Gestational Age Of Diagnosis Research Articles

Patent ductus arteriosus shunting direction and diameter predict inpatient outcomes in newborns with congenital diaphragmatic hernia.

To evaluate whether the patent ductus arteriosus (PDA) can serve as a predictive factor for inpatient outcomes in congenital diaphragmatic hernia (CDH) patients. A retrospective cohort study was conducted on 59 CDH patients at the Capital Institute of Pediatrics from January 2020 to August 2022. Echocardiography was performed at least three times: within 2-3 h after birth, pre-operatively, and post-operatively of CDH surgery. Based on the direction of the PDA shunt in the first echocardiogram, patients were classified into three groups: left-to-right shunting or closed PDA (L-R), bi-directional shunting, and right-to-left shunting (R-L). The mortality rate was 15.3% (9/59), with all non-survivors having R-L shunting and group mortality of 39.1% (9/23). The direction of the PDA shunt was significantly associated with the duration of ventilation and length of hospital stay (p < 0.05). Decreased PDA diameter or pre-operative shunting direction change towards L-R or bi-directional shunting were associated with higher survival rates, while increased PDA diameter or continuous R-L shunting were associated with higher mortality rates. Pre-operative PDA shunt direction, PDA size after birth and before surgery, gestational age of diagnosis, and shortening fraction before surgery were significantly correlated with patient outcomes. The direction of the preoperative PDA shunt was the most relevant factor among these relationships (p = 0.009, OR 20.6, CI 2.2∼196.1). Our findings highlight the importance of monitoring changes in PDA shunt directionality and diameter in the early stage after birth, as these parameters may serve as valuable predictors of patient outcomes.

Pathophysiology, diagnosis, and management of twin anemia polycythemia sequence in monochorionic multiple gestations.

Twin anemia polycythemia sequence (TAPS) is a consequence of unequal sharing of red blood cells between monochorionic twins resulting in anemia in the donor and polycythemia in the recipient twin. Prenatally TAPS can occur spontaneously or complicate incomplete laser surgery for twin transfusion syndrome. While there may be clinical overlap with twin transfusion syndrome or selective fetal growth restriction, diagnosis relies on Doppler measurement of middle cerebral artery peak systolic velocities. Significantly discordant velocities are diagnostic, while severity staging is based on signs of cardiovascular compromise. Conservative management, fetoscopic laser coagulation, selective twin reduction, fetal blood and exchange transfusion, and delivery may be selected guided by the gestational age of diagnosis, the severity of the condition, the likelihood of success, and the patients' priorities. Prenatal curative treatment that minimizes the risk for prematurity and residual morbidity at birth is most likely to offer the greatest short-term and long-term benefits.

Quality of surgical management of placenta accreta spectrum in a tertiary center in Sri Lanka: baseline study for quality improvement project: problems and solutions

IntroductionPlacenta accreta spectrum (PAS) is associated with a multitude of maternal and fetal complications. Events related to its management have resulted in significant psychological morbidity, with lifelong consequences which warrant continuous support to cope with their lives. The objective of the study is to highlight the importance of multidisciplinary holistic care and explore room for improvement in the provision of care for women with PAS.MethodsOur study was conducted on deliveries complicated with PAS from January 2019 to June 2021. 27 women were diagnosed with PAS during this period and received treatment. Impact of life event scale- revised (IES-R) and short form health survey-36(SF-36) questionnaires were administered to assess the impact of PAS on their lives. In depth interviews were conducted with the women. A multidisciplinary team meeting was later conducted to formulate a comprehensive care plan for women with PAS.ResultsThe response rate was 96.2%. Mean age of the sample is 34.1 years (SD 4.3). Interval to current pregnancy varies from 0.6 years to 10 years with mean of 4.6 years. Mean gestational age of diagnosis of PAS was 25.4(SD 6.7) weeks. The care bundle provided for women with PAS was evaluated in all cases.Surgery was conducted electively in 82% of patients. Blood transfusions were noted in 85%. Mean pre-operative stay was 9.5 days (SD 8.3) and mean post-operative stay was 8.8 days (SD 8). Total hospital stay ranged from 6 to 48 days (mean 19.5 days, SD 11.4).IES-R scores were significant in 4/26 patients. There was no correlation with the interval from the surgery with any of the subscales or with the total scores. The lapsed time after the surgery had a significant correlation with physical functioning and pain domains of the SF-36 questionnaire.Description of the experience, loss of femininity with loss of the uterus, concerns and fears about the future and measures to improve the quality of care were the themes identified and described.A multidisciplinary team meeting, consisting of consultant obstetricians performing surgery for PAS, anesthetists, hematologist, transfusion medicine specialist, urologist, physiotherapist, nutritionist and nursing officers from ICU and wards, was held and their contributions helped to map out a definitive care plan.ConclusionsPAS is associated with long term physical and psychological morbidity. Continuous support through quarterly clinic visits and telephone conversations may alleviate the psychological trauma. However, some physical disabilities may be lifelong and life changing. Importance of reducing primary caesarean section and promoting trial of labour after caesarean delivery should be promoted among patients and caregivers.

Prenatal diagnosis and pregnancy outcomes of sixty-three fetuses with tetralogy of Fallot

Objective: To analyze the pregnancy outcomes of fetal tetralogy of Fallot and to explore its prenatal diagnosis and treatment procedures. Methods: The clinical data of 63 cases of fetal tetralogy of Fallot (62 cases were singleton and 1 case was one of twin) were collected retrospectively from November, 2013 to November, 2017 in Beijing Obstetrics and Gynecology Hospital. Results: (1) Totally, 63 cases out of 46 352 pregnancies were diagnosed fetal tetralogy of Fallot by fetal ultrasonic cardiogram with about 0.136%(63/46 352) occurrence rate, and the mean gestational age was (23±3) weeks. And 50 cases (79%, 50/63) terminated pregnancy by induced labour. (2) Totally, 57 cases (90%,57/63) accepted genetic diagnosis.Eight cases (13%, 8/63) existed chromosome abnormality including 21-trimosy in 6 cases, 18-trisomy in 1 case and 22q11.2 microdeletion syndrome in 1 case; and these 8 cases were determined before 28 gestational weeks. (3) And 13 cases (21%, 13/63) of no fetal genetic abnormality selected to continue pregnancy. Twelve cases underwent full term delivery (5 cases were cesarean section delivery and 7 cases were vaginal delivery). Twelve newborns underwent surgical radical operation on heart malformation and got recovery. One case underwent preterm cesarean section at 35 gestational weeks for one of twin, and the newborn with tetralogy of Fallot was dead. The other the newborns survived and were followed up for tetralogy of Fallot surgery from 1 month to 3 years old after birth and recovered. Conclusions: Fetal tetralogy of Fallot mainly is diagnosed by ultrasonic cardiogram in the second trimester. The gestational age of diagnosis may be as early as 15 gestational weeks. Fetal tetralogy of Fallot with no genetic abnormality could underwent radical heart malformation operation after birth. It is necessary to undergo genetic testing on fetal tetralogy of Fallot and prenatal multidisciplinary counseling as well.

130 Maternal and perinatal outcomes according to gestational age of diagnosis of preeclampsia: A retrospective cohort study

Introduction Preeclampsia represents a multisystemic disorder characterized by hypertension and proteinuria, or dysfunction of target organs, with onset after twenty weeks of pregnancy. It is a frequent condition and its complications are important causes of maternal morbidity and mortality Objective To evaluate the clinical outcomes of women affected by severe pre-eclampsia and perinatal complications, determining its association with gestational age at the moment of diagnosis Methods An analytical and observational study was developed from the secondary analysis of a pre-existing database of 565 patients with severe maternal morbidity, which included 376 pregnant women with severe preeclampsia conducted in a school maternity in Northeast of Brazil. Statistical analysis was performed using Epi Info version 7.1. With the objective to compare the maternal, fetal and neonatal complications in women with early (less than 34 weeks of pregnancy) and late preeclampsia (34 weeks of pregnancy or more) we used the chi-square test of association and Fisher’s exact test, whenever appropriate, calculating the prevalence ratio (PR) and its 95% confidence interval Results Women with early onset of severe preeclampsia had significantly higher risk for developing acute renal failure (PR: 17.60; 95% CI 2.19 to 141.40), abruption placenta (PR: 3.6; 95% CI: 1.40 to 9.19) and prolonged hospitalization (PR: 3.44; 95% CI: 2.42 to 4.90). Comparing the perinatal outcomes among women with early and late preeclampsia, the first had significantly higher prevalence ratio of having children with low birth weight (PR: 2.85; 95% CI: 2, −3.39), stillbirths (PR: 5.75; 95% CI: 2.43 to 13.60) and early neonatal deaths (PR: 6.28; 95% CI: 1.24 to 31.91). In addition, newborns of women with early-onset severe preeclampsia more often required neonatal intensive care (PR: 8.17; 95% CI: 5.48 to 12.20) Conclusion This study confirms the heterogeneity of preeclampsia, showing that the precocity of onset is an important indicator of the severity and possibly of the disease’s the etiology. There is a clear need to increase medical adherence to guidelines of preeclampsia for early diagnosis and prevention of its complications

Factors relevant to newborn birth weight in pregnancy complicated with abnormal glucose metabolism

Factors relevant to newborn birth weight in pregnancy complicated with abnormal glucose metabolism

OC18.05: Just images: Placental rim sign: a unique three‐dimensional representation of circumvallate placentation

We present ongoing data regarding a sign of circumvallate placentation represented by a circumferential “rim” along the placental edge in the second trimester. Patients with placental abnormality of folding of the membranes on 2-dimensional imaging (rule out synechiae, bands) were prospectively followed to delivery. 35 patients with gestational age of diagnosis from 14–24 weeks were studied. Two-dimensional imaging showed a 3–4 mm band of tissue that appeared to extend freely upward from the fetal surface of the placenta on two sides, giving the impression of “handles”. Differential diagnosis prior to three-dimensional imaging included placental band, synechiae, and extrachorial abnormality. Three-dimensional sweep and volume rendering allowed for accurate diagnosis of the placental rim sign in all cases. For these patients, the incidence of subsequent premature labor or significant bleeding was 40%. Post delivery pathology confirmed diagnosis of placental circumvallate histology. Variations with low risk of adverse outcome were seen with placental marginallis pathology. Three-dimensional imaging of the placental edge is an accurate system for identifying circumvallate placentation. http://www.interscience.wiley.com/jpages/0960-7692/suppmat/index.html This article contains supplementary material available via the Internet from the Journal http://www.interscience.wiley.com/jpages/0960-7692/suppmat/index.html Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.