Optimal timing of the second trimester fetal ultrasound in the obese gravida

In 2008, an American College of Obstetricians and Gynecologists (ACOG) committee opinion1 defined late-preterm (LPT) infants as infants born between 34 0/7 weeks and 36 6/7 weeks of gestation. However, this is often mistakenly believed by authors to represent 34–36 completed weeks of gestation, as in this article.2 As a matter of fact, 34–36 completed weeks of gestation includes babies born between 34 0/7 and 36 0/7 weeks gestational age. This is because 36 weeks is completed the day after 35 6/7, which is 36 0/7. With ongoing evidence that LPT babies have poor outcomes when compared to full-term infants, it is imperative that we use standardized terminology for LPT infants when planning future studies. In 2005, the National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health (NIH) defined LPT birth (LPTB) as births between 34 completed weeks (34 0/7 weeks, or day 239) and less than 37 completed weeks (36 6/7 weeks, or day 259) of gestation.3 This therefore represents a 3-week period as opposed to the definition used in this paper, wherein the authors defined LPTB as birth between 34 and 36 completed weeks gestation. The definition used in this paper is incorrect, as it excludes babies between 36 0/7 and 36 6/7 gestational age, and this subset should be included in the late preterm4 cohort. The authors seem to have misinterpreted the ACOG committee opinion (34 0/7 to 36 6/7 weeks of gestation) by defining LPTB as birth between 34 and 36 completed weeks of gestation. Their conclusion that 45% of respondents correctly defined LPTB as birth between 34–36 completed weeks gestation (which is an incorrect definition) is thus inaccurate. Simply stated,4 36 weeks of gestation are completed at 36 0/7, and therefore, 36 completed weeks is numerically represented as 36 0/7 and not 36 6/7. I would like to urge all providers to have uniformity in utilization of standardized definitions when using the terminology “completed weeks of gestation.” The use of universally accepted terminology is important for consistency in literature and future studies evaluating outcomes of LPT infants.

Quantifying the burden of stillbirths before 28 weeks of completed gestational age in high-income countries: a population-based study of 19 European countries

The mechanisms underlying the altered neurodevelopment commonly experienced by children born preterm, but without brain lesions, remain unknown. While individuals born the earliest are at most risk, late preterm children also experience significant motor, cognitive and behavioural dysfunction from school age, and reduced income and educational attainment in adulthood. We used transcranial magnetic stimulation and functional assessments to examine corticomotor development in 151 children without cerebral palsy, aged 10-13 years and born after gestations of 25-41 completed weeks. We hypothesized that motor cortex and corticospinal development are altered in preterm children, which underpins at least some of their motor dysfunction. We report for the first time that every week of reduced gestation is associated with a reduction in corticomotor excitability that remains evident in late childhood. This reduced excitability was associated with poorer motor skill development, particularly manual dexterity. However, child adiposity, sex and socio-economic factors regarding the child's home environment soon after birth were also powerful influences on development of motor skills. Preterm birth was also associated with reduced left hemisphere lateralization, but without increasing the likelihood of being left handed per se. These corticomotor findings have implications for normal motor development, but also raise questions regarding possible longer term consequences of preterm birth on motor function.

The gestational age at which the delivery occurs is important in determining the perinatal outcome. In this study, the foetal outcome was analysed according to the gestational age in weeks in spontaneous vaginal delivery occurring between 36 completed weeks to 40 completed weeks of gestation. To study the foetal outcome according to the weeks of gestation in spontaneous vaginal delivery occurring between 36 completed weeks to 40 completed weeks of gestation. A retrospective study of women who spontaneously delivered vaginally, at gestational age between 36 completed weeks to 40 completed weeks from 1 July 2019 to 30 September 2019 was conducted at GMERS Medical College and Hospital, Sola.Total 390 cases were studied.Foetal outcome in terms of birth weight, APGAR score at 1 minute, and NICU admissions were noted and analysed according to the weeks of gestation at delivery, and entered into a database.The results were analysed and presented in the form of tables and graphs. The average birth weight increased with increase in the weeks of gestation at the time of the spontaneous delivery. The average birth weight of neonates born in 36th, 37th and 38th week was 2.314Kg, 2.623Kg and 2.704Kg, respectively. 14.28% of the babies born in the 36th week of gestation were admitted to the NICU. 4.705% and 4.347% of the babies born in the 37thand 38th week of gestation respectively, were admitted to the NICU.The Mean APGAR score of the neonates born in 36th, 37th, 38th and 39th week were 8.714, 9.235, 9.347, and 9.645, respectively. Thus, the mean APGAR score increased by the weeks of gestation at the time of the spontaneous delivery. Unnecessary induction of labour or elective LSCS before 39 weeks should be discouraged. In case of elective deliveries, unless there is a health risk to the mother or baby, it is best to wait to deliver until reaching full term at 39 weeks.

There are only few reports worldwide on the outcome of very pre-term infants and very low birthweight infants for a whole country. In Switzerland official population statistics are based on birthweight only, gestational age not yet being documented. The aim of the present study was to assess the outcome at two years of age for a geographically defined high-risk neonatal population based on both birthweight and gestational age. All infants born in 1996 included in the Swiss Neonatal Network (a national anonymous registry established by the Swiss Society of Neonatology for liveborn infants before 32 completed gestational weeks or weighing less than 1500 g) were divided into three groups according to gestational age and birth weight: Group 1: born <32 completed gestational weeks and weighing =1500 g; group 2: born after 32 completed gestational weeks and weighing <1500 g; group 3: born <32 gestational weeks and weighing <1500 g. Information at 24 months corrected age about growth, neurological outcome, frequency of respiratory infections, prescription of antibiotics and medical consultations during this period was obtained from the paediatricians caring for the infants. Fair outcome was defined as survival without serious neonatal complications or abnormal neurological findings at 24 months corrected for prematurity. 723 infants were born alive in Switzerland between 1.1. and 31.12.1996 before 32 completed weeks or weighing less than 1500 g at birth. Mortality was 4.3% for a total of 163 infants in group 1 (<32 weeks, =1500 g), 4.6% for 108 infants in group 2 (>32 weeks, <1500 g) and 18.6% for 452 infants in group 3 (<32 weeks, <1500 g). 6.5% of group 1 survivors followed up to 24 months corrected age had a poor neurological outcome as compared to 9.3% in group 2 and 10.9% in group 3. Infants in group 1 needed antibiotics less often after hospital discharge (interquartile range IQR: 0-2 courses) than infants in group 2 (0-3 courses) and 3 (0-3 courses). Infants in group 2 suffered from fewer airway infections (interquartile range 2-5 times) than in group 1 (2-6 times) and 3 (1-7 times). Infants in group 3 needed more medical consultations (IQR 12-21) than those in group 1 (10-16) and 2 (11-16). The overall fair outcome at 24 months corrected age was 85.3% in group 1, 80.7% in group 2 and 59.6% in group 3. A close correlation between overall fair outcome and gestational age at birth on the one hand and with birthweight on the other can be observed. This study gives estimates for mortality, poor and fair outcome at 24 months corrected age for very low birth weight infants (<1500 g) and for very pre-term infants (<32 completed gestational weeks). Gestational age is as important for predicting outcome as birthweight and should therefore be integrated into national statistics.

Singleton birthweight by gestational age following in vitro fertilization in the United States

A retrospective study comparing maternal and neonatal outcome of singleton fetuses delivered at 37–38 weeks of completed gestation with those delivered at 39 completed weeks of gestation or longer by elective caesarean section at the University of Nigeria Teaching Hospital, Enugu between January 1, 2004 and December 31, 2008. There were 164(21.3%) elective caesarean deliveries during the study period. 117 (71.3%) were performed between 37–38 weeks of completed gestation and 47(28.7%) at 39 completed weeks of gestation. Elective caesarean births at 37-38 weeks were associated with significantly higher rates of admission to the neonatal care unit, neonatal jaundice, and a higher proportion of newborns with Apgar score <6 at 5minutes. As a result of increased morbidity and iatrogenic prematurity in the developing countries due to elective caesarean delivery at 37-38weeks associated with increased cost of admissions in the newborn special care units, elective caesarean delivery should be advised at or after 39 weeks of gestation unless there is evidence of fetal lung maturity. At 39 completed weeks of gestation, elective caesarean delivery is associated with better fetal outcomes than at 37-38 weeks of completed gestation.

Objective The objective of this study was to establish twin-specific birth weight percentiles by gestational age using U.S. twin births resulting from in vitro fertilization (IVF). Study Design A retrospective analysis of birth weight by completed weeks of gestation for 76,710 twin IVF births reported to the Society for Assisted Reproductive Technologies from 2006 to 2010. Mean and median birth weights and 3rd, 5th, 10th, 25th, 50th, 75th, 90th, and 97th percentiles were calculated by completed week of gestation and infant sex. Results IVF twin birth weight accelerates until term and then declines. The deceleration in twin birth weight occurs at 39 completed weeks of gestation for larger twins, those at or above the 50th percentile in weight. For smaller twins, the growth deceleration occurs earlier, at 38 weeks of gestation. IVF female and male twin birth weights for gestational age were similar to all IVF twins, showing similar decelerations near term. Conclusion Using U.S. IVF twin-specific growth charts, with known date of conception, twins demonstrate a deceleration in birth weight near term. Larger twins demonstrate a deceleration in birth weight by 39 completed weeks of gestation; smaller twins show a deceleration at 38 weeks. These data may assist in the clinical management of twins near term.

Risk of Stillbirth in Pregnancies Complicated by Diabetes, Stratified by Fetal Growth.

There are only few reports worldwide on the outcome of very pre-term infants and very low birthweight infants for a whole country. In Switzerland official population statistics are based on birthweight only, gestational age not yet being documented. The aim of the present study was to assess the outcome at two years of age for a geographically defined high-risk neonatal population based on both birthweight and gestational age. All infants born in 1996 included in the Swiss Neonatal Network (a national anonymous registry established by the Swiss Society of Neonatology for liveborn infants before 32 completed gestational weeks or weighing less than 1500 g) were divided into three groups according to gestational age and birth weight: Group 1: born <32 completed gestational weeks and weighing =1500 g; group 2: born after 32 completed gestational weeks and weighing <1500 g; group 3: born <32 gestational weeks and weighing <1500 g. Information at 24 months corrected age about growth, neurological outcome, frequency of respiratory infections, prescription of antibiotics and medical consultations during this period was obtained from the paediatricians caring for the infants. Fair outcome was defined as survival without serious neonatal complications or abnormal neurological findings at 24 months corrected for prematurity. 723 infants were born alive in Switzerland between 1.1. and 31.12.1996 before 32 completed weeks or weighing less than 1500 g at birth. Mortality was 4.3% for a total of 163 infants in group 1 (<32 weeks, =1500 g), 4.6% for 108 infants in group 2 (>32 weeks, <1500 g) and 18.6% for 452 infants in group 3 (<32 weeks, <1500 g). 6.5% of group 1 survivors followed up to 24 months corrected age had a poor neurological outcome as compared to 9.3% in group 2 and 10.9% in group 3. Infants in group 1 needed antibiotics less often after hospital discharge (interquartile range IQR: 0-2 courses) than infants in group 2 (0-3 courses) and 3 (0-3 courses). Infants in group 2 suffered from fewer airway infections (interquartile range 2-5 times) than in group 1 (2-6 times) and 3 (1-7 times). Infants in group 3 needed more medical consultations (IQR 12-21) than those in group 1 (10-16) and 2 (11-16). The overall fair outcome at 24 months corrected age was 85.3% in group 1, 80.7% in group 2 and 59.6% in group 3. A close correlation between overall fair outcome and gestational age at birth on the one hand and with birthweight on the other can be observed. This study gives estimates for mortality, poor and fair outcome at 24 months corrected age for very low birth weight infants (<1500 g) and for very pre-term infants (<32 completed gestational weeks). Gestational age is as important for predicting outcome as birthweight and should therefore be integrated into national statistics.

Infants born preterm or small for gestational age have elevated rates of morbidity and mortality. Using birth certificate records in Texas from 2002 to 2004 and Environmental Protection Agency air pollution estimates, we relate the quantile functions of birth weight and gestational age to ozone exposure and multiple predictors, including parental age, race, and education level. We introduce a semi-parametric Bayesian quantile approach that models the full quantile function rather than just a few quantile levels. Our multilevel quantile function model establishes relationships between birth weight and the predictors separately for each week of gestational age and between gestational age and the predictors separately across Texas Public Health Regions. We permit these relationships to vary nonlinearly across gestational age, spatial domain and quantile level and we unite them in a hierarchical model via a basis expansion on the regression coefficients that preserves interpretability. Very low birth weight is a primary concern, so we leverage extreme value theory to supplement our model in the tail of the distribution. Gestational ages are recorded in completed weeks of gestation (integer-valued), so we present methodology for modeling quantile functions of discrete response data. In a simulation study we show that pooling information across gestational age and quantile level substantially reduces MSE of predictor effects. We find that ozone is negatively associated with the lower tail of gestational age in south Texas and across the distribution of birth weight for high gestational ages. Our methods are available in the R package BSquare.

Shorter gestational age at birth is associated with worse academic performance in childhood. Socio-economic and demographic factors that affect a child's development may modify the relationship between gestational age and later academic performance. The purpose of this study was to investigate socio-economic and demographic effect modification of gestational age's association with kindergarten-level literacy skills in a longitudinal Wisconsin birth cohort. We sampled 153145 singleton births (2007-2010) that linked to Phonological Awareness Literacy Screening-Kindergarten (PALS-K) scores (2012-2016 school years). PALS-K outcomes included meeting the screening benchmark (≥28 points, range 0-102 points) and the standardised score. Multivariable linear regressions of PALS-K outcomes on gestational age (completed weeks) included individual interactions for five maternal attributes measured at delivery: Medicaid coverage, education, age, race/ethnicity, and marital status. Each additional completed gestational week was associated with a 0.5 percentage point increase in the probability of meeting the PALS-K literacy benchmark. The benefit of an additional week of gestational age was 0.5 percentage points (95% confidence interval 0.3, 0.7 percentage points) greater for Medicaid-covered births (0.8 percentage points) relative to non-Medicaid births (0.3 percentage points). Relative to only completing high school, having college education weakened this association by 0.3-0.6 percentage points, depending on years in college. Similar but modest relations emerged with standardised scores. Socio-economic advantage as indicated by non-Medicaid coverage or higher levels of completed maternal education may diminish the cost of preterm birth on a child's kindergarten-level literacy skills.

Neurodevelopmental disabilities and special care of 5-year-old children born before 33 weeks of gestation (the EPIPAGE study): a longitudinal cohort study

OBJECTIVE: To estimate observed compared with predicted survival rates of extremely premature infants born during 2000–2009, to identify contemporary predictors of survival, and to determine if improved survival rates occurred during the decade. METHODS: We conducted a retrospective cohort analysis of 237 inborn neonates without major congenital anomalies born from 2000 to 2009 after 22 to 25 completed weeks of gestation. Observed survival rates at each gestational age were compared with predicted survival rates based on gestational age, birth weight, sex, singleton or multiple gestation, and antenatal corticosteroid administration estimated by a Web-based calculator that was derived from 1998 to 2003 outcomes of a large national cohort. Multivariable logistic regression analysis was used to identify significant predictors of survival of the study cohort, including year of birth. RESULTS: Survival rates for the decade by gestational age (compared with predicted rates) were: 22 weeks, 33% (compared with 19%); 23 weeks, 58% (compared with 38%); 24 weeks, 87% (compared with 58%); and 25 weeks, 85% (compared with 70%). Antenatal corticosteroids were administered in 96% of pregnancies. Variables that significantly predicted survival and their odds ratios (OR) with 95% confidence intervals (CI) are: antenatal corticosteroid administration (OR 5.27, CI 1.26–22.08); female sex (OR 3.21, CI 1.42–7.26); gestational age (OR 1.89, CI 1.27–2.81); 1-minute Apgar score (OR 1.39, CI 1.15–1.69); and birth year (OR 1.17, CI 1.02–1.34). The number needed to treat with any antenatal corticosteroid therapy to prevent one death was 2.4. CONCLUSION: In this single-institution cohort treated aggressively (antenatal corticosteroid administration [even if less than 24 weeks], tocolysis until steroid course complete, cesarean for fetal distress) by perinatologists and neonatologists, survival rates at 22–25 weeks of gestation age for inborn infants during the 2000s exceeded predicted rates, with increasing odds of survival during the decade. Antenatal corticosteroid administration had a significant effect on survival. (Obstet Gynecol 2012;119:795–800)

Improving Survival of Extremely Preterm Infants Born Between 22 and 25 Weeks of Gestation