Fetal Doppler reference values in women with a normal body mass index

Objectives: To construct gestation specific reference limits for fetal umbilical (UA), middle cerebral artery (MCA) pulsatility indices (PI) and the cerebroplacental ratio (CPR) in singleton pregnancies with normal BMI between 16 and 40 weeks of gestation. Methods: We ultrasonographically examined 596 fetuses from women with normal nutritional and health status and minimal environmental constraints on fetal growth. Each mother was considered only once for measurement of fetal Doppler indices, at gestations between 16 and 40 weeks in a prospective cross-sectional study. Gestational age was confirmed by fetal crown-rump length measurement between 11 and 14 weeks. Pulsatility indices of umbilical and middle cerebral arteries were measured by real time and Doppler ultrasonography. CPR ratio was calculated by dividing MCA PI by UA PI. The fetal Doppler measurements obtained from the current study were compared with commonly used reference charts. For each parameter separate polynomial regression models were fitted to estimate the gestation specific means and standard deviations, assuming that the measurements have a normal distribution at each gestational age. Results: A significant difference of fetal Doppler indices was observed between our study and previously published reference charts for most gestational weeks. The fitted 10th, 50th and 90th centiles at 40 weeks of gestation were 0.65, 0.87 and 1.08 for UA PI; 0.93, 1.32 and 1.71 MCA PI; 1.02, 1.58 and 2.13 for CPR. Conclusions: These charts can be used for better defining the normal range of fetal arterial Doppler indices. This will be useful in the diagnosis and management of fetuses with abnormal fetal growth.

Comparison of ultrasound fetal biometry of singleton fetuses with a reference chart in pregnant women with normal nutritional and health status

Objetives: The aim of this study was to compare fetal biometry of singleton fetuses in pregnant women with normal nutritional and health status in the Ampara district, with a commonly used reference chart. Methods: A cross sectional study was carried out in the Ampara District. Women with normal nutritional and health status and minimal environmental constraints on fetal growth (n=714) were enrolled during the first trimester and gestational age was confirmed by fetal crown-rump length measurement between 11 weeks + 0 days and 13 weeks + 6 days. For this study, each mother was considered only once for measurement of fetal biometry, at gestations between 11 and 41 weeks. Fetal bi-parietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL) were measured using standard techniques, and separate regression models were fitted to estimate the means and standard deviations and derive gestation specific centiles for each parameter, assuming that the measurements have a normal distribution at each gestational age. The fetal biometry results obtained from the current study were compared with a commonly used reference chart. Results: The fitted 10th, 50th and 90th centiles at 40 weeks of gestation were, 87.9 mm, 93.2 mm and 98.5 mm for BPD, 313.8 mm, 328.9 mm and 344.0 mm for HC; 298.2 mm, 322.5 mm and 346.9 mm for AC and 69.7 mm, 75.0 mm and 80.2 mm for FL. When compared with the reference chart, significant differences of fetal biometry were seen in the third trimester but not in the second trimester. Conclusions: Ultrasound fetal biometry of singleton fetuses in pregnant women with normal nutritional and health status in the Ampara District were significantly different in the third trimester, from a routinely used reference chart.

Symphysis-pubis fundal height charts to assess fetal size in women with a normal body mass index.

OBJECTIVES: To construct symphysis-pubis fundal height (SFH) charts to estimate fetal size in pregnant women with a normal body mass index (BMI) and to describe the variation of SFH measurements according to BMI. METHODS: cross sectional study was carried out at Ampara and Gampaha Districts in Sri Lanka. Women with normal nutritional and health status, normal BMI and minimal environmental constraints on fetal growth, with ultra sound confirmation of dates by fetal crown-rump length measurements between 11 weeks and 13 weeks + six days,had their SFH measured, using non-elastic tape and standard techniques, between 24 and 41 weeks gestation. Only one measurement of SFH was obtained from each pregnant woman. Linear and polynomial regression models were fitted separately to the means and standard deviations (SD) as functions of gestational age to identify the model with the best fit. Centiles were derived from the mean and SD at each gestational age. RESULTS: Pregnant women from the districts of Ampara (n=387) and Gampaha (n=200) were recruited. Other than a difference of -1.5 cm (95% CI -2.27 to -0.23) at 38 weeks of gestation, there were no significant differences between the SFH measurements obtained from women with normal BMI in Ampara and Gampaha Districts. Using the SFH measurements from the Ampara sample, charts were created for 10th, 50th and 90th centile values of SFH. At 40 weeks of gestation these were 34 cm, 37 cm and 41 cm respectively. At 40 weeks gestation, the variation in SFH measurements between BMI sub groups within the normal range was approximately 1.4 cm to 1.6 cm. CONCLUSIONS: These SFH charts could be used to estimate fetal size in pregnant women with normal BMI.

Use of ultrasound in predicting success of intrauterine contraceptive device insertion immediately after delivery.

OBJECTIVES: To assess by ultrasound examination the success of insertion of an intrauterine contraceptive device (IUD) immediately after delivery and to determine the optimal distance between the lower end of the IUD and the internal os in predicting successful retention of an IUD. METHODS: This was a prospective study carried out between December 2012 and April 2013. Two ultrasound examinations, transabdominal and transvaginal, were performed prior to hospital discharge following delivery and again at 6 weeks following delivery in women who received a postpartum IUD. Distance from the internal os to the lower end of the IUD was measured at each examination and compared in unsuccessful and successful cases of postvaginal delivery (PVD) and post-Cesarean section (PCS) IUD insertion. Logistic regression and receiver-operating characteristics (ROC) curve analysis were used to determine the difference in success between the two modes of delivery and to determine the optimal cut-off of the internal os-to-IUD distance for successful retention, respectively. RESULTS: Ninety-one women were included in the study, comprising 60 PVD and 31 PCS IUD insertions. Thirteen PVD (22.4%) and eight PCS (25.8%) IUDs were either expelled spontaneously or removed at the 6-week scan because of improper placement. Mean distance from the internal os to the lower end of the IUD on ultrasound examination immediately after insertion was significantly greater in successful cases than in those in which IUDs were subsequently expelled/displaced (mean difference after PVD insertion, 20.1 mm (P = 0.006); mean difference after PCS insertion, 10.3 mm (P = 0.05)). Logistic regression analysis demonstrated that mode of delivery was not independently associated with successful retention of the IUD (P = 0.72; OR, 0.831 (95% CI, 0.301-2.189)). The distance from the lower end of the IUD to the internal os measured at ultrasound examination prior to hospital discharge provided reasonable predictive accuracy for determining retention of the IUD, with an area under the ROC curve of 0.74 (95% CI, 0.60-0.88) and an optimal cut-off of ≥ 30 mm (sensitivity, 64.71% (95% CI, 52.17-75.92%) and specificity, 80.95% (95% CI, 58.09-94.55%)). CONCLUSIONS: IUD insertion immediately postpartum is feasible but carries a substantial risk of unsuccessful IUD retention. Ultrasound examination after insertion of an IUD could be considered for predicting the success of IUD retention.

Protein and starch concentrates of air-classified field pea and zero-tannin faba bean for weaned pigs.

Air-classified pulse (non-oilseed legume) protein and starch may replace specialty protein and starch feedstuffs in diets for weaned pigs. In Exp. 1, three specialty protein sources (5% soy protein concentrate, 5% corn gluten meal, and 5% menhaden meal in the control diet) were replaced with 16% zero-tannin hulled or dehulled faba bean, or 17.5% field pea protein concentrate. In total, 192 group-housed pigs (2 gilts and 2 barrows per pen; BW = 7.5 +/- 1.4 kg) were fed wheat-based diets (3.60 Mcal/kg of DE and 3.3 g of standardized ileal digestible Lys/Mcal DE) over 28 d for 12 pen observations per each of 4 diets. Overall, protein source did not affect ADFI, ADG, or G:F. Apparent total tract digestibility (ATTD) of DM, GE, and P was greater (P < 0.05) for dehulled faba bean and field pea protein concentrate diets than the diet with 3 specialty protein sources. In Exp. 2, faba bean and field pea starch concentrates were compared with corn, wheat, tapioca, and potato starch as dietary energy sources. In total, 36 individually housed barrows (BW = 8.0 +/- 1.5 kg) were fed 1 of 6 diets for 15 d. Feces and urine were collected from d 8 to 14, and jugular blood was sampled after overnight fast and refeeding on d 15. Starch source did not affect N retention as a percentage of N intake. For d 0 to 14, ADFI of pigs fed field pea starch was greater (P < 0.05) than pigs fed corn, wheat, potato, and faba bean starch. Pigs fed tapioca, field pea, wheat, or corn starch grew faster (P < 0.05) than those fed faba bean or potato starch. For d 0 to 14, pigs fed corn or wheat starch had a 0.1 greater (P < 0.05) G:F than pigs fed faba bean, field pea, or potato starch. The ATTD of DM, GE, CP, and starch and the DE value of potato starch were much less (P < 0.05) than those of other starch diets. Postprandial plasma glucose was 4.9, 6.3, and 9 mmol/L greater (P < 0.05) for pigs fed tapioca than for pigs fed faba bean, wheat, and potato starch, respectively. However, postprandial plasma insulin tended to be 844 and 577 pmol/L greater (P < 0.10) for pigs fed faba bean and corn starch, respectively, than for pigs fed potato starch. The high insulin response of pigs fed faba starch could not be explained. In conclusion, air-classified pulse protein concentrates can replace specialty protein feedstuffs in diets for weaned pigs. Feeding air-classified pulse starch concentrates to starter pigs achieved a similar N retention as a percentage of N intake. The factors responsible for the reduced ADFI associated with feeding faba bean starch remain unclear.

Characterization of the nutritional value of air-classified protein and starch fractions of field pea and zero-tannin faba bean in grower pigs.

Most pulse (nonoilseed legume) seed flours can be fractionated rapidly and economically by air classification into protein and starch concentrates. The nutritional value of air-classified field pea and faba bean concentrates requires characterization to assess the feeding opportunity for pigs. Thus, the objectives were to characterize the apparent total tract digestibility (ATTD) of DM, OM, energy, starch, CP, fat, and ash; apparent ileal digestibility of CP and starch; standardized ileal digestibility (SID) of AA; and the SID AA, DE, and NE content of air-classified zero-tannin faba bean and field pea protein and starch concentrates in grower pigs. Pulse protein and starch concentrates were compared with soy protein concentrate and corn starch, respectively, as corresponding standards. The corn starch diet served as an N-free diet to correct for basal endogenous AA losses. In a Youden square design, 8 ileal-cannulated barrows (24.9 +/- 2.3 kg of BW) were fed 6 diets over 7 periods at 3 times the maintenance DE requirement. Periods encompassed a 5-d diet acclimation, 3-d feces collection, and 3-d ileal digesta collection. The ATTD of GE was 2% greater (P < 0.05) for faba bean than soy and was intermediate for field pea protein (95.6, 93.7, and 94.9%, respectively). The ATTD of GE was 3.6% greater (P < 0.05) for corn and field pea than faba bean starch (96.2, 95.1, and 92.3%, respectively). The DE content of faba bean was 5.0% greater (P < 0.05) than for field pea or soy protein (4.47, 4.23, and 4.26 Mcal/kg, respectively). The DE content of faba bean and field pea was 1.7% greater (P < 0.05) than for corn starch (3.72, 3.77, and 3.68 Mcal/kg, respectively). The NE content was 5% greater (P < 0.05) for faba bean than field pea and soy protein (3.08, 2.94, and 2.92 Mcal/kg, respectively). The NE content for field pea starch was 2.0% greater (P < 0.05) than for corn starch and faba bean starch (2.68, 2.63, and 2.61 Mcal/kg, respectively). Protein concentrates had a 14 and 11% greater (P < 0.05) DE and NE content, respectively, than starch concentrates. The SID of Lys was 6.0% greater (P < 0.05) for faba bean and field pea protein than soy protein (95.5, 92.6, and 88.7%, respectively). The SID of Lys was 6.0% greater (P < 0.05) for faba bean than field pea starch. Nutrient digestibility and digestible nutrient profiles indicated that air-classified fractions of zero-tannin faba bean and field pea constitute concentrated sources of AA and energy for pigs with high nutritional demands.