Prenatal Diagnosis of Aortic Coarctation: Prediction Algorithm according to Gestational Age

2021 ◽  
pp. 1-10
Author(s):  
Lucía Deiros-Bronte ◽  
Jesus Diez-Sebastian ◽  
Roberto Rodríguez González ◽  
Angela Uceda Galiano ◽  
María De La Calle ◽  
...  
Keyword(s):  
Gestational Age ◽  
Aortic Coarctation ◽  
Retrospective Cohort ◽  
Diagnostic Performance ◽  
Fetal Echocardiography ◽  
Prediction Algorithm ◽  
Testing Strategy ◽  
Serial Testing ◽  
Good Classification ◽  
Low Probability

<b><i>Objectives:</i></b> The aim of the study was first to quantify the diagnostic accuracy of predictive anatomical factors of aortic coarctation (CoA) and second to design a postnatal CoA probability algorithm according to gestational age (GA) in prenatal period. <b><i>Methods:</i></b> Global and according to GA diagnostic performance of cardiac anatomical variables using the ROC curve were evaluated in a retrospective cohort of fetuses with suspicion of CoA (2004–2020). A serial testing strategy to predict postnatal CoA by fetal echocardiography was designed. <b><i>Results:</i></b> 114 fetuses were included. Isthmus-to-ductal (I/D) ratio provided the best discrimination between healthy fetuses and those with CoA (AUC 0.91, 95% CI: 0.86–0.96, I/D &#x3c; 0.74 sensitivity 96.3%, I/D &#x3c; 0.6, specificity 92.5%) with good classification capacity in both the second and third trimesters of gestation. Isthmus <i>z</i>-score and pulmonary/aortic valve ratio increased accuracy in fetuses &#x3e;28 and tricuspid/mitral valve ratio (TV/MV) in fetuses ≤28 weeks. Study of I/D plus TV/MV ratio in fetuses ≤28 and I/D ratio plus isthmus <i>z</i>-scores in fetuses &#x3e;28 weeks allowed to correctly classify 91.8% of fetuses as high or low probability of postnatal CoA. <b><i>Conclusions:</i></b> Diagnostic discrimination of anatomic predictive factors for CoA varies according to GA. Specific algorithms according to GA increase accuracy in CoA’s prenatal prediction.

Early-Onset Thrombocytopenia in Small-for-Gestational-Age Neonates: A Retrospective Cohort Study

2016 ◽  
Vol 33 (S 01) ◽  
Author(s):  
S. Fustolo-Gunnink ◽  
R. Vlug ◽  
V. Smits-Wintjens ◽  
E. Heckman ◽  
A. Te Pas ◽  
...  
Keyword(s):  
Cohort Study ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Retrospective Cohort Study ◽  
Early Onset ◽  
Retrospective Cohort

scholarly journals Can a Difference in Gestational Age According to Biparietal Diameter and Abdominal Circumference Predict Intrapartum Placental Abruption?

2021 ◽  
Vol 10 (11) ◽  
pp. 2413
Author(s):  
Jee-Youn Hong ◽  
Jin-Ha Kim ◽  
Seo-yeon Kim ◽  
Ji-Hee Sung ◽  
Suk-Joo Choi ◽  
...  
Keyword(s):  
Gestational Age ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Maternal Age ◽  
Placental Abruption ◽  
Independent Predictor ◽  
Abdominal Circumference ◽  
Biparietal Diameter ◽  
Study Population ◽  
Independent Risk Factors

This study aimed to investigate whether a difference in gestational age according to biparietal diameter (BPD) and abdominal circumference (AC) could be a clinically useful predictor of placental abruption during the intrapartum period. This retrospective cohort study was based on singletons who were delivered after 32 + 0 weeks between July 2015 and July 2020. We only included cases with at least two antepartum sonographies available within 4 weeks of delivery (n = 2790). We divided the study population into two groups according to the presence or absence of placental abruption and compared the clinical variables. The incidence of placental abruption was 2.0% (56/2790) and was associated with an older maternal age, a higher rate of preeclampsia, and being small for the gestational age. A difference of >2 weeks in gestational age according to BPD and AC occurred at a higher rate in the placental abruption group compared to the no abruption group (>2 weeks, 21.4% (12/56) vs. 7.5% (205/2734), p < 0.001; >3 weeks, 12.5% (7/56) vs. 2.0% (56/2734), p < 0.001). Logistic regression analysis revealed that the differences of >2 weeks and >3 weeks were both independent risk factors for placental abruption (odds ratio (OR) (95% confidence interval), 2.289 (1.140–4.600) and 3.918 (1.517–9.771), respectively) after adjusting for maternal age, preeclampsia, and small for gestational age births. We identified that a difference in gestational age of >2 weeks between BPD and AC could be an independent predictor of placental abruption.

scholarly journals Morbidity in Late Preterm Birth: A Retrospective Cohort Study Assessing the Role of Immaturity versus Antecedent Factors

Neonatology ◽  
2021 ◽  
pp. 1-8
Author(s):  
Melissa Lorenzo ◽  
Megan Laupacis ◽  
Wilma M. Hopman ◽  
Imtiaz Ahmad ◽  
Faiza Khurshid
Keyword(s):  
Cohort Study ◽  
Preterm Birth ◽  
Preterm Delivery ◽  
Gestational Age ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Late Preterm ◽  
Multiple Gestation ◽  
Late Preterm Birth ◽  
Apnea Of Prematurity

<b><i>Introduction:</i></b> Late preterm infants (LPIs) are infants born between 34<sup>0/7</sup> and 36<sup>6/7</sup> weeks gestation. Morbidities in these infants are commonly considered a result of prematurity; however, some research has suggested immaturity may not be the sole cause of morbidities. We hypothesize that antecedents leading to late preterm birth are associated with different patterns of morbidities and that morbidities are the result of gestational age superimposed by the underlying etiologies of preterm delivery. <b><i>Methods:</i></b> This is a retrospective cohort study of late preterm neonates born at a single tertiary care center. We examined neonatal morbidities including apnea of prematurity, hyperbilirubinemia, hypoglycemia, and the requirement for continuous positive airway pressure (CPAP). Multivariable logistic regression analysis was performed to estimate the risk of each morbidity associated with 3 categorized antecedents of delivery, that is, spontaneous preterm labor, preterm premature rupture of membranes (PPROM), and medically indicated birth. We calculated the predictive probability of each antecedent resulting in individual morbidity across gestational ages. <b><i>Results:</i></b> 279 LPIs were included in the study. Decreasing gestational age was associated with significantly increased risk of apnea of prematurity, hyperbilirubinemia, and requirement of CPAP. In our cohort, the risk of hypoglycemia increased with gestational age, with the greatest incidence at 36<sup>0−6</sup> weeks. There was no significant association of risk of selected morbidities and the antecedents of late preterm delivery, with or without adjustment for gestational age, multiple gestation, small for gestational age (SGA), antenatal steroids, and delivery method. <b><i>Discussion and Conclusion:</i></b> This study found no difference in morbidity risk related to 3 common antecedents of preterm birth in LPIs. Our research suggests that immaturity is the primary factor in determining adverse outcomes, intensified by factors resulting in prematurity.

scholarly journals Comparison of adverse perinatal outcomes between Asians and Caucasians: a population-based retrospective cohort study in Ontario

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Na Zeng ◽  
Erica Erwin ◽  
Wendy Wen ◽  
Daniel J. Corsi ◽  
Shi Wu Wen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Birth Weight ◽  
Preterm Birth ◽  
Cesarean Section ◽  
Gestational Age ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Perinatal Outcomes ◽  
Population Based ◽  
Adverse Perinatal Outcomes

Abstract Background Racial disparities in adverse perinatal outcomes have been studied in other countries, but little has been done for the Canadian population. In this study, we sought to examine the disparities in adverse perinatal outcomes between Asians and Caucasians in Ontario, Canada. Methods We conducted a population-based retrospective cohort study that included all Asian and Caucasian women who attended a prenatal screening and resulted in a singleton birth in an Ontario hospital (April 1st, 2015-March 31st, 2017). Generalized estimating equation models were used to estimate the independent adjusted relative risks and adjusted risk difference of adverse perinatal outcomes for Asians compared with Caucasians. Results Among 237,293 eligible women, 31% were Asian and 69% were Caucasian. Asians were at an increased risk of gestational diabetes mellitus, placental previa, early preterm birth (< 32 weeks), preterm birth, emergency cesarean section, 3rd and 4th degree perineal tears, low birth weight (< 2500 g, < 1500 g), small-for-gestational-age (<10th percentile, <3rd percentile), neonatal intensive care unit admission, and hyperbilirubinemia requiring treatment, but had lower risks of preeclampsia, macrosomia (birth weight > 4000 g), large-for-gestational-age neonates, 5-min Apgar score < 7, and arterial cord pH ≤7.1, as compared with Caucasians. No difference in risk of elective cesarean section was observed between Asians and Caucasians. Conclusion There are significant differences in several adverse perinatal outcomes between Asians and Caucasians. These differences should be taken into consideration for clinical practices due to the large Asian population in Canada.

scholarly journals Neonatal Lupus and Complete Atrioventricular Block: Case Report in Mexico

2021 ◽  
pp. 1-7
Author(s):  
Carla Eugenia Arenas Alvarez ◽  
Juan Carlos Marin Mireles ◽  
Hebert Israel Flores Leal ◽  
Ana Norma Griselda Becerril Gonzalez ◽  
Carlos Mario Guzman Sanchez
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Atrioventricular Block ◽  
Gestational Age ◽  
Lupus Erythematosus ◽  
Fetal Echocardiography ◽  
Fetal Mortality ◽  
Complete Atrioventricular Block ◽  
Systemic Lupus ◽  
Neonatal Lupus ◽  
Complete Atrioventricular

Aims: To describe a case of neonatal lupus and complete atrioventricular block in Mexico. Presentation of case: A 38 years old pregnant patient at  28 + 6 weeks of gestational age, diagnosed with systemic lupus erythematosus six years ago, under treatment with hydroxychloroquine and prednisone, this was suspended eight months prior to pregnancy; and resumed at week 20 of gestational age. The ultrasound scan showed alive fetus, female, polyhydramnios and bradycardia. Fetal echocardiography confirmed complete atrioventricular block, without organic and structural alterations at the cardiac level. Furthermore, the immunological panel reports, positive anti-Ro antibodies. At week 33 of gestational age, the patient was admitted to the obstetric emergency room, through colic type pain and 4 cm dilation of the cervix. Alive newborn got vaginally with a weight of 1,990 g, a height of 43 cm and APGAR 8-9. Echocardiography confirmed congenital complete third degree atrioventricular block; without structural abnormalities. Discussion: Patients with systemic lupus erythematosus, are more likely to have complications during pregnancy. Neonatal lupus is a rare disorder with an incidence of 1:10,000 - 1:20,000 newborns. This is caused by the transplacental passage of maternal autoantibodies anti-SSA / Ro and/or anti-SSB / La. Besides Atrioventricular block is a complication of neonatal lupus, occurring in approximately 2% of newborns of mothers who have SSA or SSB antibodies. The most interesting finding is that 20% fetal mortality has been for this cause. Conclusion: The described case is important for its rarity. Besides, the imaging findings and immunological panel emphasized the relevance about complete and adequate evaluation of the fetus, in the context of a mother with systemic lupus erythematosus.

scholarly journals Measuring outcome differences associated with STEMI screening and diagnostic performance: a multicentred retrospective cohort study protocol

BMJ Open ◽  
2018 ◽  
Vol 8 (5) ◽  
pp. e022453 ◽  
Author(s):  
Maame Yaa A B Yiadom ◽  
Bryn E Mumma ◽  
Christopher W Baugh ◽  
Brian W Patterson ◽  
Angela M Mills ◽  
...  
Keyword(s):  
Cohort Study ◽  
Study Protocol ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Diagnostic Performance ◽  
Outcome Differences

scholarly journals Acute Kidney Injury and Bronchopulmonary Dysplasia in Premature Neonates Born Less than 32 Weeks' Gestation

2019 ◽  
Vol 37 (03) ◽  
pp. 341-348 ◽  
Author(s):  
Michelle C. Starr ◽  
Louis Boohaker ◽  
Laurie C. Eldredge ◽  
Shina Menon ◽  
Russell Griffin ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Bronchopulmonary Dysplasia ◽  
Premature Infants ◽  
Gestational Age ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Secondary Analysis ◽  
Kidney Injury ◽  
Multiple Factors

Abstract Objective This study aimed to evaluate the association between acute kidney injury (AKI) and bronchopulmonary dysplasia (BPD) in infants born <32 weeks of gestational age (GA). Study Design Present study is a secondary analysis of premature infants born at <32 weeks of GA in the Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) retrospective cohort (n = 546). We stratified by gestational age and used logistic regression to determine association between AKI and moderate or severe BPD/mortality. Results Moderate or severe BPD occurred in 214 of 546 (39%) infants, while death occurred in 32 of 546 (6%); the composite of moderate or severe BPD/death occurred in 246 of 546 (45%). For infants born ≤29 weeks of gestation, the adjusted odds ratio (OR) of AKI and the primary outcome was 1.15 (95% confidence interval [CI] = 0.47–2.86; p = 0.76). Infants born between 29 and 32 weeks of gestation with AKI had four-fold higher odds of moderate or severe BPD/death that remained after controlling for multiple factors (adjusted OR = 4.21, 95% CI: 2.07–8.61; p < 0.001). Conclusion Neonates born between 29 and 32 weeks who develop AKI had a higher likelihood of moderate or severe BPD/death than those without AKI. Further studies are needed to validate our findings and evaluate mechanisms of multiorgan injury.

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