Day Of Last Menstrual Period Research Articles

Metformin Use in the First Trimester of Pregnancy and Risk for Nonlive Birth and Congenital Malformations: Emulating a Target Trial Using Real-World Data.

Metformin is a first-line pharmacotherapy for type 2 diabetes, but there is limited evidence about its safety in early pregnancy. To evaluate the teratogenicity of metformin use in the first trimester of pregnancy. In an observational cohort of pregnant women with pregestational type 2 diabetes receiving metformin monotherapy before the last menstrual period (LMP), a target trial with 2 treatment strategies was emulated: insulin monotherapy (discontinue metformin treatment and initiate insulin within 90 days of LMP) or insulin plus metformin (continue metformin and initiate insulin within 90 days of LMP). U.S. Medicaid health care administration database (2000 to 2018). 12 489 pregnant women who met the eligibility criteria. The risk and risk ratio of nonlive births, live births with congenital malformations, and congenital malformations among live births were estimated using standardization to adjust for covariates. A total of 850 women were in the insulin monotherapy group and 1557 in the insulin plus metformin group. The estimated risk for nonlive birth was 32.7% under insulin monotherapy (reference) and 34.3% under insulin plus metformin (risk ratio, 1.02 [95% CI, 1.01 to 1.04]). The estimated risk for live birth with congenital malformations was 8.0% (CI, 5.7% to 10.2%) under insulin monotherapy and 5.7% (CI, 4.5% to 7.3%) under insulin plus metformin (risk ratio, 0.72 [CI, 0.51 to 1.09]). Possible residual confounding by glycemic control and body mass index. Compared with switching to insulin monotherapy, continuing metformin and adding insulin in early pregnancy resulted in little to no increased risk for nonlive birth among women receiving metformin before pregnancy. Under conventional statistical criteria, anything between a 49% decrease and a 9% increase in risk for congenital malformations was highly compatible with our data. National Institutes of Health.

Impact of Prolonged Pregnancy on Mode of Delivery and Fetal Outcome

Background: The “term pregnancy” is defined as the pregnancy that ends between 259 and 294 days (37-42 weeks) of pregnancy from the 1st day of last menstrual period. If the pregnancy continues beyond this mentioned period, it is called prolonged pregnancy. Post-term Pregnancy is one of the commonest obstetric conditions which associated with an increased risk of fetal and neonatal mortality and morbidity as well as an increased maternal morbidity.Objectives: The aim of this study is to determine the frequency of mode of delivery and fetal outcomes in prolonged pregnancy.Material and Methods: It is a Descriptive cross sectional study, conducted from 28th Aug, 2019 to 28thFeb, 2020 at Department of Obs & Gynae, MTI-HMC Peshawar. Sample size was 125 keeping 11% proportion of patients having poor apgar score with 95% confidence interval, 5% level of significance.5% margin of error. Sample collection was accomplished by non-probability, consecutive sampling technique. All patients between 18-40 years of age with 42 weeks of gestation or more by dates or dating scan admitted to Gynae Ward/Labour room, having regular cycles were included in the study.Results: As per descriptive statistics, mean and SDs for age was 25±4.90. Mean and SDs for gravidity was recorded as 2±0.58. Mean and SDs for parity was 2±0.58. Mean and SDs for Apgar score was recorded as 8±0.89. 28 (22.4%) patients were obese. In this study 14 (11.2%) neonates had poor apgar score. Normal vaginal delivery 66(52.8%) was the Frequent mode of delivery followed by assisted vaginal deliveries 48(38.4%) and Caesarean section11(8.8%).Conclusion: In this study, we have concluded that pregnancy should not be allowed to go post-term due to association of higher neonatal morbidity and mortality rate, and should be managed before 42 weeks of gestation.Keywords: Fetal outcome, Post term pregnancy, Poor Apgar Score

A prospective preconception cohort study of the association between Mycoplasma genitalium and fecundability in Kenyan women trying to conceive.

Is Mycoplasma genitalium-infection associated with reduced fecundability? Preconception M. genitalium-infection was associated with 27% lower fecundability though confidence intervals were wide, and the association between M. genitalium and fecundability may be dependent on concurrent bacterial vaginosis (BV). M. genitalium has been associated with cervicitis, pelvic inflammatory disease, infertility, and preterm birth, but the extent to which M. genitalium is causally related to adverse reproductive sequelae in women is debated. Kenyan women enrolled in a prospective preconception cohort provided vaginal fluid specimens and underwent monthly pregnancy testing. Stored samples from 407 women who had been trying to conceive for ≤6 months were tested for M. genitalium using a nucleic acid amplification test. Data on first day of last menstrual period, sexual behavior, pregnancy status, and vaginal specimens were collected at monthly preconception visits. The association between M. genitalium detected at the visit prior to each pregnancy test and fecundability was estimated using discrete time proportional probabilities models. Secondary analyses explored the influence of concurrent BV on the association between M. genitalium and fecundability. The 407 participants experienced 1220 menstrual cycles and 213 pregnancies. The prevalence of M. genitalium at enrollment was 7.7%. After adjustment for age, frequency of condomless sex in the last 4 weeks, and study site, M. genitalium was associated with a 27% lower fecundability, but confidence intervals were wide (adjusted fecundability ratio (aFR) 0.73, 95% CI 0.44, 1.23). In secondary analyses, when compared to cycles without M. genitalium or BV at the visit prior, women with both M. genitalium and BV at the visit prior had a 51% lower fecundability (aFR = 0.49, 95% CI 0.22, 1.09) whereas there was no association of M. genitalium alone (aFR = 0.98 (95% CI 0.54, 1.76)), and a smaller reduction in fecundability for women with BV only (aFR = 0.80 (95% CI 0.60, 1.07)). Results should be interpreted cautiously given the relatively low prevalence of M. genitalium and wide confidence intervals. In this cohort of Kenyan women trying to conceive, the association between M. genitalium and fecundability was influenced by concurrent BV status, suggesting there may be a synergistic effect of M. genitalium and BV on fecundability. This work was supported by a National Institutes of Health grant (NICHD R01 HD087346-RSM). R.S.M. received additional support for mentoring (NICHD K24 HD88229). E.M.L. was supported by pre- and post-doctoral fellowships (NIAID T32 AI07140, NICHD F32 HD100202). Data collection and management were completed using REDCap electronic data capture tools hosted at the University of Washington's Institute of Translational Health Science supported by grants from NCATS/NIH (UL1 TR002319). The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. R.S.M. receives research funding, paid to the University of Washington, from Hologic Corporation and consulting fees from Lupin Pharmaceuticals. L.E.M. receives research funding and material for research studies, paid to the University of Washington, from Hologic Corporation and Nabriva Therapeutics, travel support from Hologic, and consulting fees from Health Advances. E.M.L.'s contributions to this study primarily occurred while affiliated with the University of Washington; at the time of submission, E.M.L. was an employee of and holds stock or stock grants for AbbVie, Inc. The other authors have no conflicts of interest. N/A.

Drug exposure during pregnancy in primary care: an algorithm and observational study from SIDIAP database, Catalunya, Spain

ObjectivesTo develop an algorithm to identify pregnancy episodes in women at childbearing age using SIDIAP (Information System for the Improvement of Research in Primary Care) data (Catalunya, Spain).To describe drugs...

Assessment On Outcome Of Papaya Fruit On Premenstrual Tension Syndrome Among Adolescent Girls In Selected Setting

Background: Premenstrual syndrome is medically defined as distressing physical and psychological symptoms not caused by organic disease which appear before menstruation regress during the menstruation, perhaps a hormone imbalance, due to lack of progesterone, a poor diet and lack of exercise. Premenstrual tension syndrome is the emotional tension, insomnia, depression, irritability associated with the premenstrual week. Somatic sensations associated with the syndrome are bloating, cramping, tenderness of the breasts, swelling of hands and feet, temporary weight gain. Premenstrual disorder is a condition in which the symptoms of premenstrual syndrome are more severe and cause significant functional impairment .It has been estimated that anywhere from 3 to 9% of women suffer from this disorder (Woods, 2005). In premenstrual syndrome, symptoms can be controlled to some extent by the dietary manipulations. Studies suggest that a diet high in vitamin C, calcium and magnesium was helpful in order to reduce the level of premenstrual tension syndrome. It is advisable to take diet consisting of fruits which is rich in calcium, antioxidant, vitamin A and minerals from one week prior to menstruation. Papaya fruit is an excellent source of dietary fibre, folate, vitamin A, C and E.It also contains small amount of calcium, iron, riboflavin, thiamine and niacin. It is also very rich in antioxidant nutrients flavonoids and carotenes, very high in vitamin A and C & and also low in calorie. Materials and Methods: Premenstrual syndrome is linked to other disorders associated with inadequate calcium, iron, vitamins and minerals. Hence the researcher was interested to reduce the level of premenstrual tension syndrome by providing papaya fruit for adolescent girls. The aim of the study was to determine the outcome of papaya fruit on premenstrual tension syndrome among adolescent girls in selected setting. A Quasi experimental design was adopted. The study was conducted at selected governmentschool, Arakonam.60 adolescent girls were selected.30 in experimental and 30 in control group. Adolescent girls who fulfilled the inclusion criteria were selected by using non probability purposive sampling technique.Results:The demographic variables were age in years, age at menarche, weight in kilogram, body mass index and type of diet. The pretest and posttest level of PMTS was determined by modified premenstrual tension syndrome scale.75 mg of papaya fruit was provided by the researcher from the 5th day of last menstrual period in mid morning for 21 days. Data analysis was done by using descriptive and inferential statistics. The pretest and posttest level of premenstrual tension syndrome were compared and found that in pretest 6(20%)had mild level of premenstrual tension syndrome,24(80%)had moderate level of premenstrual tension syndrome ,none of them comes under severe level of premenstrual tension syndrome and in post test 27(90%) had mild level of premenstrual tension syndrome,3(10%) had moderate level of premenstrual tension syndrome, none of them comes under the severe level of premenstrual tension syndrome. Conclusion:Thus the study concludes that papaya fruit was effective to reduce the level of premenstrual tension syndrome. Theconceptual framework was based on modified Weidenbach’s helping art nursing theory. The research hypothesis formulated for the study was “there is a significant relationship between the premenstrual tension syndrome and papaya fruit” .The outcome was proved in comparing the pretest and post test level of premenstrual tension syndrome where the result showed p<0.05 level of significance. Thus the research hypothesis was accepted. It was also found that papaya fruit have a role in reducing PMTS. This is statistically proved that research hypothesis was accepted as papaya fruit was effective to alleviate PMTS

Preconception vitamin D and miscarriage in a prospective cohortstudy.

Is preconception vitamin D level associated with the risk of miscarriage? Preconception vitamin D levels are not associated with the risk of miscarriage in a population of women conceiving naturally. In humans, low vitamin D has been associated with prolonged menstrual cycles, delayed ovulation and a lower probability of conception. Animal and in vitro data indicate that vitamin D may affect implantation. This prospective time-to-pregnancy study included 362 women who were trying to conceive naturally between 2008 and 2015. This study included participants who had been trying to conceive naturally for 3 months or less at enrollment and aged 30-44 years. A preconception blood sample was collected and 25-hydroxyvitamin D [25(OH)D] was measured. Women who conceived (N = 362) were at risk of a miscarriage from the day of a reported positive pregnancy test until either a participant-reported pregnancy loss or 20 weeks post day of last menstrual period, whichever came first. Gestational age was defined by ovulation. Time to miscarriage (days) or censoring was modeled using a multivariate Cox proportional hazards model. Multiple imputation was performed for missing covariates and missing day of ovulation. The mean age was 33 years (SD: 3.0 years). Mean 25(OH)D was lower among those who reported their race as African-American and those with a higher BMI. After adjustment for age, race, BMI, education, exercise, alcohol and caffeine intake, compared to the referent group (30-<40 ng/ml), the hazard ratio (HR) and 95% CI for those with a low 25(OH)D level (<30 ng/ml) was 1.10 (CI: 0.62, 1.91). Among participants with a higher 25(OH)D level (≥40 ng/ml), the HR was 1.07 (CI: 0.62, 1.84). This study was limited by a 25(OH)D measurement at only a single time point. A large percentage of women in this study had sufficient vitamin D levels, which may have limited our power to detect an effect of deficiency. Women in this study were older (30-44 years), and predominantly reported their race as White which may limit generalizability. The findings of this study do not suggest an association between preconception vitamin D and miscarriage. Future research should focus on women at greater risk for miscarriage or in populations at risk for vitamin D deficiency or on supplementation. This research was supported in part by the Intramural Research Program of the NIH, National Institute of Environmental Health Sciences (Z01ES103333). This research was also supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health (NIH) under award numbers R00HD079659 and R01HD067683. The authors have no conflicts of interest. N/A.

EFFECTIVENESS OF STRUCTURED TEACHING PROGRAM ON KNOWLEDGE REGARDING CARE OF PRETERM BABIES AMONG B.SC. NURSING FOURTH YEAR STUDENTS IN SELECTED NURSING INSTITUTE OF GWALIOR, MADHYA PRADESH, INDIA

World health organization defined preterm as a live born infant delivered before 37 week from the first day of last menstrual period. These babies are also termed as immature or born early. There are three sub-categories of preterm based on gestational age:

EFFECTIVENESS OF STRUCTURED TEACHING PROGRAM ON ATTITUDE REGARDING CARE OF PRETERM BABIES AMONG B.SC. NURSING FOURTH YEAR STUDENTS IN SELECTED NURSING INSTITUTE OF GWALIOR, MADHYA PRADESH, INDIA.

World health organization defined preterm as a live born infant delivered before 37 week from the first day of last menstrual period. These babies are also termed as immature or born early. There are three sub-categories of preterm based on gestational age: Extremely preterm (&lt;28 weeks), Very preterm (28 to &lt;32 weeks) and moderate to late preterm (32 to &lt;37 weeks). In this study aim assess the effectiveness of Structured teaching program on attitude regarding Care of Preterm Babies among B.Sc. Nursing fourth year Students in Selected nursing Institute of Gwalior, Madhya Pradesh, India. This study was Quantitative research approach is adopted The research design selected for the present study Quasi experimental study to assess the effectiveness of Structured teaching program on attitude regarding Care of Preterm Babies among B.Sc. Nursing fourth year Students in Selected nursing Institute of Gwalior, Madhya Pradesh, India.

Transcerebellar diameter versus biparietal diameter for the measurement of gestational age in third trimester.

AimTo compare the accuracy of biparietal diameter and transcerebellar diameter in measuring the gestational age during the third trimester of pregnancy.Material and methodsIn this prospective observational study, 275 pregnant women with singleton pregnancy between 32 and 37 weeks gestational age were recruited from the outpatient clinics of both Helwan University Hospital and Ain Shams University Maternity Hospital, Cairo, Egypt, during the period from February 2021 to August 2021. Transcerebellar and biparietal diameters of the fetus were measured by a radiologist blinded to the women’s gestational age, and compared to the gestational age acquired from a reliable date of first day of last menstrual period.ResultsThe gestational age calculated by first day of last menstrual period ranged from 32 to 37 weeks (34.35 ± 1.4), while estimated by transcerebellar and biparietal diameters ranged from 31 to 37 weeks (34.31 ± 1.39) and 31 to 39 weeks (34.32 ± 1.44), respectively. There was a strong positive correlation between gestational age and transcerebellar diameter (r = 0.98, p <0.001) as well as biparietal diameter (r = 0.87, p <0.001), yet a stronger correlation was with transcerebellar diameter. 93.6% of gestational age assessment by transcerebellar diameter was correct compared to only 79.9% by biparietal diameter.ConclusionsTranscerebellar diameter is a reliable single sonographic fetal biometric parameter for the assessment of gestational age in third trimester of pregnancy.

Vaginal washing behaviour and fecundability among Kenyan women in a prospective preconception cohort.

Intravaginal washing, practised by a significant proportion of women globally, is associated with acquisition of human immunodeficiency virus (HIV), sexually transmitted infections and bacterial vaginosis (BV). A single prior study among women in the United States found that vaginal washing was associated with lower fecundability. To examine the association between vaginal washing and fecundability among Kenyan women. HIV-negative Kenyan women who were trying to conceive and reported no history of infertility care-seeking were followed prospectively for incident pregnancy for up to six months. At monthly visits, participants reported the first day of last menstrual period, sexual behaviour, vaginal washing behaviour, underwent pregnancy testing and provided vaginal swabs for detection of BV by Gram stain (Nugent score ≥7). Discrete time proportional probability models were used to estimate fecundability ratio (FR) and 95% confidence interval (CI) comparing menstrual cycles when women reported vaginal washing to menstrual cycles when no vaginal washing was reported. Four hundred and fifty-eight women contributed 1,376 menstrual cycles and 255 pregnancies. At enrolment, a third (35.2%, 161 of 458) of participants reported vaginal washing with the majority using water only (73.9%, 119 of 161). After adjustment for age, frequency of unprotected intercourse and study site, vaginal washing in the prior four weeks was associated with a 29% lower fecundability (adjusted FR [aFR] 0.71, 95% CI 0.53, 0.94), which did not change after further adjustment for BV at the visit prior to each pregnancy test (aFR 0.71, 95% CI 0.54, 0.95). Periconceptual vaginal washing may reduce fecundability. Potential mechanisms include vaginal washing-associated changes in the vaginal microbiota, inflammation, disruption of cervical mucus and effects on sperm function. Vaginal washing has no known health benefits, and cessation may improve women's likelihood of conceiving.

Premature rupture of membrane and perinatal outcome

Objective: To find out the complications of a pregnant woman with premature rupture of membrane (PROM) and assess the outcome of it. Materials and Methods: This prospective study was carried out at the Department of Obstetrics &amp; gynecology of Coronel Malek Medical College Hospital, Manikgonj, Bangladesh from January 2020 to December 2020. All pregnant women admitted with PROM during this period were taken as the study population. After taking proper history they were categorized as a term or preterm PROM on the basis of duration of gestation estimated from 1st day of last menstrual period (LMP), previous antenatal records, clinical examination &amp; also previous ultrasonography (USG) reports. Out of sociodemographic characteristics, age distribution and gravidity were noted. The diagnosis was done on the basis of examination and investigations. All the women with PROM were then followed up, management was given according to protocol and a cesarean section was performed according to indication. Birth weight and Apgar score of newborns were noted after delivery. Results: There were 297 cases of PROM recorded among 4461 admitted obstetrical patients over one year period. The hospital incidence of PROM was found to be 6.6%. Among them, 57.6% of patients were admitted at term and 42.4% of patients came before 37 completed weeks of gestation. Most of the pregnant women were between 20-24 years of age (43.7%), 43.2% were primigravida (56.6%) were multigravida. About 48.5% of women presented with different complications associated with PROM. Among which 15.7% of patients had oligohydramnios, 8.5% of patients presented with chorioamnionitis suggested by culture report of the high vaginal swab. Urine for culture and sensitivity was also done. About five (5.2%) developed premature labor before the 37th week of gestation. About 10% of women developed obstetric complications (failed trials) associated with medical diseases. Seventy-seven patients were delivered by cesarean section, 16.2% vaginally, 4.04% patients responded to conservative management and 2.5% patients were referred to a tertiary center for extreme prematurity with associated complicating factors. Most of the babies (38.4%) were born with birth weight between 2.1- 2.5kg and 10.3% of babies were less than 1.5kg. Conclusion: Term PROM was more in comparison to PPROM and most of them were multigravida. The cesarean section rate was high. Most common complication of was subclinical urogenital infection (53%) next oligohydramnios (25%) &amp; (13.5%) women presented with chorioamnionitis.

ESTIMATE GESTATIONAL AGE ACCORDING TO FETAL CROWN RUMP LENGTH ON ECHOGRAPHY

Objectives: Development of descriptive table of gestational age (GA) based on fetal crown rump length (CRL) in Vietnam. Methods: This study was conducted at the Center for Prenatal Diagnosis, National Hospital Obstetrics and Gynecology. Gestational age based on the first day of last menstrual period (LMP) ranges from 10 weeks to 14 weeks and 6 days. Pregnant women who are healthy, have regular menstrual periods, have not used hormonal drugs or assisted reproductive methods before. Have ultrasound measured the length of the crown-rump of the embryo based on the mandatory criteria. Data were analysed using SPSS 20.0 software. Results: 1008 singleton fetuses that met criteria, were predicted GA according to LMP. There were 1008 fetal crown rump length recorded. The mean CRL was 59.95 ± 6.79 (mm), the mean gestational age according to KCC was: 12.13 ± 0.75 (weeks). Gestational age was linearly correlated with fetal crown rump length according to the equation: CRL = 6.602+ GAx 4.398 and GA= 8.889 + CRLx 0.54. Conclusion: Gestational age can be calculated based on fetal crown rump length index by linear equation: GA = 8.889 + CRLx 0.54. The equations can be applied to calculate gestational age in ultrasound practice in Vietnam.

Association between bacterial vaginosis and fecundability in Kenyan women planning pregnancies: a prospective preconception cohort study

AbstractSTUDY QUESTIONIs bacterial vaginosis (BV) associated with fecundability?SUMMARY ANSWERWomen with BV may be at increased risk for sub-fecundity.WHAT IS KNOWN ALREADYWhile BV has been associated with poor IVF outcomes, the association between vaginal microbiota disruption and non-medically assisted conception has not been thoroughly explored.STUDY DESIGN, SIZE, DURATIONKenyan women with fertility intent were enrolled in prospective cohort that included monthly preconception visits with vaginal fluid specimen collection and pregnancy testing. Four hundred fifty-eight women attempting pregnancy for ≤3 menstrual cycles at enrollment were eligible for this fecundability analysis.PARTICIPANTS/MATERIALS, SETTING, METHODSAt monthly preconception visits, participants reported the first day of last menstrual period and sexual behavior, underwent pregnancy testing and provided vaginal specimens. Discrete time proportional probabilities models were used to estimate fecundability ratios (FRs) and 95% CI in menstrual cycles with and without BV (Nugent score ≥ 7) at the visit prior to each pregnancy test. We also assessed the association between persistent BV (BV at two consecutive visits) and fecundability.MAIN RESULTS AND THE ROLE OF CHANCEParticipants contributed 1376 menstrual cycles; 18.5% (n = 255) resulted in pregnancy. After adjusting for age, frequency of condomless sex and study site, BV at the visit prior to pregnancy testing was associated with a 17% lower fecundability (adjusted FR (aFR) 0.83, 95% CI 0.6–1.1). Persistent BV was associated with a 43% reduction in fecundability compared to cycles characterized by optimal vaginal health (aFR 0.57, 95% CI 0.4–0.8).LIMITATIONS, REASONS FOR CAUTIONDetection of vaginal microbiota disruption using Gram stain and a point-of-care test for elevated sialidase identified a non-optimal vaginal environment, but these non-specific methods may miss important relationships that could be identified by characterizing individual vaginal bacteria and bacterial communities using molecular methods. In addition, results may be subject to residual confounding by condomless sex as this was reported for the prior month rather than for the fertile window during each cycle.WIDER IMPLICATIONS OF THE FINDINGSGiven the high global prevalence of BV and infertility, an association between BV and reduced fecundability could have important implications for a large number of women who wish to conceive. Multi-omics approaches to studying the vaginal microbiota may provide key insights into this association and identify potential targets for intervention.STUDY FUNDING/COMPETING INTEREST(S)This work was supported by a National Institutes of Health grant (NICHD R01 HD087346-R.S.M.). R.S.M. received additional support for mentoring (NICHD K24 HD88229). E.M.L. was supported by pre- and post-doctoral fellowships (NIAID T32 AI07140, NICHD F32 HD100202). Data collection and management were made possible using REDCap electronic data capture tools hosted at the University of Washington’s Institute of Translational Health Science supported by grants from NCATS/NIH (UL1 TR002319). The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. R.S.M. receives research funding, paid to the University of Washington, from Hologic Corporation, and has received honoraria for consulting from Lupin Pharmaceuticals. L.E.M. receives research funding, paid to the University of Washington, from Hologic Corporation, and has received honoraria for service on scientific advisory boards from Hologic and Nabriva Therapeutics.TRIAL REGISTRATION NUMBERN/A.

Predictors of low birth weight and preterm birth in rural Uganda: Findings from a birth cohort study.

BackgroundApproximately 20.5 million infants were born weighing <2500 g (defined as low birthweight or LBW) in 2015, primarily in low- and middle-income countries (LMICs). Infants born LBW, including those born preterm (<37 weeks gestation), are at increased risk for numerous consequences, including neonatal mortality and morbidity as well as suboptimal health and nutritional status later in life. The objective of this study was to identify predictors of LBW and preterm birth among infants in rural Uganda.MethodsData were derived from a prospective birth cohort study conducted from 2014–2016 in 12 districts across northern and southwestern Uganda. Birth weights were measured in triplicate to the nearest 0.1 kg by trained enumerators within 72 hours of delivery. Gestational age was calculated from the first day of last menstrual period (LMP). Associations between household, maternal, and infant characteristics and birth outcomes (LBW and preterm birth) were assessed using bivariate and multivariable logistic regression with stepwise, backward selection analyses.ResultsAmong infants in the study, 4.3% were born LBW (143/3,337), and 19.4% were born preterm (744/3,841). In multivariable analysis, mothers who were taller (>150 cm) (adjusted Odds Ratio (aOR) = 0.42 (95% CI = 0.24, 0.72)), multigravida (aOR = 0.62 (95% CI = 0.39, 0.97)), or with adequate birth spacing (>24 months) (aOR = 0.60 (95% CI = 0.39, 0.92)) had lower odds of delivering a LBW infant Mothers with severe household food insecurity (aOR = 1.84 (95% CI = 1.22, 2.79)) or who tested positive for malaria during pregnancy (aOR = 2.06 (95% CI = 1.10, 3.85)) had higher odds of delivering a LBW infant. In addition, in multivariable analysis, mothers who resided in the Southwest (aOR = 0.64 (95% CI = 0.54, 0.76)), were ≥20 years old (aOR = 0.76 (95% CI = 0.61, 0.94)), with adequate birth spacing (aOR = 0.76 (95% CI = 0.63, 0.93)), or attended ≥4 antenatal care (ANC) visits (aOR = 0.56 (95% CI = 0.47, 0.67)) had lower odds of delivering a preterm infant; mothers who were neither married nor cohabitating (aOR = 1.42 (95% CI = 1.00, 2.00)) or delivered at home (aOR = 1.25 (95% CI = 1.04, 1.51)) had higher odds.ConclusionsIn rural Uganda, severe household food insecurity, adolescent pregnancy, inadequate birth spacing, malaria infection, suboptimal ANC attendance, and home delivery represent modifiable risk factors associated with higher rates of LBW and/or preterm birth. Future studies on interventions to address these risk factors may be warranted.

Antidepressant use during pregnancy and the risk of gestational diabetes mellitus: a nested case–control study

ObjectivesThe aim of this study was to determine the association between antidepressant (AD) classes, types and duration of use during pregnancy and the risk of gestational diabetes mellitus (GDM).Design and...

Normative values for ultrasound measurements of the female pelvic organs throughout childhood and adolescence.

Normative data from pelvic ultrasonography (US) of the pediatric female reproductive organs are outdated and limited by sample size. The purpose of this study was to report normal uterine and ovarian volumes and endometrial stripe thickness in children and young adults and throughout the menstrual cycle in post-menarchal adolescents. Females ages 0 through 20years who underwent pelvic US between January 2010 and May 2014 were identified. After excluding patients with pelvic and/or endocrine pathology, nomograms of uterine and ovarian volumes and endometrial thickness by age year were created. Data for patients ages 12years and older with a recorded day of last menstrual period were used to create additional nomograms of volumes/thickness throughout the menstrual cycle. Student's t-tests and linear regression were performed to assess differences in measurements between groups and association of volumes/thickness with age. During our study period, 5,647 patients underwent 6,953 pelvic US examinations. After further review, 907 examinations from 889 patients were included (mean age: 11.3±6.0years). Mean pelvic US volumes (cm3) per organ were 25.5±27.0 (uterus), 4.5±4.7 (right ovary) and 4.0±4.1 (left ovary). Mean endometrial thickness was 4.5±3.7mm. Right ovarian volume was significantly larger than the left (P=0.0126). Uterine volume, ovarian volume and endometrial thickness were significantly associated with age (P-values<0.0001). Plots of mean organ measurements with respect to week of menses are provided. We report normal volumes of the uterus and ovaries and endometrial stripe thickness measured by pelvic US throughout childhood and adolescence with reference to the menstrual cycle. These values are significantly associated with age and vary visually by menstrual cycle week.

ASSESSMENT OF GESTATIONAL AGE

Objective: To compare correct assessment of gestational age betweenTranscerebeller diameter versus femur length in third trimester (28-40) using first day of lastmenstrual period for actual period of gestation. Study Design: Cross-sectional descriptive study.Place and Duration of Study: Department of Obstetrics and Gynecology, Bahawal VictoriaHospital, Bahawalpur from Jun 2012 to Dec 2012. Methodology: This study was performed on327 patients in third trimester of pregnancy from 28-40 weeks fulfilling the inclusion criteria.Ultrasound measurements of transcerebellar diameter (TCD) and femur (FL) were made withcommercially available real time ultrasound equipment Toshiba Nemio-10 model 2009,Transducer frequency 50/60 Hz. Collected data was analyzed by SPSS version 10. Results: Outof 327 patients, TCD was found to give correct assessment corresponding to the gestational ageby LMP in 262 (80.1%) patients, while in 232 (70.9%) patients FL was found to give correctassessment corresponding to the gestational age by LMP. Conclusions: Transcerebellardiameter is more reliable method of gestational age determination in third trimester of pregnancythan femur length. TCD can be used as a tool to assist in the assessment of gestational age inthird trimester.

141. Neighbourhood deprivation and foetal growth: The Generation R study

Introduction Embryonic development is affected by multiple parental lifestyle factors and environmental exposures. Neighbourhood deprivation is associated with lower birth weight and higher preterm birth rates. However, the effects of living in a deprived neighbourhood on embryonic and foetal growth have not been explored yet. Hypothesis We hypothesized that living in a deprived neighbourhood is negatively associated with embryonic and foetal growth. Therefore, our objective was to assess the association between neighbourhood deprivation and embryonic and foetal growth parameters. Methods We evaluated the association between living in a deprived neighbourhood and embryonic and foetal growth parameters in 1614 mothers with a reliable first day of last menstrual period and a regular menstrual cycle. Foetal measurements included crown rump length (CRL), head circumference (HC), femur length (FL), biparietal diameter (BPD), abdominal circumference (AC) and estimated foetal weight (EFW). Results A total of 1614 pregnant women were included. Most were of Western ethnicity (70.7%) and nulliparous (59.0%). Almost every pregnancy was spontaneously conceived (95.7%). The score for neighbourhood deprivation is determined for all 4-digit zip codes and takes income, education and employment into account. A low score represents a deprived neighbourhood. Using linear mixed models, we found a statistically significant association between the neighbourhood deprivation score and FL (adjusted β −1.06 [95% CI: −1.98, −0.15]) and EFW (adjusted β −0.96 [95% CI: −1.89, −0.04]), but not with CRL, HC, AC and BPD. Discussion This population-based study shows that residing in a deprived neighbourhood is statistically associated with some, but not all, foetal growth parameters. Possibly, foetal growth parameters have different degrees of receptivity to external factors such neighbourhood deprivation. The effects we found remained above and beyond individual SES, for which we adjusted. This suggests a separate neighbourhood level effect on embryonic and foetal growth.

Ultrasonograph versus β-human chorionic gonadotropin titer for verification of termination of missed first trimester miscarriage

Introduction Miscarriage is one of the common complications of pregnancy. Up to 20% of recognized pregnancies will end in miscarriage. However, when women were followed with serial serum human chorionic gonadotropin (hCG) measurements, the actual miscarriage rate was found to be 31%. Many pregnancies are lost spontaneously before a woman recognizes that she is pregnant, and the clinical signs of miscarriage are mistaken for a heavy or late menses. In some countries with low resources, ultrasound may be not available in all medical centers. So, confirmation of complete termination of first trimesteric miscarriage may be not possible, and these cases may present with complications of inadequate treatment. So, we need to study other method for verification of successful management such as β-hCG titter. Objective The aim was to assess the usefulness of testing serum β-hCG titer to confirm the effective medical termination of the first trimester miscarriage. Patients and methods A prospective study was conducted at the Department of Obstetrics and Gynecology at Al Zahraa university Hospital in the period between December 2017 and April 2018. A total of 34 pregnant women with first trimester miscarriage (7–13 weeks from the first day of last menstrual period) were submitted for medical termination of miscarriage, and each case was subjected to ultrasonography 7 days after termination of miscarriage (for measurements of endometrial thickness) and serum β-hCG at 3 and 7 days after termination of miscarriage. Results Endometrial thickness decreased after termination of miscarriage (with cut-off value &lt;15 mm). Moreover, β-hCG decreased after medical termination of miscarriage. In our study, receiver operating characteristics curve was used to define the best cut-off value of β-hCG, which was greater than 34 mIU/ml, with sensitivity of 90%, specificity of 70.8%, positive predictive value of 56.4%, and negative predictive value of 94.4%, with diagnostic accuracy of 83.5%. Conclusion Measuring β-hCG level is an effective alternative to transvaginal ultrasound measurements of endometrial thickness to verify the completion of termination of early miscarriage.

Gestational Age Specific Postnatal Growth Curves for Singleton Babies in Tertiary Hospital of Western Nepal

Measurement of birth weight, crown-heel length, head circumference and chest circumference used to assess the intrauterine growth of a baby vary with altitude, race, gender, socioeconomic status, maternal size, and maternal diseases. The study aimed to construct centile charts for birth weight, crown-heel length and head circumference for new born at different gestational ages in Western Nepal. This was a descriptive cross-sectional study done over a period of 15 months in a tertiary care hospital of Western Nepal. Birth weight, length, head circumference and chest circumference were measured within 12-24 hours of birth. Gestational age was estimated from the first day of last menstrual period and New Ballard's scoring system. Microsoft 2007 Excel and SPSS-16 was used for data analysis. Cole's Lambda Mu Sigma method was used for constructing centile curves. Out of 2000 babies analysed, 1910 samples were used to construct smoothed intrauterine growth curve of birth weight, crown-heel length, and head circumference from 33-42 weeks of gestation. Among all, 1147 (57.35%) were male and 853 (42.65%) were female, mean gestational age was 38.13±2.44 weeks. The means of birth weight, crown-heel length, head and chest circumference were 2744.78 gm, 47.80 cm, 33.18 cm, and 30.20 cm with standard deviations of 528.29, 3.124, 1.78, and 2.35 respectively. This necessitates the update in the existing growth charts and development in different geographical regions of a country.