scholarly journals Prenatal Prediction of Difficult Intubation in Periviable Neonates Using Standard Fetal Biometric Parameters

2018 ◽  
Vol 36 (06) ◽  
pp. 594-599 ◽  
Author(s):  
Tara Lynch ◽  
J. Glantz ◽  
Kathryn Drennan

Objective To assess whether standard fetal biometric parameters can be used to predict difficult intubations in periviable neonates undergoing resuscitation. Study Design This is a retrospective case–control study of periviable neonates delivered at 23 to 256/7 weeks at an academic hospital during a 5-year period in whom intubation was attempted. Standard fetal biometric measurements were included if they were taken within 7 days of delivery. Primary outcome was intubation in one attempt and was compared with more than one attempt. Data were also collected for fetal gestational age at delivery, neonatal birth weight, estimated fetal weight, head circumference, biparietal diameter, and abdominal circumference. Parametric and nonparametric statistical tests used p < 0.05 as significant. Results In total, 93 neonates met the inclusion criteria. The mean estimated fetal weight was 675 g (standard deviation [SD] ± 140), and the mean neonatal birth weight was 706 g (SD ± 151). The median interval between fetal ultrasound and delivery was 3 days (range: 0–7 days). A total of 45 neonates (48.3%) required more than one intubation attempt. The median number of intubation attempts was 1 (range: 1–10). There was no association between intubation difficulty and fetal abdominal circumference, biparietal diameter, head circumference, gestational age, estimated fetal weight, and neonatal birth weight (all p > 0.05). Conclusion Standard biometry in periviable neonates does not predict intubation difficulty.

2017 ◽  
Vol 35 (08) ◽  
pp. 703-706
Author(s):  
Katherine Himes ◽  
Adriane Haragan

Objective Clinicians use estimated fetal weight (EFW) as a proxy for birth weight (BW) in the antenatal period. Our objective was to compare the accuracy of EFW obtained by ultrasound to BW among infants born during the periviable period and determine if accuracy of EFW varied among small for gestational age (SGA) versus appropriate for gestational age (AGA) grown neonates. Study Design We included women who delivered between 230/7 and 256/7 weeks' gestation and had an EFW within 7 days of delivery. Mean percentage difference and median absolute percentage difference between EFW and BW were calculated. Results Our cohort included 226 neonates with a mean gestational age of 241/7 ± 0.8 weeks and median BW of 653 g (interquartile range [IQR]: 580–750 g). The median absolute percentage difference between EFW and BW of fetal weight estimates was 9.2% (IQR: 3.6–17.2). EFW overestimated BW for 75% (n = 171) of the cohort. Among SGA infants, the mean percentage difference in EFW and BW was 16.2 ± 19.4% versus 6.9% ± 13.1% in AGA infants (p = 0.019). Conclusion EFW overestimated BW in this cohort. In addition, ultrasound was less accurate among infants born SGA. These data are important to consider when counseling families facing periviable delivery.


2005 ◽  
Vol 5 (3) ◽  
pp. 313-317
Author(s):  
Renato A. Moreira de Sa ◽  
Salomon J. Laurent ◽  
Yuichiro Takahashi ◽  
Masami Yamamoto ◽  
Yves Ville

OBJECTIVES: to evaluate the impact of laser therapy on inter-twin discordance in twin-to-twin transfusion syndrome (TTTS). METHODS: biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL) and estimated fetal weight were prospectively collected during a five-year period (1999 to 2004). The inter-twin discordance was expressed as a percentage of the largest twin's measurements. The measurements were made the day before laser, twice following laser and after delivery. The mean values of discordance in measurements and in fetal weight were calculated. ANOVA was used to compare mean values. RESULTS: the mean (SD) discordance for BPD, HC, AC, FL and estimated fetal weight the day before laser were 8.53% (5.28), 8.75% (2.76), 16.19% (4.85), 12.92% (5.13) and 28.50% (6.46) respectively. At the at 2nd ultrasound assessment after surgery were 4.37% (3.55), 3.73% (2.71), 8.90% (4.42), 6.61% (4.99) and 19.11% (8.01) respectively; and at birth the weight discordance was 18.55% (8.74). There was a significant decrease in discordance for HC and AC for each ultrasound assessment. CONCLUSIONS: there was a decrease in fetal growth discordance following laser therapy in TTTS. These changes might be related to re-adaptation of blood flow following laser therapy.


2014 ◽  
Vol 32 (1) ◽  
pp. 21-25
Author(s):  
NR Shapla ◽  
MA Aleem ◽  
E Jesmin ◽  
H Ahmed ◽  
YS Lepe

The estimation of foetal birth weight is an important factor in the management of high risk pregnancies. Estimated foetal weight is calculated in the standard routine antepartum evaluation of high risk pregnancies and deliveries. This prospective observational study was done at the Department of Obstetrics and Gynecology in Border Guard Hospital, Peelkhana, Dhaka over a period of 6 months from January 2012 to June 2012. The present study was carried out to compare the accuracy of actual and ultrasonographic estimation of foetal weight at term. Hundred pregnant women at different gestational age from 37 weeks to 40 weeks were selected by simple random sampling. Ultrasonography was done for determination of estimated foetal weight (EFW) at term by using Hadlock method and birth weight was measured just after delivery. Data analysis was done by percentage and paired ‘t’ test. The age range of patients were 18-37 years with mean ±SD is 25.13±4.46. Among 100 study patients 33% were nuliparous and 67% were multiparous. The mean ±SD of gestational age and actual birth weight is 38.76±1.09 and 3.11±0.391 respectively. Ultrasound biometric data that includes mean ±SD biparietal diameter (BPD) in mm, abdominal circumference (AC) in mm and femur length (FL) in cm were 90.21±3.52, 327.67±20.75 and 7.45±1.43 respectively. Mean ±SD of estimated foetal weight (EFW) Kg was 2.97±0.53. Actual birth weight is correlated with the estimated foetal weight and the result was not statistically significant (P >.05). Calculation of estimated fetal weight by ultrasonography is recommended to make decision about mode of delivery, so that an obstetrician can plan early in high risk cases. DOI: http://dx.doi.org/10.3329/jbcps.v32i1.21032 J Bangladesh Coll Phys Surg 2014; 32: 21-25


2017 ◽  
Vol 45 (2) ◽  
Author(s):  
Sertac Esin ◽  
Mutlu Hayran ◽  
Yusuf Aytac Tohma ◽  
Mahmut Guden ◽  
Ismail Alay ◽  
...  

AbstractObjective:To compare different ultrasonographic fetal weight estimation formulas in predicting the fetal birth weight of preterm premature rupture of membrane (PPROM) fetuses.Methods:Based on the ultrasonographic measurements, the estimated fetal weight (EFW) was calculated according to the published formulas. The comparisons used estimated birth weight (EBW) and observed birth weight (OBW) to calculate the mean absolute percentage error [(EBW–OBW)/OBW×100], mean percentage error [(EBW–OBW)/OBW×100)] and their 95% confidence intervals.Results:There were 234 PPROM patients in the study period. The mean gestational age at which PPROM occured was 31.2±3.7 weeks and the mean gestational age of delivery was 32.4±3.2 weeks. The mean birth weight was 1892±610 g. The median absolute percentage error for 33 formulas was 11.7%. 87.9% and 21.2% of the formulas yielded inaccurate results when the cut-off values for median absolute percentage error were 10% and 15%, respectively. The Vintzileos’ formula was the only method which had less than or equal to 10% absolute percentage error in all age and weight groups.Conclusions:For PPROM patients, most of the formulas designed for sonographic fetal weight estimation had acceptable performance. The Vintzileos’ method was the only formula having less than 10% absolute percentage error in all gestational age and weight groups; therefore, it may be the preferred method in this cohort. Amniotic fluid index (AFI) before delivery had no impact on the performance of the formulas in terms of mean percentage errors.


2017 ◽  
Vol 34 (11) ◽  
pp. 1115-1124 ◽  
Author(s):  
José Yordan ◽  
Bradley Holbrook ◽  
Pranita Nirgudkar ◽  
Ellen Mozurkewich ◽  
Nathan Blue

Objective We compared the sensitivity and specificity of abdominal circumference (AC) alone versus estimated fetal weight (EFW) to predict small for gestational age (SGA) or large for gestational age (LGA) at birth. Study Design We searched the literature for studies assessing an ultrasonographic AC or EFW after 24 weeks to predict SGA or LGA at birth. Case series or studies including anomalous fetuses or multiple gestations were excluded. We computed the sensitivity, specificity, and positive and negative predictive values of any AC or EFW cutoff analyzed by at least two studies. Results We identified 2,460 studies, of which 40 met inclusion criteria (n = 36,519). Four studies assessed AC alone to predict SGA (n = 5,119), and six assessed AC to predict LGA (n = 6,110). Sixteen assessed EFW to predict SGA (n = 13,825), and 22 evaluated EFW to predict LGA (n = 18,896). To predict SGA, AC and EFW < 10th percentile have similar ability to predict SGA. To predict LGA, AC cutoffs were comparable to all EFW cutoffs, except that AC > 35 cm had better sensitivity. Conclusion After 24 weeks, AC is comparable to EFW to predict both SGA and LGA. In settings where serial EFWs are inaccessible, a simpler screening method with AC alone may suffice.


Author(s):  
Samta Solanki ◽  
Anusha S ◽  
B S Meena

Background: Ultrasonographic assessment of gestational age by using different foetal parameter such as BPD, FL, AC are highly reliable in first and second trimester in pregnancy. In third trimester reliability of any single parameter has limitations. Methods: This was a hospital based comparative cross-sectional study done in the Department of Obstetrics and Gynaecology, S.M.S. Medical College and attached hospitals, Jaipur, Rajasthan. The period of study was from June 2018 to October 2019. Results: The mean TCD at 15 weeks and 40 weeks was 15.00 ± 0.00mm and 53.33±1.155mm respectively. The mean BPD at 16 weeks and 40 weeks was 33.50±0.70mm and 93±1.528mm respectively. The mean HC at 15 weeks and 40 weeks was 111.00±1,41mm and 340±2.00mm respectively. The mean FL at 15 weeks and 40 weeks was 18.50±0.70mm and 77.67±1.528mm respectively. The mean AC at 15 weeks and 40 weeks was 99.00±1.41mm and 365.33±8.32mm respectively. Conclusion:  We conclude that foetal transcerebellar diameter can thus be used as an alternative foetal parameter to assess gestational age and can be used in cases of wrong dates or when other routine parameters are not conclusive or did not accurately predict gestational age for e.g. in cases of hydrocephalus, brachycephaly, dolicocephaly, intrauterine growth restriction, achondroplasia or short limb dwarfism. Keywords: Gestational age, Linear regression, BPD


2017 ◽  
Vol 4 (6) ◽  
pp. 1638
Author(s):  
Sunil Pant ◽  
Sunita Dashottar

Background: The dating of the pregnancy starts well before the fertilization has occurred because the gestational age is calculated from the first day of the last menstrual period (LMP). Accurate knowledge of the Gestational Age (GA) is the key for the good antenatal care and successful deliveries of babies. Menstrual history can be unreliable or misleading at many times. There may be fallacy in the measurement of the fetal biometric parameters in estimating the gestational age in some situation. So, there is a need of another parameter for supplementing the gestational age estimation with minimal error. The aim of the study was to evaluate the placental thickness as a parameter for estimation of gestational age and also to assess the growth pattern of placenta with advancing gestational age.Methods: A total of 110 pregnant women who selected randomly from the antenatal clinics (between the gestational ages from 14 weeks to 40 weeks) who did not have any maternal or fetal complications. The biometric parameters: Biparietal Diameter (BPD), Head Circumference (HC), Abdominal Circumference (AC), Femur Length (FL) and the Placental thickness (PT) were measured by ultrasound machine LOGIQ P5 unit with a curvilinear 3.5 MHz transducer. Mean value of the placental thickness along with the standard deviation (SD) and 95% confidence interval were calculated for each gestational age from 14 weeks to 40 weeks. Pearson’s correlation analysis and linear regression analysis was done quantifying the relationship between the gestational age in weeks and the placental thickness in millimetres.Results: The mean values of placental thickness show a perfect positive relationship (increasing trend) with gestational age and the mean value of placental thickness almost correspond to the gestational age till 35 weeks of the gestational age and fall marginally from 36 weeks. Placental thickness showed positive and significant correlation with gestational age (P-value<0.001) and Pearson’s correlation coefficient (r) of 0.990.Conclusions: Placental thickness can be an additional parameter for estimation of the gestational age as it almost corresponds with the gestational age in second and third trimesters. Also, any abnormal placental thickness for the particular gestational age should raise the suspicion of underlying fetal or maternal disease condition which can cause an increased or decreased in the placental thickness and should be addressed in time.


2018 ◽  
Vol 8 (3) ◽  
pp. 82-89
Author(s):  
Tran Thao Nguyen Nguyen ◽  
Van Duc Vo ◽  
Ngoc Thanh Cao

Objectives: To identify the values of CPR in intrauterine growth restriction and evaluate the correlation between cerebroplacental ratio and adverse outcomes in intrauterine growth restriction. Material and methods: A prospective study was conducted on 74 cases of intrauterine growth restriction with an estimated fetal weight less than 10th percentile, at Departement of Obstetric and Gynecology of Hue University of Medicine and Pharmacy from 05/2016 – 05/2017. CPR was calculated by PIMCA/PIUA.. The adverse outcomes included gestational age at delivery, methods used to delivery, APGAR score below 7 at 1 minutes and 5 minutes, admission at NICU, perinatal deaths, neonatals deaths. Results: The mean of CPR in group of early IUGR and late IUGR were 0.55 ± 0.14, 1.59 ± 0.69, respectively. The mean of CPR in group IUGR with an estimated fetal weight under the 3th percentile was 1.49 ± 0.76, lower than the mean of CPR in group IUGR with an estimated fetal weight from 3th percentile to 10th percentile. With cut – off at 1, CPR < 1 had the higher prevalence in group of early IUGR, in group IUGR with the estimated fetal weight below the 3th percentile, in group IUGR with hypoamniotic or oligohydramnios. The mean of gestational age at delivery of group IUGR with CPR < 1 and CPR >1 were 37.00 ± 3.18, and 38.59 ± 1.76, respectively. The rate of emergency cesarean section deliveries in the CPR < 1 and CPR > 1 group were 68.75% and 39.65%, respectively (p <0.05). Percentage of neonatal with APGAR ≤ 7 at 1 minute in the group with CPR < 1 and CPR > 1 were 56.25% and 22.41%, respectively. Rate of prenatal death was 12.5 in group IUGR with CPR < 1. Conclusion: There was a strong correlation between CPR and adverse outcomes in intrauterine growth restriction. Key words: intrauterine growth restriction, CPR ratio, middle cerebro artery, umbilical artery


2020 ◽  
Vol 5 (2) ◽  
pp. 24-27
Author(s):  
Leo Jumadi Simanjuntak ◽  
Patrick Anando Simanjuntak

Background: Estimated fetal weight (EFW) is important to determine mode of delivery. The use of estimated fetal weight based on fundal height has been widely used, but the use on overweight mothers is still limited. Objectives: This study aimed to compare the Johnson’s and Risanto’s formula in estimating fetal weight on overweight mothers. Method: The design used was cross-sectional, conducted at Mitra Sejati, Herna, and Methodist Sussana Wesley hospital on November 2019 until January 2020. Mann-Whitney test was used to compare EFW mean differences between Johnson’s and Risanto’s to actual birth weight. Paired t-test was used to compare EFW mean differences between Johnson’s and Risanto’s. Results: There were 103 overweight pregnant mothers fulfilling study criteria. The BMI mean was 31,26 ± 5l,54 kg/m2. Both Johnson’s and Risanto’s formula had no significant mean difference compare to actual birth weight, of 332,45 gram on Johnson’s (p value = 0,070) and 298,57 gram on Risanto’s (p value = 0,863). The mean difference between Risanto’s formula and actual birth weight was significantly lower than Johnson’s (mean difference = 33,88 gram, p value = 0,01). Conclusions: EFW measurement using Johnson’s and Risanto’s formula based on fundal height can be applied and used properly by health care workers. Risanto’s formula was more accurate to estimate fetal weight than Johnson’s in overweight mothers.   Latar belakang: Menentukan taksiran berat janin (TBJ) adalah penting bagi penolong persalinan untuk menentukan jenis persalinan. Pengukuran TBJ menggunakan tinggi fundus uterus merupakan metode yang banyak digunakan, namun penggunaan pada ibu hamil dengan berat badan berlebih masih terbatas. Tujuan: Penelitian ini bertujuan membandingkan rumus Johnson dan rumus Risanto dalam menentukan TBJ pada ibu hamil dengan berat badan berlebih. Metode: Desain penelitian adalah potong lintang, data diambil di RSU Mitra Sejati, RSU Herna, dan RSU Methodist Sussana Wesley pada November 2019 – Januari 2020. Dilakukan uji Mann-Whitney untuk membandingkan perbedaan rerata TBJ dengan rumus Johnson dan Risanto dengan berat badan lahir. Uji-t berpasangan digunakan untuk membandingkan perbedaan rerata TBJ dengan rumus Johnson dan Risanto. Hasil: Didapatkan 103 ibu hamil yang memenuhi kriteria penelitian dengan rerata IMT 31,26 ± 5l,54 kg/m2. Terdapat perbedaan rerata TBJ rumus Johnson dan rumus Risanto dibandingkan berat badan lahir sebesar 332,45 gram dan 298,57 gram. Tidak terdapat perbedaan rerata bermakna antara penghitungan TBJ menggunakan rumus Johnson dengan berat badan lahir (p = 0,070) dan rumus Risanto dengan berat badan lahir (p = 0,863). Perbedaan selisih TBJ Risanto dengan berat badan lahir lebih rendah dibandingkan selisih TBJ Johnson dengan berat badan lahir, yaitu sebesar 33,88 gram dan bermakna secara statistik (p = 0,01). Kesimpulan: Pengukuran TBJ menggunakan rumus Johnson dan rumus Risanto dapat diterapkan dan digunakan dengan baik oleh tenaga medis. Rumus Risanto memiliki tingkat ketepatan yang lebih baik dibandingkan rumus Johnson dalam menentukan TBJ pada ibu hamil dengan berat badan berlebih.


2020 ◽  
Vol 3 (1) ◽  
pp. e1-e4
Author(s):  
Rabia Razaq

Background: Accurate prenatal estimation of birth weight is useful in the management of labour and delivery. Objective: To determine the correlation between clinical estimated fetal weight with actual birth weight in 3rd trimester of pregnancy and to determine the correlation between Ultrasonographic fetal weight assessment with actual birth weight in 3rd trimester of pregnancy. Material & Methods: This cross sectional study with non-probability purposive sampling technique was conducted in three tertiary care hospitals of Punjab, Department of Obstetrics & Gynaecology, Allied Hospital, Faisalabad, Lady Aitcheson Hospital Lahore and Lady Willington Hospital Lahore. Informed consent was obtained from each female to use their data for research purpose. Demographic details were also noted. Then females undergo CEFW was done by using Johnson’s formula. Then ultrasonography was done on every female by experienced radiologists to get UEFW. FW measurement was done by using Shepard formula. Then females were followed-up till delivery of fetus. Actual birth weight (ABW) was noted on birth. Pearson correlation was used to measure the correlation coefficient for CEFW and UEFW with ABW. P-value≤0.05 was taken as significant. Results: In our study the mean age of the patients was 29.60±6.23 years and the mean gestational age of 33.30±2.31 weeks. The mean BMI value of the patients was 23.08±1.26 Kg/m2, the mean CEFW value 2219.60±556.41 grams while the mean UEFW value of the patients was 2227.77±521.94 grams and the mean value of ABW of the patients was 2284.00±515.29 grams. In our study the positive correlation was found between the CEFW, UEFW with ABW of the baby. Conclusion: Our study results concluded that both the clinical estimation ultrasonography estimation showed the feasible and reliable results. Both showed positive correlation with actual birth weight.


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