35 research outputs found
New first trimester crown-rump length's equations optimized by structured data collection from a French general population
--- Objectives --- Prior to foetal karyotyping, the likelihood of Down's
syndrome is often determined combining maternal age, serum free beta-HCG,
PAPP-A levels and embryonic measurements of crown-rump length and nuchal
translucency for gestational ages between 11 and 13 weeks. It appeared
important to get a precise knowledge of these scan parameters' normal values
during the first trimester. This paper focused on crown-rump length. ---
METHODS --- 402 pregnancies from in-vitro fertilization allowing a precise
estimation of foetal ages (FA) were used to determine the best model that
describes crown-rump length (CRL) as a function of FA. Scan measures by a
single operator from 3846 spontaneous pregnancies representative of the general
population from Northern France were used to build a mathematical model linking
FA and CRL in a context as close as possible to normal scan screening used in
Down's syndrome likelihood determination. We modeled both CRL as a function of
FA and FA as a function of CRL. For this, we used a clear methodology and
performed regressions with heteroskedastic corrections and robust regressions.
The results were compared by cross-validation to retain the equations with the
best predictive power. We also studied the errors between observed and
predicted values. --- Results --- Data from 513 spontaneous pregnancies allowed
to model CRL as a function of age of foetal age. The best model was a
polynomial of degree 2. Datation with our equation that models spontaneous
pregnancies from a general population was in quite agreement with objective
datations obtained from 402 IVF pregnancies and thus support the validity of
our model. The most precise measure of CRL was when the SD was minimal
(1.83mm), for a CRL of 23.6 mm where our model predicted a 49.4 days of foetal
age. Our study allowed to model the SD from 30 to 90 days of foetal age and
offers the opportunity of using Zscores in the future to detect growth
abnormalities. --- Conclusion --- With powerful statistical tools we report a
good modeling of the first trimester embryonic growth in the general population
allowing a better knowledge of the date of fertilization useful in the
ultrasound screening of Down's syndrome. The optimal period to measure CRL and
predict foetal age was 49.4 days (9 weeks of gestational age). Our results open
the way to the detection of foetal growth abnormalities using CRL Zscores
throughout the first trimester
Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.
BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700