Repercusión del síndrome metabólico sobre el crecimiento de fetos de ratas Wistar / Repercussion of the metabolic syndrome on the growth of Wistar rat fetuses

Introducción: El síndrome metabólico es un conjunto de anomalías metabólicas como obesidad, dislipidemia, intolerancia a la glucosa e hipertensión arterial. Se realizó estudio experimental, longitudinal prospectivo en la Unidad de Toxicología Experimental de Villa Clara, periodo septiembre del 2016 y julio del 2019. Objetivo: Evaluar las modificaciones del crecimiento de los fetos de ratas con síndrome metabólico, con respecto al grupo control. Métodos: Se crearon dos grupos, uno de control y otro de estudio con síndrome metabólico inducido. Las variables estudiadas fueron: peso, talla y diámetros craneanos. Se utilizó el programa Excel 2010 y el SPSS versión 15.0 para Windows, la prueba Chi Cuadrado, y como estadístico de decisión, la significación de Monte Carlo. Resultados: Los fetos de ratas con síndrome metabólico inducido tuvieron mayor peso y talla. Conclusiones: El síndrome metabólico influyó en la ganancia del peso y la talla en los fetos en vida prenatal, al incrementar la probabilidad de macrosomía al momento del nacimiento.

Introduction: metabolic syndrome is a group of metabolic abnormalities such as obesity, dyslipidemia, glucose intolerance and arterial hypertension. An experimental, longitudinal and prospective study was carried out in the Villa Clara Experimental Toxicology Unit from September 2016 to July 2019. Objective: to evaluate the changes in the growth of rat fetuses with metabolic syndrome, with respect to the control group. Methods: two groups with induced metabolic syndrome were created, one for control and the other for study. Weight, height and cranial diameters were the studied variables. The Excel 2010 program and SPSS version 15.0 for Windows and the Chi Square test were used, as well as the Monte Carlo significance as statistical decision. Results: rat fetuses with induced metabolic syndrome had greater weight and height. Conclusions: the metabolic syndrome influenced the weight and height gain in prenatal fetuses, increasing the probability of macrosomia at birth.

Capacidad del diámetro biparietal para predecir los recién nacidos grandes para edad gestacional. Estudio de cohorte retrospectivo / Ability of biparietal diameter to predict large for gestational age newborns. A retrospective cohort study

Fundamento: Predecir el recién nacido grande para la edad gestacional es una acción de salud que necesita de herramientas tecnológicas de probada eficiencia. Objetivo: Determinar la capacidad predictiva del diámetro biparietal en los recién nacidos grandes para la edad gestacional. Metodología: Estudio de cohorte retrospectivo que incluyó 1959 gestantes cubanas con embarazo simple con captación y término del embarazo entre enero del 2009 y diciembre de 2017. En cada trimestre de gestación se compararon las condiciones tróficas adecuado para la edad gestacional (AEG) y grandes para la edad gestacional (GEG) mediante estadígrafos de tendencia central (media) y de dispersión (rango, desviación estándar) correspondientes al diámetro biparietal. Se calculó además el intervalo de confianza (IC) de 95 % para la diferencia de medias del diámetro biparietal. Asimismo, se realizó un análisis de curvas ROC para determinar si el diámetro biparietal y el peso fetal predicen la condición trófica grande para la edad gestacional en el segundo y tercer trimestre de gestación. Los datos fueron recogidos del libro registro de genética del área de salud. Resultados: El diámetro biparietal en el segundo y tercer trimestre de gestación tuvo un área bajo curva de 0.60 (IC 95 %: 0.54-0.65) y 0.59 (IC 95 %: 0.54-0.64) respectivamente. Los puntos de corte establecidos (T2: 56.55 mm, T3: 81.55 mm) tienen una especificidad y exactitud superior al 78 %. Conclusiones: El diámetro biparietal y los modelos de regresión de Shepard y de Hadlock V mostraron capacidad para discriminar el nacimiento grande para la edad gestacional del adecuado para la edad gestacional, a partir del segundo trimestre de gestación siendo más eficaces en el tercero.

Background: Predicting large for gestational age newborns is a medical action that requires technological tools with proven efficiency. Objective: To determine the predictive ability of biparietal diameter in large newborns for gestational age. Methodology: Retrospective cohort study that included 1959 Cuban pregnant women with a singleton pregnancy, with recruitment and pregnancy term between January 2009 and December 2017. In each gestational trimester, trophic conditions appropriate for gestational age (GAW) were compared and large for gestational age (GA) using central tendency (mean) and dispersion (range, standard deviation) statistics corresponding to the biparietal diameter. The 95% confidence interval (CI) for mean biparietal diameter difference was also calculated. In addition, an analysis of ROC curves was performed to determine if biparietal diameter and fetal weight predict large trophic condition for gestational age in the second and third gestational trimester. Data were gathered from the health area genetics registry book. Results: Biparietal diameter in the second and third trimester of gestation had an area under curve of 0.60 (95% CI: 0.54-0.65) and 0.59 (95% CI: 0.54-0.64) respectively. The established cut-off points (T2: 56.55 mm, T3: 81.55 mm) have a specificity and accuracy greater than 78%. Conclusions: Biparietal diameter and the Shepard and Hadlock V regression models showed ability to discriminate large for gestational age birth from adequate for gestational age birth from the second trimester of gestation onward, being more effective in the third trimester.

Relación entre biometría fetal, producto de acumulación de los lípidos y condición trófica al nacer / Relationship between fetal biometry, lipid accumulation product and the trophic condition at birth

Fundamento: Las alteraciones del estado nutricional materno generalmente se relacionan con desviaciones del crecimiento fetal, que pueden detectarse por los parámetros biofísicos fetales e identifican la posible condición trófica al nacer. Objetivo: Determinar la posible relación entre los parámetros biométricos fetales, la condición trófica al nacer y el producto de acumulación de los lípidos. Metodología: Se realizó un estudio transversal en el Policlínico Chiqui Gómez Lubian del municipio Santa Clara, durante el año 2019, en una población de 253 gestantes normopeso supuestamente sanas al inicio de la gestación. La muestra no probabilística fue de 144 gestantes. Las variables de estudio fueron: producto de acumulación de los lípidos, biometría fetal y condición trófica al nacer. Se utilizaron métodos teóricos, empíricos y estadísticos. Resultados: En el segundo trimestre ningún parámetro biométrico coincidió con la condición al nacer de pequeño, mientras que para el grande coincidieron las circunferencias cefálica y abdominal. En el tercer trimestre la longitud del fémur y la circunferencia abdominal coinciden en la identificación del pequeño y del grande. El PAL se correlacionó con la circunferencia abdominal del tercer trimestre y con el peso al nacer; presentando mayor frecuencia de valores en el tercer tertil para los nacimientos grandes. Conclusiones: La circunferencia abdominal fue el parámetro biométrico con mayor coincidencia con la condición trófica al nacer, la que se asoció con valores en el tercer tertil del PAL para la detección de nacimientos grandes, relacionándose el fenotipo normopeso metabólicamente obeso con el crecimiento fetal por exceso.

Background: Maternal nutritional status disorders are usually related to fetal growth deviations, which can be detected by fetal biophysical parameters and identify the possible trophic condition at birth. Objective: To determine the possible relationship between fetal biometric parameters, the birth trophic state and lipid accumulation product. Methodology: A cross-sectional study was conducted at the Chiqui Gómez Lubian Polyclinic in Santa Clara municipality, during 2019, in a population of 253 normal-weight pregnant women who were apparently healthy at the beginning of their gestation. The non-probability sample was made up of 144 pregnant women. Study variables were: lipid accumulation product, fetal biometry and trophic condition at birth. Theoretical, empirical and statistical methods were used. Results: In the second trimester, none of the biometric parameters matched the condition at birth as a small child, while in the large one the head and abdominal circumferences matched. In the third trimester, femoral length and abdominal circumference coincide in identifying the small one and the large one. LAP correlated with third trimester abdominal circumference and birth weight, presenting higher frequency of values in the third tertile for large births. Conclusions: Abdominal circumference was the biometric parameter with the highest coincidence with trophic condition at birth, associated with values in the third tertile of the LAP for detecting large births, relating the metabolically obese normal weight phenotype with excessive fetal growth.

Consenso SOCHOG/SOCHUMB: utilizar en Chile la curva estándar OMS ultrasonográfica de crecimiento fetal / SOCHOG/SOCHUMB consensus: OMS fetal ultrasound curve is the standard curve for ultrasound growth assessment to use in Chile

La Sociedad Chilena de Obstetricia y Ginecología (SOCHOG) y la Sociedad Chilena de Ultrasonido en Medicina y Biología (SOCHUMB) convocaron a un comité de expertos en el tema de ultrasonido y crecimiento fetal con el fin de proponer utilizar la curva fetal que mejor se adapte a la población chilena. Luego de la discusión, al no contar con curvas chilenas de crecimiento fetal, se concluye proponer que la curva estándar de la Organización Mundial de la Salud (OMS) sería la indicada dada la calidad de su metodología y por ser multicéntrica.

The Chilean Society of Obstetrics and Gynecology (SOCHOG) and the Chilean Society of Ultrasound in Medicine and Biology (SOCHUMB) have convened a committee of experts on the subject of ultrasound and fetal growth in order to propose using the fetal curve that best adapts to the Chilean population. After the discussion, since there are no Chilean fetal growth curves, it is concluded that the World Health Organization (WHO) standard curve would be the one to use given the quality of its methodology and the fact that it is multicentric.

Impact of maternal periodontal health on fetus weight in Iraqi pregnant women: a clinical study / Impacto da saúde periodontal materna no peso fetal em gestantes iraquianas: um estudo clínico

Objective: the aim of this study was to investigate the relationship between periodontal health condition and the weight of fetuses in Iraqi pregnant women in order to magnify the importance of periodontal health maintenance during pregnancy. Material and Methods: fetus weight was determined using ultrasound scanning for 222 pregnant women, accordingly they were divided into two groups: group A: normal fetus weight and group B: below normal fetal weight. Their periodontal condition was examined by means of Plaque index (PI), Gingival index (GI), Bleeding on probing (BOP) and Clinical Attachment loss (CAL) using WHO CPITN periodontal probe. WHO charts of normal fetal weight for each week were considered to determine the normality of fetus weight. Results: significant value p=0.00 was obtained when comparing the examined periodontal parameters between groups A and B, mean of periodontal parameters of PI, GI and BOP were higher in group B (1.1964: 1.4541), (1.1877: 1.4925), (0.3553: 1.3748) respectively. Q2 and IQR of PI, BOP and GI in group A were (1.190:0.3), (0.30:0.5), (1.160:0.3) respectively. And (1.460:0.24) (1.50:0.7) (1.460:0.26) in Group B. There were 4 cases of CAL in group A as opposed to 88 cases in group B, Q2 of CAL in group A=0.00, Q2 in group B=1.00. IQR=0.00 in both groups. Non-significant value p=0. 503(p>0.05) was seen when comparing the incidence of low fetal weight between the three trimesters. Conclusion: it is important to maintain a good periodontal condition and oral Hygiene status in pregnant women for healthier fetal weight and healthier pregnancy with less complications. (AU)

Objetivo: o objetivo deste estudo foi investigar a relação entre a condição de saúde periodontal e a peso dos fetos em gestantes iraquianas para ampliar a importância da manutenção da saúde periodontal durante a gravidez. Material e Métodos: o peso do feto foi determinado por ultrassonografia 222 As gestantes, consequentemente, foram divididas em dois grupos: grupo A: peso normal do feto e grupo B: abaixo do peso fetal normal. Sua condição periodontal foi examinada por meio de índice de placa (IP), gengival índice (GI), Sangramento na sondagem (BOP) e Perda de Inserção Clínica (CAL) usando a sonda periodontal CPITN da OMS. Os gráficos da OMS de peso fetal normal para cada semana foram considerados para determinar a normalidade do peso feto. Resultados: obteve-se valor significativo p=0,00 quando comparados os parâmetros periodontais examinados entre nos grupos A e B, as médias dos parâmetros periodontais do IP, GI e BOP foram maiores no grupo B (1,1964: 1,4541), (1,1877: 1,4925), (0,3553: 1,3748), respectivamente. Q2 e IQR do PI, BOP e GI no grupo A foram (1,190:0,3), (0.30:0.5), (1.160:0.3) respectivamente.E (1.460:0.24) (1.50:0.7) (1.460:0.26) no Grupo B. Houve 4 casos de CAL no grupo A em oposição a 88 casos no grupo B, Q2 de CAL no grupo A=0,00, Q2 no grupo B=1,00. IQR=0,00 em ambos os grupos. Valor não significativo p=0. 503(p>0,05) foi observado quando comparada a incidência de baixo nível fetal peso entre os três trimestres. Conclusão:é importante manter uma boa condição periodontal e Estado de higiene bucal em gestantes para maior peso fetal e gravidez mais saudável com menos complicações. (AU)

Efecto de la suplementación del zinc sobre el peso fetal en ratas diabéticas gestadas / Effect of zinc supplementation on fetal weight in pregnant diabetic rats

RESUMEN Introducción: La relación entre la deficiencia de Zn y la elevada incidencia de alteraciones en el crecimiento intrauterino en la diabetes materna aún no se ha dilucidado. En la literatura consultada no existen reportes del efecto de la suplementación con el micronutriente sobre el crecimiento fetal en modelos de diabetes con hiperglucemias moderadas. Objetivo: Determinar el efecto sobre el peso fetal de la suplementación con zinc a ratas con diabetes moderada durante la gestación. Métodos: Se utilizó un modelo de diabetes moderada inducida en ratas Wistar al segundo día de nacidas por inducción subcutánea con estreptozotocina (100mg/kg-pc). En la adultez las ratas sanas y diabéticas fueron apareadas con machos sanos. Según correspondiera recibieron durante 20 días de gestación un suplemento de sulfato de zinc (50mg/kg). Se estudiaron 395 fetos de cuatro grupos: fetos de ratas sanas sin suplemento, de ratas sanas suplementadas, de ratas diabéticas sin suplemento y de ratas diabéticas suplementadas. Los fetos se clasificaron en pequeños (PEG), adecuados (AEG) y grandes (GEG) para la edad gestacional. Resultados: La descendencia de las ratas diabéticas suplementadas mostró valores del peso fetal similares a ambos grupos sanos al término de la gestación, presentando menor porcentaje de fetos PEG y GEG, así como mayor porcentaje de AEG respecto al grupo diabético no suplementado. Conclusiones: La suplementación con Zn durante la gestación a ratas diabéticas con hiperglucemias moderadas causó efectos positivos sobre su descendencia al aumentar el porcentaje de fetos con peso adecuado.

ABSTRACT Introduction: the relationship between Zn deficiency and the high incidence of abnormal intrauterine growth in maternal diabetes has not yet been elucidated. There are no reports in the consulted literature of the effect of micronutrient supplementation on fetal growth in models of diabetes with moderate hyperglycemia. Objective: to determine the effect of zinc supplementation on fetal weight in rats with moderate diabetes during pregnancy. Methods: a model of mild diabetes was used in Wistar rats on the second day of birth by subcutaneous streptozotocin induction (100mg/kg-bw). As adults, healthy and diabetic rats were mated with healthy males. As appropriate, they received a zinc sulfate supplement (50mg/kg) during 20 days of gestation. A number of 395 fetuses from four groups were studied: fetuses from healthy rats without supplementation, from healthy rats supplemented, from diabetic rats without supplementation and from diabetic rats supplemented. Fetuses were classified as small (SGA), adequate (AGA), and large (LGA) for gestational age. Results: the offspring of the supplemented diabetic rats showed similar fetal weight values to both healthy groups at the end of pregnancy, having a lower percentage of SGA and LGA fetuses, as well as a higher percentage of AGA compared to the non-supplemented diabetic group. Conclusions: Zn supplementation during pregnancy in diabetic rats with moderate hyperglycemia had positive effects on their offspring by increasing the percentage of fetuses with adequate weight.

A natimortalidade no município do Rio de Janeiro: um estudo dos fatores relacionados aos óbitos fetais com peso maior ou igual a 2.500g / Stillbirth in the city of Rio de Janeiro: a study of factors related to fetal deaths weighing 2, 500g or more

A natimortalidade atinge de forma indiscriminada todos os países, causando grande sofrimento às famílias, sendo uma tragédia que chega a 2,6 milhões de natimortos por ano no mundo. Trata-se, majoritariamente, de mortes evitáveis por melhorias na atenção a saúde durante a gestação e parto. Objetivo geral: Analisar a natimortalidade de fetos com peso maior ou igual a 2.500g no município do Rio de Janeiro (MRJ) de 2015 a 2019. Método: Estudo descritivo, de abordagem quantitativa utilizando as bases de dados do Sistema de Informação da Vigilância dos Óbitos Infantis e Fetais (SISINF) desenvolvido na Superintendência de Vigilância em Saúde da SMS/RJ e em uso desde 2015. Resultados: No período estudado foram identificados 873 natimortos com mães, majoritariamente, jovens (20-35 anos), com poucos anos de estudo, que viviam com companheiros, eram não brancas, moradoras das áreas mais pobres da cidade. Fizeram os pré-natais nos serviços públicos, tinham início e número de consultas adequados, foram classificadas como de risco habitual, fizeram os exames de primeiro trimestre e ignorados os de terceiro. Na história obstétrica não tinham precedentes desfavoráveis (abortos/natimortos/cesarianas) ao desenvolvimento saudável da gestação do natimorto. No recorte de 326 natimortos intra-hospitalar dos anos de 2018 e 2019, 78% foram classificados como evitáveis, tendo sido encontrado um percentual aumentado de baixa adesão aos tratamentos, poucas práticas coletivas de educação em saúde, baixo registro de participação do acompanhante no trabalho de parto e elevado percentual de não realização da ausculta dos batimentos cardíacos fetais no momento do acolhimento e classificação de risco. Nas classificações de evitabilidade da população, segundo a lista brasileira, identificou-se que 87,3% eram evitáveis, sendo 96,4% destas, como por falta de adequada atenção na gestação ou no parto. Conclusão: A natimortalidade de fetos com potencial de sobrevida, no MRJ, tem um caráter evitável por tecnologias/cuidados adequadas em saúde desde o pré-natal ao parto e controle das vulnerabilidades sociais.

Stillbirth affects all countries indiscriminately, causing great suffering to families, being a tragedy that reaches 2.6 million stillbirths per year in the world. These are mostly preventable deaths due to improvements in health care during pregnancy and childbirth. General objective: To analyze the stillbirth of fetuses weighing 2,500g or more in the city of Rio de Janeiro (MRJ) from 2015 to 2019. Method: Descriptive study with a quantitative approach using the databases of the Surveillance Information System of Infant and Fetal Deaths (SISINF) developed at the Superintendence of Health Surveillance of SMS/RJ and in use since 2015. Results: In the studied period, 873 stillbirths were identified with mothers, mostly young people (20-35 years old), with a few years of study, who lived with partners, were non-white, living in the poorest areas of the city. They had prenatal care in public services, had adequate start and number of consultations, were classified as usual risk, had the first trimester exams and the third trimester were ignored. In the obstetric history, there were no unfavorable precedents (abortions/stillbirths/cesarean sections) for the healthy development of the stillbirth pregnancy. In the cut of 326 in-hospital stillbirths from 2018 and 2019, 78% were classified as preventable, with an increased percentage of low adherence to treatments, few collective health education practices, low record of companion participation at work of delivery and high percentage of non-auscultation of fetal heartbeats at the moment of reception and risk classification. In the population avoidability classifications, according to the Brazilian list, it was identified that 87.3% were preventable, 96.4% of which were due to lack of adequate care during pregnancy or childbirth. Conclusion: The stillbirth of fetuses with potential for survival, in the MRJ, is preventable by appropriate technologies/health care from prenatal care to delivery and control of social vulnerabilities.

Comparison of the effectiveness and pregnancy outcomes of labor induction with dinoprostone or single-balloon catheter in term nulliparous women with borderline oligohydramnios / 中华医学杂志(英文版)

BACKGROUNDS@#At present, there is no consensus on the induction methods in term pregnancy with borderline oligohydramnios. This study aimed to compare the effectiveness and pregnancy outcomes of labor induction with dinoprostone or single-balloon catheter (SBC) in term nulliparous women with borderline oligohydramnios.@*METHODS@#We conducted a retrospective cohort study from January 2016 to November 2018. During the study period, a total of 244 cases were enrolled. Of these, 103 cases were selected for induction using dinoprostone and 141 cases were selected for induction with SBC. The pregnancy outcomes between the two groups were compared. Primary outcomes were successful vaginal delivery rates. Secondary outcomes were maternal and neonatal adverse events. Multivariate logistic regression was used to assess the risk factors for vaginal delivery failure in the two groups.@*RESULTS@#The successful vaginal delivery rates were similar between the dinoprostone group and the SBC group (64.1% [66/103] vs. 59.6%, [84/141] P = 0.475), even after adjustment for potential confounding factors (adjusted odds ratio [aOR]: 1.07, 95% confidence interval [CI]: 0.57-2.00, P = 0.835). The incidence of intra-amniotic infection was lower in the dinoprostone group than in the SBC group (1.9% [2/103] vs. 7.8%, [11/141] P < 0.001), but the presence of non-reassuring fetal heart rate was higher in the dinoprostone group than in the SBC group (12.6% [13/103] vs. 0.7%, [1/141] P < 0.001). Multivariate logistic regression showed that nuchal cord was a risk factor for vaginal delivery failure after induction with dinoprostone (aOR: 6.71, 95% CI: 1.96-22.95). There were three factors related to vaginal delivery failure after induction with SBC, namely gestational age (aOR: 1.51, 95% CI: 1.07-2.14), body mass index (BMI) >30 kg/m2 (aOR: 2.98, 95% CI: 1.10-8.02), and fetal weight >3500 g (aOR: 2.49, 95% CI: 1.12-5.50).@*CONCLUSIONS@#Term nulliparous women with borderline oligohydramnios have similar successful vaginal delivery rates after induction with dinoprostone or SBC, with their advantages and disadvantages. In women with nuchal cord, the risk of vaginal delivery failure is increased if dinoprostone is used in the induction of labor. BMI >30 kg/m2, large gestational age, and estimated fetal weight >3500 g are risk factors for vaginal delivery failure after induction with SBC.

Alta concordancia en la evaluación clínica versus ultrasonido para estimar el peso fetal cuando se compara con el peso al nacer en recién nacidos a término / Higher agreement in clinical assessment versus ultrasound to estimate fetal weight when it compares with birth weight in full-term newborns / Alta concordância na avaliação clínica versus ultrassonografia para estimar o peso fetal quando comparado ao peso ao nascer em recém-nascidos a termo

Introducción: Objetivo: el objetivo es estimar el peso fetal por métodos clínicos y ecográficos y compararlo con el peso al nacer en recién nacidos a término. Métodos: Se trata de un estudio epidemiológico, observacional, transversal de una cohorte de recién nacidos a término sanos. El tamaño de la muestra fue de 102 neonatos nacidos en el Hospital Pablo Arturo Suárez, en Quito, Ecuador, de noviembre de 2019 a enero de 2020. Resultados: En neonatos a término, la estimación ecográfica fue del 80.00%, mientras que en la valoración clínica fue del 72.29%. El perfil del recién nacido analizado es hombre, mestizo, ecuatoriano, nacido en la región serrana, con una edad gestacional media de 38.67 semanas y un peso medio al nacer de 3.023 gramos, en quienes se estimó el peso fetal mediante ecografía y valoración clínica. La estimación del error absoluto en ambos métodos analizados fue 2.43% para ecografía y -4.65% para valoración clínica, y ambos mostraron concordancia moderada, 78.2% para ecografía y 85.6% para valoración clínica. El análisis multivariado mostró que los recién nacidos con peso modificado por ecografía tienen 13.44 veces más probabilidades de mostrar peso alterado al nacer, mientras que los recién nacidos con peso modificado por la evaluación clínica tienen 11.95 veces más probabilidades de mostrar peso alterado al nacer. Conclusiones: La precisión en la valoración clínica fue siempre mayor que en el método ecográfico, especialmente en los recién nacidos de bajo peso

Introduction: The aim of this trial was to estimate fetal weight by clinical and ultrasound methods and to compare with the weight at birth in full-term newborns. Methods: This is an epidemiological, observational, cross-sectional study of a cohort of healthy full-term newborns. The sample size was 102 neonates born at the Pablo Arturo Suarez Hospital, in Quito, Ecuador, from November 2019 to January 2020. Results: In full-term neonates, the estimate on ultrasound was 80.00%, while in the clinical assessment was 72.29%. The profile of newborn analyzed is man, mestizo, Ecuadorian, born in the highlands region, with a mean gestational age of 38.67 weeks and a mean birth weight of 3,023 grams, in whom it estimated the fetal weight through ultrasound and clinical assessment. The estimation of the absolute error in both methods analyzed was 2.43% to ultrasound and -4.65% to clinical assessment, and both showed moderate concordance, 78.2% to ultrasound, and 85.6% to clinical assessment. Multivariate analysis showed the neo-nates with modified weight by ultrasound are 13.44 times more likely to show altered weight at birth, while neonates with modified weight by the clinical assessment are 11.95 times more likely to show altered weight at birth. Conclusions: Accuracy in the clinical assessment was always higher than in the ultrasound method, especially in low weight newborns.

Introdução: Objetivo: estimar o peso fetal por métodos clínicos e ultrassonográficos e compará-lo com o peso ao nascer em recém-nascidos a termo. Métodos: Este é um estudo epidemiológico, observacional e transversal de uma coorte de recém-nascidos saudáveis ​​a termo. O tamanho da amostra foi de 102 neonatos nascidos no Hospital Pablo Arturo Suárez, em Quito, Equador, de novembro de 2019 a janeiro de 2020. Resultados: Em neonatos a termo, a estimativa ultrassonográfica foi de 80,00%, enquanto na avaliação clínica foi de 72,29%. O perfil do recém-nascido analisado é do sexo masculino, mestiço, equatoriano, nascido na região montanhosa, com idade gestacional média de 38,67 semanas e peso médio ao nascer de 3,023 gramas, sendo o peso fetal estimado por ultrassonografia e avaliação clínica. A estimativa do erro absoluto em ambos os métodos analisados ​​foi de 2,43% para ultrassom e -4,65% para avaliação clínica, e ambos apresentaram concordância moderada, 78,2% para ultrassom e 85,6% para avaliação clínica. A análise multivariada mostrou que os recém-nascidos com peso modificado ultrassonográfico têm 13,44 vezes mais chance de apresentar peso alterado ao nascer, enquanto os recém-nascidos com peso modificado pela avaliação clínica têm 11,95 vezes mais chance de apresentar peso alterado ao nascer. Conclusões: A precisão na avaliação clínica sempre foi maior do que no método ultrassonográfico, principalmente em recém-nascidos de baixo peso.

Predicting fetal weight by three-dimensional limb volume ultrasound (AVol/TVol) and abdominal circumference / 中华医学杂志(英文版)

BACKGROUND@#Fetal weight is an important parameter to ensure maternal and child safety. The purpose of this study was to use three-dimensional (3D) limb volume ultrasound combined with fetal abdominal circumference (AC) measurement to establish a model to predict fetal weight and evaluate its efficiency.@*METHODS@#A total of 211 participants with single pregnancy (28-42 weeks) were selected between September 2017 and December 2018 in the Beijing Obstetrics and Gynecology Hospital of Capital Medical University. The upper arm (AVol)/thigh volume (TVol) of fetuses was measured by the 3D limb volume technique. Fetal AC was measured by two-dimensional ultrasound. Nine cases were excluded due to incomplete information or the interval between examination and delivery >7 days. The enrolled 202 participants were divided into a model group (134 cases, 70%) and a verification group (68 cases, 30%) by mechanical sampling method. The linear relationship between limb volume and fetal weight was evaluated using Pearson Chi-squared test. The prediction model formula was established by multivariate regression with data from the model group. Accuracy of the model formula was evaluated with verification group data and compared with traditional formulas (Hadlock, Lee2009, and INTERGROWTH-21st) by paired t-test and residual analysis. Receiver operating characteristic curves were generated to predict macrosomia.@*RESULTS@#AC, AVol, and TVol were linearly related to fetal weight. Pearson correlation coefficient was 0.866, 0.862, and 0.910, respectively. The prediction model based on AVol/TVol and AC was established as follows: Y = -481.965 + 12.194TVol + 15.358AVol + 67.998AC, R2adj = 0.868. The scatter plot showed that when birth weight fluctuated by 5% (i.e., 95% to 105%), the difference between the predicted fetal weight by the model and the actual weight was small. A paired t-test showed that there was no significant difference between the predicted fetal weight and the actual birth weight (t = -1.015, P = 0.314). Moreover, the residual analysis showed that the model formula's prediction efficiency was better than the traditional formulas with a mean residual of 35,360.170. The combined model of AVol/TVol and AC was superior to the Lee2009 and INTERGROWTH-21st formulas in the diagnosis of macrosomia. Its predictive sensitivity and specificity were 87.5% and 91.7%, respectively.@*CONCLUSION@#Fetal weight prediction model established by semi-automatic 3D limb volume combined with AC is of high accuracy, sensitivity, and specificity. The prediction model formula shows higher predictive efficiency, especially for the diagnosis of macrosomia.@*TRIAL REGISTRATION@#ClinicalTrials.gov, NCT03002246; https://clinicaltrials.gov/ct2/show/NCT03002246?recrs=e&cond=fetal&draw=8&rank=67.

Local references for ultrasound-estimated fetal weight based on 2, 211 singleton pregnancies in the City of Curitiba, south of Brazil / Referências locais para o peso fetal estimado por ultrassom baseado em 2. 211 gestações únicas na cidade de Curitiba, Sul do Brasil

Abstract Objective To develop reference curves of estimated fetal weight for a local population in Curitiba, South of Brazil, and compare them with the curves established for other populations. Methods An observational, cross-sectional, retrospective study was conducted. A reference model for estimated fetal weight was developed using a local sample of 2,211 singleton pregnancies with low risk of growth disorders and well-defined gestational age. This model was compared graphically with the Hadlock and Intergrowth 21st curves. Results Reference curves for estimated fetal weight were developed for a local population. The coefficient of determination was R2 = 99.11%, indicating that 99.11% of the fetal weight variations were explained by the model. Compared with Hadlock curves, the 50th, 90th, and 97th percentiles in this model were lower, whereas the 10th percentile nearly overlapped, and the 3rd percentile was slightly higher in the proposed model. The percentiles were higher in the proposed model compared with the Intergrowth 21st curves, particularly for the 3rd, 10th, and 50th percentiles. Conclusion We provide a local reference curve for estimated fetal weight. The proposed model was different from other models, and these differences might be due to the use of different populations for model construction.

Resumo Objetivo Desenvolver curvas de referência para o peso fetal estimado em uma população de Curitiba, Sul do Brasil, e compará-las com curvas estabelecidas para outras populações. Métodos Foi realizado um estudo observacional, transversal e retrospectivo. Um modelo de referência para o peso fetal estimado foi desenvolvido usando uma amostra local de 2.211 gestações únicas de baixo risco de distúrbios do crescimento e idade gestacional bem definida. Este modelo foi comparado graficamente com as curvas de Hadlock e Intergrowth 21st. Resultados As curvas de referência para o peso fetal estimado foram desenvolvidas para uma população local. O coeficiente de determinação foi de R2 = 99,11%, indicando que 99,11% das variações do peso fetal foram explicadas pelo modelo. Em comparação com as curvas de Hadlock, os percentis 50, 90, e 97 neste modelo foram inferiores, enquanto o percentil 10 quase se sobrepôs, e o percentil 3 foi ligeiramente superior no modelo proposto. Os percentis foram maiores no modelo proposto em comparação com as curvas do Intergrowth 21st, particularmente para os percentis 3, 10, e 50. Conclusão Fornecemos uma curva de referência local para o peso fetal estimado. O modelo proposto foi diferente de outros modelos, e essas diferenças podem ser devido ao uso de diferentes populações para a construção do modelo.

A comparison between palpation method and Johnson’s rule to estimate fetal weight in term singleton pregnancies with cephalic presentation in a tertiary hospital: A prospective cross-sectional study / Philippine Journal of Obstetrics and Gynecology

Background@#Estimation of fetal weight through ultrasound or clinically, is important in the management of pregnant women. In low resource settings, where ultrasound is scarce, determination of the superior clinical method between Johnson’s rule and palpation method is of significant value.@*Objective@#The objective of this study was to determine the best clinical method in estimating fetal weight in term parturients in a tertiary government hospital. 140 term mothers with singleton pregnancies in cephalic presentation were included in this study.@*Methodology@#Fetal weight was estimated using both palpation method and Johnson’s rule and compared to the actual fetal weight. Effects of body mass index (BMI), cervical dilatation, and engagement on the accuracy of both methods were evaluated using one-way ANOVA and test of proportions. The accuracy of both methods were calculated by mean absolute error and bias. Bland-Altman analysis was used to see limits of agreement and the mean difference between estimated fetal weight to actual birthweight.@*Results@#Mean estimated fetal weight (EFW) was 2846.39 ± 427.29g by Johnson’s and 2904.29 ± 372.79g by palpation with a mean actual birthweight of 3028.30 ± 441.52g. Using paired t-test, no significant differences were found in EFW by the two methods and actual birthweight. Palpation had more estimates that differed from actual by < 100 grams at 41.43% compared to 16.43% for Johnson’s with p < 0.001. Lower bias (7.11%) was seen in palpation compared to Johnson’s (12.09%) and with more precise estimates.@*Conclusion@#Palpation method is more accurate and reliable than Johnson’s rule. Clinical palpation is easy, cost effective, simple and should be considered as a diagnostic tool for fetal weight estimation especially in rural areas. The effect modifiers are cervical dilation for palpation and engagement for Johnson’s. BMI has no effect in accuracy of estimates in both methods.

Fetal weight estimation by ultrasound: development of Indian population-based models

PURPOSE: Existing ultrasound-based fetal weight estimation models have been shown to have high errors when used in the Indian population. Therefore, the primary objective of this study was to develop Indian population-based models for fetal weight estimation, and the secondary objective was to compare their performance against established models. METHODS: Retrospectively collected data from 173 cases were used in this study. The inclusion criteria were a live singleton pregnancy and an interval from the ultrasound scan to delivery of ≤7 days. Multiple stepwise regression (MSR) and lasso regression methods were used to derive fetal weight estimation models using a randomly selected training group (n=137) with cross-products of abdominal circumference (AC), biparietal diameter (BPD), head circumference (HC), and femur length (FL) as independent variables. In the validation group (n=36), the bootstrap method was used to compare the performance of the new models against 12 existing models. RESULTS: The equations for the best-fit models obtained using the MSR and lasso methods were as follows: log₁₀(EFW)=2.7843700+0.0004197(HC×AC)+0.0008545(AC×FL) and log₁₀(EFW)=2.38 70211110+0.0074323216(HC)+0.0186555940(AC)+0.0013463735(BPD×FL)+0.0004519715 (HC×FL), respectively. In the training group, both models had very low systematic errors of 0.01% (±7.74%) and −0.03% (±7.70%), respectively. In the validation group, the performance of these models was found to be significantly better than that of the existing models. CONCLUSION: The models presented in this study were found to be superior to existing models of ultrasound-based fetal weight estimation in the Indian population. We recommend a thorough evaluation of these models in independent studies.

Obstetric outcome of induction of labor using prostaglandin gel in patients with previous one cesarean section

OBJECTIVE: After globally acceptance of planned vaginal birth after cesarean section (VBAC), the mode of induction is still a matter of debate and requires further discussion. We aimed to study obstetric outcomes in post-cesarean patients undergoing induction of labor with prostaglandin gel compared with patients who developed spontaneous labor pains. METHODS: All patients at 34 weeks or more of gestation with previous one cesarean section eligible for trial of labor after cesarean section admitted in a labor room within one year were divided in 2 groups. Group one consisted of patients who experienced the spontaneous onset of labor pains and group 2 consisted of patients who underwent induction of labor with prostaglandin gel. They were analyzed for maternofetal outcomes. Descriptive statistics, independent sample t-test, and chi-square test were applied using SPSS 20 software for statistical analysis. RESULTS: Both groups were comparable in maternal age, parity, and fetal weight, but different in bishop score, mode of delivery, and neonatal outcome. Admisson bishop score was 6.61±2.51 in group 1 and 3.15±1.27 in group 2 (P<0.005). In the patients who experienced spontaneous labor, 86.82% had successful VBAC. In the patients with induced labor, 64.34% had successful VBAC with an average dose of gel of 1.65±0.75. Both groups had one case each of uterine rupture. The neonatal intensive care unit admission rate was 4.1% in group one and 10.4% in group 2. CONCLUSION: This study reflects that supervised labor induction with prostaglandin gel in previous one cesarean section patients is a safe and effective option.

Tongue development in stillborns autopsied at different gestational ages / Desenvolvimento da língua em natimortos autopsiados em diferentes idades gestacionais

Abstract Objectives: This study aimed to analyze, through the morphometric method, the perimeter and length of the tongue, the collagen fibers, and the perimeter of blood vessels at different gestational ages and fetal weights. Material and methods: Tongues (n = 55) of stillborns autopsied at 23-40 weeks of gestational age were macroscopically analyzed, and their length and perimeter were measured. Fifty-five tongue fragments were collected through a longitudinal section in the region that accompanies the median lingual sulcus and histologically processed. Slides were stained with picrosirius and immunolabeled with CD31 antibody. Quantification was performed on collagen fibers under polarized light, and on the perimeter of vessels with the CD31. Results: A positive and significant correlation of gestational age with tongue perimeter and length was found. There was a positive and significant correlation between collagen fibers and gestational age, as well as between gestational age and the perimeter of blood vessels. Between collagen fibers and fetal weight, a positive and significant increase was observed. Regarding the correlation between the perimeter of blood vessels and the fetal weight, an increase was observed. Conclusion: As gestational age advances, there is an increase in tongue perimeter and length, in the percentage of collagen fibers, and in vascular perimeter, demonstrating that tongue formation is directly related to tongue growth and development.

Resumo Objetivo: Analisar, por meio do método morfométrico, o perímetro e o comprimento da língua, as fibras de colágeno, o perímetro dos vasos sanguíneos, em idades gestacionais e de acordo com o peso fetal. Materiais e métodos: Línguas (n = 55) de natimortos autopsiados com 23-40 semanas de idade gestacional foram analisadas macroscopicamente, medidas em comprimento e perímetro; 55 fragmentos das línguas foram coletados por meio de uma secção longitudinal na região que acompanha o sulco lingual médio e processados histologicamente. As lâminas foram coloridas com picrosirius e imunomarcadas com o anticorpo CD31. A quantificação foi feita em fibras de colágeno examinadas com microscópio de luz polarizada e o perímetro dos vasos com o CD31. Resultados: Foi encontrada uma correlação positiva e significativa da idade gestacional com o perímetro e o comprimento da língua. Houve uma correlação positiva e significativa entre as fibras de colágeno e a idade gestacional; bem como entre a idade gestacional e o perímetro dos vasos sanguíneos; e houve um aumento positivo e significativo entre as fibras de colágeno e o peso fetal. No que diz respeito à correlação entre o perímetro dos vasos sanguíneos e o peso fetal, houve um aumento. Conclusão: Conforme a idade gestacional avança, há um aumento no perímetro e no comprimento da língua, um aumento no percentual de fibras de colágeno e um aumento no perímetro vascular, demonstra que a formação da língua está diretamente relacionada ao crescimento e ao desenvolvimento da língua.

Analysis of the performance of 11 formulae for fetal weight estimation in preterm fetuses with abnormal doppler velocimetry - A retrospective multicenter study / Análise do desempenho de 11 fórmulas de estimativa de peso fetal em conceptos prematuros com Dopplervelocimetria alterada - um estudo retrospectivo multicêntrico

Abstract Objective To assess 11 formulae commonly used to estimate fetal weight in a population of premature fetuses who had abnormal Doppler velocimetry due to early-onset placental insufficiency. The performance of each formula was evaluated in subgroups of fetuses with expected growth and intrauterine growth restriction. Methods Data were collected fromfetuses andmothers who delivered at three Brazilian hospitals between November 2002 and December 2013.We used the following formulae: Campbell; Hadlock I, II, III, IV and V; Shepard; Warsof; Weiner I and II; and Woo III. Results We analyzed 194 fetuses. Of these, 116 (59.8%) were considered appropriate for gestational age (AGA), and 103 (53.1%) were male. The amniotic fluid volume was reduced in 87 (44.8%) fetuses, and the umbilical artery Doppler revealed absence or inversion of diastolic flow in 122 (62.9%) cases, and the analysis of the ductus venosus revealed abnormal flow in 60 (34.8%) fetuses. The Hadlock formulae using three or four fetal biometric parameters had low absolute percentage error in the estimated fetal weight among preterm fetuses with abnormal Doppler studies who were born within 5 days of the ultrasound evaluation. The results were not influenced by the clinical and ultrasound parameters often found in early-onset placental insufficiency. Conclusion In this study, the formulae with the best performance for fetal weight estimation in the analyzed population were Hadlock I and IV, which use four and three fetal biometric parameters respectively to estimate the weight of preterm fetuses with abnormal Doppler studies.

Resumo Objetivo Avaliar o desempenho de 11 fórmulas comumente utilizadas para estimativa de peso fetal em uma população de fetos prematuros com dopplervelocimetria alterada devido a insuficiência placentária de início precoce. O desempenho de cada fórmula foi avaliado em subgrupos de fetos com crescimento adequado e com crescimento intrauterino restrito. Métodos Foram coletados os dados de mães e fetos cujos partos foram acompanhados em 3 instituições brasileiras entre novembro de 2002 e dezembro de 2013. As fórmulas selecionadas para análise foram: Campbell; Hadlock I, II, III, IV e V; Shepard; Warsof; Weiner I e II; e Woo III. Resultados Foram analisados os pesos de 194 fetos, dos quais 116 (59,8%) foram considerados adequados para a idade gestacional, 103 (53,1%) eram do sexo masculino, em 87 (44,8%) havia redução do volume de líquido amniótico, em 122 (62,9%) o Doppler de artéria umbilical demonstrou ausência ou inversão do fluxo na diástole, e em 60 (34,8%) a análise do duto venoso indicou fluxo anormal. A média do erro percentual absoluto (EPA) demonstrou que as fórmulas de Hadlock que utilizam 3 ou 4 parâmetros biométricos fetais apresentaram o melhor desempenho. Os resultados obtidos para essas fórmulas não sofreram influência dos parâmetros clínicos e ultrassonográficos frequentemente encontrados na insuficiência placentária de início precoce. Conclusão O presente estudo demonstrou o melhor desempenho das fórmulas de Hadlock que contêm 3 ou 4 parâmetros da biometria para estimativa de peso de fetos prematuros com anormalidades ao mapeamento Doppler.

Oxidative stress effects in the uterus, placenta and fetus of pregnant rats submitted to acute and chronic stress

Abstract Purpose: To evaluate the effects of oxidative stress in pregnant rats submitted to acute and chronic stress, relating to alterations in the uterus, placenta and fetus. Methods: Twenty-four female Wistar albino (Rattus norvegicus), were divided into four groups, for induction of oxidative stress the animals were submitted to cold and physical immobilization. Plasma fasting glucose and MDA were determined in all groups and the fetuses and placentas were measured. Results: There were no statistical differences in the levels of malonic dialdehyde (MDA), however the averages of chronic stress group were higher compared to control groups, which could explain the observed adverse effects; there was no correlation between puppies' size, the weight of the placenta and MDA values. Conclusions: Chronic stress causes adverse effects, when compared to control groups; chronic stress group had fetuses, placentas and number of puppies, significantly lower compared to other groups. The rats exposed to chronic stress, also presented a higher frequency of fetal resorption.

The trends and risk factors to predict adverse outcomes in gestational diabetes mellitus: a 10-year experience from 2006 to 2015 in a single tertiary center

OBJECTIVE: To investigate the change of maternal characteristics, delivery and neonatal outcomes in gestational diabetes mellitus (GDM) over recent 10 years and to identify the risk factors associated with adverse outcome. METHODS: Consecutive GDM patients (n=947) delivered in our institution were included. Research period was arbitrarily divided into 2 periods (period 1: from 2006 to 2010, period 2: from 2011 to 2015). Multiple pregnancies or preexisting diabetes were excluded. Maternal baseline characteristics, delivery and neonatal outcomes were reviewed. Fetal biometric findings by prenatal ultrasonography were collected. Adverse pregnancy outcome (APO) was defined by the presence of one of the followings; shoulder dystocia, neonatal macrosomia (>4 kg), neonatal hypoglycemia (< 35 mg/dL), respiratory distress syndrome (RDS), and admission to the neonatal intensive care unit (NICU) in term pregnancy. RESULTS: Period 2 was associated with older maternal age (34 vs. 33, P < 0.001) and higher proportion of GDM A2 compared to period 1 (30.9% vs. 23.0%, P=0.009). By univariate analysis, APO was associated with increased body mass index (BMI) at pre-pregnancy (23.4 kg/m² vs. 21.8 kg/m², P=0.001) or delivery (27.9 kg/m² vs. 25.8 kg/m², P < 0.001), higher HbA1c at diagnosis (5.6% vs. 5.3%, P < 0.001) or delivery (5.8% vs. 5.5%, P=0.044), and larger fetal biometric findings (abdominal circumference [AC] and estimated fetal weight, P=0.029 and P=0.007, respectively). Multivariate analysis showed pre-pregnancy BMI (odds ratio [OR], 1.101; 90% confidence interval [CI], 1.028–1.180) and fetal AC (OR, 1.218; 90% CI, 1.012–1.466) were independently associated with adverse outcomes. CONCLUSION: Our study demonstrated the trends and relevant factors associated with the adverse outcomes.

Hepatic toxicity caused by PLGA-microspheres containing usnic acid from the lichen C ladonia substellata (AHTI) during pregnancy in Wistar rats

ABSTRACT This study aimed to evaluate the teratogenic and hepatotoxic potential of the usnic acid encapsulated into PLGA-microspheres. In total, 12 female Wistar rats in pregnancy were randomly distributed in the control group (n= 6) that received 1.0 mL of physiological solution and treatment group (n= 6) that received 25 mg/kg of encapsulated usnic acid by oral administration. All females were euthanized at day 20 of pregnancy and their fetuses were removed and analyzed. During the pregnancy was observed a reduction in weight gain. There was no difference in serum transaminases levels analyzed as well as any difference in liver weight in both groups. The histomorphometric analysis of the liver from the treatment group revealed an increase in number of hepatocytes and a decrease in nuclear area of these cells. Moreover, no alteration was observed in cell area of hepatocytes or number of Kupffer cells. The fetuses had an increase in total number of hepatocytes and a reduction in the amount of megakaryocytes. These results show the hepatotoxic potential of usnic acid during pregnancy. However, its toxicity can be minimized by encapsulation in microspheres.

Establishment of reference intake of water for Korean adults in 2015 / 한국영양학회지

PURPOSE: This review was performed to establish a reference intake of water for Korean (KDRI-water) adults in 2015 by examining current knowledge of the relationship between water intake and health and the general status of water intake and loss. We expect that this study will be utilized for further refinement of KDRI-water. METHODS: Documents were searched using RISS, NDSL, DBPIA, CINAHL, and Pubmed with the keywords ‘water intake, water supply, water ingestion, hydration, dehydration, water balance, and fluid balance’. RESULTS: Water balance is essential for the maintenance of health. Based on this assumption, numerous studies have been performed to investigate the association of water intake with several diseases such as urolithasis, obesity, diabetes, and cancer as well as other health problems, including constipation, cognition, and fetal weight. Effects of water intake for prevention or relief of these health problems vary. Water is supplied to the body by eating foods and drinking liquids such as plain water and beverages. Metabolic water is another source of water input. Water is lost through urine, skin, respiration, and feces. KDRI-water 2015 was set by adequate intake (AI) based on water intake volume, which was the sum of water intakes from foods and fluids reported by the Korea National Health and Nutrition Examination Survey, with extra milk intake of 200 mL. AIs in some age groups were modified considering their estimated energy requirements. CONCLUSION: Accurate data of water intake is critically important for the establishment of KDRI-water. Therefore, improvement of systems investigating water intake is required, and more studies on the status of water intake and loss in Korean people are needed for definite KDRI-water establishment.