scholarly journals Predictive value of the quantitative fetal fibronectin levels for the management of women presenting with threatened preterm labour – A revised cut off level: A retrospective cohort study

Author(s):  
Kassam Mahomed ◽  
Ibinabo Ibiebele ◽  
Christine Fraser ◽  
Consuela Brown
2019 ◽  
Author(s):  
Juan Jesus Fernández Alba ◽  
Estefania Soto Pazos ◽  
Rocio Moreno Cortes ◽  
Angel Vilar Sanchez ◽  
Carmen Gonzalez Macias ◽  
...  

Abstract Background Gestational diabetes mellitus is associated with increased incidence of adverse perinatal outcomes including newborns large for gestational age, macrosomia, preeclampsia, polihydramnios, stillbirth, and neonatal morbidity. Thus, fetal growth should be monitored by ultrasound to limit fetal overnutrition, and thereby, its clinical consequence, macrosomia. However, it is not clear which reference curve to use to define the limits of normality. Our aim is to determine which method, INTERGROWTH21st or customized curves, better identifies the nutritional status of newborns of diabetic mothers.Methods This retrospective cohort study compared the risk of malnutrition in SGA newborns and the risk of overnutrition in LGA newborns using INTERGROWTH21st and customized birth weight references in gestational diabetes. Additionally, to determine the ability of both methods in the identification of neonatal malnutrition and overnutrition, we calculate sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratios.Results 231 pregnant women with GDM were included in the study. The rate of SGA indentified by INTERGROWTH21st was 4.7% vs 10.7% identified by the customized curves. The rate of LGA identified by INTERGROWT21st was 25.6% vs 13.2% identified by the customized method. Newborns identified as SGA by the customized method showed a higher risk of malnutrition than those identified as SGA by INTERGROWTH21st.(RR 4.24 vs 2.5). LGA newborns according to the customized method also showed a higher risk of overnutrition than those classified as LGA according to INTERGROWTH21st. (RR 5.26 vs 3.57). In addition, the positive predictive value of the customized method was superior to that of INTERGROWTH21st in the identification of malnutrition (32% vs 27.27%), severe malnutrition (22.73% vs 20%), overnutrition (51.61% vs 32.20%) and severe overnutrition (28.57% vs 14.89%).Conclusions In pregnant women with GDM, the ability of customized fetal growth curves to identify the newborns with alterations in nutritional status exceeds that of INTERGROWTH21st.


2021 ◽  
Author(s):  
Yi Ye ◽  
Guanghui Zheng ◽  
Yueyue Kong ◽  
Jiawei Ma ◽  
Guojun Zhang ◽  
...  

Abstract Background: Previous studies discuss the positive predictive value through whether the bacteria are coagulase-negative staphylococci. The view may need to be updated. The aim was to evaluate the positive predictive value of different bacteria species isolated from cerebrospinal fluid cultures and discuss the rationality to view coagulase-negative staphylococci as a group.Methods: This retrospective cohort study recruit all adults with positive cerebrospinal fluid cultures sampled by lumbar puncture 2012-2020 in the Department of Neurosurgery. The exposure was bacteria species, and the outcome was positive predictive value. An episode was defined as a patient with one bacteria. When episodes with a bacteria species reached five, the bacteria species was analyzed specifically. The positive predictive value was defined as the incidence of isolated-bacteria-related infected episodes. The isolated-bacteria-related infected episode was defined as the patient was with clinical features of bacterial meningitis, and the improvement was related to sensitive antibacterial agents. Then the differences of the positive predictive value of different bacteria in all specific bacteria species, coagulase-negative staphylococci, and non-coagulase-negative staphylococci bacteria were calculated, respectively. The results were statistically significant when P-value <.05.Results: 1180 episodes from 1133 patients with 79 bacteria were studied; the positive predictive value was 54.3%. The bacteria included 67 bacteria species, ten bacteria genus, viridans streptococci, and unclassified coagulase-negative staphylococci. Twenty-four specific bacteria species were analyzed. The range of positive predictive values of them was 29.4%-100.0% (P<.0001). The positive predictive value for Enterobacter aerogenes, Pseudomonas aeruginosa, Enterobacter cloacae, and Klebsiella oxytoca was the highest, while the positive predictive value for Staphylococcus cohnii was the lowest. Moreover, 767 (65.0%) were with coagulase-negative staphylococci, the positive predictive value was 46.4%, and the range was 29.4%-85.7% (P=.0020); 413 (35.0%) were with non-coagulase-negative staphylococci bacteria, the positive predictive value was 69.0%, and the range was 40.0%-100.0% (P<.0001).Conclusions: This study suggests that the positive predictive value of different bacteria species is different. It is more reasonable to discuss the positive predictive value of bacteria isolated from cerebrospinal fluid cultures through the bacteria species rather than whether they are coagulase-negative staphylococci.Trial registration: This is a retrospective study without interventions on participants.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jiang-Nan Wu ◽  
Ming-Qing Li ◽  
Feng Xie ◽  
Bin Zhang

Abstract Background Plenty of studies explored the relationship between uterine artery (UtA) Doppler indices and the onset of preeclampsia at different trimesters. However, few studies test the gestational week-specific predictive value of the UtA indices for subsequent preeclampsia and compare the difference of right or left UtA indices (e.g., pulsatility or resistance index [PI or RI]). Methods Hospital-based retrospective cohort study of singleton pregnant women who received the Doppler test between 2012 and 2016 was conducted in 2018. The predictive performance of the UtA indices for preeclampsia and its variants, including early-onset preeclampsia (< 34 weeks) and preterm preeclampsia (< 37 weeks), was estimated. Results The UtA indices, with a cutoff value of 1.11 for the right and left UtA-PI, and 0.66 and 0.63 for the right and left UtA-RI, respectively, were effective predictors for subsequent preeclampsia. The prediction was satisfactory at the 9th week of the Doppler scan: areas under the curve ≥ 0.80, the Youden index ranging from 0.54 to 0.58, the sensitivity of 63.2 ~ 73.7%, and the specificity 84.2 ~ 91.3%, respectively. The UtA indices had comparable performance in screening for early-onset and preterm preeclampsia but showed lower predictive value for late-onset cases. Among these indices, the right UtA-RI had the highest specificity (all P < 0.01), while the left UtA-PI showed good authenticity (higher Youden index) in predicting the disorder. Conclusions The second-trimester measured UtA indices had a satisfactory performance at the 9th week in predicting subsequent preeclampsia. The right UtA-RI was the first choice in ruling out preeclampsia, while the left UtA-PI showed the best authenticity of the prediction.


2020 ◽  
Author(s):  
Juan Jesus Fernández Alba ◽  
Estefania Soto Pazos ◽  
Rocio Moreno Cortes ◽  
Angel Vilar Sanchez ◽  
Carmen Gonzalez Macias ◽  
...  

Abstract Background Gestational diabetes mellitus is associated with increased incidence of adverse perinatal outcomes including newborns large for gestational age, macrosomia, preeclampsia, polyhydramnios, stillbirth, and neonatal morbidity. Thus, fetal growth should be monitored by ultrasound to assess for fetal overnutrition, and thereby, its clinical consequence, macrosomia. However, it is not clear which reference curve to use to define the limits of normality. Our aim is to determine which method, INTERGROWTH21st or customized curves, better identifies the nutritional status of newborns of diabetic mothers. Methods This retrospective cohort study compared the risk of malnutrition in SGA newborns and the risk of overnutrition in LGA newborns using INTERGROWTH21st and customized birth weight references in gestational diabetes. The nutritional status of newborns was assessed using the ponderal index . Additionally, to determine the ability of both methods in the identification of neonatal malnutrition and overnutrition, we calculate sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratios. Results 231 pregnant women with GDM were included in the study. The rate of SGA indentified by INTERGROWTH21st was 4.7% vs 10.7% identified by the customized curves. The rate of LGA identified by INTERGROWTH21st was 25.6% vs 13.2% identified by the customized method. Newborns identified as SGA by the customized method showed a higher risk of malnutrition than those identified as SGA by INTERGROWTH21st. (RR 4.24 vs 2.5). LGA newborns according to the customized method also showed a higher risk of overnutrition than those classified as LGA according to INTERGROWTH21st. (RR 5.26 vs 3.57). In addition, the positive predictive value of the customized method was superior to that of INTERGROWTH21st in the identification of malnutrition (32% vs 27.27%), severe malnutrition (22.73% vs 20%), overnutrition (51.61% vs 32.20%) and severe overnutrition (28.57% vs 14.89%). Conclusions In pregnant women with DMG, the ability of customized fetal growth curves to identify newborns with alterations in nutritional status appears to exceed that of INTERGROWTH21st


2017 ◽  
Vol 20 (1) ◽  
pp. 84-89 ◽  
Author(s):  
Cameron Sklar ◽  
Maryna Yaskina ◽  
Sue Ross ◽  
Kentia Naud

Significant management decisions in triplet pregnancies are made based mainly on ultrasound measurements of fetal growth, although there is a paucity of data examining the accuracy of fetal weight measurements in these gestations. To evaluate accuracy of prenatal ultrasound to diagnose growth abnormalities (intrauterine growth restriction, severe growth discordance) in triplet pregnancies, a retrospective cohort study of 78 triplet pregnancies (234 fetuses) delivered at a single tertiary hospital from January 2004 to May 2015 was performed. Growth percentiles from the last ultrasound were derived from estimated fetal weight using Hadlock's formula for each triplet. Growth discordance was calculated for each triplet set using the formula {(estimated fetal weight largest triplet - estimated fetal weight smallest)/estimated fetal weight largest}. These estimations were compared to birth weights. Sensitivity of ultrasound to predict ≥1 growth restricted fetus in a triplet set was 55.6% [95% CI 35.3, 74.5]; specificity was 100% [95% CI 93.0, 100]; positive predictive value (PPV) 100% [95% CI 74.7, 100]; negative predictive value (NPV) 81.0% [95% CI 73.2, 85.7%]. Sensitivity of ultrasound to detect fetal growth discordance >25% in a triplet set was 80.0% [95% CI 44.4, 97.5], specificity 94.1% [95% CI 85.6, 98.4]; PPV 66.7% [95% CI 42.4, 84.5]; NPV 97.0% [95% CI 90.2, 99.1]. Prenatal ultrasound currently remains the most reliable tool to screen for growth anomalies in triplet pregnancies; however, it appears to have less than ideal sensitivity, missing a number of cases of intra-uterine growth restriction and significant growth discordance.


2019 ◽  
Vol 133 (06) ◽  
pp. 477-481 ◽  
Author(s):  
D Selwyn ◽  
J Howard ◽  
P Cuddihy

AbstractObjectivePre-operative imaging is often used to predict the extent of a cholesteatoma and anatomical variation to plan for surgery. This study aimed to measure the predictive accuracy of computed tomography findings.MethodsA retrospective cohort study was conducted of all patients in a district general hospital undergoing mastoid surgery within a consecutive 12-month period, in whom computed tomography had been performed prior to operative intervention. The study measured the key findings of pre-operative computed tomography imaging and compared them to the intra-operative findings.ResultsA total of 106 patients were included. The sensitivity and specificity for predicting cholesteatoma were 79 per cent and 81 per cent respectively. The positive predictive value was 90 per cent and the negative predictive value was 65 per cent. In predicting complications of cholesteatomas, the sensitivity was 70 per cent, whereas the specificity was 91 per cent. The positive predictive value was 88 per cent and the negative predictive value was 76 per cent.ConclusionPre-operative computed tomography conducted prior to mastoid surgery has high positive predictive values for both predicting cholesteatomas and complications (90 per cent and 88 per cent respectively).


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