Abdominal Circumference Measurements Research Articles

Estimating fetal weight in gastroschisis: A 10 year audit of outcomes at the National Maternity Hospital.

To identify whether conventional methods of estimating fetal growth (Hadlock's formula), which relies heavily on abdominal circumference measurements, are accurate in fetuses with gastroschisis. A retrospective cohort study was performed between the period January 1, 2011 and December 31, 2021 in a tertiary referral maternity hospital identifying all pregnancies with a diagnosis of gastroschisis. Projected fetal weight was obtained using the formula (EFW [Hadlock's formula] + 185 g × [X/7]) where X was the number of days to delivery. During the study period 41 cases were identified. The median maternal age was 25. The median BMI was 25 and 63% were primiparous women (n = 26). Median gestation at diagnosis was 21 weeks. Median gestation at delivery was 36 weeks. A total of 4.8% of mothers had a history of drug use (n = 2). The rate of maternal tobacco use was 21.9% (n = 9). A total of 4.8% of fetuses had additional congenital anomalies including amniotic band syndrome and myelomeningocele (n = 2). Estimated fetal weight (EFW) and birth weight data were available for 34 cases. A Wilcoxon signed-rank test showed projected EFW using Hadlock's formula did not result in a statistically significant different birth weight (Z = -1.3, P = 0.169). Median projected weight and actual birth weight were 2241.35 and 2415 g respectively. Median difference was 0.64 g (95% CI: -148 to -28.5). Our data showed accuracy using standard formulae for EFW in fetuses with gastroschisis.

The Influence of Pericardial Fat on Left Ventricular Diastolic Function.

Heart failure is a major cause of morbidity and mortality worldwide; left ventricular diastolic dysfunction plays a leading role in this clinical context. Diastolic dysfunction may be predisposed by increased abdominal fat and, consequently, increased pericardial and epicardial adiposity. This study aimed to determine whether pericardial fat (PF) and epicardial fat (EF) are associated with left ventricular diastolic function. A total of 82 patients had their abdominal circumference measured and underwent transthoracic echocardiography to measure the thickness of PF and EF and assess the left ventricular diastolic function. Two groups were created based on mean pericardial fat (PF) thickness (4.644 mm) and were related to abdominal circumference and echocardiographic parameters. Subjects in the PF High group showed a significant decrease in septal e' (p < 0.0001), lateral e' (p < 0.0001), and E/A ratio (p = 0.003), as well as a significant increase in E/e' ratio (p < 0.0001), E wave deceleration time (p = 0.013), left atrial volume (p < 0.0001), the left ventricle mass (p = 0.003), tricuspid regurgitant jet velocity (p < 0.0001), and the left ventricle diameter (p = 0.014) compared to the PF Low group. Correlations were found between pericardial fat and nine echocardiographic parameters in the study, while epicardial fat (EP) only correlated with eight. Measurement of abdominal circumference, PF, and EF is an early indicator of diastolic changes with transthoracic echocardiography being the gold standard exam.

Neck circumference as an alternative marker of metabolic syndrome in Peruvian adults: A retrospective, cross-sectional study

Neck circumference is a low-cost and simple anthropometric measure that has been proven to accurately assess central obesity. However, evidence of its use and feasibility in low-resource settings is limited. We aimed to compare the utility of neck circumference with standard physical measures of obesity in northern Peru. This was a retrospective, cross-sectional study conducted among adults screened for metabolic syndrome. Body mass index, waist circumference, neck circumference, and additional measurements for metabolic syndrome were obtained. Assessments were performed following the WHO STEPS Surveillance Manual. Pearson correlation coefficients and multiple linear regression models were used to estimate the relationship of neck circumference to waist circumference and body mass index. Data from 250 participants showed a normal, homogeneous distribution in both men and women with respect to age and physical/biochemical measurements. The mean age was 53.6 years. A positive correlation of neck circumference with body mass index (r = 0.51 for women and 0.65 for men) and waist circumference (r = 0.6 for women and 0.74 for men) was observed. Multiple linear regression showed that a 1-cm increase in neck circumference increased body mass index by 0.72 kg/m2 (p < 0.001) in men and 0.94 kg/m2 (p < 0.001) in women, and waist circumference by 2.20 cm (p < 0.001) in men and 2.27 cm (p < 0.001) in women. Our findings suggest that neck circumference is a valid and reliable measure that will replace body mass index and waist circumference in Peruvian adults with central obesity; due to the strong correlation that exists between the NC and these anthropometric measurements, mainly because it is an easy, quick measurement and is less vulnerable to errors such as in the measurement of abdominal circumference or variabilities in weight.

Incidence of neonatal morbidity in small-for-gestational-age twins based on singleton and twin charts.

To compare morbidity, as measured by length of stay in the neonatal intensive care unit (NICU), in twin and singleton gestations classified as small-for-gestational age (SGA) according to estimated fetal weight < 10th percentile on twin or singleton growth charts. NICU length of stay was compared in 1150 twins and 29 035 singletons that underwent ultrasound assessment between 35 + 0 and 36 + 6 weeks' gestation. Estimated fetal weight was obtained from measurements of head circumference, abdominal circumference and femur length using the Hadlock formula. Gestational age was derived from the first-trimester crown-rump length measurement, using the larger of the two twins. Singletons and twins were compared in terms of NICU admission rate and length of stay according to classification as SGA by the Fetal Medicine Foundation singleton and twin reference distributions. The overall proportions of twins and singletons admitted to NICU were similar (7.3% vs 7.4%), but twins tended to have longer lengths of stay in NICU (≥ 7 days: 2.4% vs 0.8%; relative risk (RR), 3.0 (95% CI, 1.6-4.4)). Using the singleton chart, a higher proportion of twins were classified as SGA compared with singletons (37.6% vs 7.0%). However, the proportion of SGA neonates entering NICU was similar (10.2% for twins and 10.1% for singletons) and the proportion of SGA neonates spending ≥ 7 days in NICU was substantially higher for twins compared with singletons (3.7% vs 1.4%; RR, 2.6 (95% CI, 1.4-4.7)). When singleton charts are used to define SGA in twins and in singletons, there is a greater degree of growth-related neonatal morbidity amongst SGA twins compared with SGA singletons. Consequently, singleton charts do not inappropriately overdiagnose fetal growth restriction in twins and they should be used for monitoring fetal growth in both twins and singletons. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Fetal Biometric Parameter Reference Charts of a Central Anatolian Turkish Population.

The assessment of fetal biometry using ultrasound provides accurate pregnancy dating and also screening of fetal growth. Fetal biometry, which is common practice in the second and third trimesters of pregnancy, is fetal morphometry, which involves taking measurements of the different anatomical body parts. These fetal dimensions vary on ethnicity. The aim of this study is to demonstrate fetal biometric parameters measurement results of the Central Anatolia Turkish population with detailed percentile tables and graphs to screen fetal growth more accurately. This cross-sectional study was performed on a total of 1132 fetuses (47% girl, and 53% boy) between 15 and 40 weeks of gestation. Biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL) measurements are performed in a standardized manner every gestational week. BPD and HC were measured at the level of the thalami on the horizontal plane of the fetal head. HC was measured using the ellipse method. AC measurement was taken at the circular cross-section of the upper fetal abdomen. FL was measured along with the ossified diaphysis of the femur. All measurements were taken in millimeters. Pregnant women's mean age was 27.58 (17-43), and the mean body mass index was 27.68 (15.06-50.78) as demographic data. 38.13% of women had their first, 29.74% had their second, and 32.13% had three or more gestations within our study. Percentile data of fetuses for each parameter (BPD, HC, AC, and FL) and for each week were shown as tables and percentile graphics. Fetal 50th percentile measurements were compared between our study and other studies from different countries. The Kruskal-Wallis test results showed that BPD (p = 0.827), HC (p = 0.808), AC (p = 0.846), and FL (p = 0.725) values have a statistically similar mean in all studies. Hierarchical cluster analysis results showed that our results for BPD, HC, AC, and FL percentile curves have been found closer to Italian population results. However, our results were statistically different from Asian, Nigerian, non-Hispanic American, and Brazilian populations for each of the different parameters. The specialization of fetal biometric charts for a particular population can ensure a more accurate assessment of fetal growth rate. We showed fetal biometric percentile tables and graphics of the Central Anatolian Turkish population in this study. These results may provide a valuable contribution to obstetrical practice.Further studies can be conducted in different regions of Turkiye, thus comparisons could be possible over the country.

Fetal Medicine Foundation charts for fetal growth in twins.

To derive reference distributions of estimated fetal weight (EFW) in twins relative to singletons. Gestational-age- and chorionicity-specific reference distributions for singleton percentiles and EFW were fitted to data on 4391 twin pregnancies with two liveborn fetuses from four European centers, including 3323 dichorionic (DC) and 1068 monochorionic diamniotic (MCDA) twin pregnancies. Gestational age was derived using the larger of the two crown-rump length measurements obtained during the first trimester of pregnancy. EFW was obtained from ultrasound measurements of head circumference, abdominal circumference and femur length using the Hadlock formula. Singleton percentiles were obtained using the Fetal Medicine Foundation population weight charts for singleton pregnancies. Hierarchical models were fitted to singleton Z-scores with autoregressive terms for serial correlations within the same fetus and between twins from the same pregnancy. Separate models were fitted for DC and MCDA twins. Fetuses from twin pregnancies tended to be smaller than singletons at the earliest gestational ages (16 weeks for MCDA and 20 weeks for DC twins). This was followed by a period of catch-up growth until around 24 weeks. After that, both DC and MCDA twins showed reduced growth. In DC twins, the EFW corresponding to the 50th percentile was at the 50th percentile of singleton pregnancies at 23 weeks, the 43rd percentile at 28 weeks, the 32nd percentile at 32 weeks and the 22nd percentile at 36 weeks. In MCDA twins, the EFW corresponding to the 50th percentile was at the 36th percentile of singleton pregnancies at 24 weeks, the 29th percentile at 28 weeks, the 19th percentile at 32 weeks and the 12th percentile at 36 weeks. In DC and, to a greater extent, MCDA twin pregnancies, fetal growth is reduced compared with that observed in singleton pregnancies. Furthermore, after 24 weeks, the divergence in growth trajectories between twin and singleton pregnancies becomes more pronounced as gestational age increases. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Assessment of Nailfold Capillaroscopy Findings in Pregnant Women having Preeclampsia: A Research Protocol

Introduction: Pregnancy causes significant vascular and cutaneous changes in a woman’s body. Preeclampsia is one of the life-threatening conditions associated with high blood pressure and proteinuria after the 20th week of pregnancy. It can cause placental hypoperfusion and placental insufficiency, leading to foetal defects or, in severe cases, foetal loss, which can be prevented by early diagnosis and treatment. There are many ways to observe and study the microcirculation non invasively the safest and most accessible method is nailfold capillaroscopy. Nail-fold Video Capillaroscopy (NVC) is a handheld digital microscope used to observe the microcirculation at the nailfold of the hands. Thus, comparing the capillary status with healthy subjects will help establish an early diagnosis and manage cases to prevent further complications in the mother and newborn. Need of the Study: The pathophysiology states that preeclampsia is related to systemic endothelial dysfunction, causing the release of Tumour Necrosis Factor (TNF) alpha, a proinflammatory mediator, leading to hypoxia of the placenta and the loss of endothelial cell-lined capillaries. Thus, there is a need to find if there is an established correlation in association of decreased Capillary Density (CD) in individuals with preeclampsia. Although evidence supporting a link between decreased CD and preeclampsia is limited, timely assessment and prevention are crucial. Nailfold capillaroscopy, an accessible and non invasive imaging method, holds promising calibre for understanding microvascular changes in preeclampsia. This could facilitate post-conception monitoring and early interventions to identify and address circulatory issues in affected women with preeclampsia. Aim: To study and compare the nailfold capillary changes in women diagnosed with preeclampsia and women having normal and uneventful pregnancies. Materials and Methods: A comparative cross-sectional study will be done in the Outpatient Department (OPD) and Inpatient Department (IPD) of Obstetrics and Gynaecology and the Outpatient Department of Dermatology at AVBRH Sawangi Meghe, Wardha, Maharashtra, India, from March 2023 to March 2025. A total of 150 pregnant women will be considered in the study, with 75 women being normal pregnant women (controls) and 75 pregnant women diagnosed with preeclampsia (cases). In order to confirm the gestational age of the patients, fundal height and abdominal circumference measurements will be taken. Demographic data, Basal Metabolic Index (BMI), weight gain during pregnancy, laboratory reports including Complete Blood Count (CBC), coagulation profile (Prothrombin Time, International Normalised Ratio, Activated Partial Thromboplastin Time), liver function tests, kidney function tests, urine examinations, and serial ultrasonography reports available for the patients will be noted. Pre-examination blood pressure will be recorded and compared with the baseline to confirm the status of preeclampsia after obtaining written consent from the patients. Nailfold capillaroscopy will be performed using a (Dinolite -AF4115ZT) dermoscope equipped with a 200X magnification, high-resolution lens in a non polarised light setting with oil immersion as a fluid coupling. The observations will be used to interpret the results of the study. Results will be calculated for finding differences between the two comparative groups of cases and controls at a p-value of ≤0.05.

LncRNA TUSC7 regulates oxidative stress level by targeting miR-23b in colorectal cancer and thus inhibits cell proliferation, migration and invasion.

Currently, multiple studies have shown that long non-coding ribonucleic acid TUSC7 exerts an anti-tumor effect in a variety of cancers. However, the function and underlying regulatory mechanism of lncRNA TUSC7 in CRC remain unclear. The relative fluorescence intensity of MMP9 in the cancer and in peritoneal tissues was measured by immunofluorescence. Peritoneal macrophages in BALB/c mice were sorted out using flow cytometry. The abdominal circumference of mice was measured. Moreover, the correlation between TUSC7 and miR-23b was detected by diluciferase experiment and the expressions of TUSC7 and miR-23b were analyzed using real-time fluorescence quantitative PCR. Last, the effect of TUSC7 on peritoneal macrophages was detected. The relative fluorescence intensity of MMP9 in cancer was significantly stronger than that it in the surrounding tissues. Measurements of abdominal circumference in mice showed that TUSC7 inhibited the metastasis of CRC. The results of dual luciferase assay and RT-qPCR experiment showed that TUSC7 could target and inhibit miR-23b. The expressions of P22, P47, gp91, p-STAT6, p-STAT3, IL-4 and IL-10 were remarkably increased in TUSC7 OE group compared with those in NC group, while the expressions of p-SHP2, MMP2 and MMP9 were evidently reduced in contrast with those in NC group. The viability, proliferation, migration and invasion of CRC cells could be inhibited by TUSC7 OE, which was reversed by TUSC7 KD. LncRNA TUSC7 can regulate the oxidative stress level and promote the M2 polarization of macrophages through targeting miR-23b of peritoneal macrophage in CRC, thus inhibiting cell proliferation, migration and invasion.

Estimation of Foetal Weight by Ultrasonography and Neonate at Birth

Background: Ultrasonography intervention in delivery is highly sensitive and primary important for further tests of foetal well-being. Objective: The purpose of the present study was to observe the correlation of estimated foetal weight with neonatal birth weight. Methodology: This was a cross-sectional study on patients at the Labour Ward of Department of Obstetrics and Gynaecology at Sir Salimullah Medical College and Mitford Hospiptal, Dhaka, Bangladesh for six months. The women were selected who had normal pregnancy with early ultrasounographic examination for confirmation of gestational age, singleton live foetus, ultrasound examination for pregnancy profile done within 3 days before delivery. A sonographic foetal weight was estimated by using measurements of foetal body parts-biparietal diameter, abdominal circumference and femoral length. To measure the femur length, first a projection was made that shows a transverse section of one of the long bones, then scan at 900 to this to obtain a longitudinal section. Results: A total number of 100 patients were recruited for this study. The mean (±SD) sonographically estimated foetal weight was 3074±534gm with ranged from 2100 to 4100 gm. The mean (±SD) neonatal birth weight was 2978±466 gm with ranged from 2500 to 3800 gm (p&lt;0.05). Sonographically estimated foetal weight less than 3000 g were correlated with neonatal birth weight. Out of the 100 cases 57(57.0%) cases had less than 3000 g estimated foetal weight and 43(43.0%) cases had 3000 g or more than 3000gm estimated foetal weight Sonographically. Among the 57 cases, which were less than 3000 g by Sonographically, 41 cases were less than 3000 g and 16 cases were found 3000 g or more than 3000 g in neonatal birth weight. Conclusion: Ultrasonography has definite value in the diagnosis of estimated foetal weight and can be regarded as a sensitive and specific imaging modality for pre-operative discrimination of the pregnant women. Journal of National Institute of Neurosciences Bangladesh, January 2023;9(1):42-47

Comparaison pragmatique des courbes de biométries fœtales élémentaires

IntroductionThe fetal biometrics charts recommended in France for ultrasound screening include measurements of head circumference (HC), biparietal diameter (BIP), abdominal circumference (AC) and femur length (FL). New international growth standards have been recommended since 2022. The aim of this work is to quantitatively describe the differences between these biometric curves. MethodsThe biometry curves from the French College for Fetal Ultrasound, OMS and INTERGROWTH-21 are pragmatically compared based on their original quantile regression equations (superposition and quantification of differences in millimeters and in proportion) for different percentiles of clinical interest. ResultsCompared with the new charts, CFEF underestimates HC<-3DS and AC<10eP. The proportions of differences between the CFEF and INTERGROWTH-21 or WHO curves always remained <5%. The proportions of difference of the 3rd percentile of HC and FL, 10th and 90th percentile of AC were always lower than 2%, 2%, 5% and 4% respectively, between OMS and INTERGROWTH-21. ConclusionThe switch to prescriptive standards suggests an improvement in the detection of fetuses with AC<10th percentile, an improvement in the detection of prenatal onset microcephaly, with no argument for a decrease in the detection rate of severe constitutional bone disease or modification of obstetrical guidelines.

An analytical cross-sectional study: determining gestational age using fetal clavicle length during the second trimester.

To investigate the correlation between fetal clavicle length and gestational age in pregnant patients from 14 and 27weeks of gestation. This was a retrospective cross-sectional study of patients from 14 and 27weeks of gestation. Ultrasonographic measurements such as abdominal circumference (AC), femur length (FL), humerus length (HL), clavicle length (CL), head circumference (HC), biparietal diameter (BPD), estimated fetal weight (EFW), and transverse cerebellum diameter (TCD) were made and compared. A total of 552 patients were evaluated in our clinic and CL was measured properly and successfully in all fetuses. Fetal AC, FL, HL, CL, BPD, HC, EFW and TCD measurements were significantly and strongly correlated with gestational week, and Pearson's correlation values were 0.964, 0.965, 0.959, 0.965, 0.951, 0.917, 0.925, and 0.954, respectively (p < 0.001). In the regression analysis equation, gestational week = 0.894 + CL × 0.961. There was a significant positive correlation between fetal CL (mm) and gestational week. We suggest that the 1mm = 1week rule can be used for patients with anomalies of the cerebellum and vermis, as well as for patients with unknown last menstrual period.

Bringing precision medicine to the management of pregnancy in women with glucokinase-MODY: a study of diagnostic accuracy and feasibility of non-invasive prenatal testing.

In pregnancies where the mother has glucokinase-MODY (GCK-MODY), fetal growth is determined by fetal genotype. When the fetus inherits a maternal pathogenic GCK variant, normal fetal growth is anticipated, and insulin treatment of maternal hyperglycaemia is not recommended. At present, fetal genotype is estimated from measurement of fetal abdominal circumference on ultrasound. Non-invasive prenatal testing of fetal GCK genotype (NIPT-GCK) using cell-free DNA in maternal blood has recently been developed. We aimed to compare the diagnostic accuracy of NIPT-GCK with that of ultrasound, and determine the feasibility of using NIPT-GCK to guide pregnancy management. We studied an international cohort of pregnant women with hyperglycaemia due to GCK-MODY. We compared the diagnostic accuracy of NIPT-GCK with that of measurement of fetal abdominal circumference at 28 weeks' gestation (n=38) using a directly genotyped offspring sample as the reference standard. In a feasibility study, we assessed the time to result given to clinicians in 43 consecutive pregnancies affected by GCK-MODY between July 2019 and September 2021. In terms of diagnostic accuracy, NIPT-GCK was more sensitive and specific than ultrasound in predicting fetal genotype (sensitivity 100% and specificity 96% for NIPT-GCK vs sensitivity 53% and specificity 61% for fetal abdominal circumference 75th percentile). In terms of feasibility, a valid NIPT-GCK fetal genotype (≥95% probability) was reported in all 38 pregnancies with an amenable variant and repeated samples when needed. The median time to report was 5 weeks (IQR 3-8 weeks). For the 25 samples received before 20 weeks' gestation, results were reported at a median gestational age of 20 weeks (IQR 18-24), with 23/25 (92%) reported before 28 weeks. Non-invasive prenatal testing of fetal genotype in GCK-MODY pregnancies is highly accurate and is capable of providing a result before the last trimester for most patients. This means that non-invasive prenatal testing of fetal genotype is the optimal approach to management of GCK-MODY pregnancies.

Airflow and dynamic circumference of abdomen and thorax for adults at varied continuous positive airway pressure ventilation settings and breath rates

Continuous positive airway pressure (CPAP) ventilation is a commonly prescribed respiratory therapy providing positive end-expiratory pressure (PEEP) to assist breathing and prevent airway collapse. Setting PEEP is highly debated and it is thus primarily titrated based on symptoms of excessive or insufficient support. However, titration periods are clinician intensive and can result in barotrauma or under-oxygenation during the process. Developing model-based methods to more efficiently personalise CPAP therapy based on patient-specific response requires clinical data of lung/CPAP interactions. To this end, a trial was conducted to establish a dataset of healthy subjects lung/CPAP interaction. Pressure, flow, and tidal volume were recorded alongside secondary measures of dynamic chest and abdominal circumference, to better validate model outcomes and assess breathing modes, muscular recruitment, and effort. N = 30 subjects (15 male; 15 female) were included. Self-reported asthmatics and smokers/vapers were included, offering a preliminary assessment of any potential differences in response to CPAP from lung stiffness changes in these scenarios. Additional demographics associated with lung function (sex, age, height, and weight) were also recorded.

Differential effect of ramadan fasting on intercellular adhesion molecule-1 (ICAM-1) in diabetes mellitus and non-diabetes mellitus patients

BackgroundThe month of Ramadan is a holy month for Muslims. During this month, Muslims do not eat, drink, or smoke from sunrise to sunset. Patients with type 2 diabetes mellitus (T2DM) will also fast from dawn to dusk, creating a unique opportunity to study the effects of dietary changes during fasting period. One of the interesting results of Ramadan fasting is its effect on endothelial dysfunction, measured using Intercellular Adhesion Molecule-1 (ICAM-1) as a biological marker of endothelial function. AimTo determine the changes ICAM-1 levels in T2DM and non-DM patients during Ramadan fasting. MethodsA retrospective cohort study was performed on 26 T2DM patients and 21 non-DM, age-matched patients (aged 19–60 years). Measurement of metabolic parameters (systolic and diastolic blood pressure, total calorie intake, and intensity of physical activity), anthropometry (body weight, body mass index (BMI) and abdominal circumference), total dietary intake, and laboratory analysis (blood glucose fasting, HbA1c, lipid profile, ICAM-1) were done at 4 weeks before (T0) and 14 days after Ramadan fasting (T1). ResultThe median ICAM-1 level in T2DM patients at T0 was 340.9 (193–505) ng/mL and at T1 was 312.3 (158–581) ng/mL, while the ICAM-1 level in non-DM patients at T0 was 482 (305–653) and at T1 was 398.4 (202–526) ng/mL. There was no significant difference of ICAM-1 level between study groups at both T0 and T1 (p > 0.05). Both T2DM and non-DM patients had lower ICAM-1 level following Ramadan fasting. However, only non-DM patients had significantly lower post Ramadan ICAM-1 (p = 0.008) ConclusionThere was a significant decrease in ICAM-1 level in both T2DM and non-DM patients after Ramadan fasting.

The effect of position change and abdominal massage on anxiety, pain and distension after colonoscopy: A randomized clinical trial

ContextPain, abdominal distention, and anxiety are major risk factors encountered after colonoscopy. Complementary and alternative treatments, such as abdominal massage and position change, are used to reduce the associated risk factors. ObjectiveTo determine the effect of position change and abdominal massage on anxiety, pain, and distension after colonoscopy. DesignA randomized three-group experimental trial. Setting and ParticipantsThis study was conducted with 123 patients who underwent colonoscopy at the endoscopy unit of a hospital located in western Turkey. MethodsThree groups were formed: two interventional (abdominal massage and position change) and one control, each including 41 patients. Data were gathered using a personal information form, pre- and post-colonoscopy measurement form, the Visual Analog Scale (VAS), and the Spielberger State-Trait Anxiety Inventory. Pain and comfort levels, abdominal circumference values, and vital signs of the patients were measured at four evaluation times. ResultsIn the abdominal massage group, the VAS pain scores and abdominal circumference measurements decreased the most and the VAS comfort scores increased the most 15 min after the patients were taken to the recovery room (p<0.05). Furthermore, bowel sounds were heard, and bloating was relieved in all patients in both intervention groups 15 min after they were taken to the recovery room. ConclusionsAbdominal massage and position change can be considered effective interventions for relieving bloating and facilitating flatulence after colonoscopy. Moreover, abdominal massage can be a powerful method for reducing pain and abdominal circumference and increasing patient comfort.

Intra-abdominal umbilical venous diameter and abdominal circumference discordance at 15-20weeks' gestation: simple markers in transverse abdominal plane to predict adverse pregnancy outcomes in monochorionic diamniotic twins.

This study aimed to investigate the association between simple markers in fetal abdominal plane, intra-abdominal umbilical venous diameter (DIUV) and abdominal circumference (AC) discordance at 15-20weeks' gestation, and adverse pregnancy outcomes in monochorionic diamniotic (MCDA) twins. We performed a retrospective analysis of MCDA twins with two live fetuses examined at 15-20weeks from Jun 2020 to Dec 2021 at Beijing Obstetrics and Gynecology Hospital. Measurement of fetal AC and DIUV was performed according to standard protocols. Twin pregnancies with major fetal structural anomalies, chromosomal abnormalities, miscarriage, and twin reversed arterial perfusion sequence were excluded. DIUV and AC discordance in MCDA twins with an adverse pregnancy outcome was compared with a normal pregnancy outcome. Furthermore, the performance of DIUV and AC discordance in predicting adverse pregnancy outcomes in MCDA twins was assessed. A total of 105 women with MCDA twin pregnancies were enrolled, contributing 179 visits. Adverse pregnancy outcomes occurred in 33.3% (35/105) of cases in our study. The intra-observer and inter-observer intraclass correlation coefficient (ICC) of both AC and DIUV were very good or excellent. There was no statistical difference in AC and DIUV discordance (%) between 15-16, 17-18, and 19-20weeks (χ2 = 3.928, P = 0.140; χ2 = 2.840, P = 0.242). Both AC and DIUV discordance were greater in twins with adverse pregnancy outcomes than that in twins with normal pregnancy outcome at each pregnancy periods. Both AC discordance (OR 1.2, 95% CI 1.1-1.3) and DIUV discordance (OR 1.2, 95% CI 1.1-1.2) were associated with adverse pregnancy outcomes. The AUC for predicting adverse pregnancy outcomes by AC discordance was 0.75 (95% CI 0.68-0.83), with a sensitivity of 58.7% (95% CI 51.9-64.5) and a specificity of 86.2% (95% CI 81.7-88.4). The AUC for predicting adverse pregnancy outcomes by DIUV was 0.78 (95% CI 0.70-0.86), with sensitivity and specificity of 65.1% (95% CI 58.1-70.3) and 86.2% (95% CI 81.7-88.4), respectively. The AC discordance and DIUV discordance could predict adverse pregnancy outcomes in MCDA twins. When these simple markers occurred, intensive surveillance was recommended.

ISUOG Practice Guidelines (updated): fetal cardiac screening.

ISUOG Practice Guidelines (updated): fetal cardiac screening.

Association of Spinal Alignment and Abdominal Circumference with Sarcopenia Status and Fall Risk in Patients with Osteoporosis: A Retrospective Study.

Since vertebral kyphosis and abdominal circumference are thought to influence sarcopenia and fall risk in osteoporosis, we evaluated sarcopenia and fall risk in patients with different measurements of abdominal circumference and sagittal longitudinal axis (SVA). In this post hoc study, 227 patients aged 65 years or more who visited an outpatient osteoporosis clinic were included in the analysis. Sarcopenia was determined from lean body mass, grip strength, and walking speed by dual energy X-ray absorptiometry; SVA (median 40 mm) and abdominal circumference (median 80 cm) were compared between the four groups, each divided into two groups. Nutritional management, falls, and fall anxiety scores were also examined. The incidence of sarcopenia was significantly increased in those with abdominal circumference < 80 cm in both the SVA < 40 mm and SVA ≥ 40 mm groups (p < 0.05). Nonetheless, the fall scores of those with SVA < 40 mm were lower than those of individuals with SVA ≥ 40 mm (p < 0.01). Based on the results of this study, SVA and abdominal circumference values may predict the risk of sarcopenia and falls. More research is needed before our results can be translated into clinical practice.

HEALTH SERVICES AND EMPOWERMENT OF THE ELDERLY BASED ON LEGAL ASSURANCE PERSPECTIVE IN BOJONGLOA KALER, BANDUNG CITY

Introduction: The Elderly people’s prosperity as mentioned in Indonesia’s Law No. 13 1998 article 1 verse (2) is those who are 60 years old or more. In this level, it happens the decrease process of relations among people, income and basic needs. Therefore, they require support from various parties in order to remain capable and adaptable so that they can live properly. To do that, integrated service posts (Posyandu) managed by community and governments indeed have an important role in improving elderly people’s health. Methods: This research aims especially to explore problems of giving services of health for the elderly in Posyandu and apply some efforts to solve the problem. Qualitative descriptive research design is the type of this research to explore more about sociological law which legal materials used are primary, secondary and tertiary legislation. Results: of this study shows giving health services to elderly people held at Posyandu such as only measurements of weight, height and abdominal circumference due to the limited competence of cadres and health workers. Meanwhile those elderly have not got empowerment in their Posyandu service activities. Conclusions: it is recommended to take cross-sectoral collaboration for health care and empowerment of the elderly in the context of legal certainty, as well as, Ners as the ones who are in charge of the elderly program at the community health center.

Associations of solar activity and related exposures with fetal growth

BackgroundSolar and geomagnetic activity have been shown to suppress melatonin and to degrade folate levels, important hormones for fetal development. We examined whether solar and geomagnetic activity were associated with fetal growth. MethodsWe included 9573 singleton births with 26,879 routine ultrasounds at an academic medical center in Eastern Massachusetts from 2011 through 2016. Sunspot number and Kp index were obtained from the NASA Goddard Space Flight Center. Three exposure windows were considered, including the first 16 weeks of pregnancy, one month prior to fetal growth measurement, and conception until fetal growth measurement (cumulative). Ultrasound scans from which we extracted biparietal diameter, head circumference, femur length, and abdominal circumference measurements were categorized as anatomic (<24 weeks' gestation) or growth scans (≥24 weeks' gestation) based on clinical practice. Ultrasound parameters and birth weight were standardized, and linear mixed models adjusted for long-term trends were fitted. ResultsPrenatal exposures were positively associated with larger head parameters measured <24 weeks' gestation, negatively associated with smaller fetal parameters measured ≥24 weeks' gestation, and not associated with birth weight. The strongest associations were observed for cumulative exposure in growth scans, where an interquartile range increase in sunspot number (32.87 sunspots) was associated with a −0.17 (95 % CI: −0.26, −0.08), −0.25 (−0.36, −0.15), and −0.13 (95 % CI: −0.23, −0.03) difference in mean biparietal diameter, head circumference, and femur length z-score, respectively. An interquartile range increase in cumulative Kp index (0.49) was associated with a −0.11 (95 % CI: −0.22, −0.01) and −0.11 (95 % CI: −0.20, −0.02) difference in mean head circumference and abdominal circumference z-score, respectively, in growth scans. ConclusionsSolar and geomagnetic activity were associated with fetal growth. Future studies are needed to better understand the impact of these natural phenomena on clinical endpoints.