Association between antenatal ultrasound findings and neonatal outcomes in rural Uganda: a secondary analysis

Abstract Background Although the use of prenatal ultrasound services has increased in low- income and lower middle-income countries, there has not been a concurrent improvement in perinatal mortality. It remains unknown whether individual ultrasound findings in this setting are associated with neonatal death or the need for resuscitation at delivery. If associations are identified by ultrasound, they could be used to inform the birth attendant and counsel the family regarding risk, potentially altering delivery preparedness in order to reduce neonatal mortality. Methods This was a secondary analysis of data collected from a prospective cohort. Data was gathered at Nawanyago Health Centre III in Kamuli District, Uganda. Participants included pregnant women who received second and third trimester prenatal ultrasound scans and delivered at that center between July 2010 and August 2018. All ultrasounds were performed at Nawanyago and deliveries were attended solely by midwives or nurses. Predictor variables included the following ultrasound findings: fetal number, fetal presentation, and amniotic fluid volume. The primary outcome was bag-mask ventilation (BMV) of the neonate at delivery. The secondary outcome was stillbirth or neonatal death in the delivery room. Results Primary outcome data was available for 1105 infants and secondary outcome data was available for 1098 infants. A total of 33 infants received BMV at delivery. The odds of receiving BMV at delivery was significantly increased if amniotic fluid volume was abnormal (OR 4.2, CI 1.2-14.9) and there were increased odds for multiple gestation (OR 1.9, CI 0.7-5.4) and for non-vertex fetal presentation (OR 1.4, CI 0.6-3.2) that were not statistically significant. Stillbirth or neonatal death in the delivery room was diagnosed for 20 infants. Multiple gestation (OR 4.7, CI 1.6-14.2) and abnormal amniotic fluid volume (OR 4.8, CI 1.0-22.1) increased the odds of stillbirth or neonatal death in the delivery room, though only multiple gestation was statistically significant. Conclusion Common findings that are easily identifiable on ultrasound in low- and lower middle-income countries are associated with adverse perinatal outcomes. Education could lead to improved delivery preparedness, with the potential to reduce perinatal mortality. This was a preliminary study; larger prospective studies are needed to confirm these findings.

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Investigation into the reproducibility of the association of cord blood magnesium concentration and cerebral palsy or death in children

10.21203/rs.3.rs-19283/v1 ◽

2020 ◽

Author(s):

Christopher Luke Dixon ◽

Xiaoxi Liu ◽

Alfred Balch ◽

Maged Costantine ◽

Catherine M. Sherwin

Keyword(s):

Cerebral Palsy ◽

Cord Blood ◽

Magnesium Sulfate ◽

Neonatal Death ◽

Primary Outcome ◽

Controlled Trial ◽

Secondary Analysis ◽

Magnesium Concentration ◽

Secondary Outcome ◽

Ultrasound Findings

Abstract Objective: To evaluate the association of cord blood magnesium concentrations at the time of birth with cerebral palsy (CP) and neonatal death. Study Design: A secondary analysis of a randomized controlled trial that randomized women at imminent risk of delivery between 24 and 31 weeks of gestation to receive magnesium sulfate or placebo. This ‘study’s primary outcome was a composite of either moderate to severe CP or death. Secondary outcomes included CP, moderate to severe CP, neonatal death, and neonatal head ultrasound findings. We used a logistic regression model to evaluate the relationship between the concentration of magnesium in cord blood and study outcomes. Results: A total of 668 women were included in this analysis and were randomized to magnesium sulfate at 28 ± 2.5 ‘weeks’ gestation. Cord blood magnesium concentrations were not associated with the primary outcome of infant death by 1 year of age or moderate or severe cerebral palsy, as assessed at or beyond 2 years of age (aOR 0.95 (0.67, 1.36), p = 0.79). Cord blood magnesium concentrations were not associated with any of the secondary outcome measurements. Conclusion: Cord blood magnesium concentrations were not associated with moderate to severe cerebral palsy or death, or other neurodevelopmental or sonographic outcomes.

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Sonographic Assessment of Amniotic Fluid Volume using Single Deepest Pocket (SDP) among Igbo Women with Uncomplicated Singleton Pregnancies.

10.33798/ajmas2019/00265. ◽

2019 ◽

Vol 2 (1) ◽

pp. 1-18

Author(s):

Chijioke Okeudo ◽

B.U. Ezem

Keyword(s):

Amniotic Fluid ◽

Gestational Age ◽

Cross Sectional Study ◽

Fluid Volume ◽

Singleton Pregnancy ◽

Cross Sectional ◽

South Eastern ◽

Amniotic Fluid Volume ◽

The Mean ◽

Singleton Pregnancies

Background: The amniotic fluid is fundamental for proper fetal development and growth. Ultrasound visualization of the amniotic fluid permits both subjective and objective estimates of the amniotic fluid. Objective: The objective of this study was to determine the reference values of normal single deepest pocket (SDP) – upper and lower limits, mean SDP and variation of the SDP with gestational age among Igbo women of South-Eastern Nigeria extraction carrying uncomplicated singleton pregnancy. Methodology: This was a prospective cross sectional study involving 400 women carrying uncomplicated singleton pregnancies and who were sure of the date of the first day of their last menstrual period. The single deepest pocket / maximum vertical pool were determined once at presentation at the hospital.. The study was conducted from January 1st to December 31st 2015. The second author carried out all the scanning. The SDP was obtained. Results: The womens’ mean and median ages were the same at 28 years. The gestational age range of the pregnancies was 14-41 weeks. The mean SDP was 5.8cm, while the 5th and 95th percentiles were 3.3cm and 8.5cm respectively. There was no difference in the mean SDP in both term and preterm. There was irregular but continuous rise of mean SDP to a peak of 6.8cm at gestational age of 39 weeks. In conclusion, the participants had a mean SDP of 5.8cm. There was also a positive correlation between SDP and Gestational age. We therefore recommend a longitudinal study to assess perinatal outcome and abnormal amniotic fluid volume among Igbo women of South-Eastern Nigeria. Key words: Single Deepest Pocket, Uncomplicated Singleton Pregnancy, Igbo Women.

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1129 How useful is assessment of amniotic fluid volume in antenatal surveillance of fetal growth restriction?

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2020.12.1153 ◽

2021 ◽

Vol 224 (2) ◽

pp. S696

Author(s):

Lauren Sayres ◽

Camille Driver ◽

Xinyi Yang ◽

Mary Sammel ◽

Heather Straub ◽

...

Keyword(s):

Amniotic Fluid ◽

Fetal Growth ◽

Fetal Growth Restriction ◽

Fluid Volume ◽

Growth Restriction ◽

Amniotic Fluid Volume

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Fetal hyperechogenic kidney with normal amniotic fluid volume: a diagnostic dilemma

Prenatal Diagnosis ◽

10.1002/pd.1185 ◽

2005 ◽

Vol 25 (7) ◽

pp. 553-558 ◽

Cited By ~ 23

Author(s):

R. Mashiach ◽

M. Davidovits ◽

B. Eisenstein ◽

D. Kidron ◽

M. Kovo ◽

...

Keyword(s):

Amniotic Fluid ◽

Fluid Volume ◽

Diagnostic Dilemma ◽

Amniotic Fluid Volume

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Ultrasonographic measurement of amniotic fluid volume in normal diamniotic twin pregnancies

American Journal of Obstetrics and Gynecology ◽

10.1016/s0002-9378(96)70340-x ◽

1996 ◽

Vol 174 (3) ◽

pp. 1003-1007 ◽

Cited By ~ 25

Author(s):

Ann C. Chau ◽

Siri L. Kjos ◽

Bruce W. Kovacs

Keyword(s):

Amniotic Fluid ◽

Fluid Volume ◽

Amniotic Fluid Volume ◽

Twin Pregnancies

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Function curve of the membranes that regulate amniotic fluid volume in sheep

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.01284.2004 ◽

2005 ◽

Vol 289 (1) ◽

pp. H146-H150 ◽

Cited By ~ 12

Author(s):

Job Faber ◽

Debra Anderson ◽

Roger Hohimer ◽

Qin Yang ◽

George Giraud ◽

...

Keyword(s):

Amniotic Fluid ◽

Absorption Rate ◽

Plasma Renin ◽

Fluid Volume ◽

Natural Rate ◽

Fetal Plasma ◽

Amniotic Fluid Volume ◽

Urine Production ◽

Rate Of Absorption ◽

Vascular Catheters

Seven singleton 120-day fetal lambs were prepared with a shunt from the lung to the gastric end of the esophagus, a bladder catheter, and multiple amniotic fluid and vascular catheters. The urachus was ligated. Beginning 7 days later, amniotic fluid volumes were determined by drainage, followed by replacement with 1 liter of lactated Ringer (LR) solution. Urine flow into the amnion was measured continuously. In 14 of 27 experiments, amniotic fluid volumes were determined again 2 days after the inflow into the amnion had consisted of urine only and in 13 experiments after the inflow of urine had been supplemented by an intraamniotic infusion of LR solution. Intramembranous absorption was calculated from the inflows and the changes in volume between the beginning and end of each experiment. The relations between absorption rate and amniotic fluid volume, the “function curves,” were highly individual. Urine production during the infusion of LR solution did not decrease, fetal plasma renin activity decreased ( P < 0.001), and amniotic fluid volume increased by 140% [SE (27%), P < 0.005], but the increase in the amniochorionic absorption rate of 411% [SE (48%), P < 0.001] was greater ( P < 0.005) than the increase in volume. Each of the seven fetuses was proven capable of an average intramembranous absorption rate that exceeded 4.5 liters of amniotic fluid per day. During the infusion of LR solution, the increase in the rate of absorption matched the rate of infusion (both in ml/h), with a regression coefficient of 0.75 ( P < 0.001). Thus, even for large amniotic fluid volumes, volume is not limited by the absorptive capacity of the amniochorion, and, at least in these preparations, the position of the function curve and not the natural rate of inflow was the major determinant of resting amniotic fluid volume.

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