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Dinu M, Stancioi-Cismaru AF, Gheonea M, Luciu ED, Aron RM, Pana RC, Marinas CM, Degeratu S, Sorop-Florea M, Carp-Veliscu A, Hodorog AD, Tudorache S. Intrauterine Growth Restriction-Prediction and Peripartum Data on Hospital Care. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040773. [PMID: 37109731 PMCID: PMC10145525 DOI: 10.3390/medicina59040773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/04/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives: We aimed to prospectively obtain data on pregnancies complicated with intrauterine growth restriction (IUGR) in the Prenatal Diagnosis Unit of the Emergency County Hospital of Craiova. We collected the demographic data of mothers, the prenatal ultrasound (US) features, the intrapartum data, and the immediate postnatal data of newborns. We aimed to assess the detection rates of IUGR fetuses (the performance of the US in estimating the actual neonatal birth weight), to describe the prenatal care pattern in our unit, and to establish predictors for the number of total hospitalization days needed postnatally. Materials and Methods: Data were collected from cases diagnosed with IUGR undergoing prenatal care in our hospital. We compared the percentile of estimated fetal weight (EFW) using the Hadlock 4 technique with the percentile of weight at birth. We retrospectively performed a regression analysis to correlate the variables predicting the number of hospitalization days. Results: Data on 111 women were processed during the period of 1 September 2019-1 September 2022. We confirmed the significant differences in US features between early- (Eo) and late-onset (Lo) IUGR cases. The detection rates were higher if the EFW was lower, and Eo-IUGR was associated with a higher number of US scans. We obtained a mathematical formula for estimating the total number of hospitalization days needed postnatally. Conclusion: Early- and late-onset IUGR have different US features prenatally and different postnatal outcomes. If the US EFW percentile is lower, a prenatal diagnosis is more likely to be made, and a closer follow-up is offered in our hospital. The total number of hospitalization days may be predicted using intrapartum and immediate postnatal data in both groups, having the potential to optimize the final financial costs and to organize the neonatal department efficiently.
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Affiliation(s)
- Marina Dinu
- 8th Department, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | | | - Mihaela Gheonea
- 8th Department, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Obstetrics and Gynecology Department, Emergency County Hospital, 200349 Craiova, Romania
| | - Elinor Dumitru Luciu
- Obstetrics and Gynecology Department, Emergency County Hospital, 200349 Craiova, Romania
| | - Raluca Maria Aron
- Obstetrics and Gynecology Department, Emergency County Hospital, 200349 Craiova, Romania
| | - Razvan Cosmin Pana
- 8th Department, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Obstetrics and Gynecology Department, Emergency County Hospital, 200349 Craiova, Romania
| | - Cristian Marius Marinas
- Obstetrics and Gynecology Department, Emergency County Hospital, 200349 Craiova, Romania
- 1st Department, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Stefan Degeratu
- Obstetrics and Gynecology Department, Targu-Jiu County Hospital, 210218 Targu-Jiu, Romania
| | - Maria Sorop-Florea
- Obstetrics and Gynecology Department, Targu-Jiu County Hospital, 210218 Targu-Jiu, Romania
| | - Andreea Carp-Veliscu
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Panait Sarbu Clinical Hospital of Obstetrics and Gynecology, 060251 Bucharest, Romania
| | | | - Stefania Tudorache
- 8th Department, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Obstetrics and Gynecology Department, Emergency County Hospital, 200349 Craiova, Romania
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Aydin S, Fatihoglu E, Karavas E, Kantarci M. Gestational diabetes mellitus and early hemodynamic changes in fetus. J Med Ultrasound 2021; 29:270-276. [PMID: 35127407 PMCID: PMC8772478 DOI: 10.4103/jmu.jmu_161_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/02/2020] [Accepted: 12/29/2020] [Indexed: 11/04/2022] Open
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Baier F, Weinhold L, Stumpfe FM, Kehl S, Pretscher J, Bayer CM, Topal N, Pontones C, Mayr A, Schild R, Schmid M, Beckmann MW, Faschingbauer F. Longitudinal Course of Short-Term Variation and Doppler Parameters in Early Onset Growth Restricted Fetuses. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2020; 41:e23-e32. [PMID: 31238380 DOI: 10.1055/a-0858-2290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE To evaluate the longitudinal pattern of fetal heart rate short term variation (STV) and Doppler indices and their correlation to each other in severe growth restricted (IUGR) fetuses. MATERIALS AND METHODS In this retrospective study, pregnancies with a birth weight below the 10th percentile, born between 24 and 34 gestational weeks with serial Doppler measurements in combination with a computerized CTG (cCTG) with calculated STV were included. Longitudinal changes of both Doppler indices and STV values were evaluated with generalized additive models, adjusted for gestational age and the individual. For all measurements the frequency of abnormal values with regard to the time interval before delivery and Pearson correlations between Doppler indices and STV values were calculated. RESULTS 41 fetuses with a total of 1413 observations were included. Over the course of the whole study period, regression analyses showed no significant change of STV values (p = 0.38). Only on the day of delivery, a prominent decrease was observed (mean STV d28-22: 7.97 vs. mean STV on day 0: 6.8). Doppler indices of UA and MCA showed a continuous, significant deterioration starting about three weeks prior to delivery (p = 0.007; UA and p < 0.001, MCA). Correlation between any Doppler index and STV values was poor. CONCLUSION Fetal heart rate STV does not deteriorate continuously. Therefore, cCTG monitoring should be performed at least daily in these high-risk fetuses. Doppler indices of umbilical artery (UA) and middle cerebral artery (MCA), however, showed continuous deterioration starting about 3 weeks prior to delivery.
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Affiliation(s)
- Friederike Baier
- Obstetrics and Gynecology, University-Hospital of Erlangen, Germany
| | - Leonie Weinhold
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University-Hospital of Bonn, Germany
| | | | - Sven Kehl
- Obstetrics and Gynecology, University-Hospital of Erlangen, Germany
| | - Jutta Pretscher
- Obstetrics and Gynecology, University-Hospital of Erlangen, Germany
| | | | - Nalan Topal
- Obstetrics and Gynecology, University-Hospital of Erlangen, Germany
| | | | - Andreas Mayr
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Ralf Schild
- Obstetrics and Gynecology, Diakovere Hospital, Hannover, Germany
| | - Matthias Schmid
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University-Hospital of Bonn, Germany
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Jeng MJ, Sharma M, Chao TY, Li YC, Huang SF, Chang LB, Chow L. Multiclass classification of autofluorescence images of oral cavity lesions based on quantitative analysis. PLoS One 2020; 15:e0228132. [PMID: 32017775 PMCID: PMC6999883 DOI: 10.1371/journal.pone.0228132] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 01/08/2020] [Indexed: 12/24/2022] Open
Abstract
Background Oral cancer is one of the most common diseases globally. Conventional oral examination and histopathological examination are the two main clinical methods for diagnosing oral cancer early. VELscope is an oral cancer-screening device that exploited autofluorescence. It yields inconsistent results when used to differentiate between normal, premalignant and malignant lesions. We develop a new method to increase the accuracy of differentiation. Materials and methods Five samples (images) of each of 21 normal mucosae, as well as 31 premalignant and 16 malignant lesions of the tongue and buccal mucosa were collected under both white light and autofluorescence (VELscope, 400-460 nm wavelength). The images were developed using an iPod (Apple, Atlanta Georgia, USA). Results The normalized intensity and standard deviation of intensity were calculated to classify image pixels from the region of interest (ROI). Linear discriminant analysis (LDA) and quadratic discriminant analysis (QDA) classifiers were used. The performance of both of the classifiers was evaluated with respect to accuracy, precision, and recall. These parameters were used for multiclass classification. The accuracy rate of LDA with un-normalized data was increased by 2% and 14% and that of QDA was increased by 16% and 25% for the tongue and buccal mucosa, respectively. Conclusion The QDA algorithm outperforms the LDA classifier in the analysis of autofluorescence images with respect to all of the standard evaluation parameters.
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Affiliation(s)
- Ming-Jer Jeng
- Department of Electronic Engineering, Chang Gung University, Taoyuan, Taiwan
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Mukta Sharma
- Department of Electronic Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Ting-Yu Chao
- Department of Electronic Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Ying-Chang Li
- Green Technology Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Shiang-Fu Huang
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Public Health, Chang Gung University, Taoyuan, Taiwan
- * E-mail: (SFH); (LBC)
| | - Liann-Be Chang
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
- Green Technology Research Center, Chang Gung University, Taoyuan, Taiwan
- * E-mail: (SFH); (LBC)
| | - Lee Chow
- Department of Physics, University of Central Florida, Orlando, FL, United States of America
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Huang TT, Huang JS, Wang YY, Chen KC, Wong TY, Chen YC, Wu CW, Chan LP, Lin YC, Kao YH, Nioka S, Yuan SSF, Chung PC. Novel quantitative analysis of autofluorescence images for oral cancer screening. Oral Oncol 2017; 68:20-26. [PMID: 28438288 DOI: 10.1016/j.oraloncology.2017.03.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 02/24/2017] [Accepted: 03/07/2017] [Indexed: 02/04/2023]
Abstract
OBJECTIVES VELscope® was developed to inspect oral mucosa autofluorescence. However, its accuracy is heavily dependent on the examining physician's experience. This study was aimed toward the development of a novel quantitative analysis of autofluorescence images for oral cancer screening. MATERIALS AND METHODS Patients with either oral cancer or precancerous lesions and a control group with normal oral mucosa were enrolled in this study. White light images and VELscope® autofluorescence images of the lesions were taken with a digital camera. The lesion in the image was chosen as the region of interest (ROI). The average intensity and heterogeneity of the ROI were calculated. A quadratic discriminant analysis (QDA) was utilized to compute boundaries based on sensitivity and specificity. RESULTS 47 oral cancer lesions, 54 precancerous lesions, and 39 normal oral mucosae controls were analyzed. A boundary of specificity of 0.923 and a sensitivity of 0.979 between the oral cancer lesions and normal oral mucosae were validated. The oral cancer and precancerous lesions could also be differentiated from normal oral mucosae with a specificity of 0.923 and a sensitivity of 0.970. CONCLUSION The novel quantitative analysis of the intensity and heterogeneity of VELscope® autofluorescence images used in this study in combination with a QDA classifier can be used to differentiate oral cancer and precancerous lesions from normal oral mucosae.
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Affiliation(s)
- Tze-Ta Huang
- Division of Oral and Maxillofacial Surgery, Department of Stomatology, National Cheng-Kung University Medical College and Hospital, Tainan, Taiwan; Institute of Oral Medicine, National Cheng-Kung University Medical College and Hospital, Tainan, Taiwan
| | - Jehn-Shyun Huang
- Division of Oral and Maxillofacial Surgery, Department of Stomatology, National Cheng-Kung University Medical College and Hospital, Tainan, Taiwan; Institute of Oral Medicine, National Cheng-Kung University Medical College and Hospital, Tainan, Taiwan
| | - Yen-Yun Wang
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Translational Research Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ken-Chung Chen
- Division of Oral and Maxillofacial Surgery, Department of Stomatology, National Cheng-Kung University Medical College and Hospital, Tainan, Taiwan; Institute of Oral Medicine, National Cheng-Kung University Medical College and Hospital, Tainan, Taiwan
| | - Tung-Yiu Wong
- Division of Oral and Maxillofacial Surgery, Department of Stomatology, National Cheng-Kung University Medical College and Hospital, Tainan, Taiwan; Institute of Oral Medicine, National Cheng-Kung University Medical College and Hospital, Tainan, Taiwan
| | - Yi-Chun Chen
- Institute of Oral Medicine, National Cheng-Kung University Medical College and Hospital, Tainan, Taiwan
| | - Che-Wei Wu
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Leong-Perng Chan
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Chu Lin
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Hsun Kao
- Department of Oral and Maxillofacial Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shoko Nioka
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Shyng-Shiou F Yuan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Translational Research Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Obstetrics and Gynecology and Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Pau-Choo Chung
- Department of Electrical Engineering, National Cheng Kung University, Tainan, Taiwan.
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Dall’Asta A, Brunelli V, Prefumo F, Frusca T, Lees CC. Early onset fetal growth restriction. Matern Health Neonatol Perinatol 2017; 3:2. [PMID: 28116113 PMCID: PMC5241928 DOI: 10.1186/s40748-016-0041-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 12/27/2016] [Indexed: 01/01/2023] Open
Abstract
Fetal growth restriction (FGR) diagnosed before 32 weeks is identified by fetal smallness associated with Doppler abnormalities and is associated with significant perinatal morbidity and mortality and maternal complications. Recent studies have provided new insights into pathophysiology, management options and postnatal outcomes of FGR. In this paper we review the available evidence regarding diagnosis, management and prognosis of fetuses diagnosed with FGR before 32 weeks of gestation.
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Affiliation(s)
- Andrea Dall’Asta
- Centre for Fetal Care, Queen Charlotte’s and Chelsea Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS United Kingdom
- Department of Obstetrics & Gynecology, University of Parma, Parma, Italy
| | - Valentina Brunelli
- Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine Unit, University of Brescia, Brescia, Italy
| | - Federico Prefumo
- Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine Unit, University of Brescia, Brescia, Italy
| | - Tiziana Frusca
- Department of Obstetrics & Gynecology, University of Parma, Parma, Italy
| | - Christoph C Lees
- Centre for Fetal Care, Queen Charlotte’s and Chelsea Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS United Kingdom
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Department of Development and Regeneration, KU Leuven, Belgium
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Lees CC, Marlow N, van Wassenaer-Leemhuis A, Arabin B, Bilardo CM, Brezinka C, Calvert S, Derks JB, Diemert A, Duvekot JJ, Ferrazzi E, Frusca T, Ganzevoort W, Hecher K, Martinelli P, Ostermayer E, Papageorghiou AT, Schlembach D, Schneider KTM, Thilaganathan B, Todros T, Valcamonico A, Visser GHA, Wolf H. 2 year neurodevelopmental and intermediate perinatal outcomes in infants with very preterm fetal growth restriction (TRUFFLE): a randomised trial. Lancet 2015; 385:2162-72. [PMID: 25747582 DOI: 10.1016/s0140-6736(14)62049-3] [Citation(s) in RCA: 265] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND No consensus exists for the best way to monitor and when to trigger delivery in mothers of babies with fetal growth restriction. We aimed to assess whether changes in the fetal ductus venosus Doppler waveform (DV) could be used as indications for delivery instead of cardiotocography short-term variation (STV). METHODS In this prospective, European multicentre, unblinded, randomised study, we included women with singleton fetuses at 26-32 weeks of gestation who had very preterm fetal growth restriction (ie, low abdominal circumference [<10th percentile] and a high umbilical artery Doppler pulsatility index [>95th percentile]). We randomly allocated women 1:1:1, with randomly sized blocks and stratified by participating centre and gestational age (<29 weeks vs ≥29 weeks), to three timing of delivery plans, which differed according to antenatal monitoring strategies: reduced cardiotocograph fetal heart rate STV (CTG STV), early DV changes (pulsatility index >95th percentile; DV p95), or late DV changes (A wave [the deflection within the venous waveform signifying atrial contraction] at or below baseline; DV no A). The primary outcome was survival without cerebral palsy or neurosensory impairment, or a Bayley III developmental score of less than 85, at 2 years of age. We assessed outcomes in surviving infants with known outcomes at 2 years. We did an intention to treat study for all participants for whom we had data. Safety outcomes were deaths in utero and neonatal deaths and were assessed in all randomly allocated women. This study is registered with ISRCTN, number 56204499. FINDINGS Between Jan 1, 2005 and Oct 1, 2010, 503 of 542 eligible women were randomly allocated to monitoring groups (166 to CTG STV, 167 to DV p95, and 170 to DV no A). The median gestational age at delivery was 30·7 weeks (IQR 29·1-32·1) and mean birthweight was 1019 g (SD 322). The proportion of infants surviving without neuroimpairment did not differ between the CTG STV (111 [77%] of 144 infants with known outcome), DV p95 (119 [84%] of 142), and DV no A (133 [85%] of 157) groups (ptrend=0·09). 12 fetuses (2%) died in utero and 27 (6%) neonatal deaths occurred. Of survivors, more infants where women were randomly assigned to delivery according to late ductus changes (133 [95%] of 140, 95%, 95% CI 90-98) were free of neuroimpairment when compared with those randomly assigned to CTG (111 [85%] of 131, 95% CI 78-90; p=0.005), but this was accompanied by a non-significant increase in perinatal and infant mortality. INTERPRETATION Although the difference in the proportion of infants surviving without neuroimpairment was non-significant at the primary endpoint, timing of delivery based on the study protocol using late changes in the DV waveform might produce an improvement in developmental outcomes at 2 years of age. FUNDING ZonMw, The Netherlands and Dr Hans Ludwig Geisenhofer Foundation, Germany.
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Affiliation(s)
- Christoph C Lees
- Department of Surgery and Cancer, Imperial College London, London, UK; Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
| | - Neil Marlow
- Department of Academic Neonatology, UCL Institute for Women's Health, London, UK
| | | | - Birgit Arabin
- Department of Perinatology, Isala Clinics, Zwolle, Overijssel, Netherlands; Center for Mother and Child of the Phillips University, Marburg, Germany
| | - Caterina M Bilardo
- Department of Obstetrics and Gynaecology, University Medical Center, University of Groningen, Netherlands
| | - Christoph Brezinka
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Innsbruck, Austria
| | | | - Jan B Derks
- Department of Perinatal Medicine, University Medical Center, Utrecht, Netherlands
| | - Anke Diemert
- Department of Obstetrics and Fetal Medicine, University Medical Center, Hamburg-Eppendorf, Germany
| | - Johannes J Duvekot
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, Netherlands
| | - Enrico Ferrazzi
- Children's Hospital, Buzzi, University of Milan, Milan, Italy
| | - Tiziana Frusca
- University of Parma, Parma, Italy; Maternal-Fetal Medicine Unit, University of Brescia, Brescia, Italy
| | - Wessel Ganzevoort
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, Netherlands
| | - Kurt Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center, Hamburg-Eppendorf, Germany
| | - Pasquale Martinelli
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Napoli, Italy
| | - Eva Ostermayer
- Division of Perinatal Medicine, Department of Obstetrics and Gynecology, Technical University, Munich, Germany
| | | | - Dietmar Schlembach
- Department of Obstetrics, Friedrich Schiller University of Jena, Jena, Germany
| | - K T M Schneider
- Division of Perinatal Medicine, Department of Obstetrics and Gynecology, Technical University, Munich, Germany
| | | | - Tullia Todros
- Department of Surgical Sciences, University of Turin, Sant' Anna Hospital, Turin, Italy
| | | | - Gerard H A Visser
- Department of Perinatal Medicine, University Medical Center, Utrecht, Netherlands
| | - Hans Wolf
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, Netherlands; Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, Netherlands
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Unger HW, Ome-Kaius M, Karl S, Singirok D, Siba P, Walker J, Wangnapi RA, Mueller I, Rogerson SJ. Factors associated with ultrasound-aided detection of suboptimal fetal growth in a malaria-endemic area in Papua New Guinea. BMC Pregnancy Childbirth 2015; 15:83. [PMID: 25881316 PMCID: PMC4404558 DOI: 10.1186/s12884-015-0511-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 03/19/2015] [Indexed: 01/29/2023] Open
Abstract
Background Fetal growth restriction (FGR) is associated with increased infant mortality rates and ill-health in adulthood. Evaluation of fetal growth requires ultrasound. As a result, ultrasound-assisted evaluations of causes of FGR in malaria-endemic developing countries are rare. We aimed to determine factors associated with indicators of abnormal fetal growth in rural lowland Papua New Guinea (PNG). Methods Weights and growth of 671 ultrasound-dated singleton pregnancies (<25 gestational weeks) were prospectively monitored using estimated fetal weights and birthweights. Maternal nutritional status and haemoglobin levels were assessed at enrolment, and participants were screened for malaria on several occasions. FGR was suspected upon detection of an estimated fetal weight or birthweight <10th centile (small-for-gestational age) and/or low fetal weight gain, defined as a change in weight z-score in the first quartile. Factors associated with fetal weight and fetal weight gain were additionally assessed by evaluating differences in weight z-scores and change in weight z-scores. Log-binomial and linear mixed effect models were used to determine factors associated with indicators of FGR. Results SGA and low weight gain were detected in 48.3% and 37.0% of pregnancies, respectively. Of participants, 13.8%, 21.2%, and 22.8% had a low mid-upper arm circumference (MUAC, <22 cms), short stature (<150 cms) and anaemia (haemoglobin <90 g/L) at first antenatal visit. 24.0% (161/671) of women had at least one malaria infection detected in peripheral blood. A low MUAC (adjusted risk ratio [aRR] 1.51, 95% CI 1.29, 1.76, P < 0.001), short stature (aRR 1.27, 95% CI 1.04, 1.55, P = 0.009), and anaemia (aRR 1.27, 95% CI 1.06, 1.51, P = 0.009) were associated with SGA, and a low body mass index was associated with low fetal weight gain (aRR 2.10, 95% CI 1.62, 2.71, P < 0.001). Additionally, recent receipt of intermittent preventive treatment in pregnancy was associated with increased weight z-scores, and anaemia with reduced change in weight z-scores. Malaria infection was associated with SGA on crude but not adjusted analyses (aRR 1.13, 95% CI 0.95, 1.34, P = 0.172). Conclusion Macronutrient undernutrition and anaemia increased the risk of FGR. Antenatal nutritional interventions and malaria prevention could improve fetal growth in PNG.
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Affiliation(s)
- Holger Werner Unger
- Papua New Guinea Institute of Medical Research (PNG IMR), 60, Goroka, Eastern Highlands Province 411, Papua New Guinea. .,Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Post Office Royal Melbourne Hospital, Parkville, VIC 3050, Melbourne, Australia.
| | - Maria Ome-Kaius
- Papua New Guinea Institute of Medical Research (PNG IMR), 60, Goroka, Eastern Highlands Province 411, Papua New Guinea.
| | - Stephan Karl
- Walter and Eliza Hall Institute of Medical Research (WEHI), 1G Royal Parade, Parkville 3052, Melbourne, Australia.
| | - Dupain Singirok
- Papua New Guinea Institute of Medical Research (PNG IMR), 60, Goroka, Eastern Highlands Province 411, Papua New Guinea.
| | - Peter Siba
- Papua New Guinea Institute of Medical Research (PNG IMR), 60, Goroka, Eastern Highlands Province 411, Papua New Guinea.
| | - Jane Walker
- Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK.
| | - Regina Alice Wangnapi
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Post Office Royal Melbourne Hospital, Parkville, VIC 3050, Melbourne, Australia.
| | - Ivo Mueller
- Walter and Eliza Hall Institute of Medical Research (WEHI), 1G Royal Parade, Parkville 3052, Melbourne, Australia. .,Barcelona Centre for International Health Research (CRESIB), Rosselo 132, 08036, Barcelona, Spain.
| | - Stephen John Rogerson
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Post Office Royal Melbourne Hospital, Parkville, VIC 3050, Melbourne, Australia.
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Deter RL, Lee W, Sangi-Haghpeykar H, Tarca AL, Yeo L, Romero R. A modified prenatal growth assessment score for the evaluation of fetal growth in the third trimester using single and composite biometric parameters. J Matern Fetal Neonatal Med 2014; 28:745-54. [PMID: 24993892 DOI: 10.3109/14767058.2014.934218] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To define modified Prenatal Growth Assessment Scores (mPGAS) for single and composite biometric parameters and determine their reference ranges in normal fetuses. METHODS Nine anatomical parameters (ap) were measured and the weight estimated (EWTa, EWTb) in a longitudinal study of 119 fetuses with normal neonatal growth outcomes. Expected third trimester size trajectories, obtained from second trimester Rossavik size models, were used in calculating Percent Deviations (% Dev's) and their age-specific reference ranges in each fetus. The components of individual % Dev's values outside their reference ranges, designated +iapPGAS, -iapPGAS, were averaged to give +apPGAS and -apPGAS values for the 3rd trimester. The +iapPGAS and -iapPGAS values for different combinations of ap (c1a (HC, AC, FDL, ThC, EWTa), c1b (HC, AC, FDL, ThC, EWTb), c2 (ThC, ArmC, AVol, TVol), c3 (HC, AC, FDL, EWTa)) were then averaged to give +icPGAS and -icPGAS values at different time points or at the end of the third trimester (+cPGAS, -cPGAS). Values for iapPGAS, ic1bPGAS, and ic2PGAS were compared to their respective apPGAS or cPGAS reference ranges. RESULTS All mPGAS values had one 95% range boundary at 0.0%. Upper boundaries of 1D +apPGAS values ranged from 0.0% (HC) to +0.49% (ThC) and were +0.06%, +2.3% and +1.8% for EWT, AVol and TVol, respectively. Comparable values for -apPGAS were 0.0% (BPD, FDL, HDL), to -0.58% (ArmC), -0.13% (EWT), -0.8% (AVol), and 0.0% (TVol). The +cPGAS, 95% reference range upper boundaries varied from +0.36% (c1b) to +0.89% (c2). Comparable values for -cPGAS lower boundaries were -0.17% (c1b) to -0.43% (c2). CONCLUSIONS The original PGAS concept has now been extended to individual biometric parameters and their combinations. With the standards provided, mPGAS values can now be tested to see if detection of different types of third trimester growth problems is improved.
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Affiliation(s)
- Russell L Deter
- Department of Obstetrics and Gynecology, Baylor College of Medicine , Houston, TX , USA
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Lees C. Reply: To PMID 24078432. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:237-238. [PMID: 24497422 DOI: 10.1002/uog.13267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- C Lees
- Fetal Medicine Department, Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
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