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Amnioexchange for gastroschisis does not help, and may even harm
Bhide, A
BJOG : an international journal of obstetrics and gynaecology,
September 2019, Letnik:
126, Številka:
10
Journal Article
This is a mini commentary on D Luton et al., pp. 1233–1241 in this issue. To view this article visit https://doi.org/10.1111/1471-0528.15804.
4.
Prenatal identification of invasive placentation using magnetic resonance imaging: systematic review and meta‐analysis
D'Antonio, F.; Iacovella, C.; Palacios‐Jaraquemada, J. ...
Ultrasound in obstetrics & gynecology,
July 2014, Letnik:
44, Številka:
1
Journal Article
ABSTRACT
Objective
To assess systematically the performance of prenatal magnetic resonance imaging (MRI) in diagnosing the presence, degree and topography of disorders of invasive placentation and to ...
explore the role of the different MRI signs in predicting these disorders. The diagnostic accuracy of ultrasound and MRI in the detection of invasive placentation was also compared.
Methods
MEDLINE, EMBASE, CINAHL and The Cochrane Library, including The Cochrane Database of Systematic Reviews, Database of s of Reviews of Effects and The Cochrane Central Register of Controlled Trials, were searched electronically utilizing combinations of the relevant medical subject heading terms, keywords and word variants for ‘invasive placentation’ and ‘magnetic resonance imaging’. Only prospective studies reporting a diagnosis of invasive placentation at the time of MRI and retrospective studies in which the radiologist was blinded to the final results were included in the analysis. The MRI signs explored were: uterine bulging, heterogeneous signal intensity, dark intraplacental bands on T2 weighted sequences, focal interruption of the myometrium and tenting of the bladder. Summary estimates of sensitivity, specificity, positive and negative likelihood ratios (LR+, LR–) and diagnostic odds ratio (DOR) were based, depending on the number of studies, upon DerSimonian–Laird random‐effect or hierarchical summary receiver–operating characteristics models.
Results
A total of 18 studies involving 1010 pregnancies at risk for invasive placentation were included. The overall diagnostic accuracy of MRI in detecting the presence of invasive placentation was: sensitivity, 94.4% (95% CI, 86.0–97.9%); specificity, 84.0% (95% CI, 76.0–89.8%); LR+, 5.91 (95% CI, 3.73–9.39); LR–, 0.07 (95% CI, 0.02–0.18); DOR, 89.0 (95% CI, 22.8–348.1). MRI had a high predictive accuracy in assessing both the depth and topography of placental invasion. All five MRI signs showed good predictive accuracy in the diagnosis of disorders of invasive placentation. There was no difference in either the sensitivity (P = 0.24) or the specificity (P = 0.91) between ultrasound and MRI for the detection of invasive placentation.
Conclusions
Prenatal MRI is highly accurate in diagnosing disorders of invasive placentation. Ultrasound and MRI have comparable predictive accuracy. Large population‐based studies are needed in order to assess whether ultrasound can predict the depth and topography of placental invasion as reliably as can MRI. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.
več
5.
Neurodevelopmental delay in small babies at term: a systematic review
Arcangeli, T.; Thilaganathan, B.; Hooper, R. ...
Ultrasound in obstetrics & gynecology,
September 2012, Letnik:
40, Številka:
3
Journal Article
Objective
Being small for gestational age (SGA) or having fetal growth restriction (FGR) may be associated with poorer neurodevelopmental outcomes compared to being appropriate for gestational age ...
(AGA). The aim of this paper was to evaluate the existence and magnitude of decrease in neurodevelopmental scores in SGA and FGR infants born at term from a systematic review of the existing literature.
Methods
Studies of neurodevelopment in SGA/FGR babies were identified from a search of the internet scientific databases. Studies that included preterm births and those that did not define absolute indices of standardized cognitive outcome were excluded. SGA was defined as birth weight below the 10th centile for gestation and FGR as the same birth‐weight standard with abnormal umbilical artery Doppler ultrasound or evidence of abnormal placentation on pathology specimen studies. Effect size was calculated as the standardized mean difference between neurodevelopment scores of controls and SGA/FGR children.
Results
There were 28 studies of SGA, with a total of 7861 SGA and 91 619 control AGA babies, and three studies of FGR, with a total of 119 FGR and 49 control AGA babies. Data synthesis showed that standardized neurodevelopmental scores in SGA babies were 0.32 SD (95% CI, 0.25–0.38) below those for normal controls, though with heterogeneity between studies (I2 = 68.3%). Insufficient data were available for FGR babies.
Conclusion
The findings of the study demonstrate that among babies born at term, being SGA is associated with lower scores on neurodevelopmental outcomes compared to AGA controls. A trial designed to evaluate the effects of intervention in small fetuses born at term in order to improve the neurodevelopmental outcome is urgently needed. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.
več
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Biosynthesis of Antinutritional Alkaloids in Solanaceous Crops Is Mediated by Clustered Genes
Itkin, M.; Heinig, U.; Tzfadia, O. ...
Science,
07/2013, Letnik:
341, Številka:
6142
Journal Article
Steroidal glycoalkaloids (SGAs) such as α-solanine found in solanaceous food plants— as, for example, potato— are antinutritional factors for humans. Comparative coexpression analysis between tomato ...
and potato coupled with chemical profiling revealed an array of 10 genes that partake in SGA biosynthesis. We discovered that six of them exist as a cluster on chromosome 7, whereas an additional two are adjacent in a duplicated genomic region on chromosome 12. Following systematic functional analysis, we suggest a revised SGA biosynthetic pathway starting from cholesterol up to the tetrasaccharide moiety linked to the tomato SGA aglycone. Silencing GLYCOALKALOID METABOLISM 4 prevented accumulation of SGAs in potato tubers and tomato fruit. This may provide a means for removal of unsafe, antinutritional substances present in these widely used food crops.
več
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Significance of placental cord insertion site in twin pregnancy
Kalafat, E.; Thilaganathan, B.; Papageorghiou, A. ...
Ultrasound in obstetrics & gynecology,
September 2018, 2018-Sep, 2018-09-00, 20180901, Letnik:
52, Številka:
3
Journal Article
ABSTRACT
Objective
To investigate the association between abnormal cord insertion and the development of twin‐specific complications, including birth‐weight discordance, selective fetal growth ...
restriction (sFGR) and twin‐to‐twin transfusion syndrome (TTTS).
Methods
This was a single center retrospective cohort study of twin pregnancies. Abnormal cord insertion was defined as either marginal (umbilical cord attachment site less than 2 cm to the nearest margin of the placental disc) or velamentous (cord attached to the membrane before reaching the placental disc with clear evidence of vessels traversing the membranes to connect with the placental disc), as described in placental pathology reports. Twins with major structural or chromosomal abnormalities and monochorionic monoamniotic twins were not included in the study. Information on the pregnancies, ultrasound findings, prenatal investigations and interventions was obtained from the electronic ultrasound database, while data on placental histopathological findings, pregnancy outcome, mode of delivery, birth weight, gestational age at delivery and admission to the neonatal intensive care unit were obtained from maternity records. Categorical variables were compared using the chi‐square or Fisher's exact test, while continuous variables were compared using the Student's t‐test, ANOVA for multiple comparisons and the Kruskal–Wallis test.
Results
Of the 497 twin pregnancies included in the analysis, 351 (70.6%) were dichorionic and 146 (29.4%) were monochorionic. The incidence of birth‐weight discordance of 25% or more was significantly higher in pregnancies with velamentous and those with marginal cord insertions compared to those with normal cord insertion (24.0%, 15.3% vs 7.6%, P < 0.001 and P = 0.020, respectively). In pregnancies with birth‐weight discordance of 25% or more, the smaller twins had significantly higher prevalence of velamentous (13.8%) and marginal (34.2%) cord insertions compared with the larger twins (1.8% and 18.5%, respectively, P < 0.001). The smaller twins of the monochorionic diamniotic pregnancies showed an even higher prevalence of velamentous (29.5%) and marginal (40.9%) cord insertions compared with the larger twins (2.3% and 31.5%, respectively, P < 0.001). Compared with the normal cord insertion group, only velamentous insertion was associated significantly with the risk of sFGR (odds ratio (OR), 9.24 (95% CI, 2.05–58.84), P < 0.001) and birth‐weight discordance of 20% or more (OR, 4.34 (95% CI, 1.36–14.61), P = 0.007) and 25% or more (OR, 6.81 (95% CI, 1.67–34.12), P = 0.003) in monochorionic twin pregnancies. There was no significant association between velamentous cord insertion and TTTS (P = 0.591), or between marginal cord insertion and the development of sFGR (P = 0.233), birth‐weight discordance of 25% or more (P = 0.114) or TTTS (P = 0.487). Subgroup analysis of dichorionic twins showed that abnormal cord insertion was not associated with the risk of birth‐weight discordance (P = 0.999), sFGR (P = 0.308), composite neonatal adverse outcome (P = 0.637) or intrauterine death (P = 0.349).
Conclusion
Monochorionic twins with velamentous cord insertion are at increased risk of birth‐weight discordance and sFGR. Sonographic delineation of placental cord insertion could be of value in the antenatal stratification of twin pregnancies. Prospective studies are required to assess the value and predictive accuracy of this potential screening marker. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Correlation of short‐term variation derived from novel ambulatory fetal electrocardiography monitor with computerized cardiotocography
Liu, B.; Thilaganathan, B.; Bhide, A.
Ultrasound in obstetrics & gynecology,
June 2023, 2023-06-00, 20230601, Letnik:
61, Številka:
6
Journal Article
ABSTRACT
Objectives
To compare short‐term variation (STV) outputs from a novel self‐applied non‐invasive fetal electrocardiography (NIFECG) device with those obtained on computerized cardiotocography ...
(cCTG). Technological and algorithmic limitations and mitigation strategies were also evaluated.
Methods
This was a prospective cohort study of women with a singleton pregnancy over 28 + 0 weeks' gestation attending a tertiary London hospital for cCTG assessment between June 2021 and June 2022. Women underwent concurrent monitoring with both NIFECG and cCTG for up to 1 h. Postprocessing of NIFECG data using various filtering methods produced NIFECG‐STV (eSTV) values, which were compared with cCTG‐STV (cSTV) outputs. Linear correlation, mean bias, precision and limits of agreement were assessed for STV derived by the different methods of computation and mathematical correction.
Results
Overall, 306 concurrent NIFECG and cCTG traces were collected from 285 women. Fully filtered eSTV was correlated very strongly with cSTV (r = 0.911, P < 0.001), but generated results only in 142/306 (46.4%) 1‐h traces owing to the removal of traces with lower‐quality signals. Partial filtering generated more eSTV data (98.4%), but with a weak correlation with cSTV (r = 0.337, P < 0.001). The difference in STV between the monitors (eSTV – cSTV) increased with signal loss; in traces with > 60% signal loss, the values became highly discrepant. Removal of traces with > 60% signal loss resulted in a stronger correlation with cSTV, while still generating eSTV results for 65% of traces. Correcting these remaining eSTV values for signal loss using linear regression analysis further improved correlation with cSTV (r = 0.839, P < 0.001).
Conclusions
The discrepancy between STV computed by NIFECG and cCTG necessitates signal filtering, exclusion of poor‐quality traces and eSTV correction. This study demonstrates that, with such correction, NIFECG is able to produce STV values that are strongly correlated with those of cCTG. This evidence base for NIFECG monitoring and interpretation is a promising step forward in the development of safe and effective at‐home fetal heart‐rate monitoring. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
več
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Phase‐rectified signal averaging: correlation between two monitors and relationship with short‐term variation of fetal heart rate
Liu, B.; Thilaganathan, B.; Bhide, A.
Ultrasound in obstetrics & gynecology,
June 2023, 2023-06-00, 20230601, Letnik:
61, Številka:
6
Journal Article
ABSTRACT
Objectives
To establish the correlation between phase‐rectified signal averaging (PRSA) outputs obtained from a novel self‐applicable non‐invasive fetal electrocardiography (NIFECG) monitor ...
with those from computerized cardiotocography (cCTG). A secondary objective was to evaluate the potential for remote assessment of fetal wellbeing by determining the relationship between PRSA and short‐term variation (STV).
Methods
This was a prospective observational study of women with a singleton pregnancy over 28 + 0 weeks' gestation attending a London teaching hospital for cCTG assessment. Participants underwent concurrent cCTG and NIFECG monitoring for up to 60 min. Averaged accelerative (AAC) and decelerative (ADC) capacities and STV were derived by postprocessing and filtration of signals, generating fully (F) and partially (P) filtered results. Linear correlation and accuracy and precision analysis were performed to assess the relationship between PRSA outputs from cCTG and NIFECG, using varying anchor thresholds, and their association with STV.
Results
A total of 306 concurrent cCTG and NIFECG traces were collected from 285 women. F‐filtered NIFECG PRSA (eAAC/eADC) results were generated from 65% of traces, whereas cCTG PRSA (cAAC/cADC) outputs were generated from all. Strong correlations were observed between cAAC and F‐filtered eAAC (r = 0.879, P < 0.001) and between cADC and F‐filtered eADC (r = 0.895, P < 0.001). NIFECG anchor detection decreased significantly with increasing signal loss, and NIFECG PRSA indices showed considerable deviation from those of cCTG when derived from traces in which fewer than 100 anchors were detected. Removing anchor filters from NIFECG traces to generate P‐filtered PRSA outputs weakened the correlation (AAC: r = 0.505, P < 0.001; ADC: r = 0.560, P < 0.001). Lowering the anchor threshold to 100 increased the yield of eAAC and eADC outputs to approximately 74%, whilst maintaining strong correlation with cAAC (r = 0.839, P < 0.001) and cADC (r = 0.815, P < 0.001), respectively. Both cAAC and cADC showed a very strong linear relationship with cCTG STV (r = 0.928, P < 0.001 and r = 0.911, P < 0.001, respectively). Similar findings were observed with eAAC (r = 0.825, P < 0.001) and eADC (r = 0.827, P < 0.001).
Conclusions
PRSA appears to be a method of fetal assessment equivalent to STV, but, due to its innate ability to eliminate artifacts, it generates interpretable NIFECG traces with high accuracy at a higher rate. These findings raise the possibility of self‐applied at‐home or remote fetal heart‐rate monitoring with automated reporting, thus enabling increased surveillance in high‐risk women without impacting on service demand. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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