ESTIMATE GESTATIONAL AGE ACCORDING TO FETAL CROWN RUMP LENGTH ON ECHOGRAPHY

Objectives: Development of descriptive table of gestational age (GA) based on fetal crown rump length (CRL) in Vietnam. Methods: This study was conducted at the Center for Prenatal Diagnosis, National Hospital Obstetrics and Gynecology. Gestational age based on the first day of last menstrual period (LMP) ranges from 10 weeks to 14 weeks and 6 days. Pregnant women who are healthy, have regular menstrual periods, have not used hormonal drugs or assisted reproductive methods before. Have ultrasound measured the length of the crown-rump of the embryo based on the mandatory criteria. Data were analysed using SPSS 20.0 software. Results: 1008 singleton fetuses that met criteria, were predicted GA according to LMP. There were 1008 fetal crown rump length recorded. The mean CRL was 59.95 ± 6.79 (mm), the mean gestational age according to KCC was: 12.13 ± 0.75 (weeks). Gestational age was linearly correlated with fetal crown rump length according to the equation: CRL = 6.602+ GAx 4.398 and GA= 8.889 + CRLx 0.54. Conclusion: Gestational age can be calculated based on fetal crown rump length index by linear equation: GA = 8.889 + CRLx 0.54. The equations can be applied to calculate gestational age in ultrasound practice in Vietnam.

Menopause

Menopause is the permanent cessation of menstruation, caused by ovarian failure. It can only be diagnosed a year after the last menstrual period, and is therefore a retrospective event. This chapter covers the signs, investigations, and treatments available for menopause, including Hormone Replacement Therapy, alternatives, modes of delivery, and non-hormonal alternative options. Abnormal bleeding and sexual dysfunction at the menopause are also explained. It also covers premature ovarian insufficiency, and causes and treatments for this disorder.

Effectiveness of first trimester ultrasound screening in reduction of postdated labor induction rate

Background: The gestational age calculation by ultrasonography (USG) at first trimester is based on crown-rump length is more accurate, less erratic than last menstrual period based dating. Utilization of first trimester based scanning in dating the pregnancy will reduce the labor induction rate and consequently reduce the morbidity related to induction of labor.Methods: A comparative cross-sectional study was done among 314 booked antenatal women visiting department of obstetrics and gynecology, BPKIHS for regular check-up between 37 and 41 weeks of gestation. Expected date of delivery was calculated from crown rump length (CRL) of the first trimester scan for USG group while last menstrual period was taken to calculate expected date of delivery for LMP group and were called for induction at 41 weeks of gestation. The rates of labor induction, emergency cesarean section (CS) among induced group, indication of CS and mode of delivery were compared in both the groups.Results: There was 14% labor induction rate in USG group and 24.2% in LMP (last menstrual period) group and differed significantly (p=0.022). There was no difference in the mode of delivery among participants in either groups. The rate of emergency CS among women undergoing induction of labor was 54.5% and 39.5% respectively for USG and LMP groups (p=0.258). Overall, non-reassuring fetal heart rate was the most common indication for CS in both the groups.Conclusions: The finding suggests first trimester scan among all pregnancies will reduce the post-dated inductions, as well as need of CS.

Estrogen and Progesterone Receptor Immunoexpression in Fallopian Tubes among Postmenopausal Women Based on Time since the Last Menstrual Period

Existing data on the expression of estrogen receptor (ERα) and progesterone receptor (PR) in fallopian tubes in postmenopausal women are mostly inconclusive. Therefore, we assessed ERα and PR immunoexpression in the oviducts of these women. One hundred postmenopausal women were divided into three groups based on time elapsed since the last menstrual period: (A) 1–5 years, (B) 6–10 years, and (C) ≥11 years. In all groups, both in the glandular epithelium and stroma of the ampulla and isthmus of the oviduct, immunolocalization of ERα and PR were noted. The glandular epithelium of the ampulla showed a higher percentage of PR-positive cells than the isthmus in each group. Regarding ERα, there were no significant differences. In the glandular epithelium in both the ampulla and isthmus, the percentage of ERα- and PR-positive cells was significantly higher than that in the stroma in each study group and higher in the A group than in the C group. In conclusion, in postmenopausal women, time elapsed since the last menstrual period in the fallopian tubes was positively correlated with the following: (1) the epithelium showed vacuolation of cytoplasm with greater frequency, (2) the proportion of ciliated cells decreased, and (3) the percentage of ERα- and PR-positive cells also decreased. The obtained results indicate a significant decrease in ERα and PR expression depending on the time that has elapsed since the last menstruation, which is undoubtedly related to the loss of the reproductive function of the patients.

A Study of Crinio-facial Measurement (Biparietal Diameter) of Fetus by Ultrasonography in Different Age Group of The Tribal Population of Jharkhand

Introduction: The pregnancy cannot be dated accurately by clinical evaluation alone. Sonography is a useful and an accurate tool for estimation of the gestational age. Biparietal diameter is one the robust method of the basic biometric parameter used to assess fetal size and age. Aims and objective: The aim of this study was to collect data on craniofacial measurement of fetuses of the different age group by Ultrasonography at RIMS, Ranchi and to correlate its relationship with the different fetal age group. Materials and methods: The study was carried out on 100 pregnant women who gave definite history of their last menstrual period and 100 pregnant women who were not able to give definite history of their last menstrual period, in the tribal population of Jharkhand. The cases were selected from antenatal clinic of out-patients department of obstetrics and gynecology of RIMS, Ranchi. The ultrasonography was done by Dept of Radiology, RIMS, Ranchi. Discussion: In obstetrics the duration of pregnancy is calculated by the first day of the last menstrual period at present study standard variation of gestation age base on L M P when the pregnancy cannot be date accurately alone by clinical evaluation alone. Sonography is accepted as the most useful and accurate tool for estimating gestational age. BPD diameter was measured by ultrasonography and along with clinical findings, average gestational age was determined. Conclusion: Sonography is accepted as the most useful and accurate tool for estimating gestational age in those pregnant women who were not able to give definitive history of last menstrual period. Our study showed that the Growth rate of fetal BPD increases progressively as the fetal age increase in early weeks of pregnancy whereas growth is slow in later weeks of pregnancy, our study also showed that measurement of Biparietal diameter is a useful criterion to predict GA & determining EDD. KEY WORD: Pregnancy, Gestational age (GA), Biparietal diameter (BPD), Ultrasonography (USG), Expected date of delivery (EDD).

The onset of nausea and vomiting of pregnancy: a prospective cohort study

Background Nausea and vomiting are experienced by most women during pregnancy. The onset is usually related to Last Menstrual Period (LMP) the date of which is often unreliable. This study describes the time to onset of nausea and vomiting symptoms from date of ovulation and compares this to date of last menstrual period Methods Prospective cohort of women seeking to become pregnant, recruited from 12 May 2014 to 25 November 2016, in the United Kingdom. Daily diaries of nausea and vomiting were kept by 256 women who were trying to conceive. The main outcome measure is the number of days from last menstrual period (LMP) or luteinising hormone surge until onset of nausea or vomiting. Results Almost all women (88%) had Human Chorionic Gonadotrophin rise within 8 to 10 days of ovulation; the equivalent interval from LMP was 20 to 30 days. Many (67%) women experience symptoms within 11 to 20 days of ovulation. Conclusions Onset of nausea and vomiting occurs earlier than previously reported and there is a narrow window for onset of symptoms. This indicates that its etiology is associated with a specific developmental stage at the foetal-maternal interface. Trial registration NCT01577147. Date of registration 13 April 2012

Factors associated with calendar literacy and last menstrual period (LMP) recall: a prospective programmatic implication to maternal health in Bangladesh

ObjectiveTo explore the prevalence and determinants of calendar literacy and last menstrual period (LMP) recall among women in Bangladesh.DesignCross-sectional survey.SettingsTwo rural subdistricts and one urban area from three Northern districts of Bangladesh.ParticipantsWe interviewed 2731 women who had a live birth in the last 1 year.Primary and secondary outcome measuresThe primary outcome variable was LMP recall and the secondary outcome was calendar literacy.ResultsThe majority of participants (65%) correctly mentioned the current date according to the English calendar while 12% mentioned according to the Bengali calendar. During the interview sessions, we used three different calendars: Bengali, English and Hijri to assess calendar literacy. We asked women to mark the current date using the calendar on the day of the interview. Almost 61% women marked the English calendar, 16% marked the Bengali calendar and 4% marked the Hijri calendar correctly. Sixty-three per cent women were found as calendar literate who marked any of the calendars. Among the participants, 58% had calendars available at their home and only 10% of women used calendars to track their LMPs. Overall, 53% women were able to recall their recent LMP. Among the calendar literate, 60% could recall their LMPs. Factors found associated with recalling LMP were: completed eight or more years of schooling (adj.OR 1.39), primigravida (adj.OR 1.88), the richest wealth quintile (adj.OR 1.55) and calendar literacy (adj.OR 1.59).ConclusionsDespite having reasonable calendar literacy and availability, the use of calendars for tracking LMP found very low. Calendar literacy and sociodemographic characteristics were found as the key factors associated with LMP recall. Maternal, neonatal and child health programmes in low-resource settings can promote a simple tool like calendar and target the communities where ultrasound is not available to ensure accurate LMP recall for early pregnancy registration and timely antenatal care coverage.

Association of gestational age with MRI-based biometrics of brain development in fetuses

Background Reported date of last menstrual period and ultrasonography measurements are the most commonly used methods for determining gestational age in antenatal life. However, the mother cannot always determine the last menstrual period with certainty, and ultrasonography measurements are accurate only in the first trimester. We aimed to assess the ability of various biometric measurements on magnetic resonance imaging (MRI) in determining the accurate gestational age of an individual fetus in the second half of gestation. Methods We used MRI to scan a total of 637 fetuses ranging in age from 22 to 40 gestational weeks. We evaluated 9 standard fetal 2D biometric parameters, and regression models were fitted to assess normal fetal brain development. A stepwise linear regression model was constructed to predict gestational age, and measurement accuracy was determined in a held-out, unseen test sample (n = 49). Results A second-order polynomial regression model was found to be the best descriptor of biometric measures including brain bi-parietal diameter, head circumference, and fronto-occipital diameter in relation to normal fetal growth. Normal fetuses showed divergent growth patterns for the cerebrum and cerebellum, where the cerebrum undergoes rapid growth in the second trimester, while the cerebellum undergoes rapid growth in the third trimester. Moreover, a linear model based on biometrics of brain bi-parietal diameter, length of the corpus callosum, vermis area, transverse cerebellar diameter, and cerebellar area accurately predicted gestational age in the second and third trimesters (cross-validation R2 = 0.822, p < 0.001). Conclusions These results support the use of MRI biometry charts to improve MRI evaluation of fetal growth and suggest that MRI biometry measurements offer a potential estimation model of fetal gestational age in the second half of gestation, which is vital to any assessment of pregnancy, fetal development, and neonatal care.

The onset of nausea and vomiting of pregnancy: a prospective cohort study

Background Nausea and vomiting are experienced by most women during pregnancy. The onset is usually related to Last Menstrual Period (LMP) the date of which is often unreliable. This study describes the time to onset of nausea and vomiting symptoms from date of ovulation and compares this to date of last menstrual period Methods Prospective cohort of women seeking to become pregnant, recruited from 12 May 2014 to 25 November 2016, in the United Kingdom. Daily diaries of nausea and vomiting were kept by 256 women who were trying to conceive. The main outcome measure is the number of days from last men­strual period (LMP) or luteinising hormone surge until onset of nausea or vomiting. Results Almost all women (88%) had Human Chorionic Gonadotrophin rise within 8 to 10 days of ovulation; the equivalent interval from LMP was 20 to 30 days. Many (67%) women experience symp­toms within 11 to 20 days of ovulation. Conclusions Onset of nausea and vomiting occurs earlier than previously reported and there is a narrow window for onset of symptoms. This indicates that its etiology is associated with a specific developmental stage at the foetal-maternal interface. Trial registration NCT01577147