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Zhang C, Yang X, Zhao Y, Xie D, Wang L. Acupuncture for postpartum diastasis recti abdominis and its effects on abdominal circumference, separation distance of rectus abdominis. Zhongguo Zhen Jiu 2024; 44:139-143. [PMID: 38373757 DOI: 10.13703/j.0255-2930.20230626-k0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
OBJECTIVES To observe the therapeutic efficacy of acupuncture and its effects on abdominal circumference, separation distance of rectus abdominis and quality of life in patients with postpartum diastasis recti abdominis on the basis of diastasis recti abdominis exercise. METHODS A total of 87 postpartum women with diastasis recti abdominis were randomly divided into an observation group (44 cases) and a control group (43 cases) . The control group was treated with conventional diastasis recti abdominis rehabilitation exercise, including abdominal breathing training and supine leg lifting training, 3 times a day for 2 weeks. On the basis of the treatment in the control group, the observation group was treated with acupuncture at Zhongwan(CV 12), Qihai(CV 6)and bilateral Shenshu(BL 23), Daimai(GB 26), Daheng(SP 15), Zusanli (ST 36), etc., 30 min each time, once a day for 2 weeks. Before and after treatment, the separation distance of rectus abdominis, low back pain visual analogue scale (VAS) score, abdominal circumference and 36-item short form health survey questionnaire (SF-36) score in the two groups were compared, and the clinical effect was evaluated. RESULTS After treatment, the separation distance of rectus abdominis, low back pain VAS scores, abdominal circumference of the two groups were lower than those before treatment(P<0.05), and the physiological function, physiological role, pain, mental health, emotional role, social function, energy, general health scores and total scores of SF-36 were higher than those before treatment(P<0.05); the separation distance of rectus abdominis, low back pain VAS score, abdominal circumference of the observation group were lower than those in the control group(P<0.05), the sub-item scores and total score of SF-36 of the observation group were higher than those in the control group(P<0.05).The effective rate of the observation group was 95.5% (42/44), which was higher than 79.1% (34/43) in the control group(P<0.05). CONCLUSIONS Acupuncture combined with diastasis recti abdominis exercise can effectively relieve the low back pain of postpartum diastasis recti abdominis patients, promote the recovery of recti abdominis function, and improve the quality of life. The clinical effect is superior to diastasis recti abdominis exercise alone.
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Affiliation(s)
- Caixia Zhang
- Department of Pelvic Floor Rehabilitation and Postpartum Health Care, Huai'an Maternal and Child Health Hospital Affiliated to Yangzhou University, Huai'an 223200, Jiangsu Province, China
| | - Xiaoer Yang
- Department of Pelvic Floor Rehabilitation and Postpartum Health Care, Huai'an Maternal and Child Health Hospital Affiliated to Yangzhou University, Huai'an 223200, Jiangsu Province, China.
| | - Yang Zhao
- Department of Pelvic Floor Rehabilitation and Postpartum Health Care, Huai'an Maternal and Child Health Hospital Affiliated to Yangzhou University, Huai'an 223200, Jiangsu Province, China
| | - Dandan Xie
- Department of Pelvic Floor Rehabilitation and Postpartum Health Care, Huai'an Maternal and Child Health Hospital Affiliated to Yangzhou University, Huai'an 223200, Jiangsu Province, China
| | - Lina Wang
- Department of Pelvic Floor Rehabilitation and Postpartum Health Care, Huai'an Maternal and Child Health Hospital Affiliated to Yangzhou University, Huai'an 223200, Jiangsu Province, China
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Vignola S, Donadono V, Cavalli C, Azzaretto V, Casagrandi D, Pandya P, Napolitano R. Use of focus point for plane acquisition to improve reproducibility in fetal biometry. Ultrasound Obstet Gynecol 2024; 63:237-242. [PMID: 37519218 DOI: 10.1002/uog.27436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 06/24/2023] [Accepted: 07/06/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE To assess the reproducibility of ultrasound measurements of fetal biometry using a 'focus point' to assist the acquisition of the relevant plane. METHODS This was a study of 80 women with a singleton non-anomalous pregnancy who attended University College London Hospital, London, UK, between 18 and 37 weeks' gestation. Planes to measure head circumference (HC), abdominal circumference (AC) and femur length (FL) were obtained four times by two different sonographers with different levels of experience, who were blinded to one another; the first set of images was obtained with reference to a standard image, and the second set of images was obtained using the focus point technique. The focus point was defined as a unique fetal anatomical landmark in each plane (cavum septi pellucidi for HC, two-thirds of the umbilical vein for AC and one of the two extremities of the diaphysis for FL). Once identified, the focus point was maintained in view while the sonographer rotated the probe along three axes (x, y, z) to acquire the relevant plane. Sonographers were either in training or had > 3000 scans worth of experience. Intra- and interobserver reproducibility were assessed using Bland-Altman plots, and absolute values and percentages for mean difference and 95% limits of agreement (LoA) were reported. RESULTS Overall reproducibility was good, with all 95% LoA < 8%. Reproducibility was improved by use of the focus point compared with the standard technique for both intraobserver comparison (95% LoA, < 4% vs < 6%) and interobserver comparison (95% LoA, < 7% vs < 8%). These findings were independent of sonographer seniority and plane acquired. CONCLUSIONS Reproducibility of fetal biometry assessment is improved with use of the focus point for plane acquisition, regardless of sonographer experience. We propose that this method should be implemented in clinical practice and training programs in fetal biometry. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- S Vignola
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - V Donadono
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - C Cavalli
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
- ASTT Spedali Civili, Brescia, Italy
| | - V Azzaretto
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
- ASTT Spedali Civili, Brescia, Italy
| | - D Casagrandi
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - P Pandya
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - R Napolitano
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
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Bianco C, Pelusi S, Margarita S, Tavaglione F, Jamialahmadi O, Malvestiti F, Periti G, Rondena J, Tomasi M, Carpani R, Ronzoni L, Vidali M, Ceriotti F, Fraquelli M, Vespasiani-Gentilucci U, Romeo S, Prati D, Valenti L. Predictors of controlled attenuation parameter in metabolic dysfunction. United European Gastroenterol J 2023. [PMID: 38141028 DOI: 10.1002/ueg2.12513] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/26/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND & AIMS Hepatic fat content can be non-invasively estimated by controlled attenuation parameter (CAP) during transient elastography. The aim of this study was to examine the determinants and predictors of CAP values in individuals with metabolic dysfunction. METHODS We enrolled 1230 consecutive apparently healthy individuals (Liver-Bible-2022 cohort) with ≥3 metabolic dysfunction features. CAP was measured by Fibroscan. CAP determinants and predictors were identified using backward stepwise analysis and introduced in generalized linear models. RESULTS Participants were predominantly males (82.9%), mean age was 53.8 ± 6.4 years, 600 (48.8%) had steatosis (CAP ≥ 275 dB/m), and 27 had liver stiffness measurement (LSM) ≥ 8 kPa. CAP values correlated with LSM (p < 10-22 ). In multivariable analysis, fasting insulin and abdominal circumference (AC) were the main determinants of CAP (p < 10-6 ), together with body mass index (BMI; p < 10-4 ), age, diabetes, triglycerides, ferritin, and lower HDL and thyroid stimulating hormone (TSH; p < 0.05 for all). In a subset of 592 participants with thyroid hormone measurement, we found an association between higher free triiodothyronine levels, correlating with lower TSH, and CAP values, independent of TSH and of levothyroxine treatment (p = 0.0025). A clinical CAP score based on age, BMI, AC, HbA1c, ALT, and HDL predicted CAP ≥ 275 dB/m with moderate accuracy (AUROC = 0.73), which was better than that of the Fatty Liver Index and of ALT (AUROC = 0.70/0.61, respectively) and validated it in multiple cohorts. CONCLUSION Abdominal adiposity and insulin resistance severity were the main determinants of CAP in individuals with metabolic dysfunction and may improve steatotic liver disease risk stratification. CAP values were modulated by the hypophysis-thyroid axis.
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Affiliation(s)
- Cristiana Bianco
- Precision Medicine Lab, Biological Resource Center and Department of Transfusion Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Serena Pelusi
- Precision Medicine Lab, Biological Resource Center and Department of Transfusion Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Margarita
- Precision Medicine Lab, Biological Resource Center and Department of Transfusion Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federica Tavaglione
- Clinical Medicine and Hepatology Unit, Department of Internal Medicine and Geriatrics, Fondazione Policlinico Campus Bio-Medico, Rome, Italy
- Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Oveis Jamialahmadi
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Wallenberg Laboratory, University of Gothenburg, Gothenburg, Sweden
| | - Francesco Malvestiti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Giulia Periti
- Precision Medicine Lab, Biological Resource Center and Department of Transfusion Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Jessica Rondena
- Precision Medicine Lab, Biological Resource Center and Department of Transfusion Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Melissa Tomasi
- Precision Medicine Lab, Biological Resource Center and Department of Transfusion Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Rossana Carpani
- Precision Medicine Lab, Biological Resource Center and Department of Transfusion Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luisa Ronzoni
- Precision Medicine Lab, Biological Resource Center and Department of Transfusion Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Vidali
- Clinical Chemistry Unit and Laboratory Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ferruccio Ceriotti
- Clinical Chemistry Unit and Laboratory Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mirella Fraquelli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Umberto Vespasiani-Gentilucci
- Clinical Medicine and Hepatology Unit, Department of Internal Medicine and Geriatrics, Fondazione Policlinico Campus Bio-Medico, Rome, Italy
- Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Stefano Romeo
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Wallenberg Laboratory, University of Gothenburg, Gothenburg, Sweden
- Clinical Nutrition Unit, Department of Medical and Surgical Sciences, University Magna Graecia, Catanzaro, Italy
- Cardiology Department, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Daniele Prati
- Precision Medicine Lab, Biological Resource Center and Department of Transfusion Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luca Valenti
- Precision Medicine Lab, Biological Resource Center and Department of Transfusion Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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Timis TL, Beni L, Florian IA, Orăsan M, Orăsan RI. Prevalence of metabolic syndrome and chronic inflammation in psoriasis before and after biologic therapy: a prospective study. Med Pharm Rep 2023; 96:368-383. [PMID: 37970199 PMCID: PMC10642736 DOI: 10.15386/mpr-2631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/13/2023] [Accepted: 05/28/2023] [Indexed: 11/17/2023] Open
Abstract
Background As a chronic inflammatory disease, psoriasis affects not only the skin but also the metabolic profile of the patients. Biologic therapies, including tumor necrosis alpha (TNF-a) inhibitors and interleukin (IL)-12/23 and IL-17 antagonists, have proven effective in the reduction of psoriasis severity; however their impact on the metabolic and chronic inflammatory profiles of the patients remains incompletely elucidated. Methods We performed a longitudinal case-control study on 106 psoriasis patients and an equal number of controls without the disease, as well as a prospective study on the patient group with the end point being 6 months of biologic therapy. Patients received either ixekizumab, secukinumab, guselkumab, certolizumab, ustekinumab, risankizumab, or adalimumab. Abdominal circumference, serum fasting glucose, triglycerides (TG), high-density lipoproteins (HDL), erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) were measured for both patients and controls, with an additional measurement for patients after 6 months. Results At baseline, the number of psoriasis patients suffering from obesity, metabolic syndrome, and chronic inflammation significantly outnumbered controls (p<0.05), with the calculated odds ratio being 1.88, 6.83, and 81.84 for these conditions in psoriasis, respectively. Biologic therapies increased the abdominal circumference of patients in a slight but significant fashion (p<0.05), as well as significantly improved HDL, CRP, ESR levels at 6 months (p<0.05). Moreover, after 6 months, the number of patients meeting the diagnostic criteria for metabolic syndrome and chronic inflammation was significantly lower than at baseline (p<0.001). Conclusions According to our results, biologic therapies improve the overall metabolic and inflammatory profiles of psoriasis patients, the most significant ameliorations being noticed for serum HDL, CRP, and ESR.
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Affiliation(s)
- Teodora-Larisa Timis
- Department of Physiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Lehel Beni
- Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ioan-Alexandru Florian
- Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Meda Orăsan
- Department of Pathophysiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Remus Ioan Orăsan
- Department of Physiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Liuzza F, Smakaj A, Rovere G, De Mauro D, Rollo G, Erasmo R, Fidanza A, Gruobor P, Meccariello L. Outcomes at 2 years follow-up of sacral fractures associated with unstable vertical pelvic ring injuries in obese patients: a multicentric retrospective study. Acta Biomed 2023; 94:e2023153. [PMID: 37326262 PMCID: PMC10308469 DOI: 10.23750/abm.v94i3.14487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 04/16/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND AIM Sacral fractures with concomitant unstable pelvic ring injuries are severe conditions which occur in patients involved in high-energy trauma. When operative treatment is required, high surgical experience on the field is mandatory, especially in a sub-polpulation of obese patients which have increased risk of complications. The aim of this multicentric retroscpective study was to describe and analyze clinical and radiological outcomes of sacral vertical fractures in obese patients with a minimum of 2 years follow-up. Methods: A total of 121 pelvic fractures admitted to Emergency Departments of three II level trauma centres from April 2015 to April 2021 were retrospectively reviewed. Demographics, injury mechanism, surgical data and complications were collected. The quality of life and the pelvic function were respectively measured by SF-12 questionnaires, Denis Work Scale and Majeed Score. The inter-rater agreement between the clinical scores and the Denis Work Scale was assessed. Results: A total of 19 patients were included in the study. The average follow up was 41.16 months. The average BMI was 38.63 and the mean abdominal circumference was 128.10 cm. The average Majeed and SF-12 scores were respectively 66.47 and 74.32. Five patients were able to return to their previous employment. The post traumatic life's quality and related dysfunctions are influenced by the high BMI. Conclusions: Faster recovery and early weight-bearing should be persued in order to minimize complications, expecially in obese patients. In these sample of patients, "triangular osteosynthesis" was the best treatment choice for sacral vertical fractures.
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Nagai T, Miyagami M, Okano I, Nakamura S, Okazaki Y, Sakamoto K, Kasai F, Kudo Y, Kawate N. Association of Spinal Alignment and Abdominal Circumference with Sarcopenia Status and Fall Risk in Patients with Osteoporosis: A Retrospective Study. Nutrients 2023; 15:nu15112571. [PMID: 37299534 DOI: 10.3390/nu15112571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
Since vertebral kyphosis and abdominal circumference are thought to influence sarcopenia and fall risk in osteoporosis, we evaluated sarcopenia and fall risk in patients with different measurements of abdominal circumference and sagittal longitudinal axis (SVA). In this post hoc study, 227 patients aged 65 years or more who visited an outpatient osteoporosis clinic were included in the analysis. Sarcopenia was determined from lean body mass, grip strength, and walking speed by dual energy X-ray absorptiometry; SVA (median 40 mm) and abdominal circumference (median 80 cm) were compared between the four groups, each divided into two groups. Nutritional management, falls, and fall anxiety scores were also examined. The incidence of sarcopenia was significantly increased in those with abdominal circumference < 80 cm in both the SVA < 40 mm and SVA ≥ 40 mm groups (p < 0.05). Nonetheless, the fall scores of those with SVA < 40 mm were lower than those of individuals with SVA ≥ 40 mm (p < 0.01). Based on the results of this study, SVA and abdominal circumference values may predict the risk of sarcopenia and falls. More research is needed before our results can be translated into clinical practice.
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Affiliation(s)
- Takashi Nagai
- Department of Rehabilitation Medicine, Showa University School of Medicine, Tokyo 142-866, Japan
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo 142-866, Japan
| | - Makoto Miyagami
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo 142-866, Japan
| | - Ichiro Okano
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo 142-866, Japan
| | - Shota Nakamura
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo 142-866, Japan
| | - Yuichiro Okazaki
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo 142-866, Japan
| | - Keizo Sakamoto
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo 142-866, Japan
| | - Fumihito Kasai
- Department of Rehabilitation Medicine, Showa University School of Medicine, Tokyo 142-866, Japan
| | - Yoshifumi Kudo
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo 142-866, Japan
| | - Nobuyuki Kawate
- Department of Rehabilitation Medicine, Showa University School of Medicine, Tokyo 142-866, Japan
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Wojcik KA, Machado LTP, Bastos DE Brito CI, Rebullido TR. Can 5-weeks of Hypopressive Exercise Influence Sagittal Lumbo-Pelvic Position in Athletic and Non-Athletic Females? Int J Exerc Sci 2023; 16:550-562. [PMID: 38288077 PMCID: PMC10824316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
Hypopressive exercises (HE) are part of the Low Pressure Fitness training program which is widely used by physical therapists in the rehabilitation of the pelvic floor, abdominal and spinal musculature. The aim of this study was to compare the effects of HE on the sagittal lumbo-pelvic posture in athletic and non-athletic females. It was hypothesized that a 5-week training program of HE could influence lumbo-pelvic position while reducing abdominal circumference and low back pain in athletic and non-athletic females. Twenty normoweight females (mean age = 24.8 (SD 3.5) years; body mass index = 22.4 (SD 1.6) kg/m2) participated in this study. Ten athletic females were rugby players (RG), and 10 females were non-athletic (SG). Participants completed twenty minutes of HE twice weekly for 5 weeks. Before and after the intervention, two-dimension photogrammetry was used to assess lumbar lordosis and pelvic horizontal alignment. A Visual Analog Scale was used to assess low back pain and cirtometry was used to assess abdominal circumferences at umbilical, supra and infra-umbilical levels. An analysis of variance between moments revealed no significant differences in lumbar lordosis and pelvic positioning but showed significant differences for abdominal circumferences between groups. No significant differences between groups were found for other variables. Significant correlations were found between the three different abdominal circumference measurements (p > 0.05) but not between lumbar lordosis and abdominal circumferences. These preliminary findings indicate that a 5-week HE intervention displayed non-significant changes in lumbar lordosis, pelvic horizontal alignment, and low back pain but a significant reduction in abdominal circumferences in non-athletic and athletic females.
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Affiliation(s)
- Kimberly A Wojcik
- Department of Physical Education, University Methodist Center IPA, Porto Alegre, Brazil
| | - Lucas T P Machado
- Department of Physical Education, University Methodist Center IPA, Porto Alegre, Brazil
| | | | - Tamara Rial Rebullido
- Department of Health and Physical Education, University of Monmouth, Monmouth, NJ, USA
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da Silva NF, Pinho CPS, da Silva Diniz A. Evaluation of ultrasonographic approaches aimed at determining distinct abdominal adipose tissue depots. Arch Endocrinol Metab 2023; 67:162-171. [PMID: 36651712 PMCID: PMC10689032 DOI: 10.20945/2359-3997000000584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 05/11/2022] [Indexed: 01/19/2023]
Abstract
Objective To analyze different anatomical sites in the abdominal region, in order to determine the positional parameter that identifies a higher level of visceral adipose tissue (VAT) and confers a greater cardiometabolic risk. Materials and methods This is a methodological study in which VAT was evaluated by ultrasonography (USG) in three anatomical sites in the abdomen, while the abdominal circumference (AC) was measured using seven different protocols. Additionally, the glycemic and lipid profile, C-reactive protein, and the presence of systemic arterial hypertension were evaluated. Results One hundred and six individuals with an average age of 42 (36.8-46.2) years were included. The evaluation of the calibration of the ultrasound procedure for the analysis of VAT by intra- and inter-evaluators showed high reproducibility. The pattern of abdominal fat distribution differed between sexes, with higher mean VAT in males (p < 0.05) and higher mean SAT (subcutaneous adipose tissue) in females (p < 0.005). In the abdominal scan applied to women, higher levels of VAT and lower levels of SAT were observed in the narrower waist region, between the iliac crest and the last rib (p < 0.001). In males, the profile of adipose disposition along the abdomen was uniform (p > 0.05). Correlations between VAT measured by USG and cardiometabolic parameters were relatively stronger in the upper abdomen (p < 0.05). Conclusion Women accumulate more VAT in the narrower waist region, while men accumulate VAT uniformly across the abdomen. There was relative superiority in predicting cardiometabolic risk in the upper abdomen for both sexes.
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Affiliation(s)
| | - Cláudia Porto Sabino Pinho
- Hospital das Clínicas, Universidade Federal de Pernambuco (HC-UFPE); Pronto-Socorro Cardiológico de Pernambuco, Universidade de Pernambuco (Procape UPE); Departamento de Nutrição, UFPE, Recife, PE, Brasil
| | - Alcides da Silva Diniz
- Hospital das Clínicas, Universidade Federal de Pernambuco (HC-UFPE); Pronto-Socorro Cardiológico de Pernambuco, Universidade de Pernambuco (Procape UPE); Departamento de Nutrição, UFPE, Recife, PE, Brasil
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Muacevic A, Adler JR, Fatima I, Nasir M. Relationship of Abdominal Circumference and Trunk Length With Spinal Anesthesia Block Height in Geriatric Patients Undergoing Transurethral Resection of Prostate. Cureus 2023; 15:e33476. [PMID: 36751206 PMCID: PMC9900462 DOI: 10.7759/cureus.33476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2023] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Spinal anesthesia is commonly used for various surgical procedures. Prediction of spinal anesthesia block height is always a challenging task for anesthetists. Higher than desired levels of spinal anesthesia blocks are associated with serious side effects, while inadequate block height does not provide satisfactory surgical anesthesia. In this study, we observed the relationship between the ratio of trunk length (TL) and square of the abdominal circumference (AC2) and spinal anesthesia sensory block height in geriatric patients undergoing transurethral resection of the prostate (TURP). MATERIAL & METHODS This is a cross-sectional study conducted at the Aga Khan University Hospital Karachi, Pakistan, on geriatric patients undergoing TURP under spinal anesthesia. Forty-three elderly patients (American Society of Anaesthesiology level I-III) between 60 and 80 years were recruited for the study. In hospital wards, trunk length (TL) and abdominal circumference were recorded before the procedure. In the operating rooms, spinal anesthesia was performed at L3-L4 intervertebral space with 0.5% hyperbaric bupivacaine 10mg (2mls). Block height was measured by the placement of ice pads at different dermatomes. Spearman rank correlation coefficient was used to analyze the physical parameters (TL/AC2) and spinal anesthesia block height. Results: The ratio of trunk length and square of the abdominal circumference (TL/AC2) correlates with spinal anesthesia block height in geriatric patients, where the spearman rank correlation coefficient was r =-0.284 with p = 0.015. CONCLUSION The ratio of the long axis (TL) and transection area of the abdomen (AC2), which coincides with (TL/AC2), correlated with spinal anesthesia sensory block height. Hence, elderly patients with a low TL/AC2 ratio will have higher block height after spinal anesthesia.
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Torem M, Marom O, Gonen N, Gindes L, Schreiber L, Kovo M. Is there an association between isolated sonographic abdominal circumference below the 10th percentile and placental vascular lesions? Int J Gynaecol Obstet 2023; 160:59-64. [PMID: 35277973 DOI: 10.1002/ijgo.14176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To study the association between prenatal diagnosis of isolated abdominal circumference (AC) below the 10th percentile (AC <10th) in appropriate for gestational age (AGA) neonates and placental vascular lesions. METHODS A prospective study was conducted of healthy women who underwent sonographic fetal biometric measurements, up to 7 days before delivery, and delivered AGA neonates. The study cohort was divided into those with and without prenatal isolated AC <10th. Placental histopathology lesions were classified into maternal and fetal vascular malperfusion (MVM, FVM) lesions. RESULTS Compared to the AC over 10th percentile group (n = 85), the AC <10th group (n = 85) was characterized by lower maternal body mass index, higher rate of smokers, and increased rate of induced labor (P = 0.029, P = 0.029, P = 0.001, respectively). There were no between-group differences regarding maternal age, gestational age, and neonatal outcome. Mean placental weight was lower in the isolated AC <10th (P < 0.001). The rate of MVM or FVM lesions did not differ between the groups. By multivariate logistic regression analysis, isolated AC <10th was not found to be associated with increased risk for placental vascular lesions. CONCLUSION Isolated AC <10th is associated with increased rate of induction of labor; however, it is not associated with increased placental vascular lesions.
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Affiliation(s)
- Maya Torem
- Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Or Marom
- Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Gonen
- Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liat Gindes
- Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Letizia Schreiber
- Department of Pathology, Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Kovo
- Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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11
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Dias Duarte de Carvalho Souza M, Mary Ribeiro M, Bueno Ferreira L, Silva do Carmo A, Dos Santos LC. Weight Reduction and Changes in Body Circumferences in Lactating Women as a Function of Differences in Dietary Macronutrient Content. Breastfeed Med 2022; 17:511-518. [PMID: 35353584 DOI: 10.1089/bfm.2021.0354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objectives: Investigating waist circumference (WC) and abdominal circumference (AC) evolution in lactating women, based on macronutrient intake adequacy up to 6 months after childbirth. Materials and Methods: Prospective cohort comprising lactating women recruited at a maternity hospital in Minas Gerais State, Brazil, from June 2018 to June 2019. Selected individuals were healthy adult women who had given birth 72 hours before data collection. Sociodemographic, breastfeeding, and anthropometric data were collected. Food intake was determined through 24 hours dietary recalls. Adequate carbohydrate, protein, and lipid intake was herein defined as 45-65%, 10-35%, and 20-35% of the caloric value consumed by participants, respectively. Wilcoxon test and generalized estimating equations were carried out. This research was approved by the Research Ethics Committee, as well as by the National Research Ethics Committee. Results: There was decrease in weight (-4.45 kg), body mass index (-4.43 kg/m2), WC (-4.70 cm), and AC (-4.70 cm) values from the baseline (n = 260) up to 6 months after childbirth (p < 0.001). The evolution of these measurements has indicated that high carbohydrate and low protein intake were associated with the highest AC values. Low protein and high lipid intake have led to lower WC values (p < 0.05). Conclusions: Macronutrient intake adequacy by the investigated lactating women has influenced their WC and AC evolution. This outcome has evidenced the important role played by nutritional monitoring in puerperium to prevent abdominal fat retention after pregnancy.
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Affiliation(s)
| | - Marinara Mary Ribeiro
- Department of Nutrition, Nursing School, Federal University of Minas Gerais, Belo Horizonte, Brazil
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12
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Wang G, Wang W, Jin H, Dong H, Chen W, Li X, Bai S, Li G, Chen W, Li L, Chen J. Effect of Abdominal Circumference on the Irradiated Bowel Volume in Pelvic Radiotherapy for Rectal Cancer Patients: Implications for the Radiotherapy-Related Intestinal Toxicity. Front Oncol 2022; 12:843704. [PMID: 35280741 PMCID: PMC8904399 DOI: 10.3389/fonc.2022.843704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 01/26/2022] [Indexed: 12/03/2022] Open
Abstract
Background To effectively reduce the irradiated bowel volume so as to reduce intestinal toxicity from pelvic radiotherapy, treatment in the prone position with a full bladder on a belly board is widely used in pelvic radiotherapy for rectal cancer patients. However, the clinical applicable condition of this radiotherapy mode is unclear. The aim of this study was to preliminarily identify patients who were not eligible for this radiotherapy mode by analyzing the effect of abdominal circumference on the irradiated bowel volume. Methods From May 2014 to September 2019, 179 patients with locally advanced rectal cancer were retrospectively reviewed in our center. All patients received pelvic radiotherapy. Weight, height, AC, and body mass index (BMI) were used as the research objects, and the irradiated bowel volume at different dose levels (V10, V20, V30, V40, V50) was selected as the outcome variable. Multivariate linear regression and sensitivity analyses were used to evaluate the correlation between AC and irradiated bowel volume. Generalized additive model (GAM) and piecewise linear regression were used to further analyze the possible nonlinear relationship between them. Results Among the four body size indicators, AC showed a negative linear correlation with the irradiated bowel volume, which was the most significant and stable. In adjuvant radiotherapy patients, we further discovered the threshold effect between AC and irradiated bowel volume, as AC was greater than the inflection point (about 71 cm), irradiated bowel volume decreased rapidly with the increase in AC. t-test showed that in patients with small AC (<71 cm), the irradiated bowel volume was significantly higher than that of patients with medium-large AC (≥71 cm). Especially in patients with adjuvant radiotherapy, the mean irradiated bowel volume of patients with small AC was the highest in this study. Compared with adjuvant radiotherapy, in neoadjuvant radiotherapy, the mean difference of irradiated bowel volume between patients with medium-large AC and those with small AC was larger. Conclusion AC is an independent factor influencing the irradiated bowel volume and has a strong negative linear correlation with it. Patients with small AC may not benefit from this common mode of radiotherapy, especially in adjuvant radiotherapy.
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Affiliation(s)
- Gang Wang
- Department of Abdominal Oncology, The Affiliated Hospital of Guizhou Medical University, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China
| | - Wenling Wang
- Department of Abdominal Oncology, The Affiliated Hospital of Guizhou Medical University, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China
| | - Haijie Jin
- Department of Abdominal Oncology, The Affiliated Hospital of Guizhou Medical University, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China
| | - Hongmin Dong
- Department of Abdominal Oncology, The Affiliated Hospital of Guizhou Medical University, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China
| | - Weiwei Chen
- Department of Abdominal Oncology, The Affiliated Hospital of Guizhou Medical University, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China
| | - Xiaokai Li
- Department of Abdominal Oncology, The Affiliated Hospital of Guizhou Medical University, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China
| | - Saixi Bai
- Department of Abdominal Oncology, The Affiliated Hospital of Guizhou Medical University, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China
| | - Guodong Li
- Department of Abdominal Oncology, The Affiliated Hospital of Guizhou Medical University, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China
| | - Wanghua Chen
- Department of Abdominal Oncology, The Affiliated Hospital of Guizhou Medical University, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China
| | - Leilei Li
- Department of Abdominal Oncology, The Affiliated Hospital of Guizhou Medical University, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China
| | - Juan Chen
- Department of Abdominal Oncology, The Affiliated Hospital of Guizhou Medical University, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China
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Tucker BS, Petrovski KR, Craig JR, Morrison RS, Smits RJ, Kirkwood RN. Piglet Morphology: Indicators of Neonatal Viability? Animals (Basel) 2022; 12. [PMID: 35268226 DOI: 10.3390/ani12050658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 11/24/2022] Open
Abstract
The morphological measures, crown-to-rump length (CR), and abdominal circumference (AC) have been suggested to be as good, if not better, than birth weight for predicting piglet performance. We explored the relationships between CR and AC, and piglet weights at birth and 24 h, to investigate their predictive value for piglet survival. Piglet weight and AC at birth and 24 h, and CR at 24 h were recorded for 373 piglets born to 31 sows. Morphological measures were categorised into two levels for weight and three levels for AC and CR. Further, AC and CR groupings were concatenated to create a new variable (PigProp) to describe the proportionality of piglet morphology. Proportionate piglets had equal CR and AC levels, and disproportionate piglets had contrasting levels. Birth AC was a good predictor of colostrum intake (p < 0.001) when accounting for birth weight, but 24 h weight and PigProp were good indicators of actual colostrum intake (p < 0.001 for both). The significant interaction of colostrum and PigProp showed that within the smaller piglet groups, those who had greater than 200 g of colostrum had higher 24 h weight and survival (p < 0.001 both). As expected, as body weight and colostrum intake increased, so did weight change to d 21 (P = 0.03 and trend at p = 0.1, respectively). A similar pattern was seen with increasing PigProp group (p < 0.001); however, piglets from the disproportionate group 1,3 had the greatest observed weight change (5.15 ± 0.06 kg). Our data show morphological measures may be more predictive of piglet viability in terms of both performance and survival than weight and there may be subgroups that have higher than expected chances of survival.
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14
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Lees CC, Romero R, Stampalija T, Dall'Asta A, DeVore GA, Prefumo F, Frusca T, Visser GHA, Hobbins JC, Baschat AA, Bilardo CM, Galan HL, Campbell S, Maulik D, Figueras F, Lee W, Unterscheider J, Valensise H, Da Silva Costa F, Salomon LJ, Poon LC, Ferrazzi E, Mari G, Rizzo G, Kingdom JC, Kiserud T, Hecher K. Clinical Opinion: The diagnosis and management of suspected fetal growth restriction: an evidence-based approach. Am J Obstet Gynecol 2022; 226:366-378. [PMID: 35026129 PMCID: PMC9125563 DOI: 10.1016/j.ajog.2021.11.1357] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 11/01/2022]
Abstract
This study reviewed the literature about the diagnosis, antepartum surveillance, and time of delivery of fetuses suspected to be small for gestational age or growth restricted. Several guidelines have been issued by major professional organizations, including the International Society of Ultrasound in Obstetrics and Gynecology and the Society for Maternal-Fetal Medicine. The differences in recommendations, in particular about Doppler velocimetry of the ductus venosus and middle cerebral artery, have created confusion among clinicians, and this review has intended to clarify and highlight the available evidence that is pertinent to clinical management. A fetus who is small for gestational age is frequently defined as one with an estimated fetal weight of <10th percentile. This condition has been considered syndromic and has been frequently attributed to fetal growth restriction, a constitutionally small fetus, congenital infections, chromosomal abnormalities, or genetic conditions. Small for gestational age is not synonymous with fetal growth restriction, which is defined by deceleration of fetal growth determined by a change in fetal growth velocity. An abnormal umbilical artery Doppler pulsatility index reflects an increased impedance to flow in the umbilical circulation and is considered to be an indicator of placental disease. The combined finding of an estimated fetal weight of <10th percentile and abnormal umbilical artery Doppler velocimetry has been widely accepted as indicative of fetal growth restriction. Clinical studies have shown that the gestational age at diagnosis can be used to subclassify suspected fetal growth restriction into early and late, depending on whether the condition is diagnosed before or after 32 weeks of gestation. The early type is associated with umbilical artery Doppler abnormalities, whereas the late type is often associated with a low pulsatility index in the middle cerebral artery. A large randomized clinical trial indicated that in the context of early suspected fetal growth restriction, the combination of computerized cardiotocography and fetal ductus venosus Doppler improves outcomes, such that 95% of surviving infants have a normal neurodevelopmental outcome at 2 years of age. A low middle cerebral artery pulsatility index is associated with an adverse perinatal outcome in late fetal growth restriction; however, there is no evidence supporting its use to determine the time of delivery. Nonetheless, an abnormality in middle cerebral artery Doppler could be valuable to increase the surveillance of the fetus at risk. We propose that fetal size, growth rate, uteroplacental Doppler indices, cardiotocography, and maternal conditions (ie, hypertension) according to gestational age are important factors in optimizing the outcome of suspected fetal growth restriction.
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Affiliation(s)
- Christoph C Lees
- Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College London, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI; Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI
| | - Tamara Stampalija
- Department of Obstetrics and Gynecology, Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, Scientific Institute for Research, Hospitalization and Healthcare Burlo Garofolo, Trieste, Italy; Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Andrea Dall'Asta
- Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College London, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - Greggory A DeVore
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Federico Prefumo
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Tiziana Frusca
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - Gerard H A Visser
- Department of Obstetrics, University Medical Center, Utrecht, The Netherlands
| | - John C Hobbins
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO
| | - Ahmet A Baschat
- Department of Gynecology and Obstetrics, John Hopkins Center for Fetal Therapy, Johns Hopkins University, Baltimore, MD
| | - Caterina M Bilardo
- Amsterdam UMC, University of Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, the Netherlands
| | - Henry L Galan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO; Colorado Fetal Care Center, Children's Hospital of Colorado, Aurora, CO
| | | | - Dev Maulik
- Department of Obstetrics and Gynecology, University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Francesc Figueras
- BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Wesley Lee
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Pavilion for Women, Houston, TX
| | - Julia Unterscheider
- Department of Maternal-Fetal Medicine, Royal Women's Hospital, Melbourne, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Australia
| | - Herbert Valensise
- University of Rome Tor Vergata, Rome, Italy; Department of Surgery, Policlinico Casilino, Rome, Italy
| | - Fabricio Da Silva Costa
- Maternal-Fetal Medicine Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia; School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Laurent J Salomon
- Obstétrique et Plateforme LUMIERE, Hôpital Necker-Enfants Malades (AP-HP) et Université de Paris, Paris, France
| | - Liona C Poon
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region of China
| | - Enrico Ferrazzi
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giancarlo Mari
- Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Giuseppe Rizzo
- Università di Roma Tor Vergata, Department of Obstetrics and Gynecology, Fondazione Policinico Tor Vergata, Rome, Italy; The First I.M. Sechenov Moscow State Medical University, Department of Obstetrics and Gynaecology, Moscow, Russian Federation
| | - John C Kingdom
- Placenta Program, Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Torvid Kiserud
- Department of Obstetrics and Gynecology, Haukeland University Hospital, and Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Kurt Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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15
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Mizui M, Mizoguchi Y, Tashiro T. [Examination of the Validity of the Abdominal Circumference Measurement Method Used for Visceral Fat Evaluation Using Computed Tomography]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2022; 78:257-262. [PMID: 35314534 DOI: 10.6009/jjrt.780302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE The effects of obesity, including metabolic syndrome, on health are of concern around the world. In Japan, if the abdominal circumference of a man is 85 cm or more and the abdominal circumference of a woman is 90 cm or more, the visceral fat area is equivalent to 100 cm2 or more. The evaluation of visceral fat by abdominal circumference is based on the influence of tissues other than visceral fat. The purposes of this study were to compare the abundance of visceral fat area and subcutaneous fat area and to examine the validity of estimating the visceral fat area by the abdominal circumference measurement method. METHODS We obtained data on visceral fat area, subcutaneous fat area, and abdominal circumference of 822 subjects. Next, we investigated the correlation between the abdominal circumference and the visceral fat area, the abdominal circumference and the subcutaneous fat area, and the visceral fat area and the subcutaneous fat area of the subjects. RESULT The abdominal circumference and visceral fat area were highly correlated, but the sum of visceral fat area and subcutaneous fat area was more highly correlated. There was a low correlation between the visceral fat area and the subcutaneous fat area. When the abdominal circumference exceeded the standard value, there was no correlation between the visceral fat area and the subcutaneous fat area. We concluded that there is a correlation between abdominal circumference and BMI and visceral fat area, but when these are used for estimation of visceral fat area, they are not accurate due to many errors.
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Yamada T, Yamato Y, Hasegawa T, Yoshida G, Banno T, Arima H, Oe S, Mihara Y, Ushirozako H, Ide K, Watanabe Y, Matsuyama Y. Prevalence of Locomotive Dysfunction Exacerbating Systolic Blood Pressure and Abdominal Circumference: A Longitudinal Cohort Analysis. Metab Syndr Relat Disord 2021; 19:562-566. [PMID: 34613827 DOI: 10.1089/met.2021.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: We aimed to investigate the influence of locomotive dysfunction (LD) on the future prevalence of metabolic syndrome (MetS) in community-dwelling people using propensity score matching (PSM). Materials and Methods: Two hundred and twenty-five volunteers (87 men and 138 women, mean age: 66.9 years) underwent a health screening program in 2012 and 2014. We extracted 92 volunteers with LD and 133 without LD in 2012. After performing 1:1 PSM using clinical variables, including age, sex, individual MetS components, and comorbidities between the two groups, we investigated the prevalence of MetS between the two groups (LD and non-LD) in 2014. Results: Seventy-three subjects were enrolled in each group. In 2012, the mean the 25-question Geriatric Locomotive Function Scale was 2.6 in the non-LD group and 13.4 in the LD group. The baseline prevalence of MetS was 9 (12.3%) in non-LD group and 8 (11%) in LD group. After 2 years, the prevalence of MetS in the LD group increased to 18 (24.7%), but only by 8 (11%) (P = 0.031) in the non-LD group. Among MetS components, waist circumference (84.9 vs. 82.5 cm) and systolic blood pressure (SBP) (145 vs. 140 mmHg) in the LD group were significantly higher than in the non-LD group (P = 0.047, P = 0.023). Conclusions: The longitudinal analysis showed that LD increases the prevalence of MetS and deteriorates SBP and abdominal circumference over 2 years.
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Affiliation(s)
- Tomohiro Yamada
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yu Yamato
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.,Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiko Hasegawa
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Go Yoshida
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiro Banno
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hideyuki Arima
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Shin Oe
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.,Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuki Mihara
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroki Ushirozako
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Koichiro Ide
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuh Watanabe
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yukihiro Matsuyama
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Teodorescu COD, Șandru F, Charkaoui A, Teodorescu A, Popa AR, Miron AI. The dynamic changes in the pattern of liver function tests in pregnant obese women. Exp Ther Med 2021; 22:986. [PMID: 34345268 PMCID: PMC8311227 DOI: 10.3892/etm.2021.10418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/10/2021] [Indexed: 12/29/2022] Open
Abstract
Obesity is an important problem in healthcare regarding gestating women. The objective of the present study was to highlight the impact that obesity has on the hepatic function in pregnant women by comparing the functional tests used in current practice. In addition, the aim was to identify possible predictors of liver damage by analyzing specific anthropometric data. The present study was descriptive, observational, retrospective, and based on the observation sheets found in the database of the Institute for the Health of the Mother and Child, the Obstetrics Gynecology Department of Polizu Hospital. Patients who presented for consultation in each trimester of pregnancy were included in the study. Demographic data taken into account included age, body mass index (BMI), provenance environment, anthropometric data: Abdominal circumference and the complete set of paraclinical data from which we extracted these specific liver tests: Aspartate aminotransferase (AST), alanine transferase (ALT), direct bilirubin (BD), serum albumin and gamma-glutamyl transferase (GGT). The present study included 157 patients divided into two groups, distributed as follows: Group A: 66 obese pregnant women (BMI >25 kg/m2) and group B: 91 patients with normal weight (BMI <25 kg/m2). Measurement of serum ALT and AST were the most useful tests for routine diagnosis of liver disease. The effects of pregnancy on serum levels of ALT and AST are controversial. In some studies, there was a slight increase in ALT and AST during the second and third trimesters, a fact confirmed by our study, albeit the result was not statistically significant Most published studies claim that serum ALT and AST levels do not change during pregnancy. In conclusion, obesity during pregnancy does not drastically influence liver function. However, patients with greater abdominal circumference are prone to developing minor hepatic cytolysis syndrome during the gestation period. The liver functional tests described in the aforementioned groups agree with the results provided by the specialized studies.
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Affiliation(s)
| | - Florica Șandru
- Department of Dermatology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Dermatology, ‘Elias’ Emergency University Hospital, 011461 Bucharest, Romania
| | - Adham Charkaoui
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800008 Galati, Romania
| | - Andrei Teodorescu
- Department of Morphology, University of Medicine and Pharmacy, 410028 Oradea, Romania
| | - Amorin Remus Popa
- Department of Diabetes, Nutrition, Metabolic and Internal Diseases, University of Medicine and Pharmacy, 410033 Oradea, Romania
| | - Andreea-Iuliana Miron
- Department of Dermatology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Radiology, Oncology, Hematology, ‘Colțea’ Clinical Hospital, 927180 Bucharest, Romania
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Ahn KH, Lee KS, Lee SJ, Kwon SO, Na S, Kim K, Kang HS, Lee KA, Won HS, Kim MY, Hwang HS, Park MH, Korean Society Of Ultrasound In Obstetrics Gynecology Research Group. Predictors of Newborn's Weight for Height: A Machine Learning Study Using Nationwide Multicenter Ultrasound Data. Diagnostics (Basel) 2021; 11:1280. [PMID: 34359366 DOI: 10.3390/diagnostics11071280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 11/17/2022] Open
Abstract
There has been no machine learning study with a rich collection of clinical, sonographic markers to compare the performance measures for a variety of newborns’ weight-for-height indicators. This study compared the performance measures for a variety of newborns’ weight-for-height indicators based on machine learning, ultrasonographic data and maternal/delivery information. The source of data for this study was a multi-center retrospective study with 2949 mother–newborn pairs. The mean-squared-error-over-variance measures of five machine learning approaches were compared for newborn’s weight, newborn’s weight/height, newborn’s weight/height2 and newborn’s weight/hieght3. Random forest variable importance, the influence of a variable over average node impurity, was used to identify major predictors of these newborns’ weight-for-height indicators among ultrasonographic data and maternal/delivery information. Regarding ultrasonographic fetal biometry, newborn’s weight, newborn’s weight/height and newborn’s weight/height2 were better indicators with smaller mean-squared-error-over-variance measures than newborn’s weight/height3. Based on random forest variable importance, the top six predictors of newborn’s weight were the same as those of newborn’s weight/height and those of newborn’s weight/height2: gestational age at delivery time, the first estimated fetal weight and abdominal circumference in week 36 or later, maternal weight and body mass index at delivery time, and the first biparietal diameter in week 36 or later. These six predictors also ranked within the top seven for large-for-gestational-age and the top eight for small-for-gestational-age. In conclusion, newborn’s weight, newborn’s weight/height and newborn’s weight/height2 are more suitable for ultrasonographic fetal biometry with smaller mean-squared-error-over-variance measures than newborn’s weight/height3. Machine learning with ultrasonographic data would be an effective noninvasive approach for predicting newborn’s weight, weight/height and weight/height2.
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Zhang A, Stolk TT, Lopriore E, Sun L, Duan T, Oepkes D. Second-trimester abdominal circumference discordance and adverse perinatal outcomes in monochorionic twins. J Matern Fetal Neonatal Med 2021; 35:7316-7321. [PMID: 34219590 DOI: 10.1080/14767058.2021.1947227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The perinatal outcomes in second-trimester abdominal circumference (AC) discordant twins are yet to be established. The aim of this study was to ascertain perinatal risks associated with second-trimester AC discordance in monochorionic (MC) twins. METHOD We conducted a retrospective study of all MC twin pregnancies over a 7-year period. Intertwin AC discordance at 14-26 gestational weeks was analyzed in relation to Doppler abnormalities, obstetric complications, and perinatal adverse outcomes. RESULTS A total of 246 MC twin pregnancies were included in the analysis. The smaller twins of second-trimester AC discordant pairs were at increased prevalence of abnormal umbilical artery flow (50% versus 24%, p < .001) and low positive A wave of ductus venous flow (24% versus 9%, p = .002). The second-trimester AC discordant twins were at increased risk of oligohydramnios in smaller twin (OR = 2.44, 95% CI = 1.37-4.32, p < .01), cardiomegaly in larger twin (OR = 2.95, 95% CI = 1.01-8.60, p < .05), birth weight of either twin below the 10th percentile for gestational age (OR = 5.56, 95% CI = 2.67-11.59, p < .001), birth weight discordance > 25% (OR = 9.41, 95% CI = 4.46-19.87, p < .001), IUFD (OR = 3.26, 95% CI = 1.76-6.05, p < .001), and severe neonatal morbidity (OR = 1.83, 95% CI = 1.03-3.26, p < .05). The intact survival rate in discordant and concordant twin pairs was 70% and 89%, respectively (p < .001). CONCLUSIONS Early and increase fetal surveillance of the second-trimester AC discordant twins should be utilized to establish perinatal risks, thus allowing prenatal care to improve.
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Affiliation(s)
- A Zhang
- Qingdao Women and Children's Hospital, Qingdao University School of Medicine, Qingdao, PR China
| | - T T Stolk
- Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - E Lopriore
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - L Sun
- Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - T Duan
- Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - D Oepkes
- Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
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Xie K, Gao X, Bao L, Shan Y, Shi H, Li Y. The Integrated Management of Hypertension in General Hospitals and Community Hospitals. Risk Manag Healthc Policy 2021; 14:2537-2545. [PMID: 34177280 PMCID: PMC8219293 DOI: 10.2147/rmhp.s306735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/24/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE We sought to investigate and improve the integrated management of hypertension in general and community hospitals in China. PATIENTS AND METHODS We carried out a cross-sectional study in 90 centers from 15 cities in China from 2017 to 2018. Patients with primary hypertension were included. RESULTS Of the total 4286 patients included, 43.2% of them controlled blood pressure (BP) below 140/90 mmHg while only 11.5% controlled BP below 130/80 mmHg. The control rate of low-density lipoprotein-C (LDL-C) in patients with concomitant coronary artery disease (CAD), diabetes (DM), and chronic kidney disease (CKD) was 24.7%, 49.4%, and 40.6%, respectively. Thirty-one percent of the DM patients had HbA1c levels greater than 8% while 21.7% of the non-DM patients had HbA1c≥6.5%. The control rate of body mass index (BMI) was 54.4% in men and 59.8% in women. As compared to patients from community hospitals, patients from general hospitals had poorer control of BP<140/90 mmHg (OR 0.63, 95% CI 0.55-0.73, p<0.001), comparatively better attainment of LDL-C, particularly <1.8 mmol/L in CAD (OR 3.25, 95% CI 2.02-5.24, p<0.001), similar control of HbA1c < 8.0% in diabetes (OR 0.64, 95% CI 0.41-1.00, p=0.052) and comparatively worse achievement of BMI<25 kg/m2 (OR 0.72, 95% CI 0.63-0.83, p<0.001). CONCLUSION The integrated management of hypertension needs to be improved. Besides LDL-C, the management of BP, blood glucose (BG), and BMI need to be strengthened in not only community hospitals but also general hospitals.
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Affiliation(s)
- Kun Xie
- Cardiology Department, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Xiufang Gao
- Cardiology Department, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Liwen Bao
- Cardiology Department, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Ying Shan
- Cardiology Department, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Haiming Shi
- Cardiology Department, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Yong Li
- Cardiology Department, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China
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Kikuchi K, Imaizumi T, Ando M, Kato S, Kondo T, Honda H, Yoshida Y, Maruyama S. Validity of "One-size-fits-all" Approaches for the National Health Screening and Education Program: A Large-scale Cohort Study of Corporate Insurance Beneficiaries. Intern Med 2021; 60:1681-1689. [PMID: 33390484 PMCID: PMC8222130 DOI: 10.2169/internalmedicine.5515-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective Metabolic syndrome represents a unified condition of atherosclerotic diseases caused by abdominal obesity. The aims of this study were to examine the applicability of the prevalent fixed cut-off values of the abdominal circumference (AC) and body mass index (BMI) to age and gender groups and to identify suitable lifestyle modification factors. Methods We defined an outcome as having ≥ 2 risk components that are necessary to diagnose metabolic syndrome and examined the cross-sectional association of the AC and BMI with the outcome. We also assessed the effects of time-updated lifestyle information on metabolic traits using longitudinal data. Patients We enrolled 22,953 beneficiaries of a corporate health insurance scheme who underwent annual health examinations between January 2004 and December 2014. Results The AC [per 5-cm increase, odds ratio (OR) 1.17, 95% confidence interval (CI) 1.12-1.24] and BMI (OR 1.10, 95% CI 1.07-1.13) were significantly associated with the outcome, adjusted for age, gender, current smoking status, drinking habits, and other lifestyle information. The association between the outcome and AC was modified by gender (p for interaction = 0.033), and the association between the outcome and BMI was modified by age group (p for interaction = 0.049). In the longitudinal analysis, current smoking, drinking habits, and unhealthy eating habits were associated with an increased AC and BMI, whereas regular physical activity was associated with a decreased AC and BMI. Conclusion We showed that the association between the AC or BMI and metabolic syndrome was modified by gender or age group. Further studies will be needed to customize the national health screening and education programs.
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Affiliation(s)
- Kyoko Kikuchi
- Department of Nephrology, Nagoya University Graduate School of Medicine, Japan
| | - Takahiro Imaizumi
- Department of Nephrology, Nagoya University Graduate School of Medicine, Japan
- Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Japan
| | - Masahiko Ando
- Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Japan
| | - Sawako Kato
- Department of Nephrology, Nagoya University Graduate School of Medicine, Japan
| | - Takaaki Kondo
- Program in Radiological and Medical Laboratory Sciences, Nagoya University Graduate School of Medicine, Japan
| | - Hiroyuki Honda
- Department of Biotechnology, Graduate School of Engineering, Nagoya University, Japan
- Innovative Research Center for Preventive Medical Engineering, Nagoya University, Japan
| | - Yasuko Yoshida
- Innovative Research Center for Preventive Medical Engineering, Nagoya University, Japan
| | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Japan
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Pacora P, Romero R, Jung E, Gudicha DW, Hernandez-Andrade E, Musilova I, Kacerovsky M, Jaiman S, Erez O, Hsu CD, Tarca AL. Reduced fetal growth velocity precedes antepartum fetal death. Ultrasound Obstet Gynecol 2021; 57:942-952. [PMID: 32936481 PMCID: PMC9651138 DOI: 10.1002/uog.23111] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 05/25/2023]
Abstract
OBJECTIVES To determine whether decreased fetal growth velocity precedes antepartum fetal death and to evaluate whether fetal growth velocity is a better predictor of antepartum fetal death compared to a single fetal biometric measurement at the last available ultrasound scan prior to diagnosis of demise. METHODS This was a retrospective, longitudinal study of 4285 singleton pregnancies in African-American women who underwent at least two fetal ultrasound examinations between 14 and 32 weeks of gestation and delivered a liveborn neonate (controls; n = 4262) or experienced antepartum fetal death (cases; n = 23). Fetal death was defined as death diagnosed at ≥ 20 weeks of gestation and confirmed by ultrasound examination. Exclusion criteria included congenital anomaly, birth at < 20 weeks of gestation, multiple gestation and intrapartum fetal death. The ultrasound examination performed at the time of fetal demise was not included in the analysis. Percentiles for estimated fetal weight (EFW) and individual biometric parameters were determined according to the Hadlock and Perinatology Research Branch/Eunice Kennedy Shriver National Institute of Child Health and Human Development (PRB/NICHD) fetal growth standards. Fetal growth velocity was defined as the slope of the regression line of the measurement percentiles as a function of gestational age based on two or more measurements in each pregnancy. RESULTS Cases had significantly lower growth velocities of EFW (P < 0.001) and of fetal head circumference, biparietal diameter, abdominal circumference and femur length (all P < 0.05) compared to controls, according to the PRB/NICHD and Hadlock growth standards. Fetuses with EFW growth velocity < 10th percentile of the controls had a 9.4-fold and an 11.2-fold increased risk of antepartum death, based on the Hadlock and customized PRB/NICHD standards, respectively. At a 10% false-positive rate, the sensitivity of EFW growth velocity for predicting antepartum fetal death was 56.5%, compared to 26.1% for a single EFW percentile evaluation at the last available ultrasound examination, according to the customized PRB/NICHD standard. CONCLUSIONS Given that 74% of antepartum fetal death cases were not diagnosed as small-for-gestational age (EFW < 10th percentile) at the last ultrasound examination when the fetuses were alive, alternative approaches are needed to improve detection of fetuses at risk of fetal death. Longitudinal sonographic evaluation to determine growth velocity doubles the sensitivity for prediction of antepartum fetal death compared to a single EFW measurement at the last available ultrasound examination, yet the performance is still suboptimal. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- Percy Pacora
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA
- Detroit Medical Center, Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Florida International University, Miami, Florida, USA
| | - Eunjung Jung
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Dereje W. Gudicha
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Edgar Hernandez-Andrade
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Ivana Musilova
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Marian Kacerovsky
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Sunil Jaiman
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Offer Erez
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Chaur-Dong Hsu
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
- Department of Physiology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Adi L. Tarca
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
- Department of Computer Science, Wayne State University College of Engineering, Detroit, Michigan, USA
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Hong JY, Kim JH, Kim SY, Sung JH, Choi SJ, Oh SY, Roh CR. Can a Difference in Gestational Age According to Biparietal Diameter and Abdominal Circumference Predict Intrapartum Placental Abruption? J Clin Med 2021; 10:2413. [PMID: 34072409 DOI: 10.3390/jcm10112413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/15/2021] [Accepted: 05/27/2021] [Indexed: 11/17/2022] Open
Abstract
This study aimed to investigate whether a difference in gestational age according to biparietal diameter (BPD) and abdominal circumference (AC) could be a clinically useful predictor of placental abruption during the intrapartum period. This retrospective cohort study was based on singletons who were delivered after 32 + 0 weeks between July 2015 and July 2020. We only included cases with at least two antepartum sonographies available within 4 weeks of delivery (n = 2790). We divided the study population into two groups according to the presence or absence of placental abruption and compared the clinical variables. The incidence of placental abruption was 2.0% (56/2790) and was associated with an older maternal age, a higher rate of preeclampsia, and being small for the gestational age. A difference of >2 weeks in gestational age according to BPD and AC occurred at a higher rate in the placental abruption group compared to the no abruption group (>2 weeks, 21.4% (12/56) vs. 7.5% (205/2734), p < 0.001; >3 weeks, 12.5% (7/56) vs. 2.0% (56/2734), p < 0.001). Logistic regression analysis revealed that the differences of >2 weeks and >3 weeks were both independent risk factors for placental abruption (odds ratio (OR) (95% confidence interval), 2.289 (1.140-4.600) and 3.918 (1.517-9.771), respectively) after adjusting for maternal age, preeclampsia, and small for gestational age births. We identified that a difference in gestational age of >2 weeks between BPD and AC could be an independent predictor of placental abruption.
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O'Malley EG, Reynolds CME, Killalea A, O'Kelly R, Sheehan SR, Turner MJ. Comparison of ultrasound with biomarkers to identify large-for-gestational age in women screened for gestational diabetes mellitus. J Matern Fetal Neonatal Med 2021; 35:6306-6311. [PMID: 33910459 DOI: 10.1080/14767058.2021.1911993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Large-for-gestational-age (LGA) is associated with both fetal and maternal complications. One of the few modifiable risk factors for LGA is Gestational Diabetes Mellitus (GDM); for this reason, fetal growth is usually monitored by ultrasound in the third trimester. This prospective study compared a panel of ten established biomarkers measured at the time of selective screening for GDM at 26-28 weeks gestation with the ultrasound prediction of LGA. METHOD Women were recruited using convenience sampling and consented at the first antenatal visit. Women with maternal risk factors for GDM attended for the one-step 75 g oral glucose tolerance test. An additional blood sample was taken for biomarker measurement. GDM was diagnosed according to the 2013 World Health Organization (WHO) criteria. Fetal biometry, including the abdominal circumference (AC) and the fetal abdominal subcutaneous tissue (FAST) thickness, were measured at 37 weeks gestation. RESULTS Of the 195 women included, 105 (53.8%) had GDM. Of the 195 babies, 36 (18.5%) were LGA. Whether the woman had GDM or not, fetal biometry was strongly predictive of LGA but none of the following biomarkers measured at 26-28 weeks gestation alone or in combination were predictive: c-peptide, ghrelin, gastric inhibitory polypeptide, glucagon-like peptide-1 (GLP-1), glucagon, insulin, leptin, plasminogen activator inhibitor-1, resistin and visfatin. CONCLUSIONS In women diagnosed with GDM, surveillance of fetal growth to identify LGA by ultrasound should continue in the third trimester. None of the ten established maternal biomarkers measured at the time of the OGTT was as strongly predictive of LGA as ultrasound.
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Affiliation(s)
- Eimer G O'Malley
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Ciara M E Reynolds
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Anne Killalea
- Department of Biochemistry, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Ruth O'Kelly
- Department of Biochemistry, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Sharon R Sheehan
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Michael J Turner
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin, Ireland
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Ha LC, Craig A, Grace MR, Osmundson SS, Taylor EW, Zuckerwise LC. Accuracy of estimated fetal weight assessment in fetuses with abdominal wall defects. Am J Obstet Gynecol MFM 2021; 3:100385. [PMID: 33895400 DOI: 10.1016/j.ajogmf.2021.100385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Gastroschisis and omphalocele are congenital abdominal wall defects in which the bowel and other abdominal contents extrude from the fetal abdominal cavity. Standard formulas for estimated fetal weight using ultrasound include fetal abdominal circumference measurement and have a range of error of approximately 10%. It is unknown whether the accuracy of estimated fetal weight assessment is compromised in fetuses with abdominal wall defects because of the extrusion of abdominal contents. OBJECTIVE This study aimed to assess the accuracy of standard estimated fetal weight assessment in fetuses with abdominal wall defects by comparing prenatal assessment of fetal weight with actual birthweight. STUDY DESIGN A retrospective cohort study of fetuses diagnosed with gastroschisis or omphalocele was performed at a single center from 2012 to 2018. Fetuses with additional anomalies or confirmed chromosome abnormalities were excluded. Estimated fetal weight was calculated using the Hadlock formula. Published estimates of fetal growth rate were used to establish a projected estimated fetal weight at birth from the final growth ultrasound, and the percent difference between projected estimated fetal weight at birth and actual birthweight was calculated. The Wilcoxon rank-sum test was used to examine the difference between projected estimated fetal weight and actual birthweight. RESULTS We had complete data for 112 fetuses with abdominal wall defects, including 85 with gastroschisis and 27 with omphalocele. The median (interquartile range) projected estimated fetal weight was similar to median birthweight, at 2283 g (interquartile range, 2000-2810) and 2306 g (interquartile range, 1991-264), respectively, which did not represent a statistically significant difference between projected estimated fetal weight and actual birthweight (P=.32). The median percent error was 6.8 (3.1-12.8). In addition, we did not find any statistical difference between projected estimated fetal weight and actual birthweight in patients with gastroschisis (P=.52) or omphalocele (P=.35) individually. Estimated fetal weight was underestimated in most cases (n=68 [60.7%]). CONCLUSION In fetuses with abdominal wall defects, standard measurement of fetal weight shows an accuracy that is at least comparable with previously established margins of error for ultrasound assessment of fetal weight. Standard estimated fetal weight assessment remains an appropriate method of estimating fetal weight in these fetuses.
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Shen F, Lv H, Shi Y, Lau S, Guo F, Chen Q. A pilot study on investigating the role of Salvia miltiorrhiza in fetal growth restriction. Biosci Rep 2020; 40:BSR20201222. [PMID: 32406912 DOI: 10.1042/BSR20201222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/06/2020] [Accepted: 05/14/2020] [Indexed: 11/17/2022] Open
Abstract
To date there is no effective treatment for pregnancies complicated by fetal growth restriction (FGR). Salvia miltiorrhiza, a traditional Chinese herb has been shown to promote blood flow and improve microcirculatory disturbance. In this pilot study, we evaluated whether S. miltiorrhiza can potentially become a possible therapy for FGR. Nineteen pregnant women with FGR were treated with S. miltiorrhiza and ATP supplementation for an average of 7 days, and 17 cases received ATP supplementation as controls. The estimated fetal weights (EFWs) were measured by ultrasound after treatment, and the birthweights were recorded after birth. After treatment with S. miltiorrhiza, 7 (37%) FGR cases showed an increase in EFW to above the 10th percentile, compared with 4 (23%) FGR cases in controls (odds ratio: 1.896, 95% confidence limits (CLs): 0.44-8.144). At delivery, 10 (53%) FGR cases in the treatment group delivered babies with a birthweight above the 10th percentile, compared with 6 (35%) FGR cases in the control group (odds ratio: 2.037, 95% CL: 0.532-7.793); 80 or 64% FGR cases in the treatment group showed an increase in fetal abdominal circumference (AC) or biparietal diameter (BPD) above the 10th percentile before delivery. While 44 or 30% FGR cases in the control group showed an increase in AC or BPD. No improvement of head circumference (HC) or femur length (FL) was seen. These pilot data suggest the need for multicenter randomized clinical trials on the potential of S. miltiorrhiza to improve perinatal outcome in pregnant women complicated by FGR.
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Tabacu C, Manolea MM, Dijmarescu AL, Şerbanescu MS, Boldeanu MV, Novac L. Relationship between Serum Leptin Values and Abdominal Circumference Assessed in the First Trimester of Pregnancy in Obese Women. Curr Health Sci J 2021; 47:428-32. [PMID: 35003776 DOI: 10.12865/CHSJ.47.03.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/21/2021] [Indexed: 11/24/2022]
Abstract
Higher serum leptin values have been correlated with several complications of pregnancy, while the abdominal circumference (AC) is an anthropometric measurement usually used to diagnose abdominal obesity. For this study we compared serum leptin levels between two groups of pregnant women: those with abdominal obesity (AC>88cm) and those without abdominal obesity (AC<88cm), diagnosed at the beginning of pregnancy. Serum leptin levels were obtained through measurements performed between 11-14 and 28-32 weeks of gestation. Higher serum leptin levels were found in the group of pregnant women with abdominal obesity comparing to the group without abdominal obesity, but a positive correlation between abdominal circumference and the leptin values was found only at 11-14 weeks of pregnancy. Our study showed that a simple measurement of AC performed at the beginning of pregnancy may predict the average serum levels of leptin throughout the gestation period. A better understanding of the role of leptin during development is needed to make us able to know how maternal-placental-fetal leptin exchange influence the fetal development.
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Souza MVRD, Fróes LPE, Cortez PA, Lauria MW, Aguiar RALD, Rajão KMAB. Agreement Analysis between Sonographic Estimates and Birth Weight, by the WHO and Intergrowth-21st Tables, in Newborns of Diabetic Mothers. Rev Bras Ginecol Obstet 2021; 43:20-27. [PMID: 33513632 PMCID: PMC10183843 DOI: 10.1055/s-0040-1719146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 09/17/2020] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To analyze the agreement, in relation to the 90th percentile, of ultrasound measurements of abdominal circumference (AC) and estimated fetal weight (EFW), between the World Health Organization (WHO) and the International Fetal and Newborn Growth Consortium for the 21st Century (intergrowth-21st) tables, as well as regarding birth weight in fetuses/newborns of diabetic mothers. METHODS Retrospective study with data from medical records of 171 diabetic pregnant women, single pregnancies, followed between January 2017 and June 2018. Abdominal circumference and EFW data at admission (from 22 weeks) and predelivery (up to 3 weeks) were analyzed. These measures were classified in relation to the 90th percentile. The Kappa coefficient was used to analyze the agreement of these ultrasound variables between the WHO and intergrowth-21st tables, as well as, by reference table, these measurements and birth weight. RESULTS The WHO study reported 21.6% large-for-gestational-age (LGA) newborns while the intergrowth-21st reported 32.2%. Both tables had strong concordances in the assessment of initial AC, final AC, and initial EFW (Kappa = 0.66, 0.72 and 0.63, respectively) and almost perfect concordance in relation to final EFW (Kappa = 0.91). Regarding birth weight, the best concordances were found for initial AC (WHO: Kappa = 0.35; intergrowth-21st: Kappa = 0.42) and with the final EFW (WHO: Kappa = 0.33; intergrowth- 21st: Kappa = 0.35). CONCLUSION The initial AC and final EFW were the parameters of best agreement regarding birth weight classification. The WHO and intergrowth-21st tables showed high agreement in the classification of ultrasound measurements in relation to the 90th percentile. Studies are needed to confirm whether any of these tables are superior in predicting short- and long-term negative outcomes in the LGA group.
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Affiliation(s)
| | | | - Pedro Afonso Cortez
- Universidade Metodista de São Paulo, São Bernardo do Campo, São Paulo, SP, Brazil
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Lambert C, Gleason JL, Pugh SJ, Liu A, Bever A, Grobman WA, Newman RB, Wing D, Gerlanc NM, Tekola-Ayele F, Grantz KL. Maternal Socioeconomic Factors and Racial/Ethnic Differences in Neonatal Anthropometry. Int J Environ Res Public Health 2020; 17:E7323. [PMID: 33036433 DOI: 10.3390/ijerph17197323] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/25/2020] [Accepted: 09/30/2020] [Indexed: 12/29/2022]
Abstract
Disparities in birthweight by maternal race/ethnicity are commonly observed. It is unclear to what extent these disparities are correlates of individual socioeconomic factors. In a prospective cohort of 1645 low-risk singleton pregnancies included in the NICHD Fetal Growth Study (2009-2013), neonatal anthropometry was measured by trained personnel using a standard protocol. Socioeconomic characteristics included employment status, marital status, health insurance, annual income, and education. Separate adjusted generalized linear models were fit to both test the effect of race/ethnicity and the interaction of race/ethnicity and socioeconomic characteristics on neonatal anthropometry. Mean infant birthweight, length, head circumference, and abdominal circumference all differed by race/ethnicity (p < 0.001). We observed no statistically significant interactions between race/ethnicity and full-time employment/student status, marital status, insurance, or education in association with birthweight, neonatal exam weight, length, or head or abdominal circumference at examination. The interaction between income and race/ethnicity was significant only for abdominal circumference (p = 0.027), with no other significant interactions for other growth parameters, suggesting that racial/ethnic differences in neonatal anthropometry did not vary by individual socioeconomic factors in low-risk women. Our results do not preclude structural factors, such as lifetime exposure to poverty, as an explanation for racial/ethnic disparities.
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Abstract
PURPOSE Intrauterine Growth Restriction (IUGR) is the inability of the fetus to achieve the biologically accessible growth potential. Irisin is a recently discovered adipomyokine with a crucial role in energy metabolism. Our current study aimed to investigate the relationship between the isolated IUGR in the third trimester and maternal serum irisin level. MATERIALS AND METHODS This prospective case-control study included total 137 pregnant women who were between the 24th and 39th gestational weeks and who applied to the University of Health Sciences, Ankara Zekai Tahir Burak Women's Health Training and Research Center, between 2016 October-2017 May. The Study Group consisted of 68 pregnant women who were diagnosed with Isolated IUGR with Estimated Fetal Weight (EFW) <10th percentile. The Control Group consisted of 69 low-risk uncomplicated pregnant women, matched with the Study Group in terms of gestational week, and with EFW between 10th and 90th percentiles. Demographic data, clinical findings, fetal Doppler parameters, and obstetric-neonatal outcomes were evaluated. Maternal serum irisin levels were measured by ELISA (Enzyme-Linked Immunosorbent Assay) Method and compared between the groups. RESULTS Maternal serum irisin level was found to be significantly lower in IUGR Group as compared to the Control (3.83 ng/ml vs. 4.78 ng/ml, p < .001, respectively). There was a positive correlation between maternal serum irisin level and duration of pregnancy, the weight gain during pregnancy, birth weight, fetal abdominal circumference measurement and cerebroplacental ratio (r = 0.18, p = .03; r = 0.17, p = .04; r = 0.37, p < .001; r = 0.35, p < .001; r = 0.27, p = .001, respectively). Binary Logistic Regression Analysis showed that maternal serum irisin level is an independent estimator of IUGR [OR %95 CI: 8.33 (3.22 - 25.01)]. AUC (Area Under the Curve) analysis of maternal irisin for IUGR estimation was 0.75 (p < .001, 95% CI = 0.67 - 0.82). The optimal cutoff value was below 3.86 ng/ml for maternal irisin level with a sensitivity of 54.41% and a specificity of 88.41%, positive predictive value of 82.22% and negative predictive value of 66.30%. CONCLUSION Low level of maternal serum irisin in pregnancies with isolated IUGR was consistent with the role of irisin in metabolic pathways and with the increased risk of metabolic diseases in the future life of IUGR fetuses and their mothers.
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Affiliation(s)
- Esin Merve Erol Koc
- Zekai Tahir Burak Women's Health Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Hatice Kansu Çelik
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Woman's Health, Education and Research Hospital, Ankara, Turkey
| | - Dilek Sahin
- Department of Perinatology, Zekai Tahir Burak Women Health Care Education and Research Hospital, Ankara, Turkey
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Cavina APS, Pizzo Junior E, Machado AF, Biral TM, Lemos LK, Rodrigues CRD, Pastre CM, Vanderlei FM. Effects of the Mat Pilates Method on Body Composition: Systematic Review With Meta-Analysis. J Phys Act Health 2020; 17:673-81. [PMID: 32396869 DOI: 10.1123/jpah.2019-0171] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 03/02/2020] [Accepted: 03/30/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The objective of this systematic review was to determine the efficacy of the mat Pilates method on body composition in healthy adult subjects compared with traditional exercise or control condition models. DESIGN Systematic review with meta-analysis. DATA SOURCES MEDLINE, EMBASE, SPORTDiscus, PEDro, SciELO, CINAHAL, and the Cochrane Library. RESULTS A total of 10 eligible studies were selected for revision. The findings of this review demonstrated that the mat Pilates method was not more effective than the traditional exercise or control condition models for the analyzed variables (body mass index, lean mass, body fat percentage, and abdominal circumference). Moreover, in the exploratory analysis with older people, adults, and overweight/obese individuals, the mat Pilates method was also not superior for the analyzed outcomes. CONCLUSION The findings of this study suggest that the mat Pilates method is no better than the control condition or other types of training to reduce body composition.
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Shinohara S, Okuda Y, Hirata S, Suzuki K. Predictive possibility of the transverse cerebellar diameter to abdominal circumference ratio for small-for-gestational-age fetus suspected as a cause of maternal placental syndromes: a retrospective cohort study. Hypertens Pregnancy 2020; 39:145-151. [PMID: 32248714 DOI: 10.1080/10641955.2020.1747487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective: To examine whether fetal transverse cerebellar diameter (TCD) to abdominal circumference (AC) ratio can predict small-for-gestational age suspected as a cause of maternal placental syndromes (SGA-MPS).Methods: We evaluated 473 women who underwent ultrasound examinations at 24-28 weeks of gestation. A receiver operating characteristic curve was used to determine the TCD/AC ratio thresholds to predict SGA-MPS. We used multivariable logistic regression analysis to examine the association.Results: TCD/AC ratio>14.37 was associated with SGA-MPS.Conclusions: Accurate risk stratification using the TCD/AC ratio could assist in managing patients with small-for-gestational-age fetuses at risk of developing MPS-associated adverse outcomes.
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Affiliation(s)
- Satoshi Shinohara
- Department of Obstetrics and Gynecology, University of Yamanashi, Yamanashi, Japan
| | - Yasuhiko Okuda
- Department of Obstetrics and Gynecology, University of Yamanashi, Yamanashi, Japan
| | - Shuji Hirata
- Department of Obstetrics and Gynecology, University of Yamanashi, Yamanashi, Japan
| | - Kohta Suzuki
- Department of Health and Psychosocial Medicine, Aichi Medical University School of Medicine, Aichi, Japan
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Abstract
BACKGROUND AND OBJECTIVE Obesity is a risk factor for a broad range of diseases. This study aimed to estimate association between selected variables (visceral fat, abdominal circumference and waist-hip ratio) and health risk in between male and female. MATERIALS AND METHODS The university student based cross-sectional study was conducted among male and female students. The anthropometric measurements were taken through the auto-calibrated digital scale. Bioelectrical impedance analyzer device was used to determine visceral fat area, abdominal circumference and waist-hip ratio. Independent t-test and Pearson Chi-Square was used for statistical analysis. To see the association among the all three variables, scatter plots were also drawn. RESULTS The results showed that 28.3% male and 9.4% female at risk for visceral fat, for the abdominal circumference 16.9% male and 6% female at risk and for waist-hip ratio 27.5% male and 6% female fell under risk category. There was a significant relationship among all variable for male and female. CONCLUSION Findings suggested that visceral fat area, abdominal circumference and waist-hip ratio were strong predictors of health risk. Male were more prone to health risk than female participants.
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Setruk H, Nogué E, Desenfants A, Prodhomme O, Filleron A, Nagot N, Cambonie G. Reference Values for Abdominal Circumference in Premature Infants. Front Pediatr 2020; 8:37. [PMID: 32117842 PMCID: PMC7033386 DOI: 10.3389/fped.2020.00037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 01/24/2020] [Indexed: 11/18/2022] Open
Abstract
Objectives: Abdominal distention is a common indicator of feeding intolerance in premature newborns. In the absence of a precise definition, abdominal distention and its degree are highly subjective. The aim of this study was to construct references and smoothed percentiles for abdominal circumference (AC) and AC to head circumference (HC) ratio (AC/HC) in infants born between 24 weeks and 34 weeks of gestational age. Methods: ACs and HCs were collected weekly in eutrophic premature infants without congenital abdominal or cerebral malformation. AC and HC charts were modeled using the LMS method, excluding measures associated with abdominal distention at clinical examination or intracranial abnormality at cerebral ultrasounds. Changes in AC and AC/HC over time were studied by repeated-measures analysis using mixed-effects linear models. Results: A total of 1,605 measurements were made in 373 newborns with a mean gestational age of 31 [29-33] weeks and mean birth weight of 1,540 [1,160-1,968] g. Of these measurements, 1,220 were performed in normal conditions. Gestational age, postnatal age, singleton status, and respiratory support were significantly associated with AC and AC/HC. LMS curves were generated according to gestational age groups and postnatal age, with coherent profiles. AC/HC was 0.91 [0.86-0.95] in absence of abdominal distention. It was higher in cases of abdominal distention (0.95 [0.89-1.00], p < 0.001) and necrotizing enterocolitis (0.98 [0.93-1.07], p < 0.001). Conclusions: References constructed for AC and AC/HC might be used to assess feeding tolerance in premature infants. AC/HC was more relevant than AC to rationalize the diagnosis of abdominal distention.
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Affiliation(s)
- Héléna Setruk
- Department of Neonatal Medicine, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France
| | - Erika Nogué
- Department of Medical Information, Montpellier University Hospital Center, Montpellier, France
| | - Aurélie Desenfants
- Department of Pediatrics, Carémeau Hospital, Nîmes University Hospital Center, Nîmes, France
| | - Olivier Prodhomme
- Department of Pediatric Radiology, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France
| | - Anne Filleron
- Department of Pediatrics, Carémeau Hospital, Nîmes University Hospital Center, Nîmes, France
| | - Nicolas Nagot
- Department of Medical Information, Montpellier University Hospital Center, Montpellier, France
| | - Gilles Cambonie
- Department of Neonatal Medicine, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France
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Zuckerwise LC, Ha LC, Osmundson SS, Taylor EW, J Newton. Accuracy of estimated fetal weight assessment in fetuses with congenital diaphragmatic hernia. Am J Obstet Gynecol MFM 2019; 2:100064. [PMID: 33345980 DOI: 10.1016/j.ajogmf.2019.100064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/22/2019] [Accepted: 10/24/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Congenital diaphragmatic hernia is a congenital anomaly in which fetal abdominal organs herniate into the thoracic cavity through a diaphragmatic defect, which can impede fetal lung development. Standard formulas for estimated fetal weight include measurement of fetal abdominal circumference, which may be inaccurate in fetuses with congenital diaphragmatic hernia because of displacement of abdominal contents into the thorax. OBJECTIVES This study aimed to assess the accuracy of standard estimated fetal weight assessment in fetuses with congenital diaphragmatic hernia by comparing prenatal assessment of fetal weight with actual birthweight. STUDY DESIGN A retrospective cohort study of fetuses diagnosed with congenital diaphragmatic hernia was performed at a single center from 2012 to 2018. Fetuses with multiple anomalies or confirmed chromosome abnormalities were excluded. Estimated fetal weight was calculated using the Hadlock formula. Published estimates of fetal growth rate were used to establish a projected estimated fetal weight at birth from the final growth ultrasound, and the percentage difference between projected estimated fetal weight at birth and actual birthweight was calculated. A Wilcoxan rank-sum test was used to examine the difference between projected estimated fetal weight and birthweight. RESULTS We had complete data for 77 fetuses with congenital diaphragmatic hernia. The majority (76.6%, 55 of 77) had left-sided congenital diaphragmatic hernia. The median [interquartile range] projected estimated fetal weight was similar to median birthweight, at 3177 g [2691-3568] and 3180 g [2630-3500], respectively, which did not represent a statistically significant difference between projected estimated fetal weight and birthweight (P = .66). The median absolute percentage difference between projected birthweight and actual birthweight was 6.3% [3.2-7.0]. Estimated fetal weight was overall underestimated in a minority of cases (44.2%, 34 of 77). CONCLUSION In fetuses with a congenital diaphragmatic hernia, standard measurements of fetal estimated fetal weight show accuracy that is at least comparable with previously established margins of error for ultrasound assessment of fetal weight. Standard estimated fetal weight assessment remains an appropriate method of estimating fetal weight in fetuses with congenital diaphragmatic hernia.
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Affiliation(s)
- Lisa C Zuckerwise
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN.
| | - Laura C Ha
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN
| | - Sarah S Osmundson
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN
| | - Emily W Taylor
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN
| | - J Newton
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN
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Yakaiah V, Dakshinamoorthi A, Kavimani S. Effect of Myristica fragrans extract on total body composition in cafeteria diet induced obese rats. Bioinformation 2019; 15:657-665. [PMID: 31787815 PMCID: PMC6859705 DOI: 10.6026/97320630015657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 10/07/2019] [Accepted: 10/09/2019] [Indexed: 12/04/2022] Open
Abstract
It is of interest to evaluate the effect of Myristica fragrans on body composition of cafeteria diet induced obese rats. Thirty rats (150-160g) grouped into 5 and each group contains 6 rats. Group-1 was normal control and 2-5 groups were fed with cafeteria diet for 15 weeks to induce obesity. From 16th week to 25th week test drugs were given as mentioned in the experimental protocol. Body weight, BMI, changes in body composition was measured by TOBEC, adipose tissue weights, organ weights, abdominal circumference were measured according to standard methods. After 70days of treatment with MFE 200mg/kg, 400mg/kg Body weight reduced by 9.29%, 12.87% respectively. BMI was also decreased. Abdominal circumference, total fat percentage, organ weights, was substantially reduced. At 400mg/kg of MFE has shown maximum potentiality when compared with 200mg/kg. Orlistat 50mg was used as standard drug. Tetrahydrofuran, flavonoids, saponins, present in Myristica fragrans has shown anti obesity activity. Our findings explain the potentiality of phytochemicals as a potent anti obesity agent, provide scientific evidence for its traditional use and suggest the possible mechanism of action.
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Affiliation(s)
| | | | - Subramanian Kavimani
- Mother Theresa Post Graduate and Research Institute of Health Sciences, Pondicherry
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Yapan P, Promchirachote C, Yaiyiam C, Rahman S, Pooliam J, Wataganara T. Intrapartum prediction of birth weight with a simplified algorithmic approach derived from maternal characteristics. J Perinat Med 2019; 47:643-650. [PMID: 31265430 DOI: 10.1515/jpm-2018-0347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 05/28/2019] [Indexed: 11/15/2022]
Abstract
Objective To derive and validate a population-specific multivariate approach for birth weight (BW) prediction based on quantitative intrapartum assessment of maternal characteristics by means of an algorithmic method in low-risk women. Methods The derivation part (n = 200) prospectively explored 10 variables to create the best-fit algorithms (70% correct estimates within ±10% of actual BW) for prediction of BW at term; vertex presentation with engagement. The algorithm was then cross validated with samples of unrelated cases (n = 280) to compare the accuracy with the routine abdominal palpation method. Results The best-fit algorithms were parity-specific. The derived simplified algorithms were (1) BW (g) = 100 [(0.42 × symphysis-fundal height (SFH; cm)) + gestational age at delivery (GA; weeks) - 25] in nulliparous, and (2) BW (g) = 100 [(0.42 × SFH (cm)) + GA - 23] in multiparous. Cross validation showed an overall 69.3% accuracy within ±10% of actual BW, which exceeded routine abdominal palpation (60.4%) (P = 0.019). The algorithmic BW prediction was significantly more accurate than routine abdominal palpation in women with the following characteristics: BW 2500-4000 g, multiparous, pre-pregnancy weight <50 kg, current weight <60 kg, height <155 cm, body mass index (BMI) <18.5 kg/m2, cervical dilatation 3-5 cm, station <0, intact membranes, SFH 30-39 cm, maternal abdominal circumference (mAC) <90 cm, mid-upper arm circumference (MUAC) <25 cm and female gender of the neonates (P < 0.05). Conclusion An overall accuracy of term BW prediction by our simplified algorithms exceeded that of routine abdominal palpation.
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Affiliation(s)
- Piengbulan Yapan
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkok Noi, Bangkok, Thailand
| | - Chirameth Promchirachote
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkok Noi, Bangkok, Thailand
| | - Chutima Yaiyiam
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkok Noi, Bangkok, Thailand
| | - Suraiya Rahman
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkok Noi, Bangkok, Thailand
| | - Julaporn Pooliam
- Division of Clinical Epidemiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tuangsit Wataganara
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkok Noi, Bangkok, Thailand
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Rowley A, Dyer E, Scott JG, Aiken CE. Could masking gestational age estimation during scanning improve detection of small-for-gestational-age fetuses? A controlled pre-post evaluation. Am J Obstet Gynecol MFM 2019; 1:100035. [PMID: 33345799 DOI: 10.1016/j.ajogmf.2019.100035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Antenatal detection of small-for-gestational-age fetuses improves outcomes and reduces perinatal mortality rates. However, ultrasonographic estimation of fetal weight is subject to several potential sources of error. One potential source of error is subconscious operator bias towards "normal" measurement values for gestational age (observer-expectancy bias). OBJECTIVE We aimed to determine whether the sensitivity of small-for-gestational-age detection is improved by removing real-time display of estimated gestational age during measurement of the abdominal circumference in the third trimester. STUDY DESIGN This retrospective evaluation (November 2014-May 2018 inclusive) included all singleton infants liveborn at ≥28 weeks gestation in a single United Kingdom obstetrics center. In the preintervention phase, real-time estimated gestational age was displayed to sonographers as they measured fetal abdominal circumference (the key determinant of estimated fetal weight with the use of the INTERGROWTH 21st fetal weight equation) in the third trimester. In the postintervention phase, real-time gestational age information was removed on selected ultrasound machines. Accuracy of birthweight percentile estimation was assessed before and after intervention, both in the full cohort comprising all eligible scans and in a subcohort that was scanned within 4 weeks of delivery. We assessed the accuracy of small-for-gestational-age detection using the sensitivity, positive likelihood ratio, and area under the receiver-operator curve. RESULTS Of the 18,342 eligible pregnancies, 9342 (51%) had a third-trimester growth scan. The sensitivity of ultrasonographic estimation of fetal weight for antenatal detection of small-for-gestational-age babies did not change significantly between the before and after intervention phases (31.5% confidence interval, 27.1-36.2 vs 31.7% confidence interval, 20.2-45.0). Although the sensitivity for small-for-gestational-age detection was higher in the subcohort that was scanned within 4 weeks of delivery than in the full cohort (P<.001), there was no significant difference between the before and after intervention phases (58% confidence interval, 50-66 vs 65% confidence interval, 43-84). With the use of an estimation of the abdominal circumference percentile rather than estimated fetal weight percentile significantly decreased the sensitivity for small-for-gestational-age detection in all groups (P<.01), but there was no difference between the before and after intervention phases. CONCLUSION Blinding operators to the estimated gestation of the fetus during abdominal circumference measurement does not significantly alter the antenatal detection rate of small-for-gestational-age babies. The observer-expectancy effect is therefore unlikely to be a significant contributor to the error that is associated with ultrasonographic estimation of fetal weight.
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Affiliation(s)
- Amanda Rowley
- Department of Obstetrics and Gynaecology, Addenbrookes' Hospital, Cambridge, UK
| | - Ellen Dyer
- Department of Obstetrics and Gynaecology, Addenbrookes' Hospital, Cambridge, UK
| | - James G Scott
- Red McCombs School of Business and Department of Statistics and Data Sciences, University of Texas at Austin, TX
| | - Catherine E Aiken
- Department of Obstetrics and Gynaecology, Addenbrookes' Hospital, Cambridge, UK; University Department of Obstetrics and Gynaecology, University of Cambridge, the NIHR Cambridge Comprehensive Biomedical Research Centre, UK.
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Caradeux J, Martinez-Portilla RJ, Peguero A, Sotiriadis A, Figueras F. Diagnostic performance of third-trimester ultrasound for the prediction of late-onset fetal growth restriction: a systematic review and meta-analysis. Am J Obstet Gynecol 2019; 220:449-459.e19. [PMID: 30633918 DOI: 10.1016/j.ajog.2018.09.043] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 08/25/2018] [Accepted: 09/04/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The objective of the study was to establish the diagnostic performance of ultrasound screening for predicting late smallness for gestational age and/or fetal growth restriction. DATA SOURCES A systematic search was performed to identify relevant studies published since 2007 in English, Spanish, French, Italian, or German, using the databases PubMed, ISI Web of Science, and SCOPUS. STUDY ELIGIBILITY CRITERIA We used rrospective and retrospective cohort studies in low-risk or nonselected singleton pregnancies with screening ultrasound performed at ≥32 weeks of gestation. STUDY APPRAISAL AND SYNTHESIS METHODS The estimated fetal weight and fetal abdominal circumference were assessed as index tests for the prediction of birthweight <10th (i.e. smallness for gestational age), less than the fifth, and less than the third centile and fetal growth restriction (estimated fetal weight less than the third or estimated fetal weight <10th plus Doppler signs). Quality of the included studies was independently assessed by 2 reviewers, using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. For the meta-analysis, hierarchical summary receiver-operating characteristic curves were constructed, and quantitative data synthesis was performed using random-effects models. The sensitivity of the abdominal circumference <10th centile and estimated fetal weight <10th centile for a fixed 10% false-positive rate was derived from the corresponding hierarchical summary receiver-operating characteristic curves. Heterogeneity between studies was visually assessed using Galbraith plots, and publication bias was assessed by funnel plots and quantified by Deeks' method. RESULTS A total of 21 studies were included. Observed pooled sensitivities of abdominal circumference and estimated fetal weight <10th centile for birthweight <10th centile were 35% (95% confidence interval, 20-52%) and 38% (95% confidence interval, 31-46%), respectively. Observed pooled specificities were 97% (95% confidence interval, 95-98%) and 95% (95% confidence interval, 93-97%), respectively. Modeled sensitivities of abdominal circumference and estimated fetal weight <10th centile for 10% false-positive rate were 78% (95% confidence interval, 61-95%) and 54% (95% confidence interval, 46-52%), respectively. The sensitivity of estimated fetal weight <10th centile was better when aimed to fetal growth restriction than to smallness for gestational age. Meta-regression analysis showed a significant increase in sensitivity when ultrasound evaluation was performed later in pregnancy (P = .001). CONCLUSION Third-trimester abdominal circumference and estimated fetal weight perform similar in predicting smallness for gestational age. However, for a fixed 10% false-positive rate extrapolated sensitivity is higher for abdominal circumference. There is evidence of better performance when the scan is performed near term and when fetal growth restriction is the targeted condition.
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John Dudley N. Are ultrasound foetal circumference measurement methods interchangeable? Ultrasound 2019; 27:176-182. [PMID: 32549897 DOI: 10.1177/1742271x19837307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 09/17/2019] [Indexed: 11/15/2022]
Abstract
A variety of methods is available for the ultrasound measurement of foetal circumferences; ellipse fitting and derived measurements are often used interchangeably based on an assumption of equivalence, despite evidence that results may differ. The aim of this study was to investigate the differences between ellipse fitting and derived circumferences in clinical practice. Head and abdominal circumferences originally measured using ellipse fitting were retrospectively derived from anterior-posterior and transverse diameters using a widely used formula. Where the necessary measurements were available, foetal weight was estimated. Differences between ellipse fitted and derived measurements were compared using Bland-Altman plots. Images from 65 patients (gestational age 20 to 40 weeks) were collected; four head circumference and five abdominal circumference images were excluded due to poor image quality. Data were available for estimated foetal weight calculation for 48 patients. There were small systematic differences between ellipse fitted and derived measurements. Random differences varied between 20 week scans, early growth scans and later growth scans, so were analysed in these three groups. The 95% confidence intervals were ±6 mm (±3%), ±7 mm (±2%) and ±20 mm (±6%) for head circumference at 20 weeks, earlier growth scans and later scans, respectively; the 95% confidence intervals for abdominal circumference were ±7 mm (±5%), ±11 mm (±5%) and ±17 mm (±6%) and for estimated foetal weight were ±23 g (±6%), ±69 g (±5%) and ±311 g (±12%). Foetal circumference measurement methods are not interchangeable. The derived method should be used where size, growth and estimated foetal weight charts are based on this method.
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Cavallaro A, Veglia M, Svirko E, Vannuccini S, Volpe G, Impey L. Using fetal abdominal circumference growth velocity in the prediction of adverse outcome in near-term small-for-gestational-age fetuses. Ultrasound Obstet Gynecol 2018; 52:494-500. [PMID: 29266519 DOI: 10.1002/uog.18988] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/13/2017] [Accepted: 12/08/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate whether abdominal circumference growth velocity (ACGV) improves the prediction of perinatal outcome in small-for-gestational-age (SGA) fetuses beyond that afforded by estimated fetal weight (EFW) and cerebroplacental ratio (CPR). METHODS A cohort of 235 singleton SGA fetuses at 36-38 weeks' gestation was examined. ACGV, EFW and CPR centiles were calculated. ACGV centile was determined using data from a large database of 19-21- and 36-38-week scans in an unselected population. Binary variables of ACGV < 10th , EFW < 3rd and CPR < 5th centiles were defined as abnormal. Two composite adverse outcomes (CAO) were explored: CAO-1 defined as at least one of umbilical artery pH < 7.10, 5-min Apgar score < 7 or neonatal unit admission, and CAO-2 that included in addition hypoglycemia, intrapartum fetal distress and perinatal death. Univariate and multivariate logistic regression analyses were performed to analyze the relationship between the three risk factors and their predictive value for CAO. The change in screening performance afforded by adding ACGV to EFW and CPR was assessed and receiver-operating characteristics (ROC) curves were calculated. RESULTS ACGV < 10th centile was an independent risk factor for CAO. The sensitivity, specificity, positive and negative likelihood ratios of a predictive model based on EFW < 3rd centile and CPR < 5th centile were, respectively, 51%, 70%, 1.71 and 0.69 for CAO-1 and 41%, 70%, 1.39 and 0.83 for CAO-2. After addition of ACGV < 10th centile to the model, the respective values were 82%, 46%, 1.54 and 0.38 for CAO-1 and 71%, 47%, 1.34 and 0.62 for CAO-2. Using continuous variables, the areas under the ROC curves improved marginally from 0.669 (95% CI, 0.604-0.729) to 0.741 (95% CI, 0.677-0.798) for CAO-1 and from 0.646 (95% CI, 0.580-0.707) to 0.700 (95% CI, 0.633-0.759) for CAO-2 after addition of ACGV to the model. CONCLUSIONS ACGV is a risk factor for adverse neonatal outcome that is independent of EFW and of CPR, although any improvement in the prediction of adverse outcome is not statistically significant. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Cavallaro
- Fetal Medicine Unit, Department of Maternal and Fetal Medicine, Women's Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - M Veglia
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, John Radcliffe Hospital, Oxford, UK
- Department of Obstetrics and Gynaecology, Ospedale Cristo Re, Rome, Italy
| | - E Svirko
- Fetal Medicine Unit, Department of Maternal and Fetal Medicine, Women's Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - S Vannuccini
- Fetal Medicine Unit, Department of Maternal and Fetal Medicine, Women's Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - G Volpe
- Fetal Medicine Unit, Department of Maternal and Fetal Medicine, Women's Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - L Impey
- Fetal Medicine Unit, Department of Maternal and Fetal Medicine, Women's Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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López M, Ríos-Silva M, Huerta M, Cárdenas Y, Bricio-Barrios JA, Díaz-Reval MI, Urzúa Z, Huerta-Trujillo M, López-Quezada K, Trujillo X. Effects of Moringa oleifera leaf powder on metabolic syndrome induced in male Wistar rats: a preliminary study. J Int Med Res 2018; 46:3327-3336. [PMID: 29962304 PMCID: PMC6134658 DOI: 10.1177/0300060518781726] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective To evaluate the preventive effects of Moringa oleifera on metabolic syndrome (MS) in male Wistar rats. Methods MS was induced by feeding rats a high-fat diet and drinking water containing 10% fructose for 6 weeks. In the preventive group, M. oleifera was orally administered for 3 weeks prior to the induction of MS, while in the treatment group, M. oleifera was administered for 3 weeks after the onset of MS. The treatment groups were compared with a control group of untreated rats with induced MS. Fasting glucose, oral glucose tolerance, insulin tolerance, total cholesterol, triglycerides, abdominal circumference, and systolic and diastolic blood pressure were measured before and after MS induction and/or M. oleifera treatment. Results After the induction of MS, the control group had higher fasting glucose levels than the preventive group. No significant differences were observed in insulin tolerance, oral glucose tolerance, cholesterol, triglycerides, abdominal circumference, or systolic or diastolic blood pressure. Compared with untreated controls, rats in the treatment group had significantly improved glucose tolerance, triglycerides, and abdominal circumference. Conclusions M. oleifera treatment attenuates MS in Wistar rats.
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Affiliation(s)
- Marisa López
- 1 Universidad de Colima, Unidad de Investigación Dr. Enrico Stefani, Centro Universitario de Investigaciones Biomédicas, Col. Villas San Sebastián, Colima, México
| | - Mónica Ríos-Silva
- 1 Universidad de Colima, Unidad de Investigación Dr. Enrico Stefani, Centro Universitario de Investigaciones Biomédicas, Col. Villas San Sebastián, Colima, México.,2 Universidad de Colima-Cátedras CONACyT, Centro Universitario de Investigaciones Biomédicas, Col. Villas San Sebastián, Colima, México
| | - Miguel Huerta
- 1 Universidad de Colima, Unidad de Investigación Dr. Enrico Stefani, Centro Universitario de Investigaciones Biomédicas, Col. Villas San Sebastián, Colima, México
| | - Yolitzy Cárdenas
- 1 Universidad de Colima, Unidad de Investigación Dr. Enrico Stefani, Centro Universitario de Investigaciones Biomédicas, Col. Villas San Sebastián, Colima, México
| | | | - María Irene Díaz-Reval
- 1 Universidad de Colima, Unidad de Investigación Dr. Enrico Stefani, Centro Universitario de Investigaciones Biomédicas, Col. Villas San Sebastián, Colima, México
| | - Zorayda Urzúa
- 1 Universidad de Colima, Unidad de Investigación Dr. Enrico Stefani, Centro Universitario de Investigaciones Biomédicas, Col. Villas San Sebastián, Colima, México.,4 Instituto Mexicano del Seguro Social, Unidad de Medicina Familiar #17, Manzanillo, Colima, México
| | - Miguel Huerta-Trujillo
- 1 Universidad de Colima, Unidad de Investigación Dr. Enrico Stefani, Centro Universitario de Investigaciones Biomédicas, Col. Villas San Sebastián, Colima, México.,3 Facultad de Medicina, Universidad de Colima, Col. Las Víboras, Colima, COL, México
| | - Karla López-Quezada
- 1 Universidad de Colima, Unidad de Investigación Dr. Enrico Stefani, Centro Universitario de Investigaciones Biomédicas, Col. Villas San Sebastián, Colima, México.,3 Facultad de Medicina, Universidad de Colima, Col. Las Víboras, Colima, COL, México
| | - Xóchitl Trujillo
- 1 Universidad de Colima, Unidad de Investigación Dr. Enrico Stefani, Centro Universitario de Investigaciones Biomédicas, Col. Villas San Sebastián, Colima, México
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Papageorghiou AT, Kennedy SH, Salomon LJ, Altman DG, Ohuma EO, Stones W, Gravett MG, Barros FC, Victora C, Purwar M, Jaffer Y, Noble JA, Bertino E, Pang R, Cheikh Ismail L, Lambert A, Bhutta ZA, Villar J. The INTERGROWTH-21 st fetal growth standards: toward the global integration of pregnancy and pediatric care. Am J Obstet Gynecol 2018; 218:S630-S640. [PMID: 29422205 DOI: 10.1016/j.ajog.2018.01.011] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 01/04/2018] [Accepted: 01/05/2018] [Indexed: 10/18/2022]
Abstract
The purpose of the INTERGROWTH-21st project was to develop international, prescriptive standards for fetal growth assessed by ultrasound and fundal height, preterm postnatal growth, newborn size and body composition, maternal weight gain, and infant development at the age of 2 years. Hence, we have produced, based on World Health Organization recommendations, the first comprehensive set of international standards of optimal fetal and newborn growth that perfectly match the existing World Health Organization child growth standards. Uniquely, the same population was followed up longitudinally from 9 weeks of fetal life to 2 years of age, with growth, health, and nutritional status assessment at 2 years supporting the appropriateness of the population for construction of growth standards. The resulting package of clinical tools allows, for the first time, growth and development to be monitored from early pregnancy to infancy. The INTERGROWTH-21st fetal growth standards, which are based on observing >4500 healthy pregnancies, nested in a study of >59,000 pregnancies from populations with low rates of adverse perinatal outcomes, show how fetuses should grow-rather than the more limited objective of past references, which describe how they have grown at specific times and locations. Our work has confirmed the fundamental biological principle that variation in human growth across different populations is mostly dependent on environmental, nutritional, and socioeconomic factors. We found that when mothers' nutritional and health needs are met and there are few environmental constraints on growth, <3.5% of the total variability of skeletal growth was due to differences between populations. We propose that not recognizing the concept of optimal growth could deprive the most vulnerable mothers and their babies of optimal care, because local growth charts normalize those at highest risk for growth restriction and overweight, and can be valuable for policymakers to ensure rigorous evaluation and effective resource allocation. We strongly encourage colleagues to join efforts to provide integrated, evidence-based growth monitoring to pregnant women and their infants worldwide. Presently, there are 23.3 million infants born small for gestational age in low- to middle-income countries according to the INTERGROWTH-21st newborn size standards. We suggest that misclassification of these infants by using local charts could affect the delivery of optimal health care.
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Khalil A, Morales-Rosello J, Khan N, Nath M, Agarwal P, Bhide A, Papageorghiou A, Thilaganathan B. Is cerebroplacental ratio a marker of impaired fetal growth velocity and adverse pregnancy outcome? Am J Obstet Gynecol 2017; 216:606.e1-606.e10. [PMID: 28189607 DOI: 10.1016/j.ajog.2017.02.005] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 01/08/2017] [Accepted: 02/01/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND The cerebroplacental ratio has been proposed as a marker of failure to reach growth potential near term. Low cerebroplacental ratio, regardless of the fetal size, is independently associated with the need for operative delivery for presumed fetal compromise and with neonatal unit admission at term. OBJECTIVE The main aim of this study was to evaluate whether the cerebroplacental ratio at term is a marker of reduced fetal growth rate. The secondary aim was to investigate the relationship between a low cerebroplacental ratio at term, reduced fetal growth velocity, and adverse pregnancy outcome. STUDY DESIGN This was a retrospective cohort study of singleton pregnancies in a tertiary referral center. The abdominal circumference was measured at 20-24 weeks' gestation and both abdominal circumference and fetal Dopplers recorded at or beyond 35 weeks, within 2 weeks of delivery. Abdominal circumference and birthweight values were converted into Z scores and centiles, respectively, and fetal Doppler parameters into multiples of median, adjusting for gestational age. Abdominal circumference growth velocity was quantified using the difference in the abdominal circumference Z score, comparing the scan at or beyond 35 weeks with the scan at 20-24 weeks. Both univariable and multivariable logistic regression analyses were performed to investigate the association between low cerebroplacental ratio and the low abdominal circumference growth velocity (in the lowest decile) and to identify and adjust for potential confounders. As a sensitivity analysis, we refitted the model excluding the data on pregnancies with small-for-gestational-age neonates. RESULTS The study included 7944 pregnancies. Low cerebroplacental ratio multiples of median was significantly associated with both low abdominal circumference growth velocity (adjusted odds ratio, 2.10; 95% confidence interval, 1.71-2.57, P <0.001) and small for gestational age (adjusted odds ratio, 3.60; 95% confidence interval, 3.04-4.25, P < .001). After the exclusion of pregnancies resulting in small-for-gestational-age neonates, a low cerebroplacental ratio multiples of the median remained significantly associated with both low abdominal circumference growth velocity (adjusted odds ratio, 1.76; 95% confidence interval, 1.34-2.30, P < .001) and birthweight centile (adjusted odds ratio, 0.99; 95% confidence interval, 0.998-0.995, P < .001). The need for operative delivery for fetal compromise was significantly associated with a low cerebroplacental ratio (adjusted odds ratio, 1.40; 95% confidence interval, 1.10-1.78, P = .006), even after adjusting for both the umbilical artery pulsatility index multiples of the median and middle cerebral artery pulsatility index multiples of median. The results were similar, even after the exclusion of pregnancies resulting in small-for-gestational-age neonates (adjusted odds ratio, 1.39; 95% confidence interval, 1.06-1.84, P = .018). Low cerebroplacental ratio multiples of the median remained significantly associated with the risk of operative delivery for presumed fetal compromise (P < .001), even after adjusting for the known antenatal and intrapartum risk factors. These associations persisted, even after the exclusion of small-for-gestational-age births. In appropriate-for-gestational-age-sized fetuses, abdominal circumference growth velocity was significantly lower in those with a low cerebroplacental ratio multiples of the median than in those with normal cerebroplacental ratio multiples of the median (P < .001). CONCLUSION The cerebroplacental ratio is a marker of impaired fetal growth velocity and adverse pregnancy outcome, even in fetuses whose size is considered appropriate using conventional biometry.
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Peixoto AB, da Cunha Caldas TMR, Dulgheroff FF, Martins WP, Araujo Júnior E. Fetal biometric parameters: Reference charts for a non-selected risk population from Uberaba, Brazil. J Ultrason 2017; 17:23-29. [PMID: 28439425 PMCID: PMC5392550 DOI: 10.15557/jou.2017.0003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 07/22/2016] [Accepted: 07/26/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To establish reference charts for fetal biometric parameters in a non-selected risk population from Uberaba, Southeast of Brazil. METHODS A retrospective cross-sectional study was performed among 5656 non-selected risk singleton pregnant women between 14 and 41 weeks of gestation. The ultrasound exams were performed during routine visits of second and third trimesters. Biparietal diameter (BPD) was measured at the level of the thalami and cavum septi pellucidi. Head circumference (HC) was calculated by the following formula: HC = 1.62*(BPD + occipital frontal diameter, OFD). Abdominal circumference (AC) was measured using the following formula: AC = (anteroposterior diameter + transverse abdominal diameter) × 1.57. Femur diaphysis length (FDL) was obtained in the longest axis of femur without including the distal femoral epiphysis. The estimated fetal weight (EFW) was obtained by the Hadlock formula. Polynomial regressions were performed to obtain the best-fit model for each fetal biometric parameter as the function of gestational age (GA). RESULTS The mean, standard deviations (SD), minimum and maximum of BPD (cm), HC (cm), AC (cm), FDL (cm) and EFW (g) were 6.9 ± 1.9 (2.3 - 10.5), 24.51 ± 6.61 (9.1 - 36.4), 22.8 ± 7.3 (7.5 - 41.1), 4.9 ± 1.6 (1.2 - 8.1) and 1365 ± 1019 (103 - 4777), respectively. Second-degree polynomial regressions between the evaluated parameters and GA resulted in the following formulas: BPD = -4.044 + 0.540 × GA - 0.0049 × GA2 (R2 = 0.97); HC= -15.420 + 2.024 GA - 0.0199 × GA2 (R2 = 0.98); AC = -9.579 + 1.329 × GA - 0.0055 × GA2 (R2 = 0.97); FDL = -3.778 + 0.416 × GA - 0.0035 × GA2 (R2 = 0.98) and EFW = 916 - 123 × GA + 4.70 × GA2 (R2 = 0.96); respectively. CONCLUSION Reference charts for the fetal biometric parameters in a non-selected risk population from Uberaba, Southeast of Brazil, were established.
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Affiliation(s)
- Alberto Borges Peixoto
- Mario Palmério University Hospital - University of Uberaba (Uniube), Uberaba-MG, Brazil.,Radiologic Clinic of Uberaba (CRU), Uberaba-MG, Brazil
| | | | | | - Wellington P Martins
- Department of Obstetrics and Gynecology, Ribeirão Preto Medical School, University of São Paulo (DGO-FMRP-USP), Ribeirão Preto-SP, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
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Nakano JCN, Liao AW, de Lourdes Brizot M, Miyadahira M, Francisco RPV, Zugaib M. Fetal growth according to different reference ranges in twin pregnancies with placental insufficiency. Clinics (Sao Paulo) 2015; 70:816-9. [PMID: 26735222 PMCID: PMC4676322 DOI: 10.6061/clinics/2015(12)09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 09/14/2015] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to compare different fetal growth curves in twin pregnancies with severe placental insufficiency. A retrospective cross-sectional analysis of 47 twin pregnancies with absent or reverse end diastolic flow in the umbilical artery of one fetus was performed. Pregnancies with major fetal abnormalities, twin-twin transfusion or three or more fetuses were not included. The estimated fetal weight zeta-scores were calculated for both fetuses (abnormal Doppler and co-twin) according to the following criteria: Hadlock, Liao and Araújo. The abdominal circumference zeta-scores were calculated according to Hadlock, Liao, Araújo, Ong and Stirrup. The mean estimates of the zeta-score values were calculated using generalized estimating equation regression analysis. The mean gestational age at inclusion was 27.4 ± 4.7 weeks. The fetal sex and the interaction Doppler findings × criteria correlated significantly with the zeta-score values (p < 0.001 for both variables). The estimated fetal weight mean zeta-scores (standard error) according to each criteria were as follows: Hadlock - abnormal Doppler: -2.98 (0.18), co-twin: -1.16 (0.15); Liao - abnormal Doppler: -2.89 (0.24), co-twin: -0.58 (0.19); and Araújo - abnormal Doppler: -3.05 (0.29), co-twin: -0.75 (0.18). Values for abdominal circumference were as follows: Hadlock - abnormal Doppler: -3.14 (0.26), co-twin: -1.13 (0.19); Liao - abnormal Doppler: -2.63 (0.27), co-twin: -0.42 (0.19); Araújo - abnormal Doppler: -2.44 (0.22), co-twin: -0.71 (0.14); Ong - abnormal Doppler: -3.36 (0.34), co-twin: -1.48 (0.23); and Stirrup AD -- -2.36 (0.14), co-twin: -1.18 (0.10). Sex- and plurality-specific charts should be used in the evaluation of fetal growth in twin pregnancies with placental insufficiency.
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Affiliation(s)
- Julianny Cavalheiro Nery Nakano
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Departamento de Obstetrícia e Ginecologia, São Paulo/SP, Brazil
| | - Adolfo Wenjaw Liao
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Departamento de Obstetrícia e Ginecologia, São Paulo/SP, Brazil
- Corresponding author: E-mail:
| | - Maria de Lourdes Brizot
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Departamento de Obstetrícia e Ginecologia, São Paulo/SP, Brazil
| | - Mariana Miyadahira
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Departamento de Obstetrícia e Ginecologia, São Paulo/SP, Brazil
| | - Rossana Pulcineli Vieira Francisco
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Departamento de Obstetrícia e Ginecologia, São Paulo/SP, Brazil
| | - Marcelo Zugaib
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Departamento de Obstetrícia e Ginecologia, São Paulo/SP, Brazil
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Kiriyama S, Naitoh H, Fukuchi M, Yuasa K, Horiuchi K, Fukasawa T, Tabe Y, Yamauchi H, Suzuki M, Yoshida T, Saito Y, Kuwano H. Evaluation of abdominal circumference and salivary amylase activities after unsedated colonoscopy using carbon dioxide and air insufflations. J Dig Dis 2015; 16:747-51. [PMID: 26639093 DOI: 10.1111/1751-2980.12302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 11/11/2015] [Accepted: 11/26/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess and compare abdominal distention and stress in unsedated colonoscopy using carbon dioxide (CO2 ) and air insufflations. METHODS Two hundred and five patients underwent colonoscopic examinations without sedation using either CO2 or air insufflation. Abdominal circumference and salivary amylase (sAMY) activities before and 0 and 15 min after colonoscopy were measured by a nurse who was blinded to the grouping of the patients. RESULTS In all, 102 and 103 patients were randomly recruited in the CO2 and air insufflation groups, respectively. sAMY activities before and 0 and 15 min after colonoscopy were not significantly different between the two groups. Abdominal circumference measured immediately and 15 min after colonoscopy was significantly smaller in CO2 insufflation group than in the air insufflation group (81.2 cm vs 84.0 cm, and 79.7 cm vs 83.6 cm, respectively; P <0.05). The increasing ratio of abdominal circumference immediately after colonoscopy was not significantly different between the two groups; however, the ratio at 15 min after colonoscopy using CO2 insufflation was significantly lower than that in the air insufflation group (1.007 vs 1.028, P <0.001). CONCLUSION sAMY activities after unsedated colonoscopy using CO2 insufflation were not improved; however, CO2 insufflation decreases abdominal circumference after colonoscopy compared with air insufflation.
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Affiliation(s)
| | | | | | - Kazuhisa Yuasa
- Department of Gastroenterology, Gunma Chuo Hospital, Gunma
| | | | | | - Yuichi Tabe
- Department of Surgery, Gunma Chuo Hospital, Gunma
| | | | | | | | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo
| | - Hiroyuki Kuwano
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Gunma, Japan
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Endres L, DeFranco E, Conyac T, Adams M, Zhou Y, Magner K, O'Rourke L, Bernhard KA, Siddiqui D, McCormick A, Abramowicz J, Merkel R, Jawish R, Habli M, Floman A, Magann EF, Chauhan SP; CAOG FAR Research Network. Association of Fetal Abdominal-Head Circumference Size Difference With Shoulder Dystocia: A Multicenter Study. AJP Rep 2015; 5:e099-104. [PMID: 26495163 DOI: 10.1055/s-0035-1548544] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 01/29/2015] [Indexed: 11/28/2022] Open
Abstract
Objective This study aims to determine if shoulder dystocia is associated with a difference in the fetal abdominal (AC) to head circumference (HC) of 50 mm or more noted on antenatal ultrasound. Study Design A multicenter matched case-control study was performed comparing women who had shoulder dystocia to controls who did not. Women with vaginal births of live born nonanomalous singletons ≥ 36 weeks of gestation with an antenatal ultrasound within 4 weeks of delivery were included. Controls were matched for gestational age, route of delivery, and diabetes status. Results We identified 181 matched pairs. Only 5% of the fetuses had an AC to HC of ≥ 50 mm. The proportion of AC to HC difference of ≥ 50 mm was significantly higher in shoulder dystocia cases (8%) than controls (1%, p = 0.002). With multivariate regression, the three significant factors associated with shoulder dystocia were AC to HC ≥ 50 mm (odds ratio [OR], 7.3; confidence interval [CI], 1.6-33.3; p = 0.010), femur length (OR, 1.1; CI, 1.0-1.2; p = 0.002), and induced labor (OR, 1.8; CI, 1.1-3.1; p = 0.027). Conclusion A prenatal ultrasound finding of a difference in AC to HC of ≥ 50 mm while uncommon is associated with shoulder dystocia.
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Gomez-Perez SL, Haus JM, Sheean P, Patel B, Mar W, Chaudhry V, McKeever L, Braunschweig C. Measuring Abdominal Circumference and Skeletal Muscle From a Single Cross-Sectional Computed Tomography Image: A Step-by-Step Guide for Clinicians Using National Institutes of Health ImageJ. JPEN J Parenter Enteral Nutr 2015; 40:308-18. [PMID: 26392166 DOI: 10.1177/0148607115604149] [Citation(s) in RCA: 173] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 07/28/2015] [Indexed: 12/24/2022]
Abstract
Diagnostic computed tomography (CT) scans provide numerous opportunities for body composition analysis, including quantification of abdominal circumference, abdominal adipose tissues (subcutaneous, visceral, and intermuscular), and skeletal muscle (SM). CT scans are commonly performed for diagnostic purposes in clinical settings, and methods for estimating abdominal circumference and whole-body SM mass from them have been reported. A supine abdominal circumference is a valid measure of waist circumference (WC). The valid correlation between a single cross-sectional CT image (slice) at third lumbar (L3) for abdominal SM and whole-body SM is also well established. Sarcopenia refers to the age-associated decreased in muscle mass and function. A single dimensional definition of sarcopenia using CT images that includes only assessment of low whole-body SM has been validated in clinical populations and significantly associated with negative outcomes. However, despite the availability and precision of SM data from CT scans and the relationship between these measurements and clinical outcomes, they have not become a routine component of clinical nutrition assessment. Lack of time, training, and expense are potential barriers that prevent clinicians from fully embracing this technique. This tutorial presents a systematic, step-by-step guide to quickly quantify abdominal circumference as a proxy for WC and SM using a cross-sectional CT image from a regional diagnostic CT scan for clinical identification of sarcopenia. Multiple software options are available, but this tutorial uses ImageJ, a free public-domain software developed by the National Institutes of Health.
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Affiliation(s)
| | - Jacob M Haus
- University of Illinois at Chicago, Chicago, Illinois
| | | | | | - Winnie Mar
- University of Illinois Hospital & Health Sciences System, Chicago, Illinois
| | | | - Liam McKeever
- University of Illinois at Chicago, Chicago, Illinois
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Lesmes C, Gallo DM, Panaiotova J, Poon LC, Nicolaides KH. Prediction of small-for-gestational-age neonates: screening by fetal biometry at 19-24 weeks. Ultrasound Obstet Gynecol 2015; 46:198-207. [PMID: 25704207 DOI: 10.1002/uog.14826] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 02/03/2015] [Accepted: 02/04/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the value of fetal biometry at 19-24 weeks' gestation in the prediction of delivery of small-for-gestational-age (SGA) neonates, in the absence of pre-eclampsia (PE), and examine the potential value of such assessment in deciding whether the third-trimester scan should be at 32 and/or 36 weeks' gestation. METHODS This was a screening study in 88,187 singleton pregnancies, including 5003 (5.7%) that delivered SGA neonates with birth weight < 5(th) percentile (SGA < 5(th)). Multivariable logistic regression analysis was used to determine if screening by a combination of maternal characteristics and medical history and Z-scores of fetal head circumference (HC), abdominal circumference (AC) and femur length (FL) had significant contribution in predicting SGA neonates. A model was developed for selecting the gestational age for third-trimester assessment, at 32 and/or 36 weeks, based on the results of screening at 19-24 weeks. RESULTS Combined screening by maternal factors and fetal biometry at 19-24 weeks, predicted 76%, 58% and 44% of SGA < 5(th) delivering < 32, 32-36 and ≥ 37 weeks' gestation, respectively, at a false-positive rate (FPR) of 10%. The detection rate (DR) of SGA < 5(th) delivering at 32-36 weeks improved from 58% to 82% with screening at 32 weeks rather than at 19-24 weeks. Similarly, the DR of SGA < 5(th) delivering ≥ 37 weeks improved from 44% with screening at 19-24 weeks to 61% and 76% with screening at 32 and 36 weeks, respectively. In a hypothetical model, it was estimated that if the desired objective of prenatal screening is to predict about 80% of the cases of SGA < 5(th), it would be necessary to select 28% of the population at the 19-24-week assessment to be reassessed at 32 weeks and 41% to be reassessed at 36 weeks; in 59% of pregnancies there would be no need for a third-trimester scan. CONCLUSION Prenatal prediction of a high proportion of SGA neonates necessitates the undertaking of screening in the third trimester of pregnancy, in addition to assessment in the second trimester, and the timing of such screening, either at 32 and/or 36 weeks, should be contingent on the results of the assessment at 19-24 weeks.
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Affiliation(s)
- C Lesmes
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - D M Gallo
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - J Panaiotova
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - L C Poon
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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