Background: Accurate determination of gestational age has become important for deciding the appropriate time for termination of the pregnancy as well as to monitor the fetal growth during the entire period of pregnanc...Background: Accurate determination of gestational age has become important for deciding the appropriate time for termination of the pregnancy as well as to monitor the fetal growth during the entire period of pregnancy. Objective: The aim of the study was to assess whether the trans-cerebellar diameter, placental thickness or combining both of them is more accurate for assessment of gestational age in the 3<sup>rd</sup> trimester of pregnancy. Patients and Methods: This is a cross sectional study conducted at outpatient Clinic and Obstetric ward, Ain Shams University Maternity Hospital, over a period of six months from March 2019 to September 2019. One hundred pregnant women were recruited according to inclusion criteria either from outpatient clinic or were admitted in obstetric ward Ain Shams Maternity Hospital to find out the most accurate fetal biometric measurement in the third trimester either trans-cerebellar diameter placental thickness or both compared to reliable LMP (last menstrual period) dates confirmed by crown rump length (CRL) in the first trimester. Results: Trans-cerebellar diameter mean ± SD was 46.0 ± 3.5 with range 38.2 - 51.7. The mean of placental thickness was 39.6 ± 7.1 with range 22.8 - 54.3. Placental thickness had highest determination (0.813) for last menstrual period followed by trans-cerebellar diameter (0.802). Combining trans-cerebellar diameter and placental thickness increased determination (0.902) for last menstrual period. Conclusion: Combined use of trans-cerebellar diameter and placental thickness in the third trimester of pregnancy is a reliable indicator for gestational age in women whose last menstrual period is unreliable or unknown, but placental thickness had higher accuracy than trans-cerebellar diameter.展开更多
<strong>Background:</strong><span style="font-family:Verdana;"> In routine ultrasonography</span><span style="font-family:Verdana;">,</span><span style="...<strong>Background:</strong><span style="font-family:Verdana;"> In routine ultrasonography</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> the ultrasonologist measures the</span><span style="font-family:Verdana;"> bi-parietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL) in estimating the gestational age (GA) and estimated date of delivery. However</span><span style="font-family:Verdana;">,</span><span style="font-family:""><span style="font-family:Verdana;"> as the pregnancy advances these parameters become increasingly unreliable in prediction of GA. Estimation of GA </span><span style="font-family:Verdana;">in late second and third trimester accurately still a problem till now. Fetal </span><span style="font-family:Verdana;">kidney has been shown a steady growth of 1.7 mm fortnightly (every 2 weeks) along pregnancy and is unaffected by growth abnormalities. Many studies have reported that fetal kidney length (FKL) correlates with the gestational age in late trimester very strong. The study aimed to assess the accuracy of the gestational age estimated by mean fetal kidney length compared to multiple growth parameters like BPD, HC, AC & FL in addition to the actual gestational age derived from the reliable last menstrual period.</span><b><span style="font-family:Verdana;"> Methods:</span></b><span style="font-family:Verdana;"> Cross sectional hospital based study</span></span><span style="font-family:Verdana;">, </span><span style="font-family:Verdana;">was conducted at ultrasound unit;department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University from the period of July 2018 to December 2018.</span><span style="font-family:""> </span><span style="font-family:Verdana;">A total number of 11</span><span style="font-family:Verdana;">5</span><span style="font-family:Verdana;"> Pregnant women at their third trimester by reliable LMP attended antenatal care clinic at Ain-Shams University Hospital and consented to participate in this study.</span><span style="font-family:""> </span><span style="font-family:Verdana;">Every woman was subjected to: Expected date of delivery was calculated according to Naegle’s formula: Ultrasonography:</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">Fetal biometry and estimated date of delivery (EDD) by assessment of BPD, HC, FL & AC. Expected fetal weight measured by </span><i><span style="font-family:Verdana;">Hadlock</span></i><span style="font-family:Verdana;"> <i>formula.</i></span><span style="font-family:Verdana;"> Fetal lie and presentation. Exclusion of fetal anomalies. Measurement of both right & left fetal kidney length. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> In this study</span></span><span style="font-family:Verdana;">,</span><span style="font-family:""><span style="font-family:Verdana;"> 255 participants were recruited and assessed for eligibility, 125 women were allocated to perform obstetric ultrasound just 115 completed and were included in the final analysis. The current study found that there was a highly significant positive correlation between gestational age </span><span style="font-family:Verdana;">(according to ultrasound parameters) and KL, BDP, HC, AC and FL but </span><span style="font-family:Verdana;">Kidney length was the most correlated parameter. Also this study found that there was significant positive correlation between gestational age (according to LMP) and gestational age estimated by BPD, HC, AC, FL and KL with the most significant positive correlation being with KL. Also this study found that </span><span style="font-family:Verdana;">there was no significant difference (matched) in KL and Gestational age</span><span style="font-family:Verdana;"> compared to other parameters. This means that KL is the most accurate parameter for Estimating Gestational age, correlation between MKL and GA by LMP (r =</span></span><span style="font-family:Verdana;"> 0</span><span style="font-family:Verdana;">.951, p</span><span style="font-family:""> </span><span style="font-family:Verdana;">= </span><span style="font-family:Verdana;">0.</span><span style="font-family:Verdana;">000) the most significant correlation.</span><span style="font-family:""> </span><span style="font-family:Verdana;">In this study</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> no significant difference was found between gestational age estimated by KL and gestational age in all stages of pregnancy. This means that KL remains accurate as a predictor for gestational age regardless stage of pregnancy.</span><span style="font-family:""> </span><b><span style="font-family:""><span style="font-family:Verdana;">Conclu</span><span style="font-family:Verdana;">sion: </span></span></b><span style="font-family:Verdana;">Kidney length can be used as an individual parameter in estimating</span><span style="font-family:Verdana;"> gestational age.</span>展开更多
Background: Antenatal corticosteroid (ACS) treatment has been proven to decrease rates of adverse perinatal outcomes when administered to pregnant women at risk for preterm delivery. Given the uncertainty about the be...Background: Antenatal corticosteroid (ACS) treatment has been proven to decrease rates of adverse perinatal outcomes when administered to pregnant women at risk for preterm delivery. Given the uncertainty about the benefit of ACS according to gestational age, we aimed to examine whether there was any benefit of ACS on perinatal mortality and respiratory distress syndrome (RDS) according to different gestational ages at birth. Methods: Secondary analysis of data from an observational prospective chart review study was conducted in four hospitals located in the Mwanza region, Tanzania. The study population consisted of singleton infants delivered between 27 and 34 weeks of gestation between July 2019 and February 2020. Sociodemographic and medical data were recorded from participants’ medical records. Results: Over an eight-month period, 838 preterm singletons were delivered between 27 and 34 weeks of gestation. Three hundred and twelve (37.2%) pregnant women received at least one dose of ACS. Among infants exposed to ACS, perinatal mortality rates were significantly lower than those without exposure at the 27th week (27.8% vs 94.4%, P < 0.001), the 29th week (13.3% vs 51.4%, P = 0.012) and the 34th week (3.0% vs 18.2%, P < 0.001). Among infants exposed to ACS, the RDS rate was significantly lower than those without exposure only at the 32nd week (9.5% vs 25.0%, P = 0.039). Conclusion: Our findings add to the literature about the benefits of ACS for preterm infants of various gestational ages in low-resource settings. Compared to unexposed infants, those exposed to ACS and born at 27th and 34th weeks of gestation experienced lower rates of perinatal mortality. Future research, especially among infants born before the 27th week of pregnancy, is a priority.展开更多
<strong>Background</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><strong>:</stron...<strong>Background</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><strong>:</strong></span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> Conventional ultrasound dating is not very accurate after 34 weeks of gestation and has standard deviation of about 2 weeks. </span><b><span style="font-family:Verdana;">Objective</span></b></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">:</span></b></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> Verify whether fetal colon diameter can be used as a tool for estimating gestational age (GA) of fetuses between 34 to 40 weeks. </span><b><span style="font-family:Verdana;">Materials</span></b> <b><span style="font-family:Verdana;">and</span></b> <b><span style="font-family:Verdana;">Methods</span></b></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">:</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> This was a prospective cross</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">sectional study conducted at Obstetrics and Gynecology University Hospital, Damascus, Syria, during the period </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">from</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> September 2019-September 2020. The study enrolled 395 women with uncomplicated singleton pregnancies at 34 - 40 weeks of gestation. Fetal bi-parietal diameter, head circumference, abdominal circumference, and femoral lengths were assessed by ultrasound. In addition</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">,</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> descending colon diameter was assessed at the level of colonic haustra. The correlation between GA and colon diameter was assessed by the Pearson correlation test. </span><b><span style="font-family:Verdana;">Results</span></b></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">:</span></b></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> Significant correlation between fetal colon diameter and gestational age was observed P < 0.0001 (r = 0.852). In addition, a highly significant correlation between colon </span><span><span style="font-family:Verdana;">diameter and bi-parietal diameter, femoral length, head circumference and abdominal circumference were found with P values < 0.0001. The correlation between gestational age at 3</span><sup><span style="font-family:Verdana;">rd</span></sup><span style="font-family:Verdana;"> trimester and colon diameter was significantly stronger than the correlation between gestational age and bi-parietal diameter, head circumference, and abdominal circumference.</span></span></span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">Whereas, no significant difference was found when comparing colon diameter and femoral lengths (P = 0.089). </span><b><span style="font-family:Verdana;">Conclusion</span></b></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">:</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> The present study suggested that colon di</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">ameter can be used for predicting third trimester gestational age.</span></span></span>展开更多
Background:Antenatal corticosteroids(ACS)can significantly improve the outcomes of preterm infants.This study aimed to describe the ACS use rates among preterm infants admitted to Chinese neonatal intensive care units...Background:Antenatal corticosteroids(ACS)can significantly improve the outcomes of preterm infants.This study aimed to describe the ACS use rates among preterm infants admitted to Chinese neonatal intensive care units(NICU)and to explore perinatal factors associated with ACS use,using the largest contemporary cohort of very preterm infants in China.Methods:This cross-sectional study enrolled all infants born at 24^(+0)to 31^(+6)weeks and admitted to 57 NICUs of the Chinese Neonatal Network from January 1st,2019 to December 30th,2019.The ACS administration was defined as at least one dose of dexamethasone and betamethasone given before delivery.Multiple logistic regressions were applied to determine the association between perinatal factors and ACS usage.Results:A total of 7828 infants were enrolled,among which 6103(78.0%)infants received ACS.ACS use rates increased with increasing gestational age(GA),from 177/259(68.3%)at 24 to 25 weeks’gestation to 3120/3960(78.8%)at 30 to 31 weeks’gestation.Among infants exposed to ACS,2999 of 6103(49.1%)infants received a single complete course,and 33.4%(2039/6103)infants received a partial course.ACS use rates varied from 30.2%to 100%among different hospitals.Multivariate regression showed that increasing GA,born in hospital(inborn),increasing maternal age,maternal hypertension and premature rupture of membranes were associated with higher likelihood to receive ACS.Conclusions:The use rate of ACS remained low for infants at 24 to 31 weeks’gestation admitted to Chinese NICUs,with fewer infants receiving a complete course.The use rates varied significantly among different hospitals.Efforts are urgently needed to propose improvement measures and thus improve the usage of ACS.展开更多
Background:Prenatal evaluation of fetal lung maturity(FLM)is a challenge,and an effective non-invasive method for prenatal assessment of FLM is needed.The study aimed to establish a normal fetal lung gestational age(G...Background:Prenatal evaluation of fetal lung maturity(FLM)is a challenge,and an effective non-invasive method for prenatal assessment of FLM is needed.The study aimed to establish a normal fetal lung gestational age(GA)grading model based on deep learning(DL)algorithms,validate the effectiveness of the model,and explore the potential value of DL algorithms in assessing FLM.Methods:A total of 7013 ultrasound images obtained from 1023 normal pregnancies between 20 and 41+6 weeks were analyzed in this study.There were no pregnancy-related complications that affected fetal lung development,and all infants were born without neonatal respiratory diseases.The images were divided into three classes based on the gestational week:class I:20 to 29+6 weeks,class II:30 to 36+6 weeks,and class III:37 to 41+6 weeks.There were 3323,2142,and 1548 images in each class,respectively.First,we performed a pre-processing algorithm to remove irrelevant information from each image.Then,a convolutional neural network was designed to identify different categories of fetal lung ultrasound images.Finally,we used ten-fold cross-validation to validate the performance of our model.This new machine learning algorithm automatically extracted and classified lung ultrasound image information related to GA.This was used to establish a grading model.The performance of the grading model was assessed using accuracy,sensitivity,specificity,and receiver operating characteristic curves.Results:A normal fetal lung GA grading model was established and validated.The sensitivity of each class in the independent test set was 91.7%,69.8%,and 86.4%,respectively.The specificity of each class in the independent test set was 76.8%,90.0%,and 83.1%,respectively.The total accuracy was 83.8%.The area under the curve(AUC)of each class was 0.982,0.907,and 0.960,respectively.The micro-average AUC was 0.957,and the macro-average AUC was 0.949.Conclusions:The normal fetal lung GA grading model could accurately identify ultrasound images of the fetal lung at different GAs,which can be used to identify cases of abnormal lung development due to gestational diseases and evaluate lung maturity after antenatal corticosteroid therapy.The results indicate that DL algorithms can be used as a non-invasive method to predict FLM.展开更多
Premature Rupture of Membranes (PROM) with the resulting prematurity remains a major public health issue in the Democratic Republic of Congo (DRC). This study aimed to assess expectant management of PPROM before 34 we...Premature Rupture of Membranes (PROM) with the resulting prematurity remains a major public health issue in the Democratic Republic of Congo (DRC). This study aimed to assess expectant management of PPROM before 34 weeks at the university hospital of Kinshasa. We conducted a retrospective analysis of expectantly managed PROM before 34 weeks between January 2008 and December 2018. Maternal and fetal outcomes were collected, and all data were analyzed using the SPSS 23.0 software. Of the 113 patients included in the study, 2.6% were diagnosed with PROM before 34 weeks. We observed prolongation of the pregnancy duration;the median latency period was eight days, and the average gestational age at delivery of 32.85 ± 2.5 weeks. Chorioamnionitis (23%), severe oligoamnios (7%), and acute fetal distress (4%) were complications observed during the latency period. In the postpartum period, endometritis (6.2%), neonatal jaundice (39.8%), anemia (25.7%), ulcerative necrotizing enterocolitis (6.2%), cerebromeningeal hemorrhage (5.3%), and acute respiratory distress syndrome (4.4%) were complications observed. The risk of infection during the latency period was significantly associated with irregular (P = 0.045) or lack (P = 0.006) antenatal care (ANC) attendances and C-Reactive Protein (CRP) results 6 (P = 0.013). The risk of neonatal death was significantly associated to infection during the latency period (P = 0.011), irregular (P = 0.009) or lack of ANC (P = 0.000) attendances, Birth weight g (P = 0.039) as well as Gestational age at birth between 28 to 30 Weeks (S) (P = 0.021). These findings report first-time pregnancy outcomes related to the management of PPROM before 34 weeks in our setting. We found that the conservative attitude adopted allowed the prolongation of pregnancies, reducing the risks associated with prematurity. Nevertheless, attendance in good quality ANC could reduce the frequency of PROM and related adverse outcomes.展开更多
Objective::This study aimed to determine:(1)whether recurrent deliveries of a small for gestational age(SGA)neonate are associated with increased obstetrical or neonatal complications;(2)whether the risk factors that ...Objective::This study aimed to determine:(1)whether recurrent deliveries of a small for gestational age(SGA)neonate are associated with increased obstetrical or neonatal complications;(2)whether the risk factors that can predict small for gestational age(SGA)recurrence.Methods::This study was based on Soroka Medical Center's Obstetrics electronic database.The database consisted of 109022 women who had 320932 deliveries between the year 1988-2014.The study cohort included 6.8%(7368/109022)of these patients who gave birth to a singleton SGA neonate on their first delivery and had more than one delivery.The study population was divided into two groups according to the outcome of the subsequent delivery:(1)women with sporadic SGA who delivered a non-SGA neonate(n=5416);(2)women with recurrent SGA(n=1952).SGA defined as birthweight<10 th percentile.Maternal and neonatal complications were compared between the two groups.Logistic regression was used to determine independent risk factors for SGA recurrence.Results::The prevalence of birthweight<5 th percentile was higher among the recurrent SGA group in the first delivery(P<0.001).Bedouin ethnicity was more prevalent in the recurrent SGA group(P<0.001).The rate of preterm delivery was higher in the first delivery of the recurrent SGA group(P=0.015).The sporadic SGA group had a higher rate of perinatal mortality during the first pregnancy(P=0.017).The rate of severe hypertension(P=0.005),polyhydramnios,meconium-stained amniotic fluid,nonreassuring fetal heart rate and total perinatal mortality(P<0.001)were higher in the second delivery of the recurrent SGA group.In a logistic regression model,preterm delivery and birthweight<5 th percentile at the first delivery was found to be independent risk factors for recurrence of an SGA neonate in the subsequent birth(relative risks:1.530,confidence interval:1.249-1.875;relative risks:1.826,confidence interval:1.641-2.030,respectively).Conclusion::Women with recurrent SGA neonates have specific clinical characteristics.Among women who deliver an SGA neonate,preterm delivery,and birthweight<5 th percentile are independent predictors for its recurrence.展开更多
BACKGROUND Umbilical cord milking(UCM)is an alternative placental transfusion method for delayed umbilical cord clamping in routine obstetric practice,allowing prompt resuscitation of an infant.Thus,UCM has been adopt...BACKGROUND Umbilical cord milking(UCM)is an alternative placental transfusion method for delayed umbilical cord clamping in routine obstetric practice,allowing prompt resuscitation of an infant.Thus,UCM has been adopted at some tertiary neonatal centers for preterm infants to enhance placental-to-fetal transfusion.It is not suggested for babies less than 28 wk of gestational age because it is associated with severe brain hemorrhage.For late preterm or term infants who do not require resuscitation,cord management is recommended to increase iron levels and prevent the development of iron deficiency anemia,which is associated with impaired motor development,behavioral problems,and cognitive delays.Concerns remain about whether UCM increases the incidence of intraventricular hemorrhage.However,there are very few reports of late preterm infants presenting with neonatal hemorrhage stroke(NHS)and severe coagulopathy after receiving UCM.Here,we report a case of a late preterm infant born at 34 wk of gestation.She abruptly deteriorated,exhibiting signs and symptoms of NHS and severe coagulopathy after receiving UCM on the first day of life.CASE SUMMARY A female preterm infant born at 34 wk of gestation received UCM after birth.She was small for her gestational age and described as vigorous with Apgar scores of 9 and 10 at one minute and five minutes of life,respectively.After hospitalization in the neonatal intensive care unit,she showed hypoglycemia and metabolic acidosis.The baby was administered glucose and sodium bicarbonate infusions.Intramuscular vitamin K1 was also used to prevent vitamin K deficiency.The baby developed umbilical cord bleeding and gastric bleeding on day 1 of life;a physical examination showed bilateral conjunctival hemorrhage,and a blood test showed thrombocytopenia,prolonged prothrombin time,prolonged activated partial thromboplastin time,low fibrinogen,raised D-dimer levels and anemia.A subsequent cranial ultrasound and computed tomography scan showed a left parenchymal brain hemorrhage with extension into the ventricular and subarachnoid spaces.The patient was diagnosed with NHS in addition to disseminated intravascular coagulation(DIC).Fresh frozen plasma(FFP)and prothrombin complex concentrate were given for coagulopathy.Red blood cell and platelet transfusions were provided for thrombocytopenia and anemia.A bolus of midazolam,intravenous calcium and phenobarbital sodium were administered to control seizures.The baby’s clinical condition improved on day 5 of life,and the baby was hospitalized for 46 d and recovered well without seizure recurrence.Our case report suggests that preterm infants who receive UCM should undergo careful clinical assessment for intracranial hemorrhage,NHS and severe coagulopathy that may develop under certain circumstances.Supportive management,such as intensive care,FFP and blood transfusion,is recommended when the development of massive NHS and associated DIC is suspected.CONCLUSION Our case report suggests that for late preterm infants who are small for gestational age and who receive UCM for alternative placental transfusion,neonatal health care professionals should be cautious in assessing the development of NHS and severe coagulopathy.Neonatal health care professionals should also be more cautious in assessing the complications of late preterm infants after they receive UCM.展开更多
The association between Leisure Time Physical Activity (LTPA) during pregnancy and foetal outcomes has been extensively investigated. However, epidemiological studies specifically referred to LPTA in the last months o...The association between Leisure Time Physical Activity (LTPA) during pregnancy and foetal outcomes has been extensively investigated. However, epidemiological studies specifically referred to LPTA in the last months of pregnancy are scarce. We evaluated the association between LPTA and the risk of both preterm delivery and small for gestational age (SGA) during the last three months of pregnancy in Italy. A nationwide case-control study was performed in nine Italian cities. A total of 299 preterm delivery, 364 SGA and 855 controls were enrolled in the study. A self-administered questionnaire was used to assess socio-demographic variables, medical and reproductive history, life-style habits and LTPA referred to the last three months of pregnancy. Univariate and multivariate regression analyses were performed in order to estimate Odds ratios and 95% CI. LTPA during the last three months of pregnancy decreases the risk of preterm delivery (adjusted OR = 0.56;95% CI 0.39 - 0.79). Among the different types of physical activity, walking, the most frequently referred activity, appears significantly protective against preterm delivery (adjusted OR = 0.53;95% CI 0.36 - 0.81). Moreover, a small protective effect of walking was evidenced against SGA (adjusted OR = 0.72;95% CI 0.51 - 1.00). In conclusion, a mild physical activity such as walking in the last three months of pregnancy seems to reduce the risk of preterm delivery and, at a lesser extent, of SGA, confirming the beneficial effects of physical activity along the whole pregnancy.展开更多
The objective of this study is to assess commonly used formulae (Sheppard, Campbell, Hadlock I, II, III, and IV) for estimation of fetal weight in Sudanese population. A descriptive cross-sectional study was conducted...The objective of this study is to assess commonly used formulae (Sheppard, Campbell, Hadlock I, II, III, and IV) for estimation of fetal weight in Sudanese population. A descriptive cross-sectional study was conducted at Saudi Hospital-Khartoum-Sudan;from December 2015 to April 2016. The study included 225 singleton pregnancies. The fetal biometry—Biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL) and actual birth weights (ABW) were taken. Statistical analysis showed significant results at p ≤ 0.005. Results showed that the significant highest positive correlation between the ABW and the EFW/Kg was seen in the Hadlock I, III and IV equations having an equal values (0.951) followed by Hadlock II (0.946), Sheppard (0.872) and lastly Campbell (-0.925) with significant high degree of negative correlation. The new established equation EFW<sub>FLHCAC</sub> is the best formula identified in our study to predict Sudanese babies weight ranged between 1.86 Kg to 3.987 Kg.展开更多
The epidemiological associations between the prenatal perfluoroalkyl substances(PFASs)exposure and the reproductive outcomes remain controversial.A continuous evaluation is needed to combine the inconsistent results.I...The epidemiological associations between the prenatal perfluoroalkyl substances(PFASs)exposure and the reproductive outcomes remain controversial.A continuous evaluation is needed to combine the inconsistent results.In this study,we explored the associations between PFASs exposure and the low birth weight(LBW),preterm birth and small for gestational age(SGA).The quality of selected literature,quantitative estimates,publication bias and subgroup analysis were performed on the basis of 17 retrieved articles published before December 2020.The results showed a significant positive association between the perfluorooctane sulfonate(PFOS)exposure and the risk of LBW[Odds ratio(OR)=1.17;95%confidence interval(CI):1.01,1.36;heterogeneity:P=0.30,I2=17%].The positive association was also observed between the PFOS and the risk of preterm birth(OR=1.19;95%CI:1.01,1.39,P=0.007;I2=62%).There was a paucity of evidence regarding the negative effects of perfluorooctanoic acid(PFOA),perfluorohexanesulfonic acid(PFHxS)and perfluorononanoic acid(PFNA)on the pregnancy outcomes.The findings from the subgroup analysis(the sampling period,the birth gender and biologic specimens)did not substantially altered the results of the overall pooled estimate ORs.The increased prevalence of negative birth outcomes with gestational PFASs exposure warrants further explorations from biological process perspective.展开更多
Technological advances, a deeper understanding of disease processes and increased sophistication of therapeutic methods have all led to better outcomes in rare diseases which previously had devastating effects on many...Technological advances, a deeper understanding of disease processes and increased sophistication of therapeutic methods have all led to better outcomes in rare diseases which previously had devastating effects on many women’s lives. The inevitable result of this progress is that women, who in the past did not contemplate pregnancy because of significant morbidity, now get to adulthood and are reasonably “disease free” enough to have their own families. The ever expanding, but relatively new specialty of Obstetric medicine seeks to further improve the outcome in pregnant women with intercur</span><span style="font-family:"">r</span><span style="font-family:"">ent disease by enhancing the literature base, thereby contributing to the creation of appropriate guidance in the management of these patients. This article is a brief but useful guide for the busy obstetrician who may have limited experience in dealing with multiple sclerosis in pregnant women.展开更多
Background: Many centers in Sudan use the reference data for fetal biometry. The recently published population-based reference either overestimated or underestimated the weight of the fetuses. Objective: To establish ...Background: Many centers in Sudan use the reference data for fetal biometry. The recently published population-based reference either overestimated or underestimated the weight of the fetuses. Objective: To establish a national reference for fetal biometry, and weight by gestational age for singleton fetuses in Sudan. Methods: Data were collected on all singleton live births documented in the data collection sheet done at Saudi Hospital from 2015 to 2016 (n = 225). Gestational age estimation was based on the last menstrual period and fetal ultrasound thereafter. Fetal biometry and weight and other 6 fetal weight formulae were assessed. Reference data for fetal growth by gestational age were created. Results: New charts and reference equations are reported in Sudanese population for fetal biparietal diameter, head circumference, abdominal circumference and femur length and fetal weight. Conclusion: We advocate that these reference charts and equations for fetal biometry and weight might be valuable in the clinical use for appropriate ethnic Sudanese.展开更多
<strong>Introduction</strong> <span style="font-family:""><span style="font-family:Verdana;">Accurate pregnancy dating is important for many aspects of </span><...<strong>Introduction</strong> <span style="font-family:""><span style="font-family:Verdana;">Accurate pregnancy dating is important for many aspects of </span><span style="font-family:Verdana;">obstetric care at individual level as well as population level. Traditionally</span></span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> pregnancy</span><span style="font-family:Verdana;"> dating has done by adding 9 months and 7 days to the last menstrual period (LMP) using Naegele’s formula. Determination of gestational age by ultrasound is more precise. Most commonly used parameters are mean sac diameter, gestation sac volume, crown</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">rump length (CRL), biparietal diameter (BPD), head circumference (HC) and femur length (FL). After 24 weeks</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> gestational age cannot be accurately determined by ultrasound scans. The biological variability of CRL is small and growth is very rapid. There are </span><span style="font-family:Verdana;">many factors</span><span style="font-family:"color:red;"> </span><span style="font-family:""><span style="font-family:Verdana;">that</span><span style="color:red;"> </span></span><span style="font-family:""><span style="font-family:Verdana;">can affect CRL such as measurement errors, differences in growth rates between individuals, fetal sex and maternal conditions such as diabetes </span><span style="font-family:Verdana;">mellitus. A correctly performed measurement of CRL is the most accurate way</span><span style="font-family:Verdana;"> of estimating the gestational age in early pregnancy from 8 weeks to 13 weeks + 6 days. </span><b><span style="font-family:Verdana;">Objectives </span></b><span style="font-family:Verdana;">Our study aims were to prepare a new Crown Rump Length chart with Sri Lankan population data and to compare </span><span><span style="font-family:Verdana;">new CRL chart with existing intergrowth CRL chart.</span><b><span style="font-family:Verdana;"> Method </span></b><span style="font-family:Verdana;">Prospective observationa</span></span><span style="font-family:Verdana;">l study with recruitment of subjects by Quota sampling technique was carried out from April 2015 to March 2016. Spontaneously conceived uncomplicated singleton pregnancies with normal Body Mass Index (BMI) 18.5 - 23 kg/m</span><sup><span style="font-family:Verdana;">2</span></sup><span style="font-family:Verdana;"> were recruited at the time of registration to antenatal care. Consenting woman with known LMP with regular cycles in preceding 3 months were undergone ultrasound examination only once at gestational age (GA) ranging from 8 weeks to 13 weeks + 6 days. If ultrasound dating w</span></span><span style="font-family:Verdana;">as</span><span style="font-family:Verdana;"> different from LMP dating by more than 5 days in pregnancies with POA less than 9 weeks and dating difference</span><span style="font-family:Verdana;">s</span><span style="font-family:Verdana;"> more than 7 days in pregnancies between 9 weeks and 14 weeks w</span><span style="font-family:Verdana;">ere</span><span style="font-family:""><span style="font-family:Verdana;"> excluded. Pregnancies complicated with uncertain viability, congenital anomalies and spontaneous miscarriage were excluded from statistical analysis. Data collection done with pre-tested interviewer administered form and analysis was carried out using the Statistical Package for Social Sciences (SPSS) version 21. </span><b><span style="font-family:Verdana;">Results </span></b><span style="font-family:Verdana;">A total of 653 subjects were recruited for the study and 557 turned up for ultrasound dating assessment. Dating discrepancy and multiple pregnancies excluded 31 subjects, uncertain viability and spontaneous miscarriage excluded 15 subjects resulting 511 subjects for final statistical analysis. The mean CRL increased with GA almost linearly from day 56 to 97. </span><b><span style="font-family:Verdana;">Conclusions </span></b><span style="font-family:Verdana;">We have produced new CRL chart based on Sri Lankan data and it can be used for clinical practice in Sri Lanka. There is no statistically significant difference between our CRL chart and intergrowth CRL chart.</span></span>展开更多
Aims:?The aim of this study was to explore the outcome of previous pregnancies in women who later developed diabetes. Method: A Swedish population based cohort of 23,524 women from 1990 aged 45 - 85 yr in 2000 when th...Aims:?The aim of this study was to explore the outcome of previous pregnancies in women who later developed diabetes. Method: A Swedish population based cohort of 23,524 women from 1990 aged 45 - 85 yr in 2000 when they self reported health status in a questionnaire. To identify which women who delivered we matched it towards the Swedish Medical Birth Register (SMBR). We identified 14,856 women who appeared in both registers and a total of 30,559 new birth registrations. Among these women 216 had developed diabetes after their pregnancy (ies) and additional twelve women were reported to have gestational diabetes in SMBR. These 228 women and their 455 pregnancies were compared with women without diabetes. Results: Women who developed diabetes later in life were already heavier before the pregnancy (ies) (69.2 ± 13.9 vs. 63.2 ± 10.3 kg;p < 0.001) but had less weight gain during pregnancy (13.3 ± 5.4 vs. 14.1 ± 4.6 kg;p = 0.03) compared to women without diabetes. Newborns to women with diabetes diagnosed any time after pregnancy had higher birth weight (3602 vs. 3507 g;p < 0.001), were more often large for gestational age (10.5% vs. 3.1%;p < 0.001), were more often delivered by caesarean section (4.8% vs. 2.7%;p = 0.005) and had lower Apgar scores. Conclusion: Women who developed diabetes after pregnancy had hyperglycaemia-associated complications during their pregnancy (ies). We therefore postulated that women with Type 2 diabetes are mainly recruited from women with earlier GDM. A general screening for GDM should identify these women and enable life style intervention that may prevent or at least delay diabetes.展开更多
Objective: To investigate the incidence of retinopathy of prematurity (ROP), analyze the risk factors of ROP, and put forward effective screening strategies, to reduce its incidence. Background: Retinopathy of prematu...Objective: To investigate the incidence of retinopathy of prematurity (ROP), analyze the risk factors of ROP, and put forward effective screening strategies, to reduce its incidence. Background: Retinopathy of prematurity (ROP) is an eye disease that can happen in new born premature (born early) babies or have weigh less than 3 pounds at birth. ROP happens when abnormal blood vessels grow in the retina. There are multiple risk factors, which are causing the ROP. In our study we will analyses the risk factors of ROP. Methods: From February 2016 to August 2021, 190 premature infants in the neonatal intensive care unit (NICU) who received inpatient care and ophthalmic screening was selected as study subjects. ROP group (n = 32) and non-ROP group (n = 158) were selected, and the clinical data of the two groups were compared. Including oxygen concentration, mechanical ventilation, broncho pulmonic dysplasia, delivery mode (cesarean section, vaginal delivery), blood transfusion, anemia, gestational diabetes, gestational hypertension, fetal distress, preterm birth weight, gestation age, etc. Women were divided into two groups according to whether they had gestational diabetes mellitus (GDM) or not: gestational diabetic (n = 38) and non-gestational diabetics (n = 152). Age, pregnancy times, birth times, oxygen inhalation, birth weight, and gestational age were compared between the two groups. The X<sup>2</sup> test for counting data and the t-test for measuring data are then conducted according to the distribution characteristics of the data, The correlation analysis between ROP and a single risk factor was performed by chi-square test, and the analysis of the correlation between many risk factors and ROP was conducted by Logistic regression analysis. Results: 1) The incidence of ROP in the GDM group was higher than that in the non-GDM group (P P > 0.05). 3) Univariate analysis showed that oxygen use, birth weight, gestational age, bronchopulmonary dysplasia, pregnancy-induced hypertension, and fetal distress in the ROP group and non-ROP group were statistically significant (P P > 0.05). 4) Logistic multivariate analysis showed that oxygen use, gestational hypertension, diabetes mellitus during pregnancy, fetal distress, bronchopulmonary dysplasia, birth weight, and gestational age were the main risk factors for ROP. Conclusion: 1) Gestational diabetes mellitus is a high-risk factor for ROP. 2) Oxygen inhalation, birth weight, and gestational age are related to the occurrence and development of ROP. 3) In determining the initial screening time for ROP.展开更多
Background Previous studies investigated the association between gestational anemia and neonatal outcomes.However,few studies explored whether the effects of gestational anemia could be eliminated by subsequent correc...Background Previous studies investigated the association between gestational anemia and neonatal outcomes.However,few studies explored whether the effects of gestational anemia could be eliminated by subsequent correction of anemia in the later stages of pregnancy.This study aimed to investigate the relationship between anemia in different trimesters and neonatal outcomes.Methods The study was conducted in Shanghai,China,with a sample of 46,578 pregnant women who delivered between January 1,2016 and July 1,2019.A multivariable logistic regression model was adopted to analyse the associations between maternal anemia and neonatal outcomes.Results The incidence of gestational anemia was 30.2%,including 4.4%in the first trimester,9.6%in the second trimester,and 16.2%in the third trimester.Only 24.5%(507/2066)of anemia that occurred in the first trimester and 29.6%(1320/4457)that occurred in the second trimester could be corrected in the later stages of pregnancy.Anemia occurring in the first trimester was associated with small for gestational age[odds ratio(OR)1.46;95%confidence interval(CI)1.20-1.78]and with fetal distress(OR 1.23;95%CI 1.08-1.40).Anemia corrected in the first trimester also was associated with a higher risk of small for gestational age.Conclusions Gestational anemia is a public health problem in China impacting neonatal health.Anemia in pregnancy could be corrected in only about a quarter of the women.Anemia in the first trimester,whether corrected or not,still led to lower birth weight;therefore,the prevention of anemia prior to pregnancy is important.展开更多
Background:Significant brain volume deviation is an essential phenotype in children with neurodevelopmental delay(NDD),but its genetic basis has not been fully characterized.This study attempted to analyze the genetic...Background:Significant brain volume deviation is an essential phenotype in children with neurodevelopmental delay(NDD),but its genetic basis has not been fully characterized.This study attempted to analyze the genetic factors associated with significant whole-brain deviation volume(WBDV).Methods:We established a reference curve based on 4222 subjects ranging in age from the first postnatal day to 18 years.We recruited only NDD patients without acquired etiologies or positive genetic results.Cranial magnetic resonance imaging(MRI)and clinical exome sequencing(2742 genes)data were acquired.A genetic burden test was performed,and the results were compared between patients with and without significant WBDV.Literature review analyses and BrainSpan analysis based on the human brain developmental transcriptome were performed to detect the potential role of genetic risk factors in human brain development.Results:We recruited a total of 253 NDD patients.Among them,26 had significantly decreased WBDV(<-2 standard deviations[SDs]),and 14 had significantly increased WBDV(>+2 SDs).NDD patients with significant WBDV had higher rates of motor development delay(49.8%[106/213]vs.75.0%[30/40],P=0.003)than patients without significant WBDV.Genetic burden analyses found 30 genes with an increased allele frequency of rare variants in patients with significant WBDV.Analyses of the literature further demonstrated that these genes were not randomly identified:burden genes were more related to the brain development than background genes(P=1.656e^(-9)).In seven human brain regions related to motor development,we observed burden genes had higher expression before 37-week gestational age than postnatal stages.Functional analyses found that burden genes were enriched in embryonic brain development,with positive regulation of synaptic growth at the neuromuscular junction,positive regulation of deoxyribonucleic acid templated transcription,and response to hormone,and these genes were shown to be expressed in neural progenitors.Based on single cell sequencing analyses,we found TUBB2B gene had elevated expression levels in neural progenitor cells,interneuron,and excitatory neuron and SOX15 had high expression in interneuron and excitatory neuron.Conclusion:Idiopathic NDD patients with significant brain volume changes detected by MRI had an increased prevalence of motor development delay,which could be explained by the genetic differences characterized herein.展开更多
Objective:Interventions currently recommended to control and prevent obesity have not been successful.Recent research has shifted toward the transgenerational cycle of obesity.We assessed the association between fetal...Objective:Interventions currently recommended to control and prevent obesity have not been successful.Recent research has shifted toward the transgenerational cycle of obesity.We assessed the association between fetal macrosomia and early childhood body weight.Methods:We conducted a follow-back study to link birth certificate data to the Third National Health and Nutrition Examination Survey(1988–1994)of 2621 United States-born singletons aged 2–6 years.Birth weight and gestational age data were collected from birth certificates.Fetal macrosomia was defined as≥90th percentile of gestational age-race-sex-parity specific body weight distribution in 1989 vital statistics.Results:With 12.7%(standard error=0.85%)of participants born macrosomic,the prevalence of obesity and overweight(BMI percentiles≥85th in the CDC growth chart)among children was 17.8%(1.17%).When the body weight was measured against age-sex-specific height(BMI percentiles),macrosomia was significantly associated with overweight and obesity(odds ratio[OR]=1.64,95%confidence interval=1.07–2.50)adjusted for family income,maternal age and marital status,race,maternal smoking during pregnancy,and breastfeeding.The association became insignificant after adjusting for postnatal lifestyle and parental body mass index(OR=1.38[0.84-2.26]].When body weight was measured against age,children who were too heavy for their age were more likely to be born macrosomically(OR=2.64[1.66-4.22])than their peers with healthy age-specific body weight.Conclusion:Fetal macrosomia was significantly associated with a doubled risk of heavy body weight in children aged 2–6 years.展开更多
文摘Background: Accurate determination of gestational age has become important for deciding the appropriate time for termination of the pregnancy as well as to monitor the fetal growth during the entire period of pregnancy. Objective: The aim of the study was to assess whether the trans-cerebellar diameter, placental thickness or combining both of them is more accurate for assessment of gestational age in the 3<sup>rd</sup> trimester of pregnancy. Patients and Methods: This is a cross sectional study conducted at outpatient Clinic and Obstetric ward, Ain Shams University Maternity Hospital, over a period of six months from March 2019 to September 2019. One hundred pregnant women were recruited according to inclusion criteria either from outpatient clinic or were admitted in obstetric ward Ain Shams Maternity Hospital to find out the most accurate fetal biometric measurement in the third trimester either trans-cerebellar diameter placental thickness or both compared to reliable LMP (last menstrual period) dates confirmed by crown rump length (CRL) in the first trimester. Results: Trans-cerebellar diameter mean ± SD was 46.0 ± 3.5 with range 38.2 - 51.7. The mean of placental thickness was 39.6 ± 7.1 with range 22.8 - 54.3. Placental thickness had highest determination (0.813) for last menstrual period followed by trans-cerebellar diameter (0.802). Combining trans-cerebellar diameter and placental thickness increased determination (0.902) for last menstrual period. Conclusion: Combined use of trans-cerebellar diameter and placental thickness in the third trimester of pregnancy is a reliable indicator for gestational age in women whose last menstrual period is unreliable or unknown, but placental thickness had higher accuracy than trans-cerebellar diameter.
文摘<strong>Background:</strong><span style="font-family:Verdana;"> In routine ultrasonography</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> the ultrasonologist measures the</span><span style="font-family:Verdana;"> bi-parietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL) in estimating the gestational age (GA) and estimated date of delivery. However</span><span style="font-family:Verdana;">,</span><span style="font-family:""><span style="font-family:Verdana;"> as the pregnancy advances these parameters become increasingly unreliable in prediction of GA. Estimation of GA </span><span style="font-family:Verdana;">in late second and third trimester accurately still a problem till now. Fetal </span><span style="font-family:Verdana;">kidney has been shown a steady growth of 1.7 mm fortnightly (every 2 weeks) along pregnancy and is unaffected by growth abnormalities. Many studies have reported that fetal kidney length (FKL) correlates with the gestational age in late trimester very strong. The study aimed to assess the accuracy of the gestational age estimated by mean fetal kidney length compared to multiple growth parameters like BPD, HC, AC & FL in addition to the actual gestational age derived from the reliable last menstrual period.</span><b><span style="font-family:Verdana;"> Methods:</span></b><span style="font-family:Verdana;"> Cross sectional hospital based study</span></span><span style="font-family:Verdana;">, </span><span style="font-family:Verdana;">was conducted at ultrasound unit;department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University from the period of July 2018 to December 2018.</span><span style="font-family:""> </span><span style="font-family:Verdana;">A total number of 11</span><span style="font-family:Verdana;">5</span><span style="font-family:Verdana;"> Pregnant women at their third trimester by reliable LMP attended antenatal care clinic at Ain-Shams University Hospital and consented to participate in this study.</span><span style="font-family:""> </span><span style="font-family:Verdana;">Every woman was subjected to: Expected date of delivery was calculated according to Naegle’s formula: Ultrasonography:</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">Fetal biometry and estimated date of delivery (EDD) by assessment of BPD, HC, FL & AC. Expected fetal weight measured by </span><i><span style="font-family:Verdana;">Hadlock</span></i><span style="font-family:Verdana;"> <i>formula.</i></span><span style="font-family:Verdana;"> Fetal lie and presentation. Exclusion of fetal anomalies. Measurement of both right & left fetal kidney length. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> In this study</span></span><span style="font-family:Verdana;">,</span><span style="font-family:""><span style="font-family:Verdana;"> 255 participants were recruited and assessed for eligibility, 125 women were allocated to perform obstetric ultrasound just 115 completed and were included in the final analysis. The current study found that there was a highly significant positive correlation between gestational age </span><span style="font-family:Verdana;">(according to ultrasound parameters) and KL, BDP, HC, AC and FL but </span><span style="font-family:Verdana;">Kidney length was the most correlated parameter. Also this study found that there was significant positive correlation between gestational age (according to LMP) and gestational age estimated by BPD, HC, AC, FL and KL with the most significant positive correlation being with KL. Also this study found that </span><span style="font-family:Verdana;">there was no significant difference (matched) in KL and Gestational age</span><span style="font-family:Verdana;"> compared to other parameters. This means that KL is the most accurate parameter for Estimating Gestational age, correlation between MKL and GA by LMP (r =</span></span><span style="font-family:Verdana;"> 0</span><span style="font-family:Verdana;">.951, p</span><span style="font-family:""> </span><span style="font-family:Verdana;">= </span><span style="font-family:Verdana;">0.</span><span style="font-family:Verdana;">000) the most significant correlation.</span><span style="font-family:""> </span><span style="font-family:Verdana;">In this study</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> no significant difference was found between gestational age estimated by KL and gestational age in all stages of pregnancy. This means that KL remains accurate as a predictor for gestational age regardless stage of pregnancy.</span><span style="font-family:""> </span><b><span style="font-family:""><span style="font-family:Verdana;">Conclu</span><span style="font-family:Verdana;">sion: </span></span></b><span style="font-family:Verdana;">Kidney length can be used as an individual parameter in estimating</span><span style="font-family:Verdana;"> gestational age.</span>
文摘Background: Antenatal corticosteroid (ACS) treatment has been proven to decrease rates of adverse perinatal outcomes when administered to pregnant women at risk for preterm delivery. Given the uncertainty about the benefit of ACS according to gestational age, we aimed to examine whether there was any benefit of ACS on perinatal mortality and respiratory distress syndrome (RDS) according to different gestational ages at birth. Methods: Secondary analysis of data from an observational prospective chart review study was conducted in four hospitals located in the Mwanza region, Tanzania. The study population consisted of singleton infants delivered between 27 and 34 weeks of gestation between July 2019 and February 2020. Sociodemographic and medical data were recorded from participants’ medical records. Results: Over an eight-month period, 838 preterm singletons were delivered between 27 and 34 weeks of gestation. Three hundred and twelve (37.2%) pregnant women received at least one dose of ACS. Among infants exposed to ACS, perinatal mortality rates were significantly lower than those without exposure at the 27th week (27.8% vs 94.4%, P < 0.001), the 29th week (13.3% vs 51.4%, P = 0.012) and the 34th week (3.0% vs 18.2%, P < 0.001). Among infants exposed to ACS, the RDS rate was significantly lower than those without exposure only at the 32nd week (9.5% vs 25.0%, P = 0.039). Conclusion: Our findings add to the literature about the benefits of ACS for preterm infants of various gestational ages in low-resource settings. Compared to unexposed infants, those exposed to ACS and born at 27th and 34th weeks of gestation experienced lower rates of perinatal mortality. Future research, especially among infants born before the 27th week of pregnancy, is a priority.
文摘<strong>Background</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><strong>:</strong></span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> Conventional ultrasound dating is not very accurate after 34 weeks of gestation and has standard deviation of about 2 weeks. </span><b><span style="font-family:Verdana;">Objective</span></b></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">:</span></b></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> Verify whether fetal colon diameter can be used as a tool for estimating gestational age (GA) of fetuses between 34 to 40 weeks. </span><b><span style="font-family:Verdana;">Materials</span></b> <b><span style="font-family:Verdana;">and</span></b> <b><span style="font-family:Verdana;">Methods</span></b></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">:</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> This was a prospective cross</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">sectional study conducted at Obstetrics and Gynecology University Hospital, Damascus, Syria, during the period </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">from</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> September 2019-September 2020. The study enrolled 395 women with uncomplicated singleton pregnancies at 34 - 40 weeks of gestation. Fetal bi-parietal diameter, head circumference, abdominal circumference, and femoral lengths were assessed by ultrasound. In addition</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">,</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> descending colon diameter was assessed at the level of colonic haustra. The correlation between GA and colon diameter was assessed by the Pearson correlation test. </span><b><span style="font-family:Verdana;">Results</span></b></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">:</span></b></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> Significant correlation between fetal colon diameter and gestational age was observed P < 0.0001 (r = 0.852). In addition, a highly significant correlation between colon </span><span><span style="font-family:Verdana;">diameter and bi-parietal diameter, femoral length, head circumference and abdominal circumference were found with P values < 0.0001. The correlation between gestational age at 3</span><sup><span style="font-family:Verdana;">rd</span></sup><span style="font-family:Verdana;"> trimester and colon diameter was significantly stronger than the correlation between gestational age and bi-parietal diameter, head circumference, and abdominal circumference.</span></span></span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">Whereas, no significant difference was found when comparing colon diameter and femoral lengths (P = 0.089). </span><b><span style="font-family:Verdana;">Conclusion</span></b></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">:</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> The present study suggested that colon di</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">ameter can be used for predicting third trimester gestational age.</span></span></span>
基金Tianjin Key Medical Discipline(Specialty)Construction Project(No.TJYXZDXK-039A)
文摘Background:Antenatal corticosteroids(ACS)can significantly improve the outcomes of preterm infants.This study aimed to describe the ACS use rates among preterm infants admitted to Chinese neonatal intensive care units(NICU)and to explore perinatal factors associated with ACS use,using the largest contemporary cohort of very preterm infants in China.Methods:This cross-sectional study enrolled all infants born at 24^(+0)to 31^(+6)weeks and admitted to 57 NICUs of the Chinese Neonatal Network from January 1st,2019 to December 30th,2019.The ACS administration was defined as at least one dose of dexamethasone and betamethasone given before delivery.Multiple logistic regressions were applied to determine the association between perinatal factors and ACS usage.Results:A total of 7828 infants were enrolled,among which 6103(78.0%)infants received ACS.ACS use rates increased with increasing gestational age(GA),from 177/259(68.3%)at 24 to 25 weeks’gestation to 3120/3960(78.8%)at 30 to 31 weeks’gestation.Among infants exposed to ACS,2999 of 6103(49.1%)infants received a single complete course,and 33.4%(2039/6103)infants received a partial course.ACS use rates varied from 30.2%to 100%among different hospitals.Multivariate regression showed that increasing GA,born in hospital(inborn),increasing maternal age,maternal hypertension and premature rupture of membranes were associated with higher likelihood to receive ACS.Conclusions:The use rate of ACS remained low for infants at 24 to 31 weeks’gestation admitted to Chinese NICUs,with fewer infants receiving a complete course.The use rates varied significantly among different hospitals.Efforts are urgently needed to propose improvement measures and thus improve the usage of ACS.
基金a grant from the National Key Research and Development Program of China(No.2016YFC1000104).
文摘Background:Prenatal evaluation of fetal lung maturity(FLM)is a challenge,and an effective non-invasive method for prenatal assessment of FLM is needed.The study aimed to establish a normal fetal lung gestational age(GA)grading model based on deep learning(DL)algorithms,validate the effectiveness of the model,and explore the potential value of DL algorithms in assessing FLM.Methods:A total of 7013 ultrasound images obtained from 1023 normal pregnancies between 20 and 41+6 weeks were analyzed in this study.There were no pregnancy-related complications that affected fetal lung development,and all infants were born without neonatal respiratory diseases.The images were divided into three classes based on the gestational week:class I:20 to 29+6 weeks,class II:30 to 36+6 weeks,and class III:37 to 41+6 weeks.There were 3323,2142,and 1548 images in each class,respectively.First,we performed a pre-processing algorithm to remove irrelevant information from each image.Then,a convolutional neural network was designed to identify different categories of fetal lung ultrasound images.Finally,we used ten-fold cross-validation to validate the performance of our model.This new machine learning algorithm automatically extracted and classified lung ultrasound image information related to GA.This was used to establish a grading model.The performance of the grading model was assessed using accuracy,sensitivity,specificity,and receiver operating characteristic curves.Results:A normal fetal lung GA grading model was established and validated.The sensitivity of each class in the independent test set was 91.7%,69.8%,and 86.4%,respectively.The specificity of each class in the independent test set was 76.8%,90.0%,and 83.1%,respectively.The total accuracy was 83.8%.The area under the curve(AUC)of each class was 0.982,0.907,and 0.960,respectively.The micro-average AUC was 0.957,and the macro-average AUC was 0.949.Conclusions:The normal fetal lung GA grading model could accurately identify ultrasound images of the fetal lung at different GAs,which can be used to identify cases of abnormal lung development due to gestational diseases and evaluate lung maturity after antenatal corticosteroid therapy.The results indicate that DL algorithms can be used as a non-invasive method to predict FLM.
文摘Premature Rupture of Membranes (PROM) with the resulting prematurity remains a major public health issue in the Democratic Republic of Congo (DRC). This study aimed to assess expectant management of PPROM before 34 weeks at the university hospital of Kinshasa. We conducted a retrospective analysis of expectantly managed PROM before 34 weeks between January 2008 and December 2018. Maternal and fetal outcomes were collected, and all data were analyzed using the SPSS 23.0 software. Of the 113 patients included in the study, 2.6% were diagnosed with PROM before 34 weeks. We observed prolongation of the pregnancy duration;the median latency period was eight days, and the average gestational age at delivery of 32.85 ± 2.5 weeks. Chorioamnionitis (23%), severe oligoamnios (7%), and acute fetal distress (4%) were complications observed during the latency period. In the postpartum period, endometritis (6.2%), neonatal jaundice (39.8%), anemia (25.7%), ulcerative necrotizing enterocolitis (6.2%), cerebromeningeal hemorrhage (5.3%), and acute respiratory distress syndrome (4.4%) were complications observed. The risk of infection during the latency period was significantly associated with irregular (P = 0.045) or lack (P = 0.006) antenatal care (ANC) attendances and C-Reactive Protein (CRP) results 6 (P = 0.013). The risk of neonatal death was significantly associated to infection during the latency period (P = 0.011), irregular (P = 0.009) or lack of ANC (P = 0.000) attendances, Birth weight g (P = 0.039) as well as Gestational age at birth between 28 to 30 Weeks (S) (P = 0.021). These findings report first-time pregnancy outcomes related to the management of PPROM before 34 weeks in our setting. We found that the conservative attitude adopted allowed the prolongation of pregnancies, reducing the risks associated with prematurity. Nevertheless, attendance in good quality ANC could reduce the frequency of PROM and related adverse outcomes.
文摘Objective::This study aimed to determine:(1)whether recurrent deliveries of a small for gestational age(SGA)neonate are associated with increased obstetrical or neonatal complications;(2)whether the risk factors that can predict small for gestational age(SGA)recurrence.Methods::This study was based on Soroka Medical Center's Obstetrics electronic database.The database consisted of 109022 women who had 320932 deliveries between the year 1988-2014.The study cohort included 6.8%(7368/109022)of these patients who gave birth to a singleton SGA neonate on their first delivery and had more than one delivery.The study population was divided into two groups according to the outcome of the subsequent delivery:(1)women with sporadic SGA who delivered a non-SGA neonate(n=5416);(2)women with recurrent SGA(n=1952).SGA defined as birthweight<10 th percentile.Maternal and neonatal complications were compared between the two groups.Logistic regression was used to determine independent risk factors for SGA recurrence.Results::The prevalence of birthweight<5 th percentile was higher among the recurrent SGA group in the first delivery(P<0.001).Bedouin ethnicity was more prevalent in the recurrent SGA group(P<0.001).The rate of preterm delivery was higher in the first delivery of the recurrent SGA group(P=0.015).The sporadic SGA group had a higher rate of perinatal mortality during the first pregnancy(P=0.017).The rate of severe hypertension(P=0.005),polyhydramnios,meconium-stained amniotic fluid,nonreassuring fetal heart rate and total perinatal mortality(P<0.001)were higher in the second delivery of the recurrent SGA group.In a logistic regression model,preterm delivery and birthweight<5 th percentile at the first delivery was found to be independent risk factors for recurrence of an SGA neonate in the subsequent birth(relative risks:1.530,confidence interval:1.249-1.875;relative risks:1.826,confidence interval:1.641-2.030,respectively).Conclusion::Women with recurrent SGA neonates have specific clinical characteristics.Among women who deliver an SGA neonate,preterm delivery,and birthweight<5 th percentile are independent predictors for its recurrence.
基金Supported by Zhejiang Province Medical Science and Technology Foundation of China,No.2021PY057.
文摘BACKGROUND Umbilical cord milking(UCM)is an alternative placental transfusion method for delayed umbilical cord clamping in routine obstetric practice,allowing prompt resuscitation of an infant.Thus,UCM has been adopted at some tertiary neonatal centers for preterm infants to enhance placental-to-fetal transfusion.It is not suggested for babies less than 28 wk of gestational age because it is associated with severe brain hemorrhage.For late preterm or term infants who do not require resuscitation,cord management is recommended to increase iron levels and prevent the development of iron deficiency anemia,which is associated with impaired motor development,behavioral problems,and cognitive delays.Concerns remain about whether UCM increases the incidence of intraventricular hemorrhage.However,there are very few reports of late preterm infants presenting with neonatal hemorrhage stroke(NHS)and severe coagulopathy after receiving UCM.Here,we report a case of a late preterm infant born at 34 wk of gestation.She abruptly deteriorated,exhibiting signs and symptoms of NHS and severe coagulopathy after receiving UCM on the first day of life.CASE SUMMARY A female preterm infant born at 34 wk of gestation received UCM after birth.She was small for her gestational age and described as vigorous with Apgar scores of 9 and 10 at one minute and five minutes of life,respectively.After hospitalization in the neonatal intensive care unit,she showed hypoglycemia and metabolic acidosis.The baby was administered glucose and sodium bicarbonate infusions.Intramuscular vitamin K1 was also used to prevent vitamin K deficiency.The baby developed umbilical cord bleeding and gastric bleeding on day 1 of life;a physical examination showed bilateral conjunctival hemorrhage,and a blood test showed thrombocytopenia,prolonged prothrombin time,prolonged activated partial thromboplastin time,low fibrinogen,raised D-dimer levels and anemia.A subsequent cranial ultrasound and computed tomography scan showed a left parenchymal brain hemorrhage with extension into the ventricular and subarachnoid spaces.The patient was diagnosed with NHS in addition to disseminated intravascular coagulation(DIC).Fresh frozen plasma(FFP)and prothrombin complex concentrate were given for coagulopathy.Red blood cell and platelet transfusions were provided for thrombocytopenia and anemia.A bolus of midazolam,intravenous calcium and phenobarbital sodium were administered to control seizures.The baby’s clinical condition improved on day 5 of life,and the baby was hospitalized for 46 d and recovered well without seizure recurrence.Our case report suggests that preterm infants who receive UCM should undergo careful clinical assessment for intracranial hemorrhage,NHS and severe coagulopathy that may develop under certain circumstances.Supportive management,such as intensive care,FFP and blood transfusion,is recommended when the development of massive NHS and associated DIC is suspected.CONCLUSION Our case report suggests that for late preterm infants who are small for gestational age and who receive UCM for alternative placental transfusion,neonatal health care professionals should be cautious in assessing the development of NHS and severe coagulopathy.Neonatal health care professionals should also be more cautious in assessing the complications of late preterm infants after they receive UCM.
文摘The association between Leisure Time Physical Activity (LTPA) during pregnancy and foetal outcomes has been extensively investigated. However, epidemiological studies specifically referred to LPTA in the last months of pregnancy are scarce. We evaluated the association between LPTA and the risk of both preterm delivery and small for gestational age (SGA) during the last three months of pregnancy in Italy. A nationwide case-control study was performed in nine Italian cities. A total of 299 preterm delivery, 364 SGA and 855 controls were enrolled in the study. A self-administered questionnaire was used to assess socio-demographic variables, medical and reproductive history, life-style habits and LTPA referred to the last three months of pregnancy. Univariate and multivariate regression analyses were performed in order to estimate Odds ratios and 95% CI. LTPA during the last three months of pregnancy decreases the risk of preterm delivery (adjusted OR = 0.56;95% CI 0.39 - 0.79). Among the different types of physical activity, walking, the most frequently referred activity, appears significantly protective against preterm delivery (adjusted OR = 0.53;95% CI 0.36 - 0.81). Moreover, a small protective effect of walking was evidenced against SGA (adjusted OR = 0.72;95% CI 0.51 - 1.00). In conclusion, a mild physical activity such as walking in the last three months of pregnancy seems to reduce the risk of preterm delivery and, at a lesser extent, of SGA, confirming the beneficial effects of physical activity along the whole pregnancy.
文摘The objective of this study is to assess commonly used formulae (Sheppard, Campbell, Hadlock I, II, III, and IV) for estimation of fetal weight in Sudanese population. A descriptive cross-sectional study was conducted at Saudi Hospital-Khartoum-Sudan;from December 2015 to April 2016. The study included 225 singleton pregnancies. The fetal biometry—Biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL) and actual birth weights (ABW) were taken. Statistical analysis showed significant results at p ≤ 0.005. Results showed that the significant highest positive correlation between the ABW and the EFW/Kg was seen in the Hadlock I, III and IV equations having an equal values (0.951) followed by Hadlock II (0.946), Sheppard (0.872) and lastly Campbell (-0.925) with significant high degree of negative correlation. The new established equation EFW<sub>FLHCAC</sub> is the best formula identified in our study to predict Sudanese babies weight ranged between 1.86 Kg to 3.987 Kg.
基金National Natural Science Foundation of China(No.22006010)Shanghai Sailing Program,China(No.19YF1400500)。
文摘The epidemiological associations between the prenatal perfluoroalkyl substances(PFASs)exposure and the reproductive outcomes remain controversial.A continuous evaluation is needed to combine the inconsistent results.In this study,we explored the associations between PFASs exposure and the low birth weight(LBW),preterm birth and small for gestational age(SGA).The quality of selected literature,quantitative estimates,publication bias and subgroup analysis were performed on the basis of 17 retrieved articles published before December 2020.The results showed a significant positive association between the perfluorooctane sulfonate(PFOS)exposure and the risk of LBW[Odds ratio(OR)=1.17;95%confidence interval(CI):1.01,1.36;heterogeneity:P=0.30,I2=17%].The positive association was also observed between the PFOS and the risk of preterm birth(OR=1.19;95%CI:1.01,1.39,P=0.007;I2=62%).There was a paucity of evidence regarding the negative effects of perfluorooctanoic acid(PFOA),perfluorohexanesulfonic acid(PFHxS)and perfluorononanoic acid(PFNA)on the pregnancy outcomes.The findings from the subgroup analysis(the sampling period,the birth gender and biologic specimens)did not substantially altered the results of the overall pooled estimate ORs.The increased prevalence of negative birth outcomes with gestational PFASs exposure warrants further explorations from biological process perspective.
文摘Technological advances, a deeper understanding of disease processes and increased sophistication of therapeutic methods have all led to better outcomes in rare diseases which previously had devastating effects on many women’s lives. The inevitable result of this progress is that women, who in the past did not contemplate pregnancy because of significant morbidity, now get to adulthood and are reasonably “disease free” enough to have their own families. The ever expanding, but relatively new specialty of Obstetric medicine seeks to further improve the outcome in pregnant women with intercur</span><span style="font-family:"">r</span><span style="font-family:"">ent disease by enhancing the literature base, thereby contributing to the creation of appropriate guidance in the management of these patients. This article is a brief but useful guide for the busy obstetrician who may have limited experience in dealing with multiple sclerosis in pregnant women.
文摘Background: Many centers in Sudan use the reference data for fetal biometry. The recently published population-based reference either overestimated or underestimated the weight of the fetuses. Objective: To establish a national reference for fetal biometry, and weight by gestational age for singleton fetuses in Sudan. Methods: Data were collected on all singleton live births documented in the data collection sheet done at Saudi Hospital from 2015 to 2016 (n = 225). Gestational age estimation was based on the last menstrual period and fetal ultrasound thereafter. Fetal biometry and weight and other 6 fetal weight formulae were assessed. Reference data for fetal growth by gestational age were created. Results: New charts and reference equations are reported in Sudanese population for fetal biparietal diameter, head circumference, abdominal circumference and femur length and fetal weight. Conclusion: We advocate that these reference charts and equations for fetal biometry and weight might be valuable in the clinical use for appropriate ethnic Sudanese.
文摘<strong>Introduction</strong> <span style="font-family:""><span style="font-family:Verdana;">Accurate pregnancy dating is important for many aspects of </span><span style="font-family:Verdana;">obstetric care at individual level as well as population level. Traditionally</span></span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> pregnancy</span><span style="font-family:Verdana;"> dating has done by adding 9 months and 7 days to the last menstrual period (LMP) using Naegele’s formula. Determination of gestational age by ultrasound is more precise. Most commonly used parameters are mean sac diameter, gestation sac volume, crown</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">rump length (CRL), biparietal diameter (BPD), head circumference (HC) and femur length (FL). After 24 weeks</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> gestational age cannot be accurately determined by ultrasound scans. The biological variability of CRL is small and growth is very rapid. There are </span><span style="font-family:Verdana;">many factors</span><span style="font-family:"color:red;"> </span><span style="font-family:""><span style="font-family:Verdana;">that</span><span style="color:red;"> </span></span><span style="font-family:""><span style="font-family:Verdana;">can affect CRL such as measurement errors, differences in growth rates between individuals, fetal sex and maternal conditions such as diabetes </span><span style="font-family:Verdana;">mellitus. A correctly performed measurement of CRL is the most accurate way</span><span style="font-family:Verdana;"> of estimating the gestational age in early pregnancy from 8 weeks to 13 weeks + 6 days. </span><b><span style="font-family:Verdana;">Objectives </span></b><span style="font-family:Verdana;">Our study aims were to prepare a new Crown Rump Length chart with Sri Lankan population data and to compare </span><span><span style="font-family:Verdana;">new CRL chart with existing intergrowth CRL chart.</span><b><span style="font-family:Verdana;"> Method </span></b><span style="font-family:Verdana;">Prospective observationa</span></span><span style="font-family:Verdana;">l study with recruitment of subjects by Quota sampling technique was carried out from April 2015 to March 2016. Spontaneously conceived uncomplicated singleton pregnancies with normal Body Mass Index (BMI) 18.5 - 23 kg/m</span><sup><span style="font-family:Verdana;">2</span></sup><span style="font-family:Verdana;"> were recruited at the time of registration to antenatal care. Consenting woman with known LMP with regular cycles in preceding 3 months were undergone ultrasound examination only once at gestational age (GA) ranging from 8 weeks to 13 weeks + 6 days. If ultrasound dating w</span></span><span style="font-family:Verdana;">as</span><span style="font-family:Verdana;"> different from LMP dating by more than 5 days in pregnancies with POA less than 9 weeks and dating difference</span><span style="font-family:Verdana;">s</span><span style="font-family:Verdana;"> more than 7 days in pregnancies between 9 weeks and 14 weeks w</span><span style="font-family:Verdana;">ere</span><span style="font-family:""><span style="font-family:Verdana;"> excluded. Pregnancies complicated with uncertain viability, congenital anomalies and spontaneous miscarriage were excluded from statistical analysis. Data collection done with pre-tested interviewer administered form and analysis was carried out using the Statistical Package for Social Sciences (SPSS) version 21. </span><b><span style="font-family:Verdana;">Results </span></b><span style="font-family:Verdana;">A total of 653 subjects were recruited for the study and 557 turned up for ultrasound dating assessment. Dating discrepancy and multiple pregnancies excluded 31 subjects, uncertain viability and spontaneous miscarriage excluded 15 subjects resulting 511 subjects for final statistical analysis. The mean CRL increased with GA almost linearly from day 56 to 97. </span><b><span style="font-family:Verdana;">Conclusions </span></b><span style="font-family:Verdana;">We have produced new CRL chart based on Sri Lankan data and it can be used for clinical practice in Sri Lanka. There is no statistically significant difference between our CRL chart and intergrowth CRL chart.</span></span>
基金Research Funds in Region Skane Funds at the University Hospital in Lund ALF-founding, Lund Uni- versity
文摘Aims:?The aim of this study was to explore the outcome of previous pregnancies in women who later developed diabetes. Method: A Swedish population based cohort of 23,524 women from 1990 aged 45 - 85 yr in 2000 when they self reported health status in a questionnaire. To identify which women who delivered we matched it towards the Swedish Medical Birth Register (SMBR). We identified 14,856 women who appeared in both registers and a total of 30,559 new birth registrations. Among these women 216 had developed diabetes after their pregnancy (ies) and additional twelve women were reported to have gestational diabetes in SMBR. These 228 women and their 455 pregnancies were compared with women without diabetes. Results: Women who developed diabetes later in life were already heavier before the pregnancy (ies) (69.2 ± 13.9 vs. 63.2 ± 10.3 kg;p < 0.001) but had less weight gain during pregnancy (13.3 ± 5.4 vs. 14.1 ± 4.6 kg;p = 0.03) compared to women without diabetes. Newborns to women with diabetes diagnosed any time after pregnancy had higher birth weight (3602 vs. 3507 g;p < 0.001), were more often large for gestational age (10.5% vs. 3.1%;p < 0.001), were more often delivered by caesarean section (4.8% vs. 2.7%;p = 0.005) and had lower Apgar scores. Conclusion: Women who developed diabetes after pregnancy had hyperglycaemia-associated complications during their pregnancy (ies). We therefore postulated that women with Type 2 diabetes are mainly recruited from women with earlier GDM. A general screening for GDM should identify these women and enable life style intervention that may prevent or at least delay diabetes.
文摘Objective: To investigate the incidence of retinopathy of prematurity (ROP), analyze the risk factors of ROP, and put forward effective screening strategies, to reduce its incidence. Background: Retinopathy of prematurity (ROP) is an eye disease that can happen in new born premature (born early) babies or have weigh less than 3 pounds at birth. ROP happens when abnormal blood vessels grow in the retina. There are multiple risk factors, which are causing the ROP. In our study we will analyses the risk factors of ROP. Methods: From February 2016 to August 2021, 190 premature infants in the neonatal intensive care unit (NICU) who received inpatient care and ophthalmic screening was selected as study subjects. ROP group (n = 32) and non-ROP group (n = 158) were selected, and the clinical data of the two groups were compared. Including oxygen concentration, mechanical ventilation, broncho pulmonic dysplasia, delivery mode (cesarean section, vaginal delivery), blood transfusion, anemia, gestational diabetes, gestational hypertension, fetal distress, preterm birth weight, gestation age, etc. Women were divided into two groups according to whether they had gestational diabetes mellitus (GDM) or not: gestational diabetic (n = 38) and non-gestational diabetics (n = 152). Age, pregnancy times, birth times, oxygen inhalation, birth weight, and gestational age were compared between the two groups. The X<sup>2</sup> test for counting data and the t-test for measuring data are then conducted according to the distribution characteristics of the data, The correlation analysis between ROP and a single risk factor was performed by chi-square test, and the analysis of the correlation between many risk factors and ROP was conducted by Logistic regression analysis. Results: 1) The incidence of ROP in the GDM group was higher than that in the non-GDM group (P P > 0.05). 3) Univariate analysis showed that oxygen use, birth weight, gestational age, bronchopulmonary dysplasia, pregnancy-induced hypertension, and fetal distress in the ROP group and non-ROP group were statistically significant (P P > 0.05). 4) Logistic multivariate analysis showed that oxygen use, gestational hypertension, diabetes mellitus during pregnancy, fetal distress, bronchopulmonary dysplasia, birth weight, and gestational age were the main risk factors for ROP. Conclusion: 1) Gestational diabetes mellitus is a high-risk factor for ROP. 2) Oxygen inhalation, birth weight, and gestational age are related to the occurrence and development of ROP. 3) In determining the initial screening time for ROP.
基金This work was supported by the Special Fund for the National Key Research and Development Plan Grant(2017YFC1001300)the International Cooperation Project of China and Canada NSFC(81661128010)+2 种基金the Major Program of National Natural Science Foundation of China(81490742)the Natural Science Foundation of China(31571556)Innovative research team of high-level local universities in Shanghai,and Shanghai Municipal Key Clinical Speciality,Shanghai,China.
文摘Background Previous studies investigated the association between gestational anemia and neonatal outcomes.However,few studies explored whether the effects of gestational anemia could be eliminated by subsequent correction of anemia in the later stages of pregnancy.This study aimed to investigate the relationship between anemia in different trimesters and neonatal outcomes.Methods The study was conducted in Shanghai,China,with a sample of 46,578 pregnant women who delivered between January 1,2016 and July 1,2019.A multivariable logistic regression model was adopted to analyse the associations between maternal anemia and neonatal outcomes.Results The incidence of gestational anemia was 30.2%,including 4.4%in the first trimester,9.6%in the second trimester,and 16.2%in the third trimester.Only 24.5%(507/2066)of anemia that occurred in the first trimester and 29.6%(1320/4457)that occurred in the second trimester could be corrected in the later stages of pregnancy.Anemia occurring in the first trimester was associated with small for gestational age[odds ratio(OR)1.46;95%confidence interval(CI)1.20-1.78]and with fetal distress(OR 1.23;95%CI 1.08-1.40).Anemia corrected in the first trimester also was associated with a higher risk of small for gestational age.Conclusions Gestational anemia is a public health problem in China impacting neonatal health.Anemia in pregnancy could be corrected in only about a quarter of the women.Anemia in the first trimester,whether corrected or not,still led to lower birth weight;therefore,the prevention of anemia prior to pregnancy is important.
基金grants from the Science and Technology Commission of Shanghai Municipal(No.19411964400)Shanghai Municipal Science and Technology Major Project(No.2018SHZDZX01)ZJLab.
文摘Background:Significant brain volume deviation is an essential phenotype in children with neurodevelopmental delay(NDD),but its genetic basis has not been fully characterized.This study attempted to analyze the genetic factors associated with significant whole-brain deviation volume(WBDV).Methods:We established a reference curve based on 4222 subjects ranging in age from the first postnatal day to 18 years.We recruited only NDD patients without acquired etiologies or positive genetic results.Cranial magnetic resonance imaging(MRI)and clinical exome sequencing(2742 genes)data were acquired.A genetic burden test was performed,and the results were compared between patients with and without significant WBDV.Literature review analyses and BrainSpan analysis based on the human brain developmental transcriptome were performed to detect the potential role of genetic risk factors in human brain development.Results:We recruited a total of 253 NDD patients.Among them,26 had significantly decreased WBDV(<-2 standard deviations[SDs]),and 14 had significantly increased WBDV(>+2 SDs).NDD patients with significant WBDV had higher rates of motor development delay(49.8%[106/213]vs.75.0%[30/40],P=0.003)than patients without significant WBDV.Genetic burden analyses found 30 genes with an increased allele frequency of rare variants in patients with significant WBDV.Analyses of the literature further demonstrated that these genes were not randomly identified:burden genes were more related to the brain development than background genes(P=1.656e^(-9)).In seven human brain regions related to motor development,we observed burden genes had higher expression before 37-week gestational age than postnatal stages.Functional analyses found that burden genes were enriched in embryonic brain development,with positive regulation of synaptic growth at the neuromuscular junction,positive regulation of deoxyribonucleic acid templated transcription,and response to hormone,and these genes were shown to be expressed in neural progenitors.Based on single cell sequencing analyses,we found TUBB2B gene had elevated expression levels in neural progenitor cells,interneuron,and excitatory neuron and SOX15 had high expression in interneuron and excitatory neuron.Conclusion:Idiopathic NDD patients with significant brain volume changes detected by MRI had an increased prevalence of motor development delay,which could be explained by the genetic differences characterized herein.
文摘Objective:Interventions currently recommended to control and prevent obesity have not been successful.Recent research has shifted toward the transgenerational cycle of obesity.We assessed the association between fetal macrosomia and early childhood body weight.Methods:We conducted a follow-back study to link birth certificate data to the Third National Health and Nutrition Examination Survey(1988–1994)of 2621 United States-born singletons aged 2–6 years.Birth weight and gestational age data were collected from birth certificates.Fetal macrosomia was defined as≥90th percentile of gestational age-race-sex-parity specific body weight distribution in 1989 vital statistics.Results:With 12.7%(standard error=0.85%)of participants born macrosomic,the prevalence of obesity and overweight(BMI percentiles≥85th in the CDC growth chart)among children was 17.8%(1.17%).When the body weight was measured against age-sex-specific height(BMI percentiles),macrosomia was significantly associated with overweight and obesity(odds ratio[OR]=1.64,95%confidence interval=1.07–2.50)adjusted for family income,maternal age and marital status,race,maternal smoking during pregnancy,and breastfeeding.The association became insignificant after adjusting for postnatal lifestyle and parental body mass index(OR=1.38[0.84-2.26]].When body weight was measured against age,children who were too heavy for their age were more likely to be born macrosomically(OR=2.64[1.66-4.22])than their peers with healthy age-specific body weight.Conclusion:Fetal macrosomia was significantly associated with a doubled risk of heavy body weight in children aged 2–6 years.
