OP14.04: Vasa previa: is there a role for cervical length measurement? Review of cases of antenatal management

No Abstract.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78220/1/8052_ftp.pd

Packaging as a marketing tool: Adolescents’ perceptions of branded and plain tobacco packaging

Plain packaging first appeared on the UK policy agenda in the Department of Health’s 2008 ‘Consultation on the Future of Tobacco Control’. Since then, plain (or standardised) packaging has been framed through the potential benefit to young people. Within the period of this thesis, plain packaging has been actively debated and draft plain packaging regulations were published in June 2014. An extended literature review of academic and practitioner marketing literature, internal tobacco company documents and public health packaging research, establishes that the research informing the policy debate, while consistent in its approach and findings, fails to recognise the strategic nature of pack design, the full extent of the influence that branded design can have on consumer responses, and the importance of product design as a marketing tool. This thesis attempts to address these gaps in the plain packaging evidence base. It explores if, and how, adolescents engage with different styles of packaging and product design, whether or not an association between tobacco packaging and adolescent smoking exists, and whether it is possible to observe cognitive, affective and behavioural responses to packaging. The study uses a sequential exploratory mixed methodology design with two stages of research. First, focus groups were conducted with 15 year olds (n=48) to explore adolescent responses to tobacco packaging and product design. The findings show that adolescents are most appreciative of ‘novelty’ pack designs. These ‘novelty’ packs, for instance with innovative structures or distinctive designs and colours, generated positive user imagery and influenced affective feelings among participants. Cigarettes with slim diameters, white tips and decorative designs increased appeal and communicated a weaker tasting and less harmful product. Conversely, a plain pack eliminated positive perceptions and feelings, and exposed tobacco as harmful, dirty and not for young people. The qualitative findings were used to develop measures and hypotheses which were tested in a quantitative survey.The second stage of research utilised a cross-sectional in-home survey (n=1373) with 11 to 16 year olds. Respondents were asked to rate three different pack styles - ‘novelty’, ‘regular’ and ‘plain’ - on 11 pack ratings items and four pack feelings items. The findings show adolescents hold ‘novelty’ packaging in higher regard than ‘regular’ packaging across pack ratings items. There were fewer differences between ‘novelty’ and ‘regular’ packaging for the pack feelings items. Plain packaging was consistently rated most negatively across all survey items. Logistic regressions, controlling for factors known to influence youth smoking, showed that susceptibility to smoke was associated with positive appraisal and also receptivity for ‘novelty’ packaging. There was no association with pack appraisal or receptivity for the plain pack. While susceptibility is not a direct behavioural response it is a reasonable predictor of future tobacco use. Collectively the findings show that ‘novelty’ packaging and product design holds greatest appeal for adolescents. Plain packaging limits the opportunity for tobacco companies to communicate with, mislead and influence consumers. Based upon the role of packaging for consumer goods in general, and tobacco in particular, plain packaging would effectively reduce the promotional role of packaging

Gestational Age at Delivery and Doppler Waveforms in Very Preterm Intrauterine Growth‐Restricted Fetuses as Predictors of Perinatal Mortality

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135288/1/jum2007265555.pd

Familial 4;18 chromosome translocation resulting in trisomy 4p and monosomy 18p: affected individuals with discordant phenotype

No Abstract.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/62156/1/2225_ftp.pd

Fetal Heart Rate Decelerations in Women with Sleep-Disordered Breathing

Emerging literature has shown that women with sleep-disordered breathing (SDB) have increased risk for gestational hypertension/preeclampsia and gestational diabetes. Case reports suggest an association between maternal apnea and fetal heart rate deceleration but data are lacking on how maternal sleep impacts fetal health. Since decelerations may be associated with adverse outcomes, we sought to determine whether fetal heart rate decelerations were associated with SDB. A cohort study of third trimester pregnant women with a singleton fetus was conducted. Participants underwent a home sleep test with continuous portable electronic fetal monitoring. SDB was defined as a respiratory disturbance index (RDI)≥10 events/hour. The temporality between a respiratory event and fetal heart rate decelerations was determined to be present if a deceleration occurred \u3c 30 s after a respiratory event. Forty women were included with mean (±SD) age, BMI, and gestational age of 32.0±5.5 years, 37.1±8.0 kg/m(2), and 34.6±2.4 weeks respectively. Overall, n=23 (57.5%) women had SDB. Thirty-seven late decelerations were observed in 18 women; of these, 84% were temporally associated with a respiratory event. Nine of the 18 women (50%) had SDB. Ten prolonged decelerations were observed in 6 women of which nine (90%) were temporally associated with a respiratory event. Five of the six women (83%) had an RDI≥10. These initial data suggest that, in this population, the majority of both late and prolonged fetal heart rate decelerations occur with a maternal respiratory event. Since respiratory events are characteristic of maternal SDB, this raises the possibility that SDB may influence fetal well-being

Role of ultrasonography in the management of twin gestation

Twins represent 1%–2% of all pregnancies, yet continue to account for a disproportionate share of neonatal adverse events including neonatal intensive care admission, morbidity, and mortality. Ultrasonography is central to the proper diagnosis of the type of twinning. Ideally, ultrasonography is performed before 14 weeks of gestation to determine chorionicity and amnionicity. Correct identification of the chorionicity in a twin pregnancy facilitates proper counseling and management of the gestation, including ultrasonography follow‐up. Herein, the different types of twinning are reviewed, together with the implications for ultrasonography monitoring of each specific type of twin gestation.A review of the complete diagnosis of the types of twinning and subsequent ultrasonography management of the twin gestation.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/143777/1/ijgo12483.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/143777/2/ijgo12483_am.pd

Surveillance of fetal lung lesions using the congenital pulmonary airway malformation volume ratio: natural history and outcomes

ObjectivesThe congenital pulmonary airway malformation volume ratio (CVR) is a widely used sonographic measure of relative mass size in fetuses with lung malformations. The purposes of this study were to examine serial CVR measurements to understand longitudinal growth patterns and to determine correlation with postnatal imaging.MethodsAn institutional review boardâ approved retrospective review was performed on fetuses referred for an echogenic lung malformation between 2002 and 2014. For each fetus, the CVR was prospectively calculated using 2D ultrasound and followed with advancing gestation.ResultsBased on 40 fetuses, the mean initial CVR was 0.51â ±â 0.07 at 20.5â ±â 0.3â weeks of gestation. The CVR increased after 24â weeks of gestation (pâ =â 0.0014), peaking at a CVR of 0.96â ±â 0.11 at 25.5â ±â 0.05â weeks, followed by a significant decrease in the CVR to 0.43â ±â 0.07 prior to term (pâ <â 0.0001). However, approximately one third showed no appreciable increase in size. The mean CVR was significantly correlated with postnatal chest computed tomography (CT) size dimensions (pâ =â 0.0032) and likelihood for lung resection (pâ =â 0.0055).ConclusionsFetal lung malformations tend to follow one of two distinct growth patterns, characterized by either (1) a maximal CVR between 25 and 26â weeks of gestation or (2) minimal change in relative growth. The mean CVR correlates with postnatal CT size and operative management. © 2015 John Wiley & Sons, Ltd.What’s already known about the topic?The congenital pulmonary airway malformation volume ratio (CVR) is a common prenatal ultrasound measure of relative mass size in fetuses with lung malformations.The initial CVR and maximum CVR have been shown to be predictive of hydrops and neonatal respiratory compromise, respectively.What does this study add?Gestational age is important when interpreting CVR measurements because two thirds of lesions increase in size at 25â 26â weeks before spontaneous involution occurs.The mean CVR correlates with size measured by postnatal computed tomography scan.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136421/1/pd4761_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136421/2/pd4761.pd

Three‐Dimensional Sonographic Measurement of Blood Volume Flow in the Umbilical Cord

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135361/1/jum201231121927.pd