Fetal age assessment based on 2nd trimester ultrasound in Africa and the effect of ethnicity

<p>Abstract</p> <p>Background</p> <p>The African population is composed of a variety of ethnic groups, which differ considerably from each other. Some studies suggest that ethnic variation may influence dating. The aim of the present study was to establish reference values for fetal age assessment in Cameroon using two different ethnic groups (Fulani and Kirdi).</p> <p>Methods</p> <p>This was a prospective cross sectional study of 200 healthy pregnant women from Cameroon. The participants had regular menstrual periods and singleton uncomplicated pregnancies, and were recruited after informed consent. The head circumference (HC), outer-outer biparietal diameter (BPDoo), outer-inner biparietal diameter and femur length (FL), also called femur diaphysis length, were measured using ultrasound at 12–22 weeks of gestation. Differences in demographic factors and fetal biometry between ethnic groups were assessed by t- and Chi-square tests.</p> <p>Results</p> <p>Compared with Fulani women (N = 96), the Kirdi (N = 104) were 2 years older (p = 0.005), 3 cm taller (p = 0.001), 6 kg heavier (p < 0.0001), had a higher body mass index (BMI) (p = 0.001), but were not different with regard to parity. Ethnicity had no effect on BPDoo (p = 0.82), HC (p = 0.89) or FL (p = 00.24). Weight, height, maternal age and BMI had no effect on HC, BPDoo and FL (p = 0.2–0.58, 0.1–0.83, and 0.17–0.6, respectively).</p> <p>When comparing with relevant European charts based on similar design and statistics, we found overlapping 95% CI for BPD (Norway & UK) and a 0–4 day difference for FL and HC.</p> <p>Conclusion</p> <p>Significant ethnic differences between mothers were not reflected in fetal biometry at second trimester. The results support the recommendation that ultrasound in practical health care can be used to assess gestational age in various populations with little risk of error due to ethnic variation.</p

A propriedade sem registro : o contrato e aquisição da propriedade imóvel na perspectiva civil-contitucional

Orientador : Prof. Dr. Eroulths Cortiano JuniorTese (doutorado) - Universidade Federal do Paraná, Setor de Ciências Jurídicas, Programa de Pós-Graduação em Direito. Defesa: Curitiba, 12/08/2014Inclui referênciasResumo: Esta tese objetiva uma releitura da obrigatoriedade do registro nas aquisições da propriedade imóvel, a partir do reconhecimento do contrato como dotado de função social, que realiza, igualmente, a função social como liberdade de acesso aos bens. A propriedade imobiliária no Direito Civil brasileiro está qualificada como direito real, conforme o art. 1225, I, do Código Civil, e sua transferência negocial se orienta pelo sistema da separação parcial dos planos dos direitos obrigacionais e reais, o qual prevê a necessidade do contrato de transmissão (compra e venda, doação ou permuta) com posterior registro no Cartório Imobiliário, nos termos do art. 1245 e seguintes. A Constituição Federal de 1988 garante o direito de propriedade, que deve atender à sua função social, considerando-a como direito fundamental (art. 5.o, XXII e XXIII) e como princípio geral da ordem econômica (art. 170, II e III). A necessária interação entre o Direito Civil e a Constituição, sob a supremacia hierárquica desta, conduz a entender que o direito de propriedade atual, para além da literalidade do Código Civil, deve nortear-se pela sintonia entre ambos os diplomas legais, mas a partir da observação dos princípios e dos valores constitucionais. O Direito Civil-Constitucional surge, então, como uma opção de desenvolvimento do pensamento jurídico, que visa oferecer espaço de reflexão que supere a dogmática unicamente codificada, pois, com fundamento nos princípios e na axiologia constitucional, auxilia na ressignificação de institutos clássicos, como a propriedade e o contrato. O acesso à propriedade, então, pode ser considerado para além da letra da lei, o que permite relevar o registro, com a funcionalização do contrato que, a partir de sua teleologia, da solidariedade, da alteridade e da boa-fé, pode ser o elemento constitutivo da propriedade, com base no caso concreto. A aplicação direta e imediata da Constituição nas relações interprivadas favorece a ressignificação do contrato, que alçará significado de título suficiente para garantir o direito à propriedade (acesso). A complexidade e a pluralidade das relações sociais conduzem a uma transição do modelo abstrato e individualista da propriedade para o da propriedade concreta, que se constrói na funcionalização como liberdade(s) com vistas à realização das necessidade da pessoa concretamente considerada.Abstract: The aim of this thesis is to re-read the mandatory registration on acquisition of immovable property, from the social function of contract's recognition, which also performs its social function as freedom of access to assets. The immovable property in the Brazilian Civil Law is qualified as a real right, according to art. 1225, I, Civil Code, and its negotiating transferring is guided by the partial separation between obligations and real rights, which predicts the registration of transmission's contract (sale, donation or exchange) with the state registration authority, according to art. 1245 and on Civil Code. The 1988 Federal Constitution guarantees the right to property, which must meet its social function, considering it as a fundamental right (art. 5, XXII and XXIII) and as a general principle of economic order (art. 170, II and III). The necessary interaction between the civil law and the Constitution, under the hierarchical supremacy of this leads to understand that the current property law, beyond its literal meaning of the Civil Code, shall be guided by the line between the two enactments, but from the observation of constitutional principles and values.The Civil-constitutional Law arises, then, as an option for legal thinking development, which aims to provide a reflection space that overcomes the consolidated dogmatic, therefore, on the basis of principles and the constitutional axiology, assists in reframing classical institutes, as property and contract. The access to the property can then be considered beyond the letter of the law, which allows to release the register, with the functionalization's contract which, from its teleology, solidarity, alterity and good faith, may be the constituent element of the property, based on the case. The direct and immediate constitutional applying in privates relations cooperate to the contract redefinition, which obtain the sufficient title to guarantee the right to property (access). The complexity and plurality of social relations lead to a transition from abstract and individualistic model of property to concrete one which is constructed on functionalization as freedom (s) to intending to accomplish persons needs concretely considered

Ultralydfremstilling av fostervekst

<p>Ultralyd billeddanning er i dag den beste undersøkelsesmetoden vi har til å overvåke fosterets utvikling og vekst. Ultralydmåling av fosterets størrelse og biometriske referansetabeller for svangerskapet brukes til å fastsette svangerskapets alder, beregne termin og vurdere fosterets vekst. Optimal studiedesign er ulik for hvert av disse formålene. Det er stor variasjon i fysiologisk vekst og en utfordring å identifisere fostre som har dårlig tilvekst. En enkeltmåling av fosteret kan fortelle oss om det er lite eller stort i forhold til andre fostre, men ikke om størrelsen er passelig i forhold til forventet fysiologisk vekst for dette fosteret. Tilpassede referansemodeller ("customised") justerer forventet størrelse i relasjon til føtale og maternelle faktorer og har vist seg å bedre identifisere sanne veksthemmede fostre enn bare å klassifisere i henhold til 2,5, 5 eller 10 persentilen. Men et foster som i utgangspunktet er stort for alderen, men etter hvert vokser langsomt vil ikke nødvendigvis bli fanget opp ved en slik enkeltmåling. Serielle målinger vil hjelpe, men en slik longitudinell metode blir ikke fullt ut utnyttet før det appliseres betinget ("conditional") vekstberegning. Betingelsesleddene for variasjon i vekst og målemetode kalkuleres ut fra longitudinelle data og kan så anvendes for det enkelte foster. En første måling brukes til å beregne forventet vekst og variasjon for en neste måling. Denne metoden forventes å skjerpe diagnostikken for vekst-avvik i alle vektklasser og kan sammen med tilpasningen av andre faktorer bedre overvåkningen av risikosvangerskap</p><p>Ultrasonographic imaging is today the best method for assessing fetal size and monitoring fetal growth. Ultrasound measurements of fetal size are used for age, size and growth assessment, but the statistical design and analysis are different for each of these purposes. Physiological ranges for fetal growth are wide and the identification of fetal growth-restriction is correspondingly challenging. While fetal growth is reflected in various morphometric measurements, it is the estimated fetal weight (EFW) that has become the most useful method of identifying the growth-restricted fetuses. EFW is typically classified using populationbased percentiles. The most common definition of fetal growth-restriction refers to a weight below the 2.5th, 5th or 10th percentile for gestational age. This definition is controversial because it does not make a distinction between constitutionally small, small and growth-restricted, or growth-restricted but not small fetuses. Multiple variables affect fetal weight and can be incorporated into individually adjusted percentiles (e.g. fetal gender and maternal parity, ethnicity, height, weight, and age). Such customised fetal weight percentiles seem to enhance the identification of fetuses at risk of perinatal death and morbidity. A further advancement of the method is the application of serial measurements, a method that allows the detection of growth deviation. Rather than using z-score statistics based of cross-sectional studies, the method can be further sharpened by using conditional reference ranges: terms derived from longitudinal studies of fetal growth are used to establish conditional reference values for individual fetuses. I.e. the expected mean and ranges for the next examination is calculated based on the previous measurement. These conditional reference percentiles can be combined with customizing fetal and maternal factors to further optimize the diagnostic process of identifying growth deviation</p

Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions: A Population-Based Study of 634,741 Pregnancies

<div><p>Objectives</p><p>To determine the prevalence of, and risk factors for anomalous insertions of the umbilical cord, and the risk for adverse outcomes of these pregnancies.</p><p>Design</p><p>Population-based registry study.</p><p>Setting</p><p>Medical Birth Registry of Norway 1999–2009.</p><p>Population</p><p>All births (gestational age >16 weeks to <45 weeks) in Norway (623,478 singletons and 11,263 pairs of twins).</p><p>Methods</p><p>Descriptive statistics and odds ratios (ORs) for risk factors and adverse outcomes based on logistic regressions adjusted for confounders.</p><p>Main outcome measures</p><p>Velamentous or marginal cord insertion. Abruption of the placenta, placenta praevia, pre-eclampsia, preterm birth, operative delivery, low Apgar score, transferral to neonatal intensive care unit (NICU), malformations, birthweight, and perinatal death.</p><p>Results</p><p>The prevalence of abnormal cord insertion was 7.8% (1.5% velamentous, 6.3% marginal) in singleton pregnancies and 16.9% (6% velamentous, 10.9% marginal) in twins. The two conditions shared risk factors; twin gestation and pregnancies conceived with the aid of assisted reproductive technology were the most important, while bleeding in pregnancy, advanced maternal age, maternal chronic disease, female foetus and previous pregnancy with anomalous cord insertion were other risk factors. Velamentous and marginal insertion was associated with an increased risk of adverse outcomes such as placenta praevia (OR = 3.7, (95% CI = 3.1–4.6)), and placental abruption (OR = 2.6, (95% CI = 2.1–3.2)). The risk of pre-eclampsia, preterm birth and delivery by acute caesarean was doubled, as was the risk of low Apgar score, transferral to NICU, low birthweight and malformations. For velamentous insertion the risk of perinatal death at term was tripled, OR = 3.3 (95% CI = 2.5–4.3).</p><p>Conclusion</p><p>The prevalence of velamentous and marginal insertions of the umbilical cord was 7.8% in singletons and 16.9% in twin gestations, with marginal insertion being more common than velamentous. The conditions were associated with common risk factors and an increased risk of adverse perinatal outcomes; these risks were greater for velamentous than for marginal insertion.</p></div

ORs for adverse perinatal outcomes according to umbilical cord insertion site, based on 623,478 singleton pregnancies and adjusted for maternal age and parity.

<p>NICU, neonatal intensive care unit; BW/PW, birthweight/placental weight; OR, odds ratio; CI, confidence interval.</p

ORs for velamentous and marginal cord insertions in pregnancies subsequent to pregnancies with a velamentous or marginal insertion (singleton pregnancies only), adjusted for maternal age and between 1999 and 2009.

<p>OR, odds ratio adjusted for maternal age; CI, confidence interval.</p

ORs for adverse outcome (delivery) according to umbilical cord insertion site, based on 623,478 singleton pregnancies and adjusted for maternal age and parity.

<p>OR, odds ratios; CI, confidence interval.</p

Odds ratios (ORs) for velamentous and marginal cord insertions according to maternal and pregnancy characteristics, based on 623,478 singleton pregnancies in Norway recorded between 1999 and 2009 and adjusted for maternal age and parity.

<p>CI, confidence interval; NA, not answered;</p>¥<p>not adjusted for maternal age;</p>*<p>not adjusted for parity.</p

ORs for velamentous and marginal cord insertions according to maternal conditions and folate and multivitamin supplementation, based on 623,478 singleton pregnancies in Norway and adjusted for maternal age and parity.

<p>OR, odds ratio; CI, confidence interval; GDM, gestational diabetes mellitus.</p