Estimation of fetal weight using Hadlock's formulas: Is head circumference an essential parameter?

OBJECTIVES: To test the equivalence of two fetal weight estimation formulas generated by Hadlock, a formula that includes head circumference parameter (H1), and another (H2) which excludes this parameter. A secondary aim was to identify the patients in which H2 formula is less reliable to use. STUDY DESIGN: This retrospective cohort study included a total of 1220 sonographic fetal weight estimations performed within seven days of delivery and recorded at a single medical center from January 2014 to December 2016. Estimated fetal weight was calculated using H1 and H2 formulas. Their accuracies were compared using percentage error, the proportion of weight estimations falling within ±15% error interval and by Bland-Altman analysis. Multivariate regression was performed to evaluate factors affecting weight estimation by H2 formula. RESULTS: The mean birth weight was 3288.92 ±â€¯641.27gr. The H2 formula presented with statistically significant higher value of systemic mean percent error comparing to H1 (3.19% vs. 1.87%, p < 0.001 respectively). H2 formula had a lower accuracy compared to H1 in predicting fetal weight within ±15% of birth weight (90.49% vs. 93.44%, p < 0.01 respectively). Using Bland-Altman analysis, the 95% limits of agreement between both formulas were (-142.03) to 231.79gr with a mean of 44.88gr. Factors found to influence significantly on H2 formula were long femur length (OR 1.144, p < 0.0001) and low maternal age (OR 0.947, p < 0.01). CONCLUSIONS: H1formula was more accurate than H2 formula in predicting fetal weight at term. However, the accuracy difference was found to be small. Therefore, if ultrasonographic evaluation of HC is technically difficult, Hadlock formula that excludes head circumference can be used with confidence. Caution should be paid with higher values of femur length and lower maternal age.

Recurrent pregnancy loss and future risk of female malignancies.

PURPOSE: To investigate whether patients with a history of recurrent pregnancy loss (RPL) have an increased risk for future female malignancies. METHODS: A retrospective population-based study compared the incidence of long-term female malignancies in a cohort of women with and without a history of RPL (2 or more consecutive pregnancy losses). Deliveries occurred between the years 1988 and 2013, with a mean follow-up duration of 12 years. Women with known malignancies before the index pregnancy were excluded from the analysis. Female malignancies were divided according to specific type including ovary, breast, uterine and uterine cervix. Kaplan-Meier survival curve was used to estimate the cumulative incidence of malignancies. Cox proportional hazards model was used to determine the adjusted hazard ratios (HR) for female malignancy after controlling for confounders. RESULTS: During the study period, 106,265 patients met the inclusion criteria; 6.6% (n = 7052) of patients had a diagnosis of RPL. During the follow-up period, patients with RPL had a significantly increased risk of being diagnosed with female malignancies as a group, while individually there was an increased risk of breast and uterine cervix cancer. Using a Kaplan-Meier survival curve, patients with a history of RPL had a significantly higher cumulative incidence of female malignancies. Using a Cox proportional hazards model, adjusted for confounders such as smoking, parity, and diabetes mellitus, a history of RPL remained independently associated with female malignancies (adjusted HR 1.4; P = 0.003). CONCLUSIONS: RPL is independently associated with long-term female malignancies. Patients with a history of RPL may benefit from counseling and screening for breast and uterine cervix cancer in particular.

Preeclampsia and Future Risk for Maternal Ophthalmic Complications.

Objective To investigate whether patients with a history of preeclampsia have an increased risk of long-term ophthalmic complications. Study Design A population-based study comparing the incidence of long-term maternal ophthalmic complications in a cohort of women with and without a history of preeclampsia. Results During the study period, a total of 103,183 deliveries met the inclusion criteria; 8.1% (n = 8,324) occurred in patients with a diagnosis of preeclampsia during at least one of their pregnancies. Patients with preeclampsia had a significantly higher incidence of long-term ophthalmic morbidity such as diabetic retinopathy and retinal detachment. In addition, a positive linear correlation was found between the severity of preeclampsia and the prevalence of future ophthalmic morbidities (0.3 vs. 0.5 vs. 2.2%, respectively). Kaplan-Meier survival curve indicated that women with preeclampsia had higher rates of total ophthalmic morbidity (0.2 vs. 0.4%, for no preeclampsia and with preeclampsia, respectively; odds ratio = 2.06, 95% confidence interval: 1.42-2.99; p < 0.001). In a Cox proportional hazards model, adjusted for confounders, a history of preeclampsia remained independently associated with ophthalmic complications. Conclusion Preeclampsia is an independent risk factor for long-term maternal ophthalmic morbidity, specifically diabetic retinopathy and retinal detachment. This risk is more substantial depending on the severity of the disease.

Treating diabetes during pregnancy.

INTRODUCTION: Gestational diabetes mellitus (GDM), defined as glucose intolerance with first recognition or onset during pregnancy, is steadily rising in prevalence. GDM affects ∼ 3 - 5% of pregnancies in the US and is associated with significant adverse perinatal and maternal outcomes. Diagnosing and treating GDM early in pregnancy is of utmost importance as it can prevent poor outcomes such as macrosomia, shoulder dystocia and obstetric complications. AREAS COVERED: This review describes the importance of treating GDM and the various available interventions for glycemic control in women with GDM, including the latest evidence regarding pharmacological treatments and specifically anti-hyperglycemic agents. It deals with timing of pharmacological treatments, recommended doses and what pharmacological agent should be used. EXPERT OPINION: Unless diagnosed late during pregnancy, a stepwise approach is the best way to treat GDM, beginning with diet and exercise and proceeding to pharmacological interventions if failure occurred. Although insulin is the dominant treatment, the use of anti-hyperglycemic agents such as glyburide and metformin in treating GDM has gained popularity and consideration should be made using these agents as first-line pharmacological treatment. Anti-hyperglycemic agents do not require frequent monitoring or injections and may therefore appeal more to patients. Further studies are needed regarding long-acting insulin and other anti-hyperglycemic agents such as thiazolidinediones, as well as identifying treatment options more specific to an individual based on risk factors and other variables predicting treatment outcomes in GDM.

Risk factors for peripartum hysterectomy following uterine rupture.

OBJECTIVE: To investigate risk factors for hysterectomy following uterine rupture. METHODS: A population-based study comparing all uterine ruptures with and without hysterectomy between 1988 and 2011 was conducted. Stratified analysis was performed using a multiple logistic regression analysis. RESULTS: Peripartum hysterectomy complicated 20.7% (n = 34) of uterine ruptures during the study period (n = 164). Independent risk factors for hysterectomy following uterine rupture, from a multivariable logistic regression model, were relaparotomy (OR = 32.2, 95% CI = 2.5-421.9), extended tears involving the uterine cervix (OR = 6.1, 95% CI = 1.5-24.7), severe bleeding requiring packed cells transfusions (OR = 13.7, 95% CI = 3.2-58.5) and grand multiparity (≥5 deliveries, OR = 11.4 95% CI = 2.7-47.1). CONCLUSION: Hysterectomy is not common following uterine rupture. Independent risk factors for hysterectomy include relaparotomy, extended tears involving the uterine cervix, severe bleeding requiring packed cells transfusions and grand multiparity. Trained obstetricians should be involved in cases of uterine rupture and the possibility for conducting hysterectomy should be emphasized.

["Is it safe for my baby?" acoustic exposure of diagnostic ultrasound].

As a form of energy, diagnostic ultrasound (DUS) has the potential to have effects on Living tissues, e.g. bioeffects. The two most likely mechanisms for bioeffects are heating and cavitation. Hyperthermia is considered teratogenic in human fetuses during the first trimester Actual temperature changes cannot be studied in the human fetus. The thermal index [TI) expresses the potential for rise in temperature at the ultrasound's focal point. The mechanical index (MI) indicates the potential for the ultrasound to induce inertial cavitation in tissues. Nevertheless, cavitation has not been documented in mammalian fetuses, since there is not an air-water interface, which is needed for the cavitation mechanism. Since an output of TI over 1.5 is a known hazard, the question is: What are the settings in which such hazardous exposure occurs? Our conclusions regarding safety of DUS, based on the data that has been available till now, are the following: (1) Ultrasound end-users are poorly informed regarding safety issues during pregnancy. Further efforts in the realm of education and training are needed in order to improve knowledge of end-users about the acoustic output of the machines and safety issues. (2) First trimester ultrasound is associated with negligible rise in the thermal index. (3) Increased acoustic output Levels, as expressed by TI levels, are reached while performing obstetrical Doppler studies. In particular, TI Levels may reach 1.5 and above. Doppler procedures should be performed with caution and should be as brief as possible during obstetrical ultrasound. (4) Acoustic exposure levels during 3D/4D ultrasound examination, as expressed by TI are comparable to the two-dimensional B-mode ultrasound.