This study investigated changes in the fetal atrioventricular (AV) interval from 6 to 40 weeks of gestation using Doppler echocardiography. The main findings were:
1) The AV interval dramatically decreased from 6 to 10 weeks of gestation as isovolumic contraction time acutely decreased, then gradually increased from 10 weeks to term.
2) Isovolumic contraction time was highest at 6 weeks and approached 0 milliseconds after 10 weeks, reflecting changes in ventricular function and afterload with gestation.
3) A-wave duration linearly increased from 6 weeks to term, negatively correlating with heart rate.
4) The AV interval negatively correlated with heart rate throughout gestation
This study aimed to establish normal values for fetal cardiac axis (CAx) measurement between 11+0 and 14+6 weeks gestation. The researchers measured the CAx in 100 fetuses and found that the normal range was 34.5-56.8 degrees. CAx tended to be higher at 11+0-11+6 weeks compared to later gestations. Abnormal CAx was detected in 4 out of 6 fetuses found to have congenital heart defects. The study concludes that CAx measurement is possible in the first trimester and may help identify fetuses at risk for congenital heart defects.
This study analyzed data from 4,618 women who had spontaneous vaginal deliveries at term to develop norms for fetal descent in labor. The results show:
1) Multiparous women and those who labored spontaneously without augmentation had faster fetal descent at all stations compared to nulliparous women and those whose labor was induced or augmented.
2) The median time to descend between station levels was less than 2 hours, though there was wide variation, with some women spending over 12 hours at the same high station.
3) By 6 cm dilation, the median station was 0 for nulliparous women and -1 for multiparous women. 95% of all women were at station 0
This study aimed to develop a predictive tool for unplanned cesarean delivery (CD) in nulliparous women using prenatal maternal and fetal characteristics. Over 2,200 nulliparous women were prospectively studied across seven Irish hospitals. Multivariate analysis identified that maternal age, BMI, height, fetal abdominal circumference, and head circumference can predict CD risk. A nomogram was developed and showed good predictive ability, with an AUC of 0.69. The tool may help counsel women on their chances of a vaginal delivery versus an elective CD.
The document summarizes two articles from the March 2014 issue of the Ultrasound in Obstetrics and Gynecology journal club. The first article compares the performance of traditional fetal growth charts versus a probabilistic model using biometry at 31-34 weeks to screen for small-for-gestational age fetuses in low-risk pregnancies. The probabilistic model had slightly better accuracy and allowed incorporation of maternal factors. The second article found that appropriate for gestational age fetuses in lower birth weight quartiles exhibited Doppler changes suggesting placental insufficiency and failure to reach growth potential, challenging the view that only small fetuses face these risks.
Poor neonatal acid–base status in term fetuses with low cerebroplacental ratio
J. Morales-Roselló, A. Khalil, M. Morlando, A. Bhide, A. Papageorghiou and B. Thilaganathan
Volume 45, Issue 2, Date: February (pages 156–161)
http://onlinelibrary.wiley.com/doi/10.1002/uog.14647/abstract
Human fetal growth is constrained below optimal for perinatal survival
B. Vasak, S.V. Koenen, M.P.H. Koster, C.W.P.M. Hukkelhoven, A. Franx, M.A. Hanson and G.H.A. Visser
Volume 45, Issue 2, Date: February (pages 162–167)
http://onlinelibrary.wiley.com/doi/10.1002/uog.14644/abstract
Diagnostic accuracy of placental growth factor and ultrasound parameters to predict the small-for-gestational-age infant in women presenting with reduced symphysis–fundus height
M. Griffin, P. T. Seed, L. Webster, J. Myers, L. MacKillop, N. Simpson, D. Anumba, A. Khalil, M. Denbow, A. Sau, K. Hinshaw, P. von Dadelszen, S. Benton, J. Girling, C. W. G. Redman, L. C. Chappell and A. H. Shennan
Volume 46, Issue 2, pages 182–190, August 2015
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.14860/full
This document describes the development of an updated growth chart for preterm babies that begins at 22 weeks gestation. It summarizes the process of collecting recent data from large population studies on infant size at birth and term infant measurements to update the existing Babson and Benda 1976 chart. The new chart was developed by combining data sources on weight from Canada, head circumference from Sweden and Australia, and length from Australia and Sweden. Term infant data came from the CDC. The growth patterns of infants in the NICHD Neonatal Research Network were then compared to the new chart as validation. The updated chart allows comparison of preterm infant growth to intrauterine and term references from 22 weeks to 10 weeks.
This study aimed to establish normal values for fetal cardiac axis (CAx) measurement between 11+0 and 14+6 weeks gestation. The researchers measured the CAx in 100 fetuses and found that the normal range was 34.5-56.8 degrees. CAx tended to be higher at 11+0-11+6 weeks compared to later gestations. Abnormal CAx was detected in 4 out of 6 fetuses found to have congenital heart defects. The study concludes that CAx measurement is possible in the first trimester and may help identify fetuses at risk for congenital heart defects.
This study analyzed data from 4,618 women who had spontaneous vaginal deliveries at term to develop norms for fetal descent in labor. The results show:
1) Multiparous women and those who labored spontaneously without augmentation had faster fetal descent at all stations compared to nulliparous women and those whose labor was induced or augmented.
2) The median time to descend between station levels was less than 2 hours, though there was wide variation, with some women spending over 12 hours at the same high station.
3) By 6 cm dilation, the median station was 0 for nulliparous women and -1 for multiparous women. 95% of all women were at station 0
This study aimed to develop a predictive tool for unplanned cesarean delivery (CD) in nulliparous women using prenatal maternal and fetal characteristics. Over 2,200 nulliparous women were prospectively studied across seven Irish hospitals. Multivariate analysis identified that maternal age, BMI, height, fetal abdominal circumference, and head circumference can predict CD risk. A nomogram was developed and showed good predictive ability, with an AUC of 0.69. The tool may help counsel women on their chances of a vaginal delivery versus an elective CD.
The document summarizes two articles from the March 2014 issue of the Ultrasound in Obstetrics and Gynecology journal club. The first article compares the performance of traditional fetal growth charts versus a probabilistic model using biometry at 31-34 weeks to screen for small-for-gestational age fetuses in low-risk pregnancies. The probabilistic model had slightly better accuracy and allowed incorporation of maternal factors. The second article found that appropriate for gestational age fetuses in lower birth weight quartiles exhibited Doppler changes suggesting placental insufficiency and failure to reach growth potential, challenging the view that only small fetuses face these risks.
Poor neonatal acid–base status in term fetuses with low cerebroplacental ratio
J. Morales-Roselló, A. Khalil, M. Morlando, A. Bhide, A. Papageorghiou and B. Thilaganathan
Volume 45, Issue 2, Date: February (pages 156–161)
http://onlinelibrary.wiley.com/doi/10.1002/uog.14647/abstract
Human fetal growth is constrained below optimal for perinatal survival
B. Vasak, S.V. Koenen, M.P.H. Koster, C.W.P.M. Hukkelhoven, A. Franx, M.A. Hanson and G.H.A. Visser
Volume 45, Issue 2, Date: February (pages 162–167)
http://onlinelibrary.wiley.com/doi/10.1002/uog.14644/abstract
Diagnostic accuracy of placental growth factor and ultrasound parameters to predict the small-for-gestational-age infant in women presenting with reduced symphysis–fundus height
M. Griffin, P. T. Seed, L. Webster, J. Myers, L. MacKillop, N. Simpson, D. Anumba, A. Khalil, M. Denbow, A. Sau, K. Hinshaw, P. von Dadelszen, S. Benton, J. Girling, C. W. G. Redman, L. C. Chappell and A. H. Shennan
Volume 46, Issue 2, pages 182–190, August 2015
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.14860/full
This document describes the development of an updated growth chart for preterm babies that begins at 22 weeks gestation. It summarizes the process of collecting recent data from large population studies on infant size at birth and term infant measurements to update the existing Babson and Benda 1976 chart. The new chart was developed by combining data sources on weight from Canada, head circumference from Sweden and Australia, and length from Australia and Sweden. Term infant data came from the CDC. The growth patterns of infants in the NICHD Neonatal Research Network were then compared to the new chart as validation. The updated chart allows comparison of preterm infant growth to intrauterine and term references from 22 weeks to 10 weeks.
Placental Elastography in Intrauterine Growth Restriction: A Case–control Studyasclepiuspdfs
Background: Intrauterine growth restriction (IUGR) is related to poor fetal outcome. Though, various tools are available for evaluation of IUGR they are notreliable inearly diagnosis of IUGR. Shear wave elastography (SWE) can be used to study the change in mechanical properties of various disease which can be a potential technique for early diagnosis of IUGR. Objective: The objective of the study was to compare the differences in SWE values of placentas between IUGR and normal pregnancies. Methodology: Normal second- and third-trimester pregnancies and IUGR pregnancies between 24 and 42 weeks period of gestation (POG), meeting the inclusion criteria were matched for age group and POG. SWE of placenta was performed in supine position during quiet respiration. The SWE of placenta was measured by placing the region of interest in relatively homogeneous area. The placental elasticity values obtained in pregnancies complicated by IUGR were compared with that of normal controls. Umbilical artery (UA) and fetal middle cerebral artery (MCA) Doppler findings were correlated with placental elasticity value of IUGR pregnancies.
1. The document discusses extended cycle oral contraceptives that provide contraception for 84 days by suppressing ovulation through a combination of ethinyl estradiol and levonorgestrel, followed by 7 days of placebo or low-dose estrogen pills.
2. Clinical trials showed that extended cycle pills were as effective at preventing pregnancy as conventional 28-day pills, with similar safety profiles. Adverse effects were mild and consistent with other combined oral contraceptives.
3. The extended cycle regimen was found to be over 99% effective at preventing pregnancy when taken correctly, and resulted in less frequent bleeding and spotting compared to a 28-day regimen.
Fetal echocardiographic measures to improve the prenatal diagnosis of coarcta...gisa_legal
This study aimed to identify fetal echocardiographic measures that can accurately predict postnatal coarctation of the aorta (CoA). The study retrospectively reviewed 13 cases of prenatal CoA diagnosis confirmed postnatally, 14 cases of prenatal CoA diagnosis with normal postnatal arches, and 30 controls. Measurements of the aorta, head vessels, and ventricles were made on available fetal echocardiograms. Linear mixed effects models found significant differences in the true CoA group for smaller distal transverse arch diameter, smaller distal transverse arch to head vessel index, and longer head vessel distances. The head vessel to arch index trend also differentiated true CoAs from false positives. Fetal echocardiographic
This document summarizes a study that examined the effects of a community prenatal dance program on rates of preeclampsia and preterm birth/low birth weight. The study compared outcomes of 119 women who participated in a standardized prenatal dance program to a control group of nearly 10,000 women. The dance program incorporated centering floorwork, relaxation techniques, and aerobic dancing. Results suggested lower rates of preeclampsia and preterm/low birth weight among women in the dance program compared to controls, supporting the hypothesis that a standardized prenatal dance program can reduce health risks in pregnancy.
Tricuspid valve size as a predictor in patients with severe pulmonary stenosi...gisa_legal
This study aimed to identify prenatal echocardiographic features that can predict postnatal tricuspid valve size in fetuses with severe pulmonary stenosis or pulmonary atresia with intact ventricular septum. The study found that a fetal tricuspid valve to mitral valve ratio greater than 0.63 highly predicts a favorable postnatal tricuspid valve Z-score above -3. Additionally, fetuses with antegrade flow across the pulmonary valve or more than moderate tricuspid regurgitation during the prenatal ultrasound had favorable postnatal outcomes, requiring only balloon valvuloplasty. This study provides useful information to counsel expectant parents on potential postnatal interventions needed.
Comparison of Various Clinical Methods of Birth Weight Estimation in Term Pre...CrimsonPublishers-PRM
Comparison of Various Clinical Methods of Birth Weight Estimation in Term Pregnancy by Darshit G Prajapati in Perceptions in Reproductive Medicine_Crimson Publishers
Comparison of Various Clinical Methods of Birth Weight Estimation in Term Pre...CrimsonPublishers-PRM
Comparison of Various Clinical Methods of Birth Weight Estimation in Term Pregnancy by Darshit G Prajapati in Perceptions in Reproductive Medicine_Crimson Publishers
Prediction of delivery mode by ultrasound-assessed fetal position in nulliparous women with prolonged first stage of labor
T. M. Eggebø, W. A. Hassan, K. Å. Salvesen, E. A. Torkildsen, T. B. Østborg and C. C. Lees
Volume 46, Issue 5, pages 606–610
View the free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.14773/full
Influence of ultrasound determination of fetal head position on mode of delivery: a pragmatic randomized trial
T. Popowski, R. Porcher, J. Fort, S. Javoise and P. Rozenberg
Volume 46, Issue 5, 520–525
View the free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.14785/full
1. This study compared screening for trisomies 21, 18 and 13 using cell-free DNA (cfDNA) analysis of maternal blood at 10-11 weeks' gestation to screening using the combined test at 11-13 weeks.
2. CfDNA analysis identified all cases of trisomy 21 and the majority of trisomy 18 cases, with a lower false positive rate than the combined test. Detection of trisomy 13 was lower.
3. In cases where cfDNA and karyotype results disagreed, the fetal DNA fraction was significantly lower, highlighting the importance of considering a priori risk when interpreting cfDNA results.
Cat clitoral phimosis effects on female sexual function and surgical finaladi bachtiar
This study observed 3,650 women between 2014-2016 to evaluate surgical treatment for severe clitoral phimosis (CP) caused by lichen sclerosus (LS). Nine women with severe CP underwent CO2 laser circumcision. Post-surgery, questionnaires showed significant improvements in sexual function, genital self-image satisfaction, and less sexual discomfort. However, the study was limited by its small sample size of women who had surgery and lack of a control group for comparison.
This study examined the relationship between preconceptional maternal obesity and placental weight, birth weight. The study included 259 women divided into normal (BMI <25) and obese (BMI ≥25) groups. The obese group had significantly higher placental weights compared to the normal group, even after adjusting for age and parity. However, birth weights did not significantly differ between the groups. The study found that maternal preconceptional obesity is associated with heavier placentas but not birth weight.
Ultrasound screening for fetal growth restriction at 36 vs 32 weeks' gestation: a randomized trial (ROUTE)
E. Roma, A. Arnau, R. Berdala, C. Bergos, J. Montesinos and F. Figueras
Volume 46, Issue 4, pages 391–397
View the free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.14915/full
huong dan chan doan va xu tri thai cham tang truong trong tu cung sga and fga...Võ Tá Sơn
This document provides guidelines from the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) for the diagnosis and management of small-for-gestational-age (SGA) fetuses and fetal growth restriction (FGR). It defines SGA as fetal size below the 10th percentile and distinguishes it from FGR, which indicates failure to reach growth potential and increased risk of adverse outcomes. The guidelines recommend using fetal growth velocity, customized growth charts, Doppler ultrasonography of blood flows, biophysical profile scoring, and cardiotocography to diagnose FGR and distinguish it from SGA. Early-onset and late-onset FGR are defined based on diagnosis before or after 32
Systematic review of accuracy of ultrasound in the diagnosis of vasa previa
L. Ruiter, N. Kok, J. Limpens, J.B. Derks, I.M. de Graaf, B.W.J. Mol and E. Pajkrt
Volume 45, Issue 5, pages 516–522, May 2015
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.14752/full
This document discusses several methods for measuring body composition in children, including BMI, Lange calipers, bioelectrical impedance analysis (BIA), and dual energy x-ray absorptiometry (DEXA). It provides details on the techniques and formulas used for each method and discusses their advantages and disadvantages. The conclusion emphasizes the importance of monitoring students' health and using multiple methods of assessment rather than relying on any single approach.
This document summarizes a study that examined the effect of a community-based group physical activity (CBGPA) program on the risk of preeclampsia during pregnancy. The study found that among 88 women who participated in the standardized CBGPA program, the rate of preeclampsia was significantly lower (2.2%) than the overall rate at the hospital (7.8%). Pregnancies in the CBGPA group also had lower rates of preterm birth and low birthweight compared to the overall rates. The study concludes that CBGPA may help reduce the risk of complications like preeclampsia during pregnancy.
Balance, Fit, Intrauterine Life and Lifelong Disease Salford Systems
This document discusses research analyzing relationships between placental size, birth weight, and later health outcomes. It finds that placental size is correlated with birth weight and can predict childhood BMI levels. Babies whose size does not match what is predicted based on placental measures may be physiologically vulnerable and at risk for different growth trajectories. Machine learning methods allow insights into how placental growth translates to fetal development and later health.
Uterine Artery Doppler and Prediction of PreeclampsiaAI Publications
The purpose of this study was to determine the accuracy of screening for pregnancy hypertension disorders using maternal serum biomarkers and uterine artery Doppler during the first trimester. At 11-13 weeks, uterine artery Doppler and serum measurements were taken from prospectively enrolled nulliparous women. In this study, maternal features, uterine artery Doppler imaging, and serum placental biomarkers (pregnancy-associated plasma protein-A, Inhibin-A, placental protein, A disintegrin and metalloprotease, free B-hCG, placental growth factor) were all collected and evaluated. Twenty women (2.2 percent) experienced prenatal hypertension, and forty women (4.5 percent) developed preeclampsia, with nine (1.0 percent) developing early-onset preeclampsia and sixteen (1.8 percent) developing severe preeclampsia, according to the findings. A combination screening model that included clinical features, pregnancy-associated plasma protein-A, Inhibin-A, and placental growth factor was found to be effective in detecting 75 percent of early-onset preeclampsia with a false-positive rate of 10 percent. Uterine artery Doppler, placental protein, A disintegrin and metalloprotease were all found to have no effect on diagnosis accuracy after adjusting for clinical factors. When combined with first-trimester maternal serum biomarkers (pregnancy-associated plasma protein-A, Inhibin-A, and placental growth factor), a combination of clinical features and placental growth factor can give an accurate screening for early-onset preeclampsia in nulliparous women.
An ultrasound was performed on Mrs. Sunita Sadar, age 28, who was referred by Dr. Ashok Deshmukh. The ultrasound revealed a single live fetus in cephalic presentation estimated to be 31 weeks and 6 days gestation based on measurements. Fetal cardiac activity and movements were present. The placenta was posterior and grade II maturity. No obvious congenital anomalies were seen. Fetal measurements were within normal ranges for the estimated gestational age. The impression was of a normal singleton pregnancy at 31 weeks and 6 days.
This study aimed to establish comprehensive reference ranges for fetal biometry measurements during 11-14 weeks of gestation using transabdominal ultrasound. Measurements of various fetal anatomical structures were taken from 660 viable singleton pregnancies. Reference ranges including the 5th, 50th, and 95th percentiles were calculated for each biometric parameter and plotted against gestation. The results show that all parameters increase with gestation. Ratios involving ventricle sizes and femur length decrease over time, while head circumference to abdominal circumference remains constant. The reference ranges established can help in diagnosing early growth issues and interpreting measurements in chromosomally abnormal fetuses.
Background: Doppler ultrasound velocimetry of uteroplacental umbilical and fetal vessels has become an established method of antenatal monitoring, Cerebroplacental and Cerebrouterine ratios have been studied to predict neonatal outcomes.
Aim of the Work: To assess if Cerebrouterine Ratio would be complementary to cerebroplacental Ratio in predicting adverse
neonatal outcome in preeclamptic pregnant women.
Placental Elastography in Intrauterine Growth Restriction: A Case–control Studyasclepiuspdfs
Background: Intrauterine growth restriction (IUGR) is related to poor fetal outcome. Though, various tools are available for evaluation of IUGR they are notreliable inearly diagnosis of IUGR. Shear wave elastography (SWE) can be used to study the change in mechanical properties of various disease which can be a potential technique for early diagnosis of IUGR. Objective: The objective of the study was to compare the differences in SWE values of placentas between IUGR and normal pregnancies. Methodology: Normal second- and third-trimester pregnancies and IUGR pregnancies between 24 and 42 weeks period of gestation (POG), meeting the inclusion criteria were matched for age group and POG. SWE of placenta was performed in supine position during quiet respiration. The SWE of placenta was measured by placing the region of interest in relatively homogeneous area. The placental elasticity values obtained in pregnancies complicated by IUGR were compared with that of normal controls. Umbilical artery (UA) and fetal middle cerebral artery (MCA) Doppler findings were correlated with placental elasticity value of IUGR pregnancies.
1. The document discusses extended cycle oral contraceptives that provide contraception for 84 days by suppressing ovulation through a combination of ethinyl estradiol and levonorgestrel, followed by 7 days of placebo or low-dose estrogen pills.
2. Clinical trials showed that extended cycle pills were as effective at preventing pregnancy as conventional 28-day pills, with similar safety profiles. Adverse effects were mild and consistent with other combined oral contraceptives.
3. The extended cycle regimen was found to be over 99% effective at preventing pregnancy when taken correctly, and resulted in less frequent bleeding and spotting compared to a 28-day regimen.
Fetal echocardiographic measures to improve the prenatal diagnosis of coarcta...gisa_legal
This study aimed to identify fetal echocardiographic measures that can accurately predict postnatal coarctation of the aorta (CoA). The study retrospectively reviewed 13 cases of prenatal CoA diagnosis confirmed postnatally, 14 cases of prenatal CoA diagnosis with normal postnatal arches, and 30 controls. Measurements of the aorta, head vessels, and ventricles were made on available fetal echocardiograms. Linear mixed effects models found significant differences in the true CoA group for smaller distal transverse arch diameter, smaller distal transverse arch to head vessel index, and longer head vessel distances. The head vessel to arch index trend also differentiated true CoAs from false positives. Fetal echocardiographic
This document summarizes a study that examined the effects of a community prenatal dance program on rates of preeclampsia and preterm birth/low birth weight. The study compared outcomes of 119 women who participated in a standardized prenatal dance program to a control group of nearly 10,000 women. The dance program incorporated centering floorwork, relaxation techniques, and aerobic dancing. Results suggested lower rates of preeclampsia and preterm/low birth weight among women in the dance program compared to controls, supporting the hypothesis that a standardized prenatal dance program can reduce health risks in pregnancy.
Tricuspid valve size as a predictor in patients with severe pulmonary stenosi...gisa_legal
This study aimed to identify prenatal echocardiographic features that can predict postnatal tricuspid valve size in fetuses with severe pulmonary stenosis or pulmonary atresia with intact ventricular septum. The study found that a fetal tricuspid valve to mitral valve ratio greater than 0.63 highly predicts a favorable postnatal tricuspid valve Z-score above -3. Additionally, fetuses with antegrade flow across the pulmonary valve or more than moderate tricuspid regurgitation during the prenatal ultrasound had favorable postnatal outcomes, requiring only balloon valvuloplasty. This study provides useful information to counsel expectant parents on potential postnatal interventions needed.
Comparison of Various Clinical Methods of Birth Weight Estimation in Term Pre...CrimsonPublishers-PRM
Comparison of Various Clinical Methods of Birth Weight Estimation in Term Pregnancy by Darshit G Prajapati in Perceptions in Reproductive Medicine_Crimson Publishers
Comparison of Various Clinical Methods of Birth Weight Estimation in Term Pre...CrimsonPublishers-PRM
Comparison of Various Clinical Methods of Birth Weight Estimation in Term Pregnancy by Darshit G Prajapati in Perceptions in Reproductive Medicine_Crimson Publishers
Prediction of delivery mode by ultrasound-assessed fetal position in nulliparous women with prolonged first stage of labor
T. M. Eggebø, W. A. Hassan, K. Å. Salvesen, E. A. Torkildsen, T. B. Østborg and C. C. Lees
Volume 46, Issue 5, pages 606–610
View the free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.14773/full
Influence of ultrasound determination of fetal head position on mode of delivery: a pragmatic randomized trial
T. Popowski, R. Porcher, J. Fort, S. Javoise and P. Rozenberg
Volume 46, Issue 5, 520–525
View the free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.14785/full
1. This study compared screening for trisomies 21, 18 and 13 using cell-free DNA (cfDNA) analysis of maternal blood at 10-11 weeks' gestation to screening using the combined test at 11-13 weeks.
2. CfDNA analysis identified all cases of trisomy 21 and the majority of trisomy 18 cases, with a lower false positive rate than the combined test. Detection of trisomy 13 was lower.
3. In cases where cfDNA and karyotype results disagreed, the fetal DNA fraction was significantly lower, highlighting the importance of considering a priori risk when interpreting cfDNA results.
Cat clitoral phimosis effects on female sexual function and surgical finaladi bachtiar
This study observed 3,650 women between 2014-2016 to evaluate surgical treatment for severe clitoral phimosis (CP) caused by lichen sclerosus (LS). Nine women with severe CP underwent CO2 laser circumcision. Post-surgery, questionnaires showed significant improvements in sexual function, genital self-image satisfaction, and less sexual discomfort. However, the study was limited by its small sample size of women who had surgery and lack of a control group for comparison.
This study examined the relationship between preconceptional maternal obesity and placental weight, birth weight. The study included 259 women divided into normal (BMI <25) and obese (BMI ≥25) groups. The obese group had significantly higher placental weights compared to the normal group, even after adjusting for age and parity. However, birth weights did not significantly differ between the groups. The study found that maternal preconceptional obesity is associated with heavier placentas but not birth weight.
Ultrasound screening for fetal growth restriction at 36 vs 32 weeks' gestation: a randomized trial (ROUTE)
E. Roma, A. Arnau, R. Berdala, C. Bergos, J. Montesinos and F. Figueras
Volume 46, Issue 4, pages 391–397
View the free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.14915/full
huong dan chan doan va xu tri thai cham tang truong trong tu cung sga and fga...Võ Tá Sơn
This document provides guidelines from the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) for the diagnosis and management of small-for-gestational-age (SGA) fetuses and fetal growth restriction (FGR). It defines SGA as fetal size below the 10th percentile and distinguishes it from FGR, which indicates failure to reach growth potential and increased risk of adverse outcomes. The guidelines recommend using fetal growth velocity, customized growth charts, Doppler ultrasonography of blood flows, biophysical profile scoring, and cardiotocography to diagnose FGR and distinguish it from SGA. Early-onset and late-onset FGR are defined based on diagnosis before or after 32
Systematic review of accuracy of ultrasound in the diagnosis of vasa previa
L. Ruiter, N. Kok, J. Limpens, J.B. Derks, I.M. de Graaf, B.W.J. Mol and E. Pajkrt
Volume 45, Issue 5, pages 516–522, May 2015
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.14752/full
This document discusses several methods for measuring body composition in children, including BMI, Lange calipers, bioelectrical impedance analysis (BIA), and dual energy x-ray absorptiometry (DEXA). It provides details on the techniques and formulas used for each method and discusses their advantages and disadvantages. The conclusion emphasizes the importance of monitoring students' health and using multiple methods of assessment rather than relying on any single approach.
This document summarizes a study that examined the effect of a community-based group physical activity (CBGPA) program on the risk of preeclampsia during pregnancy. The study found that among 88 women who participated in the standardized CBGPA program, the rate of preeclampsia was significantly lower (2.2%) than the overall rate at the hospital (7.8%). Pregnancies in the CBGPA group also had lower rates of preterm birth and low birthweight compared to the overall rates. The study concludes that CBGPA may help reduce the risk of complications like preeclampsia during pregnancy.
Balance, Fit, Intrauterine Life and Lifelong Disease Salford Systems
This document discusses research analyzing relationships between placental size, birth weight, and later health outcomes. It finds that placental size is correlated with birth weight and can predict childhood BMI levels. Babies whose size does not match what is predicted based on placental measures may be physiologically vulnerable and at risk for different growth trajectories. Machine learning methods allow insights into how placental growth translates to fetal development and later health.
Uterine Artery Doppler and Prediction of PreeclampsiaAI Publications
The purpose of this study was to determine the accuracy of screening for pregnancy hypertension disorders using maternal serum biomarkers and uterine artery Doppler during the first trimester. At 11-13 weeks, uterine artery Doppler and serum measurements were taken from prospectively enrolled nulliparous women. In this study, maternal features, uterine artery Doppler imaging, and serum placental biomarkers (pregnancy-associated plasma protein-A, Inhibin-A, placental protein, A disintegrin and metalloprotease, free B-hCG, placental growth factor) were all collected and evaluated. Twenty women (2.2 percent) experienced prenatal hypertension, and forty women (4.5 percent) developed preeclampsia, with nine (1.0 percent) developing early-onset preeclampsia and sixteen (1.8 percent) developing severe preeclampsia, according to the findings. A combination screening model that included clinical features, pregnancy-associated plasma protein-A, Inhibin-A, and placental growth factor was found to be effective in detecting 75 percent of early-onset preeclampsia with a false-positive rate of 10 percent. Uterine artery Doppler, placental protein, A disintegrin and metalloprotease were all found to have no effect on diagnosis accuracy after adjusting for clinical factors. When combined with first-trimester maternal serum biomarkers (pregnancy-associated plasma protein-A, Inhibin-A, and placental growth factor), a combination of clinical features and placental growth factor can give an accurate screening for early-onset preeclampsia in nulliparous women.
An ultrasound was performed on Mrs. Sunita Sadar, age 28, who was referred by Dr. Ashok Deshmukh. The ultrasound revealed a single live fetus in cephalic presentation estimated to be 31 weeks and 6 days gestation based on measurements. Fetal cardiac activity and movements were present. The placenta was posterior and grade II maturity. No obvious congenital anomalies were seen. Fetal measurements were within normal ranges for the estimated gestational age. The impression was of a normal singleton pregnancy at 31 weeks and 6 days.
This study aimed to establish comprehensive reference ranges for fetal biometry measurements during 11-14 weeks of gestation using transabdominal ultrasound. Measurements of various fetal anatomical structures were taken from 660 viable singleton pregnancies. Reference ranges including the 5th, 50th, and 95th percentiles were calculated for each biometric parameter and plotted against gestation. The results show that all parameters increase with gestation. Ratios involving ventricle sizes and femur length decrease over time, while head circumference to abdominal circumference remains constant. The reference ranges established can help in diagnosing early growth issues and interpreting measurements in chromosomally abnormal fetuses.
Background: Doppler ultrasound velocimetry of uteroplacental umbilical and fetal vessels has become an established method of antenatal monitoring, Cerebroplacental and Cerebrouterine ratios have been studied to predict neonatal outcomes.
Aim of the Work: To assess if Cerebrouterine Ratio would be complementary to cerebroplacental Ratio in predicting adverse
neonatal outcome in preeclamptic pregnant women.
Ultrasonographic Cervical Length Measurement at 10-14- and 20-24-weeks’ Gesta...AI Publications
Preterm labor is a regular occurrence in pregnancy; an estimated 15 million babies are born prematurely each year, with the number increasing. This was a prospective study of pregnant women who came to the Maternity Teaching Hospital in Erbil, Kurdistan Province, Iraq, for an outpatient clinic. On a manageable sample of 150 singleton pregnancies. In this study, one hundred fifty singleton asymptomatic pregnancies encountered the inclusion criteria during the study period, 69 primi gravid, 81 multi gravid. The correlation between the cervical length at 20–24 weeks and preterm delivery was moderately poor (r =0.715), and this correlation was highly significant (P < 0.001). In another word, a better correlation was found between preterm delivery and cervical length at 20–24 weeks than at 10–14 weeks in the prediction of preterm delivery. This study also points towards the importance of serial ultrasound scans to detect those who are at higher risk. There was no statistically significant effect of age, parity. Finally, the findings revealed that trans vaginal ultrasound is more accurate at 20-24weeks than 10-14weeks gestation for prediction of preterm labor, it can be used routinely to prevent preterm birth.
Prenatal diagnosis has advanced significantly from early techniques like amniocentesis. Now, non-invasive prenatal testing using cell-free fetal DNA from maternal blood can screen for common chromosomal abnormalities with over 99% sensitivity. Ultrasound is routinely used during pregnancy to check fetal anatomy and growth. Biochemical markers in maternal blood can assess risks for issues like Down syndrome, assess placental health through hormones like HCG, and monitor fetal well-being. Invasive techniques like amniocentesis and chorionic villus sampling allow for direct genetic testing of fetal cells.
1) The document describes a study comparing early prenatal diagnosis of fetal tetralogy of Fallot (fTOF) between 12-17 weeks gestation to diagnosis after 17 weeks.
2) It found that while detailed assessment of cardiac anatomy was possible in most early cases, referral indications and pregnancy outcomes differed significantly between early and later diagnosis groups.
3) Specifically, early diagnosis was usually due to extracardiac abnormalities, and resulted in termination 80% of the time, compared to 33% termination for later diagnoses usually due to suspected cardiac abnormalities on routine ultrasound.
Diagnosis of tetralogy of fallot and its variants in thegisa_legal
Fetal tetralogy of Fallot (fTOF) can be diagnosed in the late first and early second trimesters of pregnancy using fetal echocardiography. This study reviewed 10 cases of fTOF diagnosed between 12-17 weeks gestation and compared them to 25 cases diagnosed after 17 weeks. Key findings included: 1) Detailed cardiac anatomy was possible in most early cases, though visualization was sometimes limited; 2) Referrals for early cases often involved extracardiac anomalies while later cases were usually for suspected cardiac issues; 3) Pregnancy termination was more common for early diagnoses (80%) versus later diagnoses (33%).
This document summarizes a study that evaluated the effects of various maternal, fetal, and technical factors on the accuracy of sonographic fetal weight estimation (SFWE). The study analyzed over 9,000 SFWEs performed within a week of delivery. It found that several maternal factors, including higher weight, height, BMI, older age, diabetes, and multiparity were associated with underestimation of fetal weight. Fetal factors like male sex were also linked to underestimation, while breech presentation slightly improved accuracy. Experience level of the sonographer had little effect. Overall, the models assessed explained less than 10% of errors, suggesting most inaccuracy comes from limitations of SFWE formulas themselves.
- The document discusses the benefits of first trimester antenatal care, including screening for fetal anomalies and maternal-fetal complications. It notes that detailed ultrasound examination and markers in the first trimester can predict many complications later in pregnancy and allow for early intervention. Conditions like Down's syndrome, open neural tube defects, congenital heart defects, preeclampsia, and fetal growth restriction can potentially be detected through a combination of ultrasound assessment, medical history, and serum markers in the first trimester. This represents a shift away from traditional late pregnancy surveillance to an earlier risk assessment approach through innovations in first trimester screening.
Perinatal magnesium administration and the prevention of periventricular leuk...Ross Finesmith M.D.
This study examined the effect of magnesium sulfate (MgSO4) on the development of cystic periventricular leukomalacia (cPVL) in preterm infants. The researchers conducted a retrospective case-control study of 492 preterm infants born between 1992-1994 weighing less than 1750g who survived at least 7 days. They found infants exposed to MgSO4 in utero were less likely to develop cPVL. Specifically, 2 of 18 infants with cPVL were exposed to MgSO4 compared to 14 of 36 controls, indicating MgSO4 exposure is associated with a reduced risk of cPVL. Further analysis confirmed the groups were similar in other variables and preeclampsia alone did
This study evaluated 84 patients diagnosed with hypertrophic pyloric stenosis (HPS) to assess the ability of physicians to detect the condition through clinical examination compared to sonography and barium studies. The olive sign was detected in only 13 patients (15.5%) on clinical examination. Sonography revealed HPS in 71 of 81 patients (87.7%), while barium studies found HPS in 16 of 21 patients (76.2%). Sonography was significantly more accurate at detecting HPS than clinical examination. Due to the difficulty examining crying infants and increased availability of imaging, physicians' skills at detecting the olive sign through physical examination are declining, leading to underutilization of this important diagnostic tool.
Pulmonary outflow tract obstruction in fetuses with complexgisa_legal
This study aimed to identify prenatal echocardiographic markers that could predict which fetuses with right ventricular outflow tract obstruction and complex congenital heart disease would require neonatal intervention. The study reviewed prenatal echocardiograms and neonatal outcomes of 52 fetuses. It found that fetuses who required neonatal intervention had significantly lower pulmonary valve Z-scores and smaller pulmonary valve to aortic valve diameter ratios. Classifying ductus arteriosus flow direction as abnormal was highly sensitive and specific for predicting need for intervention. Analysis of the pulmonary outflow tract and ductus arteriosus flow can help identify fetuses likely to require postnatal support of pulmonary blood flow.
Value of routine ultrasound examination at 35–37 weeks’ gestation in diagnosi...Võ Tá Sơn
This study investigated the value of routine ultrasound examination at 35-37 weeks' gestation in diagnosing previously unknown fetal abnormalities. The study found:
1) Of 995 total fetal abnormalities detected, 24.8% (247) were first diagnosed at 35-37 weeks' gestation and 7.4% (74) were first diagnosed postnatally.
2) The most common abnormalities first seen at 35-37 weeks were hydronephrosis, mild ventriculomegaly, ventricular septal defect, duplex kidney, ovarian cyst, and arachnoid cyst.
3) Routine ultrasound at 35-37 weeks could potentially improve postnatal outcomes by enabling diagnosis and management planning for
This document provides an overview of obstetric ultrasound from the first trimester through delivery. It discusses the objectives and key aspects to evaluate at each gestational age, including confirming viability, dating the pregnancy, screening for anomalies and conditions like trisomy 21 and preeclampsia. Important details are provided on techniques for accurate fetal biometry and Doppler assessment of the umbilical and middle cerebral arteries to monitor fetal well-being. Amniotic fluid assessment and surveillance of high-risk twin pregnancies are also reviewed.
This study aimed to determine which combination of cardiac parameters best predicts postnatal coarctation of the aorta (CoAo) in fetuses with cardiac asymmetry. The study analyzed 85 liveborn fetuses with isolated cardiac asymmetry and complete postnatal follow-up. CoAo was confirmed in 41/85 neonates (48%). Logistic regression identified four parameters that best predicted CoAo: gestational age at diagnosis, Z-scores of the ascending aorta and aortic isthmus diameters, and the pulmonary valve/aortic valve diameter ratio. Combining these parameters allowed calculation of individual post-test probabilities for CoAo, improving prediction compared to individual parameters alone.
Magnesium Prevents the Cerebral Palsy Precursor in Premature InfantsRoss Finesmith M.D.
To determine if magnesium sulfate has an effect on the development of cystic
periventricular leukomalacia in preterm infants, this retrospective case control study
was conducted. There were 23,382 infants born at three teaching hospitals in the metropolitan New York area from January 1992 to December 1994. Four hundred ninety-two infants met our entrance criteria. Criteria included a birth weight less than 750 g, survival to at least 7 days of life and at least one cranial ultrasound after 7 days of life.
Infants exposed to magnesium sulfate in utero were less likely to develop periventricular
leukomalacia. Two of 18 (11%) infants with periventricular leukomalacia were
exposed to magnesium sulfate in-utero compared to 14 of 36 controls (39%) (p =
0.035) (OR = 0.196, 95% Cl = 0.039-0.988). Pre-eclampsia as an independent factor
was not associated with a reduced risk (p = 0.251) (OR = 0.294, 95% Cl =
0.033-2.65). Preterm infants exposed to antenatal magnesium sulfate were found to
have a reduced risk of developing cystic periventricular leukomalacia.
Screening for heart defects in the first trimesterTony Terrones
This document discusses two studies on screening for heart defects in the first trimester of pregnancy. The first study measured cardiac axis in 100 pregnancies between 11-14 weeks and found an abnormal axis in 4 cases that were later diagnosed with congenital heart disease. However, the study excluded women with high BMI and nearly 20% required additional imaging, calling into question its applicability for widespread screening. The second study found measuring ductus venosus pulsatility index could help predict heart defects, but obtaining a clear measurement may be difficult and half of postnatally diagnosed cases were missed prenatally. The document concludes that while identifying high-risk cases early is important, screening also needs to allow for timely diagnostic imaging and accurate diagnosis
This research article examines alterations in reproductive hormones during pregnancy and the risk of preeclampsia. The study followed 79 preeclamptic women and 80 healthy pregnant controls longitudinally from the third trimester through 6 weeks postpartum. Blood samples were taken at each visit and analyzed for beta-hCG, oestriol, progesterone and prolactin levels. Results showed beta-hCG and oestriol levels were significantly altered in the preeclamptic group compared to controls in the first and third trimesters respectively, indicating these hormones may help identify risk of preeclampsia earlier in pregnancy. The study aims to determine the gestational age at which hormonal changes occur that are associated with developing preecl
1) The document proposes a new model of prenatal care based on a comprehensive assessment at 11-13 weeks of gestation. This assessment uses maternal characteristics, ultrasound findings, and biochemical testing to determine patient-specific risks for various pregnancy complications.
2) Most major fetal aneuploidies, structural abnormalities, and a variety of pregnancy complications can potentially be identified or assessed at high risk during the 11-13 week assessment.
3) Based on the risk assessment, most women would be classified as low risk and require fewer prenatal visits, while high risk women would receive specialized monitoring and treatment. This shifts prenatal care from routine visits to a personalized, disease-specific approach.
Diagnostic approach and management of extrauterine pregnancyRustem Celami
An ectopic pregnancy is a pregnancy that develops outside a woman's uterus. This happens when the fertilized egg from the ovary does not reach or implant itself normally in the uterus. Instead, the egg develops somewhere else in the abdomen. The products of this conception are abnormal and cannot develop into fetuses. Urine pregnancy test is often done by women itself once amenorrhea is present about 2 weeks of expected menstrual period, however, pregnancy blood test such Beta – human Chorionic Gonadotropin (BhCG) and ultrasound examination are the best tool of diagnosis. The most common place that ectopic pregnancy occurs is in one of the fallopian tubes, a so-called tubal pregnancy. These are the tubes that transport the egg from the ovary to the uterus. Ectopic pregnancies also can be found on the outside of the uterus, on the ovaries, or attached to the bowel. Most serious complication of an ectopic pregnancy is intra-abdominal hemorrhage. In the case of a tubal pregnancy, for example, as the products of conception continue to grow in the fallopian tube, the tube expands and eventually ruptures. This can be very dangerous because a large artery runs on the outside of each Fallopian tube. If the artery ruptures, the woman can bleed severely. Ectopic pregnancy is usually found in the first 5-10 weeks of pregnancy and is the leading cause of pregnancy-related deaths in the first trimester of pregnancy in the USA. In Albania, we face difficulties not only in application of high technology of ultrasound machine in public health sector but unfortunately we are unable to perform BhCG in public health sector laboratories, such making not only challenge and even delay but an expensive process of diagnosis of this medical problem. In conclusion, since ectopic pregnancy is an abnormal pregnancy, and comes with high risk of serious complication, early diagnosis of pregnancy location and its management is crucial in preventing medical complication.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
2. disease, and there was confirmation of a healthy neonatal
outcome. Singleton and multiple gestation pregnancies
were included. All participants provided informed consent.
The University of Alberta Research Ethics Board approved
this study.
Fetal echocardiography was performed using the Sie-
mens S2000 (Mountainview, CA) or the General Electric
Voluson E8 (Boston, MA). For transabdominal imaging, 4
to 9 MHz curved or linear array transducers were used, and
for transvaginal imaging a 9 to 12 MHz endocavity probe
was used. All echocardiograms at ≤12 weeks were
attempted transabdominally with additional transvaginal
ultrasound imaging only when transabdominal imaging was
inadequate.
Gestational age was based on the first day of the last
menstrual period for most. Gestational age was based on
fetal size if at ≤15 weeks, the crown rump length (measured
in all pregnancies <12 weeks), biparietal diameter and
femur length (pregnancies of ≥12 weeks suggested the
pregnancy was > or <1 week, or for pregnancies >15
weeks, if the biparietal diameter and femur length sug-
gested the pregnancy to be < or >2 weeks).5
All pregnan-
cies had a normal fetal echocardiogram ≥17 weeks.
Pulsed Doppler interrogation of simultaneous left ven-
tricular inflow and outflow was acquired for all pregnan-
cies. At <9 weeks of gestation, it was not always possible
to determine whether the signal was from the left ventricle
but signals acquired were comparable to ventricular inflow-
outflow signals observed in 10 to 14-week gestation fetuses.
The AV interval and A-wave duration were measured from
the onset of the A wave, including when E and A waves
were partially merged (Figure 1). Doppler tracings were
analyzed both on- and offline to measure (in milliseconds)
the following: cardiac cycle duration, AV interval, isovolu-
mic contraction time, and A-wave duration (Figure 1). All
measurements were made from 3 cardiac cycles, consecu-
tive where possible, and averaged. All measurements were
generated by 1 author (DG) and assessment of inter- and
intraobserver variability was performed by a second
(LKH). Medical records were used to verify normal preg-
nancy outcome. Only pregnancies with high-quality left
ventricular inflow-outflow pulsed wave Doppler tracings
were included.
Regression analysis was used to investigate the evolu-
tion of the AV interval and its components across gesta-
tional ages. We fitted regression lines between dependent
and independent variables by applying fractional polyno-
mials or simple linear regression techniques. Fractional
polynomial regression was used when a curved relation
between dependent and independent variables was sug-
gested by exploratory analysis of the data. We assessed the
appropriateness of the final fitted models by examining
residual plots and reported the significance of the final
model (p value and adjusted R-squared), the regression
coefficients and related statistics (eg, 95% confidence inter-
vals) and the corresponding scatter-plots including the fitted
lines and corresponding 95% confidence interval area. We
estimated the association between heart rate and AV inter-
val, A-wave duration, or isovolumic contraction time using
Pearson’s correlation coefficients (r). We also reanalyzed
the data excluding repeated measures in the same fetus to
determine whether repeated measures had a significant
impact. Interobserver variability was assessed on a random
sample of »10% of the study group (overall 30 echocardio-
grams, 10 from each of the following gestational age
groups: 6 to 10+6
, 11 to 16+6
, and 17 to 40) using % differ-
ence: (absolute difference between measurement by
Observer 1 and measurement by Observer 2)/([measure-
ment by Observer 1 + measurement by Observer 2]/2). We
performed statistical analysis by using Stata v13.
Results
Two hundred seventy-four women with 279 pregnancies
were enrolled and underwent fetal echocardiography
between 6+1
weeks and 39+2
weeks of gestation. Of the 279
pregnancies, 248 were singleton, 28 were twin and 3 were
triplet gestations. Three hundred thirteen fetuses had
attempts at assessment of AV interval of which in 305
measurements could be made. Inadequate tracings were
found at all age groups. Four hundred thirty-three AV inter-
val measurements were performed in total.
From 6+1
weeks, the fetal heart rate increased to a peak
at 10 weeks then slowly decreased to term (p <0.001;
Figure 2). Ventricular inflow patterns were biphasic in none
before 9+0
weeks, in 20% at 9+0
to 9+6
weeks, in 85% from
10+0
to 10+6
weeks, and in all thereafter. The fetal AV inter-
val dramatically decreased from 6 to 10 weeks and gradu-
ally increased thereafter to term (p <0.001; Figure 3). AV
interval demonstrated a negative linear correlation with
heart rate (r = ¡0.45, p <0.0001; Figure 4). Normal ranges
for the AV interval and AV interval-RR interval by gesta-
tional age group are shown in Table 1. Regression coeffi-
cients for regression models using gestational age as an
explanatory variable are shown in Table 2. Testing for
interobserver variability indicated a 4% difference for AV
interval measurements (without major differences between
gestational age groups).
Figure 1. Assessment of the fetal AV interval (AVI) and its components
(ICT-isovolumic contraction time and A wave during atrial systole) from
simultaneous left ventricular inflow-outflow tracings at 8 (A) and 14 (B)
weeks of gestation. Note the uniphasic Doppler ventricular inflow pattern
typically seen before 10 weeks of gestation. At 14 weeks, Doppler inflow
patterns are consistently biphasic in the normal fetus.
ARTICLE IN PRESS
2 The American Journal of Cardiology (www.ajconline.org)
3. The individual components of the AV interval changed
significantly with gestation. The A-wave duration (p <0.001;
Figure 5) and the A wave/R-R interval (p ≤0.001, not
shown) increased linearly with gestation, and the A-wave
duration negatively correlated with heart rate (r = ¡0.62,
p <0.0001; Figure 5). In contrast, isovolumic contraction
time was highest at 6 weeks, acutely decreased through to 10
weeks, then remained fairly stable approaching 0 for the rest
of gestation (p <0.001; Figure 6). Isovolumic contraction
time weakly inversely correlated with heart rate (r = ¡0.18,
p = 0.02, not shown).
When the results were analyzed excluding cases with
repeat measures in the same fetus at different gestations,
there was no impact on the results, except that isovolumic
contraction time no longer inversely correlated with heart
rate (p = 0.08).
Discussion
The conduction system begins to develop shortly after
the heart undergoes morphogenesis in the third week of
gestation.6−10
The AV node is identifiable histologically
from 5 weeks.10,11
Using Doppler, the human heart beat
can be demonstrated from 5 weeks and AV synchrony has
been demonstrated from 6 weeks onward.12
The first report of normal values for fetal AV interval
was in a small cohort from 17 weeks to term and this sug-
gested that the AV interval did not change with gestational
age or heart rate.13
Shortly thereafter, however, another
group demonstrated in a larger cohort that the AV interval
increases with gestational age from the mid trimester and
inversely correlates with heart rate, findings subsequently
confirmed by other investigators.2,3,14
We have confirmed
that pulsed Doppler can demonstrate AV synchrony in
essentially all fetuses from 6 weeks. We found an acute
decrease in AV interval from 6 to 10 weeks then a gradual
increase thereafter. The AV interval inversely mirrors heart
rate which progressively increases to 10 weeks and then
gradually decreases.15
Our findings in the mid and third tri-
mester are comparable to those reported by others and sug-
gest that the inverse correlation between AV interval and
heart rate exists even from 6 weeks of gestation.2,3
The pulsed Doppler-based AV interval excludes atrial
electromechanical delay, but includes ventricular electro-
mechanical delay and isovolumic contraction time and is
longer than the PR interval.16
Isovolumic contraction is so
brief beyond 11 weeks that it has minimal impact on the
AV interval, rendering it a satisfactory proxy for PR inter-
val (in the setting of normal heart function) from then
onwards. Although the dramatic reduction in the AV inter-
val from 6 to 10 weeks’ gestation could be in part due to
faster AV conduction, our findings suggest that the AV
interval may be less reflective of the PR interval in early
gestations due to prolonged isovolumic contraction. As iso-
volumic contraction occurs following ventricular depolari-
zation, its inclusion in the assessment of AV conduction
may be inappropriate especially at earlier gestations.
Prolonged isovolumic contraction occurs when there is
increased afterload or reduced systolic function.17,18
The
embryonic circulation has high placental resistance ini-
tially, which falls late in the first trimester with trophoblast
Figure 2. Heart rate as a function of gestational age (p <0.001; adjusted R-
squared = 0.62). Fitted line and its 95% confidence intervals (shaded area)
are shown. Regression coefficients are reported in Table 2.
Figure 3. Atrioventricular (AV) interval as a function of gestational age (p
<0.001; adjusted R-squared = 0.43). Fitted line and its 95% confidence
intervals (shaded area) are shown. Regression coefficients are reported in
Table 2.
Figure 4. Atrioventricular (AV) interval as it relates to heart rate. There is
a negative linear correlation (r = ¡0.45, p <0.001).
ARTICLE IN PRESS
Miscellaneous/Evolution of the Fetal AV Interval 3
4. invasion.19
Simultaneous with the dramatic fall in isovolu-
mic contraction time, changes in the myocardium, which
likely influence function, occur. For example, animal stud-
ies suggest rapid growth of embryonic tissue causing rela-
tive myocardial hypoxia and stimulating ingrowth of
coronary vasculature.20,21
Concomitantly, the myocardium
compacts likely influencing diastolic function, and the 3
layers of the left ventricular myocardium evolve and
mature, which may improve twist.22,23
If these changes
augment ventricular contractility, this would shorten isovo-
lumic contraction. Changes in the early fetal heart rate may
be influenced by the evolution of fetal heart function as
Table 1
Normal ranges for AVI and AVI-RR interval by gestational age group
AVI (milliseconds) AVI-RR interval (milliseconds)
GA range (weeks) n Median IQ range Mean SD Median IQ range Mean SD
6 to 8 26 127 22 128 15 353 59 345 44
9 to 10 32 105 15 107 12 299 30 305 36
11 to 15 172 101 12 101 10 265 37 265 23
16 to 20 74 115 21 115 15 280 49 282 39
21 to 25 37 122 13 122 11 298 42 292 30
26 to 30 44 127 15 127 13 292 39 294 30
31 to 35 28 132 23 130 17 295 86 291 47
36 to 40 20 136 14 136 16 306 40 310 32
Total 433 112 26 113 17 280 50 284 39
AVI = atrioventricular interval, GA = gestational age, IQ = interquartile, SD = standard deviation.
Table 2
Regression coefficients for regression models using gestational age as explanatory variable
Variable Type-curve Parameter Power (p) Coefficient p Value 95% confidence intervals
Heart rate Polynomial* bo − 122.76 0.000 [119.82, 125.69]
b1 ¡2 ¡13,404.71 0.000 [¡15,246.03, ¡11,563.39]
b2 ¡2 7,644.54 0.000 [6,721, 8,567.16]
AV interval Polynomial* bo − 0.22 0.000 [0.21, 0.24]
b1 ¡1 2.45 0.000 [2.07, 2.83]
b2 ¡1 ¡1.56 0.000 [¡1.79, ¡1.34]
A-wave duration Linear bo − 0.066 0.000 [0.062, 0.070]
b1 − 0.0012 0.000 [0.0010, 0.0014]
Isovolumic contraction time Polynomial* bo − 0.06 0.000 [0.04, 0.08]
b1 ¡1 1.46 0.000 [0.99, 1.94]
b2 ¡1 ¡0.78 0.000 [¡1.07, ¡0.49]
See Stata reference manual for interpretation: StataCorp. 2017. Stata: Release 15. Statistical Software. College Station, TX: StataCorp LLC.
* The fractional polynomial model has the form: y(p1, p2,..pm)’
b = b0 + b1x(p1)
+ b2x(p2)
+ . . .+ bmx(pm)
.
Figure 5. A-wave duration as a function of gestational age (A) and heart rate (B). A-wave duration increases linearly and progressively throughout gestation
(p <0.001; adjusted R-squared = 0.51). Fitted line and its 95% confidence intervals (shaded area) are shown. Regression coefficients are reported in Table 2.
A-wave duration inversely correlated with heart rate (r = ¡0.62, p <0.0001).
ARTICLE IN PRESS
4 The American Journal of Cardiology (www.ajconline.org)
5. growth of the fetus may demand a greater cardiac output
than can be achieved by increasing stroke volume alone.
Previous investigations also suggest that the AV interval
is influenced by forces beyond AV conduction. In mothers
with anti-Ro/La autoantibodies, the transiently increased
fetal AV interval observed in many is secondary, at least in
part, to increased isovolumic contraction time.24
Clinicians
using AV intervals to assess conduction should be aware
that a prolonged isovolumic contraction may lead to false-
positive diagnoses of AV conduction disease.
The right ventricular Aa-IV interval measured by tissue
Doppler, which excludes isovolumic contraction time,
more tightly correlates with, but is shorter than the PR
interval.1
For pulsed Doppler measurements, use of the A-
wave duration could eliminate overestimation of the PR
interval related to prolonged isovolumic contraction both in
the early and late fetus. A-wave duration may be more akin
to the TDI-based Aa-IV. However, the A wave represents
flow and does not take into account electrophysiological-
mechanical and mechanical-hemodynamic delays. Further-
more, A-wave duration could be influenced by ventricular
diastolic properties, atrial function, AV valve function, and
atrial and ventricular preload. Bergman et al compared A-
wave duration and other pulsed Doppler techniques of
assessing AV interval in the mid-trimester with the PR
interval on the neonatal electrocardiogram.24
Their findings
suggested that the A-wave duration had a lower sensitivity
and negative predictive value for first degree AV block, but
higher specificity than the simultaneous mitral-aortic Dopp-
ler technique, suggesting it may be less likely to overcall
conduction abnormalities, but may underestimate the PR
interval in those with true PR prolongation. A weakness of
the latter study was the time delay between AV interval
measurement and electrocardiogram acquisition.
Although AV block does not typically evolve before 17
weeks in pregnancies with maternal autoantibodies, other
conditions are associated with earlier alterations in AV con-
duction, such as corrected transposition, single ventricles
with L-ventricular looping or heterotaxy syndrome.25
AV
block has been reported as early as 11 weeks in hetero-
taxy.26
Our normative data for AV interval and A-wave
duration from 6 to 40 weeks should facilitate detection of
AV conduction abnormalities.
In conclusion, we have established normative values for
the AV interval from 6 to 40 weeks’ gestation. As the AV
interval includes the period of isovolumic contraction, its
interpretation as a marker of cardiac conduction disease
should be used with caution in early gestation and in fetuses
with altered loading and/or ventricular dysfunction. Utiliza-
tion of A-wave duration alone may better reflect the PR
interval and requires further evaluation. Evolution of the
AV interval and isovolumic contraction time in the late
embryonic and early fetal periods suggests dramatic
changes in cardiac function and/or afterload occur during
these developmental stages.
Disclosures
The authors have no conflicts of interest and no relevant
financial relationships related to this article to disclose.
1. Nii M, Hamilton RM, Fenwick L, Kingdom JCP, Roman KS, Jaeggi
ET. Assessment of fetal atrioventricular time intervals by tissue Dopp-
ler and pulse Doppler echocardiography: normal values and correlation
with fetal electrocardiography. Heart 2006;92:1831–1837.
2. Wojakowski A, Izbizky G, Carcano ME, Aiello H, Marantz P, Otano
L. Fetal Doppler mechanical PR interval: correlation with fetal heart
rate, gestational age, and fetal sex. Ultrasound Obstet Gynecol
2009;34:538–542.
3. Tomek V, Janousek J, Reich O, Gilik J, Gebauer RA, Skovranek J.
Atrioventricular conduction time in fetuses assessed by Doppler echo-
cardiography. Physiol Res 2011;60:611–616.
4. Bolnick AD, Borgida AF, Egan JFX, Zelop CM. Influence of gesta-
tional age and fetal heart rate on the fetal mechanical PR interval. J
Matern Fetal Neonatal Med 2004;15:303–305.
5. Salomon LJ, Alfirevic Z, Bilardo CM, Chalouhi GE, Ghi T, Kagan
KO, Lau TK, Papageorghiou AT, Raine-Fenning NJ, Stirnemann J,
Suresh S, Tabor A, Timor-Tritsch IE, Toi A, Yeo G. ISUOG practice
guidelines: performance of first-trimester fetal ultrasound scan. Ultra-
sound Obstet Gynecol 2013;41:102–113.
6. Jongbloed MR, Vicente Steijn R, Hahurij ND, Kelder TP, Schalij MJ,
Gittenberger-de Groot AC, Blom NA. Normal and abnormal develop-
ment of the cardiac conduction system; implications for conduction
and rhythm disorders in the child and adult. Differentiation
2012;84:131–148.
7. Gourdie RG, Tatsuo M, Thompson RP, Mikawa T. Terminal diversifi-
cation of the myocyte lineage generates Purkinje fibers of the cardiac
conduction system. Development 1995;121:1423–1431.
8. Gourdie RG, Harris BS, Bond J, Justus C, Hewett KW, O’Brien TX,
Thompson RP, Sedmera D. Development of the cardiac pacemaking
and conduction system. Birth Defects Res Part C 2003;69:46–57.
9. Moorman AFM, de Jong F, Denyn MMFJ, Lamers WH. Development
of the cardiac conduction system. Circ Res 1998;82:629–644.
10. Kelder TP, Vicente-Steijn R, Harryvan TJ, Kosmidis G, Gittenberger-
de Groot AC, Poelmann RE, Schalij MJ, DeRuiter MC, Jongbloed
MR. The sinus venosus myocardium contributes to the atrioventricular
canal: potential role during atrioventricular node development? J Cell
Mol Med 2015;19:1375–1389.
11. Viragh S, Challice CE. The impulse generation and conduction system
of the heart. Ultrastructure of the Mammalian Heart. New York: Aca-
demic Press Inc; 1973. p. 43–89.
12. W»och A, Rozmus-Warcholinska W, Czuba B, Borowski D, W»och S,
Cnota W, Sodowski K, Szaflik K, Huhta JC. Doppler study of the
embryonic heart in normal pregnant women. J Matern Fetal Neonatal
Med 2007;20:533–539.
13. Glickstein JS, Buyon J, Friedman D. Pulsed Doppler echocardio-
graphic assessment of the fetal PR interval. Am J Cardiol
2000;86:236–239.
14. Andelfinger G, Fouron JC, Sonesson SE, Proulx F. Reference values
for time intervals between atrial and ventricular contractions of the
Figure 6. Isovolumic contraction time (ICT) as a function of gestational
age (p <0.001; adjusted R-squared = 0.29). Regression coefficients are
reported in Table 2.
ARTICLE IN PRESS
Miscellaneous/Evolution of the Fetal AV Interval 5
6. fetal heart measured by 2 Doppler techniques. Am J Cardiol
2001;88:1433–1436.
15. M€akikallio K, Jouppila P, R€as€anen J. Human fetal cardiac function
during the first trimester of pregnancy. Heart 2005;91:334–338.
16. Pasquini L, Seale AN, Belmar C, Oseku-Afful S, Thomas MJ, Taylor
MJ, Roughton M, Gardiner HM. PR interval: a comparison of electri-
cal and mechanical methods in the fetus. Early Hum Dev
2007;83:231–237.
17. Lavine SJ. Index of myocardial performance is afterload dependent in
the normal and abnormal left ventricle. J Am Soc Echocardiogr
2005;18:342–350.
18. Tei C, Nishimura RA, Seward JB, Tajik AJ. Noninvasive Doppler-
derived myocardial performance index: correlation with simultaneous
measurements of cardiac catheterization measurements. J Am Soc
Echocardiogr 1997;10:169–178.
19. Wladimiroff JW, Huisman TW, Stewart PA. Fetal and umbilical flow
velocity waveforms between 10-16 weeks’ gestation: a preliminary
study. Obstet Gynecol 1991;78(5 Pt 1):812–814.
20. Nanka O, Valasek P, Dvorakova M, Grim M. Experimental hypoxia
and embryonic angiogenesis. Dev Dyn 2006;235:723–733.
21. Wikenheiser J, Doughman YQ, Fisher SA, Watanabe M. Differential
levels of tissue hypoxia in the developing chicken heart. Dev Dyn
2006;235:115–123.
22. Sedmera D, Pexieder T, Vuillemin M, Thompson RP, Anderson RH.
Developmental patterning of the myocardium. Anat Rec 2000;258:
319–337.
23. Sedmera D, McQuinn T. Embryogenesis of the heart muscle. Heart
Fail Clin 2008;4:235–245.
24. Bergman G, Eliasson H, Bremme K, Wahren-Herlenius M, Sonesson
SE. Anti-Ro52/SSA antibody-exposed fetuses with prolonged atrio-
ventricular time intervals show signs of decreased cardiac perfor-
mance. Ultrasound Obstet Gynecol 2009;34:543–549.
25. Jaeggi ET, Hornberger LK, Smallhorn JF, Fouron JC. Prenatal
diagnosis of complete atrioventricular block associated with struc-
tural heart disease: combined experience of two tertiary care cen-
ters and review of the literature. Ultrasound Obstet Gynecol
2005;26:16–21.
26. Baschat AA, Gembruch U, Kn€opfle G, Hansmann M. First-trimester
fetal heart block: a marker for cardiac anomaly. Ultrasound Obstet
Gynecol 1999;14:311–314.
6 The American Journal of Cardiology (www.ajconline.org)
ARTICLE IN PRESS