Doppler patterns in growth restricted foetuses: determinants and outcome in a tertiary hospital in South Kerala, India

Background: Foetal growth restriction refers to a condition in which the foetus is unable to achieve its genetically determined growth potential. Doppler velocimetry in FGR not only decides the optimum time of delivery but also the optimum mode of delivery and so authors evaluated the Doppler patterns in growth restricted fetuses.Methods: Nested case-control study conducted among normal and abnormal Doppler groups at a tertiary care teaching hospital in the year 2017.Results: Among 82 growth restricted foetuses, 54 of them had normal Doppler patterns (65.85%) and 28 had abnormal Doppler patterns (34.15%).13(46.5%) had umbilical S/D elevation,2 (7.14%) had AEDV,1(3.57%) with REDV and 12 (42.8%) with CPR<1. Mean maternal age was slightly higher in the abnormal Doppler group. FGR babies with abnormal velocity waveforms had shorter diagnosis to delivery interval than those with normal Doppler and decision for delivery was taken at a lower gestational age. (p value-0.001). Mothers of FGR babies with abnormal Doppler studies underwent emergency caesarean section for non-reassuring foetal heart patterns. (p value-0.001) The mean birth weight was higher (2201.80gm) in Doppler normal FGR and it was 1929.46grams in abnormal umbilical Doppler group and 1363.33gm in AREDV (pvalue-0.001). Growth restricted with normal Doppler had shorter NICU stays than with abnormalities (p value-0.003). Term FGR went home early than early preterm. (p value-0.001).Conclusions: Growth restricted foetuses with normal umbilical velocimetry are at a lower risk than those with abnormal velocimetry in terms of prolonged diagnosis-delivery interval and shorter NICU days. The need for neonatal resuscitation at birth was more in babies with abnormal Doppler velocimetry and absent diastole /reversed diastolic flow of umbilical artery velocimetry.

Prevalencia de restricción del crecimiento intrauterino en el Hospital Universitario San José, Popayán (Colombia), 2013 / Prevalence of intra-uterine growth restriction at San José University Hospital in Popayán (Colombia), 2013

Determinar la prevalencia de restricción del crecimiento intrauterino (RCIU) en el Hospital Universitario San José (HUSJ), describir sus características y hacer una exploración de los factores de riesgo asociados a RCIU. Materiales y métodos: estudio de corte transversal en el que se incluyeron los recién nacidos vivos en un hospital universitario de referencia ubicado en la región suroccidental de Colombia en el año 2013, se excluyeron aquellos con información inconsistente. Se definió recién nacido con restricción del crecimiento intrauterino (RCIU) como el neonato vivo con índice ponderal (Rohrer) menor al percentil 10, IP = [peso (en gramos) x 100] ÷ [longitud (en cm)]3. Para el tamaño de muestra se tuvo en cuenta una prevalencia esperada de RCIU del 4 %, un error tolerado del 2 %, corrección por población finita y por no respuesta del 20 %, obteniendo así un tamaño muestral de 400 sujetos. Se realizó un muestreo aleatorio sistemático. Se utilizó un cuestionario semi-estructurado, que incluyó variables biológicas, sociales y demográficas. Se estimó la prevalencia de periodo de RCIU y se realizó exploración de los factores asociados a RCIU por medio de análisis bi y mutivariado. Se utilizó la prueba t de Student para variables continuas y chi cuadrado para categóricas.Resultados: el análisis se realizó con 392 neonatos; se excluyeron 8, por inconsistencia en la información suministrada; se encontraron 79 neonatos con RCIU para una prevalencia del 20,15 %. En la exploración de los factores de riesgo se encontró una asociación positiva con RCIU y ganancia inadecuada de peso (OR = 2,35; IC 95 %: 1,15-4,82), antecedente de RCIU (OR = 3,26; IC 95 %: 1,08-9,78), amenaza de parto pretérmino (OR = 3,58; IC 95 %: 1,15-11,1), antecedente de cesárea (OR = 2,64; IC 95 %: 1,24- 5,60), y una asociación negativa entre etnia mestiza y raza blanca (OR = 0,25; IC 95 %: 0,07-0,91). Conclusión: la prevalencia encontrada fue del 20,15%, la cual es mayor que la reportada en otras instituciones de este mismo nivel de complejidad...

To determine the prevalence of Intra-uterine Growth Restriction (IUGR) at San Jose University Hospital (HUSJ), describe its characteristics, and explore risk factors associated with IUGR.Materials and methods: Cross-sectional study of live neonates delivered in a referral university hospital located in Southwestern Colombia in 2013. Cases with inconsistent information were excluded. Neonates with intra-uterine growth restriction (IUGR) were defined as live neonates with a ponderal index (Rohrer) below the 10th percentile, PI = [weight (in grams) x 100] ÷ [length (in cm)]3. For the sample size, the following was taken into consideration: expected IUGR prevalence of 4%, 2% tolerated error, finite population correction and 20% non response, resulting in a final sample size of 400 subjects. A systematic random sampling was performed. A semi-structured questionnaire including biological, social and demographic variables was used. The prevalence of the IUGR period was estimated. Factors associated with IUGR were explored using bivariate and multivariate analyses. The Student t test was used for continuous variables and the Chi square test was used for categorical variables.Results: Overall, 392 neonates were included in the analysis, and 8 were excluded because of inconsistent information. There were 79 neonates with IUGR, for a prevalence of 20.15%. When the risk factors were explored, a positive association was found between IUGR and inadequate weight gain (OR = 2.35; 95% CI: 1.15-4.82), history of IUGR (OR = 3.26; 95% CI: 1.08-9.78), threat of preterm delivery (OR = 3.58; 95% CI: 1.15-11.1), and prior C-section (OR = 2.64; 95% CI: 1.24-5.60), and a negative association was found with mestizo ethnic background and white race (OR = 0.25; 95% CI: 0.07-0.91).Conclusion: The prevalence was found to be 20.15%, which is higher than that reported in other institutions of similar complexity level...

Milk and Protein Intake by Pregnant Women Affects Growth of Foetus.

The study assessed the effects of the daily intake of milk and protein by pregnant women on foetal growth and determined the growth pattern and velocity of growth. A total of 504 ultrasound observations from 156 respondents were collected following a cross-sectional design in the last trimester of pregnancy; majority of them were in the last month of pregnancy. De facto and purposive sampling was done, and direct interviews of affluent pregnant women were conducted. Kruskal-Wallis test shows that majority of the respondents had tendency to consume 155.65 to 465.17 mL of milk per day, resulting in better and higher foetal growth. Most respondents consumed about 50-70 g of protein per day, and the foetal growth measurements, such as abdomen-circumference, femur length, biparietal diameter, and head-circumference, on an average, were higher in the same group. Quadratic regression model exhibited that all the traits of growth pattern in Model 1 (low milk and protein intake) appeared to have more mode of decline, in contrast to Model 2 (more milk and protein intake), which shows better growth. In addition, velocity of growth pattern was obtained through the first derivative of quadratic regression of growth pattern. Moreover, 95% confidence interval calculated for regression line slope of Model 1 and Model 2 showed that the estimation point (2 B2) of Model 1 does not lay into 95% CI of Model 2; so, statistical significance assorted and also the same trend conversely hold for Model 2. The rate of growth was highly influenced by maternal milk and protein intake. These findings suggest that contribution of common nutrients or other nutritional factors present in milk and protein promote the growth of foetus.

Oxidative Stress in Early Life and Later Obesity Development

Introduction: Critical time windows exert profound influences on foetal physiological and metabolic profiles, which predispose an individual to later diseases via a 'programming' effect. Obesity has been suggested to be 'programmed' during early life. Foetuses and infants who experience adverse growth are subjected to a higher risk of obesity. However, the key factors that link adverse foetal growth and obesity risk remain obscure. To date, there is considerable evidence showing that the overall balance between free radical damage and the antioxidative process being challenged occurs throughout gestation. With the view that pregnancy is a pro-inflammatory state confronted with enhanced oxidative stress, which possesses similar characteristics to obesity (a chronic inflammatory state with increased oxidative stress), oxidative stress is thus biologically plausibly be proposed as the underlying mechanism between this causal-disease relationship. Oxidative stress could act as a programming cue for the development of obesity by inducing complex functional and metabolic deregulations as well as inducing the alteration of the adipogenesis process. Thereby, oxidative stress promotes adipose tissue deposition from early life onwards. The enhancement of fat accumulation further exaggerates oxidative derangement and perpetuates the cycle of adiposity. This review focuses on the oxidative stress pathways in prenatal and early postnatal stages, from the aspects of various endogenous and exogenous oxidative insults. Because oxidative stress is a modifiable pathway, this modifiability suggests a potential therapeutic target to fight the obesity epidemic by understanding the causal factors of oxidant induction.

Morphometric analysis of lumbosacral canal in human foetuses / Análisis morfométrico del canal lumbosacro en fetos humanos

Lumbosacral part of the spinal canal requires special attention because this is the site commonly involved in spina bifida, tethered cord syndrome and some other pathologies like fatty tumours in the spine, cysts and syrinxes. The diagnosis as well as the treatment of neural tube defects mandates an accurate knowledge of morphometry of lumbosacral vertebral canal. There are various reports on radiological morphometric measurements in human foetuses by various authors but these possess inherent variability due to imaging techniques, patient positioning, observer's measuring techniques and normal and pathological variations. To overcome all these limitations, direct measurements by vernier calliper were preferred. 30 Formalin preserved human foetuses, of all age groups and both sexes, free of congenital craniovertebral anomalies, were obtained from the museum of Dept. of Anatomy, J. N. Medical College AMU Aligarh for the present study. Foetuses were divided into five groups (I-V) based on their gestational ages. Group I foetuses were of less than 17 weeks, II of 17-20 weeks, III of 21-25 weeks, IV of 26-30 weeks and V of more than 30 weeks. Each group contained 6 foetuses having both male and female, 3 each. Morphometric parameters taken into account were length of lumbar canal, maximum transverse diameters of lumbar vertebral canal at different vertebral levels, heights of the posterior surfaces of bodies of all lumbar vertebrae and length of sacral canal. Readings of adjacent groups were compared and results were analyzed by using Student's 't' test. Lumbar canal starts growing in length significantly in group III foetuses onward. There was consistency in the growth of lumbar canal diameters with gestational age at all levels. Heights of vertebral bodies of Ist two lumbar vertebrae showed variability in some adjacent groups. The same in the next three grew constantly with the growth of foetuses. Sacral canal showed variable growth in lengths in different grou...

La porción lumbosacra del canal espinal requiere una atención especial; es un sitio frecuentemente implicado en la espina bífida, el síndrome de médula anclada y algunas otras patologías como tumores de grasa en la columna vertebral, quistes y siringomelia. El diagnóstico y el tratamiento de los defectos del tubo neural requieren de un conocimiento preciso de la morfometría del canal vertebral lumbosacro. Existen diversos informes radiológicos sobre mediciones morfométricas en fetos humanos por parte de diversos investigadores, pero estos poseen una variabilidad inherente debido a las técnicas de imagen, posicionamiento del paciente, técnicas de medición del observador y, las variaciones normales y patológicas. Para superar todas estas limitaciones, para las mediciones directas se utilizó un caliper vernier. 30 fetos humanos conservados en formalina, de todas las edades y de ambos sexos, sin anomalías congénitas craneovertebrales, fueron obtenidos del museo del Departamento de Anatomía, J. N. Facultad de Medicina de la UMA, Aligarh. Los fetos fueron divididos en cinco grupos (I-V) sobre la base de su edad gestacional. El grupo I de fetos fueron los menores de 17 semanas, el II de 17-20 semanas, el III de 21-25 semanas, IV de 26 a 30 semanas, V de más de 30 semanas. Cada grupo contenía 6 fetos de ambos sexos (1:1/H:M)). Los parámetros morfométricos tomados en cuenta fueron la longitud del canal lumbar, el diámetro transversal máximo del canal vertebral lumbar en diferentes niveles, la altura de las superficies posteriores de los cuerpos de todas las vértebras lumbares y la longitud del canal sacro. Las mediciones de los grupos fueron comparadas y analizadas mediante el uso de la prueba de "t". El canal lumbar comenzó a aumentar en longitud significativamente desde el grupo de fetos III en adelante. No hubo consistencia en el crecimiento de los diámetros del canal lumbar con la edad gestacional en todos los niveles. Las alturas de los primeros dos cuerpos verte...

Prevalencia y caracterización de los recién nacidos con anomalías craneofaciales en el Instituto Materno Infantil de Bogotá / Prevalence and characterisation of the newborn suffering craniofacial anomalies at the Instituto Materno Infantil in Bogotá

Objetivos Determinar la frecuencia y caracterizar los neonatos nacidos con anomalías craneofaciales atendidos en el Instituto Materno Infantil (IMI). Métodos Se recolectaron los datos de nacidos o remitidos al IMI, estrato, procedencia, factores de riesgo general y específico, género, edad gestacional, correlación peso y edad gestacional, diagnóstico de la anomalía, cariotipo y condición al egreso de los neonatos con anomalías craneofaciales atendidos entre 1 de Marzo de 2000 y 15 de Agosto de 2001. Resultados La prevalencia de anomalía congénita fue 2,7 por ciento y de anomalía craneofacial 0,6 por ciento. De 52 pacientes, 69 por ciento tenía factores de riesgo específico, 38 por ciento era prematuro y 33 por ciento tenía retardo del crecimiento intrauterino; 65 por ciento correspondió a hendiduras, 55,8 por ciento a anomalía múltiple y 46 por ciento a síndromes. Se estableció diagnóstico etiológico en 38 por ciento de los casos; 12 por ciento tenía cromosomopatía. Fallecieron 18 niños (35 por ciento) y en 13 la muerte se atribuyó a la anomalía, 6 de éstos tenían cromosomopatía. Se evidenció la utilidad del cariotipo para hacer diagnóstico etiológico y establecer pronóstico. Los neonatos con anomalías craneofaciales tuvieron 3 veces más riesgo de morir que el resto de neonatos hospitalizados. Se demostró asociación estadísticamente significativa de la mortalidad con prematurez, retardo de crecimiento, cromosomopatía y diagnósticos de anomalía múltiple y síndrome. Conclusiones Prematurez, retardo de crecimiento, anomalía múltiple, diagnóstico de síndrome y cromosomopatía evidencian un perfil de riesgo para mortalidad.

Objectives Determining the frequency and characteristics of newborn suffering craniofacial abnormalities who were attending the Instituto Materno Infantil (IMI) in Bogotá. Methods Data was gathered regarding the newborn suffering such alterations who attended IMI from March 1 st 2000 to August 15 th 2001. The variables analysed were: being born in or having been remitted to the IMI, social strata, origin, general and specific risk factors, gender, correlation between weight and gestational age, clinical and aetiological diagnosis of the anomaly, karyotype and condition on leaving IMI. Results There was 2,7 percent prevalence for congenital defects and 0,6 percent for craniofacial abnormalities. 69 percent of the 52 patients had specific risk factors, 38 percent had been preterm, 33 percent had suffered retarded intra-uterine growth, 65 percent had cleft palates, 55,8 percent multiple abnormalities and 46 percent syndromes. Aetiological diagnosis was established in 38 percent; 12 percent had chromosomopathy. Eighteen children (35 percent) died, death being attributed to their defect in 13 of them, six by chromosomopathy. This study revealed the use of karyotype in making an aetiological diagnosis and determining prognosis. Mortality for the group suffering craniofacial abnormalities was threefold that of other hospitalised neonatal patients. Significant statistical association was shown between mortality and preterm condition, retarded growth, chromosomopathy and a diagnosis of multiple defects and/or syndromes. Conclusions Prematurity, retarded growth, multiple defects, syndrome diagnosis and chromosomopathy revealed a mortality risk profile.