scholarly journals A study on foetal outcome after diagnosis of oligohydramnios at term in tertiary care center

2017 ◽  
Vol 6 (10) ◽  
pp. 4329
Author(s):  
Sunanda K. M. ◽  
Sudha H. C.
Keyword(s):  
Birth Weight ◽  
Predictive Value ◽  
Care Center ◽  
Tertiary Care ◽  
Control Group ◽  
Study Group ◽  
Foetal Distress ◽  
History Of ◽  
Foetal Outcome ◽  
The Mean

Background: Oligohydramnios is associated with a variety of ominous pregnancy outcomes such as foetal distress, low birth weight, perinatal morbidity and increased incidence of Caesarean section. Objective of present study was to determine the outcome of maternal and Foetal wellbeing after diagnosis of oligohydramnios at term pregnancy.Methods: 50 pregnant women aged between 18 – 27 years were screened with history of oligohydramnios by ultrasound scanning after 37 completed weeks, compared with 50 controls with no oligohydramnios.Results: The mean age of the study group was 22.7 years and of the control group was 22.4 years, respectively. Majority of the patients were primigravidae in both the groups. The mean gestational age was 39.5 weeks in study group and 39.4 in control group. The occurrence of non reactive NST was more in study group compared to the control group. The efficacy of AFI as a screening test to predict foetal distress is more significant with Positive Predictive Value of 57% and Negative Predictive Value of 80%. The mean birth weight was 2.5 kg in the study group compared to 2.75 kg in the control group which is statistically significant. 34 % of the newborns were admitted to NICU in study group compared to 14% in the control group.Conclusions: In the presence of oligohydramnios, the occurrence of non-reactive NST, meconium stained liquor, development of foetal distress are very high.

The predictive value of serum cancer antigen 125 (CA125) levels on pregnancy outcome in threatened miscarriages

2019 ◽  
Vol 47 (7) ◽  
pp. 704-709
Author(s):  
Mosunmola A. Adeku ◽  
Omololu Adegbola ◽  
Godwin O. Ajayi
Keyword(s):  
Pregnancy Outcome ◽  
Predictive Value ◽  
Mean Value ◽  
Maternal Serum ◽  
Enzyme Linked Immunosorbent Assay ◽  
Control Group ◽  
Study Group ◽  
Cancer Antigen 125 ◽  
Serum Ca125 ◽  
The Mean

Abstract Background Spontaneous miscarriages are common pregnancy complications which result in psychological and emotional burden in the affected women. It is therefore necessary to identify biomarkers that can predict pregnancy outcome in women with threatened miscarriages so as to assist in their counselling and management. Methods The study compared levels of maternal serum CA125 in 65 pregnancies with threatened miscarriages (study group) with 65 normal intrauterine pregnancies (control group) between 6 weeks and 19 weeks + 6 days gestation using an enzyme linked immunosorbent assay (ELISA) technique. Results The mean age of the study and control groups were 29.5 ± 0.14 years and 30.1 ± 0.14 years, respectively. The mean serum CA125 in the study group was 30.1 ± 1.1 IU/mL while that of the control group was 22.9 ± 1.2 IU/mL and this was statistically significant (P = 0.0001). The mean serum CA125 level in the women whose pregnancies were aborted (aborters) was 34.8 ± 1.4 IU/mL while the mean value among those whose pregnancies continued till term (non-aborters) was 27.3 ± 1.2 IU/mL. This was statistically significant (P = 0.001). Further analysis using CA125 ≥36.2 IU/mL (mean value of serum CA125 among aborters + 1 standard deviation) as a threshold for intrauterine pregnancies that eventually got aborted showed a sensitivity of 66.7%, specificity of 83.3%, positive predictive value of 55.6%, negative predictive value of 88.9% and the diagnostic effectiveness (accuracy) was 79.4%. Conclusion The measurement of serum CA125 is a useful predictor of pregnancy outcome in threatened miscarriages.

scholarly journals Craniomegaly in Neonate and Infants Requiring Neurosurgical Intervention: An Experience at Tertiary Care Center

2022 ◽  
Author(s):  
Sangh Mittra ◽  
Hanuman Prasad Prajapati ◽  
Raj Kumar
Keyword(s):  
Head Circumference ◽  
Care Center ◽  
Tertiary Care ◽  
Dandy Walker Malformation ◽  
Improved Outcomes ◽  
History Of ◽  
The Mean ◽  
Walker Malformation ◽  
Age Range

Abstract Background The identification of neurosurgical causes of craniomegaly and early institution of therapy requires for better clinical and functional outcomes. Aims and Objectives The aim of this study was to evaluate the neurosurgical causes, managements, and outcomes of craniomegaly in neonate and infants. Materials and Methods The cases with a history of head enlargement from neonatal period were included in this study. Their causes, managements, and outcomes were recorded retrospectively during the period of January 2010 to February 2013, in neurosurgery department at SGPGIMS Lucknow, and June 2018 to June 2020, at UPUMS, Saifai, Etawah, UP, India. Results Out of 41 cases, there were 30 (73.14%) cases of hydrocephalus, 4 (9.76%) Dandy-Walker malformation, 2 (4.88%) subdural collection, 2 (4.88%) arachnoid cyst, 1 (2.44%) craniosynostosis, and 2 (4.88%) with tubercular meningitis. The age range of our cases was 18 to 178 days and the mean age was 102.54 ± 50.73. Preoperative head circumference range was 39 to 62 cm (mean: 55.27 ± 6.58cm). Majority of the cases (n = 32, 78.05%) were managed with ventriculoperitoneal shunt surgeries. Out of 41 cases, 33(80.49%) had improved outcomes, 7 (17.07%) stabilized, and mortality occurred in 1 (2.44%) case. Postoperatively, there was improvement in the head circumference (range: 39–60 cm and mean: 46.15 ± 5.83 cm) on 6 to 24 months (mean: 17.85 ± 5.18 months) of follow-up. Conclusion Hydrocephalus was the commonest neurosurgical cause of head enlargement in neonate and infants. Shunt surgery was the most common form of management of these cases. Early detection, institution of therapy, and periodic follow-up program for diagnosing and treating complications were the key to successful outcomes in these patients.

scholarly journals Association of gestational age, Apgar score and neonatal outcomes in newborns with meconium stained amniotic fluid

2019 ◽  
Vol 6 (4) ◽  
pp. 1563
Author(s):  
Preeti Garg ◽  
Devendra Barua ◽  
Shruti Saxena
Keyword(s):  
Amniotic Fluid ◽  
Gestational Age ◽  
Apgar Score ◽  
Tertiary Care ◽  
Neonatal Outcomes ◽  
Control Group ◽  
Study Group ◽  
Increased Risk ◽  
The Mean ◽  
Meconium Stained Amniotic Fluid

Background: Infants born with meconium stained fluid are at increased risk of fetal hypoxia, evidenced by increased rates of abnormalities indicated by fetal monitoring in labor, low neonatal Apgar scores, and fetal deaths. The study is conducted to determine association of gestational age, Apgar score and neonatal outcomes in newborn born with meconium stained amniotic fluid in tertiary care centre of central India.Methods: The study was conducted over a period of 2 years from January 2012 to January 2014 in Department of Pediatrics, Sri Aurobindo Medical College and Hospital, Indore, Madhya Pradesh, India. One hundred newborns with meconium stained amniotic fluid (study group) and one hundred newborns with clear amniotic fluids (control group) were studied in this period. Gestational age, Apgar score and neonatal outcomes were compared among two groups.Results: The mean gestational age in study group was 38.89±1.14 weeks and in control group was 38.59±0.99 weeks. The mean Apgar score at 1 min was 5.80±1.59 in study group and in the control group was 7.86±0.35. 32 babies in meconium stained liquor had hypoxia of which 11 had respiratory distress, 11 required mechanical ventilation (MAS 08, sepsis 03), 2 newborns had HIE stage 2 and 5 patients died. The above findings suggest higher gestational age, lower Apgar score and poor neonatal outcomes are associated with meconium stained liquor.Conclusions: The study depicts significant co-relation with higher gestational age, lower Apgar at 1 and 5 minutes and poor neonatal outcome in babies with meconium stained amniotic fluid.

P–424 Evaluating the relationship between endoplasmic reticulum stress and recurrent pregnancy loss in a young population cohort

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
N F Topba. Selcuki ◽  
K Cakmak ◽  
S Yilmaz ◽  
I Ozdemir ◽  
E Oral
Keyword(s):  
Endoplasmic Reticulum ◽  
Er Stress ◽  
Predictive Value ◽  
Pregnancy Loss ◽  
Recurrent Pregnancy Loss ◽  
Female Reproductive Tract ◽  
Receiver Operating Curve ◽  
Control Group ◽  
Study Group ◽  
The Mean

Abstract Study question Does endoplasmic reticulum (ER) stress evaluated by X-box binding protein 1 (XBP–1) among patients aged 18–30 years play a role in recurrent pregnancy loss (RPL)? Summary answer High levels of XBP–1 observed in patients with known RPL indicate that ER stress plays an important role in RPL. What is known already Female reproductive tract undergoes dynamic changes during oogenesis which require protein synthesis, folding, maturation, which take place in the ER. ER is also responsible for destruction of unfolded/misfolded proteins. Excess accumulation of these faulty proteins leads to ER stress, which actives unfolded protein response (UPR). XBP–1 is a transcription factor involved in UPR and regulates ER stress-mediated apoptosis. Regulation of ER homeostasis is important in folliculogenesis, oocyte maturation and embryogenesis. It is also known that ER stress has a positive correlation with age and it is associated with age-related diseases. Study design, size, duration This prospective case-controlled study was conducted at University of Health Sciences Turkey, Istanbul Kanuni Sultan Suleyman Training and Research Hospital Department of Obstetrics and Gynecology between March 2020 – September 2020. A total of 70 subjects were included in the study. All patients gave their written informed consent before their enrollment in the study. Participants/materials, setting, methods 38 patients aged 18–30 years with a history of RPL were included in the study. Patients who had miscarriages due to fetal abnormalities, patients with infections, endocrine or genetic disorders, smokers, alcohol and/or drug abusers, with acute/chronic inflammatory diseases, patients using steroids, anti-inflammatory and antioxidant medications were excluded from the study. Age-matched 32 healthy subjects without RPL were included in the control group. XBP–1 levels were determined using Human XBP–1 ELISA Kit (Elabscience Co., USA). Main results and the role of chance The mean age in the control group and in the study group were 25.21±3.3 and 25.26±2.6, respectively and they were statistically similar (p = 0.324). When groups were compared according to thyroid stimulating hormone (TSH) levels and body mass index (BMI), which are additional risk factors of RPL both groups were statistically similar (p = 0.642 and 0.942, respectively). As expected gravidity and abortus numbers were significantly higher in the study group (p < 0.001). A mean XBP–1 level of 1233.41± 3902.97 was determined in the control group. The mean value of the study group was calculated to be 2251.49± 9621.12. Mean XBP–1 level in the study group was significantly high (p < 0.001). A receiver operating curve (ROC) analysis was conducted in the study group. The area under the curve was found to be 87% (95% CI: 79% - 95%). The specificity was 75%, sensitivity was 89%, positive LR was 3.5, negative LR was 0.15, positive predictive value was 80% and negative predictive value was 87% for the cut-off XBP–1 level at 1364.68 pg/mL. Limitations, reasons for caution Small sample size is an important limitation of this study. In addition, evaluating XBP–1 only in serum samples does not let us drive any conclusions on the local changes of ER stress. Studies with larger samples sizes and studying XBP–1 levels in tissue samples of endometrial material is needed. Wider implications of the findings: The significantly high levels of XBP–1 in RPL patients younger than 30 years, indicate higher ER stress in this group even when age dependent increase in ER stress is calculated out of the equation. XBP–1 can be a promising marker in evaluating patients with a fertility wish for RPL risk. Trial registration number NCT04455256

The effects of plasma viscosity in thromboembolic events among patients with essential thrombocytosis: A case-control study

2021 ◽  
pp. 1-8
Author(s):  
Tekin Güney ◽  
Ferda Can ◽  
Afra Alkan ◽  
Sema Akıncı ◽  
İmdat Dilek
Keyword(s):  
Myeloproliferative Neoplasms ◽  
Philadelphia Chromosome ◽  
Plasma Viscosity ◽  
World Health ◽  
Control Group ◽  
Study Group ◽  
Thromboembolic Events ◽  
History Of ◽  
Patient Groups ◽  
The Mean

INTRODUCTION: Essential thrombocythemia (ET) is an entity of classic Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs), characterized by thrombocytosis with megakaryocytic hyperplasia where in the thrombocytes are increased with abnormal function. Thrombotic events are seen frequently and represent the main cause of morbidity and mortalityin patients with MPNs, mainly polycythemia vera and ET. This study has aimed to research the effects of clonally increased thrombocytes on plasma viscosity (PV) levels among patients with ET and the relationship between PV and thromboembolism history, according to the hypotheses about the effects of PV in thromboembolic events among patients with ET. METHODS: A total of 55 patients were enrolled in the study group, 18 of who had been newly diagnosed with ET according to 2016 World Health Organization criteria and had not previously been treated. 37 of them had already been diagnosed with ET and had been treated. There were 47 healthy volunteers in the control group. 5 cc blood samples were taken from the patients into tubes including an anticoagulant to measure their PV levels. RESULTS: PV of the control group was found to be lower than in the study group and both each patient groups (p <  0.05). No relationship was found between the patient groups in terms of PV (p = 0.404). The mean PV levels of the 16 patients with a history of thromboembolism and the 39 patients with no such history were 2.42±0.17 cP and 2.33±0.20 cP, respectively. The mean PV levels were found to be similar according to their history of thromboembolism in all patient groups and in treated patients (p = 0.572 vs p = 0.991). CONCLUSION: We have found that PV levels were increased in clonally increased thrombocytes in patients with ET when compared with the control group. This is the first study in this field according to our knowledge.

scholarly journals The effectiveness of baby massage in increasing infant’s body weight

2021 ◽  
Vol 10 (s1) ◽  
Author(s):  
Kurniati Puji Lestari ◽  
Firdha Rahma Nurbadlina ◽  
Wagiyo Wagiyo ◽  
Muhammad Jauhar
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Growth And Development ◽  
Health Workers ◽  
Health Care Facilities ◽  
Control Group ◽  
P Value ◽  
History Of ◽  
The Mean ◽  
The Impact

Background: The low birth weight (LBW) problem is found in various developing countries with an increasing trend of cases every year. This is caused by nutritional status and a history of maternal health. The impact of LBW in children is they are more likely to experience delayed growth and development. This study aims to identify the effect of baby massage on infants’ body weight.Design and Methods: The research design used was quasi-experimental pre and post-test type with control group. There were 16 infants for each group selected by purposive sampling. Baby massage was given to the infants twice a week within four weeks, 10 to 15 min per session. Data analysis was used paired t-test and independent t-test.Results: The mean age of infants was 3.69 months for both group, the mean age at birth was 37.8 weeks (intervention) and 38 weeks (control), the mean birth weight of infants was 2,295 grams (intervention) and 2,288 grams (control). Most of the infants was male for both group. There was an effect of baby massage on the increase in infants’ weight gain with a history of low birth weight significantly with a p value <0.05.Conclusions: Baby massage can increase infants’ weight with a history of low birth weight aged 1-6 months. The role of health workers is to provide education and practice baby massage for mothers in order to stimulate the growth and development of infants. This intervention can be integrated with maternal and child health programs in primary health care facilities.

scholarly journals AB0814 PREGNANCY COURSE ASSESSMENT IN PATIENTS WITH RHEUMATIC DISEASES COMPARED TO CONTROLS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1431.2-1432
Author(s):  
O. Hamdi ◽  
M. Sellami ◽  
M. Yasmine ◽  
A. Fazaa ◽  
S. Miladi ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Rheumatic Diseases ◽  
Premature Delivery ◽  
Control Group ◽  
Study Group ◽  
Childbearing Age ◽  
Significant Difference ◽  
History Of ◽  
The Mean ◽  
The Impact

Background:Rheumatic diseases such as rheumatoid arthritis (RA) and spondyloarthritis (SA) may occur among women of childbearing age. Adverse events during pregnancy including disease flare, preterm delivery, and neonatal or fetal death have been reported.Objectives:Our aim was to assess the impact of rheumatic diseases on the course of pregnancy.Methods:We conducted a cross-sectional study involving patients with RA (2010 ACR/EULAR criteria) and SA (2009 ASAS criteria) (study group) as well as healthy controls (control group) matched by age and gender. All women included had at least one pregnancy. Data were collected through telephonic interviews. We used the Student t test to compare the study group and the control group.Results:We enrolled 57 patients (30 RA and 27 SA) and 57 controls. The mean age in the study and the control groups were respectively 43.2 ± 8.2 years [26-48] and 37.5 ± 6 years. The mean chronic inflammatory rheumatisms duration was 13.81 ± 6.2 years. A history of primary sterility was found in 3 patients (1 RA and 2 SA) and none in the control group. The mean age during the first pregnancy was significantly higher in the study group (28 ± 6.2 years versus 24 ± 7 years in the control group) (p=0.01). Eight patients (5 RA and 3 SA) had a history of spontaneous miscarriage. A terminated pregnancy was noted in 3 patients (1 RA and 2 SA). Complications during pregnancy in the study group were gestational diabetes (0.3%), premature delivery (0.3), premature rupture of membranes (0.3%), abortion threat (0.3%) and pre-eclampsia (6%). Pregnancy was more associated with complications in the study group (p=0.05). Cesarean section was more used in the study group (28 patients versus 9 in the control group; p= 0.00). The main indications of cesarean section in the study group were macrosomia (11 patients), scar uterus (6 patients), sacroiliitis (4 SA patients), twin pregnancy (2 patients), and undetermined reasons (6 patients). Fetal presentation in the study group was the seat presentation (3%), top presentation (4%), face (2%), and forehead presentation (0.3%) with no significant difference with the control group. Complications of childbirth in the study group were hemorrhage of delivery (10.3%), cord widening (6.6%), perinatal asphyxia (4.9%), and dystocia (1.9%). However, no statistically significant differences were found between the two groups in the prevalence of complications of childbirth. During pregnancy, 5 patients were on salazopyrine, 2 on corticosteroids and, 1 on non-steroidal anti-inflammatories.Conclusion:Our study showed that pregnancies with rheumatic diseases were at increased risk of having maternal complications and adverse neonatal outcomes.Disclosure of Interests:None declared

scholarly journals Efficacy of acupressure on nausea and vomiting among children with leukemia following chemotherapy

2018 ◽  
Vol 9 (1) ◽  
pp. 89
Author(s):  
Youssria El-Sayed Yousef ◽  
Nora Abd- Elhamid Zaki ◽  
Amal Sayed
Keyword(s):  
Side Effects ◽  
Demographic Data ◽  
Nausea And Vomiting ◽  
Control Group ◽  
Study Group ◽  
Experiment Study ◽  
History Of ◽  
The Mean ◽  
Interview Questionnaire ◽  
Quasi Experiment Study

Background/Objective: Nausea and vomiting (N&V) remain the main side effects associated with cancer chemotherapy. This study determines the effect of acupressure on the control of N&V among children with leukemia receiving chemotherapy.Methods: This quasi-experiment study was conducted at two Pediatric Oncology Departments in South Egypt. Two groups of children with leukemia aging 6-18 years were included from October 2017 till March 2018. The study group (n = 60) received acupressure, while the control group (n = 60) didn’t. All were subjected to socio-demographic and clinical interview questionnaire and Rhodes Index for N&V Likert scale for assessment of frequency, duration, stress and severity of nausea and vomiting.Results: Both groups had similar demographic data, were similar in diagnosis, disease severity, family history of neoplasia, and experienced similar chemotherapy-related side effects. Significant reduction of frequency, distress and severity of nausea and frequency, duration and severity of vomiting in addition to mean scores N\&V scale among children of the study group after application of acupressure when compared to children in the control group.Conclusions: The application of acupressure at P6 in children with acute leukemia who were receiving chemotherapy led to significant reduction in the mean scores of N&V in addition to their frequency, duration and severity within 48 hours from the beginning of chemotherapy in comparison to the control group. Therefore, acupressure techniques showed be used to reduce chemotherapy induced N&V in children with leukemia.

scholarly journals Outcome of expectantly managed small-for-gestational-age pregnancies with normal Doppler parameters- a prospective cohort study

2021 ◽  
Vol 10 (3) ◽  
pp. 1134
Author(s):  
Sneha Mishra ◽  
Krishna Agarwal
Keyword(s):  
Birth Weight ◽  
Caesarean Section ◽  
Gestational Age ◽  
Expectant Management ◽  
Control Group ◽  
P Value ◽  
Study Group ◽  
Biophysical Profile ◽  
Group 3 ◽  
The Mean

Background: SGA foetuses with normal Dopplers are not at risk of IUD. However, there is lack of consensus about timing of delivery of SGA foetuses. Clinicians commonly induce all SGA pregnancies at 37 weeks. Expectant management of SGA foetuses beyond 37 weeks is not well studied.Methods: We followed up women with clinically suspected growth restriction with foetal biometry, Doppler and biophysical profile. Pregnancies with foetal AC between 10th to 3rd centile with normal Dopplers were recruited in the study group. The women were allowed to go in spontaneous labor till 39+6/7 weeks or were induced at 39+6/7 weeks. The outcome of such cases was compared with controls who were induced at 37+0/7 weeks.Results: Spontaneous labor occurred in 42% subjects in study group whereas in control group all were induced. Mean gestation at delivery in the study group was increased (39.57±0.71 versus 37.0±0.0, p value <0.001). Almost 81% of the subjects in study group delivered after 39 weeks. The rate of caesarean section was significantly lower in study group (3% versus 22%, p value-0.024). Also, the risk of intrapartum foetal distress was lower in study group (3/36 versus 1/36).The mean birth weight in the study group was higher (2426.5±154.1 gm versus 2297.9±101.4 gm, p value <0.001.Conclusions: Expectant management of SGA pregnancies with normal Doppler parameters leads to a significant increase in gestational age at birth and the mean birth weight and a significant reduction in caesarean section rate. 

scholarly journals COMPARISON OF PERINATAL OUTCOME IN TWIN PREGNANCY WITH AND WITHOUT CERVICAL CERCLAGE

2020 ◽  
pp. 48-52
Author(s):  
Kalpana Damor ◽  
Sandhaya Choudhary ◽  
Himanshi Gangwal
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Low Birth Weight ◽  
Apgar Score ◽  
Twin Pregnancy ◽  
Control Group ◽  
Study Group ◽  
Second Trimester ◽  
Cervical Cerclage ◽  
The Mean

Background: The incidence of multifetal pregnancies has registered increase globally. Babies born from multiplebirth pregnancies are much more likely to result in premature birth than those from single pregnancies. Knowledge of role of cervical cerclage in preventing preterm birth especially in twin pregnancy can be helpful to prevent complication related to preterm birth and ultimately of low birth weight babies. Methods: Depending upon who opt for the procedure 100 patients were divided equally into two groups: 1)Twin pregnancy with cervical cerclage; 2)Twin pregnancy without cervical cerclage. We measured maternal outcomes which include time for which patient required to be hospitalized, maternal pyrexia, cervical or bladder injury and other maternal morbidity and perinatal outcomes which include preterm delivery (delivery before 37 completed weeks), low birth weight (birth weight ≤2000 g), IUGR, perinatal mortality, indicators of perinatal morbidity (APGAR scores and neonatal unit admission), stillbirth, second trimester loss and presence of congenital malformations. Results: In Study group 22% delivered before 34 weeks of gestation, 46% delivered between 34 and 37 weeks of gestation, 32% delivered after 37 weeks of gestation compared to 44%, 48% and 8% respectively in Control group. The mean gestational age at delivery was 35.3 weeks in Study group and was 33.2 weeks in Control group. In study group 47% neonates had birth weight less than 2Kg and in Control group 69% neonates had birth weight less than 2Kg. In Study group 95% had Apgar score more than 6 whereas in Control group 86% had APGAR score more than 6. The mean APGAR for Study group was 8.5 and for Control group was 7.5. 45% neonates had complications in Study group whereas 67% neonates in Control group. Overall Low birth weight was most common complications in both the groups. Respiratory distress was more common in Control group. Conclusions: In spite of close vigilance, preterm birth in twin gestation is common and unpredictable. It is difficult to predict those who may require cervical cerclage although all multiple pregnancies are at high risk. Cerclage should be considered an option for patients with twin pregnancies in the second trimester to prolong the duration of gestation as close to term as possible.

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