Comparative study of Doppler USG changes – Cerebro Placental Ratio between IUGR and and AGA Foetus, Its implication on Perinatal Outcome

INTRODUCTION: FETAL GROWTH RESTRICTION- Intrauterine fetal growth which results in the birth of an infant weighing less than its genetic growth potential. SGA is often defined as an estimated fetal weight or abdominal circumference less than 10th centile and severe SGA as EFW or abdominal circumference less than the 3rd centile. Fetal growth restriction is defined as “SGA with abnormal Doppler indices such as umbilical artery pulsatality index above the 95th centile or mean uterine artery PI above 95th centile. (CPR) is the ratio of the fetal middle cerebral artery (MCA) pulsatility index (PI) to umbilical artery (UA) PI. Recent studies indicate that an abnormal CPR appears to identify IUGR fetuses at increased risk for adverse intrapartum and neonatal complications. It is believed to be a proxy for suboptimal fetal growth given it quantifies both suboptimal placental function and subsequent fetal circulatory adaptations. It is believed that the CPR better predicts adverse perinatal outcomes than its individual components and better than conventional anthropometry. AIMS AND OBJECTIVES: 1. To evaluate the distribution of Ratio of Doppler pulsatility index (PI) measurements of the middle cerebral artery to umbilical artery (Cerebroplacental ratio) values in patient IUGR and AGA coming to Tertiary Care Centre, Government Theni Medical College. 2. To evaluate the distribution of this Doppler parameter between these two groups with neonatal outcome. 3. To emphasize on the importance of altered cerebroplacental ratio in predicting the adverse perinatal outcome in patients with abnormal cerebroplacental ratio and timely intervention in these fetus to prevent adverse perinatal outcome. Study Design: Comparative Case Control Study. STUDY PERIOD: October 2016 - Sepember 2018. Place of Study Government Theni Medical College Hospital, Theni. Study Population: All Booked Cases of 32-40wks. Case Group (100) Patients with Growth Restriction & Associated risk factors like GES. HT, Chronicht, Non Severe Pre Ecclampsia, GDM H/O IUGR, Heart Disease, Severe Anaemia. Control Group: (100) Patients with AGA Fetus willing to Participate in Study. Sample Size: 200. METHODOLOGY: Using a 3.5-MHz duplex Doppler system, growth-retarded fetuses will be studied between 30 to 41 weeks gestation. Velocity recordings were obtained from the middle cerebral artery and umbilical artery to calculate the ratio between the two pulsatality indexes. The cerebral-umbilical Doppler ratio is usually constant during the last 10 weeks of gestation. Therefore, a single cut off value (1.0) was used, above which velocimetry was considered normal and below which it was considered abnormal. RESULTS: Abnormal CPR at term was associated with increased need for operative delivery 77% for presumed fetal compromise and admission to the NICU. The CPR has been shown to be a good predictor of the fetal oxygenation status at birth and can be used to identify pregnancies that are at risk for adverse outcomes. 68% has low APGAR scores even @5min Study suggest that the CPR is superior to the MCA pulsatility index alone in predicting adverse perinatal outcomes because it reflects acute changes more accurately. Accurate measurement of the CPR is important. CPR is more effective in predicting adverse perinatal outcomes compared 72% babies need NICU admission as against only 8% in patients with normal CPR need NICU admission with the individual doppler parameters of MCA and UA. CPR being an independent predictor any operative delivery for intrapartum fetal compromise, irrespective of fetal size. Conversely, a normal CPR was more likely to be associated with spontaneous vaginal delivery 76%. This study indicate that an abnormal CPR appears to identify IUGR fetuses at increased risk for adverse intrapartum and neonatal complications. Because the majority of these AGA foetuses have a normal Doppler resistance (PI, RI, or S/D ratio) of the UA, the physician may falsely conclude that there is no increased risk for adverse outcome, even though an abnormal CPR may be present but not measured. Therefore, it is imperative that Doppler assessment of the MCA must be done. To identify those at risk for perinatal complications. There a role for late third-trimester evaluation of all fetuses, given the ability to detect AGA fetuses outcome when they have an abnormal CPR. Because these fetuses may not be identified using traditional clinical tools such as fundal height measurements, evaluation of the amniotic fluid, or antepartum testing. CONCLUSION: The data from the would suggest that third-trimester routine ultrasound might be of value for identifying those fetuses at risk for adverse outcome during labor and subsequent neonatal complications. Whose weights are greater than the 10th centile but are at risk for adverse outcome because of an abnormal CPR. CPR identified more fetuses with adverse outcome than did the biophysical profile. Because the cost of ultrasound equipment is decreasing, portable ultrasound machines can be purchased these machines allow the clinician to use color Doppler to identify the UA and MCA and acquire pulsed Doppler waveforms in which the UA and MCA PI and are automatically measured and the CPR computed. Although further studies may be considered before this becomes accepted protocol, clinicians might consider this as an option to refine the predictability of adverse outcome high-risk fetuses undergoing antepartum testing. In conclusion, the CPR should be considered as an assessment tool in fetuses undergoing third-trimester ultrasound examination, irrespective of the findings of the individual umbilical artery and middle cerebral artery measurements in all fetuses

On The System Of Double Equations

Thisnbsp papernbsp concernsnbsp with thenbsp problem of obtain infinitely many non-zero distinct integers N1, N2nbspsuch that N1-N2 = 4k + 2(kgt0)and nbspN1N2 = (2k+1)a2 where 2k+1 is square-free. A fewnbsp examplesnbsp arenbsp given.nbsp Some observations among N1, N2nbspare presented

Integral solutions of the heptic equation with five unknowns

The non-homogeneous Diophantine equation of degree seven with five variables represented by is analyzed for its non-zero distinct integer solutions. A few interesting relation between the solutions and special numbers namely Polygonal numbers, Pyramidal numbers, centered Polygonal numbers are exhibited

Cystic Lymphangioma of Adrenal Gland

An 18 year old female presented with vaginal bleeding at 2 months of gestation. Ultrasonography revealed a large retroperitoneal cyst. Histopathological examination of the excised cyst showed features suggestive of a cystic adrenal lymphangioma. This case is reported because of its rarity and detection during pregnancy.Key Words: Retroperitoneal cyst, adrenal cystic lymphangioma

Clinicopathological profile of colorectal polyps: retrospective analysis from tertiary care center in Southern India

Background: Colorectal Cancer is the fourth most commonly diagnosed and chronological changes in colorectal polyps and cancer is important in efficacy of screening strategies. In this study, we aimed to compare clinicopathological features of colorectal polyps and also aimed to characterise the distribution and the pathological features of polyps during an 18-year period divided in to two groups.Methods: This is retrospective analysis of cases that underwent colonoscopy and found to have colorectal polyps were re-viewed retrospectively for 18 year period are retrieved. 18 year period was divided in to 2001 to 2010 and 2011 to 2018.Results: Among 4230 patients underwent colonoscopy between January 2001 and September 2018, 1356 were excluded; of the remaining 2874, 986 were found to have 1,272 polyps. 306 patients had 412 polyps in 2001 to 2010 group and 680 patients had 860 polyps in 2011 to 2018 group. Adenomas on the left sided colon were significantly higher in the first time period (40.2% vs 30%, p <0.0003). Polyps on the right sided colon were significantly higher in the second time period (37.3% vs 36.9%, p <0.0005). The most common histology in the both periods is tubular adenoma. Histology of adenomas with high grade dysplasia were significantly more in first period (12.4% vs 7.6%, p <0.005).Conclusions: Our data shows shift in polyps from left side to right side colon in recent years. There was no significant change in shift in advanced adenomas from left side to right side of colon

Observation on the Binary Quadratic Equation 3x² -8xy+3y² +2x+2y+6=0

The binary quadratic equation 22 3 8 3 2 2 6 0 x xy y x y is studied for its non-trivial integral solutions. The recurrence relations satisfied by the solutions x and y are given. A few interesting properties among the solutions are presented

DIOPHANTINE QUADRUPLE INVOLVING JACOBSTHAL LUCAS NUMBER AND THABIT-IBN-KURRAH NUMBER WITH PROPERTY D(1)

We search for three distinct integers a,b,c such that product of any two from the set added with 1 is a perfect square. Also, we show that the triple can be extended to the quadruple with property D(1)

ONE INTERESTING FAMILY OF 3-TUPLE

This paper concerns with the study of constructing a special family of 3-tuples (a,b,c) such that the product of any two elements of the set added with their sum is a Perfect square

Towards a novel framework of barriers and drivers for digital transformation in industrial supply chains

© 2019 PICMET. Businesses across all sectors are facing the complexity of an increasingly digital economy. Digital transformation offers vast opportunities to businesses and entire supply chains. While many investments are targeted at the organization level, the supply chain perspective can lead to even greater impacts on business performance. However, as supply chains involve interconnections between multiple actors, comprehensive digitalization initiatives at this level are very complex. Several strategic factors affect decision-making around digital investments. For this reason, a framework that categorizes all these factors is needed in order to help managers build digitalization strategies for their supply chains. In this paper, based on a review of existing literature, we give indications for a framework encompassing barriers to and drivers for digital transformation in the context of industrial supply chains. Our framework preliminarily allocates these factors by using two dimensions. The first one classifies them using several categories: financial, knowledge and skills, regulatory, technological, market, organizational, and cultural. The second dimension classifies determinants at the level on which actions can be made, i.e. market, supply chain, or organization. The framework can support organizations to exploit the opportunities provided by digitalization of supply chains and will help managers understand the complexity involved