Fernandez Hospital Pvt Ltd

Hyderabad andhra Pradesh, India

Fernandez Hospital Pvt Ltd

Hyderabad andhra Pradesh, India
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Pochiraju M.,Fernandez Hospital Pvt Ltd | Surampudi K.,Fernandez Hospital Pvt Ltd | Marakani L.R.,Fernandez Hospital Pvt Ltd | Dasari S.,Fernandez Hospital Pvt Ltd | Gundabattula S.R.,Fernandez Hospital Pvt Ltd
International Journal of Infertility and Fetal Medicine | Year: 2013

Aim: To compare risk factors for extratubal gestations with tubal gestations. Materials and methods: Case control design with retrospective examination of an electronic database to identify ectopic gestations. Ectopic gestations were confirmed through ultrasound examination or serum beta hCG levels. We defined an ectopic gestation as implantation of pregnancy outside uterine cavity; tubal ectopic including implantation in the tube, isthmic, ampullary, or fimbrial and extratubal ectopic including implantation in the ovaries, cervix, abdomen, interstitia or cesarean scar. Results: Ninety-one (1.1%, 95% CI: 0.9-1.3, 1 in 90 pregnancies) of 8,203 pregnancies during the study period were ectopic gestations including 69 (0.8%, 95% CI: 0.7-1.1, 1 in 120 pregnancies) tubal gestations and 22 (0.3%, 95% CI: 0.2-0.4, 1 in 372 pregnancies) gestations in extratubal locations. Extratubal ectopic gestations were more common in women with advanced maternal age (odds ratio: 7.4, 95% CI: 1.3, 43.9, p = 0.03) compared to women with tubal ectopic gestations. Conclusion: Risk factors for extratubal gestation did not differ from risk factors for tubal gestations except for advanced maternal age. Pregnant women with advanced maternal age have to be additionally counseled on the increased risk for extratubal gestations.


Dudlani M.,Fernandez Hospital Pvt Ltd | Surapaneni T.,Fernandez Hospital Pvt Ltd
International Journal of Infertility and Fetal Medicine | Year: 2011

Aim: To determine associations of advanced paternal age with fetal growth and adverse neonatal outcomes. Methods: A hospital-based unmatched case-control study with random selection of controls. Fetal growth was determined by serial ultrasound measurements and growth was classified at birth by a neonatalogist based on the Lubchenco charts. Advanced paternal age was explored using two cutoffs (35 and 40 years). Likelihood ratios, unadjusted and adjusted odds ratios and the 95% confidence intervals around point estimates are presented. Results: The study covered 218 pregnant women that included 137 (63.72%) pregnant women who delivered a live AGA/LGA baby and 78 (36.28%) pregnant women who delivered a live small for gestational age baby and 45 (20.64%) fathers with advanced paternal age based on a cutoff of ≥ 40 years and 73 (33.49%) fathers with advanced paternal age based on a age cutoff ≥ 35 years. Although advanced paternal age (both ≥ 35 and ≥ 40 years) was protective for small for gestational age babies in a bivariate analysis, the association was not significant in a multivariate regression model that adjusted for maternal age, parity, diabetes and gestational age at delivery. Advanced paternal age (both ≥ 35 and ≥ 40 years) did not show a clinically meaningful positive or negative likelihood ratio with other adverse neonatal outcomes. Conclusion: Paternal age does not seem to be associated with fetal growth or adverse neonatal outcomes; however, a prospective cohort study is necessary to provide further evidence after controlling for potential confounders.


Pochiraju M.,Fernandez Hospital Pvt Ltd | Nirmalan P.K.,Fernandez Hospital Pvt Ltd
Journal of Clinical and Diagnostic Research | Year: 2014

Background: An estimated 4.9 million women in India are infertile. If we add secondary infertility to these estimates, the number of infertile couples in India may rise to 17.9 million. Increased use of assisted conception services and information on outcomes after assisted conceptions are useful, to appropriately counsel women who utilize such services. Aim: To determine as to whether outcomes of pregnancy differ between assisted conceptions and natural conceptions in pregnant women with singleton foetuses. Settings and Design: A retrospective observational study done a single tertiary care centre in southern India. Materials and Methods: This study included pregnant women with singleton gestations, who delivered at the study institute in 2012. Assisted conception was considered to include all invasive and non-invasive methods like ovulation induction (OI), Intrauterine insemination (IUI), in vitro fertilization (IVF), intracytopalsmic sperm injection (ICSI). Outcomes of interest included gestational age at delivery, birth weight, small for gestational age babies, still births, neonatal deaths and caesarean sections. Point estimates and the 95% confidence intervals around point estimates of associations with assisted conceptions and outcomes were determined by using bivariate analysis and a multivariate logistic regression model. Results: This study included 6,712 women who were pregnant with a singleton foetus, including 460 (6.85%, 95% CI: 6.27, 7.48) women who conceived with assistance Women who conceived with assistance were more likely to be older (p<0.001), nulliparous (p<0.001), who had a higher prevalence of obesity (p<0.001), pre-gestational diabetes mellitus (p=0.009), gestational diabetes (p<0.001) and pre-pregnancy hypothyroidism (p<0.001) in this population. Assisted conceptions were not significantly associated with small for gestational age babies (p=0.09), still births (p=0.56), or neonatal deaths (p=0.89). Assisted conceptions were associated with a higher incidence of caesarean sections (adjusted OR: 1.37, 95%CI: 1.11-1.70) in a multivariate logistic regression model. Conclusion: After adjusting for differences in maternal characteristics, pregnant women with singleton foetuses, who conceived with assistance, had similar outcomes, except for higher caesarean section rates, as compared to women who conceived naturally.


Firdous Z.,Fernandez Hospital Pvt Ltd | Aziz N.,Fernandez Hospital Pvt Ltd
International Journal of Infertility and Fetal Medicine | Year: 2011

Adherent placenta is a rare but life- and fertility-threatening condition, with a rapid increase in incidence in this decade. Cesarean hysterectomy, the traditional management, is associated with very high morbidity due to massive blood loss and adjacent organ damage. The objective was to study the effect of preoperative internal iliac artery balloon catheter placement as a means of reducing morbidity. Methods: Adherent placenta cases were identified using hospital database over a 9 years period from 2001 to 2009 at Fernandez hospital, a tertiary perinatal center with 5000 deliveries annually. Mothers who had preoperative internal iliac artery balloon placements were compared with those who did not have. Maternal morbidity was assessed in the form of intraoperative blood loss, total units of blood products transfused, mean operative time, length of postoperative hospital stay, use of adjuvant procedures (for control of hemorrhage), adjacent organ damage, cardiac arrest, and maternal mortality. Results: Forty-one subjects with a diagnosis of adherent placenta were identified out of 32,354 deliveries (incidence of 1:789) and 27 of these had peripartum hysterectomy. Six had preoperative internal iliac artery balloons placement before hysterectomy (study group) and 21 had hysterectomy alone (control group). Significant difference was found in mean amount of blood loss (p = 0.002) and in mean number of blood products given (p = 0.04). No statistically significant difference was found in mean operative time and length of postoperative hospital stay. There were four subjects who had adjacent organ damage, two had cardiac arrest, two required recombinant factor VIIa in the control group when compared with none in the study group. Conclusion: Preoperative placement of internal iliac artery occlusion balloon catheters reduced morbidity by minimizing blood loss and adjacent organ damage.


Singh A.,Fernandez Hospital Pvt Ltd | Surapaneni T.,Fernandez Hospital Pvt Ltd | Nirmalan P.K.,Fernandez Hospital Pvt Ltd
Journal of Clinical and Diagnostic Research | Year: 2014

Background: Pre-Eclampsia (PE) affects 6-31% of pregnant women with multiple gestations. There are conflicting reports on the association of PE with Chorionicity and zygosity; however, there is a lack of information on this potential association in a population of pregnant Asian Indian women. Aim: To determine as to whether chorionicity and zygosity were associated with PE in a population of Asian Indian women with twin gestations. Settings and Design: A retrospective observational study was done at a single tertiary care centre in Southern India. Material and Methods: The study included pregnant women with twin gestations, who was delivered at the study institute in 2012. Hypertension in pregnancy was categorized, based on the criteria of the International Society for the Study of Hypertension in Pregnancy. Chorionicity was determined by using ultrasonography and zygosity was determined, based on clinical criteria. Point estimates and the 95% confidence intervals around point estimates of PE and associations of chorionicity and zygosity with PE were determined by using bivariate analysis, logistic regression models and area under Receiver Operator Characteristic (ROC) curves. Results: This study included 208 women with twin gestations. The incidence of PE in dichorionic twin gestations was 13.17% (n=22, 95% CI: 8.66, 18.96), it was 4.87% (n=2, 95% CI: 0.83, 15.19) in monochorionic twin gestations, it was 16.36% (n=9, 95% CI: 8.29, 27.91) in dizygous twin gestations and it was 4.88% (n=2, 95% CI: 0.83, 15.19) in monozygous twin gestations. Neither chorionicity (adjusted OR: 2.59, 95% CI: 0.55, 12.19) nor zygosity (adjusted OR 2.72, 95% CI: 0.49, 15.13) were associated with PE In a multivariate logistic regression model. Conclusion: Although it was not statistically significant, the clinical incidence of PE was higher in dichorionic and dizygous twin gestations.


Marakani L.R.,Fernandez Hospital Pvt Ltd | Dasari S.,Fernandez Hospital Pvt Ltd | Gundabattula S.R.,Fernandez Hospital Pvt Ltd | Joseph E.,Fernandez Hospital Pvt Ltd
International Journal of Infertility and Fetal Medicine | Year: 2013

Objective: To assess the reduction in fetal loss following transabdominal cervicoisthmic cerclage done for repeated failed vaginal cerclages and/or inaccessible cervices. Study design: An observational study of 113 pregnancies in 90 women after transabdominal cervicoisthmic cerclage from January 1999 to December 2010 at Fernandez Hospital, Hyderabad, Andhra Pradesh, India. Results: Mean gestational age at the time of elective transabdominal cervicoisthmic cerclage was 11.6 weeks. Patients were delivered by lower segment cesarean section (LSCS) with a mean gestational age of 36 weeks. Live birth rate was 90.5%. Incidence of mid-trimester miscarriages was 8.6% after cerclage compared with 62.9% before cerclage. Before cerclage, only 13.1% pregnancies continued beyond 28 weeks whereas after cerclage, 88.6% crossed the period of viability. Prior to cerclage, preterm delivery rate was 7.0% (as majority of the pregnancies were lost prior to period of clinical viability) and only 13.6% of these preterm babies survived. Although the incidence of preterm deliveries was 23.8% after cerclage, 80% of these preterm babies survived. Excluding first-trimester miscarriages, fetal loss was 93.3% prior to cerclage and 13.7% postcerclage. In effect, the take home baby rate among pregnancies was only 5.8% before cerclage compared with 86.7% after cerclage. Mean birth weight after cerclage was 2.5 kg. Conclusion: Transabdominal cerclage reduces fetal loss and improves pregnancy outcome in women who had failed vaginal cerclages and in those with inaccessible cervices.


Surapaneni T.,Fernandez Hospital Pvt Ltd | Fernandez E.,Fernandez Hospital Pvt Ltd
International Journal of Infertility and Fetal Medicine | Year: 2010

The current study aimed to determine the prevalence of obesity and gestational diabetes (GDM) and the association of obesity and gestational diabetes with adverse pregnancy outcomes in a population of pregnant women. Routine antenatal care included the estimation of body mass indices, assessment of blood glucose levels, including glucose challenge tests and oral glucose tolerance test, fetal growth monitoring and nutritional counseling. The prevalence of GDM and obesity in this population was 8.43% (95% CI: 7.47-9.40) and 19.49% (95% CI: 18.12-20.87) respectively. The prevalence of obesity increased to 54.63% (95% CI: 52.91-56.36), if we used the ICMR guidelines for BMI in this population. Cesarean sections (adjusted OR: 2.04, 95% CI: 1.43-2.89), large for gestational age (LGA) babies (adjusted OR: 3.82, 95% CI: 2.11-6.92) and macrosomia (adjusted OR: 20.90, 95% CI: 3.29-132.77) was associated with obesity in GDM (based on the ICMR guidelines for BMI). Results from this study indicate that gestational diabetes and obesity are increasingly important priorities for perinatal care in India.


Vavilala S.,Fernandez Hospital Pvt Ltd | Geeta K.,Fernandez Hospital Pvt Ltd
International Journal of Infertility and Fetal Medicine | Year: 2011

Objective: To examine the clinical utility of 11-13 +6 weeks scan for screening for chromosomal abnormalities and to assess the potential value of the same ultrasound examination in the early diagnosis of fetal structural anomalies. Design: A prospective interventional study at Fetal Medicine Unit, Fernandez Hospital Pvt Ltd, a tertiary care perinatal center, Hyderabad, India, between September 2005 and March 2010. Methods: All pregnant women < 13 +6 weeks at booking are offered a routine obstetric scan between 11 and 13 +6 weeks. All scans are done by obstetricians who are accredited by Fetal Medicine Foundation. All expectant mothers undergoing 11-13 +6 weeks scan were included; all expectant mothers with antenatal booking after 14 weeks were excluded from the study. Results: Between September 2005 and March 2010, a total of 11,012 scans were done between 11 and 13 +6 weeks. Complete follow-up was available for 7,916 cases; 1,460 are ongoing pregnancies and 1,636 expectant mothers were lost to follow-up. The median maternal age in our population is 27 years and 340 (4.30%) mothers had advanced (> 35 years) maternal age. The median NT in our population is 1.58 mm. Increased nuchal translucency (NT > 95th percentile) was found in 362 (4.59%) scans. Miscarriages/abortions and termination of pregnancy were significantly higher in women whose fetus had an increased nuchal translucency thickness. Nuchal translucency thickness was significantly higher in women with advanced maternal age (ANOVA F = 0.002, Fishers exact test p-value for equality of medians = 0.04). Absent fetal nasal bones were present in 20 (5.57%) of women with increased NT compared to five (0.07%) women with normal NT. Among 7,916 women, 367 (4.64%) women were screen positive for chromosomal abnormalities. After counseling, only 40 screen-positive women accepted prenatal diagnostic procedures. Skull/brain abnormalities were found in 25 fetal images, abdominal abnormalities in 17, spinal abnormalities in eight, bladder abnormalities in five and cardiac abnormalities in five fetal images. Conclusion: The 11-13 +6 weeks ultrasound scan is an important diagnostic tool that should be offered to all pregnant women as a routine standard of antenatal care in the first trimester of pregnancy in India. However, as a screening tool, it mandates addition of cost-effective biochemical tests. To make the combined screening cost-effective, this study calls for making a national policy for Down's syndrome screening for India. © Jaypee Brothers Medical Publishers (P) Ltd.


Marakani L.R.,Fernandez Hospital Pvt Ltd | Gundabattula S.R.,Fernandez Hospital Pvt Ltd
International Journal of Infertility and Fetal Medicine | Year: 2012

Approximately 1% of women with a molar pregnancy may have a recurrence. Chemotherapy is not indicated for recurrent molar pregnancies. An adequate interconception interval is important to ensure that the serum beta-human chorionic gonadotropin (β-hCG) from a new pregnancy does not interfere with the follow-up of the molar pregnancy that is done to detect persistent disease. We discuss the case of a nulliparous woman who had four molar pregnancies and her future reproductive options.


Sultana R.,Fernandez Hospital Pvt Ltd | Marakani L.R.,Fernandez Hospital Pvt Ltd | Gundabattula S.R.,Fernandez Hospital Pvt Ltd
International Journal of Infertility and Fetal Medicine | Year: 2011

Aim: To determine potential associations of abdominal fat distribution with insulin resistance and cardiovascular risk in women with polycystic ovary syndrome (PCOS). Methods: Cross-sectional study that included detailed clinical examination, body mass indices (BMI), waist-hip ratio, insulin resistance and cardiovascular risk scores for 350 women registered between August 2008 and December 2009. Biochemical analysis included fasting blood glucose level, serum insulin level, triglycerides, total cholesterol and HDL cholesterol. Primary outcomes of interest included insulin resistance and cardiovascular risk score. Results: The mean age of the subjects was 25.77 years. Oligoovulation was present in 99% of the women. Eighty-two (23.43%, 95% CI: 19.21%, 28.08%) women were obese and 100 (28.57%, 95% CI: 24.02%, 33.47%) women had android obesity. Insulin resistance was present in 136 (38.86%, 95% CI: 33.85%, 44.05%) women and 107 (30.57%, 95% CI: 25.91%, 35.55%) women had a cardiovascular risk >1. Women with a waist-hip ratio >0.85 were more likely to have insulin resistance (OR 2.70, 95% CI: 1.68, 4.35, p < 0.001) and at increased risk for cardiovascular events (OR: 1.82, 95% CI: 1.12, 2.97, p = 0.02). Obese women were more likely to have insulin resistance (OR 2.53, 95% CI: 1.53, 4.19, p < 0.001) and at increased risk for cardiovascular events (OR: 2.17, 95% CI: 1.30, 3.63, p = 0.003). Conclusion: Long-term health hazards of PCOS have to be considered as these may be prevented to some extent by early identification and interventions, such as changing the lifestyle of the individual.

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