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GÜNÜŞEN İ, SARGIN A, AKDEMİR A, ERGENOĞLU AM. The effects of uterine size with or without abdominal obesity on spinal block level and vasopressor requirement in elective cesarean section: a prospective observational study. Turk J Med Sci 2019; 49:50-57. [PMID: 30761854 PMCID: PMC7350837 DOI: 10.3906/sag-1804-167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background/aim Hypotension is a serious complication caused by spinal anesthesia that places both the mother and fetus at increased risk. We aimed to investigate the effects of uterine size with or without abdominal obesity on sensory block level of pregnant women receiving spinal anesthesia. Materials and methods This study included 125 term parturients who underwent cesarean section. Motor and sensory block characteristics, the distance between the symphysis pubis and the fundus (SPF), the distance between the symphysis pubis and the xiphoid (SPX), newborn and placental weights, adverse effects, and doses of ephedrine were recorded. Results Sensory block level and ephedrine dose were significantly correlated with the SPX and the combined newborn and placenta weights (P < 0.05). The incidence of hypotension was related to the SPX and the combined newborn and placenta weight (P < 0.05). There was no correlation between the SPF and sensory block level or ephedrine dose. The sensory block level was higher for patients who had greater SPX values and higher combined newborn and placenta weights. The incidence of hypotension and the ephedrine dose were also higher in these subjects. Conclusion SPX values and combined newborn and placenta weights are more predictive of sensory block level than SPF values in parturients receiving spinal anesthesia.
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Affiliation(s)
- İlkben GÜNÜŞEN
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ege University, IzmirTurkey
| | - Asuman SARGIN
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ege University, IzmirTurkey
| | - Ali AKDEMİR
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ege University, IzmirTurkey
| | - Ahmet Mete ERGENOĞLU
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ege University, IzmirTurkey
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Anggraini D, Abdollahian M, Marion K, Nuryani S, Ramadhan F, Rahayu RP, Rachman IR, Wurianto W. The Impact of Scientific and Technical Training on Improving Databases' Adequacy for Fetal Growth Chart Development in Limited-Resource Settings: A Case Study in the Province of South Kalimantan, Indonesia. J Pregnancy 2019; 2019:8540637. [PMID: 30854237 PMCID: PMC6377992 DOI: 10.1155/2019/8540637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 12/13/2018] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES To assess the impact of scientific and technical training on midwives' abilities in collecting and recording the key performance indicators for fetal growth chart development in limited-resource settings. METHODS A descriptive design was used to describe midwives' abilities in timely collecting and recording the minimum data required to estimate fetal weight and develop fetal growth chart. The study was conducted among 19 urban and rural midwives in South Kalimantan, Indonesia, between April 2016 and October 2017. The training provided access to antenatal care information on 4,946 women (retrospective cohort study) and 381 women (prospective cohort study). RESULTS The average amount of recorded antenatal care data on the key performance indicators of fetal growth assessment has been significantly improved (from 33.4% to 89.1%, p-value < 0.0005) through scientific and technical training. CONCLUSIONS Scientific knowledge and technical abilities have enabled midwives to timely record routine data of the key performance indicators for fetal growth surveillance. Access to this information is vital during different stages of pregnancy. The information can be utilised as evidence-based guidelines to assess fetal risks through fetal weight estimation and to develop fetal growth chart that is currently not available in Indonesian primary healthcare systems.
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Affiliation(s)
- Dewi Anggraini
- School of Science (Mathematical and Geospatial Sciences), College of Science, Engineering, and Health, RMIT University, GPO BOX 2476, Melbourne, VIC 3001, Australia
- Study Program of Mathematics, Faculty of Mathematics and Natural Sciences, University of Lambung Mangkurat (ULM), Ahmad Yani Street, Km. 36, Banjarbaru, South Kalimantan 70714, Indonesia
- Study Program of Statistics, Faculty of Mathematics and Natural Sciences, University of Lambung Mangkurat (ULM), Ahmad Yani Street, Km. 36, Banjarbaru, South Kalimantan 70714, Indonesia
| | - Mali Abdollahian
- School of Science (Mathematical and Geospatial Sciences), College of Science, Engineering, and Health, RMIT University, GPO BOX 2476, Melbourne, VIC 3001, Australia
| | - Kaye Marion
- School of Science (Mathematical and Geospatial Sciences), College of Science, Engineering, and Health, RMIT University, GPO BOX 2476, Melbourne, VIC 3001, Australia
| | - Supri Nuryani
- Ulin Public Hospital, 43 Ahmad Yani Street, Km. 2.5, Banjarmasin, South Kalimantan 70233, Indonesia
- Abdi Persada Midwifery Academy, 365 Sutoyo S. Street, Banjarmasin, South Kalimantan, 70115, Indonesia
| | - Fadly Ramadhan
- Study Program of Mathematics, Faculty of Mathematics and Natural Sciences, University of Lambung Mangkurat (ULM), Ahmad Yani Street, Km. 36, Banjarbaru, South Kalimantan 70714, Indonesia
| | - Rezky Putri Rahayu
- Study Program of Mathematics, Faculty of Mathematics and Natural Sciences, University of Lambung Mangkurat (ULM), Ahmad Yani Street, Km. 36, Banjarbaru, South Kalimantan 70714, Indonesia
| | - Irfan Rizki Rachman
- Study Program of Mathematics, Faculty of Mathematics and Natural Sciences, University of Lambung Mangkurat (ULM), Ahmad Yani Street, Km. 36, Banjarbaru, South Kalimantan 70714, Indonesia
| | - Widya Wurianto
- Study Program of Mathematics, Faculty of Mathematics and Natural Sciences, University of Lambung Mangkurat (ULM), Ahmad Yani Street, Km. 36, Banjarbaru, South Kalimantan 70714, Indonesia
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Pugh SJ, Ortega-Villa AM, Grobman W, Newman RB, Owen J, Wing DA, Albert PS, Grantz KL. Estimating gestational age at birth from fundal height and additional anthropometrics: a prospective cohort study. BJOG 2018; 125:1397-1404. [PMID: 29473290 DOI: 10.1111/1471-0528.15179] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Accurate assessment of gestational age (GA) is critical to paediatric care, but is limited in developing countries without access to ultrasound. Our objectives were to assess the accuracy of prediction of GA at birth and preterm birth classification using routinely collected anthropometry measures. DESIGN Prospective cohort study. SETTING United States. POPULATION OR SAMPLE A total of 2334 non-obese and 468 obese pregnant women. METHODS Enrolment GA was determined based on last menstrual period, confirmed by first-trimester ultrasound. Maternal anthropometry and fundal height (FH) were measured by a standardised protocol at study visits; FH alone was additionally abstracted from medical charts. Neonatal anthropometry measurements were obtained at birth. To estimate GA at delivery, we developed three predictor models using longitudinal FH alone and with maternal and neonatal anthropometry. For all predictors, we repeatedly sampled observations to construct training (60%) and test (40%) sets. Linear mixed models incorporated longitudinal maternal anthropometry and a shared parameter model incorporated neonatal anthropometry. We assessed models' accuracy under varied scenarios. MAIN OUTCOME MEASURES Estimated GA at delivery. RESULTS Prediction error for various combinations of anthropometric measures ranged between 13.9 and 14.9 days. Longitudinal FH alone predicted GA within 14.9 days with relatively stable prediction errors across individual race/ethnicities [whites (13.9 days), blacks (15.1 days), Hispanics (15.5 days) and Asians (13.1 days)], and correctly identified 75% of preterm births. The model was robust to additional scenarios. CONCLUSIONS In low-risk, non-obese women, longitudinal FH measures alone can provide a reasonably accurate assessment of GA when ultrasound measures are not available. TWEETABLE ABSTRACT Longitudinal fundal height alone predicts gestational age at birth when ultrasound measures are unavailable.
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Affiliation(s)
- S J Pugh
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - A M Ortega-Villa
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, Medical Center Drive, National Cancer Institute, Rockville, MD, USA
| | - W Grobman
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - R B Newman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - J Owen
- Department of Ob/Gyn, The University of Alabama at Birmingham Center for Women's Reproductive Health, Birmingham, AL, USA
| | - D A Wing
- Division of Maternal-Fetal Medicine, Department of Obstetrics-Gynecology, School of Medicine, University of California, Irvine, Orange, CA, USA.,Miller Children's Hospital/Long Beach Memorial Medical Center, Long Beach, CA, USA
| | - P S Albert
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, Medical Center Drive, National Cancer Institute, Rockville, MD, USA
| | - K L Grantz
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
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Papageorghiou AT, Ohuma EO, Gravett MG, Hirst J, da Silveira MF, Lambert A, Carvalho M, Jaffer YA, Altman DG, Noble JA, Bertino E, Purwar M, Pang R, Cheikh Ismail L, Victora C, Bhutta ZA, Kennedy SH, Villar J. International standards for symphysis-fundal height based on serial measurements from the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project: prospective cohort study in eight countries. BMJ 2016; 355:i5662. [PMID: 27821614 PMCID: PMC5098415 DOI: 10.1136/bmj.i5662] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To create international symphysis-fundal height standards derived from pregnancies of healthy women with good maternal and perinatal outcomes. DESIGN Prospective longitudinal observational study. SETTING Eight geographically diverse urban regions in Brazil, China, India, Italy, Kenya, Oman, United Kingdom, and United States. PARTICIPANTS Healthy, well nourished pregnant women enrolled into the Fetal Growth Longitudinal Study component of the INTERGROWTH-21st Project at 9-14 weeks' gestation, and followed up until birth. MAIN OUTCOME MEASURES Symphysis-fundal height was measured every five weeks from 14 weeks' gestation until birth using standardised methods and dedicated research staff who were blinded to the symphysis-fundal height measurements by turning the tape measure so that numbers were not visible during examination. The best fitting curve was selected using second degree fractional polynomials and further modelled in a multilevel framework to account for the longitudinal design of the study. RESULTS Of 13 108 women screened in the first trimester, 4607 (35.1%) met the study entry criteria. Of the eligible women, 4321 (93.8%) had pregnancies without major complications and delivered live singletons without congenital malformations. The median number of symphysis-fundal height measurements was 5.0 (range 1-7); 3976 (92.0%) women had four or more measurements. Symphysis-fundal height measurements increased almost linearly with gestational age; data were used to determine fitted 3rd, 50th, and 97th centile curves, which showed excellent agreement with observed values. CONCLUSIONS This study presents international standards to measure symphysis-fundal height as a first level screening tool for fetal growth disturbances.
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Affiliation(s)
- Aris T Papageorghiou
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - Eric O Ohuma
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Michael G Gravett
- Center for Perinatal Studies, Swedish Medical Center, Seattle, WA, USA
- Global Alliance to Prevent Prematurity and Stillbirth, Seattle, WA, USA
| | - Jane Hirst
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - Mariangela F da Silveira
- Departamento Materno-Infantil, Universidade Federal de Pelotas, Pelotas, RS, Brazil
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Ann Lambert
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - Maria Carvalho
- Faculty of Health Sciences, Aga Khan University, Nairobi, Kenya
| | - Yasmin A Jaffer
- Department of Family & Community Health, Ministry of Health, Muscat, Sultanate of Oman
| | - Douglas G Altman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Julia A Noble
- Department of Engineering Science, University of Oxford, Oxford, UK
| | - Enrico Bertino
- Dipartimento di Scienze Pediatriche e dell'Adolescenza, Cattedra di Neonatologia, Università degli Studi di Torino, Turin, Italy
| | - Manorama Purwar
- Nagpur INTERGROWTH-21st Research Centre, Ketkar Hospital, Nagpur, India
| | - Ruyan Pang
- School of Public Health, Peking University, Beijing, China
| | - Leila Cheikh Ismail
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - Cesar Victora
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Zulfiqar A Bhutta
- Division of Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Stephen H Kennedy
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - José Villar
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
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Deeluea J, Sirichotiyakul S, Weerakiet S, Khunpradit S, Patumanond J. Fundal height growth curve patterns of pregnant women with term low birth weight infants. Risk Manag Healthc Policy 2014; 7:131-7. [PMID: 25053895 PMCID: PMC4105228 DOI: 10.2147/rmhp.s64893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the patterns of fundal height (FH) growth curve in pregnant women with term low birth weight (LBW) infants compared with the standard FH growth curve for Thai women. Subjects and methods A retrospective study was conducted at the four governmental general hospitals in the northern part of Thailand between 2009 and 2011. All data were obtained from antenatal records and labor registry. Serial FH measurements in centimeters of 75 pregnant women with term LBW infants were plotted against the standard FH growth curve for Thai women throughout pregnancy. Results Six patterns of the FH growth curve were summarized: pattern I: FH below or around the tenth percentile throughout pregnancy (n=17, 22.7%); pattern II: FH below normal in early pregnancy, caught up with normal, then decelerated or stagnant (n=19, 25.3%); pattern III: FH normal in early pregnancy, then decelerated or stagnant (n=17, 22.7%); pattern IV: FH normal in early pregnancy, decelerated or stagnant, then caught up to normal (n=6, 8.0%); pattern V: FH normal throughout pregnancy except for the last visit (n=6, 8.0%); and pattern VI: FH normal throughout pregnancy (n=10, 13.3%). Conclusion Patterns I–V may be used to recognize women who are likely to deliver term LBW infants from early pregnancy, during pregnancy, and on the day of admission for labor. Ultrasound evaluation is still recommended in cases with known risk factors that might be undetectable by FH, or in cases where FH measurement may be inaccurate.
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Affiliation(s)
- Jirawan Deeluea
- Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand ; Department of Obstetrics and Gynecology Nursing, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
| | - Supatra Sirichotiyakul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sawaek Weerakiet
- Department of Obstetrics and Gynecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suthit Khunpradit
- Department of Obstetrics and Gynecology, Lamphun Hospital, Lamphun, Thailand
| | - Jayanton Patumanond
- Clinical Epidemiology Unit and Clinical Research Center, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
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Deeluea J, Sirichotiyakul S, Weerakiet S, Arora R, Patumanond J. Fundal height growth curve for underweight and overweight and obese pregnant women in Thai population. ISRN OBSTETRICS AND GYNECOLOGY 2013; 2013:657692. [PMID: 24455289 PMCID: PMC3880769 DOI: 10.1155/2013/657692] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 11/12/2013] [Indexed: 11/17/2022]
Abstract
Objectives. To develop fundal height growth curves for underweight and overweight and obese pregnant women based on gestational age from last menstrual period and/or ultrasound. Methods. A retrospective study was conducted at four hospitals in the northern part of Thailand between January 2009 and March 2011. Fundal height, gestational age, height, and prepregnancy weight were extracted from antenatal care and delivery records. Fundal height growth curves were presented as smoothed function of the 10th, 50th, and 90th percentiles between 20 and 40 weeks of gestation, derived from multilevel models. Results. Fundal height growth curve of the underweight was derived from 1,486 measurements (208 women) and the overweight and obese curve was derived from 1,281 measurements (169 women). The 50th percentile line of the underweight was 0.1-0.4 cm below the normal weight at weeks 23-31 and 0.5-0.8 cm at weeks 32-40. The overweight and obese line was 0.1-0.4 cm above the normal weight at weeks 22-29 and 0.6-0.8 cm at weeks 30-40. Conclusions. Fundal height growth curves of the underweight and overweight and obese pregnant women were different from the normal weight. In monitoring or screening for abnormal intrauterine growth in these women, fundal height growth curves specifically developed for such women should be applied.
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Affiliation(s)
- Jirawan Deeluea
- Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Department of Obstetrics and Gynecology Nursing, Faculty of Nursing, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Supatra Sirichotiyakul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Sawaek Weerakiet
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Rajin Arora
- Department of Obstetrics and Gynecology, Lampang Regional Hospital, Lampang 52000, Thailand
| | - Jayanton Patumanond
- Clinical Epidemiology Unit & Clinical Research Center, Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand
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