Predictive accuracy of cerebroplacental ratio for adverse perinatal and neurodevelopmental outcomes in suspected fetal growth restriction: systematic review and meta-analysis.

OBJECTIVE: The cerebroplacental ratio (CPR) has been proposed for the routine surveillance of pregnancies with suspected fetal growth restriction (FGR), but the predictive performance of this test is unclear. The aim of this study was to determine the accuracy of CPR for predicting adverse perinatal and neurodevelopmental outcomes in suspected FGR. METHODS: PubMed, EMBASE, CINAHL and Lilacs were searched from inception to 31 July 2017 for cohort or cross-sectional studies reporting on the accuracy of CPR for predicting adverse perinatal and/or neurodevelopmental outcomes in singleton pregnancies with FGR suspected antenatally based on sonographic parameters. Summary receiver-operating characteristics (ROC) curves, pooled sensitivities and specificities, and summary likelihood ratios (LRs) were generated. RESULTS: Twenty-two studies (including 4301 women) met the inclusion criteria. Summary ROC curves showed that the best predictive accuracy of CPR was for perinatal death and the worst was for neonatal acidosis, with areas under the summary ROC curves of 0.83 and 0.57, respectively. The predictive accuracy of CPR was moderate to high for perinatal death (pooled sensitivity and specificity of 93% and 76%, respectively, and summary positive and negative LRs of 3.9 and 0.09, respectively) and low for composite of adverse perinatal outcomes, Cesarean section for non-reassuring fetal status, 5-min Apgar score < 7, admission to the neonatal intensive care unit, neonatal acidosis and neonatal morbidity, with summary positive and negative LRs ranging from 1.1 to 2.5 and 0.3 to 0.9, respectively. An abnormal CPR result had moderate accuracy for predicting small-for-gestational age at birth (summary positive LR of 7.4). CPR had a higher predictive accuracy in pregnancies with suspected early-onset FGR. No study provided data for assessing the predictive accuracy of CPR for adverse neurodevelopmental outcome. CONCLUSION: CPR appears to be useful in predicting perinatal death in pregnancies with suspected FGR. Nevertheless, before incorporating CPR into the routine clinical management of suspected FGR, randomized controlled trials should assess whether the use of CPR reduces perinatal death or other adverse perinatal outcomes. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd

Multidisciplinary consensus on screening for, diagnosis and management of fetal growth restriction in the Netherlands

Screening for, diagnosis and management of intrauterine growth restriction (IUGR) is often performed in multidisciplinary collaboration. However, variation in screening methods, diagnosis and management of IUGR may lead to confusion. In the Netherlands two monodisciplinary guidelines on IUGR do not fully align. To facilitate effective collaboration between different professionals in perinatal care, we undertook a Delphi study with uniform recommendations as our primary result, focusing on issues that are not aligned or for which specifications are lacking in the current guidelines. We conducted a Delphi study in three rounds. A purposively sampled selection of 56 panellists participated: 27 representing midwife-led care and 29 obstetrician-led care. Consensus was defined as agreement between the professional groups on the same answer and among at least 70% of the panellists within groups. Per round 51 or 52 (91% - 93%) panellists responded. This has led to consensus on 27 issues, leading to four consensus based recommendations on screening for IUGR in midwife-led care and eight consensus based recommendations on diagnosis and eight on management in obstetrician-led care. The multidisciplinary project group decided on four additional recommendations as no consensus was reached by the panel. No recommendations could be made about induction of labour versus expectant monitoring, nor about the choice for a primary caesarean section. We reached consensus on recommendations for care for IUGR within a multidisciplinary panel. These will be implemented in a study on the effectiveness and cost-effectiveness of routine third trimester ultrasound for monitoring fetal growth. Research is needed to evaluate the effects of implementation of these recommendations on perinatal outcomes. NTR436

The PLANES study: a protocol for a randomised controlled feasibility study of the placental growth factor (PlGF) blood test-informed care versus standard care alone for women with a small for gestational age fetus at or after 32 + 0 weeks' gestation.

BackgroundStillbirth remains a major concern across the globe and in some high-resource countries, such as the UK; efforts to reduce the rate have achieved only modest reductions. One third of stillborn babies are small for gestational age (SGA), and these pregnancies are also at risk of neonatal adverse outcomes and lifelong health problems, especially when delivered preterm. Current UK clinical guidance advocates regular monitoring and early term delivery of the SGA fetus; however, the most appropriate regimen for surveillance of these babies remains unclear and often leads to increased intervention for a large number of these women. This pilot trial will determine the feasibility of a large-scale trial refining the risk of adverse pregnancy outcome in SGA pregnancies using biomarkers of placental function sFlt-1/PlGF, identifying and intervening in only those deemed at highest risk of stillbirth.MethodsPLANES is a randomised controlled feasibility study of women with an SGA fetus that will be conducted at two tertiary care hospitals in the UK. Once identified on ultrasound, women will be randomised into two groups in a 3:1 ratio in favour of sFlt-1/PlGF ratio led management vs standard care. Women with an SGA fetus and a normal sFlt-1/PlGF ratio will have a repeat ultrasound and sFlt-1/PlGF ratio every 2 weeks with planned birth delayed until 40 weeks. In those women with an SGA fetus and an abnormal sFlt-1/PlGF ratio, we will offer birth from 37 weeks or sooner if there are other concerning features on ultrasound. Women assigned to standard care will have an sFlt-1/PlGF ratio taken, but the results will be concealed from the clinical team, and the woman's pregnancy will be managed as per the local NHS hospital policy. This integrated mixed method study will also involve a health economic analysis and a perspective work package exploring trial feasibility through interviews and questionnaires with participants, their partners, and clinicians.DiscussionOur aim is to determine feasibility through the assessment of our ability to recruit and retain participants to the study. Results from this pilot study will inform the design of a future large randomised controlled trial that will be adequately powered for adverse pregnancy outcome. Such a study would provide the evidence needed to guide future management of the SGA fetus.Trial registrationISRCTN58254381 . Registered on 4 July 2019

The Difference in Switching Costs Between Bouts of Identical and Different Tasks in Temnothorax rugatulus

A colony of social insects has many tasks to complete for the good of the colony. The tasks, such as brood care, feeding, foraging and building, could be split among its members (implying specialization). Alternatively, ants could just freely switch between tasks, either doing whatever needs to be done or whatever tasks they come into contact with. If individuals switch from one task to another, they may incur costs, including a time cost. So far, research has yet to quantify such task switching costs. To learn more about switching cost, specifically quantifying the cost in terms of time, videos of Temnothorax rugatulus were observed for specific tasks, such as brood care, feeding, foraging and building. The switching costs were measured in two ways depending on whether the non-switching time or switching time were being measured. For the non-switching time between bouts of the same task, the interval time started when the ant stopped touching the brood item and ended when the ant started touching the brood item. For the switching time between two different tasks, time began when the ant stopped one task and ended when the ant began a second task. The interval time was calculated by recording the time, using the timeline on the video, that the ant stopped one task (or bout of one task) and moved on the next. The data collected from the videos were analyzed using a Welch Two-Sample T-test. Through the study, it was discovered that there was, in fact, no significant delay when Temnothorax rugatulus switch from one task to another

Uncertainty in the application of Bay Shape Equations.

From the several existing empirical equations that describe the planform of a bay, the Parabolic Bay Shape Equation (PBSE) is the only one that explicitly assesses an equilibrium bay shape. Research has been performed on the uncertainties regarding the static equilibrium planform (SEP) plotted by this equation but results have been more of a qualitative nature. This paper is an attempt to quantify the uncertainty in the application of the PBSE using existing bays. By means of an expert elicitation, a database consisting of the position of the control points needed to plot the SEP was generated. The elicitation was held under experts in the field of coastal/hydraulic engineering and consisted of two parts. In the Part 1 of the elicitation, twenty-two expert volunteers where asked to place the three control points needed to draw the SEP on a vertical aerial photograph of Taquaras/Taquarinhas Bay, an stable bay, approximately 1800m wide and 750m indent, in the south of Brazil. The software program MEPBAY, which facilitates the use of the PBSE was used to translate the position of the control points into the SEP's corresponding to the bay. The distribution of the location of the SEP along four evenly spaced (200m) profiles in the southern part of the bay was determined. The overall bias of the location of the SEP calculated over the four profiles is in the order of 40m (landward) and the average bandwidth is 116 m. The bandwidth and standard deviation of the SEP increase when moving alongshore toward the curved section of the bay. This means that the uncertainty in the application of the PBSE is dependent on the particular point of interest along the bay. In Part 2 of the elicitation thirty volunteers participated. This time the consequence of the placement of the control points (the corresponding SEP) was visible. Comparing the results from Part 1 and 2, it was observed that when volunteers are directly confronted with the result of the placement of the control points (a plotted SEP) a much smaller variation in the position of the SEP occurs. This in turn means that the PBSE is a robust method provided the user sees the result of his/her choices in placement of the control points. After quantifying the uncertainty when applying the PBSE to a stable bay an unstable situation was analyzed. For this case the bay of Imbituba in southern Brazil was chosen. The construction of a breakwater to shelter the port of Imbituba in the south of the bay was accompanied by an increase in sedimentation of the port. Superimposed plots of the coastline of the bay of Imbituba from different years confirm a general trend of accretion of the southern part of the bay accompanied with a retreat of the coastline in the northern part. After the application of the PBSE it was clear that the breakwater caused a change in the equilibrium state of the bay. Between 1947 and 2001 the Bay of Imbituba has changed from a dynamic equilibrium to a close to static equilibrium in the northern part of the bay and an unstable equilibrium status in the southern part. The tendency of the sedimentation of the southern part of the bay can be explained by looking at the SEP belonging to the new up coast diffraction point (tip of the breakwater): The seaward position of the SEP predicts a need for sediment in order to achieve a stable planform.Civil Engineering and Geoscience