Date Of Last Menstrual Period Research Articles

Prescription medication use during pregnancy in the United States from 2011 to 2020: trends and safety evidence.

Medication use during pregnancy has increased in the United States despite the lack of safety data for many medications. This study aimed to inform research priorities by examining trends in medication use during pregnancy and identifying gaps in safety information on the most commonly prescribed medications. We identified population-based cohorts of commercially (MarketScan 2011-2020) and publicly (Medicaid Analytic eXtract/Transformed Medicaid Statistical Information System Analytic Files 2011-2018) insured pregnancies ending in live birth from 2 health care utilization databases. Medication use was based on filled prescriptions between the date of last menstrual period through delivery, as well as the period before the last menstrual period and during specific trimesters. We also included a cross-sectional representative sample of pregnancies ascertained by the National Health and Nutrition Examination Survey (2011-2020), with information on prescription medication use during the preceding month obtained through maternal interviews. Teratogen Information System was used to classify the available evidence on teratogenic risk. Among over 3 million pregnancies, the medications most commonly dispensed at any time during pregnancy were analgesics, antibiotics, and antiemetics. The top medications were ondansetron (16.8%), amoxicillin (13.5%), and azithromycin (12.4%) in MarketScan, nitrofurantoin (22.2%), acetaminophen (21.3%; mostly as part of acetaminophen-hydrocodone products), and ondansetron (19.5%) in Medicaid Analytic eXtract/Transformed Medicaid Statistical Information System Analytic Files, and levothyroxine (5.0%), sertraline (2.9%), and insulin (2.9%) in the National Health and Nutrition Examination Survey group. The most commonly dispensed suspected teratogens during the first trimester were antithyroid medications. The use of antidiabetic and psychotropic medications has continued to increase in the United States during the last decade, opioid dispensation has decreased by half, and antibiotics and antiemetics continue to be common. For one-quarter of medications, there is insufficient evidence available to characterize their safety profile in pregnancy. There is a need for more drug research in pregnant patients. Future research should focus on anti-infectives with high utilization and limited level of evidence on safety for use during pregnancy. Although lack of evidence is not evidence of safety concerns, it does not indicate risk either. In many instances, the benefits outweigh the risks when these medications are used clinically, and some of the medications with no proven safety may be necessary to treat patients.

Correcting for measurement error in assessing gestational age in a low-resource setting: a regression calibration approach.

Measurement error in gestational age (GA) may bias the association of GA with a health outcome. Ultrasound-based GA is considered the gold standard and is not readily available in low-resource settings. We corrected for measurement error in GA based on fundal height (FH) and date of last menstrual period (LMP) using ultrasound from the sub-cohort and adjusted for the bias in associating GA with neonatal mortality and low birth weight (< 2,500 grams, LBW). We used data collected from 01/2015 to 09/2019 from pregnant women enrolled at two public hospitals in Siaya county, Kenya (N = 2,750). We used regression calibration to correct for measurement error in FH- and LMP-based GA accounting for maternal and child characteristics. We applied logistic regression to associate GA with neonatal mortality and low birth weight, with and without calibrating FH- and LMP-based GA. Calibration improved the precision of LMP (correlation coefficient, from 0.48 to 0.57) and FH-based GA ( from 0.82 to 0.83). Calibrating FH/LMP-based GA eliminated the bias in the mean GA estimates. The log odds ratio that quantifies the association of GA with neonatal mortality increased by 29% (from -0.159 to -0.205) by calibrating FH-based GA and by more than twofold (from -0.158 to -0.471) by calibrating LMP-based GA. Calibrating FH/LMP-based GA improved the accuracy and precision of GA estimates and strengthened the association of GA with neonatal mortality/LBW. When assessing GA, neonatal public health and clinical interventions may benefit from calibration modeling in settings where ultrasound may not be fully available.

Can the date of last menstrual period be trusted in the first trimester? Comparisons of gestational age measures from a prospective cohort study in six low-income to middle-income countries

ObjectivesWe examined gestational age (GA) estimates for live and still births, and prematurity rates based on last menstrual period (LMP) compared with ultrasonography (USG) among pregnant women at seven sites...

Utilidad de la medición de la longitud del sacro fetal como parámetro predictor de la edad gestacional

Objective: To establish the usefulness of fetal sacral length measurement for the prediction of gestational age. Methods: A longitudinal and prospective study was conducted between January 2016 and December 2022 in women with low-risk singleton pregnancies, between 14 and 40 weeks of gestation, who attended prenatal consultation at the Central Hospital “Dr. Urquinaona”, Maracaibo. Biparietal diameter, abdominal circumference, femur length, and fetal sacrum length were measured during pregnancy. Results: For the final analysis, data from 215 healthy women was selected. A total of 3,033 total evaluations were performed, with the lowest number of evaluations at 38 weeks with 104 and the highest number of 139 at 22 weeks. When analyzing the correlation between sacral length and gestational age by date of last menstrual period and the rest of the ultrasound variables used, strong, positive, and significant correlations were found (p &lt; 0.0001). The average difference between the gestational age determined by the date of the last menstrual period and that obtained by the model was +/- 0.3 weeks. The value of the coefficient of determination of the model of gestational age predicted by measurement was 0.975. When combining the four ultrasound parameters studied in the resulting model, it was 0.990. Conclusion: Measurement of fetal sacral length by ultrasonography is useful for predicting gestational age with high precision.

Postpartum Depression in Reproductive-Age Women With and Without Rheumatic Disease: A Population-Based Matched Cohort Study.

To examine postpartum depression (PPD) among women with axial spondyloarthritis (axSpA), psoriatic arthritis (PsA), or rheumatoid arthritis (RA) in comparison with a matched population without rheumatic disease (RD). A retrospective analysis using the 2013-2018 IBM MarketScan Commercial Claims and Encounters Database was conducted. Pregnant women with axSpA, PsA, or RA were identified, and the delivery date was used as the index date. We restricted the sample to women ≤ 55 years with continuous enrollment ≥ 6 months before date of last menstrual period and throughout pregnancy. Each patient was matched with 4 individuals without RD on: (1) maternal age at delivery, (2) prior history of depression, and (3) duration of depression before delivery. Cox frailty proportional hazards models estimated the crude and adjusted hazard ratios (aHR) and 95% CI of incident postpartum depression within 1 year among women with axSpA, PsA, or RA (axSpA/PsA/RA cohort) compared to the matched non-RD comparison group. Overall, 2667 women with axSpA, PsA, or RA and 10,668 patients without any RD were included. The median follow-up time in days was 256 (IQR 93-366) and 265 (IQR 99-366) for the axSpA/PsA/RA cohort and matched non-RD comparison group, respectively. Development of PPD was more common in the axSpA/PsA/RA cohort relative to the matched non-RD comparison group (axSpA/PsA/RA cohort: 17.2%; matched non-RD comparison group: 12.8%; aHR 1.22, 95% CI 1.09-1.36). Postpartum depression is significantly higher in women of reproductive age with axSpA/PsA/RA when compared to those without RD.

Identification of pregnancies and their outcomes in healthcare claims data, 2008-2019: An algorithm.

Pregnancy is a condition of broad interest across many medical and health services research domains, but one not easily identified in healthcare claims data. Our objective was to establish an algorithm to identify pregnant women and their pregnancies in claims data. We identified pregnancy-related diagnosis, procedure, and diagnosis-related group codes, accounting for the transition to International Statistical Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) diagnosis and procedure codes, in health encounter reporting on 10/1/2015. We selected women in Merative MarketScan commercial databases aged 15-49 years with pregnancy-related claims, and their infants, during 2008-2019. Pregnancies, pregnancy outcomes, and gestational ages were assigned using the constellation of service dates, code types, pregnancy outcomes, and linkage to infant records. We describe pregnancy outcomes and gestational ages, as well as maternal age, census region, and health plan type. In a sensitivity analysis, we compared our algorithm-assigned date of last menstrual period (LMP) to fertility procedure-based LMP (date of procedure + 14 days) among women with embryo transfer or insemination procedures. Among 5,812,699 identified pregnancies, most (77.9%) were livebirths, followed by spontaneous abortions (16.2%); 3,274,353 (72.2%) livebirths could be linked to infants. Most pregnancies were among women 25-34 years (59.1%), living in the South (39.1%) and Midwest (22.4%), with large employer-sponsored insurance (52.0%). Outcome distributions were similar across ICD-9 and ICD-10 eras, with some variation in gestational age distribution observed. Sensitivity analyses supported our algorithm's framework; algorithm- and fertility procedure-derived LMP estimates were within a week of each other (mean difference: -4 days [IQR: -13 to 6 days]; n = 107,870). We have developed an algorithm to identify pregnancies, their gestational age, and outcomes, across ICD-9 and ICD-10 eras using administrative data. This algorithm may be useful to reproductive health researchers investigating a broad range of pregnancy and infant outcomes.

Contribution of Fetal MRI in the Antenatal Diagnosis of Alobar Holoprosencephaly: A Case Report

Introduction: Holoprosencephaly is a rare cerebral malformation, of multiple etiologies and often associated with other malformations, particularly facial. It results from a defect in the early development of the prosencephalon. The fetal prognosis is extremely poor, especially in the alobar form. Objective: The aim of this work is to illustrate through this observation the contribution of fetal MRI in the antenatal diagnosis of this rare and serious pathology. Case Report: We report the case of a 26-year-old primigravida and primiparous parturient referred for suspected agenesis of the vermis and corpus callosum following a first ultrasound performed in the third trimester of pregnancy. The pregnancy was not followed up and the date of last menstrual period was unknown. A fetal MRI was performed showing: A mono-fetal pregnancy in cephalic presentation with fundial placenta, A single ventricle with posterior cystic expansion and laminated aspect of the cerebral parenchyma at the frontal level, A bilateral pyelo ureteral junction syndrome. Conclusion: Alobar holoprosencephaly is a rare and fatal pathology with a great etiological heterogeneity. It can be part of a polymalformative syndrome. It results from a cleavage anomaly of the prosencephalon into cerebral hemispheres. The antenatal diagnosis is based on obstetrical ultrasound completed by fetal MRI allowing an exhaustive lesion assessment of this pathology with an extremely reserved prognosis.

Accuracy of Self-assessment of Gestational Duration Among Adolescents Seeking Abortion Using Information in Addition to Date of Last Menstrual Period

This diagnostic study evaluates whether using additional information beyond the date of last menstrual period is associated with improved accuracy of self-assessed gestational duration among adolescents seeking abortion.

Antenatal multiple micronutrient supplements versus iron-folic acid supplements and birth outcomes: Analysis by gestational age assessment method.

Meta-analyses consistently have found that antenatal multiple micronutrient supplementation (MMS) compared with iron and folic acid (IFA) alone reduce adverse birth outcomes. In 2020, the World Health Organization (WHO) placed a conditional recommendation for MMS and requested additional trials using ultrasounds to establish gestational age, because the evidence on low birthweight (LBW), preterm birth and small for gestational age(SGA) was considered inconsistent. We conducted meta-analyses to determine if the effects of MMS on LBW, preterm birthand SGA differed by gestational age assessment method. Using data from the 16 trials in the WHO analyses, we calculated the effect estimates of MMS versus IFA on birth outcomes (generic inverse variance method and random effects model) stratified by method of gestational age assessment: ultrasound, prospective collection of the date of last menstrual period (LMP) and confirmation of pregnancy by urine testand recall of LMP. The effects of MMS versus IFA on birthweight, preterm birthand SGA appeared consistent across subgroups with no evidence of subgroup differences (p > 0.05). When limited to the seven trials that used ultrasound, the beneficial effects of MMS were demonstrated: risk ratiosof 0.87 (95% confidence interval [CI] 0.78-0.97) for LBW, 0.90 (95% CI, 0.79-1.03) for preterm birth and 0.9 (95% CI, 0.83-0.99) for SGA. Sensitivity analyses indicated consistency in the results. These results, together with recent analyses demonstrating comparable effects of MMS (vs. IFA) on maternal anaemia outcomes, strengthen the evidence to support a transition from IFA to MMS programmes in low- and middle-income countries.

Development and Validation of ICD-10-CM-based Algorithms for Date of Last Menstrual Period, Pregnancy Outcomes, and Infant Outcomes.

Validation studies of algorithms for pregnancy outcomes based on International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes are important for conducting drug safety research using administrative claims databases. To facilitate the conduct of pregnancy safety studies, this exploratory study aimed to develop and validate ICD-10-CM-based claims algorithms for date of last menstrual period (LMP) and pregnancy outcomes using medical records. Using a mother-infant-linked claims database, the study included women with a pregnancy between 2016-2017 and their infants. Claims-based algorithms for LMP date utilized codes for gestational age (Z3A codes). The primary outcomes were major congenital malformations (MCMs) and spontaneous abortion; additional secondary outcomes were also evaluated. Each pregnancy outcome was identified using a claims-based simple algorithm, defined as presence of ≥ 1 claim for the outcome. Positive predictive values (PPV) and 95% confidence intervals (CI) were calculated. Overall, 586 medical records were sought and 365 (62.3%) were adjudicated, including 125 records each for MCMs and spontaneous abortion. Last menstrual period date was validated among maternal charts procured for pregnancy outcomes and fewer charts were adjudicated for the secondary outcomes. The median difference in days between LMP date based on Z3A codes and adjudicated LMP date was 4.0 (interquartile range: 2.0-10.0). The PPV of the simple algorithm for spontaneous abortion was 84.7% (95% CI 78.3, 91.2). The PPV for the MCM algorithm was < 70%. The algorithms for the secondary outcomes pre-eclampsia, premature delivery, and low birthweight performed well, with PPVs > 70%. The ICD-10-CM claims-based algorithm for spontaneous abortion performed well and may be used in pregnancy studies. Further algorithm refinement for MCMs is needed. The algorithms for LMP date and the secondary outcomes would benefit from additional validation in a larger sample.

Accuracy of Trans-Cerebellar Diameter and Placental Thickness in Third Trimesteric Pregnant Women for Calculation of Gestational Age: A Cross Sectional Study

Background: Accurate determination of gestational age has become important for deciding the appropriate time for termination of the pregnancy as well as to monitor the fetal growth during the entire period of pregnancy. Objective: The aim of the study was to assess whether the trans-cerebellar diameter, placental thickness or combining both of them is more accurate for assessment of gestational age in the 3rd trimester of pregnancy. Patients and Methods: This is a cross sectional study conducted at outpatient Clinic and Obstetric ward, Ain Shams University Maternity Hospital, over a period of six months from March 2019 to September 2019. One hundred pregnant women were recruited according to inclusion criteria either from outpatient clinic or were admitted in obstetric ward Ain Shams Maternity Hospital to find out the most accurate fetal biometric measurement in the third trimester either trans-cerebellar diameter placental thickness or both compared to reliable LMP (last menstrual period) dates confirmed by crown rump length (CRL) in the first trimester. Results: Trans-cerebellar diameter mean ± SD was 46.0 ± 3.5 with range 38.2 - 51.7. The mean of placental thickness was 39.6 ± 7.1 with range 22.8 - 54.3. Placental thickness had highest determination (0.813) for last menstrual period followed by trans-cerebellar diameter (0.802). Combining trans-cerebellar diameter and placental thickness increased determination (0.902) for last menstrual period. Conclusion: Combined use of trans-cerebellar diameter and placental thickness in the third trimester of pregnancy is a reliable indicator for gestational age in women whose last menstrual period is unreliable or unknown, but placental thickness had higher accuracy than trans-cerebellar diameter.

IMPACT OF CONTINUOUS MATERNAL ENROLLMENT ON STILLBIRTH GESTATIONAL AGE DISTRIBUTIONS AND MATERNAL CHARACTERISTICS AMONG MEDICAID ENROLLEES.

Stillbirths are defined as intrauterine fetal deaths occurring at ≥20 weeks of gestation. While uncommon (1), late pregnancy loss is tragic and therefore an important focus for research. The Medicaid program covers health care for nearly half of all US pregnancies (2), and Medicaid administrative claims provide an important data source for pregnancy studies. Typically, maternal enrollment from the date of the last menstrual period (LMP) onward is required in order to capture fetal exposures incurred during early gestation. However, because of Medicaid eligibility restrictions focusing on low-income families, qualified pregnant persons and children, and individuals with disabilities (3), a sizable proportion of women become eligible for Medicaid only after their pregnancy is recognized, while those already enrolled before the LMP date are likely to already have children and to qualify under the low-income family criterion or due to disability. Thus, selection of pregnancies on the basis of time of Medicaid enrollment (before or after LMP) results in different populations of women and potentially different risk levels for adverse pregnancy outcomes. Because the date of LMP is not directly recorded in Medicaid claims data and LMP estimation for stillbirth based on claims has been elusive, enrollment requirements imposed to ensure complete claims records for a desired look-back period are typically based on a fixed gestational age (e.g., 20 weeks or 45 weeks as a minimum or maximum gestational age of stillbirth). It is unknown how imposing different enrollment requirements affects the selection of stillbirths in the Medicaid population.

P007Accuracy of self-assessment of pregnancy duration eligibility for medication abortion among young people: The advantages of expanding screening questions beyond date of last menstrual period

<h3>Objectives</h3> We examine young people's accuracy of self-assessment of gestational duration using an expanded set of screening questions beyond date of last menstrual period (LMP). <h3>Methods</h3> From October 2019 to March 2020, we surveyed patients seeking abortion at seven facilities and compared their self-assessments of gestational duration with measurement on ultrasound. Screening questions included estimated date of LMP, date they got pregnant and number of weeks pregnant. Using the 70-day threshold for medication abortion, we defined accuracy as area under the receiving operating curve (AUC) and compared AUC values between adolescents (aged 15–19, n=111) and young adults (aged 20–24, n=331) using Sidak-adjusted p-values. <h3>Results</h3> Non-response to the LMP date question was somewhat higher among adolescents (24.6%) vs. young adults (17.6, p=0.11). Accuracy (AUC) was similar for adolescents (0.80, 95% CI, 0.73–0.87) and young adults (0.82, 95% CI, 0.78–0.87) (p=0.55) using LMP date alone and assuming ineligibility for medication abortion (>70 days' gestation) if no LMP date was provided. Accuracy increased significantly, particularly among adolescents, when additional screening questions were utilized when LMP was missing. Adding the date they got pregnant marginally improved AUC to 0.83 (95% CI, 0.75–0.81) for adolescents (p=0.35). Adding number of weeks pregnant improved AUC for adolescents (0.86, 95% CI, 0.78–0.93) and young adults (0.86, 95% CI, 0.81–0.90) at p<0.10. <h3>Conclusions</h3> Young people are as accurate as young adults in dating pregnancy duration, particularly with screening questions beyond date of LMP. Young people should be offered expanded models of medication abortion care including no-test and telehealth options.

Kliniğimizde Tedavi Edilen Tubal Ektopik Gebelik Olgularında Hemoperitonyumun Önemi ve Retrospektif Analizi

Aim: The purpose of this study is to present the importance of hemoperitoneum and retrospective analysis of tubal ectopic pregnancy cases treated in our clinic.&#x0D; Material and Methods: This study respectively included 86 women who were diagnosed and treated for tubal ectopic pregnancy (EP) in our single-centre clinic between January 2012 and August 2013. Age, date of last menstrual period, human chorionic gonadotropin (β-hCG) level, the size and the presence of tubal EP masses, fetal cardiac activity and treatment procedures were evaluated and compared. The presence of hemoperitoneum for predictive treatment methods and factors that affecting the success of treatment methods were investigated.&#x0D; Results: The mean age of the patients was 29.1±5.7 (16-41) years. Mean β-hCG level was 4448,5±8351,9 IU/L. Laparatomy was performed to 14 patients (16.3%), laparoscopy to 5 patients (5.8%), expectant management to 15 patients (17.4%). Methotrexate (MTX) treatment was given to 46 patients (53.5%) and laparoscopy was performed to 1 patient (1.2%) and laparatomy to 5 patients (5.8%) due to MTX treatment failure in 6 patients. Compared with the MTX treatment of tubal EP, the possible factors that affecting surgical management, such as the initial β-hCG level (p=0.004), whether there is hemorrhage in the abdominal cavity (p=0.03), the size of ectopic pregnancy mass (p=.005) and the presence of fetal heart activity (p

Association between SARS-CoV-2 infection during pregnancy and postpartum depressive and anxiety symptoms: finding from the International Registry of Coronavirus Exposure in Pregnancy (IRCEP) study.

While there has been concern over the perinatal mental health implications of the COVID-19 outbreak, evidence on the risk of postpartum depression and anxiety following SARS-CoV-2 infection is limited. We studied this question using the International Registry of Coronavirus Exposure in Pregnancy, which included both a prospective and retrospective cohort. Study participants were required to have been tested for SARS-CoV-2 between the date of last menstrual period and delivery. The exposure of interest was SARS-CoV-2 infection during pregnancy, as well as COVID-19 severity (severe, moderate, mild, and asymptomatic). The outcome was postpartum depression and anxiety symptoms, assessed by the 4-item Patient Health Questionnaire. The final analytic cohort consisted of 3819 participants (COVID-19 positive: 771; COVID-19 negative: 3048). After adjusting for confounding by socio-demographics, prior obstetric and maternal health comorbidities, mothers with severe COVID-19 had an increased risk of depressive (aRR: 1.72; 95%CI: 1.18–2.52) and anxiety (aRR: 1.40; 0.98–2.00) symptoms. The strength of the association was attenuated for women with moderate COVID-19 (aRR = 1.12; 0.86–1.44 for depressive symptoms; aRR = 1.18; 0.96–1.44 for anxiety symptoms). No increased risk was observed for mild or asymptomatic illness. The findings can inform targeted interventions to minimize the risk of adverse COVID-19-related mental health outcomes for pregnant women.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00737-022-01274-0.

Discrepancy Rate and Associated Factors of Gestational Age Determination by Last Menstrual Period Compared with First-Trimester Ultrasound in Certain Menstrual Period Pregnant Women

Objective: To assess discrepancy rate and associated factors of gestational age (GA) determination by last menstrual period (LMP) compared with first-trimester ultrasound in certain menstrual period pregnant women.0 Materials and Methods: The present study was a cross-sectional study that was conducted at Srinagarind Hospital, Khon Kaen University, Thailand between May 2020 and January 2021. Participants were singleton pregnant women who reported certain LMP dates. GA was estimated using Naegele’s rule and crown-rump length (CRL) measurement. Differences of GA more than five days at GA of 8 or fewer⁶/⁷ weeks and more than seven days at GA of nine⁰/⁷ to twelve⁶/⁷ weeks were considered discrepant. Factors associated with discrepancy were determined by calculating an odds ratio (OR) with a 95% confidence interval (CI). Results: Of the 220 participants, 67 had discrepant GA obtained from LMP and CRL measures, accounting for a rate of 30.5% (95% CI 24.4% to 36.9%). Factors associated with increased risk of discrepant GA consisted of low household income (adjusted OR 2.76; 95% CI 1.43 to 5.31) and long intervals of the menstrual cycle (adjusted OR 3.85; 95% CI 1.85 to 8.02). Conclusion: Approximately one-third of participants in the present study had a discrepancy of LMP and early ultrasound-based GA measures. Factors influencing the risk of discrepant GA between these two methods included household income and interval of menstruation. Keywords: Gestational age; Last menstrual period; First-trimester ultrasound; Discrepancy

Assessment of Gestational Age among Bangladeshi New Born Infant by New Ballard Score

Background: Assessment of gestational age is important in clinical practice to identify infants at risk for morbidity and mortality related to their gestational age. Globally, LMP date is uncertain or unknown in 20% of pregnant women. In most developing countries, the majority of women are uncertain about LMP and are more likely to be late attendees for prenatal care. In Bangladesh, assessment of gestational age by using NBS, has not been evaluated. Aim: The aim of the study was to validate New Ballard Score (NBS) for assessment of gestational age among Bangladeshi newborns. Methodology: This descriptive cross-sectional study was conducted in the Department of Paediatrics and in the Department of Gynaecology &amp; Obstetrics, Dhaka Medical College Hospital, from January 2014 to June 2014. A total of 100 newborns of both sexes (whose mothers provided exact history of last menstrual period (LMP) and confirmed by prenatal ultrasonography) were included in the study. Prenatal ultrasonography was performed in 17 + 10 weeks (mean + SD) of gestation. Informed consent was taken from all the mothers. Gestational age of the babies was determined on the basis of New Ballard Score. Confirmed gestational age• • by Last Menstrual Period (C-GLMP) was defined as gestational age by Last Menstrual Period confirmed by agreement within two weeks with gestational age by prenatal ultrasonography. The study included assessment of gestational age of newborns by New Ballard Score (NBS), by menstrual history &amp; assessment of confirmed gestational age by menstrual history and by prenatal ultrasonography. Comparison was made between assessed gestational age by NBS and confirmed gestational age by (both LMP and USG) in cases of both preterm and term newborns. Assessed gestational age by NBS and assessed gestational age by menstrual history were also compared with gestational age assessed by USG. Results: The mean (±SD) age of babies examined were 29.6 (±15.2) hr and range 0.5-94 hr. Out of 100 .....

Study on Compliance with Radiation Protection Rules in the Medical Imaging Department of Pr Bocar Sidy Sall Hospital of Kati (Mali)

Objective: Evaluate the level of compliance with radiation protection rules in the medical imaging department of the University Hospital Center (CHU) of Kati. Methodology: This was a cross-sectional and descriptive study carried out in the medical imaging department of Pr Bocar Sidy Sall (BSS) Hospital of Kati. A questionnaire was developed and sent to the staff of the medical imaging department. The assessment focused on the radiation protection of personnel, radiation protection measures for patients, the delimitation and signage of zoning as well as the application of radiation protection principles. Results: Twenty-one people participated in the study, 90% of whom were men. The 30 - 39 age group was predominant with 61.90%. 33.33% of the staff knew the principles of radiation protection; 86% of our sample knew the basic rules of radiation protection. The majority of the staff in the imaging department (61.90%) had a perfect knowledge of protective equipment. For 76% of our workforce, the limits of the radiation doses received are regulated in Mali. 76% of those surveyed have not taken any additional training in radiation protection. The doors are closed during the X-ray examination for 76.19% of the respondents and 95% of the staff put themselves behind the sealed screen during the examination. For 81% of the respondents, the design of the premises met radiation protection standards. 62% of practitioners have a dosimeter and 80% of them wear it during their shift. For 62% of our sample, the change of the dosimeter is quarterly. The systematic request for DDR (date of last menstrual period) in women and the adaptation of the delivered dose to the patient’s morphology was only carried out by 65% of practitioners. The majority of staff (81%) did not benefit from medical surveillance, while for 55% of respondents the level of radiation protection in the establishment was average. Conclusion: This study enabled us to highlight the shortcomings in terms of radiation protection within the imaging department of the CHU Kati.

Accuracy of self-assessment of gestational duration among people seeking abortion

Mifepristone, used together with misoprostol, is approved by the United States Food and Drug Administration for medication abortion through 10 weeks' gestation. Although in-person ultrasound is frequently used to establish medication abortion eligibility, previous research demonstrates that people seeking abortion early in pregnancy can accurately self-assess gestational duration using the date of their last menstrual period. In this study, we establish the screening performance of a broader set of questions for self-assessment of gestational duration among a sample of people seeking abortion at a wide range of gestations. We surveyed patients seeking abortion at 7 facilities before ultrasound and compared self-assessments of gestational duration using 11 pregnancy dating questions with measurements on ultrasound. For individual pregnancy dating questions and combined questions, we established screening performance focusing on metrics of diagnostic accuracy, defined as the area under the receiver operating characteristic curve, sensitivity (or the proportion of ineligible participants who correctly screened as ineligible for medication abortion), and proportion of false negatives (ie, the proportion of all participants who erroneously screened as eligible for medication abortion). We tested for differences in sensitivity across individual and combined questions using McNemar's test, and for differences in accuracy using the area under the receiver operating curve and Sidak adjusted P values. One-quarter (25%) of 1089 participants had a gestational duration of >70 days on ultrasound. Using the date of last menstrual period alone demonstrated 83.5% sensitivity (95% confidence interval, 78.4-87.9) in identifying participants with gestational durations of >70 days on ultrasound, with an area under the receiver operating characteristic curve of 0.82 (95% confidence interval, 0.79-0.85) and a proportion of false negatives of 4.0%. A composite measure of responses to questions on number of weeks pregnant, date of last menstrual period, and date they got pregnant demonstrated 89.1% sensitivity (95% confidence interval, 84.7-92.6) and an area under the receiver operating curve of 0.86 (95% confidence interval, 0.83-0.88), with 2.7% of false negatives. A simpler question set focused on being >10 weeks or >2 months pregnant or having missed 2 or more periods had comparable sensitivity (90.7%; 95% confidence interval, 86.6-93.9) and proportion of false negatives (2.3%), but with a slightly lower area under the receiver operating curve (0.82; 95% confidence interval, 0.79-0.84). In a sample representative of people seeking abortion nationally, broadening the screening questions for assessing gestational duration beyond the date of the last menstrual period resulted in improved accuracy and sensitivity of self-assessment at the 70-day threshold for medication abortion. Ultrasound assessment for medication abortion maynot be necessary, especially when requiring ultrasound could increase COVID-19 risk or healthcare costs, restrict access, or limit patient choice.

Use of sildenafil and other phosphodiesterase type 5 inhibitors among pregnant women in Scandinavia

For phosphodiesterase type 5 (PDE5) inhibitors, such as sildenafil, the only approved indication in women is for pulmonary arterial hypertension. These drugs are increasingly being proposed and tested for treatment of female infertility and complications in pregnancy. However, the extent of use of PDE5 inhibitors in the general pregnant population over the last decades is unknown. Therefore, we conducted a descriptive cohort study using data from the population health registers in the Scandinavian countries. By linking the Medical Birth Registers and the Prescribed Drug Registers in Denmark (1997-2017), Norway (2004-2017), and Sweden (2006-2016), women with filled prescriptions of PDE5 inhibitors in outpatient settings in the 90days before the date of last menstrual period and/or during pregnancies were identified. With additional linkage to the National Patient Registers, information on maternal, pregnancy, and infant characteristics, co-morbidities, and co-medication was collected and described. Among over 3million singleton pregnancies, only 77 were pregnancies in women who had at least one filled prescription of a PDE5 inhibitor within the 90days before the start of pregnancy to delivery. Prescription fills most often occurred before the last menstrual period and in the first trimester, with very few occurring later in pregnancy. Sildenafil was the most used PDE5 inhibitor. Among pregnant women using PDE5 inhibitors, 44% were 35years of age or older, eight had a cardiovascular diagnosis, and three specifically had a diagnosis of pulmonary arterial hypertension. Among the infants born to mothers using PDE5 inhibitors, nine were born preterm, six were small-for-gestational age, five had an Apgar score at 5minutes below 8, 18 were admitted to the Neonatal Intensive Care Unit, and eight had respiratory and cardiovascular conditions. Few women used PDE5 inhibitors in outpatient settings before or during pregnancy in the Scandinavian countries in the last decades. Only a small proportion had a diagnosis for pulmonary arterial hypertension, suggesting off-label use in the remaining users. Use was predominantly in mothers over age 35years. The safety of fetal exposure to sildenafil and other PDE5 inhibitors in pregnancy has not been established. As maternal age continues to increase and additional uses of PDE5 inhibitors are investigated, the safety of these drugs in pregnancy should be thoroughly evaluated.