Gestational Age Range Research Articles

Arterial Stiffness and Carotid Intima-Media Thickness in Children Exposed to Smokeless Tobacco in Fetal Life.

Arterial stiffening and increased intima-media thickness can be seen as early as childhood and are associated with increased risk of cardiovascular events in adult life. The authors hypothesized that exposure to prenatal smokeless tobacco (Swedish snus) without additional nicotine exposure after the breastfeeding period would be associated with increased arterial stiffness and intima-media thickening in preschool children. This was a longitudinal follow-up cohort study of children aged 5 to 6 years exposed to high doses of nicotine in utero. Women exclusively using snus and unexposed controls were enrolled in early pregnancy (gestational age range, 6-12 weeks). Exposure data were collected during and after pregnancy with questionnaires from both groups. For this study, only children of women using >48 mg nicotine per day during their entire pregnancy were included in the exposure group. Outcomes were determined in 40 healthy children (21 exposed to snus in utero). Ultrasonography of the common carotid artery was used to determine carotid intima-media thickness and calculate arterial stiffness index from the relationship between pulsatile changes in arterial diameter and arterial pressure. Children exposed to snus in fetal life had higher carotid stiffness (median 4.1 [interquartile range (IQR), 2.4-5] versus 2.9 [IQR, 2.1-3.5]; P=0.014) than tobacco-free controls. Carotid strain (relative diameter change) was lower in children exposed to snus (mean 16% [SD, 5.7%] versus 21% [SD, 6.6%]) than in controls (P=0.015). Carotid intima-media thickness did not differ significantly between children exposed to snus and controls. Exposure to snus during fetal life was associated with a stiffer carotid artery in preschool children.

Cost effectiveness of a protocol using palivizumab in preterm infants

ObjectiveThe main objective was to evaluate the cost-effectiveness of protocol use of palivizumab in premature established by consensus in our Hospital comparing it based on the recommendations of various Scientific Societies. As a secondary objective risk factors and severity of hospitalized patients attending the established protocol in our Hospital were analyzed. MethodsThe study period was 4 seasons with the expanded protocol (retrospective data) versus 2 with restricted or agreed protocol (prospective data). The perspective of the study was the Health System, including the costs of hospitalization and palivizumab our center. The calculation of the effectiveness was determined with the admission rate of premature patients stratified by weeks of gestational age <29, <32; and <35.For the analysis of risk factors and severity in patients admitted seasons with the new protocol are collected prospectively clinical data and environmental and social factors. ResultsIn the range of gestational age < 29 years old and < 32 greater effectiveness of the extended protocol was not demonstrated against the consensus. Only more effective for EG <35 in the accumulated data and comparing seasons 12/13 and 08/09 to 13/14 for individual data was observed. This range has an associated incremental cost effectiveness ratio of €53 250,07 (range: € 14793,39 to €90446,47 for singles data and €50525,53 (€28688.22 to €211 575,65) for accumulated. The establishment of this protocol in our center meant an average saving per season €169911,51.A cost-effectiveness of the extended protocol appropriate relationship is found if the cost of palivizumab per patient was less than €1206,67 (calculated for maximum use of the vial) and a higher rate of hospitalization of 9.21%.Children entering the season with the new protocol (season 12/13 and 13/14) are 63.4% in children under 3 months and 90% are term infants who do not belong to any population at risk, while many of them have associated risk factors you vary as have school-age siblings, rural residence, parental smoking, poor educational background of parents, lack of artificial feeding and family history of allergy. ConclusionsThe consensus protocol has not been a significant increase in hospitalization rates in preterm infants <32 weeks gestational age patients. In those <35 has been observed a higher rate of hospitalization, with a very unfavorable cost-effectiveness for all clinical scenarios valued relationship.

Effects of gender on fetal cortical development: a secondary analysis of a prospective cross-sectional study.

The primary objective was to evaluate the effects of fetal sex on fetal cortical development in low-risk pregnancies. Secondary objective was the evaluate the impact of gestational age. This was a secondary analysis of a prospective cross-sectional study on low-risk fetuses undergoing fetal neurosonography between 19 and 34 weeks of gestation. The depth of Sylvian Fissure (SF), Parieto Occipital Fissure (POF) and Calcarine Fissure (CF) were evaluated and related to fetal sex. Neurosonographic variables were normalized for fetal head circumference and expressed as multiple of the median (MoM). A total of 344 fetuses were considered (173 male, 171 female). The baseline characteristic of the two groups were similar except a higher birthweight present in male fetuses (p=0.044). The depth SF (p=0.023) CF (p=0.014) and POF (p=0.046) showed significantly higher values in male fetuses when all the gestational age range was considered. However, when data were controlled for gestational age, these differences resulted significant only after 28 weeks. Differences in cortical development related to gender occur after 28 weeks of gestation with an increase depth of SF, POF and CF in male fetuses.

Coagulation parameters in very preterm infants.

The aim of this study was to define normal percentile values of coagulation parameters in preterm infants below 32 weeks of gestational age. This retrospective cohort study was conducted at Istanbul Medical Faculty. Preterm infants who were born prior to 32 weeks of gestation, between 2011 and 2021 were included and evaluated for coagulation parameters. Blood samples obtained through umbilical catheters prior to administration of heparinized flushes/fluids, vitamin K or fresh frozen plasma (FFP). Infants with a major bleeding disorder, intrapartum asphyxia or a history of familial bleeding disorders were excluded. Infants were grouped according to their gestational ages and birth weights: less than 24, 25-26, 27-28, 29-30, 31-32 weeks and <500, 500-749, 750-999, 1000-1249, 1250-1499, more than 1500 g. Third to 97th percentile values of both prothrombin time (PT) and activated partial thromboplastin time (aPTT) were defined. A total of 420 preterm infants were included. The median value and range of gestational age and birth weight of the infants were 29 (22.3-32.9) weeks and 1150 (395-2790) g, respectively. PT values were similar between subgroups according to gestational age but longer in infants with a birth weight less than 1000 g. aPTT values in infants born less than 24 weeks of gestation were found significantly longer. As maturation of the coagulation system increases by gestational age, very preterm infants (<32 gestational week (GW)) are under increased risk of bleeding. Determination of normal percentile distribution of coagulation parameters for preterm infants will shed light on the interpretation of coagulation parameters of these infants and minimize unnecessary FFP administrations.

Comparison of simultaneous auscultation and ultrasound for clinical assessment of bowel peristalsis in neonates.

Assessment of bowel health in ill preterm infants is essential to prevent and diagnose early potentially life-threatening intestinal conditions such as necrotizing enterocolitis. Auscultation of bowel sounds helps assess peristalsis and is an essential component of this assessment. We aim to compare conventional bowel sound auscultation using acoustic recordings from an electronic stethoscope to real-time bowel motility visualized on point-of-care bowel ultrasound (US) in neonates with no known bowel disease. This is a prospective observational cohort study in neonates on full enteral feeds with no known bowel disease. A 3M™ Littmann® Model 3200 electronic stethoscope was used to obtain a continuous 60-s recording of bowel sounds at a set region over the abdomen, with a concurrent recording of US using a 12l high-frequency Linear probe. The bowel sounds heard by the first investigator using the stethoscope were contemporaneously transferred for a computerized assessment of their electronic waveforms. The second investigator, blinded to the auscultation findings, obtained bowel US images using a 12l Linear US probe. All recordings were analyzed for bowel peristalsis (duration in seconds) by each of the two methods. We recruited 30 neonates (gestational age range 27-43 weeks) on full enteral feeds with no known bowel disease. The detection of bowel peristalsis (duration in seconds) by both methods (acoustic and US) was reported as a percentage of the total recording time for each participant. Comparing the time segments of bowel sound detection by digital stethoscope recording to that of the visual detection of bowel movements in US revealed a median time of peristalsis with US of 58%, compared to 88.3% with acoustic assessment (p < 0.002). The median regression difference was 26.7% [95% confidence interval (CI) 5%-48%], demonstrating no correlation between the two methods. Our study demonstrates disconcordance between the detection of bowel sounds by auscultation and the detection of bowel motility in real time using US in neonates on full enteral feeds and with no known bowel disease. Better innovative methods using artificial intelligence to characterize bowel sounds, integrating acoustic mapping with sonographic detection of bowel peristalsis, will allow us to develop continuous neonatal bowel sound monitoring devices.

Delayed diagnosis of congenital cataract in preterm infants: Findings from the IoLunder2 cohort study.

Early detection is critical to achieving optimal outcomes in children with congenital cataract. We hypothesized that detection of congenital cataract in preterm infants would be delayed compared with term/post-term peers due to delayed delivery of whole population child health interventions. Secondary analysis of data using a nested case-control study approach in a prospective population-based cohort study. Inclusion criteria comprised children diagnosed with congenital cataract requiring surgical intervention during the first two years of life in UK and Ireland in 2009 and 2010. Association between late detection (after eight weeks post-natal age, ie outside the neonatal and infant eye national screening programme) of cataract and preterm birth (gestational age less than 37 weeks) was assessed using multivariable logistic regression. Of 186 children with congenital cataract, 17 children were born preterm (9%, gestational age range 24-37weeks). Neonatal detection occurred in 64/186 (34%), and late detection in 64 children (34%). Late detection was independently associated with premature birth, specifically moderate/late preterm birth (adjusted odds ratio 3.0, 95%CI 1.1 to 8.5). Our findings suggest that, despite enhanced eye surveillance being recommended for those born moderate/late preterm (32+ weeks gestational age, ie not eligible for retinopathy of prematurity screening), congenital cataract is not being effectively detected through the routine screening programme for this vulnerable group. It is necessary to improve the effectiveness of the screening programme, and care must be taken to ensure that competing health care needs of preterm children do not prevent universal child health interventions.

Gestational age at birth and hospitalisations for infections among individuals aged 0–50 years in Norway: a longitudinal, register-based, cohort study

Preterm birth is associated with increased risk of childhood infections. Whether this risk persists into adulthood is unknown and limited information is available on risk patterns across the full range of gestational ages. In this longitudinal, register-based, cohort study, we linked individual-level data on all individuals born in Norway (January 01, 1967-December 31, 2016) to nationwide hospital data (January 01, 2008-December 31, 2017). Gestational age was categorised as 23-27, 28-31, 32-33, 34-36, 37-38, 39-41, and 42-44 completed weeks. The analyses were stratified by age at follow-up: 0-11 months and 1-5, 6-14, 15-29, and 30-50 years. The primary outcome was hospitalisation due to any infectious disease, with major infectious disease groups as secondary outcomes. Adjusted hospitalisation rate ratios (RRs) for any infection and infectious disease groups were estimated using negative binomial regression. Models were adjusted for year of birth, maternal age at birth, parity, and sex, and included an offset parameter adjusted for person-time at risk. Among 2,695,830 individuals with 313,940 hospitalisations for infections, we found a pattern of higher hospitalisation risk in lower gestational age groups, which was the strongest in childhood but still evident in adulthood. Comparing those born very preterm (28-31) and late preterm (34-36) to full-term (39-41 weeks), RRs (95% confidence interval) for hospitalisation for any infectious disease at ages 1-5 were 3.3 (3.0-3.7) and 1.7 (1.6-1.8), respectively. At 30-50 years, the corresponding estimates were 1.4 (1.2-1.7) and 1.2 (1.1-1.3). The patterns were similar for the infectious disease groups, including bacterial and viral infections, respiratory tract infections (RTIs), and infections not attributable to RTIs. Increasing risk of hospitalisations for infections in lower gestational age groups was most prominent in children but still evident in adolescents and adults. Possible mechanisms and groups that could benefit from vaccinations and other prevention strategies should be investigated. St. Olav's University Hospital and Norwegian University of Science and Technology, Norwegian Research Council, Liaison Committee for education, research and innovation in Central Norway, European Commission, Academy of Finland, Sigrid Jusélius Foundation, Foundation for Pediatric Research, and Signe and Ane Gyllenberg Foundation.

Evaluation of management of Cesarean Scar Pregnancy (CSP).

Objective: To evaluate our experience in treatment of Caesarean Scar Pregnancy (CSP). Study Design: Cross Sectional Descriptive study. Setting: Department of Gynecology and Obstetrics, Independent Medical College Faisalabad. Period: Jan 2016 to Jan 2021. Material &amp; Methods: The data for this study retrospectively obtained from outpatient department, emergency ward and labor ward registers. Data was analyzed by simple descriptive statics. Diagnosis of CSP was made by using transvaginal ultrasound and color flow Doppler ultrasound. Treatment offered was either medical management as systemic methotrexate or surgical as D&amp;C or laparotomy. The aim was to do conservative treatment for fertility sparing. Patient age, gestational age at time of presentation, number of previous Cesarean Section and success of overall management strategy was analyzed. Results: In this study we had 12 patients diagnosed to have CSP with at least one scar on uterus of previous caesarean section. The mean age of patients was 32.5± 2 years and the gestational age range was from 5 weeks and 3 days to 10 weeks and 1 day. The diagnosis was done by using transvaginal ultrasound and color flow Doppler ultrasound. Which showed high velocity and low impedance flow in sub trophoblastic area. Out of 12 patient’s 58.33 percent were treated with systemic methotrexate and had successful outcome. These were followed by B-hCG levels till non pregnant serum level of B-hCG of &lt;5.1IU was achieved. 16.66 percent patients underwent D&amp;C, but due to hemorrhage they were treated with laparotomy as supplementary procedure. 41.55 percent Patients were treated by laparotomy as their primary management with aim of fertility sparing surgery. The laparotomy was found to be successful treatment in all the patients who underwent surgical management as their primary treatment. Conclusion: Prompt diagnosis has pivotal role in reducing morbidity and mortality associated with CSP. Medical management is found to be successful at early gestational age. Fertility sparing surgery is better option as gestation advances more than 8 weeks to avoid undesirable outcome like hemorrhage and hysterectomy.

Prevalence of Prematurity in the Neonatology Unit of the Reference Health Centre of the Commune I of Bamako (Mali)

Prematurity is defined as any viable birth before the 37th week of amenorrhea (259th day), starting from the first day of the last menstrual period during our study period, 1006 newborns were hospitalised in the neonatology unit. In Africa, preterm infants are one of the leading causes of neonatal mortality and account for one fifth of all neonatal mortality cases. Materials and Method: This was a prospective descriptive study of premature newborns hospitalised at the commune I neonatology unit from July 2018 to June 2019. We included all premature infants hospitalized during the study period, whose records were usable. Result: In our study, we had a prevalence of 11.93%, the average maternal age was 24.26 years with extremes of 15 and 40 years. The majority of premature babies came from the maternity ward of the CSRéf 85%. The average birth weight was 1650 g, with a predominance of the 1500 to 1800 g range (45.84%). The average gestational age according to the Farr score was 33.89 days, with the most common gestational age range being 35-36 days, i.e. 43.33%. The most common complications were: probable neonatal infection 85%, followed by haemodynamic disorders 35% and respiratory distress 34.7%. The average length of hospital stay was 5.13 days, with extremes of 3 days to 90 days. In-hospital mortality was 7.5%, with respiratory distress being the most common cause of death (66.7%) followed by seizures (11.1%).

Antenatal steroids: benefits, risks, and new insights.

Being born before 37 weeks' gestation, or preterm birth, is a leading cause of early childhood death and life-long disability. Antenatal steroids (ANS) are recommended for women judged at risk of imminent preterm delivery. The primary intent of ANS treatment is to rapidly mature the fetal lungs to reduce the risk of mortality and lasting morbidity. Despite being used clinically for some 50 years, a large number of uncertainties remain surrounding the use of ANS. In particular, the choice of agent, dose / regimen, and appropriate gestational age range for ANS therapy all remain unclear. Unresolved concerns regarding potential risk of harms from ANS treatment, especially in light of the modest benefits seen with expanding late-preterm administration, make it increasingly important to optimize the dosing and application of this important and widely used treatment. This review will serve to summarize past data, provide an update on recent developments, and chart a way forward to maximize the overall benefit of this important therapy.

Periviable Premature Rupture of Membranes—Maternal and Neonatal Risks: A Meta-Analysis [ID: 1363862

INTRODUCTION: Periviable rupture of membranes counseling should describe maternal and neonatal outcomes associated with both immediate delivery or expectant management; unfortunately, most published data focuses on neonatal outcomes and maternal risk estimates vary widely. We performed a meta-analysis to describe outcomes associated with expectant management compared to immediate delivery of periviable PROM. METHODS: We performed a systematic review of the literature including published clinical trials and observational cohorts after the year 2000. Publications were selected if they included maternal and neonatal outcomes for both expectant management and immediate delivery. Gestational age range was limited from 14 to 25 weeks. The primary outcome was maternal sepsis. Secondary outcomes included chorioamnionitis, hemorrhage, laparotomy, and neonatal survival. Pooled risk differences were calculated for each outcome using a random effects model. Publication bias was assessed using funnel plots and Harbord test. RESULTS: A total of 2,550 studies were initially screened, and 44 manuscripts were reviewed. Of these, 5 publications met inclusion for analysis: 4 retrospective and 1 prospective. Overall, 61.1% of women chose expectant management. Expectant management was associated with a 4% increased risk of maternal sepsis, 30% increased risk of chorioamnionitis, and 28% increased risk of any laparotomy. Neonatal survival with expectant management was 34% compared to 0% with immediate delivery. CONCLUSION: Women who choose to undergo expectant management experience an increased risk of sepsis, chorioamnionitis, and laparotomy with only one-third of neonates surviving to discharge. Knowledge of these risks is critical to counseling patients with this diagnosis.

Placental lesions associated with stillbirth by gestational age, according to feature importance: Results from the stillbirth collaborative research network

IntroductionPrevious studies have identified lesions commonly found in placentas associated with stillbirth but have not distinguished across a range of gestational ages (GAs). The objective of this study was to identify lesions associated with stillbirths at different GAs by adapting methods from the chemical machine learning field to assign lesion importance based on correlation with GA. MethodsPlacentas from the Stillbirth Collaborative Research Network were examined according to standard protocols. GAs at stillbirth were categorized as: <28 weeks (extreme preterm stillbirth [PTSB]), 28–33′6 weeks (early PTSB), 34–36′6 weeks (late PTSB), ≥37 weeks (term stillbirth). We identified and ranked the most discriminating placental features, as well as those that were similar across GA ranges, using Kernel Principal Covariates Regression (KPCovR). ResultsThese analyses included 210 (47.2%) extreme PTSB, 85 (19.1%) early PTSB, 62 (13.9%) late PTSB, and 88 (19.8%) term stillbirths. When we compute the KPCovR, the first principal covariate indicates that there are four lesions (acute funisitis & nucleated fetal red blood cells found in extreme PTSB; multifocal reactive amniocytes & multifocal meconium found in term stillbirth) that distinguish GA ranges among all stillbirths. DiscussionThere are distinct placental lesions present across GA ranges in stillbirths; these lesions are identifiable using sophisticated feature selection. Further investigation may identify histologic changes across gestations that relate to fetal mortality.

A prospective study on correlation of cord blood bilirubin with occurrence of neonatal hyperbilirubinemia

Background: Neonatal hyperbilirubinemia is one of the most common problems that can occur in a healthy new-born. This physiological rise in indirect component of bilirubin resolves gradually without any intervention in majority of cases. But few babies require intervention in the form of phototherapy and exchange transfusion when the bilirubin levels exceed the normal physiological range for gestational age. The study was aimed to evaluate the predictive value of cord blood bilirubin level for identifying newborn for development of significant hyperbilirubinemia. Methods: It was a prospective observational study carried out in Adichunchanagiri Institute of Medical Sciences, B.G. Nagara, Karnataka. The cord blood bilirubin at birth and 48 hrs serum bilirubin levels were measured. Also, blood group, Rh status and DCT (direct coomb’s test) were tested to estimate the risk in development of hyperbilirubinemia. Results: A total of 210 were included in the study, out of which 52 babies required phototherapy, with a sensitivity of 94.23% and specificity of 3.97%, with the mean cord blood bilirubin level of 2.6mg/dl, having sensitivity of 63.46% and specificity of 90.50%. The multivariate analysis showed ABO and Rh incompatibility, cord blood bilirubin level and lower gestational age had an increased the risk of hyperbilirubinemia requiring phototherapy. Conclusions: Cord blood bilirubin may be used as a potential tool to determine hyperbilirubinemia in newborns. And initiation of phototherapy early in at-risk neonates may decrease the hyperbilirubinemia related morbidity and mortality. Keywords: hyperbilirubinemia; cord blood bilirubin; phototherapy; newborn

Assessment of normal pulmonary development using functional magnetic resonance imaging techniques

The mainstay of assessment of the fetal lungs in clinical practice is via evaluation of pulmonary size, primarily using 2D ultrasound and more recently with anatomical magnetic resonance imaging.The emergence of advanced magnetic resonance techniques such as T2* relaxometry in combination with the latest motion correction post-processing tools now facilitates assessment of the metabolic activity or perfusion of fetal pulmonary tissue in vivo. This study aimed to characterize normal pulmonary development using T2* relaxometry, accounting for fetal motion across gestation. Datasets from women with uncomplicated pregnancies that delivered at term, were analyzed. All subjects had undergone T2-weighted imaging and T2* relaxometry on a Phillips 3T magnetic resonance imaging system antenatally. T2* relaxometry of the fetal thorax was performed using a gradient echo single-shot echo planar imaging sequence. Following correction for fetal motion using slice-to-volume reconstruction, T2* maps were generated using in-house pipelines. Lungs were manually segmented and mean T2* values calculated for the right and left lungs individually, and for both lungs combined.Lung volumes were generated from the segmented images, and the right and left lungs, as well as both lungs combined were assessed. Eighty-seven datasets were suitable for analysis. The mean gestation at scan was 29.9±4.3 weeks (range: 20.6-38.3) and mean gestation at delivery was 40±1.2 weeks (range: 37.1-42.4). Mean T2* values of the lungs increased over gestation for right and left lungs individually and for both lungs assessed together (P=.003; P=.04; P=.003, respectively). Right, left, and total lung volumes were also strongly correlated with increasing gestational age (P<.001 in all cases). This large study assessed developing lungs using T2* imaging across a wide gestational age range. Mean T2* values increased with gestational age, which may reflect increasing perfusion and metabolic requirements and alterations in tissue composition as gestation advances. In the future, evaluation of findings in fetuses with conditions known to be associated with pulmonary morbidity may lead to enhanced prognostication antenatally, consequently improving counseling and perinatal care planning.

Analysis of pregnant women coagulopathy biomarker factors on covid-19 infection in the fetal

Background: Of the 62 babies born, 20 (32 percent) were infected with covid-19, the average age of premature birth.Purpose: To analyze the relationship between coagulopathy biomarker factors in pregnant women infected with covid-19 and the incidence of covid-19 infection in newborns.Method: Cross-sectional with the retrospective method. The inclusion criteria were babies born from mothers infected with covid-19, and newborns aged 0-28 days. The number of samples is 145. The sampling technique is purposive sampling. The data collection instrument is an observation sheet. Data were collected for 12 weeks from hospital medical records. Analysis of chi-square test data and independent t-test.Results: Participants were young adults as much as 86 (61.4 percent). Gestational age-based delivery was premature as much as 55 (37.9 percent). The gestational age range at delivery is 28 weeks to 41 weeks, gestational age when infected with covid-19 trimester III a gestational age range is from 29 weeks to 41 weeks. Coagulopathy biomarker values experienced There were 140 abnormal D-dimers with a range of &gt;500 (96.6 percent). All babies are born of mothers infected with covid-19, less than 0 days after birth, 39 were infected (27.1 percent) were infected with covid-19 at &lt;0 days. D-dimer coagulopathy biomarkers exist a significant relationship (p-value &lt; 0.05) against infection of newborns from the inside Womb.Conclusion: Coagulopathy biomarker factors in pregnant women are related to the occurrence of babies infected with covid-19. Where the incidence of infection in newborns has occurred since zero days born.

Patient-specific fetal radiation dosimetry for pregnant patients undergoing abdominal and pelvic CT imaging.

Accurate estimation of fetal radiation dose is crucial for risk-benefit analysis of radiological imaging, while the radiation dosimetry studies based on individual pregnant patient are highly desired. To use Monte Carlo calculations for estimation of fetal radiation dose from abdominal and pelvic computed tomography (CT) examinations for a population of patients with a range of variations in patients' anatomy, abdominal circumference, gestational age (GA), fetal depth (FD), and fetal development. Forty-four patient-specific pregnant female models were constructed based on CT imaging data of pregnant patients, with gestational ages ranging from 8 to 35weeks. The simulation of abdominal and pelvic helical CT examinations was performed on three validated commercial scanner systems to calculate organ-level fetal radiation dose. The absorbed radiation dose to the fetus ranged between 0.97 and 2.24 mGy, with an average of 1.63±0.33 mGy. The CTDIvol -normalized fetal dose ranged between 0.56 and 1.30, with an average of 0.94±0.25. The normalized fetal organ dose showed significant correlations with gestational age, maternal abdominal circumference (MAC), and fetal depth. The use of ATCM technique increased the fetal radiation dose in some patients. A technique enabling the calculation of organ-level radiation dose to the fetus was developed from models of actual anatomy representing a range of gestational age, maternal size, and fetal position. The developed maternal and fetal models provide a basis for reliable and accurate radiation dose estimation to fetal organs.

Brain growth in fetuses with congenital diaphragmatic hernia.

To perform a volumetric evaluation of the brain in fetuses with right or left congenital diaphragmatic hernia (CDH), and to compare brain growth trajectories to normal fetuses. We identified fetal MRIs performed between 2015 and 2020 in fetuses with a diagnosis of CDH. Gestational age (GA) range was 19-40 weeks. Control subjects consisted of normally developing fetuses between 19 and 40weeks recruited for a separate prospective study. All images were acquired at 3 Tesla and were processed with retrospective motion correction and slice-to-volume reconstruction to generate super-resolution 3-dimensional volumes. These volumes were registered to a common atlas space and segmented in 29 anatomic parcellations. A total of 174 fetal MRIs in 149 fetuses were analyzed (99 controls [mean GA: 29.2±5.2weeks], 34 fetuses left-sided CDH [mean GA: 28.4±5.3weeks], and 16 fetuses right-sided CDH [mean GA: 27±5.4weeks]). In fetuses with left-sided CDH, brain parenchymal volume was -8.0% (95% confidence interval [CI] [-13.1, -2.5]; p=.005) lower than normal controls. Differences ranged from -11.4% (95% CI [-18, -4.3]; p<.001) in the corpus callosum to -4.6% (95% CI [-8.9, -0.1]; p=.044) in the hippocampus. In fetuses with right-sided CDH, brain parenchymal volume was -10.1% (95% CI [-16.8, -2.7]; p=.008) lower than controls. Differences ranged from -14.1% (95% CI [-21, -6.5]; p<.001) in the ventricular zone to -5.6% (95% CI [-9.3, -1.8]; p=.025) in the brainstem. Left and right CDH are associated with lower fetal brain volumes.

PlGF (Placental Growth Factor) testing in clinical practice – identifying the optimal threshold

Accurate diagnosis of preterm preeclampsia (PE) may improve the management of affected pregnancies. Previous studies have demonstrated that reduced levels of Placental growth factor (PlGF) levels (< 100 pg/mL) provide superior diagnostic performance to evaluate pregnant individuals with suspected hypertension. A single cut-off may not provide optimal test interpretation, since PlGF levels vary considerably across gestational age (GA) range. Our group recently generated centile curves for PlGF levels by combining data from Toronto and Cambridge, UK. We compared the diagnostic accuracy of GA-specific percentile values of PlGF, vs. a single cutoff of 100 pg/mL, in the setting of diagnostic testing for suspected preeclampsia in a single high-risk pregnancy center. Secondary analysis of published data in 979 high-risk pregnant women with singleton pregnancies evaluated between 2017-2019 at Mount Sinai Hospital, Toronto, Canada. PlGF testing was performed between 20+0 and 35+6 weeks of gestation. We compared the diagnostic accuracy of PlGF< 100 pg\mL vs. PlGF< 2.5% for GA. Primary outcomes were prediction of early-onset PE and preterm birth (PTB)< 32 weeks’ gestation. Overall, 374 (38.2%) had a normotensive pregnancy, 244 (24.9%) developed gestational hypertension19.3%, 189 () developed late-onset PE, and 172 (17.6%) developed early-onset PE. PlGF< 2.5% for GA provided better sensitivity with comparable specificity for diagnosis of early-onset PE and PTB< 32 weeks, when compared to a single threshold of 100 pg\mL, thereby improving the area under the ROC curve (Figure 1). Table 1 compares adjusted odds ratios (aOR) for maternal and fetal outcomes, between PlGF interpretation methods. Compared to PlGF< 100 pg\mL., PlGF < 2.5% for GA increased aOR for early-onset PE and PTB< 32 weeks (58.2 vs to 95.1 and 15.7 vs. 20.6 respectively). Low PlGF levels in high-risk pregnant women are strongly associated with adverse pregnancy outcomes. Adopting a PlGF < 2.5% for GA interpretation approach provides better diagnostic accuracy for the diagnosis of early-onset PE and PTB< 32 weeks.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Surfactant therapy using a bronchofiberscope in respiratory distress syndrome.

Avoiding endotracheal intubation and using nasal continuous positive airway pressure as the initial treatment is recommended in infants with respiratory distress syndrome (RDS), and modes of lesser invasive surfactant administration have recently been reported. We report a pilot study assessing the feasibility of surfactant therapy using a bronchofiberscope (STUB) in RDS. Surfactant was administered to 31 preterm infants (gestational age range of 28 weeks 0 days to 36 weeks 6 days) diagnosed with RDS, through the working channel of the bronchofiberscope or endotracheal tubes. Patient characteristics, outcomes, adverse events, and comorbidities were assessed in the two groups. Twelve infants received STUB. Two of the 12 infants (17%) needed subsequent intubation and additional surfactant administration. Nineteen infants received surfactant through endotracheal tubes. Four of the 19 infants (21%) required additional surfactants. There was no significant difference in the number of infants that needed additional surfactant (p= 1.00). Gestational age, birthweight, length of hospitalization, adverse events, such as desaturations and bradycardias, and comorbidities were similar between the two groups. Days of invasive ventilation were significantly shorter in the STUB group (p= 0.0002). STUB was feasible in this small cohort and reduced the need for intubation to 17%, leading to fewer days of invasive ventilation, without increasing comorbidities and adverse events. To the best of our knowledge, this is the first study to administer surfactants using bronchofiberscopes.

Comparison of Intramuscular Versus Rectal Diclofenac Sodium in Post Caesarean Pain Relief

Objective: To compare the mean post-operative pain after intramuscular versus rectal Diclofenac Sodium in post-caesarean patients.&#x0D; Study Design: Quasi-experimental study.&#x0D; Place and Duration of Study: Department of Obstetrics &amp; Gynaecology, Benazir Bhutto Hospital, Rawalpindi Pakistan, from May to Nov 2017.&#x0D; Methodology: A total of 60 women, aged 18-45years, undergoing elective caesarean section were selected. Patients in Group-A were given, Diclofenac 75mg intramuscularly in the gluteal area every 8 hours, while patients in Group-B received a Diclofenac Sodium suppository every 8 hours post-operatively. All patients were followed for pain post-operatively, and final post-caesarean pain was noted at 24 hours post-operatively using a visual analogue scale.Results: The mean age of patients in the Group-A was 29.27±4.68 years, and in Group-B was 30.57±4.80years. The range of gestational age in the study was from 37 to 41 weeks, with an average age of 39.07±1.26 weeks. Mean post-operative pain in Group-A (Intramuscular Diclofenac Sodium-Group) was 1.13±0.43 minutes, whereas in Group-B (Rectal Diclofenac SodiumGroup), was 2.16±0.83 (p-value = 0.001).&#x0D; Conclusion: Mean post-operative pain after using intramuscular Diclofenac sodium is less than Diclofenac Sodium administered rectally in post-operative patients in caesarean sections.