Estimated Gestational Age Research Articles

Accuracy of portable ultrasound machines for obstetric biometry.

To evaluate the accuracy of two portable ultrasound machines (PUM) in assessing fetal biometry and estimated gestational age (EGA). This was a secondary analysis of data from the Fetal Age Machine Learning Initiative, an observational study of pregnant women in the USA and Zambia. Each participant underwent ultrasound assessment by an experienced sonographer using both a high-specification ultrasound machine (HSUM) and a PUM (Butterfly iQ or Clarius C3) to measure fetal biometry and calculate EGA at each visit. By comparing paired PUM and HSUM scans, we estimated agreement between individual biometry measurements and aggregate gestational age estimates by reporting mean difference, intraclass correlation coefficient (ICC) and Bland-Altman plots, adjusting for trend. Between April and December 2021, 818 participants contributed 1386 paired PUM-HSUM ultrasound investigations, of which 991 PUM scans were obtained using the Butterfly iQ device and 395 using the Clarius C3 device. Gestational age at scan ranged from 7 to 38 weeks. Compared with HSUM, the Butterfly iQ PUM had a mean difference of -0.20 (95% CI, -0.60 to 0.20) days in the first trimester and -0.68 (95% CI, -0.93 to -0.44) days in the second/third trimesters. Compared with HSUM, the Clarius C3 PUM had a mean difference of -0.47 (95% CI, -1.11 to 0.18) days in the first trimester and -1.67 (95% CI, -2.10 to -1.25) days in the second/third trimesters. ICCs were 0.989 or greater throughout. Increasing gestational age was associated with increasing error and absolute error in EGA and fetal biometry. Both PUM devices demonstrated a modest trend toward underestimation of EGA with advancing gestational age in second/third-trimester scans, compared with HSUM. The Butterfly iQ and Clarius C3 PUM devices were highly accurate in performing fetal biometry in a diverse population from the USA and Zambia. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

The role of fetal hemoglobin in the artificial placenta: A premature ovine model.

A radical paradigm shift in the treatment of premature infants failing conventional treatment is to recreate fetal physiology using an extracorporeal Artificial Placenta (AP). The aim of this study is to evaluate the effects of changing fetal hemoglobin percent (HbF%) on physiology and circuit function during AP support in an ovine model. Extremely premature lambs (n = 5) were delivered by cesarean section at 117-121 d estimated gestational age (EGA) (term = 145d), weighing 2.5 ± 0.35kg. Lambs were cannulated using 10-14Fr cannulae for drainage via the right jugular vein and reinfusion via the umbilical vein. Lambs were intubated and lungs were filled with perfluorodecalin to a meniscus with a pressure of 5-8cm H2O. The first option for transfusion was fetal whole blood from twins followed by maternal red blood cells. Arterial blood gases were used to titrate AP support to maintain fetal blood gas values. The mean survival time on circuit was 119.6 ± 39.5h. Hemodynamic parameters and lactate were stable throughout. As more adult blood transfusions were given to maintain hemoglobin at 10mg/dL, the HbF% declined, reaching 40% by post operative day 7. The HbF% was inversely proportional to flow rates as higher flows were required to maintain adequate oxygen saturation and perfusion. Transfusion of adult blood led to decreased fetal hemoglobin concentration during AP support. The HbF% was inversely proportional to flow rates. Future directions include strategies to decrease the priming volume and establishing a fetal blood bank to have blood rich in HbF.

Relationship between postnatal foot length and selected anthropometric parameters in the estimation of gestational age among Nigerian neonates

Background: Anthropometric parameters such as body weight, body length, occipitofrontal circumference and foot length are known to increase with gestational age. The estimated gestational age (EGA) is the approximate duration of pregnancy to the nearest two weeks at the point of birth. Objective: To determine if there is a relationship between postnatal foot length and anthropometric parameters such as body weight, body length and occipito-frontal circumference in the estimation of gestational age among Nigerian neonates. Methods: At the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria, a cross-sectional study was carried out among 260 neonates with EGA 30- 42 weeks within the first 48 hours of life between December 2017 and December 2019. Postnatal foot lengths were measured with Vernier digital caliper while body weight, body length and occipitofrontal circumference (OFC) were also measured using standard procedures. Results: The postnatal foot length, body weight, body length and occipitofrontal circumference showed steady rise with increasing estimated gestational age. The boy weight ranged from 1.19± 0.14kg at 30 weeks to 3.41±0.44 at 42 weeks. The range of body length was 37.78±2.58cm at 30weeks to 50.60±1.67cm at 42 weeks. The occipitofrontal circumference also ranged from 26.65±1.47cmat 30 weeks to 35.40±1.63cm at 42 weeks. The foot length had strong correlation with the body weight (r = 0.892), body length (r = 0.754) and OFC (r = 0.801) in the preterm neonates. In the term neonates, the foot length had moderate correlations with each of the three parameters (r = 0.632, r = 0.473and r = 0.496). Conclusion: Postnatal foot length had the highest correlation with body weight among preterm and term neonates hence, it will be a useful proxy for birth weight in the estimation of gestational age among Nigerian neonates.

Antibiotic Use for Sepsis in Hospitalized Neonates in Botswana: Factors Associated with Guideline-Divergent Prescribing.

In low- and middle-income countries, where antimicrobial access may be erratic and neonatal sepsis pathogens are frequently multidrug-resistant, empiric antibiotic prescribing practices may diverge from the World Health Organization (WHO) guidelines. This study examined antibiotic prescribing for neonatal sepsis at a tertiary referral hospital neonatal unit in Gaborone, Botswana, using data from a prospective cohort of 467 neonates. We reviewed antibiotic prescriptions for the first episode of suspected sepsis, categorized as early-onset (EOS, days 0-3) or late-onset (LOS, >3 days). The WHO prescribing guidelines were used to determine whether antibiotics were "guideline-synchronous" or "guideline-divergent". Logistic regression models examined independent associations between the time of neonatal sepsis onset and estimated gestational age (EGA) with guideline-divergent antibiotic use. The majority (325/470, 69%) were prescribed one or more antibiotics, and 31 (10%) received guideline-divergent antibiotics. Risk factors for guideline-divergent prescribing included neonates with LOS, compared to EOS (aOR [95% CI]: 4.89 (1.81, 12.57)). Prematurity was a risk factor for guideline-divergent prescribing. Every 1-week decrease in EGA resulted in 11% increased odds of guideline-divergent antibiotics (OR [95% CI]: 0.89 (0.81, 0.97)). Premature infants with LOS had higher odds of guideline-divergent prescribing. Studies are needed to define the causes of this differential rate of guideline-divergent prescribing to guide future interventions.

SAT494 Impending Thyroid Storm during Pregnancy in a Patient with Gestational Trophoblastic Disease

Abstract Disclosure: R. Kulkarni: None. Z. Sibai: None. Background: Gestational trophoblastic disease (GTD) is a rare complication of pregnancy that arises due to abnormal proliferation of trophoblasts of the placenta. The incidence of GTD in the United States of America is about 110 to 120 per 100,000 pregnancies. Abnormal trophoblastic proliferation leads to higher than expected B-HCG levels compared to normal pregnancy. Since the beta subunit of β-hCG has similar structure to TSH, β-hCG stimulates TSH receptor and causes hyperthyroidism during pregnancy which can be asymptomatic, mild or it can lead to severe cases of thyroid storm. Clinical Case: A 19-year-old African American woman with no PMH, 8 weeks primigravida presented with complaints of nausea, abdominal pain and difficulty walking. Associated symptoms included blurry vision, excessive sweating, tremors and palpitations. Physical examination finding included sinus tachycardia and low BMIof 18.6kg/m2, bilateral hand tremors, weakness of bilateral lower extremities. Initial labs showed quantitative β-hCG level of 283,163(H) m(iU)/mL, TSH <0.010 (L) m(iU)/L , FT4 2.54 (H) ng/dL, negativeTSI and TPO Abs. Burch-Wartofsky Point Scale score was 35 suggestive of impending thyroid storm. Pelvic ultrasound showed intrauterine pregnancy with estimated gestation age of 7 weeks 3 days with findings suggestive of fetal demise. Patient underwent Dilatation and Curettage for suspected molarpregnancy. Final histopathological report of aborted specimen verified the diagnosis of partial molar pregnancy. Based on clinical history, physical finding and lab results, patient was diagnosed with gestational trophoblastic disease induced impending thyroid storm. Endocrinology initiated management with Propranolol 40 mg TID and Methimazole 10 mg daily withimprovement in her clinical symptoms in two days. One week follow up as an outpatient showed resolution of symptoms, normalization of free T4 and down trending β-hCG titers to 166 m(iU)/mL. Propranolol and methimazole were stopped. Conclusion:Gestational trophoblastic disease although a rare clinical entity, it is potentially a life-threatening condition. β-hCG is a glycoprotein, and its beta subunit is structurally similar to TSH, allowing it to bind to the TSH receptor and causing hyperstimulation of the thyroid follicular cells leading to various degrees of hyperthyroidism. GTD associated with significant high level of β-HCG, in rare cases can cause severe consequences like thyroid storm. Therefore, GTD should be considered as a differential diagnosis in patient’s presenting with sever thyrotoxicosis during pregnancy. The mainstay of management is evacuation of the molar pregnancy. In severe cases of hyperthyroidism, Beta blocker and thioamides can be considered for symptoms relief and to speed the recovery. Follow-up with serial quantitative β-hCG measurements is crucial to evaluate for persistent molar tissue. Presentation Date: Saturday, June 17, 2023

Postnatal foot length in the estimation of gestational age in relation to intrauterine growth pattern among Nigerian neonates.

To determine the relationship between postnatal foot lengths and estimated gestational age (EGA) in relation to intrauterine growth patterns determined at birth among Nigerian neonates. Hospital-based, cross-sectional. Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. 260 neonates with EGA 30- 42 weeks within 48 hours of life. Postnatal foot lengths (FL) were measured with Vernier digital calliper in millimetres. The intra-uterine growth pattern was determined using the Lubchenco chart. Pearson correlation and regression analysis tests were performed. Postnatal foot length in relation to Intra-Uterine Growth Pattern. The mean postnatal FL had a strong positive correlation with the EGA from 30 through 42 weeks (r = 0.855, p < 0.001). The overall mean foot length for preterm neonates was 65.44 (6.92) mm, while that of term neonates was 77.92 (4.24) mm. The linear regression equation was generated as: EGA = 9.43 + (0.37 × FL), p < 0.001. The EGA as measured by FL had the highest positive correlation with Small for Gestational Age (SGA) intra-uterine-growth pattern, followed by Appropriate for Gestational Age (AGA) and least by Large for Gestational Age (LGA) respectively (r = 0.936> 0.861 > 0.666). The postnatal foot length correlated well with estimated gestational age, and the correlation was best among SGA infants. None declared.

The new frontier in ECLS: Artificial placenta and artificial womb for premature infants

Outcomes for extremely low gestational age newborns (ELGANs), defined as <28 weeks estimated gestational age (EGA), remain disproportionately poor. A radical paradigm shift in the treatment of prematurity is to recreate the fetal environment with extracorporeal support and provide an environment for organ maturation using an extracorporeal VV-ECLS artificial placenta (AP) or an AV-ECLS artificial womb (AW). In this article, we will review clinical indications, current approaches in development, ongoing challenges, remaining milestones and ethical considerations prior to clinical translation.

Enteral Feeding and Antibiotic Treatment Do Not Influence Increased Coefficient of Variation of Total Fecal Bile Acids in Necrotizing Enterocolitis.

Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency in preterm infants. In animal models, the accumulation of ileal bile acids (BAs) is a crucial component of NEC pathophysiology. Recently, we showed that the coefficient of variation of total fecal BAs (CV-TBA) was elevated in infants who develop NEC compared to matched controls. However, neither the type of enteral nutrition nor antibiotic treatments-parameters that could potentially influence BA levels-were used to match pairs. Thus, we assessed the relationships between exposure to enteral feeding types and antibiotic treatments with NEC status and CV-TBA. Serial fecal samples were collected from 79 infants born with birth weight (BW) ≤1800 gm and estimated gestational age (EGA) ≤32 weeks; eighteen of these infants developed NEC. Total fecal BA levels (TBA) were determined using a commercially available enzyme cycling kit. Relationships between CV-TBA and dichotomous variables (NEC status, demographics, early exposure variables) were assessed by independent samples t-tests. Fisher's exact tests were used to assess relationships between NEC status and categorical variables. High values for CV-TBA levels perfectly predicted NEC status among infants in this study. However, feeding type and antibiotic usage did not drive this relationship. As in previous studies, high values for the CV-TBA levels in the first weeks of life perfectly predicted NEC status among infants. Importantly, feeding type and antibiotic usage-previously identified risk factors for NEC-did not drive this relationship.

Conservative Management of Patent Ductus Arteriosus Is Feasible in the Peri-Viable Infants at 22-25 Gestational Weeks.

The purpose of this study was to determine the natural course of hemodynamically significant (HS) patent ductus arteriosus (PDA) with conservative management and whether the presence or prolonged duration of HS PDA affected mortality/morbidities in infants at 22-25 weeks estimated gestational age (EGA). We retrospectively reviewed the medical records of 77 infants born at 22-25 weeks EGA, stratified into 22-23 weeks (n = 21) and 24-25 weeks EGA (n = 56). HS PDA was present in 77%, 76%, and 77%, and open ductus at discharge was 12%, 13%, and 12% in the total and at 22-23 and 24-25 weeks EGA infants, respectively. For backup rescue treatment, 7% and 5% of the infants received oral ibuprofen and device closure, respectively. A mortality rate of 9% was found in the HS PDA (+) infants, significantly lower than the 28% in HS PDA (-) infants. There are no significant differences in morbidities. In multivariate analyses, the presence and/or prolonged duration of HS PDA was not associated with increased mortality or morbidity. Spontaneous closure of HS PDA was achieved through conservative management in the peri-viable infants at 22-25 weeks EGA.

Estimation of gestational age in Shami goats based on transabdominal ultrasonographic measurements of fetal parameters

Estimated gestational age is essential for breeding farm animals because pregnant females require special care and nutrition, which varies according to gestation. The study aimed to estimate the gestational age of Shami does by transabdominal ultrasonographic measurement of fetal parameters. Thirty-three Shami does aged 2-2.5 years with confirmed conception dates were used. The does were examined in a standing position using a transabdominal 3.5 MHz convex sector probe of real-time ultrasonography. The does were examined weekly starting on 21 days of pregnancy until parturition. Measurements of the fetal parameters that include; the crown-rump length, head diameter, chest diameter, trunk diameter were obtained from the ultrasonographic images using the software Screen Calipers. Results showed that the gestational sac and embryos were observed first on 21 and 35 days of pregnancy. The litter size of pregnant does range between two and three kids. Crown-rump length ranged between 24.68±1.32 - 71.71±1.84 mm on 41-60 days. The head diameter was 15.63±0.82 - 45.04±0.92 mm on 41-120 days. Chest diameter was 11.52±0.84 - 56.35±0.93 on 51-110 days, and trunk diameter was 10.69±0.85 - 57.38±0.85 mm on 41-130 days of gestation. The highest positive correlations were obtained between the gestational age chest diameter (r=0.935), crown-rump length (r=0.917), head diameter (r=0.917) and trunk diameter (r=903). In conclusion, transabdominal ultrasonography is a practical method for pregnancy diagnosis and embryo monitoring in Shami goats. Also, it is reliable to estimate gestation age starting on 41 days of pregnancy. The chest diameter was the best fetal parameter, but trunk diameter can be used for the longest period to estimate the gestational age of Shami goats.

Amount of Proteinuria and Duration of Expectant Management in Severe Preeclampsia.

The aim of the study is to evaluate the association between the amount of proteinuria at the time of diagnosis of preeclampsia with severe features (severe preeclampsia [SPE]) and duration of expectant management (EM) and other perinatal outcomes. This is a retrospective cohort study of patients with SPE delivering live, non-anomalous singletons at 230/7 to 342/7 weeks' estimated gestational age (EGA) at a single tertiary center 2016 to 2018. Patients with proteinuria assessment (24-hour total urine protein or urine protein-to-creatinine ratio extrapolation) within 3 days of SPE diagnosis were included. Patients delivered for an indication other than SPE were excluded. Patients were categorized by amount of proteinuria (mg): none (≤300), mild (301-1,000), moderate (1,001-3,000), and massive (≥3,001). The primary outcome was the proportion of potential EM time achieved (%EM), i.e., days of EM divided by days from SPE diagnosis to 34 weeks. Secondary outcomes included delivery EGA, days of EM, and perinatal outcomes. Bivariable and multivariable analyses compared outcomes across groups. Of 295 patients included, 21% had no proteinuria, 33% mild, 19% moderate, and 27% massive. Groups differed by EGA at diagnosis, age, parity, chronic hypertension, and renal disease. %EM was not significantly different between groups (adjusted β coefficient 4.1 [95% CI -5.3, 13.5] for mild proteinuria vs. none, -4.1 [95% CI -14.9, 6.6] for moderate proteinuria vs. none, and -5.6 [95% CI -16.0, 4.7] for massive proteinuria vs. none). Increasing proteinuria was associated with earlier delivery EGA but only days of EM in the mild versus no proteinuria groups. There was no significant association between proteinuria and maternal composite morbidity, but patients with mild and massive proteinuria had higher odds of neonatal composite morbidities compared with no proteinuria. Among patients with SPE, proteinuria level was not consistently associated with duration of EM. However, patients with the greatest amounts of proteinuria may have worse neonatal and selected maternal outcomes. · Amount of proteinuria was not associated with the duration of expectant management.. · Greater proteinuria was associated with earlier delivery in severe preeclampsia.. · Massive proteinuria in preeclampsia was associated with select adverse maternal and neonatal outcomes..

The acquisition of mechanoreceptive competence by human digital Merkel cells and sensory corpuscles during development: An immunohistochemical study of PIEZO2

BackgroundPIEZO2 is a transmembrane protein forming part of an ion channel required for mechanotransduction. In humans, PIEZO2 is present in axon terminals of adult Meissner and Pacinian corpuscles, as well as Merkel cells in Merkel cell-neurite complexes. MethodsTo study the acquisition of functional capability for mechanotransduction of developing type I slowly adapting low-threshold mechanoreceptors, i.e., Merkel cell-neurite complexes, a battery of immunohistochemical and immunofluorescence techniques was performed on human skin specimens covering the whole development and growth, from 11 weeks of estimated gestational age to 20 years of life. In addition, developmental expression of PIEZO2 type I (Meissner’s corpuscles) and type II (Pacinian corpuscles) rapidly adapting mechanoreceptors was studied in parallel. ResultsThe first evidence of Merkel cells showing the typical morphology and placement was at 13 weeks of estimated gestation age, and at this time positive immunoreactivity for PIEZO2 was achieved. PIEZO2 expression in axons terminals started at 23 WEGA in Pacinian corpuscles and at 36 WEGA in the case of Meissner corpuscles. The occurrence of PIEZO2 in Merkel cells, Meissner and Pacinian corpuscles was maintained for all the time investigated. Interestingly PIEZO2 was absent in most Aβ type I slowly adapting low-threshold mechanoreceptors that innervate MC while it was regularly present in most Aβ type I and type II rapidly adapting low-threshold mechanoreceptors that supplies Meissner and Pacinian corpuscles. ConclusionThe present results provide evidence that human cutaneous mechanoreceptors could perform mechanotransduction already during embryonic development.

106. Pregnancy and Delivery Outcomes in Adolescent and Young Adult Mothers in the Military Health System

We aim to examine risk factors in military-connected adolescent and young adult mothers after Affordable Care Act implementation that may predict adverse pregnancy and delivery outcomes. Dependent daughter (DD), active duty (AD) spouse, and AD service member (ADSM) mothers within the San Antonio Military Health System (SAMHS) ages 26 years and under at their initial prenatal visit between 2015-2019 were included. Data was collected retrospectively from Military Health System electronic inpatient and outpatient records. Demographic data included date and age at first prenatal visit, marital status, beneficiary status, sponsor’s rank (enlisted or officer) and estimated gestational age (EGA) at first prenatal visit and birth. Records were reviewed for preeclampsia, gestational diabetes mellitus (GDM), premature rupture of membranes (PROM), premature labor, substance use, sexually transmitted infection (STI), elective abortion, and pregnancy loss. Maternal and neonatal outcomes were compared to the demographic data. There were 4557 eligible mothers ranging from 13 to 26 years. Almost three-quarters of mothers were married. Median age at first prenatal visit was 20 years for unwed and 23 years for married mothers. DD, ADSM, and AD spouses made up 15.9%, 28.7%, and 55.3% of mothers, respectively. Eighty-six percent of mothers had an enlisted sponsor. A quarter of the eligible mothers had missing data. Age at initial prenatal visit was not significantly associated with preeclampsia (p=0.5266), premature labor (p=0.1755), PROM (p=0.3325), and pregnancy loss (p=0.4813). Beneficiary status was not significantly associated with preeclampsia (p=0.8775), premature labor, (p=0.3381), and PROM (p=0.4954). STI was significantly associated with younger mothers (p<0.001), DD (p<0.0001), presentation to care in the second or third trimester (p<0.0001), and enlisted rank (p=0.0005). Delayed entry to prenatal care was significantly associated with preeclampsia, GDM, substance use, STI (p<0.0001), DD, and younger age (p<0.0001). EGA at birth was significantly associated with age, beneficiary status, and initial prenatal visit trimester (p<0.0001). Initiation of prenatal care in the first trimester within the SAMHS in terms of timing remains consistent with nationally published data. Younger age and DD status are associated with delayed initiation of prenatal care. However, younger maternal age is not associated with certain adverse maternal pregnancy and delivery outcomes in military-connected mothers. This could indicate that universal access to healthcare may improve pregnancy and delivery outcomes in adolescent and young adult mothers.

Neurodevelopmental Outcomes following Preterm Birth and the Association with Postmenstrual Age at Discharge.

This study aimed to (1) define the prevalence of motor, cognitive, and language delays in preterm infants born <32 weeks estimated gestational age (EGA); and (2) identify the relationship between the timing of discharge from the neonatal intensive care unit (NICU) and neurodevelopmental outcome in early childhood. This retrospective study of 172 preterm infants born <32 weeks EGA and hospitalized in a level-IV NICU captured medical factors, including timing of discharge, from the NICU stay. Standardized developmental testing at 1 to 2 years corrected age was conducted in the newborn follow-up clinic. At 1 to 2 years corrected age, the sample had an average Bayley Scales of Infant and Toddler Development (Bayley-III) cognitive composite score of 91.5 ± 17.4, language composite score of 84.5 ± 17.3, and motor composite score of 88.9 ± 18.4. Lower EGA at birth, necrotizing enterocolitis, patent ductus arteriosus, and oxygen requirement for >28 days were independently associated with higher postmenstrual age (PMA) at NICU discharge. Higher PMA at discharge was associated with poorer cognitive outcome [p < 0.001, β = -1.1 (-1.6, -0.7)], poorer language outcome [p = 0.049, β = -0.5 (-0.9, -0.003)], and poorer motor outcome [p <0.001, β = -1.0 (-1.5, -0.5)]. For every additional week of hospitalization, scores were an average of 1.1 points lower in cognitive, 1.0 point lower in motor, and 0.5 points lower in language domains of the Bayley-III assessment. Poorer cognitive, language, and motor outcomes were associated with longer hospitalization, even after controlling for medical risk factors known to be associated with poorer outcome. This provides further evidence for the potential role of the environment in impacting developmental outcomes of infants hospitalized in the NICU. · There are high rates of developmental impairment among preterm infants born <32 weeks at 1 year to 2 years.. · The longer the infant is exposed to the NICU environment, the higher the risk of neurodevelopmental challenges.. · These findings provide increased motivation for optimizing the early NICU environment..

Early-onset fetal growth restriction defined by only abdominal circumference is associated with perinatal mortality

SMFM recently expanded the definition of fetal growth restriction (FGR) to include abdominal circumference < 10th centile (%) as a diagnostic criterion in addition to the classic criterion of estimated fetal weight (EFW) < 10%. The broader definition is associated with improved detection of small for gestational age (SGA) neonates. Early-onset FGR diagnosed based on EFW alone prior to 32 estimated gestational age (EGA) is associated with increased risk of perinatal death. Among fetuses with normal EFW, we aimed to determine whether early-onset FGR diagnosed based on AC alone is associated with increased risks of adverse neonatal outcomes.

Impact of serum uric acid concentration on ultrasound scanned pregnant women in Calabar, Nigeria

Objectives: To evaluate the effect of serum uric acid elevation on the fetus and to determine the existence of a connection between hyperuricemia and gestational hyperten sion (pre-eclampsia).Materials and method: A prospective cross-sectional case-controlled ultrasound scan study was done on 200 singleton pregnant women between 20 to 40 weeks gestational age in a 12-month period. The age range for the cases and control were from 15 to 39 years. Uric acid concentration in the serum obtained from all the women was analyzed utilizing manual colorimetric method. Pearson’s correlation and the student t-tests were used to analyze the data obtained.Results: Maternal serum uric acid had negative correlation with fetal heart rate (FHR) (p = 0.025) and a positive correlation with estimated gestational age (EGA) (p = 0.040) including estimated fetal weight EFW (p = 0.046). A significant positive correlation between uric acid and proteinuria (p = 0.009) was observed. Uric acid was higher in pre-eclamptics than gestational hypertensives (8.528±2.679 mg/dl versus 6.542±1.746 mg/dl, p = 0.016). Also, uric acid in pregnancy induced hypertension (PIH) was higher than the normotensives (7.535±2.165 mg/dl versus 5.437±1.636 mg/dl).Conclusion: Maternal hyperuricemia predisposes to fetal bradycardia which may have possibly led to the two fetal demise recorded in the present study. Increased EFW with hyperuricemia may be due to higher body mass index (BMI) of the subjects. Therefore, high serum uric acid has a significant role in foretelling the appearance of preeclampsia but not gestational hypertension.

Novel multinutrient human milk-based human milk fortifier promotes growth and tolerance in premature infants.

The objective of this study was to determine whether human milk supplemented with a novel human milk-based human milk fortifier (Novel HMF), compared with a bovine milk-based HMF (Bovine HMF), supports preterm infant growth through 36 weeks' postmenstrual age (PMA). This single-center, prospective trial compared growth and nutrition outcomes of preterm infants provided a human milk-based diet (mother's own milk or donor milk) supplemented with a Novel HMF with historic controls provided Bovine HMF. Preterm infants with an estimated gestational age (EGA) between 23 and 33 weeks' PMA and birth weight between 750 and 1800 g were eligible for study inclusion. Weight, length, and head circumference (HC) were monitored weekly. The occurrence of late-onset sepsis, nil per os (NPO) days, necrotizing enterocolitis, metabolic acidosis, and serious adverse events were monitored. Birth weight, length, HC, and EGA were similar between the Novel HMF (n = 37) and Bovine HMF (n = 49) groups. The days to regain birth weight was shorter in the Novel HMF group (9.4 ± 4.0 vs 11.4 ± 4.8, P = .0343), with similar weight gain (g/day) from birth to 36 weeks' PMA. Adjusted weight growth velocity (g/kg/day) was significantly higher in the Novel HMF group at 14 and 21 days but similar at 36 weeks' PMA. The Novel HMF group experienced fewer NPO days with a similar total number of feeding days. A novel, multinutrient, human milk-based HMF is well tolerated and meets the nutrition needs of preterm infants.

Right ovarian torsion and oophorectomy in second trimester of pregnancy with subsequent live birth at term

Introduction: Ovarian torsion is a cause of acute abdomen in pregnancy with an incidence of less than 1% occurring most commonly in the first trimester. The symptoms are non-specific with a propensity for missed or delayed diagnosis which may worsen the morbidity associated with this condition. Management is mainly surgical and pregnancy outcome is usually satisfactory. Case presentation: We present the case of a 29-year-old G2 P0 +1 with background polycystic ovaries who complained of abdominal pains at an Estimated Gestational Age (EGA) of 21 weeks in pregnancy. Clinical suspicion was confirmed with a 2D abdominopelvic ultrasound and she subsequently had emergency exploratory laparotomy with right oophorectomy. Pregnancy progressed well and she had a live birth at term. Conclusion: Ovarian torsion is rare in pregnancy. Complications following prompt surgical intervention are however, few and pregnancy outcomes are usually favourable. Keywords: Ovarian cyst; torsion; acute abdomen; cyst accident; pregnancy.

Getting Babies Safely Home: A Retrospective Chart Review of Car Safety Seat Tolerance Screening Outcomes

The American Academy of Pediatrics recommends pre-discharge Car Seat Tolerance Screening (CSTS) for all neonates born <37 weeks estimated gestational age (EGA), or otherwise at risk for cardiorespiratory compromise. Screening is burdensome and there remains tremendous variation in testing criteria and methodology. We conducted a retrospective chart review of 1,072 infants who underwent CSTS between 11/2013 and 7/2016 at a single academic health center. CSTS outcomes (failure and, separately, significant cardiorespiratory instability (CRI)), including those not meeting failure thresholds) were analyzed for all infants screened, and for preterm infants by screening location (Neonatal Intensive Care Unit (NICU) and Mother/Baby Unit (MBU)). Logistic regression was used to estimate associations between infant characteristics and CSTS outcomes. Overall incidence of CSTS failure was 9.2%. Among all infants, hemodynamically significant congenital heart disease, apnea, chronic lung disease, and being small for EGA were associated with failure. Additionally, those born ≤28 weeks EGA had 2.4 times greater likelihood of failure than those 34-36 weeks EGA. Among preterm infants in the NICU and MBU, those of earlier EGA were also more likely to fail. Almost half (47.5%) of all preterm infants demonstrated CRI during CSTS. We found high CSTS failure rates, and identified key infant characteristics that were associated with increased likelihood of failure. Significant CRI events were remarkably common. Larger, prospective studies are needed to elucidate risk factors for instability and failure, and define practical criteria for CSTS recommendations.

572 Quality care during a pandemic: an improvement project to increase documentation of home blood pressure

SARS-CoV2 prompted drastic changes in healthcare delivery to reduce community spread, including swift integration of telehealth. As Yale New Haven Hospital’s Women’s Center (WC) transitioned prenatal care to telehealth, we sought to ensure assessment of blood pressure (BP), recognizing increased risk of hypertensive disorders of pregnancy in our lower socio-economic population. Our primary aim was documentation of BP in 75% of telehealth visits within 10 weeks for WC patients with estimated gestational age (EGA) > 28 weeks or earlier if diagnosis of hypertension, history of hypertensive disorder of pregnancy, obesity, or renal disease.