Customised fetal growth curves in twin pregnancies: an Italian multicentre study

Objectives To construct reference limits for gestation of fetal biometric parameters stratified by chorionicity and customised for obstetrical and parents' characteristics. Methods Fetal biometric measurements derived from serial ultrasound examinations obtained from uncomplicated twin pregnancies delivering after 36 weeks of gestation were collected by 19 Italian fetal medicine units under the auspices of the Italian Society of Ultrasound in Obstetrics and Gynecology (SIEOG). The measurements acquired in each fetus at each examination included biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL). Multilevel linear regression models were used to adjust for the serial ultrasonographic measurements obtained and the clustering of each fetus in twin pregnancy. The impact of maternal and paternal characteristics (height, weight, ethnicity), parity, fetal sex and mode of conception were also considered. Models for each parameter were constructed stratified by fetal chorionicity and compared to our previously constructed growth curves from singleton. Results The dataset included 1781 twin pregnancies (dichorionic 1289; monochorionic diamniotic 492) with 8923 ultrasonographic examination with a median of 5 (range 2–11) observations per pregnancy. Growth curves of twin pregnancies differ from those of singletons, and differences were more marked in MCDA and during the third trimester. A significant influence of parents' characteristics was found as in singleton pregnancies. Conclusions Curves of fetal biometric measurements in twins are influenced by parents' characteristics. There is a reduction in growth rate during the third trimester. The reference limits for gestation constructed in this study from uncomplicated twin pregnancies may provide a useful tool for the identification of fetal growth abnormalities in twin pregnancies

Household-based biodigesters promote reduction of enteric virus and bacteria in vulnerable and poverty rural area.

The present study evaluated the river water quality improvement by implementation of household-based biodigesters in vulnerability and poverty rural area, in Minas Gerais State-Brazil. For that, 78 household-based biodigesters were installed for domestic wastewater treatment. Wastewater was collected before and after treatment and the physicochemical parameters and pathogens removal (human adenovirus (HAdV), hepatitis A (HAV) virus, Salmonella sp. and Escherichia coli) were evaluated; Additionally, river water was sampled before and after the household-based biodigesters implementation, to verify the contamination reduction and the positive impact of domestic wastewater treatment on waterborne pathogen reduction, considering HAdV, HAV, Salmonella sp. and E. coli quantification. The applicability in real-scale of decentralized treatment systems using household-based biodigesters promoted reduction of 90, 99, 99.99 and 99.999% from HAV, Salmonella sp., E. coli and HAdV from domestic wastewater, respectively; The river water quality improvement before the wastewater treatment application was highlight in the present study, considering that the reduction of waterborne pathogens in this water in 90, 99.99 and 99.999% of E. coli, HAV and HAdV, respectively (Salmonella sp. was not detected in river water). In general, this is an important study for encouraging the decentralized sanitation in vulnerable and poverty area, as well in rural sites, considering the positive impact of this implementation on public health

A etnografia como extensão da guerra por outros meios: notas sobre a pesquisa com militares

Este artigo pretende abordar resultados e consequências da realização de pesquisas etnográficas com militares. Partindo de uma discussão mais ampla sobre a ideia de antropólogos trabalhando "com militares", pretendo posteriormente situar os resultados de uma etnografia realizada no Exército brasileiro, tomada a partir de sintomas e/ou efeitos colaterais ocorridos durante e depois da pesquisa de campo. Ao retomar a relação estabelecida, e também a que não foi estabelecida, foi possível constatar a centralidade dos conceitos de "amigo" e "inimigo", para definir um amplo escopo de ligações entre o universo militar e o "mundo de fora". Tais conceitos, de início tomados como relações derivadas de uma noção nativa de guerra, em certa medida projetam-se nas relações entre militares e pesquisadores, o que levou a tratar a etnografia, neste caso específico, em continuidade com uma noção antropológica (posteriormente transformada) de guerra: guerra como relação. A partir dessa premissa relacional, pretende-se pensar algumas consequências metodológicas para uma antropologia deste tipo de objeto de pesquisa.<br>This article investigates the results and consequences of carrying out ethnographic research with the military. Beginning with a wide-ranging discussion of the idea of anthropologists working "with the military", I then seek to situate the results of an ethnography carried out with the Brazilian Army through the symptoms and/or collateral effects that were visible both during and after my research. By taking up the relationship that was established, and also that which was not, it was possible to observe the centrality of the concepts of "friend" and "enemy" in the definition of a wide range of ties between the military world and the "outside world". These concepts, which were initially understood to be relationships derived from a native notion of warfare, project themselves, to some extent, upon the relationships between military men and researchers, which, in this specific case, led me to approach ethnography in continuity with a, formerly transformed, anthropological notion of warfare: warfare as relation. From this relational premise, I will investigate certain methodological consequences of an anthropology of this sort of research object

Timing of Delivery for Twins With Growth Discordance and Growth Restriction: An Individual Participant Data Meta-analysis

OBJECTIVE:First, to evaluate the risks of stillbirth and neonatal death by gestational age in twin pregnancies with different levels of growth discordance and in relation to small for gestational age (SGA), and on this basis to establish optimal gestational ages for delivery. Second, to compare these optimal gestational ages with previously established optimal delivery timing for twin pregnancies not complicated by fetal growth restriction, which, in a previous individual patient meta-analysis, was calculated at 37 0/7 weeks of gestation for dichorionic pregnancies and 36 0/7 weeks for monochorionic pregnancies.DATA SOURCES:A search of MEDLINE, EMBASE, ClinicalTrials.gov, and Ovid between 2015 and 2018 was performed of cohort studies reporting risks of stillbirth and neonatal death in twin pregnancies from 32 to 41 weeks of gestation. Studies from a previous meta-analysis using a similar search strategy (from inception to 2015) were combined. Women with monoamniotic twin pregnancies were excluded.METHODS OF STUDY SELECTION:Overall, of 57 eligible studies, 20 cohort studies that contributed original data reporting on 7,474 dichorionic and 2,281 monochorionic twin pairs.TABULATION, INTEGRATION, AND RESULTS:We performed an individual participant data meta-analysis to calculate the risk of perinatal death (risk difference between prospective stillbirth and neonatal death) per gestational week. Analyses were stratified by chorionicity, levels of growth discordance, and presence of SGA in one or both twins. For both dichorionic and monochorionic twins, the absolute risks of stillbirth and neonatal death were higher when one or both twins were SGA and increased with greater levels of growth discordance. Regardless of level of growth discordance and birth weight, perinatal risk balanced between 36 0/7-6/7 and 37 0/7-6/7 weeks of gestation in both dichorionic and monochorionic twin pregnancies, with likely higher risk of stillbirth than neonatal death from 37 0/7-6/7 weeks onward.CONCLUSION:Growth discordance or SGA is associated with higher absolute risks of stillbirth and neonatal death. However, balancing these two risks, we did not find evidence that the optimal timing of delivery is changed by the presence of growth disorders alone

Timing of Delivery for Twins With Growth Discordance and Growth Restriction: An Individual Participant Data Meta-analysis

OBJECTIVE:First, to evaluate the risks of stillbirth and neonatal death by gestational age in twin pregnancies with different levels of growth discordance and in relation to small for gestational age (SGA), and on this basis to establish optimal gestational ages for delivery. Second, to compare these optimal gestational ages with previously established optimal delivery timing for twin pregnancies not complicated by fetal growth restriction, which, in a previous individual patient meta-analysis, was calculated at 37 0/7 weeks of gestation for dichorionic pregnancies and 36 0/7 weeks for monochorionic pregnancies.DATA SOURCES:A search of MEDLINE, EMBASE, ClinicalTrials.gov, and Ovid between 2015 and 2018 was performed of cohort studies reporting risks of stillbirth and neonatal death in twin pregnancies from 32 to 41 weeks of gestation. Studies from a previous meta-analysis using a similar search strategy (from inception to 2015) were combined. Women with monoamniotic twin pregnancies were excluded.METHODS OF STUDY SELECTION:Overall, of 57 eligible studies, 20 cohort studies that contributed original data reporting on 7,474 dichorionic and 2,281 monochorionic twin pairs.TABULATION, INTEGRATION, AND RESULTS:We performed an individual participant data meta-analysis to calculate the risk of perinatal death (risk difference between prospective stillbirth and neonatal death) per gestational week. Analyses were stratified by chorionicity, levels of growth discordance, and presence of SGA in one or both twins. For both dichorionic and monochorionic twins, the absolute risks of stillbirth and neonatal death were higher when one or both twins were SGA and increased with greater levels of growth discordance. Regardless of level of growth discordance and birth weight, perinatal risk balanced between 36 0/7-6/7 and 37 0/7-6/7 weeks of gestation in both dichorionic and monochorionic twin pregnancies, with likely higher risk of stillbirth than neonatal death from 37 0/7-6/7 weeks onward.CONCLUSION:Growth discordance or SGA is associated with higher absolute risks of stillbirth and neonatal death. However, balancing these two risks, we did not find evidence that the optimal timing of delivery is changed by the presence of growth disorders alone

Timing of Delivery for Twins With Growth Discordance and Growth Restriction:An Individual Participant Data Meta-analysis

OBJECTIVE: First, to evaluate the risks of stillbirth and neonatal death by gestational age in twin pregnancies with different levels of growth discordance and in relation to small for gestational age (SGA), and on this basis to establish optimal gestational ages for delivery. Second, to compare these optimal gestational ages with previously established optimal delivery timing for twin pregnancies not complicated by fetal growth restriction, which, in a previous individual patient meta-analysis, was calculated at 37 0/7 weeks of gestation for dichorionic pregnancies and 36 0/7 weeks for monochorionic pregnancies. DATA SOURCES: A search of MEDLINE, EMBASE, ClinicalTrials.gov, and Ovid between 2015 and 2018 was performed of cohort studies reporting risks of stillbirth and neonatal death in twin pregnancies from 32 to 41 weeks of gestation. Studies from a previous meta-analysis using a similar search strategy (from inception to 2015) were combined. Women with monoamniotic twin pregnancies were excluded. METHODS OF STUDY SELECTION: Overall, of 57 eligible studies, 20 cohort studies that contributed original data reporting on 7,474 dichorionic and 2,281 monochorionic twin pairs. TABULATION, INTEGRATION, AND RESULTS: We performed an individual participant data meta-analysis to calculate the risk of perinatal death (risk difference between prospective stillbirth and neonatal death) per gestational week. Analyses were stratified by chorionicity, levels of growth discordance, and presence of SGA in one or both twins. For both dichorionic and monochorionic twins, the absolute risks of stillbirth and neonatal death were higher when one or both twins were SGA and increased with greater levels of growth discordance. Regardless of level of growth discordance and birth weight, perinatal risk balanced between 36 0/7-6/7 and 37 0/7-6/7 weeks of gestation in both dichorionic and monochorionic twin pregnancies, with likely higher risk of stillbirth than neonatal death from 37 0/7-6/7 weeks onward. CONCLUSION: Growth discordance or SGA is associated with higher absolute risks of stillbirth and neonatal death. However, balancing these two risks, we did not find evidence that the optimal timing of delivery is changed by the presence of growth disorders alone. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42018090866

Timing of Delivery for Twins With Growth Discordance and Growth Restriction: An Individual Participant Data Meta-analysis

OBJECTIVE: First, to evaluate the risks of stillbirth and neonatal death by gestational age in twin pregnancies with different levels of growth discordance and in relation to small for gestational age (SGA), and on this basis to establish optimal gestational ages for delivery. Second, to compare these optimal gestational ages with previously established optimal delivery timing for twin pregnancies not complicated by fetal growth restriction, which, in a previous individual patient meta-analysis, was calculated at 37 0/7 weeks of gestation for dichorionic pregnancies and 36 0/7 weeks for monochorionic pregnancies. DATA SOURCES: A search of MEDLINE, EMBASE, ClinicalTrials.gov, and Ovid between 2015 and 2018 was performed of cohort studies reporting risks of stillbirth and neonatal death in twin pregnancies from 32 to 41 weeks of gestation. Studies from a previous meta-analysis using a similar search strategy (from inception to 2015) were combined. Women with monoamniotic twin pregnancies were excluded. METHODS OF STUDY SELECTION: Overall, of 57 eligible studies, 20 cohort studies that contributed original data reporting on 7,474 dichorionic and 2,281 monochorionic twin pairs. TABULATION, INTEGRATION, AND RESULTS: We performed an individual participant data meta-analysis to calculate the risk of perinatal death (risk difference between prospective stillbirth and neonatal death) per gestational week. Analyses were stratified by chorionicity, levels of growth discordance, and presence of SGA in one or both twins. For both dichorionic and monochorionic twins, the absolute risks of stillbirth and neonatal death were higher when one or both twins were SGA and increased with greater levels of growth discordance. Regardless of level of growth discordance and birth weight, perinatal risk balanced between 36 0/7-6/7 and 37 0/7-6/7 weeks of gestation in both dichorionic and monochorionic twin pregnancies, with likely higher risk of stillbirth than neonatal death from 37 0/7-6/7 weeks onward. CONCLUSION: Growth discordance or SGA is associated with higher absolute risks of stillbirth and neonatal death. However, balancing these two risks, we did not find evidence that the optimal timing of delivery is changed by the presence of growth disorders alone. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42018090866