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Objective: To compare the diagnostic performance of different manufacturers' immunoassays for the soluble fms‐like tyrosine kinase‐1 (sFlt‐1)‐to‐placental growth factor (PlGF) ratio with that of a point‐of‐care (PoC) test for glycosylated fibronectin (GlyFn) in women with suspected pre‐eclampsia (PE). Methods: This was a prospective, single‐center, double‐blinded, non‐interventional study of East Asian women with a singleton pregnancy who presented with hypertension with or without clinical features of PE after 20 weeks' gestation between January 2020 and March 2022. Maternal serum samples were collected at the time of presentation, and subsequent management followed the departmental protocol, based on gestational age, severity of hypertension, fetal condition and presence of severe PE features. Women diagnosed with PE at presentation were excluded. PE was diagnosed according to the 2018 International Society for the Study of Hypertension in Pregnancy classification. Levels of sFlt‐1 and PlGF were measured using the Cobas e411 (Roche Diagnostics), BRAHMS KRYPTOR (ThermoFisher Scientific) and iMAGIN 1800 (Ningbo Aucheer) platforms. GlyFn levels were measured using the Lumella™ GlyFn PoC test (DiabetOmics Inc.). The predictive performance of each test to rule out PE within 7 days and rule in PE within 28 days from the date of presentation was assessed. Based on the PROGNOSIS study, a sFlt‐1/PlGF ratio of ≤ 38 on the Roche platform was used to predict the absence of PE within 7 days. The sFlt‐1/PlGF ratio was classified as high or low using platform‐specific thresholds equivalent to a Roche sFlt‐1/PlGF ratio of 38, which were derived using Passing–Bablok regression. GlyFn was categorized as high or low using two reported clinical management thresholds (263 μg/mL and 510 μg/mL). Results: Overall, 236 women with suspected PE were included, of whom 70 (29.7%) were diagnosed with PE; 36 (51.4%) and 70 (100%) developed PE within 7 days and 28 days, respectively. Eighty‐eight (37.3%) women had a sFlt‐1/PlGF ratio of > 38 on the Roche platform, 79 (33.5%) women had a sFlt‐1/PlGF ratio of > 55 on the KRYPTOR platform and 96 (40.7%) women had a sFlt‐1/PlGF ratio of > 40 on the iMAGIN 1800 platform. Furthermore, 62 (26.3%) and four (1.7%) women had a GlyFn level of > 263 μg/mL and > 510 μg/mL, respectively. The negative predictive value (NPV) of the sFlt‐1/PlGF ratio measured on the Roche, KRYPTOR and iMAGIN 1800 platforms to rule out PE within 7 days after presentation was 83.3%, 82.0% and 82.9%, respectively, while that for GlyFn > 263 μg/mL and > 510 μg/mL was 82.6% and 70.4%, respectively. The corresponding positive predictive values (PPV) to rule in PE within 28 days after presentation were 50.5%, 52.3% and 46.7%, respectively, for the sFlt‐1/PlGF ratio, and 35.4% and 50.0%, respectively, for GlyFn > 263 μg/mL and > 510 μg/mL. Conclusions: The predictive performance of different manufacturers' assays for the sFlt‐1/PlGF ratio to rule in and rule out PE were similar once standardized to a common threshold. Our findings suggest that the sFlt‐1/PlGF ratio and GlyFn using a cut‐off of 263 μg/mL can both be utilized to rule out PE within 7 days after assessment, with a moderate NPV. The PPV for ruling in PE within 28 days remains poor. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

This research is based on sustainable approach for microwave joining of ferritic stainless steel (SS-430) and austenitic stainless steel (SS-316L) using Nickel (Ni) powder as an additive material. The fabricated weldment revealed sound metallurgical bonding with a complete melting of sandwich layer along with the melting of a thin layer of faying surfaces to be joined. The X-ray diffraction study revealed the formation of various intermetallic and carbides (Cr3C2, Mo2C and martensite) in the joint region. There is significant grain growth with coarse ferritic along with martensite phase at the grain boundaries in the heat-affected zone (HAZ) of the SS-430 and along the faying surfaces of SS-430 was observed. The average microhardness of the joint zone was observed to be about 350 ± 30 HV with porosity in the range of 1–1.3%. The fabricated weldment revealed a brittle mode of failure from the ferritic HAZ area with marginal elongation (about 7.1%). [ABSTRACT FROM AUTHOR]

Objective: To examine the external validity of the Fetal Medicine Foundation (FMF) competing‐risks model for the prediction of small‐for‐gestational age (SGA) at 11–14 weeks' gestation in an Asian population. Methods: This was a secondary analysis of a multicenter prospective cohort study in 10 120 women with a singleton pregnancy undergoing routine assessment at 11–14 weeks' gestation. We applied the FMF competing‐risks model for the first‐trimester prediction of SGA, combining maternal characteristics and medical history with measurements of mean arterial pressure (MAP), uterine artery pulsatility index (UtA‐PI) and serum placental growth factor (PlGF) concentration. We calculated risks for different cut‐offs of birth‐weight percentile (< 10th, < 5th or < 3rd percentile) and gestational age at delivery (< 37 weeks (preterm SGA) or SGA at any gestational age). Predictive performance was examined in terms of discrimination and calibration. Results: The predictive performance of the competing‐risks model for SGA was similar to that reported in the original FMF study. Specifically, the combination of maternal factors with MAP, UtA‐PI and PlGF yielded the best performance for the prediction of preterm SGA with birth weight < 10th percentile (SGA < 10th) and preterm SGA with birth weight < 5th percentile (SGA < 5th), with areas under the receiver‐operating‐characteristics curve (AUCs) of 0.765 (95% CI, 0.720–0.809) and 0.789 (95% CI, 0.736–0.841), respectively. Combining maternal factors with MAP and PlGF yielded the best model for predicting preterm SGA with birth weight < 3rd percentile (SGA < 3rd) (AUC, 0.797 (95% CI, 0.744–0.850)). After excluding cases with pre‐eclampsia, the combination of maternal factors with MAP, UtA‐PI and PlGF yielded the best performance for the prediction of preterm SGA < 10th and preterm SGA < 5th, with AUCs of 0.743 (95% CI, 0.691–0.795) and 0.762 (95% CI, 0.700–0.824), respectively. However, the best model for predicting preterm SGA < 3rd without pre‐eclampsia was the combination of maternal factors and PlGF (AUC, 0.786 (95% CI, 0.723–0.849)). The FMF competing‐risks model including maternal factors, MAP, UtA‐PI and PlGF achieved detection rates of 42.2%, 47.3% and 48.1%, at a fixed false‐positive rate of 10%, for the prediction of preterm SGA < 10th, preterm SGA < 5th and preterm SGA < 3rd, respectively. The calibration of the model was satisfactory. Conclusion: The screening performance of the FMF first‐trimester competing‐risks model for SGA in a large, independent cohort of Asian women is comparable with that reported in the original FMF study in a mixed European population. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

In this study, a hybrid microwave heating (MH) approach was employed to fabricate SS-430 to SS-430 joints using a nano-based SS-316L powder as a binding agent. The microstructural aspects of the developed fusion zone (FZ) revealed the perfect diffusion bonding between the faying surfaces through the fully melting of the filler material. The formation of martensite was observed at the diffused zone/heat-affected zone along both interfacing surfaces of the SS-430 base metals to be butt welded. The phase analysis of the developed reaction layer in the FZ showed the presence of small amounts of carbide particles (mainly chromium carbides) along with the presence of the main Ni-Fe-Cr enriched solid solution matrix. The hardness of the diffused zone/heat-affected zone is significantly high (760 ± 15HV) due to the presence of martensite followed by FZ hardness (410 ± 8HV) and then followed by base metal hardness (190 ± 4HV). The tensile properties of the fabricated weldment were evaluated by employing a computer-controlled universal testing machine. The tested weldment exhibits 475 MPa with an elongation of about 35%. [ABSTRACT FROM AUTHOR]

In the present work, the microwave-assisted butt joining of austenite stainless steel (SS-316L) with an SS-316L filler was investigated. The fabricated weldments were characterized in terms of phase analysis, identification of microstructural features, elemental study, microhardness, tensile and flexural properties. The results reveal a dense microstructure in the fusion zone (FZ); phase analysis reveals the presence of mainly two phases: the primary delta (δ) ferrite phase along with the Fe–Ni-based solid solution matrix. The microhardness of the FZ was measured to about 450 ± 45 HV; which is 2.05 times the base metal hardness. The weldment exhibits an ultimate tensile strength of about 495 MPa (about 95.74% of base metal strength). The flexural strength of the fabricated weldment tested on a 3-point bend test was measured to be 763.59 MPa (about 72.03% of base metal strength). [ABSTRACT FROM AUTHOR]

Objective: To determine whether maternal serum glycosylated fibronectin (GlyFn) level in the first trimester increases the sensitivity of the Fetal Medicine Foundation (FMF) triple test, which incorporates mean arterial pressure, uterine artery pulsatility index and placental growth factor, when screening for pre‐eclampsia (PE) in an Asian population. Methods: This was a nested case–control study of Chinese women with a singleton pregnancy who were screened for PE at 11–13 weeks' gestation as part of a non‐intervention study between December 2016 and June 2018. GlyFn levels were measured retrospectively in archived serum from 1685 pregnancies, including 101 with PE, using an enzyme‐linked immunosorbent assay (ELISA), and from 448 pregnancies, including 101 with PE, using a point‐of‐care (POC) device. Concordance between ELISA and POC tests was assessed using Lin's correlation coefficient and Passing–Bablok and Bland–Altman analyses. GlyFn was transformed into multiples of the median (MoM) to adjust for maternal and pregnancy characteristics. GlyFn MoM was compared between PE and non‐PE pregnancies, and the association between GlyFn MoM and gestational age at delivery with PE was assessed. Risk for developing PE was estimated using the FMF competing‐risks model. Screening performance for preterm and any‐onset PE using different biomarker combinations was quantified by area under the receiver‐operating‐characteristics curve (AUC) and detection rate (DR) at a 10% fixed false‐positive rate (FPR). Differences in AUC between biomarker combinations were compared using the DeLong test. Results: The concordance correlation coefficient between ELISA and POC measurements was 0.86 (95% CI, 0.83–0.88). Passing–Bablok analysis indicated proportional bias (slope, 1.08 (95% CI, 1.04–1.14)), with POC GlyFn being significantly higher compared with ELISA GlyFn. ELISA GlyFn in non‐PE pregnancies was independent of gestational age at screening (P = 0.11), but significantly dependent on maternal age (P < 0.003), weight (P < 0.0002), height (P = 0.001), parity (P < 0.02) and smoking status (P = 0.002). Compared with non‐PE pregnancies, median GlyFn MoM using ELISA and POC testing was elevated significantly in those with preterm PE (1.23 vs 1.00; P < 0.0001 and 1.18 vs 1.00; P < 0.0001, respectively) and those with term PE (1.26 vs 1.00; P < 0.0001 and 1.22 vs 1.00; P < 0.0001, respectively). GlyFn MoM was not correlated with gestational age at delivery with PE (P = 0.989). Adding GlyFn to the FMF triple test for preterm PE increased significantly the AUC from 0.859 to 0.896 (P = 0.012) and increased the DR at 10% FPR from 64.9% (95% CI, 48.7–81.1%) to 82.9% (95% CI, 66.4–93.4%). The corresponding DRs at 10% FPR for any‐onset PE were 52.5% (95% CI, 42.3–62.5%) and 65.4% (95% CI, 55.2–74.5%), respectively. Conclusions: Adding GlyFn to the FMF triple test increased the screening sensitivity for both preterm and any‐onset PE in an Asian population. Prospective non‐intervention studies are needed to confirm these initial findings. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

In this research paper, the ferritic stainless steel (SS)-430 was butt-joined using nickel (Ni) and austenitic stainless steel (SS-316 L) as interface powder materials. The trials were conducted using a home microwave device that ran at 2.45 GHz and 1000 W. The fabricated weldments demonstrated metallurgical bonding of the SS-430 faying surfaces with the Ni and SS-316 L-based filler materials. The presence of various carbide phases in the joint region of both Ni and SS-316 L-based filler materials was discovered using XRD investigation. The formation of various carbides particle was significantly high in case of joint formed with Ni-based filler materials as compared to the SS-316 L-based filler materials. Microhardness of the joint zone was reported as 310 ± 25 HV and 290 ± 11 HV for weldment obtained with Ni and SS-316 L-based filler materials. The tensile strength of weldment fabricated with SS-316 L-based filler materials (416.70 MPa) is significantly high as compared to weldment fabricated with Ni-based filler materials (318.70 MPa). This was because of the presence of relatively harder carbide particles present in the joint of Ni-based filler materials, which significantly reduces the ductility and tensile strength of the fabricated weldment. [ABSTRACT FROM AUTHOR]

Objective: To assess whether pregnancy-associated plasma protein-A (PAPP-A) alters or provides equivalent screening performance as placental growth factor (PlGF) when screening for preterm pre-eclampsia (PE) at 11-13 weeks of gestation.Methods: This was a secondary analysis of a non-intervention screening study of 6546 singleton pregnancies that were screened prospectively for preterm PE in the first trimester between December 2016 and June 2018. Patient-specific risks for preterm PE were estimated by maternal history, mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), PlGF and PAPP-A. A competing-risks model with biomarkers expressed as multiples of the median was used. All women and clinicians were blinded to the risk for preterm PE. The performance of screening for preterm PE using PlGF vs PAPP-A vs both PAPP-A and PlGF was assessed by comparing areas under the receiver-operating-characteristics (AUC) curves. McNemar's test was used to compare detection rate at a fixed false-positive rate (FPR) of 10%.Results: PlGF and PAPP-A were measured in 6546 women, of whom 37 developed preterm PE. The AUC and detection rate at 10% FPR using PlGF in combination with maternal history, MAP and UtA-PI were 0.854 and 59.46%, respectively. The respective values were 0.813 and 51.35% when replacing PlGF with PAPP-A and 0.855 and 59.46% when using both PAPP-A and PlGF. Statistically non-significant differences were noted in AUC when replacing PlGF with PAPP-A (ΔAUC, 0.04; P = 0.095) and when using both PAPP-A and PlGF (ΔAUC, 0.002; P = 0.423). However, on an individual case basis, screening using PlGF in conjunction with maternal history, MAP and UtA-PI identified three (8.1%) additional pregnancies that developed preterm PE and that were not identified when replacing PlGF with PAPP-A. Screening using PAPP-A in addition to maternal history and other biomarkers did not identify any additional pregnancies.Conclusion: On an individual case basis, adoption of a screening strategy that uses PAPP-A instead of PlGF results in reduced detection of preterm PE, consistent with previous literature. © 2022 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objectives: To determine whether first-trimester biomarkers of placental function can be used to screen for spontaneous preterm birth (sPTB), and to develop prediction models using maternal factors, obstetric history and biomarkers of placental function at 11-13 weeks for the calculation of patient-specific risk for sPTB.Methods: This was a retrospective secondary analysis of data derived from a prospective cohort study on first-trimester screening for pre-eclampsia in singleton pregnancies attending for routine Down syndrome screening at 11 + 0 to 13 + 6 weeks' gestation at a tertiary obstetric unit between December 2016 and September 2019. A split-sample internal validation method was used to explore and develop prediction models for all sPTB at < 37 weeks and for PTB at < 37 weeks after preterm prelabor rupture of membranes (PPROM) using maternal risk factors, uterine artery Doppler indices, serum placental growth factor (PlGF), pregnancy-associated plasma protein-A (PAPP-A) and β-human chorionic gonadotropin (β-hCG). Screening performance was assessed using receiver-operating-characteristics (ROC)-curve analysis, with calculation of the areas under the ROC curves (AUCs).Results: A total of 9298 singleton pregnancies were included in this study. sPTB at < 37 weeks occurred in 362 (3.89%) cases, including 231 (2.48%) cases of PPROM. sPTB at < 34 weeks occurred in 87 (0.94%) cases, including 39 (0.42%) cases of PPROM. Identified maternal risk factors for sPTB at < 37 weeks included chronic hypertension, conception using in-vitro fertilization and history of PTB. Maternal risk factors for PPROM at < 37 weeks included conception using in-vitro fertilization and history of PTB. Median PlGF multiples of the median (MoM) and PAPP-A MoM were significantly reduced in women with sPTB at < 37 weeks, as well as in those who had PPROM, compared to those who delivered at term. Screening by a combination of maternal risk factors, PAPP-A and PlGF achieved better performance in predicting sPTB at < 37 weeks (AUC, 0.630 vs 0.555; detection rate (DR), 24.8% vs 16.6% at a false-positive rate (FPR) of 10%; P ≤ 0.0001) and PPROM at < 37 weeks (AUC, 0.643 vs 0.558; DR, 28.1% vs 17.0% at a FPR of 10%; P ≤ 0.0001) than using maternal risk factors alone. Both models were successfully applied to the internal validation dataset, with AUCs of 0.628 and 0.650, respectively.Conclusions: We demonstrated that low levels of maternal serum PAPP-A and PlGF in the first trimester are associated with increased risks of sPTB and PPROM at < 37 weeks. However, further research is needed to identify additional biomarkers to improve the screening performance of the combined model that includes maternal risk factors, PAPP-A and PlGF before clinical application. © 2022 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of haemostatic sealant compared with bipolar coagulation on ovarian reserve after laparoscopic cystectomy for ovarian endometriomas.Design: Patient-blinded, randomised controlled trial.Setting: University-affiliated tertiary hospital.Population: Women aged 18-40 years with 3-8 cm unilateral or bilateral endometriomas.Methods: Ninety-four patients were randomised to receive haemostasis by the application of haemostatic sealant (n = 47) or standard care (n = 47).Main Outcome Measures: Primary outcome was the effect on the antral follicular count 3 months after the operation as it captures the effect on the ovary subjected to treatment. Secondary outcomes included the change in anti-Mullerian hormone, follicular-stimulating hormone and peri-operative outcomes including haemostasis, complications, pain, and satisfaction scores.Results: A total of 94 patients aged 32.36 ± 4.92 years underwent laparoscopic cystectomy for ovarian endometriomas. The average diameter of the endometrioma was 4.21 ± 1.38 cm. The increase in antral follicle count of the affected ovaries at 3 months in the intervention group (+2.36 ± 0.37) was significantly (P = 0.013) higher than that in the control group (+1.08 ± 0.36). Repeated measures analysis of variance revealed significant effect with time (P < 0.001) and of interaction of group × time (P = 0.029) for affected ovary antral follicle count. No significant difference was noted between the two groups with regard to follicular-stimulating hormone, anti-Mullerian hormone, and other secondary outcomes.Conclusions: Applying haemostatic sealant after laparoscopic cystectomy of ovarian endometriomas produced a greater increase in antral follicle count 3 months after surgery compared with the control group.Tweetable Abstract: RCT: Haemostatic sealant in laparoscopic cystectomy of endometriomas increase in the antral follicle count after surgery. [ABSTRACT FROM AUTHOR]

Objective: To (1) evaluate the normal development of the Sylvian fissures in the anterior coronal view of the fetal brain at 18-30 weeks' gestation by transvaginal three-dimensional (3D) ultrasound, (2) develop reference ranges of measurements of the right and left Sylvian fissure angles during normal pregnancy at 18-30 weeks' gestation, and (3) examine intra- and interobserver repeatability of measurements of the right and left Sylvian fissure angles.Methods: This was a prospective cross-sectional study of 422 women with a singleton pregnancy attending an ultrasound-based research clinic between March and December 2017. The entry criteria for the study were appropriately grown live fetus with no suspected structural and/or chromosomal defects between 18 + 0 and 30 + 6 weeks' gestation. Normal development of the Sylvian fissures was assessed in the anterior coronal plane of the fetal brain using transvaginal 3D volume multiplanar imaging. The coronal view was visualized as a single image from the three orthogonal views. Subsequently, the right and left Sylvian fissure angles were measured between a horizontal reference line (0°) and a line drawn along the upper side of the respective Sylvian fissure. Intra- and interobserver repeatability of the Sylvian fissure angle measurements was assessed by Bland-Altman plots. Reference equations were constructed for right and left Sylvian fissure angles for gestational age (GA) and head circumference (HC) using the Generalized Additive Models for Location Scale and Shape package.Results: In the anterior coronal view of the fetal brain, an inward rotation of the upper portion of the Sylvian fissures was observed during the second and third trimesters of pregnancy. There was a significant negative polynomial association between the Sylvian fissure angles and GA and HC. Both Sylvian fissure angles crossed the reference line (zero), going from positive to negative, at around 25 weeks' gestation or at HC of 22 cm. Z-score difference between the smoothed percentiles of the right and left Sylvian fissure angles indicated that median, 10th and 90th smoothed percentiles were closest and almost the same for the GA-based references between 18 and 28 weeks and for the HC-based references between 14 and 24 cm. The intraclass correlation coefficient of the right and left Sylvian fissure angle measurements between the two sonographers was excellent at 0.993 (95% CI, 0.988-0.996) and 0.991 (95% CI, 0.985-0.995), respectively. On Bland-Altman analysis, the mean difference between the two sonographers in right Sylvian fissure angle measurement was 0.4° (95% CI, -10.2 to 10.1°) and in left Sylvian fissure angle it was 1.0° (95% CI, -9.6 to 11.6°).Conclusions: Assessment of the Sylvian fissure angles is highly reproducible. Sylvian fissure angle reference charts can serve as a screening tool for malformations of cortical development, guiding subsequent follow-up and referral for fetal brain magnetic resonance imaging and/or assessment by an expert neurosonologist. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objective: To ascertain whether stress biomarkers and psychological indices of stress may predict both conception and miscarriage rates in women undergoing in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI).Design: Prospective observational study.Setting: A university-affiliated tertiary hospital.Population: Infertile women who were undergoing fresh or frozen IVF/ICSI cycles.Methods: Women were recruited to (1) complete validated psychological questionnaires (visual analogue scale of stress, state-trait anxiety inventory, perceived stress scale, fertility problem inventory, Beck depression inventory, and general health questionnaire), at the time of embryo transfer (ET) and pregnancy testing (PT), and (2) provide saliva samples for α-amylase (sAA) measurement before and after ET and at PT.Main Outcome Measures: Women were grouped according to subsequent reproductive outcome; scores/levels of all tests were then compared between groups at each time-point.Results: In all, 197 women completed the study, of which 92 conceived and 28 miscarried. The level of psychological stress, as measured by questionnaires, was highest at the time of PT, whereas the level of biological stress as measured by sAA level (IU/l) post-ET (1.8 × 105  ± 1.5 × 105 ) was significantly (P < 0.001) higher than pre-ET (1.2 × 105  ± 1.0 × 105 ) and at PT (1.0 × 105  ± 1.1 × 105 ). However, there was no difference in psychological scoring and in sAA levels between women who did or did not conceive and who had miscarried or had an ongoing pregnancy.Conclusions: The level of sAA is highest following ET, whereas psychological stress is highest at PT. However, neither stress level appeared to be of prognostic value in predicting conception or miscarriage.Tweetable Abstract: Stress level fluctuated at different time-points, but it did not predict conception or miscarriage. [ABSTRACT FROM AUTHOR]

Objectives: To assess the suitability of the new INTERGROWTH‐21st and World Health Organization (WHO) estimated fetal weight (EFW) references in a Southern Chinese population. A secondary aim was to determine the accuracy of EFW by assessing the difference between EFW and actual birth weight. Methods: This was a prospective cross‐sectional cohort study. Viable singleton pregnancies at 11–13 weeks' gestation were recruited to undergo a single standardized fetal biometric scan after 20 weeks. The gestational age at which the scan was performed was allocated randomly at the time of recruitment. EFW was predicted using both the Hadlock and INTERGROWTH‐21st weight estimation model formulae. Population‐specific EFW references were constructed. Z‐scores were used to compare these references against the INTERGROWTH‐21st and WHO international size references. Gestational‐age‐adjusted projection was used to assess the difference between EFW on the day of delivery and birth weight for fetuses having biometry scans ≥ 34 weeks. Results: Fetuses of 970 participants had biometry scans. The median number of scans per gestational week was 48 (interquartile range, 43–53). Z‐score comparison indicated that the WHO 10th, 50th and 90th centiles of the EFW reference were consistently higher than the corresponding local centiles, whilst the INTERGROWTH‐21st 10th centile was lower. Fewer than 2% of fetuses scanned at or after 34 weeks would be considered as potentially large‐for‐gestational age, irrespective of which model was used to predict weight. Adopting the WHO international reference would result in approximately one in six fetuses being regarded as potentially small‐for‐gestational age, 50% more than the number determined using a population‐specific reference. Systematic errors of extrapolated EFW were similar, ranging from 5.5% to 7.4%. Conclusions: Centers seeking to use new references, such as the INTERGROWTH‐21st and/or WHO international references, as a means of determining whether a fetus is small‐ or large‐for‐gestational age, would be advised to assess the suitability of these references within their own population using standardized methodology. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objectives: To assess the suitability of the new INTERGROWTH-21st and World Health Organization (WHO) estimated fetal weight (EFW) references in a Southern Chinese population. A secondary aim was to determine the accuracy of EFW by assessing the difference between EFW and actual birth weight.Methods: This was a prospective cross-sectional cohort study. Viable singleton pregnancies at 11-13 weeks' gestation were recruited to undergo a single standardized fetal biometric scan after 20 weeks. The gestational age at which the scan was performed was allocated randomly at the time of recruitment. EFW was predicted using both the Hadlock and INTERGROWTH-21st weight estimation model formulae. Population-specific EFW references were constructed. Z-scores were used to compare these references against the INTERGROWTH-21st and WHO international size references. Gestational-age-adjusted projection was used to assess the difference between EFW on the day of delivery and birth weight for fetuses having biometry scans ≥ 34 weeks.Results: Fetuses of 970 participants had biometry scans. The median number of scans per gestational week was 48 (interquartile range, 43-53). Z-score comparison indicated that the WHO 10th , 50th and 90th centiles of the EFW reference were consistently higher than the corresponding local centiles, whilst the INTERGROWTH-21st 10th centile was lower. Fewer than 2% of fetuses scanned at or after 34 weeks would be considered as potentially large-for-gestational age, irrespective of which model was used to predict weight. Adopting the WHO international reference would result in approximately one in six fetuses being regarded as potentially small-for-gestational age, 50% more than the number determined using a population-specific reference. Systematic errors of extrapolated EFW were similar, ranging from 5.5% to 7.4%.Conclusions: Centers seeking to use new references, such as the INTERGROWTH-21st and/or WHO international references, as a means of determining whether a fetus is small- or large-for-gestational age, would be advised to assess the suitability of these references within their own population using standardized methodology. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objective: To examine preferences for follow-up testing in women screened with high or intermediate risk for Down syndrome in the first or second trimester.Design: Prospective cohort study.Setting: Three public hospitals in Hong Kong, China.Sample: Women with pregnancies termed as high risk (≥1:250; HR) or intermediate risk (1:251-1200; IR) for Down syndrome.Methods: Women with pregnancies screened as HR were offered the choices of: (1) an invasive test plus chromosomal microarray (CMA) to obtain more detailed fetal genetic information; (2) non-invasive cell-free prenatal DNA screening (NIPT) to detect trisomies 13, 18 and 21, and to avoid procedure-related miscarriage; and (3) to decline any further testing. Women received standardised counselling informing them that the reporting times were identical, the procedure miscarriage risk was 0.1-0.2% and that there was no charge for screening. Women with IR pregnancies (1:251-1200) were offered NIPT as a secondary screening test.Main Outcome Measures: Uptake rate for NIPT.Results: Three hundred and forty-seven women had pregnancies deemed as HR; 344 (99.1%) women opted for follow-up testing, 216 (62.2%) of whom chose NIPT. Five hundred and seven of 614 women (82.6%) with IR risk chose NIPT. Seven (21%) of 34 women with nuchal translucency ≥3.5 mm opted for NIPT.Conclusion: In a setting where reporting times are similar and there is no cost difference between options, approximately 60% of women with pregnancies classed as HR would opt for NIPT, offering simple but limited aneuploidy assessment, over a diagnostic procedure with comprehensive and more detailed assessment.Tweetable Abstract: 60% of pregnant Chinese women prefer NIPT over CMA when screened as high risk for Down syndrome. [ABSTRACT FROM AUTHOR]

Objective: To assess the potential of screening for pre-eclampsia (PE) in a Chinese population.Design: Case-control study.Setting: Teaching hospital in Hong Kong.Population: A total of 3330 women having a viable singleton pregnancy attending first-trimester Down-syndrome screening.Methods: Mean arterial pressure (MAP), bilateral uterine artery pulsatility index (UtA-PI), and placental growth factor (PlGF) were measured. Screening markers were transformed to multiples of the gestational median (MoM) and adjusted for maternal and pregnancy characteristics. MoM distributions in PE and non-PE pregnancies were compared with published expected values. PE screening performance was assessed using area under receiver operating curves (AUROC).Main Outcome Measures: PE detection rate.Results: A total of 30 (0.9%) women developed either early (<34 weeks) or late (≥34 weeks) onset PE. MAP was dependent on maternal BMI, UtA-PI on fetal crown rump length, uterine artery peak systolic velocity (UtA-PSV) on maternal age and gestation, and PlGF on gestation in non-PE pregnancies. MoM distributions determined using published Fetal Medicine Foundation models deviated significantly from one for both MAP (P < 0.0001) and PI (P < 0.0001), but not PlGF (P = 0.52) in non-PE pregnancies, whilst PlGF MoM distributions in those who developed early as opposed to late onset PE were significantly higher (P = <0.05). AUROC for any PE using multiple markers was 0.72 (95% CI: 0.64-0.81) with detection rates of 72 and 55% for early and late PE, respectively, for a 10% false positive rate.Conclusion: Detection rates for PE in our Chinese population were lower than the expected 90-95% even after adjusting MoM for local women's characteristics.Funding: General Research Fund (Project number 470513).Tweetable Abstract: Pre-eclampsia screening in the Chinese population had detection rates lower than previously published results. [ABSTRACT FROM AUTHOR]

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In view of a persistently high prevalence of hepatitis B surface antigen (HBsAg) carriage in our obstetric population, we examined the association between HBsAg carriage with maternal ABO and rhesus (Rh) blood group phenotypes determined at routine antenatal screening. In a retrospective study, the antenatal screening results of women booked for confinement between 1998 and 2011 in our hospital were examined for the relationship between HBsAg carriage with the ABO and rhesus blood groups, taking into account also the effects of advanced maternal age (≥35 years) and parity status (nulliparous or multiparous), and year of birth before or following the availability of the hepatitis B vaccine (1984). HBsAg carriage was found in 9.9%, 9.6%, 9.1% and 10.2% ( P = 0.037) for group-A ( n = 20 581 or 26.1%), -B ( n = 20 744 or 26.4%), -AB ( n = 5138 or 6.5%) and -O ( n = 32 242 or 41.0%) among the 78 705 women in the study cohort. Rhesus negativity was found in 0.6%, and HBsAg carriage was 12.3% and 9.8%, respectively, for the Rh-negative and Rh-positive women ( P = 0.071). Carriage rate between group-O and non-O was influenced by nulliparity, age ≥35 years and Rh-positive status. Regression analysis indicated that group-B ( P = 0.044, aOR = 1.062, 95% CI 1.002-1.127) and group-AB ( P = 0.016, aOR = 1.134, 95% CI 1.024-1.256) were associated with HBsAg carriage. Blood groups-B and -AB are associated with increased hepatitis B virus (HBV) infection in our population, and further studies are warranted to elucidate the implications of this on the sequelae of HBV infection. [ABSTRACT FROM AUTHOR]

We examined the impact of the neonatal hepatitis B immunization programme, first provided to all neonates born to mothers screened positive for hepatitis B surface antigen (HBsAg) in late 1983, on the age-specific prevalence of HBsAg carriage in teenage mothers managed in 1998–2008. HBsAg carriage was found in 2·5%, 2·7%, 8·8% and 8·0% of mothers aged ⩽16, 17, 18, and 19 years, respectively (P = 0·004), which was also correlated with advancing age (P = 0·011). While neither difference nor correlation with age was found in mothers born before 1984, the prevalence of 1·2%, 1·5%, 7·1% and 8·3%, respectively, was significantly different among (P = 0·008) and correlated with (P = 0·002) age in mothers born 1984 onwards. Regression analysis indicated there was a significantly higher incidence of HBsAg carriage from age 17 onwards (adjusted odds ratio 2·55, 95% confidence interval 1·07–6·10, P = 0·035), suggesting that the protective effect of the vaccine declined in late adolescence. [ABSTRACT FROM PUBLISHER]

The relationship between chronic hepatitis B virus ( HBV) infection with atherosclerosis and cardiovascular disorders remains unclear, and the impact of maternal HBV infection on the development of pregnancy-induced hypertension ( PIH) and pre-eclampsia ( PE) is also controversial. This retrospective cohort study was conducted to examine the relationship between maternal hepatitis B surface antigen ( HBs Ag) status with PIH and PE in singleton pregnancies that delivered at 24 weeks of gestation and beyond. Among the 86 537 cases in the cohort, 10% were HBs Ag positive, and overall 2.0% had PIH, of whom 56.3% developed PE. HBsAg-positive women had higher weight and body mass index ( BMI), but lower incidences of advanced age, nulliparity, PIH (1.6% vs 2.0%, P = 0.007) and PE (0.8% vs 1.1%, P = 0.005). On multiple logistic regression analysis adjusting for the effects of nulliparity, advanced age, high BMI, and underlying renal, cardiac and autoimmune diseases, HBs Ag carriage was associated with significantly reduced incidence of PIH ( aOR 0.79, 95% CI 0.66-0.95) and PE ( aOR 0.71, 95% CI 0.56-0.91). Our results indicate that maternal HBs Ag carriage is independently associated with reduced PE. As chronic HBV infection alters the immune response of the individual, our observation could be related to enhanced maternal immunotolerance of the foetus and hence a reduction in the incidence of PE. The implications of our findings on the long-term health outcome of the infected women, from cardiovascular morbidity to malignancies, warrant further studies. [ABSTRACT FROM AUTHOR]

. Information on the impact of maternal hepatitis B virus (HBV) infection on pregnancy outcome is conflicting. Some studies reported an association with increased infant birthweight, which could be interpreted as advantageous to pregnancy. A retrospective study was performed to compare birthweight outcome between 6261 and 55 817 singleton pregnancies in mothers screened positive and negative for hepatitis B surface antigen (HBsAg), respectively. The HBsAg positive women were younger, had higher body mass index (BMI) and incidence of overweight, but less gestational weight gain, and were associated with increased macrosomia (birthweight ≥4000 g) in mothers <35 years (odds ratio, OR, 1.28), BMI ≥25 kg/m2 (OR 1.24), without gestational diabetes mellitus (GDM, OR 1.19), and in male infants (OR 1.18). It was also associated with increased large-for-gestational age (LGA, birthweight >90th percentile) infants in nulliparas (OR 1.13), age <35 years (OR 1.12), BMI ≥25 kg/m2 (OR 1.19), with (OR 1.36) and without (OR 1.09) GDM, and in male infants (OR 1.13). When the effects of high BMI, advanced age, GDM, and male infants were controlled for, positive HBsAg was significantly associated with macrosomic (adjusted odds ratio, aOR, 1.15) and LGA (aOR 1.11) infants. In view of the latest findings on the association between high infant birthweight with increased risk of obesity, diabetes mellitus, and various forms of malignancies from childhood to adulthood, further studies are warranted to determine if maternal hepatitis B infection would impact adversely on the long-term health of the offspring through its effect on increasing birthweight. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Leung T, Stuart O, Sahota D, Suen S, Lau T, Lao T. Head-to-body delivery interval and risk of fetal acidosis and hypoxic ischaemic encephalopathy in shoulder dystocia: a retrospective review. BJOG 2011;118:474-479. To examine the association between head-to-body delivery interval (HBDI) and cord arterial pH and base excess (BE), and the risk of development of hypoxic ischaemic encephalopathy (HIE). Retrospective review. A university hospital. Pregnancies complicated with shoulder dystocia during the period 1995-2009. Cases were identified from a search of the hospital electronic delivery records. Cord arterial pH and BE, and the incidence of HIE and perinatal death, were retrieved from medical records and correlated with HBDI, birth weight, mode of delivery and presence of nonreassuring fetal heart rate pattern and maternal diabetes using univariate analysis, followed by multivariate analysis. Any association between cord pH and HBDI. Of the 200 cases identified, the mean (standard deviation) HBDI was 2.5 minutes (1.5 minutes). Both HBDI and the presence of nonreassuring fetal heart rate pattern were independent factors for pH, and HBDI was the only significant factor for BE. Arterial pH dropped at a rate of 0.011 per minute [95% confidence interval (95% CI), 0.017-0.004; P = 0.002] with HBDI. The mode of delivery, birth weight and maternal diabetes did not affect blood gas levels. The respective risks of severe acidosis (pH < 7) and HIE with HBDI of <5 minutes were 0.5% and 0.5% versus 5.9% and 23.5% with HBDI ≥ 5 minutes. Cord arterial pH drops with HBDI during shoulder dystocia, but the risk of acidosis or HIE is very low with HBDI < 5 minutes. [ABSTRACT FROM AUTHOR]

Increased rubella susceptibility has been shown in subjects from the Asian-Pacific region where chronic hepatitis B virus (HBV) infection is endemic. This study was performed to explore the relationship between chronic HBV infection and rubella susceptibility in the obstetric population. We conducted a retrospective cohort study on 50556 pregnant women delivered in a university obstetric unit from January 1998 to June 2008. The incidence of rubella susceptibility according to maternal HBV carrier status was examined. HBV infection and rubella susceptibility were found in 5105 (10.1%) and 6102 (12.1%) women, respectively. Rubella susceptibility was more common in women with HBV (13.1% vs 12.0%, P = 0.017), even after adjusting for other confounding factors (odds ratio 1.11, 95% confidence interval 1.01-1.21). Advancing age was associated with progressively decreasing odds of rubella susceptibility, from 0.48 at age 20-24 years to 0.34 at age ≥40 years in women without HBV infection, but had no effect in women with hepatitis B. In conclusion, our study is the first to demonstrate an association between chronic HBV infection with rubella susceptibility. Further studies are warranted to confirm whether chronic HBV infection, especially that acquired by vertical transmission, may impair the immune response to rubella vaccine or natural infection throughout the reproductive age. [ABSTRACT FROM AUTHOR]

The article presents a study on the comparison of the likelihood ratios (LR) of nuchal translucency (NT) through multiples of the medial (MoM), delta-NT and the combination of the approaches. The study included 5, 907 singleton pregnancies with outcome screened at 12th week of gestation between January 2006 and May 2008. Results indicate that 14 of the 5, 907 pregnancies were diagnosed with trisomy 21. Results also show that LRs through delta-NT model were greater than the combined models.

This study aimed to examine the prevalence of maternal hepatitis B virus (HBV) infection in the past 10 years and the age- and parity-specific incidences for evidence of control of HBV infection in the female reproductive population. We conducted a retrospective cohort study on 58 736 consecutive pregnant women delivered from July 1998 to June 2008. Maternal HBV status and demographic data were retrieved from a computerized database for analysis by year, age, year of birth and parity. A total of 5788 (10.1%) women had HBV infection, and the annual prevalence was around 10% throughout. When categorized by maternal age into six 5-year cohorts, the incidence increased from 6.8% in the <20 years cohort to 10.8% in the 20–24 and 25–29 year cohorts, then declined to 9.3% in the ≥40 years cohort ( P < 0.001). When categorized by year of birth into 5-year cohorts, the incidence varied from 9.2% for the 1965–1969 cohort to 11.3% in the 1980–1984 cohort, which then declined to 7.3% in the ≥1985 cohort ( P < 0.001). Multiparas had higher incidence when compared with nulliparas overall (10.5% vs 9.6%, P = 0.001), and significantly higher incidences for the 25–29 year ( P = 0.009), 30–34 year ( P < 0.001) and 35–39 year ( P = 0.032) cohorts when analysed by age. In conclusion, the prevalence of maternal HBV infection remained constant at 10% for the past decade. The changes in relation to age and parity suggested that horizontal transmission, probably by sexual contact, had played an important role in maintaining the same prevalence as reported from Hong Kong 20 years ago. [ABSTRACT FROM AUTHOR]

The article presents a study which identifies the number of ultrasound examinations needed in training sonographers to get an accurate measurement of the fetal frontomaxillary facial (FMF) angle in 11-13 week of gestation. Eight sonographers, accredited for nuchal translucency thickness (NT) measurement, were trained using three-dimensional (3D) ultrasound volumes in a case-by-case basis. Results showed that the competence in measuring FMF angle was obtained after 90 cases median number.

The article presents a study on the performance of the screened pregnancy strategies used to detect fetal Down syndrome. It states that combined biochemistry (BC) screening and ultrasound were carried out to examine pregnant women wherein data were analyzed using contingent model approach. The results show that a 5% false-positive rate with combined screening policy (NT-BC) accumulated 88% detection rate and 2.3 had an absent nasal bone.

The article presents a study which probes on which biochemical markers in both the first and the second trimesters are the best predictors for fetal growth and small-for-gestational age (SGA). The study uses Chinese women with a singleton pregnancy in which markers including placental volume (PlaV) and uterine pulsatility index (UtA-PI) were examined. The study found that among the markers only the first-trimester PlaV and second-trimester PlaV plus UtA-PI are independent predictors for SGA.

The article presents a study which determines that fetal nasal bone length (NBL) in a Chinese population and its relevance in screening chromosomal defects in the first trimester of pregnancy. The study features Chinese women with singleton pregnancies between January 2004 and June 2007. The study suggests that the NBL in Chinese fetuses is similar to other ethnic groups and that the NBL measurement appears insignificant in improving the screening for aneuploidy.

The article presents a study which compares the inter and intraobserver variation of fetal biometric measurements by using the two-dimensional (2D) and three-dimensional (3D) ultrasound imaging. It says that optimal standard image plane is important for sonographers to make a precise biometric measurement. The study suggests that both 2D and 3D ultrasounds are reproducible and 3D ultrasound significantly reduces the variation for head circumference, abdominal circumference, and femur length.

The article presents the result of the study conducted on the combination of fetal nuchal translucency (NT) thickness, pregnancy-associated plasma protein-A (PAPP-A), and the maternal serum free beta human chorionic gonadotropin as an effective screening program. It also explores the independent effect of covariates on their levels in Chinese ethnic women undergoing first-trimester down syndrome screening. The study's result shows the value of determining localized biochemical marker correction.

The article presents a study which observes women with a spontaneously conceived singleton pregnancy and regular menstrual cycle in the preceding 12-month period. It aims to develop a sonographic dating formula based on fetal crown-rump length (CRL) in a population in Hong Kong, China. It derived a formula which is suitable for dating of naturally conceived pregnancies between 6 to 15 weeks of gestation having no prediction error and was compared favorably with established CRL dating formulae.

The article aims to develop a customized birth weight model in Great Britain. Coefficients supported the findings of the past research that suggest that birth weight was affected by maternal ethnicity, age, parity, body mass index, smoking, fetal gender and gestational age at delivery. The authors conclude that models have been derived to determine customized or predicted birth weight that are both robust and reproducible.

Objective To assess the effect of increasing body mass index (BMI) on pregnancy outcome in a population of Chinese women. Design A retrospective study. Setting A university teaching hospital. Population Women delivering singleton babies between 1995 and 2005 who sought antenatal care before 20 weeks of gestation. Methods A total of 29 303 women were categorised into six BMI groups according to WHO’s classification. Univariate, multivariate and logistic regression analysis were performed to compare obstetric and perinatal outcomes between BMI groups. Main outcome measures Incidences of caesarean delivery, pre-eclampsia, gestational diabetes, preterm delivery, small for gestational age (SGA) and large for gestational age (LGA), perinatal death, and the respective odd ratios in reference to the normal group with BMI ≥ 18.5 kg/m2 and <23 kg/m2. Results The median BMI increased with increasing maternal age, parity, gestation at the first visit, but decreased with year of delivery ( P < 0.001). Concerning the obstetric outcomes, increasing BMI was associated with increasing incidence of caesarean section, pre-eclampsia, gestational diabetes, preterm delivery, LGA, as well as SGA according to customised growth standards ( P < 0.001). The odds ratios for most of these adverse outcomes are higher than those reported in Caucasian population. Increasing BMI was not associated with the rate of stillbirth, neonatal death or shoulder dystocia. Conclusion Increasing BMI is associated with increased risks of adverse obstetric outcomes. The impacts of high BMI on pre-eclampsia, gestational diabetes and preterm delivery in Chinese women might be stronger than that in Caucasian. Hence, it may be appropriate to use a lower BMI cutoff for defining overweight in Chinese. [ABSTRACT FROM AUTHOR]

Background/Aim: Over 190 million people in the world suffer from diabetes mellitus. Diabetics are 25 times more likely to have a leg amputated because of unhealing foot ulcers. Herbal medicine has been used in China to salvage the ulcerated limb. With the aim to study the efficacy of two commonly used herbs for ulcer healing, namely Radix Astragali and Radix Rehmanniae, a good animal model needs to be developed for a proper in vivo investigation. Methods: Firstly, a diabetic animal model was established by streptozotocin injection. Then standard wounds were created on the feet of the diabetic rats. Digital photographs were taken and analyzed by a novel image analysis software. Results: The average ulcer area in the Radix Rehmanniae treatment group was 11.45 mm2, which was significantly smaller than the 15.12 mm2 in the water treatment group (p = 0.04). Radix Astragali, on the other hand, was found to have no significant effect on ulcer shrinkage. Conclusion: Further investigation is needed for the identification of the active principles of Radix Rehmanniae. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The article presents a study that hopes to determine whether the first trimester crown-rump length, maternal serum levels of pregnancy-associated plasma protein A and free beta-human chrorionic gonadotropin are independent predictors of birth weight. The methods and results of the study are described.

Objective To examine the effectiveness of first-trimester fetal trisomy 21 screening using a combination of maternal age, nuchal translucency thickness (NT) and maternal serum free beta-human chorionic gonadotropin (β-hCG) and pregnancy-associated plasma protein-A (PAPP-A) levels in a predominantly Chinese population in Hong Kong. Methods This was a prospective study over a 1.5-year period of 2990 women who underwent combined screening for trisomy 21 between 11 + 0 and 13 + 6 weeks of gestation in a university fetal medicine unit. NT was measured according to the criteria set by The Fetal Medicine Foundation (FMF), maternal serum free β-hCG and PAPP-A levels were measured, and the risk of trisomy 21 was calculated using The FMF' s algorithm. Fetal karyotyping was advised when the risk was 1:300 or above. All subjects were followed up for pregnancy and fetal outcome. Results Of the 2990 women who underwent the screening program, 99% were Chinese. There were 57 twin pregnancies, giving a total of 3047 fetuses. Thirty-one percent of the women were 35 years old or above. One hundred and eighty-five (6.1%) fetuses were screen-positive; this included 14 cases of trisomy 21 and 17 cases of other chromosomal abnormalities. The positive predictive value was 16.7%. Among the 2862 screen-negative fetuses, only 18 (0.6%) cases had an unknown fetal outcome. There were no cases in which trisomy 21 was missed and the infant was liveborn. Conclusion First-trimester combined screening for fetal trisomy 21 is highly effective among Chinese subjects. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to compare the efficacy and safety of oral misoprostol 400 μg with intramuscular syntometrine in the management of the third stage of labor. Material and Methods: This was a double-blind randomized controlled trial conducted in a tertiary care hospital. Three hundred and fifty-five women randomized to receive either oral misoprostol 400 μg or intramuscular syntometrine in the third stage of labor were studied. The change in hemoglobin level from before to 48 h after delivery, use of additional oxytocics and treatment related side effects were the main outcome measures. Results: There were no significant differences between the two groups in terms of the change in hemoglobin level and mean blood loss. The incidence of shivering was significantly higher in the misoprostol group whilst that of vomiting was significantly higher in the syntometrine group. There were no differences in the incidence of nausea, headache, diarrhea and pyrexia between the two groups. Conclusion: Orally administeredmisoprostol at a dose of 400 μg is an acceptable alternative in preventing post-partum blood loss, as measured by the peri-partum change in hemoglobin level and was not associated with an increased incidence of side effects. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective To determine whether first-trimester maternal serum levels of pregnancy-associated plasma protein-A (PAPP-A) and free beta-human chorionic gonadotro pin (fß-hCG) are independent predictors of second-trimester fetal growth parameters. Methods This was a cohort study over a 1-year period involving 594 Chinese women who underwent both first-trimester combined screening for Down syndrome and a routine second-trimester ultrasound examination. Maternal PAPP-A and fß-hCG levels (expressed in log10 of multiples of median (MoM)), crown-rump length (CRL) (expressed in standardized Z-score (Z-CRL)), and maternal height and weight, were correlated with the Z-score of biparietal diameter (Z-BPD), femur length (Z-FL) and abdominal circumference (Z-AC) measured in the second trimester, using the Pearson test, followed by multiple regression analysis. Results Z-BPD, Z-FL and Z-AC were positively correlated with loglo PAPP-A MoM, CRL and maternal height (all P < 0.05), while loglo fß-hCG MoM was negatively correlated with Z-AC (P < 0.05). After controlling for the effects of CRL, maternal height and weight, log10 PAPP-A MoM was found to be an independent positive predictor of Z-FL (r = 0.797, P < 0.001) and Z-AC (r = 0.305, P = 0.049), and log10 fß-hCG MoM was an independent negative predictor of Z-FL (r = -0.3 81, P = 0.023) and Z-AC (r = -0.418, P = 0.002). Neither hormonal level was related to Z-BPD. Conclusions First-trimester PAPP-A and fß-hCG are independent factors that influence subsequent fetal growth. PAPP-A level is positively correlated with FL and AC in the second trimester, while fß-hCG level is negatively correlated with them. However, BPD is not affected by either of the hormones. [ABSTRACT FROM AUTHOR]

Objective To study the effects of maternal and pregnancy characteristics on fetal biometric size using longitudinal ultrasound measurements and to construct customized models for fetal biometric size charts. Methods A cohort of 533 healthy pregnant women with normal singleton pregnancies were recruited for regular ultrasound examination for fetal biometry between 24 and 40 weeks' gestation. Multilevel modeling was used to construct models of fetal head size, femur length and abdominal circumference. Variables of maternal and pregnancy characteristics including booking weight and height, age, parity and fetal sex were included in the construction of the customized fetal biometric size charts. Results Increased fetal head size and abdominal circumference were significantly associated with extremes of maternal age. Maternal height had a statistically significant influence on biparietal diameter. Maternal booking weight had an influence on fetal abdominal circumference and femur length. Fetal sex was found to have a statistically significant influence on the final regression models of biparietal diameter, head circumference and femur length. Parity had an influence on fetal head circumference and abdominal circumference. Conclusions Maternal and pregnancy characteristics have a significant influence on in-utero fetal biometry. We produced models to construct customized fetal biometric size charts. Further validation studies are necessary to evaluate the clinical usefulness of such customized fetal biometric size charts. [ABSTRACT FROM AUTHOR]

Objective To derive a nomogram of fetal maxillary bone length (MAX) for a Chinese population and to study whether first-trimester maternal serum levels of pregnancy-associated plasma protein-A (PAPP-A) is an independent predictor of fetal MAX. Methods This was a prospective observational study over 10 months examining Chinese women with a singleton pregnancy who attended the first-trimester screening program for Down syndrome. The subjects had the fetal crown-rum p length (CRL), nuchal translucency, MAX, maternal serum PAPP-A and free beta-human chorionic gonadotropin (fβ-hCG) levels measured. A nomogram of MAX was derived using normal pregnancies with reliable dates. The correlations between MAX, CRL, PAPP-A and fβ-hCG levels were studied, after correction for gestational dependency using Z-score transformation for the ultrasound markers (Z-MAX and Z-CRL), and logarithmic transformation of multiple of gestation- specific medians for the biochemical markers (log10PAPP- A multiples of the median (MoM) and log10fβ-hCG MoM), using the Pearson test and multiple regression analysis. Results During the study period, 607 Chinese women met the inclusion criteria. The mean gestational age at the first-trimester screening teas 12 + 4 weeks (SD, 4 days). Curve estimation analysis showed that a linear relationship fit best between MAX and CRL (MAX (mm) -0.01 + 0.101 * CRL (mm); r = 0.826; P < 0.0001), and between MAX and gestational age (MAX (mm) = -8.465 + 0.170 * gestational age (day); r = 0.754: SD = 0.71; P < 0.0001). There were significant positive correlations between Z-MAX and Z-CRL (r = 0.62 7; p = <0.0001), Z-MAX and log10PAPP-A MoM (r = 0.23 9; P = <0.0001). Multiple regression analysis showed that both Z-CRL (P = <0.0001) and log10 PAPP-A MoM (P = 0.048) were independent predictors for Z-MAX. Conclusion Both CRL and maternal levels of PAPP-A are independent predictors of the fetal MAX measured during the first trimester. The positive correlation between PAPP-A levels and fetal MAX is consistent with the known biological function of PAPP-A on bone growth. This association must be adjusted for when both PAPP-A and MAX are combined for screening of Down syndrome. [ABSTRACT FROM AUTHOR]

Electrocardiograms (ECG) was examined in 15 fetuses during fetal heart rate decelerations in labour. Sinus bradycardia was demonstrated in six cases and in two cases inversion of the P wave was seen. In seven cases there was complete dissociation of the P wave from the QRS complex, indicating complete atrioventricular heart block. Many decelerations are vagally mediated, but such cases associated with complete atrioventricular heart block may be due to the effect of hypoxia on the bundle of His. [ABSTRACT FROM PUBLISHER]