Which chart and which cut-point: deciding on the INTERGROWTH, World Health Organization, or Hadlock fetal growth chart

Objective To determine how various centile cut points on the INTERGROWTH-21st (INTERGROWTH), World Health Organization (WHO), and Hadlock fetal growth charts predict perinatal morbidity/mortality, and how this relates to choosing a fetal growth chart for clinical use. Methods We linked antenatal ultrasound measurements for fetuses > 28 weeks’ gestation from the British Columbia Women’s hospital ultrasound unit with the provincial perinatal database. We estimated the risk of perinatal morbidity/mortality (decreased cord pH, neonatal seizures, hypoglycemia, and perinatal death) associated with select centiles on each fetal growth chart (the 3rd, 10th, the centile identifying 10% of the population, and the optimal cut-point by Youden’s Index), and determined how well each centile predicted perinatal morbidity/mortality. Results Among 10,366 pregnancies, the 10th centile cut-point had a sensitivity of 11% (95% CI 8, 14), 13% (95% CI 10, 16), and 12% (95% CI 10, 16), to detect fetuses with perinatal morbidity/mortality on the INTERGROWTH, WHO, and Hadlock charts, respectively. All charts performed similarly in predicting perinatal morbidity/mortality (area under the curve [AUC] =0.54 for all three charts). The statistically optimal cut-points were the 39th, 31st, and 32nd centiles on the INTERGROWTH, WHO, and Hadlock charts respectively. Conclusion The INTERGROWTH, WHO, and Hadlock fetal growth charts performed similarly in predicting perinatal morbidity/mortality, even when evaluating multiple cut points. Deciding which cut-point and chart to use may be guided by other considerations such as impact on workflow and how the chart was derived.

CUSTOMISED FETAL GROWTH CHARTS VERSUS POPULATION-BASED GROWTH CHARTS IN IDENTIFYING ADVERSE FETAL OUTCOMES: A SYSTEMATIC REVIEW

One for all antenatal growth charts may not adequately capture risks for adverse fetal outcomes. This review appraises studies on customised growth curves in preventing adverse fetal effects and compares them with population-based growth charts. A review was done on articles published in PubMed database, Cochrane database and Google Scholar. The search criteria were English written described fetal outcomes using a customised fetal growth chart published between 2007 and 2020. All selected articles reported antenatal follow-up data and compared the intervention using the customised antenatal growth chart to the population-based antenatal growth chart. The primary outcome measure was the incidence of small for gestational age (SGA) and stillbirths. The feasibility of using a customised fetal growth chart versus a population-based fetal growth chart was assessed as the process indicator. Twenty-two articles comparing the use of customised growth charts to population-based growth charts were found. Sixteen studies depicted a significant improvement in the detection of pathological SGA over a population-based growth chart ,and another two studies showed significant in detecting large gestational age (LGA). In conclusion, the customised growth charts improve the detection of pathological SGA antenatally. The feasibility of the intervention depends on the training, policy, infrastructure, staffing, awareness and ethics. A summarised framework analysis for implementing customised growth charts is proposed for future research.

Functional preparedness of women of the first period of mature age of different somatotypes

Background and Study Aim. It is believed that the somatotype is a predictor of indicators of functional readiness. There are significant differences in the aerobic performance of the body for people of different somatotypes among students girls and men. Features of manifestation of anaerobic possibilities of an organism at persons of various somatotypes from 7 to 30 years old are described. We can assume that women of the first adulthood period of different somatotypes, indicators of functional readiness are manifested in different ways. The aim of the study was to identify the features of aerobic, anaerobic lactate and anaerobic alactate productivity of women of the first period of mature age of different somatotypes. Material and Methods. The study involved 210 females 25-35 years old. Somatotype was determined in all subjects. Functional readiness was determined by indicators of anaerobic lactatic productivity, anaerobic alactatic productivity and aerobic productivity of the organism. The power of aerobic energy supply processes was investigated by VO2max. To determine the VO2max used cycling ergometric version of the PWC 170 test. The subjects was performed a stepwise increasing load on the ergometer to determine the TAM. At the end of each stage, heart rate was recorded. The TAM level corresponded to the inflection point on the heart rate growth chart. The capacity of anaerobic lactate processes of energy supply was investigated by indicator of the maximum quantity of mechanical work for 1 minute (MQMK). The subjects performed a bicycle ergometric load duration 1 min with a power of 225 W with a maximum pedaling frequency. The power of anaerobic lactate processes of energy supply was determined by the Wingate anaerobic test WAnT 30. The power of anaerobic alactate processes of energy supply was determined by the test WAnT 10. Statistical processing was performed using the program STATISTICA 13. Results. According to absolute indicators (WAnT10. WAnT30. MQMK, TAM, VO2max) the advantage of representatives of endomorphic-mesomorphic somatotype was established. According to relative indicators of aerobic productivity (TAM, VO2max) representatives of the ectomorphic and balanced somatotype predominate. Conclusions. High values of absolute indicators of functional readiness are associated with high values ​​of body mass in combination with a high percentage of muscle for women of different somatotypes. Accordingly, for representatives of somatotypes with lower body mass are characterized by lower absolute values ​​of all indicators of functional fitness. The relative indicators of aerobic productivity are dominated by representatives of somatotypes, which are characterized by lower body mass.

Advanced Kidney Volume Measurement Method Using Ultrasonography with Artificial Intelligence-Based Hybrid Learning in Children

In this study, we aimed to develop a new automated method for kidney volume measurement in children using ultrasonography (US) with image pre-processing and hybrid learning and to formulate an equation to calculate the expected kidney volume. The volumes of 282 kidneys (141 subjects, <19 years old) with normal function and structure were measured using US. The volumes of 58 kidneys in 29 subjects who underwent US and computed tomography (CT) were determined by image segmentation and compared to those calculated by the conventional ellipsoidal method and CT using intraclass correlation coefficients (ICCs). An expected kidney volume equation was developed using multivariate regression analysis. Manual image segmentation was automated using hybrid learning to calculate the kidney volume. The ICCs for volume determined by image segmentation and ellipsoidal method were significantly different, while that for volume calculated by hybrid learning was significantly higher than that for ellipsoidal method. Volume determined by image segmentation was significantly correlated with weight, body surface area, and height. Expected kidney volume was calculated as (2.22 × weight (kg) + 0.252 × height (cm) + 5.138). This method will be valuable in establishing an age-matched normal kidney growth chart through the accumulation and analysis of large-scale data.

Nutritional Status and Body Image Satisfaction among Adolescent Girls

Background: Adolescence is a phase of accelerated growth and major physical changes take place in the body. Nutritional status during the crucial period of adolescence could be a potential predictor of body image perception. Objectives: The study aimed at assessing the nutritional status and body image satisfaction among adolescent girls. Methods: Descriptive study was conducted among 135 adolescent girls of selected school, Kochi selected through random sampling method. Tools used were structured questionnaire for demographic data, BMI for age growth chart (5-19 years) Z score according to WHO and nutritional history to assess nutritional status and body image satisfaction was assessed by modified version (SF-14) of Body Shape Questionnaire (BSQ). Data was analyzed using SPSS version. Results: Majority (63.7%) of them having normal nutritional status, 17.8 % of them were mild thinness, 8.9% were overweight 7.4% of them were showing severe thinness and only 2.2 % of them were obese. Among that majority (57.8%) had mild concern, 8.9% of them having moderate concern and 2.2% of them having marked concern regarding the body image irrespective of their BMI. And also there was highly statistically significant (p=.000) association between nutritional status and body image satisfaction. Interpretation and Conclusion: Though majority of study groups satisfied about their body image few girls felt moderate to marked concern with their nutritional status. Raising awareness of body image size and increasing body satisfaction with weight status should be established by good receptions of healthy lifestyle among girls. Keywords: nutritional status, body image satisfaction, adolescent girls.

388Investigating the utility of the customised fetal growth chart: a pragmatic randomised controlled trial

Background To determine if the routine use of a customised fetal growth chart, when compared to a standard growth chart, reduces the risk of adverse pregnancy outcome through increased detection of adverse growth. Methods A double-blind, single centre, randomised controlled trial was conducted. All women with a singleton pregnancy receiving routine antenatal care through hospital clinics were included and randomised to either a standard growth chart (SC) or a customised growth chart (CC). Serial measurements of symphyseal fundal height (SFH) were plotted onto the chart in the electronic clinical record; pre-programmed alerts notified the clinician when growth or size required review. The primary outcome measure was a composite perinatal morbidity/mortality outcome. Results 3993 women were recruited; 45.4% nulliparous; 50.0% Caucasian, 17.8% Asian; 34.9% were overweight/obese prior to pregnancy; average 30 (SD 5.5) years old. The median (IQR) number of growth alerts was 2 (0-3) for both groups (p = 0.378); there was no difference in the total number of ultrasounds per pregnancy (median [IQR] 3 [2-4] for both groups, p = 0.266). There was no significant difference in primary composite outcome (CC 6.4%, SC 7.5%, p = 0.171) or individual components, apart from stillbirth (CC n = 1 0.05%, SC n = 8 0.4%, p = 0.039). Conclusions Use of a CC resulted in no difference in primary outcome, number of growth alerts or number of ultrasounds. Key messages In a large, pragmatic RCT use of a CC in conjunction with serial SFH measurements may infer some benefit over a SC, particularly in relation to stillbirth.