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BACKGROUND: Early access to antenatal care and high-cost technologies for pregnancy dating challenge early neonatal risk assessment at birth in resource-constrained settings. To overcome the absence or inaccuracy of postnatal gestational age (GA), we developed a new medical device to assess GA based on the photobiological properties of newborns' skin and predictive models. OBJECTIVE: This study aims to validate a device that uses the photobiological model of skin maturity adjusted to the clinical data to detect GA and establish its accuracy in discriminating preterm newborns. METHODS: A multicenter, single-blinded, and single-arm intention-to-diagnosis clinical trial evaluated the accuracy of a novel device for the detection of GA and preterm newborns. The first-trimester ultrasound, a second comparator ultrasound, and data regarding the last menstrual period (LMP) from antenatal reports were used as references for GA at birth. The new test for validation was performed using a portable multiband reflectance photometer device that assessed the skin maturity of newborns and used machine learning models to predict GA, adjusted for birth weight and antenatal corticosteroid therapy exposure. RESULTS: The study group comprised 702 pregnant women who gave birth to 781 newborns, of which 366 (46.9%) were preterm newborns. As the primary outcome, the GA as predicted by the new test was in line with the reference GA that was calculated by using the intraclass correlation coefficient (0.969, 95% CI 0.964-0.973). The paired difference between predicted and reference GAs was -1.34 days, with Bland-Altman limits of -21.2 to 18.4 days. As a secondary outcome, the new test achieved 66.6% (95% CI 62.9%-70.1%) agreement with the reference GA within an error of 1 week. This agreement was similar to that of comparator-LMP-GAs (64.1%, 95% CI 60.7%-67.5%). The discrimination between preterm and term newborns via the device had a similar area under the receiver operating characteristic curve (0.970, 95% CI 0.959-0.981) compared with that for comparator-LMP-GAs (0.957, 95% CI 0.941-0.974). In newborns with absent or unreliable LMPs (n=451), the intent-to-discriminate analysis showed correct preterm versus term classifications with the new test, which achieved an accuracy of 89.6% (95% CI 86.4%-92.2%), while the accuracy for comparator-LMP-GA was 69.6% (95% CI 65.3%-73.7%). CONCLUSIONS: The assessment of newborn's skin maturity (adjusted by learning models) promises accurate pregnancy dating at birth, even without the antenatal ultrasound reference. Thus, the novel device could add value to the set of clinical parameters that direct the delivery of neonatal care in birth scenarios where GA is unknown or unreliable. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2018-027442.
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Anomalías Múltiples , Recien Nacido Prematuro , Femenino , Edad Gestacional , Humanos , Recién Nacido , Aprendizaje Automático , Parto , EmbarazoRESUMEN
INTRODUCTION AND HYPOTHESIS: The aim of this study was to assess the occurrence of severe perineal lacerations in vaginal delivery and its relationship with predisposing clinical and obstetric factors. METHODS: A retrospective cohort analysis using an electronic clinical database at a University Referral Center for high-risk pregnancies was performed. A total of 941 vaginal deliveries were analyzed, over 10 consecutive months in 2013 and 2014. The relationship between obstetric and clinical characteristics and lacerations, especially severe forms, was analyzed. The frequency and severity of birth canal lacerations were compiled and classified as mild (unintentional laceration grades I and II, and mediolateral episiotomy) and severe (grades III and IV). The crude and adjusted odds ratios and 95% confidence intervals were estimated in univariate and multivariate logistic regression models. RESULTS: The overall incidence of perineal lacerations in vaginal delivery was 78.2% (n = 731). Lacerations were considered mild in 708 women (75.7%) and severe in 23 women (2.5%). Maternal age, parity, use of forceps, mediolateral episiotomy, and birth weight influenced the occurrence of some degree of tear. The chance of severe lacerations increased 1.77-fold per week with the gestational age (1.03-3.03, P = 0.025), while primiparity increased the chance of laceration 5.32-fold. Episiotomy did not show a protective effect against severe laceration occurrence (P = 0.999). CONCLUSIONS: Severe perineal lacerations were associated with operative delivery, primiparity, gestational age, and epidural anesthesia. Episiotomy was not protective.
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Parto Obstétrico , Laceraciones/etiología , Perineo/lesiones , Adulto , Causalidad , Estudios de Cohortes , Episiotomía , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Introduction: A new medical device was previously developed to estimate gestational age (GA) at birth by processing a machine learning algorithm on the light scatter signal acquired on the newborn's skin. The study aims to validate GA calculated by the new device (test), comparing the result with the best available GA in newborns with low birth weight (LBW). Methods: We conducted a multicenter, non-randomized, and single-blinded clinical trial in three urban referral centers for perinatal care in Brazil and Mozambique. LBW newborns with a GA over 24 weeks and weighing between 500 and 2,500â g were recruited in the first 24â h of life. All pregnancies had a GA calculated by obstetric ultrasound before 24 weeks or by reliable last menstrual period (LMP). The primary endpoint was the agreement between the GA calculated by the new device (test) and the best available clinical GA, with 95% confidence limits. In addition, we assessed the accuracy of using the test in the classification of preterm and SGA. Prematurity was childbirth before 37 gestational weeks. The growth standard curve was Intergrowth-21st, with the 10th percentile being the limit for classifying SGA. Results: Among 305 evaluated newborns, 234 (76.7%) were premature, and 139 (45.6%) were SGA. The intraclass correlation coefficient between GA by the test and reference GA was 0.829 (95% CI: 0.785-0.863). However, the new device (test) underestimated the reference GA by an average of 2.8 days (95% limits of agreement: -40.6 to 31.2 days). Its use in classifying preterm or term newborns revealed an accuracy of 78.4% (95% CI: 73.3-81.6), with high sensitivity (96.2%; 95% CI: 92.8-98.2). The accuracy of classifying SGA newborns using GA calculated by the test was 62.3% (95% CI: 56.6-67.8). Discussion: The new device (test) was able to assess GA at birth in LBW newborns, with a high agreement with the best available GA as a reference. The GA estimated by the device (test), when used to classify newborns on the first day of life, was useful in identifying premature infants but not when applied to identify SGA infants, considering current algohrithm. Nonetheless, the new device (test) has the potential to provide important information in places where the GA is unknown or inaccurate.
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INTRODUCTION: Recognising prematurity is critical in order to attend to immediate needs in childbirth settings, guiding the extent of medical care provided for newborns. A new medical device has been developed to carry out the preemie-test, an innovative approach to estimate gestational age (GA), based on the photobiological properties of the newborn's skin. First, this study will validate the preemie-test for GA estimation at birth and its accuracy to detect prematurity. Second, the study intends to associate the infant's skin reflectance with lung maturity, as well as evaluate safety, precision and usability of a new medical device to offer a suitable product for health professionals during childbirth and in neonatal care settings. METHODS AND ANALYSIS: Research protocol for diagnosis, single-group, single-blinding and single-arm multicenter clinical trial with a reference standard. Alive newborns, with 24 weeks or more of pregnancy age, will be enrolled during the first 24 hours of life. Sample size is 787 subjects. The primary outcome is the difference between the GA calculated by the photobiological neonatal skin assessment methodology and the GA calculated by the comparator antenatal ultrasound or reliable last menstrual period (LMP). Immediate complications caused by pulmonary immaturity during the first 72 hours of life will be associated with skin reflectance in a nested case-control study. ETHICS AND DISSEMINATION: Each local independent ethics review board approved the trial protocol. The authors intend to share the minimal anonymised dataset necessary to replicate study findings. TRIAL REGISTRATION NUMBER: RBR-3f5bm5.
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Recien Nacido Prematuro/fisiología , Tamizaje Neonatal , Óptica y Fotónica/instrumentación , Piel/fisiopatología , Brasil/epidemiología , Estudios de Casos y Controles , Femenino , Edad Gestacional , Humanos , Recién Nacido , Óptica y Fotónica/métodos , Embarazo , Estándares de Referencia , Fenómenos Fisiológicos de la PielRESUMEN
O abortamento recorrente é condição heterogênea que acomete 0,5 a 3 porcento das mulheres em idade reprodutiva. Em aproximadamente 50 porcento dos casos a causa de abortamento recorrente não é definida e o conhecimento da fisiopatologia ainda é limitado. Entre as causas propostas de abortamento recorrente, os fatores endócrinos permanecem entre os mais controversos. Foram associados ao abortamento de repetição: diabetes mellitus, resistência à insulina, doenças da tireóide, síndrome de ovários policísticos, aumento de hormônio luteinizante, entre outros. A insuficiência da fase lútea perdeu atualmente sua importância como causa de abortamento de repetição