OBJECTIVE We sought to compare fundal height and handheld ultrasound–measured fetal abdominal circumference (HHAC) for the prediction of fetal growth restriction (FGR) or large for gestational age. STUDY DESIGN This was a diagnostic accuracy study in nonanomalous singleton pregnancies between 24 and 40 weeks’ gestation. Patients underwent HHAC and fundal height measurement prior to formal growth ultrasound. FGR was defined as estimated fetal weight less than 10%, whereas large for gestational age was defined as estimated fetal weight greater than 90%. Sensitivity and specificity were calculated and compared using methods described elsewhere. RESULTS There were 251 patients included in this study. HHAC had superior sensitivity and specificity for the detection of FGR (sensitivity, 100% vs 42.86%) and (specificity, 92.62% vs 85.24%). HHAC had higher specificity but lower sensitivity when screening for LGA (specificity, 85.66% vs 66.39%) and (sensitivity, 57.14% vs 71.43%). CONCLUSION HHAC could prove to be a valuable screening tool in the detection of FGR. Further studies are needed in a larger population.
Background Over 20,000 parents in the United States face the challenge of participating in decisions about whether to use life support for their infants born on the cusp of viability every year. Clinicians must help families grasp complex medical information about their baby’s immediate prognosis as well as the risk for significant long-term morbidity. Patients faced with this decision want supplemental information and frequently seek medical information on the Internet. Empirical evidence about the quality of websites is lacking. Objective We sought to evaluate the quality of online information available about periviable birth and treatment options for infants born at the cusp of viability. Methods We read a counseling script to 20 pregnant participants that included information typically provided by perinatal and neonatal providers when periviable birth is imminent. The women were then asked to list terms they would use to search the Internet if they wanted additional information. Using these search terms, two reviewers evaluated the content of websites obtained via a Google search. We used two metrics to assess the quality of websites. The first was the DISCERN instrument, a validated questionnaire designed to assess the quality of patient-targeted health information for treatment choices. The second metric was the Essential Content Tool (ECT), a tool designed to address key components of counseling around periviable birth as outlined by professional organizations. DISCERN scores were classified as low quality if scores were 2, fair quality if scores were 3, and high quality if scores were 4 or higher. Scores of 6 or higher on the ECT were considered high quality. Interreviewer agreement was assessed by calculated kappa statistic. Results A total of 97 websites were reviewed. Over half (57/97, 59%) were for-profit sites, news stories, or personal blogs; 28% (27/97) were government or medical sites; and 13% (13/97) were nonprofit or advocacy sites. The majority of sites scored poorly in DISCERN questions designed to assess the reliability of information presented as well as data regarding treatment choices. Only 7% (7/97) of the websites were high quality as defined by the DISCERN tool. The majority of sites did not address the essential content defined by the ECT. Importantly, only 18% of websites (17/97) indicated that there are often a number of reasonable approaches to newborn care when faced with periviable birth. Agreement was strong, with kappa ranging from .72 to .91. Conclusions Most information about periviable birth found on the Internet using common search strategies is of low quality. News stories highlighting positive outcomes are disproportionately represented. Few websites discuss comfort care or how treatment decisions impact quality of life.
what would be expected given aneuploidy incidence in women <35 years old. This is most likely due to the skewed maternal age distribution observed in this average risk cohort (see image 1). Overall, performance in the average risk cohort much resembles that seen in high risk pregnancies. When compared to current serum biochemical screening protocols, expanding NIPT into the average risk population would allow for markedly improved screening performance of common aneuploidies.162 Exogenous oxytocin for labor induction or augmentation and autism spectrum disorder OBJECTIVE: Exogenous intrapartum oxytocin has been hypothesized to be a risk factor for autism spectrum disorder (ASD). We examined the association between cumulative oxytocin dose administered during labor with subsequent diagnosis of ASD. STUDY DESIGN: Retrospective case-control study of deliveries within a Utah healthcare system. ASD cases were identified through the Utah Registry of Autism and Developmental Disabilities, a CDC validated registry that ascertains ASD cases within a 4 county surveillance region by querying records from the Utah Department of Health (UDOH), clinics and hospitals, behavioral health centers, and the Utah State Bureau of Education to identify children with a medical diagnosis of ASD and/or autism special education eligibility. Controls were matched on birth year, gender, and county of residence in a 4:1 ratio. Children with congenital anomalies/aneuploidy were excluded. Clinical variables, including oxytocin exposure, were obtained from review of hospital records and/or the UDOH's Office of Vital Records and Statistics. Cumulative oxytocin dose was calculated from time of admission until delivery and categorized into 4 quartiles of increasing exposure for analysis (1 st quartile referent ¼ no oxytocin, 2 nd ¼ quartile 1-695 mU, 3 rd quartile ¼ 696-3490 mU, 4 th quartile > 3490 mU). Single and multiple variable logistic regression models were fit to investigate the association between ASD and oxytocin exposure, adjusting for potential confounders. RESULTS: 11,487 pregnancies were analyzed, resulting in 2,294 cases with ASD and 9,193 controls. In univariate analyses, there were no associations between oxytocin exposure and ASD. After controlling for potential confounders related to maternal health, pregnancy events/complications, and socioeconomic status, intrapartum exogenous oxytocin exposure was not associated with ASD. A sex-stratified analysis yielded similar results (Table). CONCLUSION: Exogenous oxytocin use for induction or augmentation of labor is not associated with increased risk of ASD. OBJECTIVE: While patients facing periviable birth often search the internet for information after physician counseling, empiric evidence about the quality of websites is lacking. We sought to characterize online information as it pertains to patients facing periviable delivery. STUDY DESIGN: Twenty term patients were read a script about decision-making in the setting of periviable birth. They were then asked to list terms they would...
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