Date Of Last Menstrual Period Research Articles

Ultrasonographic Evaluation of Foetal Binocular Distance in Second & Third Trimester of Pregnancy and Correlation with Gestation Age

Background: Foetal Binocular Distance in Second & Third Trimester of Pregnancy and correlation with Gestation Age is important. Objective: The purpose of the study was to sonographically measure the foetal binocular distance, determine the foetal gestational age & to find out relationship between them in 2nd & 3rd trimester of gestation. Methodology: This cross sectional study was carried out in the department of radiology and imaging Mymensingh Medical College Hospital, Mymensingh and Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh during the period of July 2012 to June 2013. In all the cases BPD, FL, AC, Binocular distance (BD) in cm and gestational age in weeks were measured by USG. Each patient was voluntary enrolled into the study without any specific indication. The measurement was performed only once for each patient. The foetal outer binocular distance was identified in the occipito-transverse or occipito-posterior-foetal positions. With the head in the occipito-posterior position, the transducer was placed in a plane that transected the occiput, orbits, and nasal processes. Measurements were obtained only when the fetal face was directly perpendicular to the uterine wall, since measurements in an oblique plane were considered to be unreliable. Result: The correlation between binocular distance (BD) in cm and gestational age (GA) in wks was calculated. This correlation was highly significant (r = 0. 973; p<0.001).Conclusion:Excellent correlation was found to exist between binocular diameter and gestational age. In the absence of known date of last menstrual period or where fundal height does not agree with dates, these parameters are valuable in estimating the gestational age of the foetus.Journal of Current and Advance Medical Research, 2016;3(1):10-15

Antidepressant Use Late in Pregnancy and Risk of Persistent Pulmonary Hypertension of the Newborn

Importance The association between selective serotonin reuptake inhibitor (SSRI) antidepressant use during pregnancy and risk of persistent pulmonary hypertension of the newborn (PPHN) has been controversial since the US Food and Drug Administration issued a public health advisory in 2006. Objective To examine the risk of PPHN associated with exposure to different antidepressant medication classes late in pregnancy. Design and Setting Cohort study nested in the 2000-2010 Medicaid Analytic eXtract for 46 US states and Washington, DC. Last follow-up date was December 31, 2010. Participants A total of 3 789 330 pregnant women enrolled in Medicaid from 2 months or fewer after the date of last menstrual period through at least 1 month after delivery. The source cohort was restricted to women with a depression diagnosis and logistic regression analysis with propensity score adjustment applied to control for potential confounders. Exposures for Observational Studies SSRI and non-SSRI monotherapy use during the 90 days before delivery vs no use. Main Outcomes and Measures Recorded diagnosis of PPHN during the first 30 days after delivery. Results A total of 128 950 women (3.4%) filled at least 1 prescription for antidepressants late in pregnancy: 102 179 (2.7%) used an SSRI and 26 771 (0.7%) a non-SSRI. Overall, 7630 infants not exposed to antidepressants were diagnosed with PPHN (20.8; 95% CI, 20.4-21.3 per 10 000 births) compared with 322 infants exposed to SSRIs (31.5; 95% CI, 28.3-35.2 per 10 000 births), and 78 infants exposed to non-SSRIs (29.1; 95% CI, 23.3-36.4 per 10 000 births). Associations between antidepressant use and PPHN were attenuated with increasing levels of confounding adjustment. For SSRIs, odds ratios were 1.51 (95% CI, 1.35-1.69) unadjusted and 1.10 (95% CI, 0.94-1.29) after restricting to women with depression and adjusting for the high-dimensional propensity score. For non-SSRIs, the odds ratios were 1.40 (95% CI, 1.12-1.75) and 1.02 (95% CI, 0.77-1.35), respectively. Upon restriction of the outcome to primary PPHN, the adjusted odds ratio for SSRIs was 1.28 (95% CI, 1.01-1.64) and for non-SSRIs 1.14 (95% CI, 0.74-1.74). Conclusions and Relevance Evidence from this large study of publicly insured pregnant women may be consistent with a potential increased risk of PPHN associated with maternal use of SSRIs in late pregnancy. However, the absolute risk was small, and the risk increase appears more modest than suggested in previous studies.

Investigating Implausible Gestational Age and High Birthweight Combinations.

Birth certificate data overestimate national preterm births because a high percentage of last menstrual period (LMP) dates have errors. Study goals were to determine: (i) To what extent errors in transfer of birthweight and LMP date from medical records to birth certificates contribute to implausibly high birthweight-for-gestational-age births; (ii) What percentage of implausible births would be resolved if the clinical estimate (CE) from birth certificates were used instead of LMP-based gestational age, and with what degree of certainty; and (iii) Of those not resolved, what percentage had a medical explanation. Medical records and birth certificates for all singleton infants with implausibly high birthweight-for-gestational-age based on LMP delivered in the Kaiser Permanente Northwest system in Oregon during 1998-2007 were examined. Percentages of implausible records resolved under various scenarios were calculated. A total of 100 births with implausibly high birthweight-for-gestational age combinations were identified. When LMP date and birthweight from medical records were used instead of from birth certificates, 31% of births with implausible combinations were resolved. Substituting the CE on the birth certificate for the LMP date resolved 92%. Of the latter, the clinician's gestational age estimate in the medical record was obtained in early pregnancy in 72%. Five of the eight births with unresolved implausible combinations were to mothers with diabetes; the remaining three had no documented medical explanation. In this study, use of the birth certificate CE rather than the LMP resulted in a clinically reliable reclassification for the majority of implausible birthweight-for-gestational age deliveries.

Comparación de la confiabilidad de la ecografía obstétrica del primer trimestre y la fecha de la última menstruacion en la prediccion de la fecha de parto vaginal espontáneo en pacientes admitidas en un centro de atención de I nivel en Manizales (Colombia

Objetivo: Comparar el grado de aciertos de la fecha real del parto con los pronósticos de la fecha probable de parto por métodos clínicos y ecográficos. Materiales y métodos: Estudio transversal, en 647 partos atendidos en ASSBASALUD (Manizales-Colombia) años 2012-2013. Las variables más importantes fueron: Fecha de la última mestruación (FUM) confiable o no, escolaridad, ecografía del primer trimestre, Índice Masa Corporal (IMC). Test de Capurro. Resultados: Se validaron 344 (53.2%). 56.4% de las mujeres tenían FUM no confiable. El IMC inicial tuvo un promedio de 22.2. La ganancia de peso fue de 11kg en promedio y el de la gestacional al nacer fue de 39 semanas más 3 días. El perímetro abdominal tuvo como promedio 101.8cm y el de la altura uterina fue de 34cm. Conclusiones: Los partos a término son obtenidos en al menos el 90.7% de los casos de acuerdo a la ecografía, la FUM y el test de Capurro. Palabras clave: Ultrasonografía, edad gestacional, nacimiento a término, Índice de Masa Corporal, peso fetal.

Antidepressant use late in pregnancy and risk of persistent pulmonary hypertension of the newborn.

The association between selective serotonin reuptake inhibitor (SSRI) antidepressant use during pregnancy and risk of persistent pulmonary hypertension of the newborn (PPHN) has been controversial since the US Food and Drug Administration issued a public health advisory in 2006. To examine the risk of PPHN associated with exposure to different antidepressant medication classes late in pregnancy. Cohort study nested in the 2000-2010 Medicaid Analytic eXtract for 46 US states and Washington, DC. Last follow-up date was December 31, 2010. A total of 3,789,330 pregnant women enrolled in Medicaid from 2 months or fewer after the date of last menstrual period through at least 1 month after delivery. The source cohort was restricted to women with a depression diagnosis and logistic regression analysis with propensity score adjustment applied to control for potential confounders. EXPOSURES FOR OBSERVATIONAL STUDIES: SSRI and non-SSRI monotherapy use during the 90 days before delivery vs no use. Recorded diagnosis of PPHN during the first 30 days after delivery. A total of 128,950 women (3.4%) filled at least 1 prescription for antidepressants late in pregnancy: 102,179 (2.7%) used an SSRI and 26,771 (0.7%) a non-SSRI. Overall, 7630 infants not exposed to antidepressants were diagnosed with PPHN (20.8; 95% CI, 20.4-21.3 per 10,000 births) compared with 322 infants exposed to SSRIs (31.5; 95% CI, 28.3-35.2 per 10,000 births), and 78 infants exposed to non-SSRIs (29.1; 95% CI, 23.3-36.4 per 10,000 births). Associations between antidepressant use and PPHN were attenuated with increasing levels of confounding adjustment. For SSRIs, odds ratios were 1.51 (95% CI, 1.35-1.69) unadjusted and 1.10 (95% CI, 0.94-1.29) after restricting to women with depression and adjusting for the high-dimensional propensity score. For non-SSRIs, the odds ratios were 1.40 (95% CI, 1.12-1.75) and 1.02 (95% CI, 0.77-1.35), respectively. Upon restriction of the outcome to primary PPHN, the adjusted odds ratio for SSRIs was 1.28 (95% CI, 1.01-1.64) and for non-SSRIs 1.14 (95% CI, 0.74-1.74). Evidence from this large study of publicly insured pregnant women may be consistent with a potential increased risk of PPHN associated with maternal use of SSRIs in late pregnancy. However, the absolute risk was small, and the risk increase appears more modest than suggested in previous studies.

Validity of pre and post-term birth rates based on the date of last menstrual period compared to early obstetric ultrasonography.

The aim of this study was to assess the validity of the last menstrual period (LMP) estimate in determining pre and post-term birth rates, in a prenatal cohort from two Brazilian cities, São Luís and Ribeirão Preto. Pregnant women with a single fetus and less than 20 weeks' gestation by obstetric ultrasonography who received prenatal care in 2010 and 2011 were included. The LMP was obtained on two occasions (at 22-25 weeks gestation and after birth). The sensitivity of LMP obtained prenatally to estimate the preterm birth rate was 65.6% in São Luís and 78.7% in Ribeirão Preto and the positive predictive value was 57.3% in São Luís and 73.3% in Ribeirão Preto. LMP errors in identifying preterm birth were lower in the more developed city, Ribeirão Preto. The sensitivity and positive predictive value of LMP for the estimate of the post-term birth rate was very low and tended to overestimate it. LMP can be used with some errors to identify the preterm birth rate when obstetric ultrasonography is not available, but is not suitable for predicting post-term birth.

A prospective cohort study of a woman's own gestational age and her fecundability.

What is the magnitude of the association between a woman's gestational age at her own birth and her fecundability (cycle-specific probability of conception)? We found a 62% decrease in fecundability among women born <34 weeks of gestation relative to women born at 37-41 weeks of gestation, whereas there were few differences in fecundability among women born at later gestational ages. One study, using retrospectively collected data on time-to-pregnancy (TTP), and self-reported data on gestational age, found a prolonged TTP among women born <37 gestational weeks (preterm) and with a birthweight ≤1500 g. Other studies of women's gestational age at birth and subsequent fertility, based on data from national birth registries, have reported a reduced probability of giving birth among women born <32 weeks of gestation. We used data from a prospective cohort study of Danish pregnancy planners ('Snart-Gravid'), enrolled during 2007-2011 and followed until 2012. In all, 2814 women were enrolled in our study, of which 2569 had complete follow-up. Women eligible to participate were 18-40 years old at study entry, in a relationship with a male partner, and attempting to conceive. Participants completed a baseline questionnaire and up to six follow-up questionnaires until the report of pregnancy, discontinuation of pregnancy attempts, beginning of fertility treatment, loss to follow-up or end of study observation after 12 months. Among women born <34 gestational weeks, the cumulative probability of conception was 12, 28 and 48% within 3, 6 and 12 cycles, respectively. Among women born at 37-41 weeks of gestation, cumulative probability of conception was 47, 67 and 84% within 3, 6 and 12 cycles, respectively. Relative to women born at 37-41 weeks' gestation, women born <34 weeks had decreased fecundability (fecundability ratio (FR) 0.38, 95% confidence interval (CI): 0.17-0.82). Our data did not suggest reduced fecundability among women born at 34-36 weeks of gestation or at ≥42 weeks of gestation (FR 1.03, 95% CI: 0.80-1.34, and FR 1.13, 95% CI: 0.96-1.33, respectively). Data on gestational age, obtained from the Danish Medical Birth Registry, were more likely to be based on date of last menstrual period than early ultrasound examination, possibly leading to an overestimation of gestational age at birth. Such overestimation, however, would not explain the decrease in fecundability observed among women born <34 gestational weeks. Another limitation is that the proportion of women born before 34 weeks of gestation was low in our study population, which reduced the precision of the estimates. By using prospective data on TTP, our study elaborates on previous reports of impaired fertility among women born preterm, suggesting that women born <34 weeks of gestation have reduced fecundability. The study was supported by the National Institute of Child Health and Human Development (R21-050264), the Danish Medical Research Council (271-07-0338), and the Health Research Fund of Central Denmark Region (1-01-72-84-10). The authors have no competing interests to declare.

Prescription of antihypertensive medications during pregnancy in the UK

This study aimed to describe the management of antihypertensive medications in pregnancy by general practitioners in the UK and compare it with current guidelines. We used electronic medical records from The Health Improvement Network database from 1996 to 2010 to identify completed pregnancies. The study cohort included the first pregnancy identified during the study period in women aged 13-49 years. Information on both hypertension diagnoses and prescription of specific antihypertensive medications within the 90 days before the last menstrual period (LMP) and during pregnancy was ascertained from electronic medical records. Among 148,544 eligible pregnancies, we identified 1995 (1.3%) during which the women had pre-existing hypertension diagnosed by the LMP date. Overall, the prevalence of antihypertensive medications during the first trimester was 1.5%; beta-blockers were the most commonly prescribed antihypertensive. Among women with pre-existing hypertension, 36% were prescribed an antihypertensive medication during the 90 days before the LMP. Among those, 9.6% and 22.2% had discontinued their medication by the first and second trimesters, respectively. For contraindicated drugs such as angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers, the corresponding discontinuation rates were around 25% and 70%. Women who switched therapy received preferably either methyldopa or an alpha/beta-blocker. In this population of UK pregnant women, prescription patterns of antihypertensive medications were dominated by recommended treatments, although some patients continued on contraindicated drugs throughout pregnancy or switched to preferred agents in a delayed fashion.

Accuracy of Ultrasound to Determine Gestational Age in Third Trimester

Rapid and accurate determination of gestational age (GA) may be vital to the appropriate care of the critically ill pregnant patient and improve obstetric care through allowing the optimal timing of necessary interventions and the avoidance of unnecessary ones. Ultrasound scans are considered to be the most cost-effective, accurate and safe methods for measurement of various fetal parts in pregnant women. The aim of this research is to explore the accuracy of ultrasound in determining gestational age of fetus in third trimesters. Data collected for all pregnant women referred to the Maternity & Children’s Hospital in Jeddah. Only women with single live fetus were included in this study. Women who participated in the study were selected on following criteria: Regular menstrual cycles, known date of last menstrual period and previous live normal neonates in multipara. All scans were performed by a single ultrasonologist on one ultrasound machine. From collected data, it was found that out of 53 (100%) patients, 44 (84.62%) pregnant woman have different gestational age from US and last menstrual period (LMP). From this study we can conclude that the main method to follow fetus growth in third trimester not biparietal diameter (BPD) measurement only. The BPD in third trimester is not reliable and be useless when the patient pass 30 weeks and the BPD has to be side with other measurements when we take it in later trimesters to emphasize the normal growth of fetus and avoid wrong measurement of ultrasound.

The Contribution of Preterm Birth and Intrauterine Growth Restriction to Infant Mortality in Tanzania

Our objectives were to examine the associations of neonatal and infant mortality with preterm birth and intrauterine growth restriction (IUGR), and to estimate the partial population attributable risk per cent (pPAR%) of neonatal and infant mortality due to preterm birth and IUGR. Participants were HIV-negative pregnant women and their infants enrolled in Dar es Salaam, Tanzania. Gestational age calculated from date of last menstrual period was used to define preterm, and small for gestational age (SGA) was used as proxy for IUGR. Survival of infants was ascertained at monthly follow-up visits. Cox proportional hazard models were used to estimate the associations of preterm and SGA with neonatal and infant mortality. Study included 7225 singletons, of whom 15% were preterm and 21% were SGA; majority of preterm or SGA babies had birthweight ≥2500 g. Compared to term and appropriately sized babies (AGA), relative risks (RR) of neonatal mortality among preterm-AGA was 2.6 [95% CI 1.8, 3.9], RR among term-SGA was 2.3 [95% CI 1.6, 3.3], and the highest risk was among the preterm-SGA babies (RR 15.1 [95% CI 8.2, 27.7]). Risk associated with preterm was elevated throughout the infancy, and risk associated with SGA was elevated during the neonatal period only. The pPAR% of neonatal mortality for preterm was 22% [95% CI 17%, 26%] and for SGA it was 26% [95% CI 16%, 36%]. Preterm and SGA birth substantially increased the risk of mortality. Interventions for prevention and management of these conditions are likely to reduce of infant mortality in Tanzania.

Detection of triploidy at 11-14 weeks' gestation: a cohort study of 198 000 pregnant women

To assess the detection rate of triploidy at first-trimester screening for trisomy 21 and evaluate outcome in triploid pregnancies. From 2008 to 2011, 198 427 women with singleton pregnancies underwent first-trimester screening between 11 + 2 and 14 + 0 weeks' gestation. Screening parameters included nuchal translucency, maternal serum free β-human chorionic gonadotropin (β-hCG) and pregnancy-associated plasma protein-A (PAPP-A). In all triploid fetuses, these parameters were re-evaluated. Karyotypes were established by invasive testing (chorionic villus sampling or amniocentesis) or postabortem and obtained from the Danish Cytogenetic Central Register and the Danish Fetal Medicine Database. A total of 30 triploid fetuses underwent first-trimester screening. Twenty-five were diagnosed as a result of abnormal first-trimester scan findings, a detection rate of 83.3%. Twenty-three fetuses were identified due to a high risk for trisomy 13, 18 or 21 and two fetuses due to structural abnormalities. The incidence of triploidy at first-trimester screening was 1:6614. A smaller crown-rump length than that estimated by date of last menstrual period was found in 95% of the fetuses with data available for evaluation. Eight fetuses had a larger biparietal diameter than expected for gestational age. Fetuses with a 69,XXX karyotype had significantly lower multiples of the median values for β-hCG and PAPP-A than did 69,XXY fetuses (P = 0.045 and P = 0.02 forβ-hCG and PAPP-A, respectively). No infants with triploidy were born in the study period. Among the triploid gestations detected on first-trimester screening, 20 (80.0%) women chose termination of pregnancy, four (16.0%) had spontaneous miscarriage and one (4.0%) was stillborn. First-trimester screening for trisomy 21 also provides a high detection rate for triploidy.

Post-Intubation Sore Throat and Menstruation Cycles

BackgroundPostoperative sore throat is one of the most common complications of general anesthesia and intubation with prevalence of 18%-65% in different studies. Several risk factors including female gender, postoperative nausea and vomiting and so on have been mentioned.ObjectivesThe aim of this study was to evaluate the incidence of postoperative sore throat in females and its association with menstrual cycles.Patients and MethodsOne hundred females between 18-45 years old with ASA class I or II without predicted difficult airway that were candidate for operation in supine position were enrolled in study. Patients who had pulmonary disease, smoking, common cold within two weeks prior to the operation, previous traumatic intubation history, removable dentures, any congenital or acquired deformity in face, neck, mouth and airway, any known pathology in mouth like aphthous and mouth ulcer,pregnant women, and patients with irregular cycles, and those taking oral contraceptive pills were excluded. By the same protocol general anesthesia was provided and the patients were asked to fill out a three-point scale questionnaire (Low, High, None) 1,6 and 24 hours following intubation to study and record the incidence and severity of sore throat, dysphagia and hoarseness. The date of last menstrual period had been recorded as well.ResultsOf 100 patients, in the first six hours, 51 patients had sore throat and 49 had no pain. During the first 6 hours, 33 patients (33%) had dysphagia and 13 patients had hoarseness at 6th postoperative hour. Age, weight, LMP, intubation time, operation and extubation time and coughing were compared to sore throat, dysphagia and hoarseness. The association between the incidence of coughing and bucking and sore throat was significant (P = 0.03). None of the parameters had a statistically meaningful association with dysphagia.ConclusionsAccording to our results, by omitting probable risk factors of incidence of sore throat and evaluation of role of hormonal changes in women represented in menstrual cycles, there was no significant association between menstrual cycle and sore throat incidence.

Copper T380 intrauterine device for emergency contraception: highly effective at any time in the menstrual cycle

Does the efficacy of placing a copper intrauterine device (IUD) for emergency contraception (EC) to prevent pregnancy depend on menstrual cycle timing and timing of unprotected intercourse (UPI)? If the urine pregnancy test is negative prior to IUD placement, the copper IUD is highly effective for EC at any point in the menstrual cycle. The use of the Copper T380A for EC has been encouraged by the failure of oral EC methods to decrease rates of unintended pregnancy and the documented success of the IUD in reducing unintended pregnancies. However scant data exist regarding the efficacy and safety of IUD insertion for EC when accounting for menstrual cycle timing and time since UPI. This is a secondary analysis of data obtained from a previously published prospective cohort study of women who received the Copper T380A IUD for EC between July 1997 and January 2000. We included 1840 participants according to the study inclusion criteria of a known last menstrual period (LMP) and cycle lengths of 25-35 days. The original study included women aged between 18 and 44 years who presented for EC at 18 sites throughout China and who had regular menstrual cycles between 24 and 42 days, a known LMP, UPI within 120 h (5 days) and a negative urine pregnancy test (cutoff <25 IU/ml). Women with uncertain LMP dates were excluded. This study included only participants with cycle lengths of 25-35 days. Among the 1840 participants with usual cycle lengths of 25-35 days, 850 (46.2%) had their IUD inserted following UPI in the expected fertile window and 84 (4.6%) had the insertion >5 days after the predicted ovulation day and 52 (2.8%) had the insertion >5 days after UPI. There were no pregnancies in the first month among the 1771 women who had information available regarding their 1-month follow-up pregnancy test. This was a secondary analysis of an observational study, and thus participants were not randomized to an alternative postcoital method. There were a small number of women who had UPI >5 days after their predicted ovulation day thus limiting the confidence of assuring a low risk of pregnancy in this situation. The ovulation day was calculated based on the LMP prior to IUD insertion and not on the subsequent first day of menses following IUD insertion. If the urine pregnancy test is negative prior to IUD placement, the copper IUD is likely to be effective for EC at almost any point in the menstrual cycle. The original study was funded by the UNDP/UNPFA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction. The donors and sponsors of the study had no role in the study design, data collection, data analysis, data interpretation, writing of the report or the decision to submit the paper for publication.

P2.179 Exposure to Neisseria Gonorrhoeae (GC) During the Perimenstrual Period May Increase Risk of Infection in Female GC Contacts

Previous studies have shown that a woman is more likely to be diagnosed with gonococcal (GC) infection during the first five days of her menstrual cycle (active menstruation) than during...

Low-birthweight rates higher among Bangladeshi neonates measured during active birth surveillance compared to national survey data.

Birth size is an important gauge of fetal and neonatal health. Birth size measurements were collected within 72 h of life for 16 290 live born, singleton infants in rural Bangladesh from 2004 to 2007. Gestational age was calculated based on the date of last menstrual period. Newborns were classified as small-for-gestational age (SGA) based on a birthweight below the 10th percentile for gestational age, using three sets of US reference data. Birth size distributions were explored based on raw values as well as after z-score standardisation in reference to World Health Organization (WHO) 2006 growth standards. Mean (SD) birthweight (g), length (cm) and head circumference (cm) measurements, completed within [median (25th, 75th percentile)] 15 (8, 23) h of life, were 2433 (425), 46.4 (2.4) and 32.4 (1.6), respectively. Twenty-two per cent were born preterm. Over one-half (55.3%) of infants were born low birthweight; 46.6%, 37.0% and 33.6% had a weight, length and head circumference below -2 z-scores of the WHO growth standard at birth; and 70.9%, 72.2% and 59.8% were SGA for weight based on Alexander et al., Oken et al. and Olsen et al. references, respectively. Infants in this typical rural Bangladesh setting were commonly born small, reflecting a high burden of fetal growth restriction and preterm birth. Our findings, produced by active birth surveillance, suggest that low birthweight is far more common than suggested by cross-sectional survey estimates. Interventions that improve fetal growth during pregnancy may have the largest impact on reducing SGA rates.

Three-dimensional ultrasonography using the VOCAL technique for estimation of reference range between 7 and 11weeks embryonic volume

Abstract Objective Accurate estimation of gestational age (GA) is the basis of vital decisions in pregnancy and hence its importance in obstetric management. This study tries estimating a reference range of 3D embryonic volume using the VOCAL technique for pregnancies between 7 and 11 weeks. Materials and methods This cross-sectional study included 62 singleton normal uneventful pregnancies. All women were essentially sure of the date of last menstrual period. All women were submitted to 3D ultrasonographic examination with VOCAL technique to determine the embryonic volume. In addition the crown-rump length was measured. Regression analysis was performed to predict the gestational age from the fetal volume. Results There was a strong positive correlation between embryonic volume and menstrual age, gestational age and crown-rump length (r = 0.919, 0.938 and 0.941, respectively). Power regression model produced R2 value of 0.838 with a regression equation (y = 52.22 + 6.5 x). Conclusion This study demonstrated that embryonic/fetal volume is a good predictor of gestational age with a power regression equation (y = 52.22 + 6.5 x) for the period from 7 to 10 weeks + 6 days. We suggest using the embryo volume as an early evidence of growth restriction in high risk pregnancy.

Prognostic factors for low birthweight repetition in successive pregnancies: a cohort study

BackgroundTo identify prognostic factors associated with recurrence of low birthweight (LBW) in successive gestations, a study was carried out with a subsample of mothers enrolled in the 2004 Pelotas Birth Cohort.MethodsData were collected by hospital-based interviews. Newborns were weighed and measured. Gestational age was defined according to the date of last menstrual period, ultra-sound scan before the 20th week of pregnancy or the Dubowitz method. Mothers who reported at least one LBW newborn in the two previous gestations were included. Prevalence ratios (PR) and 95% confidence intervals were estimated from Poisson Regression. All estimates were adjusted for parity.ResultsA total of 4558 births were identified in 2004, and 565 met inclusion criteria, out of which 86 (15.2%) repeated LBW in 2004. Among mothers with two LBW babies before 2004, 47.9% presented LBW recurrence. Belonging to the highest socio-economic stratum (PR 0.89; 0.01-0.46) and gaining ≥ 10 kg during pregnancy (PR 0.09; 0.01-0.77) were protective against LBW recurrence. Higher risk of LBW recurrence was observed among mothers with higher parity (≥3 previous deliveries; PR=1.93; 95% CI 1.23-3.02); who had given birth to a previous preterm baby (PR=4.01; 2.27-7.10); who delivered a female newborn in current gestation (PR=2.61; 1.45-4.69); and that had not received adequate antenatal care (PR=2.57; 1-37-4.81).ConclusionImproved quality of antenatal care and adequate maternal weight gain during pregnancy may be feasible strategies to prevent LBW repetition in successive pregnancies.

Trivalent Inactivated Influenza Vaccine and Spontaneous Abortion

To estimate the association between spontaneous abortion and influenza vaccine receipt with a case-control study utilizing data from six health care organizations in the Vaccine Safety Datalink. Women aged 18-44 years with spontaneous abortion during the autumn of 2005 or 2006 were identified using International Classification of Diseases, 9th Revision, Clinical Modification codes. Cases of spontaneous abortion at 5-16 weeks of gestation were confirmed by medical record review; date of fetal demise was based on ultrasound information when available. Control group individuals with a live birth were individually matched to case group individuals by health care organization and date of last menstrual period (LMP). The primary exposure of interest was influenza vaccination during the 28 days preceding the date of spontaneous abortion of the matched pair. Conditional logistic regression models adjusted for maternal age, health care utilization, maternal diabetes, and parity. Our final analysis included 243 women with spontaneous abortion and 243 matched control group women; 82% of women with spontaneous abortion had ultrasound confirmation of fetal demise. Using clinical diagnosis and ultrasound data, the mean gestational age at fetal demise was 7.8 weeks. Mean ages at LMP of case group women and control group women were 31.7 and 29.3 years, respectively (P<.001). Sixteen women with spontaneous abortion (7%) and 15 (6%) matched control group women received influenza vaccine within the 28-day exposure window. There was no association between spontaneous abortion and influenza vaccination in the 28-day exposure window (adjusted matched odds ratio 1.23, 95% confidence interval 0.53-2.89; P=.63). There was no statistically significant increase in the risk of pregnancy loss in the 4 weeks after seasonal inactivated influenza vaccination. II.

Cervical human papillomavirus detection is not affected by menstrual phase

ObjectivesIn many settings, human papillomavirus (HPV) DNA testing already plays an important role in cervical cancer screening. It is unclear whether hormonal fluctuations associated with menstrual phase or oral contraceptive...

Maternal serum endoglin as an early marker of pre-eclampsia in high-risk patients

BackgroundPre-eclampsia is a potentially serious condition that still accounts for significant morbidity and mortality for the affected mother and neonate. Although the pathogenesis is not fully understood, it is now widely accepted that vascular endothelial dysfunction is the most important and principal event in the pathophysiology of the disease. The aims of our study were to compare serum soluble endoglin levels at week 13 in normotensive pregnant women and in high-risk women, to determine whether the maternal plasma soluble endoglin concentration at 26 weeks is increased in pregnancies that subsequently develop pre-eclampsia, and to identify if soluble endoglin measurement improves the results of screening for pre-eclampsia.MethodsThis work was conducted in 60 healthy pregnant controls and 110 pregnant women at high risk for pre-eclampsia. Gestational age was confirmed by date of last menstrual period and first trimester ultrasound. The time of onset of pre-eclampsia was defined as the time of first elevated blood pressure or urinary protein measurement leading to the diagnosis. Blood samples were collected for measurement of soluble endoglin and other routine laboratory tests, including measurement of urinary proteins. Serum soluble endoglin was estimated by sandwich enzyme-linked immunosorbent assay.ResultsThere was a highly significant increase in serum soluble endoglin in high-risk women compared with controls at week 13 (P < 0.001). Further determination of soluble endoglin revealed a more significant increase in women who developed early-onset pre-eclampsia compared with those who developed late-onset pre-eclampsia. Moreover, a significant positive correlation was found between soluble endoglin and both diastolic blood pressure and total urinary protein, ie, severity of pre-eclampsia.ConclusionEstimation of serum soluble endoglin at gestational week 13 could be used as a sensitive screening test for women at high risk of developing pre-eclampsia prior to onset of its clinical manifestations, which could potentially improve the outcome of pregnancy.