Prediction Of Gestational Age Research Articles

Prolonged oligohydramnios and the adverse composite outcome of death or severe neurodevelopmental impairment at 3 years of age in infants born at 22–29 gestational weeks

ObjectiveTo investigate the association between prolonged oligohydramnios and a composite outcome of death or severe neurodevelopmental impairment (NDI) at 3 years of age. MethodsThis single-center retrospective cohort study enrolled infants born at 22–29 weeks of gestational age without major congenital anomalies. The patients were classified into three groups depending on the existence and duration of oligohydramnios: no/non-prolonged oligohydramnios (no or 0–7 days of oligohydramnios), prolonged oligohydramnios (8–14 days), and very prolonged oligohydramnios (> 14 days). The primary outcome was a composite of death or severe NDI, which was defined as severe cerebral palsy, developmental delay, severe visual impairment, or deafness at age 3. ResultsOut of the 843 patients, 784 (93 %), 30 (3.6 %), and 29 (3.4 %) were classified into the no/non-prolonged, prolonged, and very prolonged oligohydramnios groups, respectively. After excluding patients lost to follow-up, the adverse composite outcome at 3 years of age was observed in 194/662 (29 %), 7/26 (27 %), and 8/23 (35 %) in the corresponding groups. The composite outcome showed no significant trend with the duration of oligohydramnios (P = 0.70). In a logistic regression model controlling the known predictors of gestational age, birth weight, small-for-gestational-age, male sex, multiple pregnancy, hypertensive disorders of pregnancy, antenatal corticosteroids, and the number of family–social risk factors, the duration of oligohydramnios was not independently associated with the composite outcome; odds ratio 1.3 (95 % confidence interval, 0.78–2.0). ConclusionProlonged oligohydramnios was not associated with the composite outcome of death or severe NDI at 3 years of age.

To find the correlation between transverse cerebellar diameter measured by cranial ultrasound within 48 h of birth and gestational age as estimated by last menstrual period

Background: Gestational age (GA) may be assessed at any time during pregnancy, and several modes of assessment exist, each requiring better diagnostic techniques that may result in more precise estimates of GA, which could lead to quicker medical management of a pregnant patient. The largest diameter across both hemispheres, measured from outer to outer margin, is the transverse cerebellar diameter (TCD). Aims and Objectives: We aimed to predict the correlation between TCD measured by cranial ultrasound within 48 h of birth and GA as estimated by the last menstrual period. Materials and Methods: The present study was conducted in the Department of Pediatrics, Dr. S. N. Medical College, Jodhpur, Rajasthan. Ethical clearance was obtained from the Institutional Ethical Committee. It was a cross-sectional observational study and the duration of the study was 6 months. We split the population into three groups based on GA: (a) <32 weeks of GA, (b) 32–36+6 days of GA, and (c) 37–42 weeks of GA. We enrolled 25 neonates from each group. Results: A very strong positive correlation between TCD and GA in infants was <32 weeks of gestation age, in infants 32–36 weeks+6 days of gestation age, and in infants 37–42 weeks of gestation age. Regression analysis shows a very strongly significant relationship. Hence, the TCD is a better predictor of GA in the third trimester. Our study reported that there is a close relationship between TCD and GA, with TCD increasing linearly from <32 weeks to 42 weeks. GA can be predicted to be 1.43 weeks by assessing TCD on neonatal cranial ultrasonography images. Conclusion: The TCD is a better predictor of GA in the third trimester. Our study reported that there is a close relationship between TCD and GA, with TCD increasing linearly from <32 weeks to 42 weeks.

An Exploratory Analysis of Maternal Health Variables Increasing the Severity of Congenital Heart Disease in Infants.

Congenital heart defects (CHD) are the most prevalent birth anomaly and leading cause of infant morbidity and mortality worldwide. Heart defects are often attributed to chromosomal abnormality or environmental factors, but most causes remain unknown. The purpose of this analysis was to explore maternal health variables and the relationships to birth outcomes in infants with CHD. Secondary analysis of data from the Wisconsin Pediatric Cardiac Registry. Maternal history of CHDs (odds ratio [OR] = 2.38; 95% confidence interval [CI], 1.42-3.98) and serious health conditions (OR = 1.537; 95%: CI, 1.08-2.17) increase infant risk and CHD severity. Maternal history of hypertension, serious health conditions, CHD, obesity, and income were predictors of birth weight (R² = 0.049, P < .05). Maternal history of hypertension, influenza, serious health conditions, and housing were predictors of gestational age (R2 = 0.045, P < .05). Birth weight (BW) and gestational age (GA) did not correlate to the severity of CHD in this study (simple vs complex, BW = -0.014, GA = 0.011, r). Maternal well-being influences the health of infants born with CHD. Positive maternal health contributes to near-normal birth weight and gestational age. Nurses must discuss optimal reproductive life planning strategies for decreasing risk of CHD and other infant disorders.

Sono-fetal tibial length evaluation as a predictor of gestational age: A case of Nigerian population

Background: Accurate pregnancy dating is essential for guiding patients about the option of termination of pregnancy or in analysis of biochemical serum screening test and to ensure adequate management of pregnant women with the intention to reduce maternal morbidity and mortality, especially when considering the best parameter for estimating gestational age, it is important that the structure has little biological variation, and can be measured with high degree of reproducibility. This study was designed to evaluate the use of fetal tibia length as a tool for the estimation of gestational age among the Nigerian population. Materials and Methods: This was a cross-sectional study, which involved 215 pregnant women selected using convenient sampling technique based on the inclusion criteria in a single private diagnostic centre in Port Harcourt. Ultrasound scan was done on each subject and fetal biometric parameters (Biparietal diameter, femur length and tibial length) and gestational age were assessed and documented. Data obtained were analyzed using descriptive and inferential statistics. Results: The majority (n = 12) of the pregnant women had gestational age of 25 weeks. The mean values for BPD, FL and TL of those with 17th week GA were 36.70±1 0.35, 23.65±0.7 and 22.28±1.42 as the least mean values while the highest mean values were identified in patients that had 41 weeks of GA, which were 95.20±0.00, 79.40±0.00 and 58.00±0.00 for BPD, FL and TL respectively. There were no statistically significance mean differences between BPD (t = 225.17, p = 0.001), FL (t = 100.84, p = 0.001) and TL (t = -33.38, p = 0.001) and the estimated gestational age of 17 weeks. Conclusion: The fetal tibial length (FTL) increases with advancing gestational age in apparently healthy fetus. The FTL can be strongly use as a tool for the prediction of fetal gestational age, where other parameters cannot be evaluated.

Assessment of Correlation between Transcerebellar Diameter and Gestation age in IUGR pregnancies

Background: Accurate assessment of the gestational age is very critical in the management of IUGR cases and their associated complications. Present study was done with the objective to evaluate the Correlation between Transcerebellar Diameter and Gestation age in IUGR pregnancies. Material and Methods: This Prospective Cross-sectional study was conducted on antenatal women of gestational age 15-40 weeks with IUGR pregnancies cases attending the antenatal clinic and admitted in the Department of Obstetrics and gynecology, and sent to Department of Radiology KNSH MandC and IGMC Shimla for Antenatal USG Scan. In every patient TCD was measured. Data was analysed by appropriate statistical test using EPI INFO Version 7.2 software. Correlation coefficients were then used to compare TCD with Gestational age in IUGR pregnancies. Results: In this study 120 cases were studied out of which 20 were pregnancies with IUGR. Age distribution of IUGR pregnancies was 20 to 27years with mean age of 22.6±2.14 years. Maximum number of patients 13(65%) was between 21-25 years followed by 16-20 years 4(20%). Youngest patient was 20 years old and the eldest was 27 years. Maximum number of patients 8(40%) was between 30-36 weeks and 36-42 weeks of gestation and least number of patients 1 (5%) were between 24- 30weeks. In third trimester of pregnancy it was observed that TCD shows strongest correlation with gestational age and shows a statistically significant correlation (P is less than 0.001).It was noted that there is a correlation between gestational age and TCD in second trimester of IUGR pregnancies however the correlation was statistically insignificant(P&gt;0.05). Conclusion: TCD is better predictor of gestational age in IUGR pregnancies as it remains nearly unaffected and correlates more closely with gestational age both in second and third trimester of pregnancy.

Prenatal lead exposure, telomere length in cord blood, and DNA methylation age in the PROGRESS prenatal cohort

BackgroundLead is a ubiquitous pollutant with deleterious effects on human health and remains a major current public health concern in developing countries. This heavy metal may interfere with nucleic acids via oxidative stress or epigenetic changes that affect biological markers of aging, e.g., telomere length and DNA methylation (DNAm). Telomere shortening associates with biological age in newborns, and DNA methylation at specific CpG sites can be used to calculate “epigenetic clocks". ObjectiveThe aim of this study was to examine the associations of prenatal lead exposures with telomere length and DNA-methylation-based predictors of age in cord blood. DesignThe study included 507 mother–child pairs from the Programming Research in Obesity, Growth, Environment and Social Stressors (PROGRESS) study, a birth cohort in Mexico City. Maternal blood (second trimester, third trimester and at delivery) and bone lead levels (one month postpartum) were measured using inductively coupled plasma-mass spectrometry and X-ray fluorescence, respectively. Cord blood leukocyte telomere length was measured using quantitative PCR and apparent age by DNA methylation biomarkers, i.e., Horvath's DNA methylation age and the Knight's predictor of gestational age. ResultsAverage maternal age was 28.5 ± 5.5 years, and 51.5% reported low socioeconomic status. Children's mean telomere length was 1.2 ± 1.3 relative units, and mean DNA methylation ages using the Horvath's and Knight's clocks were −2.6 ± 0.1 years and 37.9 ± 1.4 weeks (mean ± SD), respectively. No significant associations were found between maternal blood and bone lead concentrations with telomere length and DNAm age in newborns. ConclusionWe found no associations of prenatal lead exposure with telomere length and DNA methylation age biomarkers.

Maternal depressive symptoms and stress during pregnancy as predictors of gestational age at birth and standardized body mass index from birth up to 2\u2009years of age

BackgroundWhile depressive symptoms and stress during pregnancy are known to affect gestational age and weight at birth, evidence on their impact on child anthropometric development in the long term remains limited, showing inconsistent effects. Importantly, previous research indicated a substantially stronger impact of categorically rather than dimensionally assessed mental health problems on birth outcomes and child development.MethodsThe Patient Health Questionnaire was used to assess depressive symptoms and stress during the 2nd trimester of pregnancy dimensionally and categorically, with scores ≥10 indicating clinical significance. Gestational age at birth and BMI-SDS from birth up to 2 years of age were examined as dependent variables. Structural equation modeling was used to examine the prediction of birth outcomes and child anthropometry by mental health problems while controlling for multiple maternal and child characteristics in 322 mother-child dyads.ResultsDimensionally assessed mental health problems did not significantly predict birth outcomes. While categorical depressive symptoms significantly predicted a higher child BMI-SDS, categorical stress significantly predicted a lower gestational age at birth. Neither categorical nor dimensional mental health problems significantly predicted child BMI-SDS at 6, 12, and 24 months postpartum.ConclusionsDepressive symptoms and stress during pregnancy seem to differentially affect birth outcomes, and only if clinically relevant. The results implicate the importance to timely treat pregnant women that are greatly affected by mental health problems to potentially reduce adverse birth outcomes.

Sonographic Assessment of Fetal Neck Circumference (NC) As a Predictor of Gestational Age

Abstract Background The need for development of population based nomograms for ultrasound fetal dating cannot be overemphasised. The objective of this study was to develop a nomogram of Fetal Neck Circumference (NC) for predicting gestational age for this population. Methods This was a cross sectional prospective study of 203 singleton normal pregnant women of 15–40 weeks’ gestation. Fetal NC was measured the 5th, 50th and 95th centile values were estimated at each week of gestational age, 50th centile values were then compared to Caucasian and African population study to assess variability. Results A nomogram was derived and NC values showed no statistical significant difference compared to the Caucasians (p = 0.065, 0.257) and African (p = 0.947) population. There was a strong positive significant correlation (r2 = 0.799; p = 0.001) between NC and average gestational age. Method of least square yielded to the equation y = 2.22x + 5.390. NC relationship with BPD (r2 = 0.859; p = 0.001), FL (r2 = 0.842; p = 0.001) and HC (r2 = 0.662; p = 0.001) were also significant and positive. Estimated weekly increase in NC was 0.72 cm. Conclusion This study derived nomogram for ultrasound measurement of fetal NC in a Northern Nigerian population. However, NC values from this study differ less with an African population than with Caucasian study population.

The Role of Fetal Kidney Length and Fetal Transverse Diameter of Heart in Prediction of Gestational Age

Objective: Currently there is no single ultrasonological parameter for accurate estimation of gestational age in third trimester. The present study is undertaken to validate the fetal kidney length and fetal transverse diameter of heart measurement as a measurement of fetal growth with less variability. Materials &amp; Methods: It is a cohort study conducted in Department of Obstetrics and Gynaecology, NEIGRIHMS from 2015 to 2016. 224 women with singleton pregnancies and sure of LMP were enrolled. Each woman underwent minimum three ultrasonographic measurements- at first trimester for gestational age by CRL, at second trimester with fetal conventional biometry, at third trimester with Fetal kidney length, transverse diameter of heart and fetal conventional biometric parameters and analysed with SPSS Version22. Results: The gestational age with CRL was within three days of the menstrual age. In second trimester, conventional parameter (BPD,HC,AC,FL) were better parameters. Conventional parameter did not correspond to gestational age calculated from LMP. (BPD, R2= 0.4819, HC R2- 0.507, AC R2- 0.5175, FL R2-0.5243, Combined Conventional parameter R2- 0.5888). Fetal kidney length (R2-0.8356) and transverse diameter of heart (R2-0.8795) better correlated with gestational age. Conclusion: Kidney length and transverse diameter of heart are better predictors of gestational age in third trimester.

Mechanisms of Early Adversity Associated Increases In Risk For Psychiatric Disorders

Overall Abstract Early adverse exposures, such as maternal stress or toxins during pregnancy and childhood adversity are thought to result in long-lasting consequences on many systems, including the brain and ultimately in an increased risk for psychiatric disorders. The impact of these environmental risk factors is moderated by genetic variation. The biological mechanisms underlying this increased risk are still unclear. This symposium will focus on potential mechanisms mediating these lasting effects and their moderation by genetic variation, with epigenetics, specifically DNA methylation as main candidate. The developing brain is highly sensitive to environmental exposures during the in utero period and three of the presentations will focus on how environmental factors during pregnancy alter risk for psychiatric symptoms as well as brain structure and function and have lasting influences on the epigenome at birth. Prenatal exposures such as cigarette smoke, heavy metals, and folic acid are associated with changes in DNA methylation measured in infants at birth Kelly Bakulski (University of Michigan) will report on data generated in an autism enriched-risk birth cohort that examines the sensitivity of DNA methylation at birth, measured in placental tissue and cord blood, to in utero environmental exposures and the development of autism spectrum disorder or related traits by age three. Margit Burmeister (University of Michigan) will present a study of iron deficiency in newborns in China, demonstrating the detrimental effects of pre-and postnatal iron deficiency with regards to brain structure and function. This is complemented by genome-wide epigenetic analyses that investigate the impact of iron deficiency in the presence of lead exposure and pesticides. Another set of pregnancy-related risk factors associated with increased risk for emotional and behavioral problems in children are stress and depression during pregnancy. Katri Raikkonen (University of Helsinki, Finland) will present data from a large prospective study of pregnancy risk factors and their effects on cord blood DNA methylation and child behavior up to 3.5 years of age. Maternal depression during pregnancy was related to significant changes in a recently established epigenetic predictors of gestational age, with increasing depression, associated with more “immature” epigenetic age. This epigenetic marker was then in turn predicting total behavioral, emotionally reactive, and withdrawn problems in boys. Finally, risk for psychiatric symptoms following exposure to childhood adversity is moderated by genetic variation. Understanding the mechanisms of this moderation may help in targeting specific treatments to children with combined genetic and environmental risk. Sara Jaffee (University of Pennsylvania) showed that 8- to 11-year-old children from the UK who carried two copies of the serotonin transporter polymorphism had elevated levels of internalizing and externalizing problems following exposure to adverse life events because of their coping strategies. Influencing the coping styles of these children may be an effective treatment strategy in this subgroup of children. At the end of the symposium, Elisabeth Binder (MPI of Psychiatry, Munich) will comment of common mechanisms emerging from the data presented in the individuals talk and how a better understanding of these factors will aid biology-based diagnoses of psychiatric disorders and individualized treatment approaches.

Sonographic Assessment of the Fetal Thoracic Length (FTL) as a Predictor of Gestational Age (GA) in Nigerian Population

Sonographic Assessment of the Fetal Thoracic Length (FTL) as a Predictor of Gestational Age (GA) in Nigerian Population

Determination of Gestational Age: A Perspective With the Bangladeshi Ethnicity

Determination of gestational age (GA) with precision is vital to the proper care of pregnant mothers. Our present study aimed at determining the gestational ages by the ultrasonic measurements of four standard fetal parameters namely biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL) specifically focusing on the Bangladeshi ethnic population. The current study is cross-sectional but data were collected in a prospective nature. There were 229 Bangladeshi women who had usual singleton fetuses with the evidence of menstrual dates by sonography before 14 weeks. Fetal anatomical structures have been scanned and measured at the time of sonographic inspection. Multiple linear regression models of GA by the date of last menstrual period (LMP) and GA by ultrasonographic measures have been fitted on four fetal parameters for our analysis. In the present analysis, we have found that all the response variables i.e. gestational age by LMP and gestational age by ultrasonography (USG) clearly depend on the fetal parameters. The best subsets regression analysis shows that BPD, AC, and FL are the best predictors of GA by LMP (adj R 2 = 96.54). In terms of Mallow’s Cp and adj R 2 , it is found that all the fetal parameters BPD, AC, HC and FL are important predictors for GA by USG. It has been observed that multiple fetal parameters measured by ultrasonography can be useful to predict gestational age during second and third trimesters. Precise estimation of gestational age by this method is helpful to reduce pregnancy-related complicacy and maternal death in the developing countries including Bangladesh.

Reinforcing cerclage for a short cervix at follow-up after the primary cerclage procedure

Objective: To determine whether a reinforcing cerclage (RC) for a short cervix measured after the primary cerclage procedure prolonged pregnancy. Methods: We conducted a retrospective cohort study of 157 women with singleton gestations who underwent cerclage for standard indications. Women were grouped according to cervical length (CL) at the time of follow-up 1–2 weeks after the initial cerclage placement: ≥25 mm (106 women) and <25 mm with (20 women) or without RC (31 women). Gestational age (GA) at delivery was compared by ANOVA. Survival risk analysis was applied to model GA at delivery adjusted for indication and CL before and after the first cerclage. Results: Women with CL ≥25mm delivered later than women with CL < 25mm after the first cerclage (p < 0.01). RC did not delay delivery for women with CL < 25 mm (p = 0.17) after the primary procedure. Indication for the primary cerclage (p < 0.01) and CL (p < 0.01) after the primary cerclage were the best predictors for GA at delivery. Conclusion: Placement of RC for short cervix did not prolong duration of pregnancy, GA at delivery or modify the probability of preterm birth.

Cervical Length and Maximum Vertical Pocket as Predictors of Gestational Age at Delivery in Pregnancies Treated With Selective Fetoscopic Laser Photocoagulation for Severe Twin–Twin Transfusion Syndrome [94

OBJECTIVE: To evaluate the effect of polyhydramnios on cervical length and whether cervical length recovery after amnioreduction during selective fetoscopic laser photocoagulation is associated with a greater gestational age at delivery in pregnancies complicated by severe twin–twin transfusion syndrome. METHODS: Retrospective study of pregnancies complicated by severe twin–twin transfusion syndrome treated by selective fetoscopic laser photocoagulation performed between March 2010 and October 2013 at a single center. Preoperative maximum vertical pocket and preoperative and postoperative cervical lengths were measured. The cervical length difference was calculated with a difference of ±3 mm considered no change. Data were analyzed with Spearman and Pearson correlation coefficients calculated for gestational age at delivery. RESULTS: Thirty-nine women were included in the study population. Preoperative (ρ=0.352; P=.035) and postoperative (ρ=0.332, P=.044) cervical lengths were found to have significant positive correlations with gestational age. A subgroup analysis excluding iatrogenic deliveries less than 34 weeks of gestation (n=22) showed a similar correlation with postoperative cervical length, but only a trend toward significance (ρ=0.379; P=.06). Change in cervical length and preoperative maximum vertical pocket were not statistically correlated with gestational age at delivery. The overall survival rate was 74.3% (57/78). There were two fetal survivors in 56.4% (22/39) and at least one survivor in 89.7% (35/39). CONCLUSION: Selective fetoscopic laser photocoagulation remains an effective therapy for pregnancies complicated by severe twin–twin transfusion syndrome. This study is concordant with prior research indicating that cervical length before and after treatment has a significant correlation with gestational age at delivery. However, severity of polyhydramnios and change in cervical length postprocedure were not found to be statistically significant.

Assessment of fetal gestational age in different trimesters from ultrasonographic measurements of various fetal biometric parameters

Introduction: Fetal biometry is a methodology devoted to measuring several parts of fetal anatomy and their growth. Aim: The present study was carried out to assess gestational age in the second and third trimesters with the help of ultrasonographic measurements of four fetal biometric parameters (i.e., biparietal diameter [BPD], head circumference [HC], abdominal circumference [AC], and femur length [FL]) in the local population (Jaipur Zone) of Rajasthan, and also to evaluate efficacy and significance of these four fetal biometric parameters in the prediction of gestational age by ultrasound. Materials and methods: Three hundred and thirty cases of normal pregnant females were studied (165 - second trimester [13–28 weeks] and 165 - third trimester [29–40 weeks]) with the known last menstrual period (LMP) and studied once during gestation. Results: Biparietal diameter and head circumference were found to be equally best predictors of gestational age and to determine the expected date of delivery (EDD) in the second trimester and BPD and FL in the third trimester. Abdominal circumference was the least accurate parameter in both trimesters. Variability in predicting gestational age (using all four parameters) was ±2 weeks in the second trimester and +2 to −4 weeks in the third trimester. The accuracy decreased and variability increased as the pregnancy advanced from the second to third trimester. Mean measurements of fetal biometric parameters were found lower than Western monograms in each week of both trimesters. Conclusions: Variation in predicted gestational age by ultrasonography (USG) is attributed to the anthropometric difference between the two populations due to racial, genetic, nutritional, and socioeconomic factors. Therefore, population-specific measurements should be made to generate tables and regression equations for more precise reporting of gestational age and EDD by USG.

P30.07: Predicting gastroschisis perinatal outcome from antenatal characteristics

Objectives: The objective was to estimate a reference range of 3D embryo volume using VOCAL for pregnancies between 7 & 11weeks. Methods: This is a cross-sectional study including 60 singleton pregnancies with an E6 (GE, USA)with an endocavitary volumetric 4–9 MHz probe, using VOCAL with a manual tracer at 30◦, the outer aspect of the embryo was drawn manually on every image displayed sequentially in this plane. At the end of the 180◦ rotation, the built in software calculated the volume automatically. Results: The mean CRL was 23.7 ± 9.0 mm (range 9 to 38 mm). Mean fetal volume was 1.7 ± 1.2 cm3 (range 0.35 to 4.0 cm3). There was a strong positive correlation between fetal volume and menstrual age, gestational age and CRL (r = 0.919, 0.938 and 0.941, resp.). Power regression model produced an R2 value of 0.880 with a regression equation (y = 8.657 * ×0.150). The predicted gestational age fitted well with that predicted from CRL with a minimal difference and a P of 0.234. Conclusions: This pilot study demonstrated a strong correlation between fetal volume estimation and crown-rump length measurement for the prediction of gestational age (r = 0.950). Embryonic/fetal volume is a good predictor of gestational age with a power regression equation (y = 8.657 * ×0.150) for the period from 7 weeks to 10 weeks + 6 days.

P30.06: Intrapartum translabial sonography: a prospective analysis of various methods to predict the mode of delivery in prolonged second stage of labor

Objectives: The objective was to estimate a reference range of 3D embryo volume using VOCAL for pregnancies between 7 & 11weeks. Methods: This is a cross-sectional study including 60 singleton pregnancies with an E6 (GE, USA)with an endocavitary volumetric 4–9 MHz probe, using VOCAL with a manual tracer at 30◦, the outer aspect of the embryo was drawn manually on every image displayed sequentially in this plane. At the end of the 180◦ rotation, the built in software calculated the volume automatically. Results: The mean CRL was 23.7 ± 9.0 mm (range 9 to 38 mm). Mean fetal volume was 1.7 ± 1.2 cm3 (range 0.35 to 4.0 cm3). There was a strong positive correlation between fetal volume and menstrual age, gestational age and CRL (r = 0.919, 0.938 and 0.941, resp.). Power regression model produced an R2 value of 0.880 with a regression equation (y = 8.657 * ×0.150). The predicted gestational age fitted well with that predicted from CRL with a minimal difference and a P of 0.234. Conclusions: This pilot study demonstrated a strong correlation between fetal volume estimation and crown-rump length measurement for the prediction of gestational age (r = 0.950). Embryonic/fetal volume is a good predictor of gestational age with a power regression equation (y = 8.657 * ×0.150) for the period from 7 weeks to 10 weeks + 6 days.

Gestational age estimation using transcerebellar diameter with grading of fetal cerebellar growth

Abstract Background : The transverse cerebellar diameter (TCD) serves as a reliable predictor of gestational age (GA) of the fetus and is a standard against which aberrations in other fetal parameters can be compared, especially when the GA cannot be determined by the date of the last menstrual period or an early pregnancy scan. Aim : The aim of this study was to derive a regression equation and evaluate the relationship between transverse cerebellar diameter and gestational age, which will be helpful in assessing the fetal gestational age and also to evaluate the grades of cerebellum and to see its growth. Materials &amp; methods : The prospective study was carried out in 292 pregnant women between 14-40 weeks of pregnancy attending the Konaseema Institute of Medical Sciences &amp; Research Foundation, Amalapuram for routine ultrasound examination. Transverse cerebellar diameter was measured and cerebellum was graded using ultrasonography. Results : Fetal cerebella were found to be in 29%, 10% and 61 % cases as grade I, II and III respectively. The grade changed from I to III progressively with advancing gestation. The median GA and TCD were 20 wks and 22 mm for grade I, 32 wks and 30 mm for grade II and 36 wks and 38 mm for grade III. Conclusion : Regression analysis indicated a strong relationship between TCD and gestational age indicating TCD is a good marker for estimation of gestational age.

Factors influencing initiation of antenatal care in Ibadan, Nigeria

Objective: Late antenatal care (ANC) registration and irregular attendance have been implicated as factors preventing women from receiving the full benefits of effective ANC. Therefore, this study seeks to elicit the factors that impact pregnant women's timing of registration for ANC in a mission hospital, in Ibadan, Nigeria. Method: A cross-sectional study of 160 women attending the booking clinic over a 4-week period. A structured questionnaire was utilized to collect data on sociodemographic characteristics, index pregnancy, previous pregnancy and past obstetrical history. Result: Only 14 women (9.4%) booked at first trimester while 93 (62.4%) and 42 (28.2%) booked at second and third trimesters respectively. For previous and current pregnancies, the husband's instruction was the leading influence for booking, at 71 (45.8%) and 89 (57.4%) respectively. Knowledge of ANC timing, experience of loss of child and miscarriage were significant predictors of gestational age at booking. Conclusion: This study suggests the need for education at a pre-conceptual stage of the benefits of early initiation of ANC for women.

Preconception Cardiovascular Risk Factors and Pregnancy Outcome

Pregnancy-related cardiovascular conditions are associated with both poorer pregnancy outcomes and cardiovascular disease later in life. Little is known about the relationship between preconception cardiovascular risk factor levels and pregnancy complications. Data from the Cardiovascular Risk in Young Finns Study were linked with birth registry data for 1142 primiparous women. Age-standardized levels of total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, blood pressure, insulin, and glucose from the study visit prior to last menstrual period were calculated. These factors were examined as predictors of gestational age, preterm birth (<37 weeks), birthweight, low birthweight (<2500 g), small-for-gestational-age (weight <10th percentile for gestational age), hypertensive disorders of pregnancy, and gestational diabetes, using linear and Poisson regression with adjustment for age, body mass index, smoking, and socioeconomic status. Higher triglycerides were associated with a higher risk of hypertensive disorders (adjusted risk ratio [aRR] = 1.42 [95% confidence interval (CI) = 0.90-2.23]), preeclampsia (1.70 [1.08-2.65]), and gestational diabetes (1.68 [1.25-2.25]). After removing women with pregnancy complications (n = 30), the estimated aRR for the association between systolic blood pressure and preterm birth was 1.23 (95% CI = 0.99-1.54); for HDL-c and low birthweight, 0.97 (0.73-1.28); for diastolic blood pressure and small-for-gestational-age, 0.98 (0.81-1.20); and for systolic blood pressure and small-for-gestational-age, 1.18 (0.97-1.45). High lipid levels before pregnancy predict an increased risk of preeclampsia and gestational diabetes. Reported associations between these pregnancy complications and later cardiovascular disease of the mother are probably explained, at least in part, by maternal conditions that precede pregnancy. Interventions to improve cardiovascular health before pregnancy may reduce risk of pregnancy complications.