Antenatal Examination Research Articles

Application of machine learning algorithm for predicting gestational diabetes mellitus in early pregnancy†

Abstract Objective To study the application of a machine learning algorithm for predicting gestational diabetes mellitus (GDM) in early pregnancy. Methods This study identified indicators related to GDM through a literature review and expert discussion. Pregnant women who had attended medical institutions for an antenatal examination from November 2017 to August 2018 were selected for analysis, and the collected indicators were retrospectively analyzed. Based on Python, the indicators were classified and modeled using a random forest regression algorithm, and the performance of the prediction model was analyzed. Results We obtained 4806 analyzable data from 1625 pregnant women. Among these, 3265 samples with all 67 indicators were used to establish data set F1; 4806 samples with 38 identical indicators were used to establish data set F2. Each of F1 and F2 was used for training the random forest algorithm. The overall predictive accuracy of the F1 model was 93.10%, area under the receiver operating characteristic curve (AUC) was 0.66, and the predictive accuracy of GDM-positive cases was 37.10%. The corresponding values for the F2 model were 88.70%, 0.87, and 79.44%. The results thus showed that the F2 prediction model performed better than the F1 model. To explore the impact of sacrificial indicators on GDM prediction, the F3 data set was established using 3265 samples (F1) with 38 indicators (F2). After training, the overall predictive accuracy of the F3 model was 91.60%, AUC was 0.58, and the predictive accuracy of positive cases was 15.85%. Conclusions In this study, a model for predicting GDM with several input variables (e.g., physical examination, past history, personal history, family history, and laboratory indicators) was established using a random forest regression algorithm. The trained prediction model exhibited a good performance and is valuable as a reference for predicting GDM in women at an early stage of pregnancy. In addition, there are certain requirements for the proportions of negative and positive cases in sample data sets when the random forest algorithm is applied to the early prediction of GDM.

HUBUNGAN PENGETAHUAN DAN RIWAYAT PENYAKIT DENGAN KELAHIRAN PREMATUR DI RUMAH SAKIT UMUM DAERAH KOTA PADANGSIDIMPUAN

The World Health Organization (WHO) reports that every year 13 million babies are born prematurely worldwide and one million babies die. The results of the 2013 Basic Health Research (Riskesdas) showed that 32.4% of infant deaths aged 0-6 days were caused by prematurity. Premature incidence in Padangsidimpuan City Hospital continues to increase from 2011-2014. The purpose of this study was to determine the relationship between knowledge and history of disease with premature birth at the Padangsidimpuan City General Hospital. This type of research is an analytic study with a cross sectional approach. The population was all mothers who gave birth prematurely and not prematurely at the Padangsidimpuan City Hospital. The sample in this study was the entire population of 92 people. The sample in this study amounted to 92 people. Data were collected through medical records and interviews using a questionnaire. Data were analyzed by univariate, bivariate using Chi-Square test at 95% confidence level (P < 0.05). The results showed that there was a relationship between medical history (p= 0.0001) and preterm birth, while the knowledge variable (p=0.061) was not related to preterm birth. It is recommended for health workers to further optimize health services by conducting antenatal care examinations according to standards to determine blood pressure, Hb levels, blood glucose in the prevention of preeclampsia, anemia, diabetes mellitus which can be at risk of prematurity. Padangsidimpuan City Hospital is expected to improve health counseling to mothers about a good age for pregnancy and childbirth, namely at the age of 20-34 years. The health office is expected to develop an atmosphere for community groups through perwiritan in socializing about prematurity

Associations Between Trajectory of Different Blood Pressure Components in Pregnancy and Risk of Adverse Birth Outcomes - A Real World Study.

BackgroundHigh blood pressure during pregnancy has been suggested to be associated with adverse birth outcomes (ABO), but it is unclear how different blood pressure changes and the extent of the effect. Therefore, we aimed to investigate the association between blood pressure trajectories (systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), pulse pressure (PP)) of pregnant women and ABO in a real-world study.Material and MethodsLeveraging 28,679 pregnant women and their fetuses from a register-based cohort from January 1, 2010, to December 31, 2019. Blood pressure trajectories were estimated by package “traj” in R software using real-world blood pressure data of routine antenatal care examinations. Logistic regression models were applied to examine the association between trajectories of different blood pressure components (SBP, DBP, MAP, and PP) during pregnancy and the risk of ABO.ResultsTrajectories of all blood pressure components were identically labeled as low-stable, moderate-increasing, moderate-decreasing and high-stable. After adjusting for confounding factors, compared with pregnant women with the low-stable pattern, pregnant women with a high-stable or moderate-increasing pattern had a significantly increased risk of developing adverse birth outcomes. Pregnant women with a moderate-decreasing pattern had no significant increased risk of ABO but had a lower risk of adverse birth outcomes than those with a moderate-increasing pattern. The trajectories crossed at 17–20 weeks of gestation for all blood pressure components.ConclusionOur study results indicated that reduction and maintenance of blood pressure to a low level of less than 110 mmHg for SBP and 65 mmHg for DBP after 20 weeks of gestation would benefit prevention of adverse birth outcomes, regardless of the level of blood pressure at early pregnancy.

Effectiveness factors analysis of near-miss incidence referral in obstetric complications at Waras Wiris Andong General Hospital on Boyolali District

AbstractMaternal mortality in Indonesia is still very high, and the biggest problem is obstetric complications. It is possible that the mother who has obstetric complications is safe and recovered (near miss) or died. This research was an observational analytic epidemiological study conducted to determine the effectiveness of near-miss incidence referral in obstetric complications using a cross-sectional approach. The sampling technique used was a random sampling system with 85 respondents. The effectiveness of referral affects near-miss incidence, meaning that mothers who get referral according to procedure only have a 0.107 times greater chance of not occurring near miss. Pregnant women who had a history of the disease had a risk of 0.157 times greater for the absence of near-miss than mothers who did not have a history. Pregnant women with high risk have 0.157 times no near-miss than those with low risk. Maternal antenatal examination affects the incidence of a near miss. It was found that the mother's history of illness, the risk of pregnancy owned by the mother and the effectiveness of referrals could affect the incidence of near miss in obstetric complications. In conclusion, there is an influence between the effectiveness of the referral and the near-miss incident at the Waras Wiris Andong Regional Hospital, Boyolali RegencyKeywords: referral, effectiveness, near-miss, obstetric complication

Association of Elevated Maternal Serum Total Bile Acids With Low Birth Weight and Intrauterine Fetal Growth Restriction

Bile acids play essential roles in metabolic modulation. Excessive serum total bile acid (sTBA) levels during pregnancy are associated with adverse perinatal outcomes; however, their association with the risk of intrauterine growth restriction (IUGR) remains unclear. To investigate the association between maternal sTBA concentration during pregnancy and the risk of IUGR. This retrospective cohort study included pregnant individuals who delivered live singleton neonates and had regular antenatal examination records available at a hospital-based center in Shanghai, China, from 2014 to 2018. Data were analyzed from July to November 2020. Maternal sTBA concentration during pregnancy. Fetal birth weight and probability of low birth weight (LBW) and IUGR. This study included 68 245 singleton pregnancies with live births for analysis. The mean (SD) age of the pregnant individuals was 30.5 (3.8) years, 67 168 patients (98.4%) were Han, and 50 155 (73.5%) were nulliparous. Nonlinear regression models suggested that there was an inverted J-shaped association between maternal sTBA level during pregnancy and fetal birth weight, with a steep decrease in birth weight at high sTBA levels (estimated mean [SE] birth weight for sTBA of 40.8 ug/mL, 2879 [39.9] g) and greater birth weights at lower sTBA levels (estimated mean [SE] birth weight for sTBA 0.4 μg/mL, 3290 [3.9] g; and for 4.1 μg/mL, 3334 [1.6] g). Lower birth weight and a higher incidence of IUGR were observed in patients with gestational hypercholanemia (sTBA ≥4.08 μg/mL) compared with those without gestational hypercholanemia (birth weight: estimated adjusted mean [SE], 3309 [3.32] vs 3338 [0.80] g; P = .005; incidence of IUGR: 62 of 4467 [1.4%] vs 312 of 63 778 [0.5%]; P < .001). Moreover, compared with patients with sTBA concentrations of less than 4.08 μg/mL, those with gestational hypercholanemia had an increased risk of LBW (adjusted odds ratio [aOR], 1.29; 95% CI, 1.09-1.53) and IUGR (aOR, 2.18; 95% CI, 1.62-2.91). In addition, there was an additive interaction between hypertensive disorders in pregnancy (HDP) and hypercholanemia on LBW and IUGR risk. The highest risks of LBW and IUGR were found in pregnant individuals with both HDP and hypercholanemia compared with those with normotensive pregnancies with sTBA concentrations less than 4.08 μg/mL (LBW: aOR, 9.13; 95% CI, 6.88-12.12; IUGR: aOR, 19.14; 95% CI, 12.09-30.28). This study found that gestational hypercholanemia was associated with an increased risk of LBW and IUGR, especially in pregnant individuals with HDP. Therefore, it would be meaningful to monitor sTBA concentration during the follow-up of pregnancies with potential IUGR.

Objective Structured Clinical Examination (OSCE) on Antenatal Assessment among Nursing students

Background: The assessment of knowledge and skills plays an important part in student nurse’s progression because they need to demonstrate competency and confidence in the performance of clinical skills. OSCE has been recognized as the most reliable method for evaluation of clinical skills among Nursing students. The study aims to assess the effectiveness of OSCE on antenatal assessment among nursing students. Methods: An experimental approach with post-test only design was used to select 60 IV Year BSc Nursing students. They were selected by using a simple random sampling method. 30 were in the experimental group received planned teaching program on antenatal assessment and evaluated by OSCE, 30 were in the control group received traditional method of teaching on antenatal assessment and evaluated by traditional clinical evaluation (TCE). An observational checklist and the opinionnaire on the usefulness of OSCE were used to collect the data. Results: Average marks scored by the students who are evaluated by OSCE (21.96±1.44) were higher as compared to traditional clinical evaluation scoring (14.93±2.75) which was statistically significant (p&lt; 0.001) Most of the students gave positive feedback on OSCE. Conclusion: Learning in the nursing clinical area gives present reality to nursing students to build up the information, abilities, dispositions, and skills. OSCE is an important, reasonable, helpful and acceptable method for assessing student’s clinical performance due to different positive particulars. The study concluded that OSCE was an effective method to evaluate the clinical skills of nursing students on antenatal examination.

Utilization and associated factors of reproductive health services among 20\u201339-year-old women in rural China: a cross-sectional study

BackgroundThe use of reproductive health (RH) services is important to promote RH. However, little is known about RH services in rural areas, especially in low- and middle-income countries. China is the most populous country in the world, and 40.4% of its population is rural. Our study determined the utilization of and factors associated with RH services in rural China.MethodsA cross-sectional study of 978 20- to 39-year-old women was performed in four villages of four cities in Hunan Province. A researcher-created structured questionnaire was used to collect the data. The data were entered into EpiData v3.0 and analysed using SPSS v18.0. Statistical significance was defined as a two-sided P-value of less than 0.05. Descriptive statistics were used to examine the socio-demographic factors and the use of RH services by the sample population. Chi-square tests were used to assess associations between categorical variables. Logistic regression analyses were performed to examine factors that correlated with the use of RH services.ResultsThe top three services used were antenatal examinations (90.2%), postpartum visits (73.0%) and free folic acid supplements (71.6%). Age, monthly household income, employment, spousal education level, and artificial abortion history were associated with RH service utilization (P < 0.05). The most desired RH service was cervical/breast cancer prevention services (58.9%). The most preferred method participants used to obtain information on RH services was the internet.ConclusionsThe utilization rate for RH services in rural China needs improvement. Future efforts should target high-risk populations of women by providing them with RH-related information and cultivating positive attitudes towards RH services.

Behavioral Determinants of Pregnant Mothers and Husbands in Containing Pregnancy Examination During the Covid-19 Pandemic

ANC is a health service provided to pregnant women in an effort to improve the welfare of the mother and fetus. The pandemic (COVID-19) is now a problem faced by 200 countries around the world. The method used in this paper uses a comprehensive strategy, such as searching for articles in research journal databases, searching through the internet, reviewing articles. There are 5 national articles and 5 international articles, analyzed through analysis of objectives, suitability of topics, research methods used, sample size, research ethics, results of each article, and limitations that occur. The results of this study indicate that the increase in anxiety of pregnant women in the era of the COVID-19 pandemic is due to the lack of knowledge of pregnant women about COVID-19 and how to prevent it. In reducing the mother's anxiety level to carry out Antenatal Care checks, a deep understanding of COVID-19 and how to prevent it, and avoiding false news (hoaxes) can be given. The conclusion based on the analysis that has been carried out is, there are factors of maternal anxiety and husband's support in conducting Antenatal Care examinations, namely inaccurate information circulating to the wider community, then the level of knowledge related to covid-19 and its prevention.

Behavioral Determinants of Pregnant Mothers and Husbands in Containing Pregnancy Examination During the Covid-19 Pandemic

ANC is a health service provided to pregnant women in an effort to improve the welfare of the mother and fetus. The pandemic (COVID-19) is now a problem faced by 200 countries around the world. The method used in this paper uses a comprehensive strategy, such as searching for articles in research journal databases, searching through the internet, reviewing articles. There are 5 national articles and 5 international articles, analyzed through analysis of objectives, suitability of topics, research methods used, sample size, research ethics, results of each article, and limitations that occur. The results of this study indicate that the increase in anxiety of pregnant women in the era of the COVID-19 pandemic is due to the lack of knowledge of pregnant women about COVID-19 and how to prevent it. In reducing the mother's anxiety level to carry out Antenatal Care checks, a deep understanding of COVID-19 and how to prevent it, and avoiding false news (hoaxes) can be given. The conclusion based on the analysis that has been carried out is, there are factors of maternal anxiety and husband's support in conducting Antenatal Care examinations, namely inaccurate information circulating to the wider community, then the level of knowledge related to covid-19 and its prevention.

The Impact of COVID-19 Pandemic on Antenatal Visits and Routine Examinations in Paleteang District of Pinrang Regency, Indonesia

Maternal and child health care has been a big challenge in Indonesia. Moreover, the COVID-19 pandemic has caused considerable restrictions to maternal and newborn healthcare services. Consequently, community health services faced changes in policies such as limiting antenatal care visits, which resulted in irregular health examination for pregnant women. Therefore, this study aims to examine the frequency of the village midwives’ house visits during the COVID-19 pandemic and the appropriate routine examination of pregnant women. This is an observational study conducted from March to late October 2020. Data were collected in Pinrang sub-district of South Sulawesi using cluster random sampling targeted at pregnant women in six villages. The Chi square test was used to identify possible association between both variables. Out of the 63 pregnant women who participated in this study, more than 54% reported to have been visited and received medical examinations. The results shows that there is a significant relationship between the number of visits and appropriate examination with p value 0.04 and potential risk OR 4.860 (95% CI: 0.956 to 24.703). The village midwives’ visitation frequency was quite high during the COVID-19 but a potential risk was recorded for pregnant women who had incomplete routine examination. Therefore, there is need for collaborative effort between the local government and related sectors to improve maternal home health care services.

Prenatal phthalate exposure reduction through an integrated intervention strategy.

Pregnancy represents a sensitive susceptibility window to phthalate esters (PAEs). In this study, we develop an intervention strategy for reducing the exposure of pregnant women to phthalates. Thirty-five pregnant women, who initially underwent maternity examination, were recruited from an ongoing longitudinal prospective prenatal cohort study. The intervention strategy integrates diet, lifestyle, and environmental factors. Participants were encouraged to modify their behaviors and habits according to the intervention strategy at three different periods. Urine samples were collected from the participants after antenatal examination every month, for 8 months, to measure ten PAE metabolites. Mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), mono-n-butyl phthalate (MnBP), and mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP) declined significantly after the 1st intervention, while mono-isobutyl phthalate (MiBP) and mono-methyl phthalate (MMP) noticeably decreased after the 2nd intervention. The sum of the molar concentrations of MEHP, MEHHP, MEOHP, and MECPP reduced by 20 to 40% during subsequent intervention. In addition, the sum of the molar concentrations of MEP, MnBP, MMP, and MiBP as well as the sum of the molar concentrations of the ten metabolites also reduced. Our findings suggest that intervention through written recommendations can effectively reduce the burden of phthalates during pregnancy.

Relationship Maternal Characteristics (Parity And Age) With The Length of Time For Labor During The First And Second Stages of Labor at RSUD dr. R. Koesma Tuban

One of the important social indicators to measure the success of maternal mortality eradication programs and to see the status of maternal health is the Maternal Mortality Rate (MMR). The results of the initial survey in 2019 were 184 who experienced periods I and II, while in 2020 there were 222 people. The purpose of this study was to determine the relationship maternal characteristics (parity and age) with the length of time for labor during the first and second stages of labor at RSUD dr. R. Koesma Tuban. The research design used an analytical method with a cross-sectional research design. The population used was all mothers who gave birth in the maternity room at RSUD dr. R. Koesma Tuban in 2021 many 842 respondents, obtained a sample size of many 271 respondents. The sampling technique uses simple random sampling. Data collection uses secondary data, namely the independent and dependent variables. While the test used is chi-square with a significant level α = 0.05. The results showed that almost all of the results of the study showed that the length of time of delivery for the first and second stages of the primiparous tended to give birth accordingly, whereas in multiparous and grade multi the delivery was appropriate. Based on the chi-square test, it was found that x2 count = 5.705 ˃ x2 table = 3.841, then H0 was rejected H1 accepted This means that there is a relationship between maternal characteristics (parity and age) and the length of time for labor during the first and second stages of labor at RSUD dr. Koesma Tuban. From the research, it can be concluded that the characteristics of the mother (parity and age) can affect the length of time of stages I and II. One of the preventive efforts that can be done is to provide counseling about the ideal age for marriage, especially for women, regular antenatal examinations, counseling on family planning programs that can be used for married women under 20 years old and women over 35 years old.

Rare Fetus-in-Fetu: Experience From a Large Tertiary Pediatric Referral Center.

Objective: Fetus-in-fetu (FIF) is an extremely rare disease, and most prior publications are single case reports. Here, we describe the clinical characteristics, imaging manifestations, and the treatment and related complications of FIF from a large tertiary pediatric referral center.Materials: After institutional review board approval, patients with a diagnosis of FIF between January 2010 and November 2019 were further selected and reexamined. We analyzed the general clinical characteristics, imaging manifestations, treatment, and prognosis of the patients.Results: A total of seven (four male and three female) patients with FIF were included in the study. All patients were diagnosed with FIF during the antenatal ultrasound examination along with an abnormal increase in alpha fetoprotein, and it was confirmed by subsequent pathological examination. The median gestation period when FIF was first diagnosed was 25 (range: 22–32) weeks. Ultrasound, computed tomography, and magnetic resonance imaging were the main pre-operative diagnostic techniques used. All patients underwent FIF resection within 1 month after birth: four patients had open surgery and three had laparoscopic surgeries (one case was converted to open surgery); only one patient developed ascites after surgery. All patients are growing up healthy and without tumor recurrence at the last follow-up. The level of alpha fetoprotein decreased to normal within 1 year (range 3-10 months) after surgery performed.Conclusion: As the size of the FIF increases, it can be found and diagnosed in antenatal ultrasound examination. Surgery is an important curative treatment for FIF and generally results in excellent long-term quality of life.

FEATURES OF ULTRASOUND IMAGING IN FETAL INTRAUTERINE GROWTH RETARDATION

Fetal growth retardation complicates an average of 10% of all pregnancies. Today, ultrasound examination is used in obstetrics for diagnosis. Therefore, early detection of this complication is the key to adequate treatment and reduction of perinatal consequences. A deeper understanding of the early accompanying ultrasound parameters will allow timely detection or prevention of intrauterine fetal development. The aim of the research was to conduct an ultrasound antenatal examination of women with intrauterine growth retardation. Ultrasound fetometry and placentometry were conducted in women with intrauterine growth retardation (the main group, n-41) and women in the comparison group with the physiological course of pregnancy (n-12). At the initial ultrasound examination, among women in the main group, fetuses below the 10th percentile were probably more common and had a decrease in biparietal head size and abdominal circumference (p = 0.001, p = 0.08). With repeated ultrasound examination, the frequency of detecting decreased indicators of biparietal head size, head circumference, abdominal circumference, femoral shaft length below the 10th percentile among women in the main group increases by 1.5 times, and significantly differs from the indicators of the comparison group. (p = 0.0002, p = 0.001). A decrease in the biophysical profile of the fetus to 6-7 points accompanies 63.4% of pregnancies with intrauterine growth retardation. The amniotic fluid index below the 5th percentile in relation to the gestational age in women at the initial examination was 2.4%, and at the second examination - 7.3%. The placental ultrasound marker of premature maturation by gestational age 21.4%, the presence of petrification in 58.5%. In case of timely detection of the fetometric and placentometric changes, it is possible, from the standpoint of modern obstetrics, to start etiopathogenetic therapy and prevention of this complication of pregnancy.

Gambaran Karakteristik Ibu Hamil dalam Pemeriksaan Antenatal Care di Puskesmas Pasir Panjang Kota Kupang

Maternal mortality according to World Health Organization is death during pregnancy or within a period of 42 days after the end of pregnancy, due to all causes related to or aggravated by pregnancy or its handling, but not due to accident or injury. The causes of maternal death can be divided into two groups, namely direct obstetric death and indirect obstetric death. One of the efforts to reduce the Maternal Mortality Rate (MMR) is by providing standard Antenatal Care (ANC) services. This research aims to describe the characteristics of mothers in Antenatal Care examinations at the pubic health center of Pasir Panjang, Kupang City. This type of research used a descriptive design with a population of all K4 pregnant women register data at the pubic health center of Pasir Panjang in January-December 2019 as many as 403 pregnant women. Sampling using a total sampling technique of 403 pregnant women. The results showed that the characteristics of mothers according to age were in the 20-35 year old group (83.4%), parity in the nulliparous group (45.9%), residence in Pasir Panjang village (33.5%), history of maternal ANC visits according to the consecutive trimester of age Trimester I (98,1%), Trimester II (88,1%), and Trimester III (90.3%).

Fetüslerin Sifilizden Zarar Görmemesi: Antenatal Bakım, Maternal ve Neonatal Sonuçlar

Objective: Syphilis is a disease as old as human history.Untreated syphilis during pregnancy can cause serious prenatal adverse outcomes, including stillbirth, and congenital syphilis. World Health Organization, obstetrics and gynecology societies recommends screening syphilis at the first antenatal care visit. In this present study, it was aimed to discuss antenatal follow-up, maternal and neonatal outcomes of patients having syphilis infection during pregnancy. Material and Method: Patients diagnosed with syphilis during pregnancy were included in the study. Patients were screened by a Non-Treponomal test and positive results were confirmed by the Treponemal test. Patients data including antenatal examinations, maternal and neonatal results, syphilis treatment, newborn examination findings, syphilis treatment follow-up were obtained and evaluated retrospectively through the hospital registry system and telephone interviews. Results: The total number of patients who were screened with RPR in the first antenatal visit of the pregnancy over two and a half years period was 24427. Ten patients were diagnosed with syphilis by Treponemal test (TP-PA) confirmation. All patients were treated by three doses of Penicillin Benzathine G 2.4 million units via intramuscular route each at a one-week interval. All women gave birth at term without complication. Forty percent of patients diagnosed gestational diabetes mellitus. No congenital syphilis occurred. None of the patients had concomitant HIV and HCV infection. Conclusion: Eradication is possible for syphilis. Early detection at the first antenatal visit and adequate treatment with penicillin would prevent maternal and congenital syphilis, and recover babies from adverse outcomes of syphilis.

FRASER SYNDROME: A CASE REPORT

Fraser syndrome (cryptophthalmos syndrome) is a congenital anomaly in which cryptophthalmos is the main feature. Other malformations can include syndactyly, craniofacial and urogenital anomalies. It is a rare autosomal recessive condition with FRAS1, FREM2 and GRIP1 genes mutation. We report a case of 2 months old male child born to consanguineous parents. He presented with unilateral cryptophthalmos and some features that were compatible with diagnostic criteria of Fraser syndrome such as syndactyly, high arched palate with ankyloglossia, cryptorchidism and hypospadias. It can be diagnosed by antenatal ultrasound and clinical examination. We also present the criteria for diagnosing Fraser syndrome, its prenatal findings and ocular management.

Biosensor for Detecting Fetal Growth Restriction in a Low-Resource Setting

One strategy for improving detection of fetal growth restriction (FGR) is developing biosensors identifying placental dysfunction as a leading pathogenesis for FGR. The aim of this pilot study was to investigate the performance of a biosensor specified to detect placental dysfunction by means of maternal arterial turbulence acoustics in a low-resource setting. A cohort of 147 singleton pregnant women were prospectively followed with double-blinded biosensor tests, sonographic estimation of fetal weight (EFW) and Doppler flow at 26–28, 32–34 and 37–39 weeks of pregnancy. Full term live births with recorded birth weights (BWs) and without major congenital malformations were included. Outcomes were defined as (A) a solitary biometric measure (BW &lt; 3rd centile) and as (B) a biometric measure and contributory functional measure (BW &lt; 10th centile and antenatally detected umbilical artery pulsatility index &gt; 95th centile). Data from 118 women and 262 antenatal examinations were included. Mean length of pregnancy was 40 weeks (SD ± 8 days), mean BW was 3008 g (SD ± 410 g). Outcome (A) was identified in seven (6%) pregnancies, whereas outcome (B) was identified in one (0.8%) pregnancy. The biosensor tested positive in five (4%) pregnancies. The predictive performance for outcome (A) was sensitivity = 0.29, specificity = 0.97, p = 0.02, positive predictive value (PPV) was 0.40 and negative predictive value (NPV) was 0.96. The predictive performance was higher for outcome (B) with sensitivity = 1.00, specificity = 0.97, p = 0.04, PPV = 0.20 and NPV = 1.00. Conclusively, these pilot-study results show future potential for biosensors as screening modality for FGR in a low-resource setting.

Desperation in the time of COVID-19

Desperation in the time of COVID-19

Efficacy of Antenatal Ultrasound Examination in Diagnosis of Congenital Cardiac Anomalies in an Unselected Population: Retrospective Study from a Tertiary Centre.

In Low- and Middle-Income Countries like India, where the services and surgical care for Congenital Heart Disease (CHD) are available only in selected centres with geographical variations, it is important to detect Heart defects early and give the parents an opportunity to plan ahead for seeking appropriate care at the earliest. Several developments in recent years such as improvement of quality of ultrasound machines, sonographer's experience, skills and better description of cardiac views have contributed to improve detection rate. A retrospective study was done between March 2016 and December 2019, and showed ultrasound evidence of CHD was included. The total number of morphology scans done during study period was 50,435. The number of congenital anomalies detected was 1482, out of which CHD was detected in 334 (22.5%). Outcome of 50 pregnancies were not available while the rest (284) were available for follow up in post-natal period. There were 51 cases of CHD, missed on routine antenatal morphological screening, which were diagnosed in the post-natal period. There were 18 cases of over-diagnosed CHD on antenatal scan, but were found to have normal echo findings after birth. A systematic approach is crucial for practitioner to determine the patterns of associated defects. Use of step wise strategy helps in determining the correct diagnosis of isolated cardiac defect, associated with other system or a part of syndrome. Systematic audit of morphological scans could play an important role in improving the diagnostic accuracy, which in turn will lead to early detection.