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Background and Objectives: To evaluate weight-indexed umbilical systolic diastolic ratio (UASDR) to discriminate risk for adverse outcomes among growth restricted fetuses (FGR). Design and Setting: Retrospective study using prenatal ultrasound data and neonatal outcome data. Two primary outcomes: admission to intensive care and a composite outcome of severe neonatal morbidity. We included births among individuals with a singleton pregnancy at 24–40 weeks gestation without other indications for preterm delivery. We calculated the percentile of the measured standard UASDR, and the same value indexed to the EFW (iUASDR). Results: 296 pregnancies met inclusion criteria. Forty-seven percent required NICU admission and 31% developed a component of the composite outcome. The sensitivity of the iUASDR increased at lower birthweight percentiles. The positive predictive value of the standard UASDR was higher among fetuses with EFW <5th % and <10th % for NICU admission and composite outcome ((EFW <5th %) 0.82 (95% CI: 0.71, 0.91) and 0.60 (95% CI: 0.48, 0.72) and ((EFW <10th %) 0.81 (95% CI: 0.70, 0.89) and 0.58 (95% CI: 0.45, 0.69) compared with indexed values. Discussion: Data does not support use of the iUASDR to improve the test characteristics of the UASDR. Despite a moderate increase in specificity, the positive predictive value was low. UASDR non-indexed or standard values in conjunction with clinical findings and severity of FGR perform best. [ABSTRACT FROM AUTHOR]

Objectives: To summarize image quality variables for alloimmunized women at risk for fetal anemia. To investigate the association between image quality with the highest and median middle cerebral artery peak systolic velocity (MCA‐PSV) at the last visit and fetal anemia based on hemoglobin. Study Design: This study was a qualitative retrospective analysis of 192 Doppler ultrasound images used in the detection of fetal anemia in 26 alloimmunized women seen in a Minneapolis hospital over the past 3 years. Images were graded on seven criteria found in literature. Results: Of the images analyzed, 23 (12.0%) of the 192 met all seven image quality criteria. Using the highest MCA‐PSV value, the sensitivity, and specificity were 55.6% and 94.1%, respectively. Using the median MCA‐PSV value, the sensitivity, and specificity were 44.4% and 94.1%, respectively. Conclusions: Only a minority of Doppler images meet all suggested image criteria. This could negatively impact the accuracy of the MCA‐PSV measurements as indicated by the decreased sensitivity in our evaluations. [ABSTRACT FROM AUTHOR]

Contag SA, Bi J, Chappell MC, Rose JC. Developmental effect of antenatal exposure to betamethasone on renal angiotensin H activity in the young adult sheep. Am J Physiol Renal Physiol 298: F847-F856, 2010. First published January 13, 2010; doi:10.1152/ajprenal.00497.2009.--Antenatal corticosteroids may have long-term effects on renal development which have not been clearly defined. Our objective was to compare the responses to intrarenal infusions of ANG II in two groups of year-old, male sheep: one group exposed to a clinically relevant dose of betamethasone before birth and one not exposed. We wished to test the hypothesis that antenatal steroid exposure would enhance renal responses to ANG II in adult life. Six pairs of male sheep underwent unilateral nephrectomy and renal artery catheter placement. The sheep were infused for 24 h with ANG II or with ANG II accompanied by blockade of the angiotensin type 1 (A[T.sub.1]) or type 2 (AT2) receptor. Baseline mean arterial blood pressure among betamethasone-exposed sheep was higher than in control animals (85.8 [+ or -] 2.2 and 78.3 [+ or -] 1.0 mmHg, respectively, P = 0.003). Intrarenal infusion of ANG II did not increase systemic blood pressure (P [greater than or equal to] 0.05) but significantly decreased effective renal plasma flow and increased renal artery resistance (P < 0.05). The decrease in flow and increase in resistance were significantly greater in betamethasone- compared with vehicleexposed sheep (betamethasone P < 0.05, vehicle P [greater than or equal to] 0.05). This effect appeared to be mediated by a heightened sensitivity to the A[T.sub.1] receptor among betamethasone-exposed sheep. Sodium excretion initially decreased in both groups during ANG II infusion; however, a rebound was observed after 24 h. A[T.sub.1] blockade was followed by a significant rebound after 24 h in both groups. A[T.sub.2] blockade blunted the 24-h rebound effect among the vehicle-exposed sheep compared with the betamethasone-exposed sheep. In conclusion, antenatal corticosteroid exposure appears to modify renal responsiveness to ANG II by increasing A[T.sub.1]- and decreasing A[T.sub.2] receptor-mediated actions particularly as related to renal blood flow and sodium excretion. angiotensin receptor; renal plasma flow; glomerular filtration rate; corticosteroids doi: 10.1152/ajprenal.00497.2009.

Objective: To determine maternal and perinatal outcomes after induction of labor (IOL) at 39 weeks compared with expectant management. Methods: This is a retrospective national cohort study from the National Center for Health Statistics birth database. The study included singleton, low-risk pregnancies with a non-anomalous fetus delivered at 39–42 weeks gestation between 2015 and 2018. Maternal outcomes available included chorioamnionitis (Triple I), blood transfusion, intensive care unit (ICU) admission, uterine rupture, cesarean delivery (CD), and cesarean hysterectomy. Fetal and infant outcomes included stillbirth, 5-min Apgar ≤3, prolonged ventilation, seizures, ICU admission, and death within 28 days. We compared women undergoing IOL at 39 weeks to those managed expectantly. Non-adjusted and adjusted relative risks (aRRs) were estimated using multivariate log-binomial regression analysis. Results: There were 15,900,956 births available for review of which 5,017,524 met inclusion and exclusion criteria. For the maternal outcomes, the IOL group was less likely to require a CD (aRR 0.880; 95% CI [0.874–0.886]; p value <.01) or develop Triple I (aRR 0.714; 95% CI [0.698–0.730]; p value <.01) but demonstrated a small increase in the cesarean hysterectomy rate (aRR 1.231; 95% CI [1.029–1.472]; p value <.01). Among perinatal outcomes, the stillbirth rate (aRR 0.195; 95% CI [0.153–0.249]; p value <.01), 5-min Apgar ≤3 (aRR 0.684; 95% CI [0.647–0.723]; p value <.01), prolonged ventilation (aRR 0.840; 95% CI [0.800–0.883]; p value <.01), neonatal intensive care (NICU) admission (aRR 0.862; 95% CI [0.849–0.875]; p value <.01) were lower after 39 week IOL compared with expectant management. There were no differences in risk for neonatal seizures (aRR 0.848; 95% CI [0.718–1.003]; p value 0.011) or death (aRR 1.070; 95% CI [0.722–1.586]; p value 0.660). Conclusions: IOL at 39 weeks of gestation in a low-risk cohort is associated with a lower risk of CD and maternal infection, stillbirth, and lower neonatal morbidity. There was no effect on the risk for neonatal seizures or death. [ABSTRACT FROM AUTHOR]

Background: The optimal timing of induction for those undergoing a trial of labor after cesarean section has not been established. The little data which supports the consideration of induction at 39 weeks gestation excludes those with a history of prior cesarean section. Objective: To determine the risks and benefits of elective induction of labor (IOL) at 39 weeks compared with expectant management (EM) until 42 weeks in pregnancies complicated by one previous cesarean delivery. Study design: This is a retrospective cohort analysis of singleton non-anomalous pregnancies in the United States between January 2015 and December 2017. Data was provided by the CDC National Center for Health Statistics, Division of Vital Statistics. Analyses included only pregnancies with a history of one previous cesarean delivery (CD). Perinatal outcomes of pregnancies electively induced at 39 weeks (IOL) were compared to pregnancies that were induced, augmented or underwent spontaneous labor between 40 and 42 weeks (EM). Unlabored cesarean deliveries were excluded. Outcomes of interest included: cesarean delivery, intra-amniotic infection, blood transfusion, adult intensive care unit (ICU) admission, uterine rupture, hysterectomy, 5-minute Apgar score -3, prolonged neonatal ventilation, neonatal ICU (NICU) admission, neonatal seizure, perinatal/neonatal death. Log-binomial regression analysis was performed to calculate the relative risk (RR) for each outcome of interest, adjusting for confounding variables. Results: There were 50,136 pregnancies included for analysis with 9,381 women in the IOL group. Compared with EM, IOL at 39 weeks decreased the risk of intra-amniotic infection (1.7% vs 3.0%, p<.001; aRR: 0.58, 95% CI: [0.49-0.68]), blood transfusion (0.3% vs. 0.5%, p=.03; aRR: 0.66, 95% CI: [0.45-0.98]), and low 5-minute Apgar score (0.31% vs 0.47%, p=.031; aRR: 0.66, 95% CI: [0.44-0.97]). Conversely, IOL increased the risk of cesarean delivery (49.0% vs 27.6%, p<.001; aRR: 1.72, 95% CI: [1.68-1.77]). Furthermore, in the EM group, 919 pregnancies developed preeclampsia and 42 progressed to eclampsia. There were no differences in other perinatal outcomes. Conclusion: In pregnancies complicated by one previous cesarean delivery, elective induction of labor at 39 weeks reduced the risk of intra-amniotic infection, blood transfusion, and low 5-minute Apgar score while increased the risk of repeat cesarean delivery. [ABSTRACT FROM AUTHOR]

Background: Accurate assessment of fetal size is essential in providing optimal prenatal care. National Institute of Child Health and Human Development (NICHD) study from 2015 demonstrated that estimated fetal weight (EFW) differed significantly by race/ethnicity after 20 weeks. There is a large Somali population residing in Minnesota, many of whom are cared for at our maternal fetal medicine practice at the University of Minnesota. Anecdotally, we noticed an increased proportion of small-for-gestational age diagnoses within this population. We sought to use our ultrasound data to create a reference standard specific for this population and compare to currently applied references.Purpose: We aimed to model fetal growth standards within a healthy Somali population between 16 and 40 weeks gestation, and address possible differences in the growth patterns compared with standards for non-Hispanic White, non-Hispanic Black, Hispanic, and Asian singleton fetuses published by the NICHD in the Fetal Growth Study.Materials and Methods: This is a retrospective cohort study using ultrasound data from 527 low risk pregnancies of Somali ethnicity at single tertiary care center between 2011 and 2017. A total of 1107 scans were identified for these pregnancies and maternal and obstetrical data were reviewed. Women 18-40 years of age with low-risk pregnancies and established dating consistent with first trimester ultrasound scan were included. Exclusion criteria were any maternal, fetal or obstetrical conditions known to affect fetal growth.Results: Estimated fetal weight among Somali pregnancies differed significantly at some time points from the NICHD four ethnic groups, but generally the EFW graph curves crossed over at most time points between the study groups. At week 18, EFW was significantly larger than all other four ethnic groups (all p<.001), it was also significantly larger from the Hispanic, Black, and Asian ethnic groups at some time points between 18 and 27 weeks gestation (p < .05). Additionally, EFW among Somali pregnancies was significantly smaller than the Black and Asian ethnicity at 32 and 35-36 weeks and smaller than the White ethnicity at 30 and 38-39 weeks (p < .05). Abdominal circumference (AC) for the Somali population was significantly smaller than the other ethnic groups, especially than the White ethnicity at various time points across 16-40 weeks (p < .05). Femur and humerus length were significantly longer when compared to all other ethnic groups at most time points from 16 to 40 weeks of gestation (p < .05). Biparietal diameter (BPD) was significantly smaller than all other ethnic groups specifically at time of fetal survey (18 weeks) and at time of fetal growth assessment (32 weeks) (p < .05).Conclusions: Significant differences in fetal growth standards were found between the Somali ethnicity and other ethnic groups (White, Black, Asian, and Hispanic) at various time points from 16 to 40 weeks of gestation. Racial/ethnic-specific standards improve the precision for evaluating fetal growth and may decrease the proportion of fetuses of Somali ethnicity labeled as small-for-gestational age. [ABSTRACT FROM AUTHOR]