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.

Fetal growth in low-risk Indian population at a tertiary centre and its comparison with INTERGROWTH-21 standards: a prospective cohort study

Background: The objective of this study was to compare the fetal growth pattern in low risk Indian population with the INTERGROWTH-21 standards.Methods: Low risk women were enrolled at 10 to 20 weeks of gestation and followed up until delivery. An experienced operator performed abdominal ultrasound every 5±1 week and measured biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL) of the fetus. Newborn anthropometric measurements were taken within 12 hours of childbirth.Results: A total of 126 healthy women, enrolled at mean gestation of 16.8±1.6 weeks, completed the follow up until delivery. None of the participants developed any major obstetric or medical morbidity. The study subjects showed lower mean z scores for BPD (-0.7±1.3), HC (-0.4±1.3) and AC (-0.4±1.3) but a higher mean z-score for FL (0.3±1.7) as compared to INTERGROWTH-21 standards. From 1st through 5th visit, the z scores for BPD and HC improved whereas declined for AC and FL.Conclusions: The fetal growth in non-affluent healthy Indian women had a lower fetal growth compared to INTERGROWTH-21 standards.

Estimation of gingival blood glucose using a sensitive self-monitoring device in periodontitis patients

Background: Diabetes Mellitus is a complex disease with varying degree of systemic and oral complications. The prognosis is quite favorable if a disease is diagnosed in early stages. Since a large number of patients seek dental treatment routinely, screening procedures for early detection of subclinical cases can help in diagnosis of asymptomatic diabetes. Aim: The present study was undertaken to evaluate if gingival crevicular blood can be used for the estimation of blood glucose levels in periodontitis patients. Material and Methods: A prospective study was carried out comprising 150 patients Group A comprised of 75 subjects with gingivitis and group B comprised of 75 subjects with periodontitis. For gingival crevicular blood glucose (GCBG) level estimation, the blood was drawn onto the glucometer strip after gently probing the gingival sulcus and the readings were recorded. At the same time, blood Vijayendra Pandey, Akhilesh Chandra, Deepak Kumar, Anup Kumar Singh, Priyankesh, Alok Kumar Gupta. Estimation of gingival blood glucose using a sensitive self-monitoring device in periodontitis patients. IAIM, 2019; 6(6): 51-56. Page 52 was also collected from the index finger onto the glucometer strip for the capillary finger-prick blood glucose (CFBG) sample. Both the values were compared and statistical analysis of data was performed. Results: The mean GCBGL and CFBGL in group A was 98.43 mg/dl ± 18.62 and 103.48 mg/dl ± 13.90 respectively, while in group B it was 136.37 mg/dl ± 36.95 and 141.62 mg/dl ± 51.84, respectively. There was no statistically significant difference (p> 0.05) between the two values in both the groups. Conclusion: It can be concluded that GCBG levels are positively correlated with CFBG levels. Therefore, clearly indicating that gingival crevicular blood collected during diagnostic periodontal examination may be an excellent source of blood sample for glucometric analysis.

Value of the ratio of fetal cardiac diameter to biparietal diameter in prediction of homozygous α-thalassemia-1 fetuses / 中华超声影像学杂志

Objective To evaluate the efficacy of the ratio of the fetal cardiac diameter to biparietal diameter( CBR) as a predictor of homozygous α-thalassemia-1 . Methods Single mid-pregnancies ( 15-22weeks) at risk of homozygous α-thalassemia-1 were enrolled . A total of 251 singleton pregnancies were recruited ,in which 63 cases were homozygous α-thalassemia-1 fetuses and the rest were unaffected . The CBR and cardiothoracic ratio(CTR) were measured by two-dimensional ultrasound . Then the accuracy of these variables were analyzed and compared with each other by ROC curves . Results ①The CBR and CTR in affected fetuses were significantly higher than those in the unaffected( P ＜0 .01) . ②With CBR＞0 .43 and CTR ＞ 0 .52 as the best cut off values ,the sensitivity and specificity of predicting homozygous α-thalassemia-1 fetuses in 15-22 gestational weeks were 95 .74% , 92 .06% and 94 .15% , 85 .71% , respectively ;the area under ROC curve were compared with Z test and there was no significant difference between them ( Z ＝ 1 .500 , P ＝ 0 .1335) . ③ When CBR and CTR were combined ,the sensitivity and specificity of the prediction were significantly increased ( the sensitivity of series experiment : 99 .75% ,the specificity of parallel experiment : 98 .87% ) . Conclusions CBR is a novel , effective and noninvasive predictor of homozygous α-thalassemia-1 in mid-pregnancy whose prediction efficiency is the same as traditional CTR . The measurement of CBR is easier to standardize and is not affected by thoracic lesions such as pleural cavity ,pericardial effusion and skeletal dysplasia . If combined with CTR ,it may play an important role in improving the prenatal detection rate of homozygous α-thalassemia-1 fetuses .

Fetal Kidney Length: A Useful Parameter For Ultrasonographic Gestational Age Calculation.

Background & Objective: As the technology used in sonography has become more advanced accurate estimation of gestational age (GA) has become more demanding to plan treatments in pregnancy. Fetal kidney length (FKL) alone or its combination with other biometric parameters can be used in GA calculation more precisely in IInd&IIIrd trimester. Methodology: Two hundred three healthy pregnant females of IInd&IIIrd trimester were analyzed for GA calculation via FKL, Bi parietal diameter (BPD) and femur length (FL) using various lenear regression models. Results: Fetal kidney could be seen easily sonographically at 16thwk of gestation. FL was the most accurate single parameter (SE + 7.95 days) followed by FKL + 9.56days; BPD was the least accurate + 9.86 days. GA can be calculated most accurately by combining FKL with FL and BPD with SE + 7.12 days. Conclusion: FKL is easy to measure in IInd and IIIrd trimester and more accurate than BPD for GA estimation. So FKL could be used alone or easily incorporated into the model for dating pregnancies after 16th wk of gestation, in particular when measurements of BPD and FL are difficult.

Efectos del ácido fólico sobre variables morfométricas en ratas Wistar recién nacidas / Acid folic effects over morphometric variables in newborn Wistar rats

Introducción: el consumo de ácido fólico representa un problema de salud a nivel mundial, diversos son los defectos congénitos que se pueden prevenir si existiera un suficiente nivel materno de ácido fólico. Objetivo: demostrar los efectos del ácido fólico sobre algunas variables morfométricas en ratas Wistar recién nacidas. Material y método: se realizó un estudio experimental analítico en 116 ratas Wistar recién nacidas. Se utilizaron como variables: longitud de la cola, diámetro biparietal y masa corporal. Se formaron cinco grupos de dos ratas cada uno: un grupo control y cuatro grupos tratados con ácido fólico teniendo en cuenta, dosis y tiempo de gestación, las mediciones se tomaron al primer y tercer día de nacidas las ratas. Se aplicaron como análisis de variables: la media y desviaciones estándar y para la comparación de los promedios se utilizó un nivel de significación α ≤ 0,05. Resultados: las mediciones de la longitud de la cola arrojaron significación estadística( P < 0.05) al comparar el grupo control respecto a los grupos tratados, las variables diámetro biparietal y masa corporal no presentaron significación estadística a pesar de que la medias en la variable masa corporal de los grupos tratados fueron superiores con respecto al grupo control. Conclusiones: se demostró la necesidad del suministro de ácido fólico antes y durante la gestación en ratas Wistar, por la influencia que ejerce como cofactor durante la vida fetal estimulando la secreción de alguno de los factores de crecimiento presentes durante la vida posnatal.

Introduction: folic acid consumption represents a health problem worldwide, while several congenital defects are considerable as preventable with enough level of folic acid in mothers. Objective: to show the effects of acid folic over some morphometrical variables in newborn Wistar rats. Material and method: an experimental analytic study was carried out in 116 newborn Wistar rats. The variables used are: tail length, biparietal diameter, and body mass. Five groups of two rat each were made up: one target group and four groups treated with folic acid, taking into account dosis and gestation time; the measuring were made on the first and third day after the rats’ birth. The variable analysis were carried out by the calculation of the mean and stadard deviations, and for comparisson of the average numbers a level of significance α ≤0,05 were used. Results: the measuring of the tail length showed statistical significance (P<0.05) when the target group and the treated groups were compared, the variables biparietal diameter and body mass did not present any statistical significance despite the fact that the measures of the variable body mass in the treated groups were higher than in the target group. Conclusions: the need for acid folic supply before and during gestation in Wistar rats was proved, due to its influence as cofactor during the fetal life, stimulating the secretion of any of the growing factors during the postnatal life.

Influence of Gestational Age Estimated with Biparietal Diameter on Second Trimester Down Syndrome Screening / 中国医科大学学报

Objective to evaluate the impacts of 6 standard comparible tables of biparietal diameter(BPD)-gestational age to the second trimester Down syndrome screening and the individual risk rate for pregnant woman. Methods A total of 25 346 pregnant woman with gestational age be-tween 12 to 20 weeks were recruited and analyzed in the study,including 32 Down syndrome. For each pregnant woman,we calculated the gestation-al age by six different BPD-gestational age tables,and the prenatal screening risk value of gestational age. then ROC curve,detection rate and posi-tive rate were used to evaluate the effect of different control tables on the screening results. In addition,individual risk rate was used to determine the influence of gestational age deviation on pregnant woman. Results According to the ROC,we found that our self-designed BPD table had the best AUC(0.972),while the table designed by a hospital in Shanghai had the least AUC(0.923). the difference was significant by statistic test(P =0.045). With the same detection rate of 75%,we found our self-designed table had the least positive rate with only 2.3%,and the cutoff was 1∶280, while the table of Chinese Obstetrics and Gynecology had the highest ratio(4.8%),and the cutoff was 1∶345. Our results suggest that once gesta-tional age is estimated to be higher than actual age,the risk will be higher and the positive rate will increase. However,if gestational age is estimated to be smaller,the risk will be smaller and the negative rate will increase. Conclusion the impacts of different tables on Down syndrome screening are different. Our self-designed BPD table is the most effective to estimate gestational age,and the control table of Hongkong is ranked No.2. the wrong estimation of gestational age will largely affect the individual risk of pregnant woman.

Fetal biparietal diameter from 28 weeks of gestation measured with ultrasound

From September 1999 to September 2001 in the Institute of protection of mother and newborn, a study was conducted to measure the biparietal diameter of fetus using ultrasound on 115 pregnant women aged 20-45 among them 53 (54,8%) unipara, 44 (38,3%) secundipara and 8 (6,9%0 multipara women. In the study, a total of 597 ultrasound examination was performed. Results showed a strict correlation between the diameter and the age of fetus during the period from 28 weeks. In average, biparietal diameter reaches an increase of 1,68 mm weekly

Assessment of fetal lung maturity by free-floating particles in amniotic fluid and biparietal diameter by ultrasonography.

The accuracy of Free-floating particles (FFPs) and biparietal diameter (BPD) detected and measured by ultrasonography for assessment of fetal lung maturity were compared with the lecithin/sphingomyelin (L/S ratio) which was used as the gold standard. One hundred pregnant women in the lately third trimester who required amniocentesis for fetal lung maturity testing, from July 1998 to August 1999 at Siriraj Hospital, were included in this study. Ultrasonography was performed to evaluate the presence of FFPs in the amniotic fluid and the BPD was measured. Amniotic fluid for L/S ratio was obtained by amniocentesis. The presence of FFPs had a 58.3% specificity and a 41.7% false positive rate. A BPD value of at least 94 millimeters had 100% specificity and no false positives. When the presence of FFPs and a BPD value of at least 93 millimeters were used in combination, the test gave 100% specificity and no false positives. The presence of FFPS and a BPD value of at least 93 millimeters detected by real time ultrasonography may be used as predictive parameters to indicate fetal lung maturity.

Evaluation of Gestational Age Based on Ultrasound Fetal Growth Measurements

Monitoring fetal growth and assessing its predictors have important place in antenatal care management. Accurate prediction of gestational age (GA) and birth weight (BW) is clinically important. Standard growth curve chosen should be evaluated to see if it satisfies the criteria for a valid assesment. In this paper, for the purpose of contributing to develop national standards and to evaluate Hadlock's standard data pertaining to 1411 fetuses were examined. Of 1411 normally growing fetuses, one measurement for AC, BPD and FL was taken by ultrasound. GA was assessed via menstrual history which is also confirmed by ultrasonography. Several variables, AC, BPD, FL, FL/AC, BPD/FL and dependent variables (GA & BW) were modelled mathematically. Percentile values, correlation coefficients were calculated and well functioning regression equations were produced for the fetal growth evaluation. Simple correlation model re-confirmed that AC, BPD and FL were well predictors of GA. Via modelling by multivariate regression analysis (adj. R2=937), GA=4.945 (95% CI: 4.661- 5.654) + .606 AC + .105 BPD + .286 FL can be estimated. It couldn't be possible establishing an appropriate equation for prediction of BW vith current data. Our study is intended to draw an attention on requirement of national standards although Hadlock's standard growth curve may evaluate fetal development accurately. Forming comprehensive cohort group is under our consideration. The equation we developped (shown in the results), might be a working contribution.