Cerebral-placental-uterine ratio as novel predictor of late fetal growth restriction: prospective cohort study

OBJECTIVE

Fetal growth restriction (FGR) is a major risk factor for stillbirth and most commonly arises from uteroplacental insufficiency. Despite clinical examination and third-trimester fetal biometry, cases of FGR often remain undetected antenatally. Placental insufficiency is known to be associated with altered blood flow resistance in maternal, placental and fetal vessels. The aim of this study was to evaluate the performance of individual and combined Doppler blood flow resistance measurements in the prediction of term small-for-gestational age and FGR.

METHODS

This was a prospective study of 347 nulliparous women with a singleton pregnancy at 36 weeks' gestation in which fetal growth and Doppler measurements were obtained. Pulsatility indices (PI) of the uterine arteries (UtA), umbilical artery (UA) and fetal vessels were analyzed, individually and in combination, for prediction of birth weight < 10^th , < 5^th and < 3^rd centiles. Doppler values were converted into centiles or multiples of the median (MoM) for gestational age. The sensitivities, positive and negative predictive values and odds ratios (OR) of the Doppler parameters for these birth weights at ∼ 90% specificity were assessed. Additionally, the correlations between Doppler measurements and other measures of placental insufficiency, namely fetal growth velocity and neonatal body fat measures, were analyzed.

RESULTS

The Doppler combination most strongly associated with placental insufficiency was a newly generated parameter, which we have named the cerebral-placental-uterine ratio (CPUR). CPUR is the cerebroplacental ratio (CPR) (middle cerebral artery PI/UA-PI) divided by mean UtA-PI. CPUR MoM detected FGR better than did mean UtA-PI MoM or CPR MoM alone. At ∼ 90% specificity, low CPUR MoM had sensitivities of 50% for birth weight < 10^th centile, 68% for < 5^th centile and 89% for < 3^rd centile. The respective sensitivities of low CPR MoM were 26%, 37% and 44% and those of high UtA-PI MoM were 34%, 47% and 67%. Low CPUR MoM was associated with birth weight < 10^th centile with an OR of 9.1, < 5^th centile with an OR of 17.3 and < 3^rd centile with an OR of 57.0 (P < 0.0001 for all). CPUR MoM was also correlated most strongly with fetal growth velocity and neonatal body fat measures, as compared with CPR MoM or UtA-PI MoM alone.

CONCLUSIONS

In this cohort, a novel Doppler variable combination, the CPUR (CPR/UtA-PI), had the strongest association with indicators of placental insufficiency. CPUR detected more cases of FGR than did any other Doppler parameter measured. If these results are replicated independently, this new parameter may lead to better identification of fetuses at increased risk of stillbirth that may benefit from obstetric intervention. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

A new Isospora sp. from Carduelis tristis (Aves: Fringillidae) from Ontario, Canada

Isospora gryphoni n. sp. is described from oocysts found in the feces of the American goldfinch, Carduelis tristis, from Guelph, Ontario, Canada. The oocysts are spherical to subspherical, with a double-layered, smooth, colorless oocyst wall, 29.2 x 30.7 microm (25-33 x 28-34; n = 30) with 2-4 rice-grain-shaped polar bodies; no micropyle or residuum. Sporocysts are ovoid, 22.2 x 13.4 microm (15-25 x 12-14.5; n = 30) with a small Stieda body, indistinct substiedal body, and prominent sporocyst residuum. Sporozoites are vermiform, each with a large refractile body at the posterior end. Forty-nine of 52 (94%) wild-caught adult C. tristis and 1 juvenile bird (minimum 12 days old) were excreting oocysts of I. gryphoni. None of 36 nestlings (maximum 10 days old) was excreting oocysts. Fecal encrustations from 7 of 10 used nests were found to contain oocysts of I. gryphoni.

Effects of current and waveform on the incidence of breast meat haemorrhages in electrically stunned broiler chicken carcases

The effects of the current and its waveform on the prevalence of broken bones and breast meat haemorrhages in electrically stunned broiler chickens were examined at two poultry processing plants. Increasing the current over the range from 68 to 115 mA per bird had very little effect on the carcase quality, but increased the incidence of broken furculum and coracoid bones in birds stunned with a sinusoidal alternating current (AC). Clipping a sinusoidal AC with a thyristor had a pronounced effect on the carcase quality, and resulted in more broken bones and breast meat haemorrhages.

Fibers in idiopathic retroperitoneal fibrosis: a case report

A case of idiopathic retroperitoneal fibrosis in a 33-yr-old female is reported. Many fiber-like crystals were noted within macrophages and the interstitial tissue of the lesion. The crystals appeared tan in hematoxylin- and eosin-stained slides and were birefringent under polarized light. The identity of the crystals was not established.

Endogenous development and pathogenicity of Eimeria angusta in the ruffed grouse, Bonasa umbellus

Oocysts of Eimeria angusta were recovered from the cecum of a captive ruffed grouse which died of coccidial typhlitis. Five experimental passages were made in grouse over a 2-yr period. Prepatent period was 6.5-7.0 days; sporulation time at 22 C was 54-60 hr. Endogenous stages were not found in grouse killed 1 and 2 days after inoculation (DAI). A few immature schizonts were in cecal epithelium 4 DAI. Developing and mature schizonts, and undifferentiated gamonts were in cecal epithelium 5 DAI. Developing micro- and macrogamonts, but no oocysts, were present 6.5 DAI. Fibrinohemorrhagic typhlitis, associated with large numbers of gamonts and oocysts in the epithelium, was found 9 DAI. Cecal glands were hypertrophic and there was a heavy mixed inflammatory cell reaction. Diarrhea, depression and reduced feed intake occurred 7-10 DAI with most severe signs and greatest oocyst passage 8 or 9 DAI. Most infected birds lost weight 5-8 or 9 DAI, but none died.

Plasma concentrations of prolactin during egg laying and incubation in the ruffed grouse (Bonasa umbellus)

The plasma concentration of prolactin was measured following experimental photostimulation, during oviposition and during incubation in plasma from ruffed grouse by heterologous double-antibody radioimmunoassay. A slight increase in plasma prolactin was noted after photo-stimulation and a much larger increase was observed as subsequent eggs were laid. When the last egg was laid, plasma prolactin was maximal. This high concentration was maintained throughout incubation and declined to basal values when incubation was terminated by removal of the eggs. In hens that failed to incubate, plasma prolactin declined after the last oviposition.Brood patch development began before the first egg was laid but was not completed until incubation was initiated. Therefore, the patch began to develop when plasma concentrations of prolactin were slightly elevated but it was not fully formed until high concentrations of prolactin were maintained for several days.

Weight and histological studies of growth and regression in the bursa of Fabricius in the mallard, Anas platyrhynchos

A weight and histological study of growth and regression of the bursa of Fabricius in captive and wild mallards was made between May 1967 and May 1968. Mean bursal weight reached a maximum by 8 weeks in males and 6 weeks in females, and decreased steadily after 12 weeks in males and 16 weeks in females. During growth of the bursa there was a general enlargement of the bursal follicles, but the trabeculae between the follicles remained thin. During bursal regression the follicular size decreased, and trabeculae thickened. Ultimately the follicles and bursal lumen disappeared leaving connective tissue and blood vessels. A classification was erected to describe the phases of bursal growth and regression.