WZ research webinar summary June 2022

Prenatal Invasive Testing at a Tertiary Referral Center in India: A Report of 433 Cases Under a Single Operator.

The Journal of Obstetrics and Gynecology of India – Jan 2022
Speaker – Dr. Vandana Bansal
Moderator – Dr. Anita Kaul

The study looked at indications for invasive testing, positive predictive value according to the indication,incidence of second prick, culture failure, or miscarriage within 4 weeks of the procedure.

  1. Maximum number of procedures were due to being screen positive for chromosomal problems. According to the study the overall positive predictive value (PPV) of a screen positive test for chromosomal aneuploidies was 6.7%. The PPV was very low (2.7%) for isolated biochemistry screen positive. Dr. Anita Kaul highlighted that this could be due to patients being referred for invasive testing based on serum biochemistry reports from different labs many of whom might not be adhering to strict FMF protocols for testing and auditing. Therefore, the need to do biochemistry from standardized labs and use only combined risk results rather than isolated biochemistry results for counselling was emphasized.
  2. The study had no procedure related losses. However; it was astutely pointed by Dr. Anita Kaul that this could reflect the author’s personal expertise given her extensive experience and might not apply to all. Also Dr. Anita Kaul recommended that pre term deliveries post procedure could have been included in the outcomes analyzed.

Preserved Blood Spots Aid Antenatal Diagnosis of Citrullinemia Type-1
Journal of fetal medicine – June 2021

Speaker – Dr. Shruti Bajaj
Moderator – Dr. Divya Agarwal

The case report highlighted the importance of DNA storage in case of history of neonatal death with suspected inborn error of metabolism.

  1. Isolated biochemistry-based diagnosis of IEM is not enough to aid couples in reproductive genetic counseling. This has to be coupled with a genomic diagnosis.
  2. Dried blood spots can be a source of DNA when appropriately stored for many years.
  3. DNA banking will go a long way in aiding diagnosis even if index case is no longer available. Therefore obstetricians and neonatologists need to be made aware about DNA banking methods.

Especially in fetuses that are being terminated for malformations and neonatal deaths where cause has not yet been firmly established.


The papers presented in the research webinars strictly reflect the author’s opinions and practices. FMFI is a neutral platform for scientific discussions and does not endorse or refute these opinions.

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!

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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

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.

Webinar on 2nd trimester minor markers for aneuploidies – confusion to clarity

Date: 3 april 2016
Time: 10.30 am

This session will be useful for practitioners who deal with counseling patients regarding the findings of the second trimester fetal ultrasound scan.

Minor markers for fetal aneuploidies form a major cause of anxiety in patients and consultants alike. These markers may be variations of normal anatomy if not associated with aneuploidies. However, the call of whether or not to investigate further for fetal aneuploidies and how to follow up these cases through pregnancy is ridden with tremendous confusion. The aim of this session will be to clarify these issues.

Dr.Chinmayee Ratha, an FMF-UK accredited faculty will conduct the one-hour lecture. Dr Ratha works as a Lead Consultant – Fetal Medicine with Navodaya Hospitals, Hyderabad. There will be short MCQ during the lecture on what you have learnt. You will also have the opportunity to interact with the speaker and clear your doubts at the end of the lecture.


Webinar on Setting up of 12 weeks Fetal Wellness clinic

Date: 17 October 2015
Time: 1.30 pm – 2.30pm

This certification is for centres who are regularly providing patients with

  • Aneuploidy Risks using the FMF software
  • Risk stratification for pre-eclampsia by taking maternal blood pressure correctly according to the International Society for the Study of Hypertension in Pregnancy
  • Screening for Thalassemia in every patient
  • Screening for maternal diabetes using 75g Oral Glucose Tolerance Test [according to the International Association of Diabetes & Pregnancy Study groups ( IADPSG )


Webinar on FMFIndia’s Obstetrician Certification

Date: 28 March 2015
Time: 2.00-3.00 P.M India time.

The one hour lecture webinar on first trimester screening and NT , which will be conducted by an FMF-UK accredited faculty. You will have a chance to interact with the speaker and clear your doubts.

FMFIndia’s Mission
FMFIndia is a non-profit organisation dedicated to the education and promotion of Skilled Medical Professionals in the field of Fetal Medicine. It aims to address problems and improve the health of pregnancies of Indian women across all social strata. It will do this by increasing the number and availability of skilled professionals (physicians,ultra-sonographers, and other health-care workers) to all Indian women.

Obstetrician Certification’s Objectives

  • It is important that all the obstetricians are familiar with standard protocols of prenatal care, and offer them to all pregnant women.
  • The obstetricians should by the end of the programme be able to counsel the patient regarding risk for the common aneuploidies , risk for preeclampsia and prematurity, and guide further management. Only if they need diagnostic testing, or invasive procedure for one reason/other, should they feel the need refer the patient to higher centre.
  • We also need to ensure that all sonographers follow FMF protocols and that can be ensured only if Obstetricians review All images of NT scan and motivate their sonographers to get FMF accredited
  • FMF India has been organizing training and hands on workshops all over India to help sonographers become proficient in NT scans and a list of these centres will be found on the website