Early vs Late Fetal Growth Restriction – Dr Rachna Gupta
  • 10:55-11:15 am Tea Break
  • 11:15-11.40 am Screening & prevention of pre-eclampsia – overview – Dr Anita Kaul
  • 11.45-01.00 pm Live DEMO case Based with audience interaction – Dr Anita Kaul & Dr Rachna Gupta
  • 1:00 pm – Lunch

Jaipur outreach programme on First trimester screening

FMFIndia’s 2017 calendar began on the festive Makar Sankranti/ Pongal/ Bihu weekend with its Jaipur outreach programme on 15th January at Orchid Women’s Hospital & Fetal Medicine Centre.

FMF-India trainers, Dr Akshatha Sharma, Dr Rachna Gupta and Dr Karuna Mandal, interacted with group of OBGYNs and sonologists from in and around Jaipur (Sikar, Kota, Alwar, Chomu, Bikaner).

The highly interactive session saw;

– Queries regarding biochemical screening and problems in patient counselling.
– Discussions on how to implement FTS protocols in remote areas, and training in first trimester scan.
– In-depth discussions on prediction & management of Fetal growth restriction, topic which is very dear to obstetricians to prevent perinatal mortality.

The live demo session covered settings of ultrasound machines and technique of scanning in various stages of pregnancy.

The registrants asked for more such programmes to be held in future which we will definitely plan.

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FMF India’s Outreach programme in Kashipur

Kashipur outreach programme held on 20th Nov 2016, was conducted in association with Kashipur OBGYN society, faculty being Dr Anita Kaul, Dr Chanchal Singh, Dr Rachna Gupta and Dr Bharti Pant Gahtori.

With excellent brain storming from Dr Bharti, our local organiser, workshop was divided in two sessions. Morning session focussed on obstetricians – covering first trimester screening for aneuploidies as well as perinatal complications, diagnosis and management of fetal growth restriction and case discussions. Afternoon session focussed more on antenatal scanning skills and there was live demonstration of cases for first trimester screening, anomaly scan, fetal growth parameters and Dopplers.

There was positive feedback with this approach and we thank Dr Bharti for her efficient organising skills and hope she joins our team of trainers in the near future.

Faridabad outreach programme

Faridabad outreach programme conducted in association with FOGS by Dr Anita Kaul, Dr Rachna Gupta and Dr Nidhi Arora on 29th September, 2016 was attended by almost 100 delegates, mostly OBGYNs.

The programme was an eye opener in the sense that we need to address the learning objectives of obstetricians and sonologists differently. We realised that obstetricians are more interested in clinical and counseling aspect of scan findings rather than technique of scanning. Case based discussions were well received by the audience with active interaction. Obstetricians also clarified their doubts on management of various cases they had come across.

As a result of the feedback future programmes will be split between topics of interest to the obstetricians during the first half followed by dedicated teaching to the ultrasonologists only in the second half

Outreach Programme at Indore

Date: 9th October 2016
Venue: LASER, Sri Aurobindo Medical College & P.G. Institute, Indore, Madhya Pradesh
Dr. Anita Kaul
HOD, Fetal Medicine, Apollo Centre for Fetal Medicine, Indraprastha Apollo Hospital New Delhi
Dr. Rachna Gupta
Senior Consultant, Fetal Medicine, Maharaja Agrasen Hospital,
Visiting Consultant Center for Fetal , Indraprastha Apollo Hospital Medicine New Delhi



  • 08:45 am – 09:00 am Registration
  • 09.:00 am – 09:15 am Welcome Address

Session – I

  • 09:15 am – 09:40 am Overview of Prenatal screening – Dr Anita Kaul
  • 09:40 am – 10:00 am 1st trimester screening is the way forward – Dr. Rachna Gupta
  • 10:00 am – 10:15 am Inauguration at the hands of Chief Guest Shri P. Narahari, Collector Indore
  • Followed by Tea

Session – II

  • 10:15 am – 10:45am First Trimester Screening for Anomalies- Dr. Shweta Bhandari
  • 10:45 am – 11:15 am Multiple pregnancies in First trimester/Multifetal reduction/early identification of TTTS/SFGR -Dr. Rachna Gupta
  • 11:15 am – 11:45 pm Screening for adverse pregnancy outcomes FGR, Preeclampsia, Preterm delivery – Dr. Anita Kaul
  • 11:45 pm – 12:30 pm Panel Discussion – Moderator Dr Shweta Bhandari Soft markers and the Obstetrician-To Be or Not to be Alarmed
  • 12:30 pm – 01:15 pm Live Demo & Interaction
  • 01:15 pm – 01:30 pm Vote of thanks
  • 01:30 pm Lunch

Dr. Anita Kaul, Dr. Archana Baser, Dr. Sudhir Gokhle, Dr. Poonam Mathur, Dr. Brijbala Tiwari, Dr. Nitika Benjamin, Dr.Rachna Gupta