Resuscitation with Intact Cord Versus Clamped Cord in Late Preterm and Term Neonates: A Randomized Controlled Trial.

OBJECTIVE: To compare the effect of intact cord versus clamped cord resuscitation on the physiologic transition of neonates receiving positive-pressure ventilation (PPV) at birth. STUDY DESIGN: This open-label, parallel-group, randomized controlled superiority trial was conducted in a tertiary care hospital in India. Neonates born at ≥34 weeks of gestation after a complicated pregnancy or labor were randomized just before birth to receive resuscitation according to the Neonatal Resuscitation Program algorithm with either an intact cord (intact cord resuscitation group) or after early cord clamping (early cord clamping resuscitation group). The allocated study intervention was administered if the neonate needed PPV at birth. The primary outcome was expanded Apgar score at 5 minutes after birth. RESULTS: Birth weight, gestational age, and the incidence of pregnancy complications were similar in the 2 study groups. The proportion of neonates who received PPV was lower in the intact cord resuscitation group (28.7% vs 36.5%, P = .05; relative risk, 0.79; 95% CI, 0.61-1.01). Among neonates who received PPV, the expanded Apgar score at 5 minutes was significantly higher in the intact cord resuscitation group (median, 15 [IQR, 14-15] vs 14 [IQR, 13-15]; P < .001). The expanded Apgar score at 10 minutes, Apgar scores at 5 and 10 minutes, and oxygen saturation at 1, 5, and 10 minutes were also higher in the intact cord resuscitation group. CONCLUSION: In late preterm and term neonates, resuscitation with an intact cord results in better postnatal physiologic transition than the standard practice of resuscitation after immediate cord clamping. TRIAL REGISTRATION: Clinical Trial Registry of India (www.ctri.nic.in); trial registration no. CTRI/2020/02/023379.

Supplementation of mother's own milk with term versus preterm donor human milk: a randomized controlled trial.

The purpose of this is to evaluate the effect of supplementation of enteral feed volume with preterm versus term donor human milk (DHM) on short-term physical growth in very low birth weight (VLBW) neonates. In this open-label, variable block-sized, superiority, randomized controlled trial with allocation concealment, VLBW neonates with insufficient volume of mother's own milk (MOM) were assigned to receive either preterm (n = 48) or term (n = 54) DHM till discharge. Preterm DHM was defined as the breast milk expressed within 28 days of delivery at ≤ 34 weeks of gestation. The primary outcome was days to regain birth weight. Maternal and neonatal demographic variables were comparable in the two study groups. Days to regain birth weight were significantly more in the preterm DHM group, 17.4 (7.7) vs 13.6 (7.2) days, mean difference (95% CI) being 3.74 (0.48-7.0) days, P = 0.02). The proportion of MOM use was 82% in preterm vs 91.1%, P = 0.03 in the term milk group. Duration of skin-to-skin contact was also significantly lower in the preterm vs term milk group, the median (IQR) was 4 (0, 6) vs 4 (2, 6) hours/day, P < 0.01. However, bronchopulmonary dysplasia was higher in the preterm milk group (13% vs. 4%, P = 0.17). The velocity of gain in weight was similar in the two groups from week 1-3 but higher in the term DHM supplementation group during the 4th week. Conclusion: Supplementing MOM with preterm DHM did not result in a faster regaining of birth weight. Trial registration: CTRI/2020/02/023569; Date: 17.02.2020.

Periodontal and Dentition Status among Psychiatric Patients in Indore: A Descriptive Cross-sectional Study.

AIM: To assess and record periodontal and dentition status among psychiatric patients using modified WHO Oral Health Assessment form 1997. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted at Sri Aurobindo Institute of Medical Sciences and PG Institute, Indore, among the inpatients and outpatients. Ethical approval for the study was obtained from Institutional Review Board of Sri Aurobindo College of Dentistry. Statistical analysis was done using SPSS, IBM version 20.0. Descriptive statistics was used to find the frequencies, mean, and standard deviation of variables considered in the study. RESULTS: Among all the disorders, schizophrenia subjects had shallow pockets 28 (25.2%) and deep pockets 55 (49.5%). Only 2 (2.6%) study subjects who had major depressive disorder had more than 12 mm loss of attachment (LOA). The highest mean DMFT score was recorded for schizophrenia patients (13.0 ± 7.09). CONCLUSION: The results reveal an unmet need of projecting effective planning and implementation strategies toward the improvement of periodontal and dentition status health of the psychiatric patients. CLINICAL SIGNIFICANCE: The study highlights the importance of incorporating dental health education to psychiatric rehabilitation programs.

Rab4A organizes endosomal domains for sorting cargo to lysosome-related organelles.

Sorting endosomes (SEs) are the regulatory hubs for sorting cargo to multiple organelles, including lysosome-related organelles, such as melanosomes in melanocytes. In parallel, melanosome biogenesis is initiated from SEs with the processing and sequential transport of melanocyte-specific proteins toward maturing melanosomes. However, the mechanism of cargo segregation on SEs is largely unknown. Here, RNAi screening in melanocytes revealed that knockdown of Rab4A results in defective melanosome maturation. Rab4A-depletion increases the number of vacuolar endosomes and disturbs the cargo sorting, which in turn lead to the mislocalization of melanosomal proteins to lysosomes, cell surface and exosomes. Rab4A localizes to the SEs and forms an endosomal complex with the adaptor AP-3, the effector rabenosyn-5 and the motor KIF3, which possibly coordinates cargo segregation on SEs. Consistent with this, inactivation of rabenosyn-5, KIF3A or KIF3B phenocopied the defects observed in Rab4A-knockdown melanocytes. Further, rabenosyn-5 was found to associate with rabaptin-5 or Rabip4/4' (isoforms encoded by Rufy1) and differentially regulate cargo sorting from SEs. Thus, Rab4A acts a key regulator of cargo segregation on SEs.This article has an associated First Person interview with the first author of the paper.

Analysis of stress distribution in lingual orthodontics system for effective en-masse retraction using various combinations of lever arm and mini-implants: A finite element method study.

INTRODUCTION: The aims and objectives of this study were to evaluate the von Mises stress and principal stress distribution and displacement of anterior teeth in a lingual orthodontics system along the periodontal ligament and alveolar bone by various combinations of mini-implants and lever arm during en-masse retraction. Four 3-dimensional finite element (FE) models of the bilateral maxillary first premolar extraction cases were constructed. METHODS: Lingual brackets were (0.018-in slots) positioned over the center of the clinical crown. In all 4 models, 150 g of retraction force was applied with the help of a nickel-titanium closed coil spring with different combinations of mini-implants and lever arm on each side. FE analysis was then performed to evaluate stress distribution, principal stress, von Mises stress, and displacement of the anterior teeth using ANSYS software (version 12.1; Ansys, Canonsburg, Pa). The FE study was enough to validate the analysis results obtained by software tools with FE simulation instead of experimental readings. Thus, statistical analysis was not required. RESULTS: In this study, maximum tensile stresses were observed in the periodontal ligament at the mesial cervical region of the canine with values of 1.84 MPa, 2.02 MPa, 1.88 MPa, and 2.08 MPa for models 1-4, respectively. Maximum von Mises stress in alveolar bone was 8.05 MPa, 8.23 MPa, 8.19 MPa, and 8.37 MPa for models 1-4, respectively, which was within the optimum limit (135 MPa). Variable amounts of displacements like lingual crown tipping, lingual root tipping, and extrusion were observed in all the models. The 15-mm long lever arm models (models 2 and 4) showed a more controlled crown (0.015 mm) and root movement (0.004 mm) compared with 12-mm long lever arm models (models 1 and 3). CONCLUSIONS: In lingual orthodontics, controlled root movement increased as we increased the length of the lever arm. It was also concluded that the amount of increased controlled tipping found with the placement of the mini-implant was toward the palatal slope.

Navigating the structure-function-evolutionary relationship of CsaA chaperone in archaea.

CsaA is a protein involved in the post-translational translocation of proteins across the cytoplasmic membrane. It is considered to be a functional homolog of SecB which participates in the Sec-dependent translocation pathway in an analogous manner. CsaA has also been reported to act as a molecular chaperone, preventing aggregation of unfolded proteins. It is essentially a prokaryotic protein which is absent in eukaryotes, but found extensively in bacteria and earlier thought to be widely present in archaea. The study of phylogenetic distribution of CsaA among prokaryotes suggests that it is present only in few archaeal organisms, mainly species of Thermoplasmatales and Halobacteriales. Interestingly, the CsaA protein from these two archaeal orders cluster separately on the phylogenetic tree with CsaA from Gram-positive and Gram-negative bacteria. It, thus, appears that this protein might have been acquired in these archaeal organisms through independent horizontal gene transfer (HGT) events from different bacteria. In this review, we summarize the earlier biochemical, structural, and functional characterization studies of CsaA. We draw new insights into the evolutionary history of this protein through phylogenetic and structural comparison of bacterial CsaA with modelled archaeal CsaA from Picrophilus torridus and Natrialba magadii.

STX13 regulates cargo delivery from recycling endosomes during melanosome biogenesis.

Melanosomes are a class of lysosome-related organelles produced by melanocytes. Biogenesis of melanosomes requires the transport of melanin-synthesizing enzymes from tubular recycling endosomes to maturing melanosomes. The SNARE proteins involved in these transport or fusion steps have been poorly studied. We found that depletion of syntaxin 13 (STX13, also known as STX12), a recycling endosomal Qa-SNARE, inhibits pigment granule maturation in melanocytes by rerouting the melanosomal proteins such as TYR and TYRP1 to lysosomes. Furthermore, live-cell imaging and electron microscopy studies showed that STX13 co-distributed with melanosomal cargo in the tubular-vesicular endosomes that are closely associated with the maturing melanosomes. STX family proteins contain an N-terminal regulatory domain, and deletion of this domain in STX13 increases both the SNARE activity in vivo and melanosome cargo transport and pigmentation, suggesting that STX13 acts as a fusion SNARE in melanosomal trafficking pathways. In addition, STX13-dependent cargo transport requires the melanosomal R-SNARE VAMP7, and its silencing blocks the melanosome maturation, reflecting a defect in endosome-melanosome fusion. Moreover, we show mutual dependency between STX13 and VAMP7 in regulating their localization for efficient cargo delivery to melanosomes.

Sublingual misoprostol versus intravenous oxytocin in prevention of post-partum hemorrhage.

BACKGROUND: Post-partum hemorrhage (PPH) is the most common direct cause of maternal mortality and timely intervention can save many lives. OBJECTIVE: To compare the effectiveness of sublingual misoprostol to intravenous oxytocin in preventing post-partum hemorrhage in low risk vaginal birth. METHODS: One hundred patients with no risk factor for PPH were randomly allocated to receive 600 µg misoprostol administered sublingually or 10 IU of intravenous oxytocin immediately after the delivery of baby. Main outcome measures were post-partum blood loss, drop in hemoglobin in 24 h, duration of third stage of labor, and drug-related adverse effects. RESULTS: Mean age, parity and gestational age were similar in both groups. Mean blood loss was significantly lower in oxytocin group (114.28 ± 26.75 versus 149.50 ± 30.78 ml; p = 0.00). Drop in hemoglobin was 0.31 ± 0.16 versus 0.49 ± 0.21 g% (p = 0.01) in oxytocin and misoprostol group, respectively. Duration of third stage labor was shorter in oxytocin group (median 5 min, IQR: 4.5-5.5 versus 5.5 min, IQR: 5-6 min, p < 0.01). Although fever and shivering were common adverse effects with misoprostol but were not clinically significant. CONCLUSION: Intravenous oxytocin is more efficacious than sublingual misoprostol in preventing PPH in institutional deliveries.

Utilization of marine and agro-waste materials as an economical and active food packaging: Antimicrobial, mechanical and biodegradation studies of O-Carboxymethyl chitosan/pectin/neem composite films.

The present work deals with the eco-friendly preparation of highly degradable food packaging films consisting of O-CMC (O-Carboxymethyl Chitosan) and pectin, incorporated with neem (Azadirachta indica) leaves powder and extract. This study aimed to investigate the tensile properties, antimicrobial activity, biodegradability, and thermal behavior of the composite films. The results of tensile strength and elongation at break, showed that the incorporation of neem leaves powder improved the tensile properties (7.11 MPa) of the composite films compared to the neat O-CMC and pectin films (3.02 MPa). The antimicrobial activity of the films was evaluated against a panel of microorganisms including both gram-positive and gram-negative bacteria as well as fungi. The composite films exhibited excellent antimicrobial activity with a zone of inhibition (12-17.6 mm) against the tested microorganisms. The opacity of the composite films ranges from 1.14 to 4.40 mm-1 and the addition of fiber causes a decrease in opacity value. Biodegradability studies were conducted by Soil burial method and the films demonstrated complete biodegradability within 75 days. The results of thermogravimetric analysis (TGA) and differential scanning calorimetry (DSC) of composite films show that they are thermally stable and might be used in food packaging.

Multiomics Analysis-Based Biomarkers in Diagnosis of Polycystic Ovary Syndrome.

Polycystic ovarian syndrome is an utmost communal endocrine, psychological, reproductive, and metabolic disorder that occurs in women of reproductive age with extensive range of clinical manifestations. This may even lead to long-term multiple morbidities including obesity, diabetes mellitus, insulin resistance, cardiovascular disease, infertility, cerebrovascular diseases, and ovarian and endometrial cancer. Women affliction from PCOS in midst assemblage of manifestations allied with menstrual dysfunction and androgen exorbitance, which considerably affects eminence of life. PCOS is recognized as a multifactorial disorder and systemic syndrome in first-degree family members; therefore, the etiology of PCOS syndrome has not been copiously interpreted. The disorder of PCOS comprehends numerous allied health conditions and has influenced various metabolic processes. Due to multifaceted pathophysiology engaging several pathways and proteins, single genetic diagnostic tests cannot be supportive to determine in straight way. Clarification of cellular and biochemical pathways and various genetic players underlying PCOS could upsurge our consideration of pathophysiology of this syndrome. It is requisite to know pathophysiological relationship between biomarker and their reflection towards PCOS disease. Biomarkers deliver vibrantly and potent ways to apprehend the spectrum of PCOS with applications in screening, diagnosis, characterization, and monitoring. This paper relies on the endeavor to point out many candidates as potential biomarkers based on omics technologies, thus highlighting correlation between PCOS disease with innovative technologies. Therefore, the objective of existing review is to encapsulate more findings towards cutting-edge advances in prospective use of biomarkers for PCOS disease. Discussed biomarkers may be fruitful in guiding therapies, addressing disease risk, and predicting clinical outcomes in future.

Extracellular vesicles as mediators of cell-cell communication in ovarian cancer and beyond - A lipids focus.

Extracellular vesicles (EVs) are messengers that carry information in the form of proteins, lipids, and nucleic acids and are not only essential for intercellular communication but also play a critical role in the progression of various pathologies, including ovarian cancer. There has been recent substantial research characterising EV cargo, specifically, the lipid profile of EVs. Lipids are involved in formation and cargo sorting of EVs, their release and cellular uptake. Numerous lipidomic studies demonstrated the enrichment of specific classes of lipids in EVs derived from cancer cells suggesting that the EV associated lipids can potentially be employed as minimally invasive biomarkers for early diagnosis of various malignancies, including ovarian cancer. In this review, we aim to provide a general overview of the heterogeneity of EV, biogenesis, their lipid content, and function in cancer progression focussing on ovarian cancer.

Osteopontin as a Tumor Marker in Ovarian Cancer.

Introduction: Ovarian cancer is associated with high morbidity and mortality. This is due to the nonspecific symptoms and no effective screening methods. Currently, carbohydrate antigen-125 (CA125) is used as a tumor biomarker for the diagnosis of ovarian cancer, but it has its own limitations. Hence, there is a need for other tumor biomarkers for the diagnosis of ovarian cancer. Objective of the study was to evaluate the diagnostic test characteristics of plasma osteopontin (OPN) in detecting ovarian malignancy and comparing its performance with CA125. Materials and Methods: This is a prospective cross-sectional diagnostic test evaluation. Women with adnexal mass detected by clinical or radiological examination were enrolled as suspected cases. Women who presented with other gynecological conditions were enrolled as controls. OPN and CA125 levels were measured in all enrolled subjects. Results: Among 106 women enrolled, 26 were ovarian cancer, 31 had benign ovarian masses, and 49 were controls. Median plasma CA125 levels were higher in subjects with ovarian cancer (298 U/ml; interquartile range [IQR]: 84-1082 U/ml vs. 37.5U/ml; IQR: 17.6-82.9U/ml; P < 0.001). CA125 sensitivity, specificity, positive, and negative likelihood ratios were 88.5%, 61.3%, 2.10, and 0.19, respectively. Median plasma OPN levels were higher in subjects with ovarian cancer (63.1 ng/ml; IQR: 39.3-137 ng/ml vs. 27 ng/ml; IQR: 20-52 ng/ml; P = 0.001). Sensitivity, specificity, positive, and negative likelihood ratios of OPN were 50%, 87%, 2.58, and 0.62, respectively. Conclusion: OPN levels were higher in ovarian cancer than in the benign ovarian mass and had better specificity than CA125. OPN can better differentiate between benign and malignant ovarian mass as compared to CA125.

DIBAL-H mediated triple and quadruple debenzylations of perbenzylated cyclodextrins.

Diisobutylaluminium hydride (DIBAL-H) mediated reductive removal of benzyl groups was investigated for perbenzylated alpha-, beta- and gamma-cyclodextrins using DIBAL-H in hexane as the reagent. It was found that under the new conditions, the debenzylation can be better controlled to provide sequentially tri- and tetra-debenzylated products in moderate yields and in a regioselective manner. In the case of alpha-cyclodextrin, the removal of the third and fourth benzyl groups took a different path involving the secondary rim, compared to beta- and gamma-cyclodextrins which both gave only 6-O-debenzylated products.

Conservative Surgical Management of Mesh Erosion Following Abdominal Sacrocolpopexy.

Abdominal sacrocolpopexy (ASC) provides global support to the prolapsed vault. Hence, it is one of the successful procedures done along with pelvic organ prolapse to prevent future vault prolapse. Mostly, the synthetic mesh is used for the ASC. As, it provides a better strength. However, synthetic meshes are associated with more complications as compared to the autologous graft. Mesh erosion is one of the furious complication with the synthetic meshes. Commonly, these eroded meshes become infected, thus requiring removal. Due to the formation of adhesion and fibrosis around the mesh even the removal of these meshes is difficult. In our institute, we have performed 50 adbominal sacrocolpopexy over the past 9 years. Four mesh erosions had occurred. Two meshes were infected, which responded well to the antibiotics and conservative surgical removal of the mesh.

Regio- and stereocontrolled selective debenzylation and substitution reactions of C-2 formyl glycals. Application in the synthesis of constrained beta-sugar amino acids.

O-Benzyl-protected C-2 formyl glycals are regioselectively deprotected and acetylated first at C-3 and then at C-6 upon treatment with a ZnCl2-Ac2O-AcOH reagent combination. Treatment of the thus-obtained C-3 acetate with various nucleophiles leads to substitution at C-3 with retention of stereochemistry in the galactal series, whereas mixed results were obtained with glucal-derived compounds. Two of the azido-substituted products were converted into the corresponding beta-sugar amino acids.

Insights into archaeal chaperone machinery: a network-based approach.

Molecular chaperones are a diverse group of proteins that ensure proteome integrity by helping the proteins fold correctly and maintain their native state, thus preventing their misfolding and subsequent aggregation. The chaperone machinery of archaeal organisms has been thought to closely resemble that found in humans, at least in terms of constituent players. Very few studies have been ventured into system-level analysis of chaperones and their functioning in archaeal cells. In this study, we attempted such an analysis of chaperone-assisted protein folding in archaeal organisms through network approach using Picrophilus torridus as model system. The study revealed that DnaK protein of Hsp70 system acts as hub in protein-protein interaction network. However, DnaK protein was present only in a subset of archaeal organisms and absent from many archaea, especially members of Crenarchaeota phylum. Therefore, a similar network was created for another archaeal organism, Sulfolobus solfataricus, a member of Crenarchaeota. The chaperone network of S. solfataricus suggested that thermosomes played an integral part of hub proteins in archaeal organisms, where DnaK was absent. We further compared the chaperone network of archaea with that found in eukaryotic systems, by creating a similar network for Homo sapiens. In the human chaperone network, the UBC protein, a part of ubiquitination system, was the most important module, and interestingly, this system is known to be absent in archaeal organisms. Comprehensive comparison of these networks leads to several interesting conclusions regarding similarities and differences within archaeal chaperone machinery in comparison to humans.

Improving quality of care during childbirth in primary health centres: a stepped-wedge cluster-randomised trial in India.

BACKGROUND: Low/middle-income countries need a large-scale improvement in the quality of care (QoC) around the time of childbirth in order to reduce high maternal, fetal and neonatal mortality. However, there is a paucity of scalable models. METHODS: We conducted a stepped-wedge cluster-randomised trial in 15 primary health centres (PHC) of the state of Haryana in India to test the effectiveness of a multipronged quality management strategy comprising capacity building of providers, periodic assessments of the PHCs to identify quality gaps and undertaking improvement activities for closure of the gaps. The 21-month duration of the study was divided into seven periods (steps) of 3 months each. Starting from the second period, a set of randomly selected three PHCs (cluster) crossed over to the intervention arm for rest of the period of the study. The primary outcomes included the number of women approaching the PHCs for childbirth and 12 directly observed essential practices related to the childbirth. Outcomes were adjusted with random effect for cluster (PHC) and fixed effect for 'months of intervention'. RESULTS: The intervention strategy led to increase in the number of women approaching PHCs for childbirth (26 vs 21 women per PHC-month, adjusted incidence rate ratio: 1.22; 95% CI 1.17 to 1.28). Of the 12 practices, 6 improved modestly, 2 remained near universal during both intervention and control periods, 3 did not change and 1 worsened. There was no evidence of change in mortality with a majority of deaths occurring either during referral transport or at the referral facilities. CONCLUSION: A multipronged quality management strategy enhanced utilisation of services and modestly improved key practices around the time of childbirth in PHCs in India. TRIAL REGISTRATION NUMBER: CTRI/2016/05/006963.

Risk Factors and Incidence of Puerperal Genital Haematomas.

INTRODUCTION: Puerperal genital haematomas although an uncommon entity but is elusive. This painful condition is not only distressing and dangerous to patient but is embarrassing to the obstetrician who has conducted the delivery. AIM: This study has been planned to evaluate the incidence and risk factors for puerperal genital haematomas. MATERIALS AND METHODS: A case control study was done from August 2005 to August 2015, of all puerperal genital haematomas. All patients, who had undergone drainage for the puerperal genital haematoma, were enrolled as cases. Two controls were chosen for each case, who had delivered immediately after the case. All the patients were evaluated for the characteristics of haematoma and the management of the same. Cases and controls were compared for the evaluation of risk factors for puerperal genital haematoma. RESULTS: During the study period 27,826 vaginal deliveries were performed in our institute. Thirty nine haematomas were drained during this period. Incidence of haematomas was one in 1,113 deliveries, in our institute. Among the puerperal haematomas, vulvovaginal was the most common type. Perineal pain was the most common complaint. To evaluate the risk factors, 77 controls were enrolled. Primigravida, hypertensive disease of pregnancy and coagulopathy were the significant risk factors with p-value of <0.01, 0.01 and 0.03 respectively. Episiotomy too was a risk factor with a p-value of 0.002. CONCLUSION: Primigravida, hypertensive disease of pregnancy, coagulopathy and episiotomy are still the most common risk factors.

Prediction of perinatal outcome in preeclampsia using middle cerebral artery and umbilical artery pulsatility and resistance indices.

OBJECTIVE: In preeclampsia, changes in fetal hemodynamics can be detected 2-3 weeks earlier than any changes in cardiotocogram. Thus, these Doppler changes can be used to predict perinatal outcome. The present study is planned to assess the accuracy of the middle cerebral artery to umbilical artery (UA) pulsatility index (PI) and resistance index (RI) in predicting adverse perinatal outcome in pregnancies complicated by preeclampsia. METHODS: Total of 115 and 108 pregnant women were included in preeclampsia and control group, respectively. Weekly Doppler study was done in both groups starting from 30 weeks till 36 weeks or delivery, whichever is later. RESULTS: Mean gestational age at delivery was 250 ± 13 and 273 ± 8 days, respectively, in preeclampsia and control group (p < 0.01). Thirty-four babies in preeclampsia group had been admitted to nursery; out of which three died (p < 0.01). On receiver operating characteristic analysis, MCA /UmA PI ratio and MCA /UmA RI ratio had sensitivity of 9% and 9.7% and specificity of 98% and 96.6%, respectively, for predicting adverse perinatal outcome. CONCLUSION: Doppler indices of MCA and Um A are significantly abnormal in preeclampsia. But on diagnostic statistical analysis they have good specificity but low sensitivity for detecting adverse perinatal outcome.