Effectiveness of early pregnancy ultrasound in diagnosing fetal abnormalities in high risk women

Objective: To assess the efficacy of 11-14 weeks ultrasound in the diagnosis of fetal abnormalities in high risk women.Methods: Prospective study conducted at a teaching hospital in Karachi, Pakistan. One hundred ultrasound (mini-anomaly) scans were performed on 97 high-risk women, between 11-14 weeks of gestation.Results: The most common indication for the ultrasound scan in the study, was previous history of structural or chromosomal abnormalities (40%) followed by advanced maternal age (22%). Out of 100 ultrasounds performed, two were found to have structural abnormalities at the time of mini-anomaly scan performed at 11-14 weeks. None of the ultrasound scans found to be normal at 11-14 weeks showed an abnormality on the subsequent scans.Conclusion: Ultrasound scan performed between 11-14 weeks of pregnancy is effective in diagnosing major fetal abnormalities in the high-risk population. It can complement the anomaly scan performed in the second trimester, as some of the abnormalities become evident later in pregnancy

Value Chain and Marketing Channels of Shrimp/Prawn Sector of Gher Farming System in Bangladesh

Shrimp/prawn industry plays an important role in value chain in Bangladesh. Shrimp/prawn is the second largest exporting industry followed by garment industry in Bangladesh. The present study aims to explore the detail summary of the value chain, and marketing channels and systems in shrimp/prawn industry of Bangladesh. A numbers of case study and farm level data were used in this study. Various agents are involved in the shrimp/prawn industry from production to final consumption stage as well as the exporting of international markets. The information of the every stage of marking channels from production level to international was collected through comprehensive questionnaires. The findings of the study shows that a large numbers value chain activity involves in shrimp/prawn industry from production stage of shrimp/prawn to final exporting stage to aboard. All segments of mud snail trading channel, fry trading channel, shrimp/prawn exporting channel as well as agro-based industry that established using shell of mud snails and legs of shrimp/prawn add a significant value chain. Male and female labors, as well as children are engaged in various activities in the trading channels in shrimp/prawn industry. Even though the farmers bear the all production risks, they did not get the profit like other agents of the marketing channels of shrimp/prawn industry. All agents of marketing channels gain more financial benefits than the producers of shrimp/prawn of Bangladesh.

Knowledge and awareness of pregnant women about ultrasounsd scanning and prenatal diagnosis

Objective: Antenatal screening and ultrasound scan has become an integral part of the antenatal care in the present time. The aim of this study is to accurately describe the background knowledge and awareness of pregnant women about ultrasound scan and prenatal diagnosis.Methods: It is a clinic based cross sectional study. Four hundred women, attending the antenatal clinics, were asked to fill in a pre tested structured questionnaire. Different variables of interest were collected. Statistical Program for the social sciences (SPSS) was used for the data management.Results: Over 93.5% of the women were aware that ultrasound examination is an important investigation. They believed that it should be performed at least twice during pregnancy but were not sure about the timing of the test. Most of them felt that it was to check the growth of the baby and 97% of women considered ultrasound to be safe. However, only 26% of women had any knowledge about Down\u27s syndrome or its screening.Conclusion: Pregnant women in our set-up are aware of importance of ultrasound examination during pregnancy. However, there is a need to improve public awareness of problems like Down\u27s syndrome

The effect of grandmultiparity on pregnancy related complications: The Aga Khan University experience

Background: Grandmultiparity has been associated with complications for both mother and the fetus.Objective: To evaluate if grandmultiparity is a risk factor in the presence of adequate antenatal care.Setting: A tertiary care teaching hospital.Methods: It was a retrospective study conducted in the department of Obstetrics & Gynecology at The Aga Khan University Hospital in Karachi. During this period 9253 women were delivered, out of these 143 booked grandmultiparas (GMP) served as cases. The outcome of these women was compared with 430 non-grandmultiparas (NGMP). Logistic regression model was used to adjust for potential confounders.Results: Grandmultiparas had almost three times increased risk of having postpartum hemorrhage compared to NGMP group. Similarly, there were significantly low five-minute apgars in the GMPs compared to the NGMP group. Although the neonatal intensive care admissions were three times more in the GMPs but this did not reach statistical significance due to small number of cases in both groups.Conclusion: Our study indicates that grandmultiparity is a risk factor for pregnancy in this part of the world, even in the presence of reasonable antenatal care. This may be explained on the basis of the increased age of these women. Finally, we also recommend that an age-matched study needs to be undertaken in order to determine if age is an important determinant for risk factors in grandmultiparas

Pengembangan Metode Induksi Tukak Lambung

Scientific evaluation on pharmacological activity of medicinal herbs required repro-ducible and valid method-induced ulcer models in animal. In this study, the methodof antiulcerogenic effect was investigated using several inducers. The male white Sprague-Dawley rats divided into five groups which were orally administrated water,indomethacin (48 mg/kg bw), aspirin-HCl (150 mg/kg bw), 96% ethanol (1 ml/200 g bw), and 80% ethanol (1 ml/200 g bw), respectively. The result of this study showed that the group was induced with 80% ethanol demonstrated the highest ulcerindex. Histological examination of the stomach showed abnormality of mucosa cells on the aspirin-HCl, 96% ethanol, and 80% ethanol-induced gastric ulcer model in rats

International gestational age-specific centiles for umbilical artery Doppler indices: a longitudinal prospective cohort study of the INTERGROWTH-21st Project.

BACKGROUND: Reference values for umbilical artery Doppler indices are used clinically to assess fetal well-being. However, many studies that have produced reference charts have important methodologic limitations, and these result in significant heterogeneity of reported reference ranges. OBJECTIVES: To produce international gestational age-specific centiles for umbilical artery Doppler indices based on longitudinal data and the same rigorous methodology used in the original Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project. STUDY DESIGN: In Phase II of the INTERGROWTH-21st Project (the INTERBIO-21st Study), we prospectively continued enrolling pregnant women according to the same protocol from 3 of the original populations in Pelotas (Brazil), Nairobi (Kenya), and Oxford (United Kingdom) that had participated in the Fetal Growth Longitudinal Study. Women with a singleton pregnancy were recruited at <14 weeks' gestation, confirmed by ultrasound measurement of crown-rump length, and then underwent standardized ultrasound every 5±1 weeks until delivery. From 22 weeks of gestation umbilical artery indices (pulsatility index, resistance index, and systolic/diastolic ratio) were measured in a blinded fashion, using identical equipment and a rigorously standardized protocol. Newborn size at birth was assessed using the international INTERGROWTH-21st Standards, and infants had detailed assessment of growth, nutrition, morbidity, and motor development at 1 and 2 years of age. The appropriateness of pooling data from the 3 study sites was assessed using variance component analysis and standardized site differences. Umbilical artery indices were modeled as functions of the gestational age using an exponential, normal distribution with second-degree fractional polynomial smoothing; goodness of fit for the overall models was assessed. RESULTS: Of the women enrolled at the 3 sites, 1629 were eligible for this study; 431 (27%) met the entry criteria for the construction of normative centiles, similar to the proportion seen in the original fetal growth longitudinal study. They contributed a total of 1243 Doppler measures to the analysis; 74% had 3 measures or more. The healthy low-risk status of the population was confirmed by the low rates of preterm birth (4.9%) and preeclampsia (0.7%). There were no neonatal deaths and satisfactory growth, health, and motor development of the infants at 1 and 2 years of age were documented. Only a very small proportion (2.8%-6.5%) of the variance of Doppler indices was due to between-site differences; in addition, standardized site difference estimates were marginally outside this threshold in only 1 of 27 comparisons, and this supported the decision to pool data from the 3 study sites. All 3 Doppler indices decreased with advancing gestational age. The 3rd, 5th 10th, 50th, 90th, 95th, and 97th centiles according to gestational age for each of the 3 indices are provided, as well as equations to allow calculation of any value as a centile and z scores. The mean pulsatility index according to gestational age = 1.02944 + 77.7456*(gestational age)-2 - 0.000004455*gestational age3. CONCLUSION: We present here international gestational age-specific normative centiles for umbilical artery Doppler indices produced by studying healthy, low-risk pregnant women living in environments with minimal constraints on fetal growth. The centiles complement the existing INTERGROWTH-21st Standards for assessment of fetal well-being

Biaya Tambahan Yang Dibayar Pasien Rawat Jalan Akibat Penulisan Resep Tidak Sesuai Dengan Formularium Rumah Sakit

Almost all district public hospital already has their own formulary. The aims of study are to obtain percentage of noncompliance with the public hospital formulary, to obtain the average additional cost be paid by outpatients as a result of noncompliance with the hospital formulary, and to obtain the average of the outpatient's ability to pay for treatment. A cross sectional study has been carried out to 120 patients in RSU Kabupaten K and 100 patients in RSU Kabupaten B. Subjects of the study were adult outpatients with TB, hypertension and diabetes. Data were collected by well-trained district public hospital staff in interviewing patients. The questioner was first tried out to patients at RSU Kota Jakarta Timur. Data were analyzed by cost analysis. Results of the study are difference in drug item with formulary in RSU Kabupaten K is 66,7% for TB, 96,6% for hypertension; where as in RSU Kabupaten B 44,8% for TB, 82,3% for hypertension and 76,7% for diabetes. Average additional cost that must be paid by outpatients per encounter in RSU Kabupaten K is Rp 10.060 for TB, Rp 26.552 for hypertension; while in RSU Kabupaten B is Rp 5.818 for TB, Rp 8.956 for hypertension and Rp 15.218 for diabetes. The average outpatient's ability to pay for treatment in RSU Kabupaten K is Rp 19.807 and in RSU Kabupaten B is Rp 15.301, which are both less than outpatient treatment cost per encounter

Pre-pregnancy body mass index and gestational weight gain and their effects on pregnancy and birth outcomes: a cohort study in West Sumatra, Indonesia

Background: Indonesia has a considerably high incidence of maternal and infant mortality. The country has however been experiencing a social and economic transition, influencing its general population demographics and nutritional status including the state of health and nutrition of pregnant women. This study aimed to explore body mass index (BMI) and gestational weight gain (GWG), and their relationship with pregnancy outcomes in a sample of Indonesian pregnant women. Methods: This observational cohort study included a total of 607 pregnant women who were recruited in 2010 from maternity clinics in Western Sumatra, Indonesia. Multiple logistic and regression analyses were undertaken to compare pregnancy and birth outcomes for different BMI and GWG, using normal weight women and women with a recommended weight gain as the referent groups. Results: The prevalence of underweight (BMI < 18.5 kg/m2) in pregnancy was high at 20.1%; while 21.7% of women were overweight (BMI: 23.0–27.4 kg/m2) and 5.3% obese (BMI ≥ 27.5 kg/m2) using the Asian BMI classifications. The incidence of overweight (BMI: 25.0–29.9 kg/m2) and obese (BMI ≥ 30.0 kg/m2) according to the international BMI classifications were 13.5% and 1.1% respectively. The majority of women gained inadequate weight in pregnancy compared to the Institute of Medicine (IOM)recommendations, especially those who had a normal BMI. Birthweight adjusted mean difference aMD (95% confidence interval) 205 (46,365) and the odds of macrosomia adjusted odds ratio aOR 13.46 (2.32–77.99) significantly increased in obese women compared to those with a normal BMI. Birthweight aMD -139 (−215, −64) significantly decreased in women with inadequate GWG compared to those with recommended GWG, while SGA aOR 5.44 (1.36, 21.77) and prematurity aOR 3.55 (1.23, 10.21) increased. Conclusions: Low nutritional status and inadequate GWG remain a cause for concern in these women. The higher odds of macrosomia with increasing maternal BMI and higher odds of prematurity and small for gestational age infants with inadequate weight gain also require attention. Research and practice recommendations: Urgent attention is required by researchers, policy makers and decision makers to facilitate development of culturally sensitive interventions to enhance nutritional status and health of mothers and babies, in an area known for its high incidence of maternal and neonatal mortality. Keywords: Maternal BMI, Gestational weight gain, Pregnancy outcomes, Birthweight, Indonesia, Cohort stud

Machine learning for accurate estimation of fetal gestational age based on ultrasound images.

Accurate estimation of gestational age is an essential component of good obstetric care and informs clinical decision-making throughout pregnancy. As the date of the last menstrual period is often unknown or uncertain, ultrasound measurement of fetal size is currently the best method for estimating gestational age. The calculation assumes an average fetal size at each gestational age. The method is accurate in the first trimester, but less so in the second and third trimesters as growth deviates from the average and variation in fetal size increases. Consequently, fetal ultrasound late in pregnancy has a wide margin of error of at least ±2 weeks' gestation. Here, we utilise state-of-the-art machine learning methods to estimate gestational age using only image analysis of standard ultrasound planes, without any measurement information. The machine learning model is based on ultrasound images from two independent datasets: one for training and internal validation, and another for external validation. During validation, the model was blinded to the ground truth of gestational age (based on a reliable last menstrual period date and confirmatory first-trimester fetal crown rump length). We show that this approach compensates for increases in size variation and is even accurate in cases of intrauterine growth restriction. Our best machine-learning based model estimates gestational age with a mean absolute error of 3.0 (95% CI, 2.9-3.2) and 4.3 (95% CI, 4.1-4.5) days in the second and third trimesters, respectively, which outperforms current ultrasound-based clinical biometry at these gestational ages. Our method for dating the pregnancy in the second and third trimesters is, therefore, more accurate than published methods