33rd Week Research Articles

The effect of prenatal maternity leave on short and long-term child outcomes

Maternity leave policies are designed to safeguard the health of pregnant workers and their unborn children. We evaluate a maternity leave extension in Austria which increased mandatory prenatal leave from 6 to 8 weeks. We exploit that the assignment to the extended leave was determined by a cutoff date. We find no evidence for significant effects of this extension on children's health at birth or long-term health and labor market outcomes. Subsequent maternal health and fertility are also unaffected. We conclude that employment during the 33rd and 34th week of gestation is not harmful for expecting mothers (without major problems in pregnancy) and their unborn children.

Gestational gigantomastia

Introduction: Gigantomastia is a disease of unknown etiology, which can occur in two different situations: gestational and non-gestational phases. The gestational type is a rare complication that affects 1:28,000 to 1:100,000 pregnancies and is usually bilateral. It consists of a diffuse, massive breast increase during pregnancy. In a normal pregnancy, the breasts double in size without sequelae; however, in this disease, the breast tissue may experience a 10 to 20-fold increase. The treatment varies from drug therapy to plastic surgery (mammaplasty) and radical surgery (mastectomy). Objectives: To report a case of gestational gigantomastia, its treatment approach, and outcome. Methods: Data from this study were obtained from a multidisciplinary clinical experience, image records, and literature search. Case Report: An 18-year-old patient, admitted to the mastology department of Hospital Guilherme Álvaro, in Santos, Southeastern Brazil, was diagnosed with gigantomastia in her 23rd week of pregnancy. The exacerbated breast growth during the gestational period caused pain and functional impairment to the patient. Bilateral mastectomy was performed at 27 weeks of pregnancy due to the worsening of her pulmonary condition, leading to the risk of maternal and fetal death. Macroscopic anatomopathological examination revealed breasts with a total weight of 27 kg, lobular hyperplasia, pronounced stromal hyperplasia, and necrosis of the breast parenchyma. She stayed in the intensive care unit during the postoperative period with good progression. The patient had a normal delivery at 38 weeks of gestation with a live fetus. Discussion: The ideal management for gestational gigantomastia is not clear. The treatment includes surgeries (reduction mammaplasty and total mastectomy with or without reconstruction), medications, or a combination of both. In the current case, the treatment chosen was mastectomy during pregnancy due to respiratory distress and the risk of sepsis by ischemic tissue necrosis. During the surgical procedure, there was a risk of hemodynamic instability, given the large volume of breast removed, representing 40% of the total weight of the patient. Conclusion: Gestational gigantomastia is an exceptionally rare condition, and the literature has few reports on the subject. The therapeutic management depends on factors intrinsic to the patient, so each case requires individualization. The therapeutic decision aims at the best prognosis, taking into account possible complications and a reduction in maternal and fetal morbidity.

RELATIONSHIP BETWEEN INSULIN-LIKE GROWTH FACTOR TYPE 1 AND INTRAUTERINE GROWTH.

SUMMARYInsulin-like growth factor 1 (IGF-1) is a regulator of intrauterine growth, and circulating concentrations are reduced in intrauterine growth-restricted fetuses. The aim of our study was to investigate the relationship between IGF-1 levels in newborns and intrauterine growth, expressed as birth weight (BW). The research was designed as a cross-sectional study. The study included 71 premature newborns, gestational age (GA) ≤33 weeks. Quantitative determination of IGF-1 was performed in the 33rd post-menstrual week (pmw) to make the measurements more comparable. We used an enzyme-bound immunosorbent test for quantitative determination of IGF-1. Our results showed the mean IGF-1 level in premature newborns in 33rd pmw to be 23.1±4.56 (range 15.44-39.75) µg/L. There was no difference in IGF-1 values between male (23.1±4.98 µg/L) and female (23.1±4.87 µg/L) newborns. There was no significant difference in the average IGF-1 levels between male and female newborns with BW <50th and BW >50th percentile for GA either (p>0.50). Only BW <33rd percentile newborns had a statistically significantly lower IGF-1 level compared to newborns with greater BW. Based on our results, it is concluded that serum IGF-1 level reflects intrauterine growth only in BW <33rd percentile newborns. This fact could be used for further therapeutic purposes.

Chapter 10 - Development of handedness, anatomical and functional brain lateralization

The present chapter offers a report on the recent literature on the neural bases of hemispheric specialization (HS), anatomical and functional developmental timecourse of HS, and on the available knowledge of their relationships with the development of handedness. Strong anatomical asymmetries can be seen located along the end of the sylvian fissure and the superior temporal sulcus (STS) as soon as the 23rd gestational week. They correspond to a leftward sulcal depth asymmetry of the Sylvian fissure coupled with a rightward asymmetry of STS. These neonatal asymmetries targeting speech processing areas do not further change with development. Different from these anatomical asymmetries, the functional asymmetries of language areas develop during childhood. Such a development is characterized at birth by a predominant interhemispheric intrinsic connectivity between homotopic areas that will evolve toward left hemisphere intrahemispheric intrinsic connectivity between anterior and posterior language poles. The development of such a typical architecture of language networks in the left hemisphere dominant for language in more than 90% of humans translates into a continuous increase in the leftward asymmetries of activation during language production throughout childhood. With regard to the rightward cerebral lateralization for visuospatial functions, neuroimaging studies tend to indicate an increase in rightward lateralization of frontal-parietal network with age during visuospatial memory and visuospatial search tasks. In addition, the spatial-attentional behavioral asymmetries emerge early (in preschool children) and, then, can be modulated by factors linked to motor asymmetry and handedness. Finally, the study of manual lateralization in relation to language development has shown the importance of considering several characteristics of manual activities. In particular, the dissociation between manipulative activities and communicative gestures in young children may open further perspectives for future research on HS.

Temporal Measures in Cardiac Structure and Function During the Development of Obesity Induced by Different Types of Western Diet in a Rat Model.

Obesity is recognized worldwide as a complex metabolic disorder that has reached epidemic proportions and is often associated with a high incidence of cardiovascular diseases. To study this pathology and evaluate cardiac function, several models of diet-induced obesity (DIO) have been developed. The Western diet (WD) is one of the most widely used models; however, variations in diet composition and time period of the experimental protocol make comparisons challenging. Thus, this study aimed to evaluate the effects of two different types of Western diet on cardiac remodeling in obese rats with sequential analyses during a long-term follow-up. Male Wistar rats were distributed into three groups fed with control diet (CD), Western diet fat (WDF), and Western diet sugar (WDS) for 41 weeks. The animal nutritional profile and cardiac histology were assessed at the 41st week. Cardiac structure and function were evaluated by echocardiogram at four different moments: 17, 25, 33, and 41 weeks. A noninvasive method was performed to assess systolic blood pressure at the 33rd and 41st week. The animals fed with WD (WDF and WDS) developed pronounced obesity with an average increase of 86.5% in adiposity index at the end of the experiment. WDF and WDS groups also presented hypertension. The echocardiographic data showed no structural differences among the three groups, but WDF animals presented decreased endocardial fractional shortening and ejection fraction at the 33rd and 41st week, suggesting altered systolic function. Moreover, WDF and WFS animals did not present hypertrophy and interstitial collagen accumulation in the left ventricle. In conclusion, both WD were effective in triggering severe obesity in rats; however, only the WDF induced mild cardiac dysfunction after long-term diet exposure. Further studies are needed to search for an appropriate DIO model with relevant cardiac remodeling.

Ascaridia Galli Infection in Laying Hens and the Results of in Vitro Efficacy of Levamisole, Piperazine and Carvacrol, Whether is Necessary to Change the Deworming Protocols?

Abstract We present a case of Ascaridia galli infection in laying hens on a farm in central Serbia. During the rearing period on litter, ascaridosis was diagnosed at 15 weeks of age by routine parasitological fecal examination. Pullets were treated with flubendazole for one week, and two weeks later the hens were moved to battery cages. The production results were within technological standards until the 23rd week and the medical health status was without any clinical symptoms. After that period weight loss began, the egg production dropped to 70% and eggs were of poor quality. Subsequently, severe feather pecking and an increase of mortality were reported. The postmortal examination showed severe anemia and several gross lesions in the liver, intestines, lungs, and kidneys. Different sizes of A. galli were found in the lumen of the duodenum and jejunum. Gross changes of the intestinal mucosa were present, such as a thickened intestinal wall with hemorrhagic spots, inflammation and necrotic patches. Histopathological examination showed marked changes in the intestines, liver and kidneys. All visible live parasites were collected and stored in Earle’s balanced salts, and females were used for in vitro susceptibility testing. Median lethal concentration (LC50) of piperazine, levamisole and carvacrol for A. galli was 119.7μM, 2.71μM and 3.26μM, were applied, respectively. Based on our results, it is likely that reinfection occurred after completed dehelmintization. In relation to the new circumstances and the regulation for laying hen welfare the deworming protocol should be changed in order to ensure successful dehelmintization. In order to prevent reinfection the treatment must be done at the end of the rearing period and thus be maximally effective.

Ultrasound diagnosis of fetal adrenal hemorrhage

The confirmed incidence of new-onset adrenal gland hemorrhage has increased with the development of ultrasound diagnostics in recent years. Intrauterine developed cases are rarely recognized. Differential diagnosis of cystic lesions of the adrenal gland is often only possible after birth. In our case study, we report the ultrasonographic diagnosis and follow-up of a cystic lesion measuring 4 × 3 cm in the left fetal epigastrium in the 33rd gestational week. During pregnancy, multimodal imaging methods (both ultrasound and magnetic resonance) have confirmed the diagnosis of hemorrhage in the left adrenal gland. In the 37th gestational week, the hematoma completely resolved. At term, a 4150 gram neonate was delivered in good condition by an elective cesarean section. Postnatal endocrinological and follow-up ultrasound examinations did not find any disorder. This study is the first published case report in the literature that proves that fetal adrenal hemorrhage can intrauterin spontaneously absorb within a short period of time. Our case draws attention to the fact that adrenal bleeding may occur in the newborn regardless of birth trauma. It can also be assumed that the incidence of adrenal bleeding during pregnancy is higher than that reported in neonatal cases. Orv Hetil. 2019; 160(52): 2073-2078.

Childhood pneumonia: read the smear and clinch the diagnosis

Childhood pneumonia has a myriad of disease causing organisms. Identifying the etiology often helps us predict the natural course of the illness. We would like to share an interesting child with pneumonia by the hematological manifestation of the disease. Case report of this study is a 8 year old boy who presented with high grade fever for eleven days associated with cough. History of skin rashes which worsened following therapy with penicillin. On Examination child had maculopapular rashes predominantly over the trunk with decreased air entry in the left hemithorax. Chest x-ray done showed left lower lobe consolidation hence treated with cephalosporins and macrolide. Counts revealed falling trend in haemoglobin with high MCV count. Peripheral smear done showed agglutinated RBC’S and occasional nucleated RBC’s. Direct Coombs test was positive. With these haematological manifestations child was diagnosed to have Mycoplasma pneumonia which was proven by positive antibodies against Mycoplasma. Child recovered completely and haematological manifestations became passive after four weeks. Cold agglutinin disease is poorly understood affecting 15% of patients with Autoimmune hemolytic anemia. Respiratory tract involvement and extrapulmonary complications manifest in 3-10% and 25% respectively. Antibodies (IgM) against the I antigen on human erythrocyte membranes appear during the course of M. pneumoniae infection and produce a cold agglutinin response. AIHA typically occurs during 2-3rd week after febrile illness with sudden onset of hemolysis which is self-remitting within 4-6 weeks. The conclusion of this study is extra-pulmonary manifestations in a child with pneumonia help in diagnosing the etiology. This in turn helps us like provide rationale management and Predict the natural course of the illness.

Влияние десинхронизирующих эффектов трансмеридианных перелётов на хронорезистентность организма спортсменов

Objective: to study the effect of transmeridian air movements in contrasting geosocial conditions of competition on the direction and duration of stabilization of the chrono-resistance of athletes during periods of desynchronosis. Materials and methods: the study involved 103 highly skilled athletes – men of various specialties (age 22.6 ± 4.2 years). On the model of air movements across 7 time zones, the frequency, structure, and focus of reducing or increasing medical circulation reflecting the body's resistance during chronoadaptation were analyzed. Results: before the flight, athletes' visits to the doctor were rare exceptions. After air travel, pathological manifestations in health status were detected in more than 40% of migrants. Over 50% of the medical treatment accounted for well-compensated foci of chronic infection, relapses of erased diseases and injuries. The maximum frequency of medical treatment was observed at the 2-3rd week after the flight, at the 5th week - sporadic, but higher than in the home conditions. Conclusions: for the relative stabilization of the body's resistance in athletes in contrasting geo-modern regions, more than a month of acclimatization is required. The minimal decrease in the chrono-resistance direction is manifested at 2-3 weeks after the flight in the stage of transition of «acute» desynchronosis to hidden.

Possible Retard in the Language Development to the Children Born through IVF (In Vitro Fertilisation)

Research in recent years on a possible and evident pathology, appeared in children s case from pregnancies obtained through in vitro fertilization (IVF), did not show significant differences than the children born from pregnancies obtained naturally. Having a good start in life, the consignments studied were feed exclusively in a natural way in the first 6 months, knowing the complex role of breast milk, including nerve growth. The delay in language development has shown significant differences between the IVF consignment and the control group and the pathology exam a possible involvement in cerebral embryogenesis, especially the Broca s area, of some disturbing factors, with a maximum of action before the 23rd week.

OSTEOSARCOMA OF THE JAWS DURING PREGNANCY: CASE REPORT AND REVIEW OF THE LITERATURE

Osteosarcoma of jaw bones represents less than 1% of all head and neck malignancies. Malignancy in pregnant women is also an uncommon event, and occurs in a ratio of one case per 1000 deliveries. The aim of this study is to report a rare case of maxillary osteosarcoma in a pregnant woman, and to review the previous cases published in English literature. A 29-year old woman, in the 33rd week of gestation, presented with a 2.5 cm reddish, multilobulated and ulcerated nodule in posterior maxilla with 1 month of evolution. Computerized tomography showed an expansive tumor destroying the alveolar bone around the molars and invading the maxillary sinus. The material of the first incisional biopsy was not enough to conclude the diagnosis. Before a second biopsy was done, the patient delivered normally a healthy boy. Histologically, the tumor was composed by round cells with prominent cytoplasm and pleomorphic nuclei, sometimes multinucleated. Areas with spindle and epithelioid cells were also found, among osteoid or chondroid matrix. The lesion was extremely vascularized, with mixomatous and telangiectatic regions. The final diagnosis was conventional osteosarcoma, and the lesion was surgically removed, with clear margins. A microsurgical flap was used for reconstruction and the patient received adjuvant radiation and chemotherapy. She has been followed up for one year, with no signs of metastasis or recurrence. The influence of pregnancy on the initiation, promotion and development of sarcomas is not well established. To the best of our knowledge, no more than 10 cases of jaw osteosarcoma in pregnant women have been reported up to now. The co-existence of malignancy and pregnancy is very uncommon, and sometimes a challenge for medical professionals, especially regarding the diagnosis, the use of ancillary examinations and the treatment.

New approach in thermal pregnancy diagnosis: Teat's heating in babirusa (Babyrousa babyrussa)

Besides chemical testing, thermographic imaging is a possible method to determine pregnancy in some animals. Hilsberg (2001) defined the unilateral warming at the end of a pregnancy, caused by the metabolizing fetus and the uterus near the outer skin, as the pregnancy field. Its appearance was observed in various species at the end of the gestation period. No studies were yet carried out to investigate the changing of thermal patterns during pregnancy.This study monitored the thermographic changes of one pregnant babirusa (Babyrousa babyrussa) sow and one babirusa male by taking thermal images once a week from the estimated 3rd pregnancy week until parturition in the 23rd pregnancy week. Images were searched manually for heat areas correlated to pregnancy as well as analysed automatically for median and maximum temperatures of the animal's side. Additionally, the locations of all pixels, which were not more than 2 K below the maximum temperature, were evaluated.In the female, there was a positive correlation between maximum temperatures of left and right side to pregnancy weeks (R = 0.61, R = 0.66, respectively; p < 0.05). The female's median temperatures and all temperatures of the male were not correlated to pregnancy weeks. Differences between median and maximum temperatures were significantly different during the 2nd, and 3rd trimester in the female, but not in the male. Temperature differences between 1st and 2nd trimester were not significant in both animals. The location of the warmest areas in the female shifted from thorax and flank to be mainly localised on the teats. In the male, the warmest areas remain localised on thorax and flank. No distinct pregnancy field was observed, but the warming of the teats could be seen in the images and the evaluated data.The teats are less insulated in most animals. Contraindications for thermal imaging like insulation could therefore become less important, allowing thermal pregnancy diagnosis for a larger range of animals than before. Based on these findings we suggest that the warming of the teats could be used for thermal pregnancy diagnosis when a pregnancy field is not observable.

Emergent Laparoscopic Removal of a Perforating Intrauterine Device During Pregnancy Under Regional Anesthesia

To describe and demonstrate a technique for laparoscopic removal of a perforating intrauterine device (IUD) during pregnancy, and to provide tips to facilitate safe laparoscopic surgery during pregnancy. Video presentation of the technique for laparoscopic removal of a perforating IUD in a pregnant woman. Department of Neuroscience, Reproductive Sciences, and Dentistry, University of Naples Federico II, Naples, Italy. A 30-year-old woman, gravida 3, para 2, with a copper T IUD (Nova T 380; Bayer, Leverkusen, Germany) perforating the left adnexa presented to the emergency room complaining of left lower quadrant pain. The patient had the IUD inserted by her gynecologist 3 months before the onset of the symptoms. Ultrasound revealed a 6-week intrauterine pregnancy with the presence of fetal cardiac activity along with the IUD perforating the left adnexa. The patient returned at 11 weeks of gestation complaining of worsening abdominal pain and excruciating left lower quadrant pain. She was scheduled for laparoscopic excision of the perforating IUD [1-3]. Considering her pregnancy, laparoscopy under regional anesthesia was performed in the minimal Trendelenburg position at 12 degrees, through open laparoscopic access [4]. Intra-abdominal pressure of 8 mmHg and ultrasound energy to cut and coagulate, avoiding monopolar/bipolar energy owing to the presence of a copper IUD, were used. The IUD and tube were extracted in an endobag through umbilical access, under a 5-mm, 0-degree telescope in left lateral access [5]. The procedure was carried out uneventfully, and the IUD was removed. Fetal viability was confirmed after the procedure. At the time of this report, the patient was in the 23rd week of gestation, and the pregnancy was progressing without any problems. Laparoscopic removal of perforated IUD during pregnancy under regional anesthesia is a feasible and safe option that should be considered when needed.

Contemporary Trends in Cesarean Delivery Utilization for Live Births Between 22 0/7 and 23 6/7 Weeks of Gestation.

In 2014, the Society for Maternal-Fetal Medicine, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the American Academy of Pediatrics, and the American College of Obstetricians and Gynecologists published an executive summary of a joint workshop to establish obstetric interventions to be considered for periviable births. We sought to evaluate changes in practice patterns since the publication of these guidelines. We conducted a population-based cohort study of all singleton live births delivered between 22 0/7 and 23 6/7 weeks of gestation in the United States within two time epochs: pre-executive summary (Epoch 1: 2012-2013) and post-executive summary (Epoch 2: 2015-2016) guideline release. The primary outcome was the difference in the rate of cesarean delivery between pre-executive summary and post-executive summary guideline publication. Secondary outcomes included differences in rates of individual and composite neonatal interventions (neonatal intensive care unit admission, ventilation, surfactant and antibiotic administration), maternal adverse outcomes (intensive care unit admission, transfusion, hysterectomy, uterine rupture), and neonatal mortality. Multivariable logistic regression estimated the association of delivery epoch with outcomes. There were 15,846,405 live births in the United States between 2012-2013 and 2015-2016, of which 14,799 (0.1%) were singletons delivered between 22 and 24 weeks of gestation. Among these live births, 7,374 (52.3%) were delivered in Epoch 1 and 7,425 (47.7%) in Epoch 2. Cesarean delivery rates increased from Epoch 1 to Epoch 2 (24.3% vs 28.4%, P<.001), which was attributable to increased cesarean utilization during the 23rd week (36.3% vs 40.8%, difference 4.5%, 95% CI 2.3-6.6). Likewise, the rate of composite neonatal interventions increased (50.6% vs 56.9%, difference 6.3%, 95% CI 4.6-8.0) between Epochs 1 and 2, in association with a slight reduction in neonatal mortality (67.2% vs 64.6%, P=.009). There was no statistically significant difference in composite (8.9% vs 9.5%, P=.261) adverse maternal outcomes between delivery epochs. The frequency of delivery by cesarean in the 23rd week increased by 4.5% after publication of the periviable birth executive summary. The observed increase in cesarean delivery and composite neonatal interventions between delivery cohorts was associated with a small reduction in neonatal mortality.

Population dynamics of pear psylla Cacopsylla pyricola foerster

Population buildup of pear psylla (Cacopsylla pyricola) Foerster on pear was studied under temperate conditions of Kashmir valley during 2014–2015. The population was correlated with maximum and minimum temperature (°C), morning and evening relative humidity (%), and rainfall (mm). The results revealed that the population of nymphs and adults was observed till harvest (1st week of September) with three peaks during June and July (23rd, 27th and 29th standard week). The maximum population was observed during June i.e. 12.57/12 shoots.

Should we use Palivizumab immunoprophylaxis for infants against respiratory syncytial virus? \u2013 a cost-utility analysis

BackgroundPassive immunization against RSV (Respiratory Syncytial Virus) is given in most western countries (including Israel) to infants of high risk groups such as premature babies, and infants with Congenital Heart Disease or Congenital Lung Disease. However, immunoprophylaxis costs are extremely high ($2800–$4200 per infant). Using cost-utility analysis criteria, we evaluate whether it is justified to expand, continue or restrict nationwide immunoprophylaxis using palivizumab of high risk infants against RSV.MethodsEpidemiological, demographic, health service utilisation and economic data were integrated from primary (National Hospitalization Data, etc.) and secondary data sources (ie: from published articles) into a spread-sheet to calculate the cost per averted disability-adjusted life year (DALY) of vaccinating various infant risk groups. Costs of intervention included antibody plus administration costs. Treatment savings and DALYs averted were estimated from applying vaccine efficacy data to relative risks of being hospitalised and treated for RSV, including possible long-term sequelae like asthma and wheezing.ResultsFor all the groups RSV immunoprophylaxis is clearly not cost effective as its cost per averted DALY exceeds the $105,986 guideline representing thrice the per capita Gross Domestic Product. Vaccine price would have to fall by 48.1% in order to justify vaccinating Congenital Heart Disease or Congenital Lung Disease risk groups respectively on pure cost-effectiveness grounds. For premature babies of < 29 weeks, 29–32 and 33–36 weeks gestation, decreases of 36.8%, 54.5% and 83.3% respectively in vaccine price are required.ConclusionsBased solely on cost-utility analysis, at current price levels it is difficult to justify the current indications for passive vaccination with Palivizumab against RSV. However, if the manufacturers would reduce the price by 54.5% then it would be cost-effective to vaccinate the Congenital Heart Disease or Congenital Lung Disease risk groups as well as premature babies born before the 33rd week of gestation.

Characterization and automatic classification of preterm and term uterine records.

Predicting preterm birth is uncertain, and numerous scientists are searching for non-invasive methods to improve its predictability. Current researches are based on the analysis of ElectroHysteroGram (EHG) records, which contain information about the electrophysiological properties of the uterine muscle and uterine contractions. Since pregnancy is a long process, we decided to also characterize, for the first time, non-contraction intervals (dummy intervals) of the uterine records, i.e., EHG signals accompanied by a simultaneously recorded external tocogram measuring mechanical uterine activity (TOCO signal). For this purpose, we developed a new set of uterine records, TPEHGT DS, containing preterm and term uterine records of pregnant women, and uterine records of non-pregnant women. We quantitatively characterized contraction intervals (contractions) and dummy intervals of the uterine records of the TPEHGT DS in terms of the normalized power spectra of the EHG and TOCO signals, and developed a new method for predicting preterm birth. The results on the characterization revealed that the peak amplitudes of the normalized power spectra of the EHG and TOCO signals of the contraction and dummy intervals in the frequency band 1.0-2.2 Hz, describing the electrical and mechanical activity of the uterus due to the maternal heart (maternal heart rate), are high only during term pregnancies, when the delivery is still far away; and they are low when the delivery is close. However, these peak amplitudes are also low during preterm pregnancies, when the delivery is still supposed to be far away (thus suggesting the danger of preterm birth); and they are also low or barely present for non-pregnant women. We propose the values of the peak amplitudes of the normalized power spectra due to the influence of the maternal heart, in an electro-mechanical sense, in the frequency band 1.0-2.2 Hz as a new biophysical marker for the preliminary, or early, assessment of the danger of preterm birth. The classification of preterm and term, contraction and dummy intervals of the TPEHGT DS, for the task of the automatic prediction of preterm birth, using sample entropy, the median frequency of the power spectra, and the peak amplitude of the normalized power spectra, revealed that the dummy intervals provide quite comparable and slightly higher classification performances than these features obtained from the contraction intervals. This result suggests a novel and simple clinical technique, not necessarily to seek contraction intervals but using the dummy intervals, for the early assessment of the danger of preterm birth. Using the publicly available TPEHG DB database to predict preterm birth in terms of classifying between preterm and term EHG records, the proposed method outperformed all currently existing methods. The achieved classification accuracy was 100% for early records, recorded around the 23rd week of pregnancy; and 96.33%, the area under the curve of 99.44%, for all records of the database. Since the proposed method is capable of using the dummy intervals with high classification accuracy, it is also suitable for clinical use very early during pregnancy, around the 23rd week of pregnancy, when contractions may or may not be present.

Teenage Pregnancies in Nepal – The Problem Status and Socio-Legal Concerns

Teenage pregnancy is an issue that needs to be addressed for a better health of the women and the society. The present analysis is undertaken to find out the incidence of teenage mothers who have had hospital delivery and focuses upon the various reasons for teenage pregnancy with a brief discussion upon the associated medicolegal and social aspects. A cross sectional study was carried out in a tertiary hospital in western region of Nepal. The delivery case register were reviewed for teenage pregnancies and the relevant data was captured in a data sheet and analysed. During the study period, a total of sixty-nine teenage pregnancies culminated into delivery/ childbirth. The mean age of teenage mother was 18.16±0.99 years. Majority of the teenage mothers had not completed their secondary education and were of low socioeconomic strata. Mode of delivery was caesarean section in thirty four cases, whereas vaginal delivery was conducted in thirty five cases. Live births accounted for 67 deliveries, a still birth case was of anencephalic foetus while the other one was a preterm which was spontaneously delivered at the 23rd weeks of gestation. Education and awareness in the form of campaign, advertisements, road shows, television or radio programmes are suggested for a decline in the rate of teenage marriages and teenage pregnancies in Nepal in the days to come.

Foetal Kidney Development and Amniotic Fluid Formation in Upper Egyptian Pregnancies

AbstractBackground: The foetal kidney development is important for its normal function. The Amniotic Fluid Index (AFI) is used to assess the amniotic fluid volume. The main source of the amniotic fluid is the foetal urine.Aim of the Work: To establish reference values for the foetal kidney length and the AFI throughout the second and third trimesters of the normal Upper Egyptian pregnancies and to clarify the correlations between these measurements.Subject and Methods: An ultrasonographic examination was performed to measure the foetal kidney length and the AFI on 232 normal pregnant women from the 14th week to the 42nd week of gestation. The correlations between the measurements were analysed statistically.Results: The foetal kidney length increased gradually with gestation. There was a significantly positive correlation between the foetal kidney length and the gestational age. The linear regression showed that the gestational age could be assessed by using the foetal kidney length with an accuracy of ±1.078 week. From the 14th week, the AFI increased progressively until the 24th week. There was a positive correlation between the AFI and the gestational age and between the AFI and the foetal kidney length. From the 25th week to the 32nd week, the AFI demonstrated little variations. From the 33rd week, the AFI declined gradually. There was a negative correlation between the AFI and the gestational age and between the AFI and the foetal kidney length.Conclusion: The present study introduces reference values for both the foetal kidney length and the AFI in the normal Upper Egyptian pregnancies. It also discusses the correlation between the foetal kidney length and the AFI as early as the second trimester of pregnancy. At first, it is a direct correlation. Then, it shows minimal variations. Finally, it becomes an inverse one. The obtained information could be usefully applied clinically.

Congenital Esophageal Atresia-Surgical Treatment Results in the Context of Quality of Life.

Esophageal atresia (EA) is one of the most frequent congenital malformations of the gastrointestinal tract. The aim of the study was to assess surgical treatment results in the context of the quality of life (QoL) of children after correction of EA. The data were collected among 73 patients after surgery of EA. The work diagnostic survey method was applied using authors' own questionnaire and standardized questionnaire, the PedsQL 4.0 generic core scales. Analysis of children growth was done based on World Health Organization percentile charts for body height and weight. Medical background for each patient, including demographic data, type of EA, type of delivery, the age of gestation, associated anomalies, mode of repair-primary and subsequent, if applicable, was collected from clinical records. Additional anomalies were divided into cardiac, skeletal, respiratory, renal, central nervous system, and other malformations (VACTERL association, CHARGE syndrome, trisomy chromosomes 18 and 21, and others). In this study, 23% of children in the study group weighted below third percentile, 36% were born between 33rd and 37th week of gestation; 56% had at least one associated congenital anomalies. The QoL of children born before 37th week of gestational age was lower (p < 0.034) in social functioning than children born in term. The presence of concomitant anomalies does affect the overall generic QoL. No statistical correlation was found between the type of anomaly (with/without TEF) and patients' QoL. It seems to be needed to extend psychological care of premature infants with EA.