This study aimed to compare the complications of preterm twins versus singletons and analyze differences across gestational ages.Preterm twins delivered between 2 March 2022 and 6 November 2022 were compared to an age...This study aimed to compare the complications of preterm twins versus singletons and analyze differences across gestational ages.Preterm twins delivered between 2 March 2022 and 6 November 2022 were compared to an age-matched control group of singletons,involving 65 twins and 103 singletons.The most common complication in premature infants was neonatal jaundice(87.72%),followed by patent foramen ovale(79.76%)and neonatal respiratory distress syndrome(NRDS)(57.14%).Twins had significantly higher Apgar scores at 1,5,and 10 minutes compared to singletons.However,twins showed a higher incidence of ventricular septal defect(VSD)(7.69%)than singletons,with a statistically significant difference.In contrast,twins exhibited significantly lower rates of neonatal jaundice(78.46%),electrolyte imbalance(18.4%),and acid-base imbalance(9.23%)compared to singletons.Furthermore,as gestational age increased,the incidence of intrauterine infection,electrolyte and acid-base imbalances,neonatal coagulation disorders,patent ductus arteriosus(PDA),anemia,and NRDS in preterm infants gradually decreased,with all differences reaching statistical significance(P<0.05).These findings highlight the importance of close monitoring and timely management of complications in premature infants to prevent severe outcomes.展开更多
Background:With an increasing proportion of multiparas,proper interpregnancy intervals(IPIs)are urgently needed.However,the association between IPIs and adverse perinatal outcomes has always been debated.This study ai...Background:With an increasing proportion of multiparas,proper interpregnancy intervals(IPIs)are urgently needed.However,the association between IPIs and adverse perinatal outcomes has always been debated.This study aimed to explore the association between IPIs and adverse outcomes in different fertility policy periods and for different previous gestational ages.Methods:We used individual data from China’s National Maternal Near Miss Surveillance System between 2014 and 2019.Multivariable Poisson models with restricted cubic splines were used.Each adverse outcome was analyzed separately in the overall model and stratified models.The stratified models included different categories of fertility policy periods(2014-2015,2016-2017,and 2018-2019)and infant gestational age in previous pregnancy(<28 weeks,28-36 weeks,and≥37 weeks).Results:There were 781,731 pregnancies enrolled in this study.A short IPI(≤6 months)was associated with an increased risk of preterm birth(OR[95%CI]:1.63[1.55,1.71]for vaginal delivery[VD]and 1.10[1.03,1.19]for cesarean section[CS]),low Apgar scores and small for gestational age(SGA),and a decreased risk of diabetes mellitus in pregnancy,preeclampsia or eclampsia,and gestational hypertension.A long IPI(≥60 months)was associated with an increased risk of preterm birth(OR[95%CI]:1.18[1.11,1.26]for VD and 1.39[1.32,1.47]for CS),placenta previa,postpartum hemorrhage,diabetes mellitus in pregnancy,preeclampsia or eclampsia,and gestational hypertension.Fertility policy changes had little effect on the association of IPIs and adverse maternal and neonatal outcomes.The estimated risk of preterm birth,low Apgar scores,SGA,diabetes mellitus in pregnancy,and gestational hypertension was more profound among women with previous term births than among those with preterm births or pregnancy loss.Conclusion:For pregnant women with shorter or longer IPIs,more targeted health care measures during pregnancy should be formulated according to infant gestational age in previous pregnancy.展开更多
Objective:To explore the correlation between fetal foot length measured by ultrasound and gestational age.Methods:This study employed ultrasound to measure the fetal foot length,femoral length,and foot length/femoral ...Objective:To explore the correlation between fetal foot length measured by ultrasound and gestational age.Methods:This study employed ultrasound to measure the fetal foot length,femoral length,and foot length/femoral length ratio in 214 pregnant women from 12 to 40 weeks of gestation,all of whom had no pregnancy complications or obstetric complications,and whose fetuses were normal.Results:A significant positive correlation was found between fetal foot length and gestational age(r=0.967,p<0.001);a similarly significant positive correlation was observed between fetal femoral length and gestational age(r=0.972,p<0.001);and a non-significant positive correlation was noted between the foot length/femoral length ratio and gestational age(r=0.943,p<0.001).Conclusion:Ultrasound can accurately measure fetal foot length and femoral length,both of which exhibit a significant positive correlation with gestational age,making them important reference indicators for assessing fetal growth and development.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
Being born with nonoptimal birth characteristics decreases the chance of becoming a father. Urogenital malformations as well as metabolic syndrome are more common in men born small for gestational age （SGA） and coul...Being born with nonoptimal birth characteristics decreases the chance of becoming a father. Urogenital malformations as well as metabolic syndrome are more common in men born small for gestational age （SGA） and could be contributing factors to the reduced fertility rate seen in these men. It could imply that men becoming fathers by assisted reproductive technology （ART） more often are born with low birth weight （LBW）, preterm, and/or SGA than men conceiving without treatment and also that men where intracytoplasmic sperm injection （ICSI） had to be performed more often are born with nonoptimal birth characteristics than men where conventional in vitro fertilization （IVF） successfully could be used. In this retrospective, case-control study using Swedish national registers, we compared the birth characteristics of 1206 men who have become fathers by ART with a control group consisting of age-matched men who became fathers without treatment. The differences in birth characteristics between men becoming fathers by IVF and ICSI were also assessed. For men becoming fathers by ART, OR of being born with LBW was 1.66 （95% CI = 1.17-2.36） compared with fathers who conceived without treatment. OR of being born prematurely was 1.32 （95% CI = 1.00-1.77）. Men becoming fathers via ICSI had a doubled increased likelihood of being born SGA compared with men who became fathers via IVF （OR = 2.12; 95% CI = 1.17-3.83）. In conclusion, we have found that men becoming fathers by ICSI treatments had more often been born SGA than men becoming fathers by conventional IVF.展开更多
In the present research,we describe a computer-aided detection(CAD)method aimed at automatic fetal head circumference(HC)measurement in 2D ultrasonography pictures during all trimesters of pregnancy.The HC might be ut...In the present research,we describe a computer-aided detection(CAD)method aimed at automatic fetal head circumference(HC)measurement in 2D ultrasonography pictures during all trimesters of pregnancy.The HC might be utilized toward determining gestational age and tracking fetal development.This automated approach is particularly valuable in low-resource settings where access to trained sonographers is limited.The CAD system is divided into two steps:to begin,Haar-like characteristics were extracted from ultrasound pictures in order to train a classifier using random forests to find the fetal skull.We identified the HC using dynamic programming,an elliptical fit,and a Hough transform.The computer-aided detection(CAD)program was well-trained on 999 pictures(HC18 challenge data source),and then verified on 335 photos from all trimesters in an independent test set.A skilled sonographer and an expert in medicine personally marked the test set.We used the crown-rump length(CRL)measurement to calculate the reference gestational age(GA).In the first,second,and third trimesters,the median difference between the standard GA and the GA calculated by the skilled sonographer stayed at 0.7±2.7,0.0±4.5,and 2.0±12.0 days,respectively.The regular duration variance between the baseline GA and the health investigator’s GA remained 1.5±3.0,1.9±5.0,and 4.0±14 a couple of days.The mean variance between the standard GA and the CAD system’s GA remained between 0.5 and 5.0,with an additional variation of 2.9 to 12.5 days.The outcomes reveal that the computer-aided detection(CAD)program outperforms an expert sonographer.When paired with the classifications reported in the literature,the provided system achieves results that are comparable or even better.We have assessed and scheduled this computerized approach for HC evaluation,which includes information from all trimesters of gestation.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
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
<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: 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
BACKGROUND Few studies have investigated the association between gestational age,birth weight,and esophageal cancer risk;however,causality remains debated.We aimed to establish causal links between genetic gestational...BACKGROUND Few studies have investigated the association between gestational age,birth weight,and esophageal cancer risk;however,causality remains debated.We aimed to establish causal links between genetic gestational age and birth weight traits and gastroesophageal reflux disease(GERD),Barrett’s esophagus(BE),and esophageal adenocarcinoma(EA).Additionally,we explored if known risk factors mediate these links.AIM To analyze of the relationship between gestational age,birth weight and GERD,BE,and EA.METHODS Genetic data on gestational age and birth weight(n=84689 and 143677)from the Early Growth Genetics Consortium and outcomes for GERD(n=467253),BE(n=56429),and EA(n=21271)from genome-wide association study served as instrumental variables.Mendelian randomization(MR)and mediation analyses were conducted using MR-Egger,weighted median,and inverse variance weighted methods.Robustness was ensured through heterogeneity,pleiotropy tests,and sensitivity analyses.RESULTS Birth weight was negatively correlated with GERD and BE risk[odds ratio(OR)=0.78;95%confidence interval(CI):0.69-0.8]and(OR=0.75;95%CI:0.60-0.9),respectively,with no significant association with EA.No causal link was found between gestational age and outcomes.Birth weight was positively correlated with five risk factors:Educational attainment(OR=1.15;95%CI:1.01-1.31),body mass index(OR=1.06;95%CI:1.02-1.1),height(OR=1.12;95%CI:1.06-1.19),weight(OR=1.13;95%CI:1.10-1.1),and alcoholic drinks per week(OR=1.03;95%CI:1.00-1.06).Mediation analysis showed educational attainment and height mediated the birth weight-BE link by 13.99%and 5.46%.CONCLUSION Our study supports the protective role of genetically predicted birth weight against GERD,BE,and EA,independent of gestational age and partially mediated by educational attainment and height.展开更多
AIM To investigate the effect of disease activity or thiopurine use on low birth weight and small for gestational age in women with inflammatory bowel disease(IBD).METHODS Selection criteria included all relevant arti...AIM To investigate the effect of disease activity or thiopurine use on low birth weight and small for gestational age in women with inflammatory bowel disease(IBD).METHODS Selection criteria included all relevant articles on the effect of disease activity or thiopurine use on the risk of low birth weight(LBW) or small for gestational age(SGA) among pregnant women with IBD. Sixtynine abstracts were identified,35 papers were full text reviewed and,only 14 of them met inclusion criteria. Raw data were extracted to generate the relative risk of LBW or SGA. Quality was assessed using the Newcastle Ottawa Scale.RESULTS This meta-analysis is reported according to PRISMA guidelines. Fourteen studies met inclusion criteria,and nine reported raw data suitable for meta-analysis. We found an increased risk ratio of both SGA and LBW in women with active IBD,when compared with women in remission: 1.3 for SGA(4 studies,95%CI: 1.0-1.6,P = 0.04) and 2.0 for LBW(4 studies,95%CI: 1.5-2.7,P < 0.0001). Women on thiopurines during pregnancy had a higher risk of LBW(RR 1.4,95%CI: 1.1-1.9,P = 0.007) compared with non-treated women,but when adjusted for disease activity there was no significant effect on LBW(RR 1.2,95%CI: 0.6-2.2,P = 0.6). No differences were observed regarding SGA(2 studies; RR 0.9,95%CI: 0.7-1.2,P = 0.5). CONCLUSION Women with active IBD during pregnancy have a higher risk of LBW and SGA in their neonates. This should be considered in treatment decisions during pregnancy.展开更多
Objective To examine the effect of periconceptional multi‐micronutrient supplementation on gestation and birth outcomes.Methods A population‐based community intervention program was conducted in 18 counties in China...Objective To examine the effect of periconceptional multi‐micronutrient supplementation on gestation and birth outcomes.Methods A population‐based community intervention program was conducted in 18 counties in China.Participants were divided into an intervention group,who received multi‐micronutrient supplementation from at least 3 months before pregnancy throughout the first trimester,and a control group.Pregnant women were followed up to record information about birth outcomes.Maternal socio‐economic characteristics and main birth outcomes were evaluated.Gestational age was further analyzed using survival analysis,to determine the time distribution of delivery.Results Periconceptional multi‐micronutrient supplementation was associated with higher birth weight,birth length and occipitofrontal head circumference,and with lower incidence rates for stillbirth,low birth weight,and preterm birth.Moreover,periconceptional multi‐micronutrient supplementation changed the time distribution of delivery,making the deliveries more clustered in the period between day 275 and day 295 of gestation.Conclusion Our study shows that periconceptional multi‐micronutrient supplementation is beneficial for fetal development and optimizes all measured aspects of health in neonates in socioeconomically disadvantaged areas in China.The change in time distribution of deliveries caused by multi‐micronutrient supplementation needs further clarification.展开更多
· AIM: As a result of the increase in premature births and the advances in neonatal intensive care, retinopathy of prematurity (ROP) remains one of the most important causes of childhood blindness worldwide. The ...· AIM: As a result of the increase in premature births and the advances in neonatal intensive care, retinopathy of prematurity (ROP) remains one of the most important causes of childhood blindness worldwide. The main factors in the development of ROP are gestational age, birth weight and oxygen therapy. ROP continues to gain importance due to the increasing survival rates of more immature babies. · METHODS: Between January 2007 and October 2008, 203 premature infants treated at the Neonatal Intensive Care Unit (NNICU) were prospectively enrolled and the relationship between known risk factors and the occurance of ROP was studied. · RESULTS: ROP in various stages developed in 86 cases (42.4%). Statistically significant correlations were found between the development of ROP and birth weight (P < 0.0001) gestational age (P <0.0001), oxygen treatment and its duration (P <0.0001 and P =0.002), mechanical ventilation (MV) and its duration (P =0,0001 and P =0.0001), apnea(P = 0.001), intraventricular hemorrhage (IVH) (P =0.046), sepsis (P =0.0001), use of erythropoietin (EPO) (P =0.003), the number of blood transfusions and frequency (P =0.0001 and P =0.0001), surfactant application (P =0.0001), the presence of patent ductus arteriosus (PDA) (P =0.001) or bronchopu- lmonary dysplasia (BPD) (P =0.0001). No significant correlations were found between the occurance of ROP and maternal pre-eclampsia (P =0.293), multiple pregnancy (P = 0.218), or hyperbilirubinemia (P =0.494). Severity of ROP was related significantly with birth weight (P =0.0001), but no significant correlation between severity of ROP and gestational age was present. · CONCLUSION: Early description and reduction of the risk factors related with the occurance of ROP with the help of routine screening programs may warrant the prevention of visual loss, however early ophthalmic diagnosis and treatment are still mandatory to provide better visual rehabilitation. ·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
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 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: Prematurity is the leading cause of neonatal mortality. Most preterm births can be associated to an identifiable risk factor. In Cameroon, especially in the Southwest Region, there is limited data regardin...Background: Prematurity is the leading cause of neonatal mortality. Most preterm births can be associated to an identifiable risk factor. In Cameroon, especially in the Southwest Region, there is limited data regarding prematurity associated risk factors. The aim of this study was to evaluate the risk factors and complications of prematurity in two health facilities in the Fako division, the BRH and RHL. Methods: A hospital based retrospective case control study was done from the 1<sup>st</sup> of January 2021 to 28<sup>th</sup> of February 2022. We assessed the gestational ages at which preterm birth occurred and their short-term outcome using a structured pretested questionnaire to collect data from files. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 26. Results: The minimum sample size was 137 preterms. 45.5% of cases were born between 34 and increased the risk of having a preterm birth meanwhile being married (AOR: 0.410;95% CI: 0.217 - 0.773;p = 0.006) decreased the risk. Hospital complications were neonatal infection 103 (51.5%), respiratory distress 79 (39.5%) and neonatal jaundice 61 (30.50%). Among the cases, 97 (48.50%) stayed in the hospital for 2 to 4 weeks and 177 (88.5%) were discharged alive. Conclusions: Modifiable factors that increased the risk of prematurity were advanced maternal age, secondary level of education, rural residence, and prenatal alcohol consumption. Being married decreased the risk. The most common hospital complications in both the cases and controls were neonatal infection, respiratory distress syndrome and neonatal jaundice.展开更多
文摘This study aimed to compare the complications of preterm twins versus singletons and analyze differences across gestational ages.Preterm twins delivered between 2 March 2022 and 6 November 2022 were compared to an age-matched control group of singletons,involving 65 twins and 103 singletons.The most common complication in premature infants was neonatal jaundice(87.72%),followed by patent foramen ovale(79.76%)and neonatal respiratory distress syndrome(NRDS)(57.14%).Twins had significantly higher Apgar scores at 1,5,and 10 minutes compared to singletons.However,twins showed a higher incidence of ventricular septal defect(VSD)(7.69%)than singletons,with a statistically significant difference.In contrast,twins exhibited significantly lower rates of neonatal jaundice(78.46%),electrolyte imbalance(18.4%),and acid-base imbalance(9.23%)compared to singletons.Furthermore,as gestational age increased,the incidence of intrauterine infection,electrolyte and acid-base imbalances,neonatal coagulation disorders,patent ductus arteriosus(PDA),anemia,and NRDS in preterm infants gradually decreased,with all differences reaching statistical significance(P<0.05).These findings highlight the importance of close monitoring and timely management of complications in premature infants to prevent severe outcomes.
基金supported by grants from the National Key Research and Development Program of China(Nos.2022YFC2704600,2022YFC2704605,2019YFC1005100)National Health Commission of the People’s Republic of China,the China Medical Board(No.11-065)+1 种基金WHO(No.CHN-12-MCN-004888)UNICEF(No.2016EJH016)
文摘Background:With an increasing proportion of multiparas,proper interpregnancy intervals(IPIs)are urgently needed.However,the association between IPIs and adverse perinatal outcomes has always been debated.This study aimed to explore the association between IPIs and adverse outcomes in different fertility policy periods and for different previous gestational ages.Methods:We used individual data from China’s National Maternal Near Miss Surveillance System between 2014 and 2019.Multivariable Poisson models with restricted cubic splines were used.Each adverse outcome was analyzed separately in the overall model and stratified models.The stratified models included different categories of fertility policy periods(2014-2015,2016-2017,and 2018-2019)and infant gestational age in previous pregnancy(<28 weeks,28-36 weeks,and≥37 weeks).Results:There were 781,731 pregnancies enrolled in this study.A short IPI(≤6 months)was associated with an increased risk of preterm birth(OR[95%CI]:1.63[1.55,1.71]for vaginal delivery[VD]and 1.10[1.03,1.19]for cesarean section[CS]),low Apgar scores and small for gestational age(SGA),and a decreased risk of diabetes mellitus in pregnancy,preeclampsia or eclampsia,and gestational hypertension.A long IPI(≥60 months)was associated with an increased risk of preterm birth(OR[95%CI]:1.18[1.11,1.26]for VD and 1.39[1.32,1.47]for CS),placenta previa,postpartum hemorrhage,diabetes mellitus in pregnancy,preeclampsia or eclampsia,and gestational hypertension.Fertility policy changes had little effect on the association of IPIs and adverse maternal and neonatal outcomes.The estimated risk of preterm birth,low Apgar scores,SGA,diabetes mellitus in pregnancy,and gestational hypertension was more profound among women with previous term births than among those with preterm births or pregnancy loss.Conclusion:For pregnant women with shorter or longer IPIs,more targeted health care measures during pregnancy should be formulated according to infant gestational age in previous pregnancy.
文摘Objective:To explore the correlation between fetal foot length measured by ultrasound and gestational age.Methods:This study employed ultrasound to measure the fetal foot length,femoral length,and foot length/femoral length ratio in 214 pregnant women from 12 to 40 weeks of gestation,all of whom had no pregnancy complications or obstetric complications,and whose fetuses were normal.Results:A significant positive correlation was found between fetal foot length and gestational age(r=0.967,p<0.001);a similarly significant positive correlation was observed between fetal femoral length and gestational age(r=0.972,p<0.001);and a non-significant positive correlation was noted between the foot length/femoral length ratio and gestational age(r=0.943,p<0.001).Conclusion:Ultrasound can accurately measure fetal foot length and femoral length,both of which exhibit a significant positive correlation with gestational age,making them important reference indicators for assessing fetal growth and development.
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Being born with nonoptimal birth characteristics decreases the chance of becoming a father. Urogenital malformations as well as metabolic syndrome are more common in men born small for gestational age （SGA） and could be contributing factors to the reduced fertility rate seen in these men. It could imply that men becoming fathers by assisted reproductive technology （ART） more often are born with low birth weight （LBW）, preterm, and/or SGA than men conceiving without treatment and also that men where intracytoplasmic sperm injection （ICSI） had to be performed more often are born with nonoptimal birth characteristics than men where conventional in vitro fertilization （IVF） successfully could be used. In this retrospective, case-control study using Swedish national registers, we compared the birth characteristics of 1206 men who have become fathers by ART with a control group consisting of age-matched men who became fathers without treatment. The differences in birth characteristics between men becoming fathers by IVF and ICSI were also assessed. For men becoming fathers by ART, OR of being born with LBW was 1.66 （95% CI = 1.17-2.36） compared with fathers who conceived without treatment. OR of being born prematurely was 1.32 （95% CI = 1.00-1.77）. Men becoming fathers via ICSI had a doubled increased likelihood of being born SGA compared with men who became fathers via IVF （OR = 2.12; 95% CI = 1.17-3.83）. In conclusion, we have found that men becoming fathers by ICSI treatments had more often been born SGA than men becoming fathers by conventional IVF.
文摘In the present research,we describe a computer-aided detection(CAD)method aimed at automatic fetal head circumference(HC)measurement in 2D ultrasonography pictures during all trimesters of pregnancy.The HC might be utilized toward determining gestational age and tracking fetal development.This automated approach is particularly valuable in low-resource settings where access to trained sonographers is limited.The CAD system is divided into two steps:to begin,Haar-like characteristics were extracted from ultrasound pictures in order to train a classifier using random forests to find the fetal skull.We identified the HC using dynamic programming,an elliptical fit,and a Hough transform.The computer-aided detection(CAD)program was well-trained on 999 pictures(HC18 challenge data source),and then verified on 335 photos from all trimesters in an independent test set.A skilled sonographer and an expert in medicine personally marked the test set.We used the crown-rump length(CRL)measurement to calculate the reference gestational age(GA).In the first,second,and third trimesters,the median difference between the standard GA and the GA calculated by the skilled sonographer stayed at 0.7±2.7,0.0±4.5,and 2.0±12.0 days,respectively.The regular duration variance between the baseline GA and the health investigator’s GA remained 1.5±3.0,1.9±5.0,and 4.0±14 a couple of days.The mean variance between the standard GA and the CAD system’s GA remained between 0.5 and 5.0,with an additional variation of 2.9 to 12.5 days.The outcomes reveal that the computer-aided detection(CAD)program outperforms an expert sonographer.When paired with the classifications reported in the literature,the provided system achieves results that are comparable or even better.We have assessed and scheduled this computerized approach for HC evaluation,which includes information from all trimesters of gestation.
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<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>
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.
基金Supported by the National Natural Science Foundation of China,No.81860379 and No.81560345Key Research and Development Program of Jiangxi Province,No.20223BBG71009。
文摘BACKGROUND Few studies have investigated the association between gestational age,birth weight,and esophageal cancer risk;however,causality remains debated.We aimed to establish causal links between genetic gestational age and birth weight traits and gastroesophageal reflux disease(GERD),Barrett’s esophagus(BE),and esophageal adenocarcinoma(EA).Additionally,we explored if known risk factors mediate these links.AIM To analyze of the relationship between gestational age,birth weight and GERD,BE,and EA.METHODS Genetic data on gestational age and birth weight(n=84689 and 143677)from the Early Growth Genetics Consortium and outcomes for GERD(n=467253),BE(n=56429),and EA(n=21271)from genome-wide association study served as instrumental variables.Mendelian randomization(MR)and mediation analyses were conducted using MR-Egger,weighted median,and inverse variance weighted methods.Robustness was ensured through heterogeneity,pleiotropy tests,and sensitivity analyses.RESULTS Birth weight was negatively correlated with GERD and BE risk[odds ratio(OR)=0.78;95%confidence interval(CI):0.69-0.8]and(OR=0.75;95%CI:0.60-0.9),respectively,with no significant association with EA.No causal link was found between gestational age and outcomes.Birth weight was positively correlated with five risk factors:Educational attainment(OR=1.15;95%CI:1.01-1.31),body mass index(OR=1.06;95%CI:1.02-1.1),height(OR=1.12;95%CI:1.06-1.19),weight(OR=1.13;95%CI:1.10-1.1),and alcoholic drinks per week(OR=1.03;95%CI:1.00-1.06).Mediation analysis showed educational attainment and height mediated the birth weight-BE link by 13.99%and 5.46%.CONCLUSION Our study supports the protective role of genetically predicted birth weight against GERD,BE,and EA,independent of gestational age and partially mediated by educational attainment and height.
文摘AIM To investigate the effect of disease activity or thiopurine use on low birth weight and small for gestational age in women with inflammatory bowel disease(IBD).METHODS Selection criteria included all relevant articles on the effect of disease activity or thiopurine use on the risk of low birth weight(LBW) or small for gestational age(SGA) among pregnant women with IBD. Sixtynine abstracts were identified,35 papers were full text reviewed and,only 14 of them met inclusion criteria. Raw data were extracted to generate the relative risk of LBW or SGA. Quality was assessed using the Newcastle Ottawa Scale.RESULTS This meta-analysis is reported according to PRISMA guidelines. Fourteen studies met inclusion criteria,and nine reported raw data suitable for meta-analysis. We found an increased risk ratio of both SGA and LBW in women with active IBD,when compared with women in remission: 1.3 for SGA(4 studies,95%CI: 1.0-1.6,P = 0.04) and 2.0 for LBW(4 studies,95%CI: 1.5-2.7,P < 0.0001). Women on thiopurines during pregnancy had a higher risk of LBW(RR 1.4,95%CI: 1.1-1.9,P = 0.007) compared with non-treated women,but when adjusted for disease activity there was no significant effect on LBW(RR 1.2,95%CI: 0.6-2.2,P = 0.6). No differences were observed regarding SGA(2 studies; RR 0.9,95%CI: 0.7-1.2,P = 0.5). CONCLUSION Women with active IBD during pregnancy have a higher risk of LBW and SGA in their neonates. This should be considered in treatment decisions during pregnancy.
基金supported by the National"973"Project on Population and Health(No.2007CB511901)
文摘Objective To examine the effect of periconceptional multi‐micronutrient supplementation on gestation and birth outcomes.Methods A population‐based community intervention program was conducted in 18 counties in China.Participants were divided into an intervention group,who received multi‐micronutrient supplementation from at least 3 months before pregnancy throughout the first trimester,and a control group.Pregnant women were followed up to record information about birth outcomes.Maternal socio‐economic characteristics and main birth outcomes were evaluated.Gestational age was further analyzed using survival analysis,to determine the time distribution of delivery.Results Periconceptional multi‐micronutrient supplementation was associated with higher birth weight,birth length and occipitofrontal head circumference,and with lower incidence rates for stillbirth,low birth weight,and preterm birth.Moreover,periconceptional multi‐micronutrient supplementation changed the time distribution of delivery,making the deliveries more clustered in the period between day 275 and day 295 of gestation.Conclusion Our study shows that periconceptional multi‐micronutrient supplementation is beneficial for fetal development and optimizes all measured aspects of health in neonates in socioeconomically disadvantaged areas in China.The change in time distribution of deliveries caused by multi‐micronutrient supplementation needs further clarification.
文摘· AIM: As a result of the increase in premature births and the advances in neonatal intensive care, retinopathy of prematurity (ROP) remains one of the most important causes of childhood blindness worldwide. The main factors in the development of ROP are gestational age, birth weight and oxygen therapy. ROP continues to gain importance due to the increasing survival rates of more immature babies. · METHODS: Between January 2007 and October 2008, 203 premature infants treated at the Neonatal Intensive Care Unit (NNICU) were prospectively enrolled and the relationship between known risk factors and the occurance of ROP was studied. · RESULTS: ROP in various stages developed in 86 cases (42.4%). Statistically significant correlations were found between the development of ROP and birth weight (P < 0.0001) gestational age (P <0.0001), oxygen treatment and its duration (P <0.0001 and P =0.002), mechanical ventilation (MV) and its duration (P =0,0001 and P =0.0001), apnea(P = 0.001), intraventricular hemorrhage (IVH) (P =0.046), sepsis (P =0.0001), use of erythropoietin (EPO) (P =0.003), the number of blood transfusions and frequency (P =0.0001 and P =0.0001), surfactant application (P =0.0001), the presence of patent ductus arteriosus (PDA) (P =0.001) or bronchopu- lmonary dysplasia (BPD) (P =0.0001). No significant correlations were found between the occurance of ROP and maternal pre-eclampsia (P =0.293), multiple pregnancy (P = 0.218), or hyperbilirubinemia (P =0.494). Severity of ROP was related significantly with birth weight (P =0.0001), but no significant correlation between severity of ROP and gestational age was present. · CONCLUSION: Early description and reduction of the risk factors related with the occurance of ROP with the help of routine screening programs may warrant the prevention of visual loss, however early ophthalmic diagnosis and treatment are still mandatory to provide better visual rehabilitation. ·
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.
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: Prematurity is the leading cause of neonatal mortality. Most preterm births can be associated to an identifiable risk factor. In Cameroon, especially in the Southwest Region, there is limited data regarding prematurity associated risk factors. The aim of this study was to evaluate the risk factors and complications of prematurity in two health facilities in the Fako division, the BRH and RHL. Methods: A hospital based retrospective case control study was done from the 1<sup>st</sup> of January 2021 to 28<sup>th</sup> of February 2022. We assessed the gestational ages at which preterm birth occurred and their short-term outcome using a structured pretested questionnaire to collect data from files. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 26. Results: The minimum sample size was 137 preterms. 45.5% of cases were born between 34 and increased the risk of having a preterm birth meanwhile being married (AOR: 0.410;95% CI: 0.217 - 0.773;p = 0.006) decreased the risk. Hospital complications were neonatal infection 103 (51.5%), respiratory distress 79 (39.5%) and neonatal jaundice 61 (30.50%). Among the cases, 97 (48.50%) stayed in the hospital for 2 to 4 weeks and 177 (88.5%) were discharged alive. Conclusions: Modifiable factors that increased the risk of prematurity were advanced maternal age, secondary level of education, rural residence, and prenatal alcohol consumption. Being married decreased the risk. The most common hospital complications in both the cases and controls were neonatal infection, respiratory distress syndrome and neonatal jaundice.
