Clinical Assessment Of Gestational Age Research Articles

Comparative Study of Gestational Age Using Mean Fetal Kidney Length and Other Sonographic Fetal Parameters in Singleton Pregnancy After 24 Weeks

Introduction: To accurately estimate the fetus age and follow up on the growth of different fetal organs, it is vital to know the accurate date of birth. It also helps to prevent prenatal and postnatal complications for the newborn. It is common for antenatal mothers to be unaware of last menstrual period (LMP). In such situations, it would be difficult to calculate the delivery date. According to various studies, up to 30% of women were not sure of their LMP. The treating obstetricians would have to be very careful when the exact LMP is unknown in order to prevent post maturity and prematurity deliveries. Material And Methods: The present study is prospective comparative study of Department of Obstetrics and Gynaecology in Guntur Medical College and Hospital, Andhra Pradesh, India. After 24 weeks of gestational age are included who are at age between 20-35 yrs which is of 200 sample size in the year 2020-21. Clinical assessment of gestational age was done by palpating the fundal height of the patient. Following this using ultrasound, meam fetal kidney length (FKL) along with other fetal parameters were calculated. Result: In the present study, BPD ranged from 28-40 wks, whereas the mean BPD was 35.25+2.67 HC ranged between 27-40 and the mean BPD was 35.35+2.88 MKL ranged between 27-41 and the mean MKL was 35.93+3.49. Upon the composite of multiple parameters GA ranged between 27.8-39.6 and the mean was 3.5.36+2.7. Conclusion: The FKL is very much useful in assessing the gestational age. From our study we state that there is a significant correlation between fatal kidney length and the gestational age. Hence fetal kidney is appropriate in estimation of gestational age.

Victor(iou)’s myologists: snapshots of a legacy

Victor(iou)’s myologists: snapshots of a legacy

Detection and risk stratification of women at high risk of preterm birth in rural communities near Nagpur, India

BackgroundPresently, preterm birth is globally the leading cause of neonatal mortality. Prompt community based identification of women at high risk for preterm births (HRPB) can either help to avert preterm births or avail effective interventions to reduce neonatal mortality due to preterm births. We evaluated the performance of a package to train community workers to detect the presence of signs or symptoms of HRPB.MethodsPregnant women enrolled in the intervention arm of a cluster randomized trial of Antenatal Corticosteroids (ACT Trial) conducted at Nagpur, India were informed about 4 directly observable signs and symptoms of preterm labor. Community health workers actively monitored these women from 24 to 36 weeks of gestation for these signs or symptoms. If they were present (HRPB positive) the identified women were brought to government health facilities for assessment and management. HRPB positive could also be determined by the provider if the woman presented directly to the facility. Risk stratification was based on the number of signs or symptoms present. The outcome of preterm birth was based on the clinical assessment of gestational age < 37 weeks at delivery or a birth weight of <2000 g.ResultsBetween July 1, 2012 and 30 November, 2013, 686 of 7050 (9.7%) pregnant women studied, delivered preterm. 732 (10.4%) women were HRPB positive, of whom 333 (45.5%) delivered preterm. Of the remaining 6318(89.6%) HRPB negative women 353 (5.6%) delivered preterm. The likelihood ratio (LR) of a preterm birth in the HRPB positives was 8.14 (95% confidence interval 7.16–9.26). The LR of a preterm birth increased in women who had more signs or symptoms of HRBP (p < 0.00001). More signs or symptoms of HRPB were also associated with a shorter time to delivery, lower birth weight and higher rates of stillbirths, neonatal deaths and postnatal complications. Addition of risk stratification improved the prediction of preterm delivery (Integrated Discrimination Improvement 17% (95% CI 15–19%)).ConclusionsThe package for detection of signs and symptoms of HRPB is feasible, promising and likely to improve management of preterm labor.Trial registrationNCT01073475 on February 21, 2010 and NCT01084096 on March 9, 2010.

201 Assessment of Gestational Age in Very Preterm Neonates Using Cerebellar Measurements at Cranial Ultrasound - What is the Best Approach?

Background and aims: Clinical assessment of gestational age (GA) can be challenging. Several ultrasound approaches to estimate GA using cerebellar measurements have been reported, claiming to be simpler and more accurate than clinical assessment. We compare the accuracy of 3 previously described cerebellar measurements for estimating the GA in VLBW infants. Methods: We studied prospectively VLBW infants under 32 weeks GA defined by certain dates, IVF date or early fetal ultrasound. We excluded infants with IUGR, neurological problems or scan abnormality except isolated GLH/transient flares. Ultrasound acquisition and cerebellar measurements were made by author AG. Measurements of the vermis anterior-posterior diameter (APD, Cuddihy 1999), transverse cerebellar diameter via anterior (TCDa, Makhoul 2000) and mastoid fontanelles (TCDm, Davies 2001) were obtained. Estimated GA was calculated using published equations, and compared to known GA using intraclass correlation coefficient (ICC). Results: We studied 60 infants. Mean birth GA was 28.4 weeks and mean postnatal age at scan was 1 week. ICC was 0.801 for APD, 0.123 for TCDa and 0.802 for TCDm (p< 0.001). Best estimates of GA were obtained with TCDm (difference SD 1 week) and APD (difference SD 1.3 weeks). Conclusions: APD and TCD gave good estimates of GA and can be recommended. We obtained similar measurements of TCD via the two approaches, but only the equation for the mastoid fontanelle gave a good estimate of GA with excellent ICC. Studies assessing the use of cerebellar measurements for estimating GA in growth restricted, neurologically abnormal and older infants are needed.

Measuring the Agreement Between two Methods to Assess Gestational Age: P060

Introduction: In clinical practice, a new method for gestational age assessment often can only be evaluated by comparing it with other established techniques (“gold standard”). Objective: To describe, through graphical techniques and simple statistical calculations, a way of evaluating the agreement between two methods for the clinical assessment of gestational age, and thereby to determine if they are exchangeable. Material and methods: This is an observational cohort study. Between 2000 and 2001, 137 women with pregnancies of less than 16 gestational weeks were prospectively enrolled at Maternidad Sardá of Buenos Aires. The last normal menstrual period (LNMP) and ultrasound scan (US) measurements were used to the estimate of the gestational age. Mean difference (d: FUM – US), standard deviation (sd), 95% confidence interval and average value between both methods were calculated for each case and plotted (“95% limits of agreement” [d + 2 sd]). Results: Mean gestational age at first ultrasound scan was 19.6 + 4.9 (95% CI 18.7 – 20.4) weeks. Concordance between both methods increased by 71.5% (63 - 78) at +/- 10 days to 82.5% (95% CI 75 - 87) at +/- 2 weeks. The mean difference was 0.35 + 1.89 (95% CI 0.03 – 0.67) weeks and the 95% limits of agreement showed that, regardless of the gestational age, the differences reached 7.5 weeks. Conclusions: The estimate of gestational age by the last normal menstrual period was higher than that by ultrasound scan in 25% of the cases and lower in 20%, suggesting that in the clinical practice these methods are not exchangeable.

Assessment of Gestational Age in the Cameroonian Newborn Infant: A Comparison of Four Scoring Methods

A clinical assessment of gestational age using four different methods was performed in the same population of 358 Cameroonian newborn infants with the aim of determining the most applicable in the local context. Method applicability was compared in terms of validity, accuracy, reliability, and ease of administration. The gestational age ranged from 25 to 44 weeks. The infants were evaluated within 72 h from birth, using the scoring methods of Farr (FSM), Dubowitz (DSM), Ballard (New Ballard Score--NBS) and Eregie (ESM). The DSM was the most valid with a 93 per cent agreement within +/-2 weeks of gestational age by dates followed by the ESM with 92.4 per cent. The NBS and the FSM showed lower validity of 85.6 per cent and 78.3 per cent respectively. The ESM was the most accurate with a mean difference (MD) in weeks (+/-1 SD) between gestational age by method and gestational age by dates of 0.259+/-1.376, followed by the NBS with 0.355+/-1.51. The DSM was fairly accurate with a MD of 0.500+/-1.31, and the FSM the least accurate with a MD of 1.228+/-1.495. The DSM was the most reliable with a high correlation coefficient (r) of 0.94. The NBS and the ESM had comparable reliability with correlation coefficient of 0.93 each. The easiest to administer was the ESM, completed in an average of 41 s, followed by the FSM in 1 min 22 s. The NBS was completed in 2 min 48 s and the DSM in 4 min 28 s. We concluded that the Eregie model has comparable validity and reliability to the Dubowitz score but is more accurate, simple, and very easy to administer. It is therefore recommended where the workload is heavy and health personnel limited, as is the case in developing countries.

Cerebellar vermis diameter at cranial sonography for assessing gestational age in low-birth-weight infants.

Clinical assessment of gestational age for very-low-birth-weight infants is often inaccurate. Survival rates are more dependent on gestational age than on the birth weight. To assess whether cerebellar vermis diameter might predict gestational age in infants under 2,000 g and/or under 32 weeks' gestation. We carried out a retrospective review of the hard-copy images of midline sagittal views of the cerebellum obtained at cranial sonography, performed via the anterior or posterior fontanelle, in 518 infants admitted to a regional neonatal intensive care unit between June 1991 and November 1996. The vermis diameter was measured from the base of the fourth ventricle to the junction of folium and tuber vermis. We generated regression equations for estimating gestational age from vermis diameter, and from vermis diameter and birth weight, for the 86 infants of known gestational age (less than 32 weeks), with birth weight under 2,000 g and who had scans carried out within 1 week of birth. Measurement of cerebellar vermis diameter alone allowed prediction of gestational age to +/- 1.53 weeks using a 68 % prediction interval, or +/- 3.0 weeks using a 95 % prediction interval. Gender was not significant in the regression analysis. Cerebellar vermis diameter predicts gestational age with slightly more precision than the new Ballard score.

Cerebellar vermis measurement at cranial sonography for assessing gestational age in the newborn weighing less than 2000 grams.

Prognosis of the very low birth weight infant depends more on gestational age than birth weight, but clinical assessment of gestational age of very low birth weight infants is inaccurate. We wished to determine how well cerebellar vermis dimensions might predict gestational age in infants of birth weight less than 2000 g. We obtained suitable midline sagittal images of the cerebellar vermis at cranial sonography, performed via the anterior or posterior fontanelle, in 41 infants, from the regional neonatal intensive care unit whose gestational age was known. We measured the cerebellar vermis area and diameter on the hard-copy image provided the margins of the vermis were clearly visible, the cerebellar tonsils were excluded from the image, and the anterior and posterior divisions of the corpus medullare were visible on the image. Vermis diameter was measured from the base of the fourth ventricle to the junction of folium and tuber vermis. Vermis area was calculated using a stereological method using a test system of regularly spaced points randomly placed over a magnified image of the cerebellar vermis. We generated regression equations for estimating gestational age using combinations of birth weight, vermis area, or vermis diameter for the 26 infants with birth weight of less than 2000 g for whom the cerebellar vermis measurements were obtained within one week of birth. Vermis area and diameter correlated very highly. They both can be used for predicting gestational age. The addition of either vermis area or diameter to birth weight improves accuracy of gestational age assessment. If birth weight was presumed to be unknown, cerebellar vermis area or diameter allow prediction of gestational age to within +/- 1.3 weeks (1 standard error) or +/- 2.5 weeks, using a 95% prediction interval. If the same method of reporting is applied to the New Ballard Score, the New Ballard Score predicts gestational age +/- 1.7 weeks (1 standard error) or +/- 3.4 weeks, using a 95% prediction interval.

Hemolysis of blood in intravenous tubing caused by heat

of vitamin K-dependent procoagulants are decreased, but the immunologically determined antigen concentration of these factors is unchanged. Consequently, the disparity between coagulant activity and antigen level (i.e., a low coagulant/ant igen ratio) indicates probable vitamin K deficiency. The abnormalities are usually corrected within a few hours after a parenterally administered dose of the vitamin. 9 In our patients, the antigen level of factor II did not change significantly during the study, which suggests an equal production of the protein precursor of factor II. Five to 7 days after a single parenteral dose of vitamin KI, evidence of vitamin K deficiency could be observed in preterm infants but not in term infants during T P N combined with antibiotic therapy. In other words, vitamin K deficiency developed earlier in preterm infants than in full-term infants, if the vitamin K sources were blocked. The mechanism of the earlier vitamin K deficiency in preterm infants is not known. Perhaps immaturi ty of the enzymes of the vitamin K cycle causes this phenomenon. Our observations indicate that preterm infants are endangered by vitamin K deficiency and need more frequent vitamin K prophylaxis than full-term infants require. R E F E R E N C E S 1. Corrigan JJ. The vitamin K dependent proteins. Adv Pediatr 1981;28:57. 2. Frick PG, Riedler G, Br6gly H. Dose response and minimal daily requirement for vitamin K in man. J Appl Physiol 1967;33:387. 3. Sann L, Leclercq M, Guillaumont M, Trouyez R, Bethenod M, Bonrgeay-Causse M. Serum vitamin Kj concentrations after oral administration of vitamin K~ in low birth weight infants. J PEDlATR 1985;107:608. 4. Shirahata A, Najiri T, Takarapi T, Horinchi T, Yamada K. Normotest screening and prophylactic oral administration for idiopathic vitamin K deficiency in infancy. Acta Haematol Jpn 1982;45:203. 5. Dubowitz L, Dubowitz V, Goldberg C. Clinical assessment of gestational age in the newborn infant. J PEDIATR 1970;77:1. 6. Merskey L, Kleiner GH, Johnson AJ. Quantitative estimation of split products of fibrinogen in human serum: relation to diagnosis and treatment. Blood 1966;28:1. 7. Breen FA, Tullis JI. Ethanol gelation: a rapid screening test for intravascular coagulation. Ann Intern Med 1968; 69:1197. 8. Mancini G, Carbonara AO, Hereman JF. Immunochemical quantitation of antigens by single radial immunodiffusion. Int J Immunochem 1965;2:235. 9. Lanne PA, Hathaway WE. Vitamin K in infancy. J PEDIATR 1985;106:351.

Use of physical and neurologic observations in assessment of gestational age in low birth weight infants

The relative validities of three clinical assessment methods for estimating gestational age in newborn low birth weight infants were evaluated with reference to estimates based on the date of the mother's last menstrual period. For 1246 infants in eight diverse institutions, estimates based on physical criteria correlated more strongly with dates estimates, yielded estimates more similar on average to dates estimates, and yielded higher proportions of correct classifications of prematurity and small for gestational age than did estimates based on neurologic criteria or neurologic and physical criteria combined. These results support the use of physical criteria rather than neurologic or combined criteria for the clinical assessment of gestational age in low birth weight infants. In a subsample of 511 black and white infants, there were no ethnic differences in mean error of estimate for any of the three methods.

The Neurological Assessment of the Preterm and Full-term Newborn Infant

The Dubowitzes have accomplished in this little book the same task they undertook with quantitating the estimate of gestational age in the newborn (Dubowitz LMS, Dubowitz V, Goldberg C: Clinical Assessment of Gestational Age, J Pediatr 1970;77:1-10). They have reviewed in this book the available data on neurologic examinations of newborns, compiled them into an orderly arrangement, tested them for interobserver accuracy and practicality, and given us their revised and finished product. The Dubowitzes' previous article on gestational age has been accepted as the gold standard for this procedure, and it would seem that this book might fulfill the same need for the neurologic examination of full-term and premature infants. However, the predictability of newborn neurologic examinations has been disappointing, at best. Even though the Dubowitzes have refined the tests, added allowances for premature infants, and given a few case histories that have been documented with computed tomographic (CT) scans

Clinical assessment of gestational age in the newborn infant. Comparison of two methods

A clinical assessment of gestational age was performed in a group of 92 newborn infants. The Dubowitz method (1970) based on 10 neurological and 11 ‘external’ criteria and the Finnström method (1977) based on 7 ‘external’ criteria have been applied. A comparison between these two methods showed a correct estimation of gestational age within ±2 weeks in 86.95% of cases with the Finnström method and in 80.72% of cases with the Dubowitz method. A correct estimation within ±3 weeks was found in more than 90% of the infants with both methods. No significant difference between the two methods was found. In about 10% of cases the Dubowitz method could not be applied because of the serious conditions of the infants. Assessment of gestational age with the Finnström method proves to be less stressful for the infant, less time consuming and feasible on a larger number of infants than the assessment with the Dubowitz method. For these reasons the Finnström method seems to be more advisable for clinical routine work.

A Synopsis of Children's Diseases

In the preface to the fifth edition, the authors express their intention that this synopsis of pediatrics should become a reference handbook for the general practitioner and pediatrician, and at the same time, it should meet the needs of undergraduate students. The authors have succeeded in their intention by presenting the traditional pediatric subjects in a precise, well-organized, at times, laconic manner. The sections on the healthy child, his growth and development, including the appendix on growth and development records, clinical assessment of gestational age of the newborn, and the use of stycar chart of developmental sequences are concisely and clearly written and should be of practical value not only for the novice but also for the experienced practitioner. Most sections on pediatric diseases have excellent, well-defined paragraphs on etiology, pathology, pathogenesis, epidemiology, and clinical presentation of disease entities. Several sections, however, appear to be deficient in coverage of rather

Clinical assessment of gestational age at birth: the effects of sex, birthweight, and weight for length of gestation

During studies on different aspects of fetal growth rate infants who were small-for-dates (SFD) large-for-dates (LFD) or within the normal range of birthweight for length of gestation (AFD) were examined within 48 h of birth. Gestational age was clinically assessed by the Dubowitz method. Among 140 AFD infants boys had higher mean values than girls for total and external scores, but there was no difference in neurological scores. Multiple regression of the score for external criteria on gestation, bithweight and sex, showed a significant contribution for birthweight and sex in addition to gestation; whereas gestation was the only significant explanatory variable in the regression of the score for neurological criteria. When infants in the three weight groups were matched for length of gestation and sex, the SFD group had significantly lower mean total and external scores than the AFD group. The mean scores for the LFD group were not significantly higher than the AFD group. The neurological scores did not differ in the three groups. Maturation of external characteristics is related to weight as well as gestation. When assessment is made after birth by a clinical examination which includes these characteristics, the length of gestation of some SFD infants will be underestimated. The sex of the infant should also be borne in mind.

Clinical Assessment of Gestational Age

There is disagreement among authors as to what criteria are most reliable in assessing postnatal fetal age. A comparison–for objectivity, accuracy, and frequency of use– of specific criteria was made using three independent examiners at different educational levels: a second‐year medical student, a perinatal nurse practitioner, and a pediatrics resident. It was shown that trained examiners develop favorite criteria which differ among examiners and thus sacrifice accuracy; however, accurate assessment of fetal age can be accomplished by an examiner with minimum clinical knowledge.

Clinical assessment of gestational age in the neonate.

Clinical assessment of gestational age in the neonate.

Fetal maturity: Amniotic fluid analysis correlated with neonatal assessment

The birth weights and gestational age assessments, in weeks of neonates have been compared with the creatinine level and the percentage of orange-staining cells in the amniotic fluid. In an attempt to verify the accuracy of these tests, two groups were analyzed, the first with the use of the last normal menstrual period as obtained by maternal history and the second with the use of the clinical assessment of the neonate within 24 hours of birth. Correlation was also carried out with birth weight. The accuracy of creatinine concentration and orange-staining cells is not disturbed in high-risk pregnancies. The creatinine level is more accurate for both gestational age and baby weight than the percentage of orange-staining cells. When the gestational age is around 36 weeks, creatinine values are reliable; if the gestational age is 38 weeks or more, the orange-staining cell count is more accurate. The clinical assessment of gestational age is very accurate and helpful. It improves the results obtained by correlation of the gestational age with the percentage of orange-staining cells.

Clinical assessment of gestational age in the newborn infant

A scoring system for gestational age, based on 10 neurologic and 11 “external” criteria, has been applied to 167 newborn infants. The “external” score gave a better correlation with gestation than did the neurologic score, but the combined total score was better than either alone. The correlation coefficient for the total score against gestation was 0.93. The error of prediction of a single score was 1.02 weeks and of the average of two independent assessments was 0.7 weeks. The method gives consistent results within the first 5 days and is equally reliable in the first 24 hours of life. This scoring system is more objective and reproducible than trying to guess gestational age on the presence or absence of individual signs.