The risk to the mother and fetus is significantly increased in pregnancy complicated by infection and fever. Obstetricians often face problems in treating pyrexia in pregnancy due to its atypical presentations. Maternal immune function is usually decreased in normal pregnancy and many of the potent antibiotics should be used with caution in pregnant women due to the risk of teratogenicity (1,2). Therefore, some febrile diseases may take a more severe course in pregnancy leading to transplacental transmission of infectious agents and fetal jeopardy. Further, intrapartum fever in absence of infection has also been found to be associated with increased risk of developing neonatal hypoxic encephalopathy and unexplained neonatal seizures (3,4). In presence of maternal fever fetus is exposed to various inflammatory mediators as measured by umbilical cord blood cytokines even in documented absence of neonatal sepsis (5). The underlying maternal cytokine polymorphism is strongly associated with both intrapartum fever and cerebral palsy at term (6,7). Studies have shown that increased brain temperature increases oxygen consumption lowering the threshold of hypoxic injury. Hypothermia ameliorates hypoxic brain injury in term neonates (8,9). So it remains doubtful whether hyperthermia per se, independent from the underlying infection causes neonatal brain injury or they act together. Here we have performed a study on pregnant women suffering from fever of infectious origin to detect the various life threatening medical complications leading to severe maternal morbidity and its impact on fetal outcome. The specific objectives of our study were to assess the highly variable medical complications of the pregnant women suffering from fever according to the etiological basis and also the possible fetal complications. Materials and Methods Present study was a prospective observational study conducted in the
BACKGROUND Antenatal ultrasound of the foetus has brought considerable improvements in antenatal care without resultant major complications. It helps a lot in timely and accurate recognition of intrauterine growth restriction, which has a 10% incidence in the general population. This study was carried out to determine a statistically significant cutoff value or range for the ratio of Trans Cerebellar Diameter (TCD)/Abdominal Circumference (AC) by which foetal growth restriction can be diagnosed after 28 weeks of gestation. The study aimed at evaluating the accuracy of TCD measured by ultrasound in predicting the gestational age and asymmetric IUGR prenatally. METHODS The study population comprised of antenatal mothers attending the Gynaecology and Obstetrics OPD and indoor clinic at IPGMER and SSKM Hospital over a period of 1 year. An estimated 100 mothers constituted the study subjects-50 clinically suspected IUGR pregnancies and 50 presumably normal pregnancies. It was an observational analytical study. No separate control group was required. Babies without IUGR within the study cohort served as control. After obtaining history and examination, ultrasonic measurements on the subjects were made with 2dimensional real time ultrasound. Electronic callipers were used to measure TCD in outer to outer fashion. RESULTS Fetal parameters like BPD, AC, FL have good sensitivity in assessing IUGR as their values are significantly different from normal pregnancies. Head circumference and TCD values do not change significantly between age matched IUGR foetuses. TCD has linear variation with gestational age and thus is a better parameter for assessing gestational age than other ones. CONCLUSIONS The TCD/AC ratio, which utilizes both the least and the most affected foetal biometric parameters, should provide a very sensitive method for detecting asymmetrical and possibly symmetrical IUGR at any gestational age. This ratio may be especially useful in the evaluation of patients with poor or unknown gestational dating, allowing for early clinical intervention in abnormal cases.
AIM:The study was designed to compare the accuracy of trans vaginal sonography, hysteroscopy, and histo pathological examination of endometrium after Dilatation & Curettage in cases of abnormal uterine bleeding, to detect different aetiology of abnormal uterine bleeding in these women and to formulate the ideal investigation of abnormal uterine bleeding in these women. METHODS: A total of 70 peri menopausal and postmenopausal women with abnormal uterine bleeding were taken into the study. After thorough history and clinical examination, the patient was sent for trans vaginal ultra sonographic assessment, followed by a hysteroscopy & dilatation and curettage done as an indoor procedure with a 30 degree rigid hysteroscope (Carl storz) with a 5 mm sheath. The endometrium was sent for histopathology. Diagnosis according to all the three modalities were compared and evaluated. RESULTS: While comparing between TVS and hysteroscopy in total study group taking hysteroscopy as standard, TVS showed a good sensitivity of 85.7% while specificity of 56.5 %. Whereas, during comparison between D & C and hysteroscopy in total study population taking hysteroscopy as standard, sensitivity of D & C came out to be 61.9% while specificity was 88.9%. This shows that D & C is missing a high percentage of cases. There was a fair strength of agreement between hysteroscopy and TVS. There was a moderate strength of agreement between hysteroscopy and Dilatation & curettage. CONCLUSION: TVS is more sensitive in diagnosing cases of fibroids mainly intramural and subserous ones which are missed by hysteroscopy. According to our study it can be concluded that TVS can be taken up as a first line of investigation since it is highly sensitive followed by hysteroscopic guided biopsy. KEYWORDS: Transvaginal sonography, Hysteroscopy, abnormal uterine bleeding. INTRODUCTION:Abnormal uterine bleeding (AUB) is a common presenting symptom among women. AUB is presented in 33% of women referred to gynecologists and this pattern increases to 69% in peri menopausal and post-menopausal women. 1 in peri menopausal women anovulation, benign uterine neoplasia, and endometrial hyperplasia cause abnormal uterine bleeding in majority. In postmenopausal women, vaginal/ endometrial atrophy and hormone therapy are the most common causes. 1 only about 10 % of postmenopausal bleeding results from endometrial cancer. With the increase in life expectancy a third of a woman's life will be in her post-menopausal period, so it is imperative to understand and manage the postmenopausal period so as to allow women to enjoy optimum health.Hospital based curettage without hysteroscopy is still commonly performed, even though it is no longer the gold standard. However the main diagnostic methods which are also being used in these patients are transvaginal ultrasonography and outpatient hysteroscopy. 2 According to some authors, diagnostic hysteroscopy represents an indispensable pre surgical investigation. 2
Objective The aim of this study was to compare the predictability of the Vintzileos’ formula with the Hadlock's formula in estimating the fetal weight nearest to the actual birth weight. Methods It was a prospective observational study conducted with 138 antenatal mothers with single viable fetus and no major congenital abnormalities. A two-dimensional ultrasound scan was performed between 38 and 40 weeks gestation, which measured the biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL) and thigh circumference (TC) at the level of midthigh, and incorporated them to estimate fetal weight using the Hadlock's and the Vintzileos’ formulae. Results For the majority of the study population (63.04%), the mean fetal weight estimated by the Vintzileos’ formula was nearer to the mean actual birth weight compared to the Hadlock's formula. There was strong correlation (Karl Pearson's correlation coefficient r = 0.98, p-value <0.05) between the sonologically estimated and the neonatal thigh circumference. Conclusion The results of this study show that the fetal thigh circumference, if incorporated with other standard biometric parameters in estimating fetal weight by ultrasound, improves the predictability of birth weight estimation, and can predict intrauterine growth restriction. How to cite this article Sanyal P, Ghosh TK, Dasgupta S, Karim R, Mukherjee A, Das A. Predictability of Fetal Birth Weight from Measurement of Fetal Thigh Circumference by Twodimensional Ultrasound: A Prospective Study. J South Asian Feder Obst Gynae 2012;4(1):35-38.
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