A retrospective segmentation analysis of placental volume by magnetic resonance imaging from first trimester to term gestation

Background Abnormalities of the placenta affect 5–7% of pregnancies. Because disturbances in fetal growth are often preceded by dysfunction of the placenta or attenuation of its normal expansion, placental health warrants careful surveillance. There are limited normative data available for placental volume by MRI. Objective To determine normative ranges of placental volume by MRI throughout gestation. Materials and methods In this cross-sectional retrospective analysis, we reviewed MRI examinations of pregnant females obtained between 2002 and 2017 at a single institution. We performed semi-automated segmentation of the placenta in images obtained in patients with no radiologic evidence of maternal or fetal pathology, using the Philips Intellispace Tumor Tracking Tool. Results Placental segmentation was performed in 112 women and had a high degree of interrater reliability (single-measure intraclass correlation coefficient =0.978 with 95% confidence interval [CI] 0.956, 0.989; P<0.001). Normative data on placental volume by MRI increased nonlinearly from 6 weeks to 39 weeks of gestation, with wider variability of placental volume at higher gestational age (GA). We fit placental volumetric data to a polynomial curve of third order described as placental volume = –0.02*GA3 + 1.6*GA2 – 13.3*GA + 8.3. Placental volume showed positive correlation with estimated fetal weight (P=0.03) and birth weight (P=0.05). Conclusion This study provides normative placental volume by MRI from early first trimester to term gestation. Deviations in placental volume from normal might prove to be an imaging biomarker of adverse fetal health and neonatal outcome, and further studies are needed to more fully understand this metric. Assessment of placental volume should be considered in all routine fetal MRI examinations

Growing up on HAART: The experiences and needs of HIV positive adolescents in care and treatment in the Western Cape Province of South Africa

HIV positive adolescents are becoming a progressively more sizeable and prominent sub-group in the South African HIV/AIDS epidemic. As HAART becomes increasingly available, vertically infected children can be expected to survive into adolescence and adulthood. Additionally, sexual transmission of HIV remains a problem, and incidence and prevalence rates among South African youth are high. Experience from the developed world indicates that providing effective care and treatment for youth can be a challenging task. In light of the antiretroviral rollout in South Africa, this exploratory study aimed to identify the experiences and needs of adolescents growing up in care or on treatment for HIV in the Western Cape

Growing up on HAART : the experiences and needs of HIV positive adolescents in care and treatment in the Western Cape province of South Africa

Includes bibliographical references (leaves 84-102).HIV positive adolescents are becoming a progressively more sizeable and prominent sub-group in the South African HIV/AIDS epidemic. As HAART becomes increasingly available, vertically infected children can be expected to survive into adolescence and adulthood. Additionally, sexual transmission of HIV remains a problem, and incidence and prevalence rates among South African youth are high. Experience from the developed world indicates that providing effective care and treatment for youth can be a challenging task. In light of the antiretroviral rollout in South Africa, this exploratory study aimed to identify the experiences and needs of adolescents growing up in care or on treatment for HIV in the Western Cape. To this end, a review of the existing literature on the psychosocial aspects of HIV infection in adolescents was undertaken. Relevant articles were identified, summarized and entered into a database, and particular attention was given to research conducted in the context of sub-Saharan Africa. Additionally, focus groups interviews were conducted with 26 young people attending an adolescent infectious diseases clinic at a tertiary hospital in the Western Cape. Focus groups proceeded according to a pre-set discussion guide and investigated participants' current life experinces, views on the future and self-perceived needs. All interviews were recorded, translated into English, and transcribed, and data were coded and analyzed using NVivo qualitative data analysis software. The study revealed that the psychosocial issues associated with HIV infection in adolescents coalesce around five central themes: knowledge and understanding about personal serostatus, mental health, network of support, treatment management, and healthy behaviour. These issues present challenges to HIV positive adolescents in the present, and affect their outlook on the future. Findings reveal that despite the fact that young seropositive South Africans live in a country where social contexts, available resources and healthcare systems differ markedly from those in developed countries, they share similar concerns and face many of the same challenges as other HIV positive young people around the world. Future studies should investigate each of the five identified themes in greater depth by determining the contextual correlates of individual views, experiences and needs