ABSTRACT
OBJECTIVE: To describe a reference curve for cervical length (CL) in mid-trimester twin gestations using transvaginal ultrasound (TVU) and to investigate whether short CL increases spontaneous preterm birth (sPTB) in asymptomatic twin pregnancies. METHODS: This was a prospective cohort study performed at 17 outpatient antenatal facilities of Brazil with women at 18 0/7 to 22 6/7 weeks of gestation who participated in a randomized clinical trial screening phase (P5 trial) between July 2015 and March 2019. TVU was performed to provide CL measurement in all screened women. Almost all women with CL ≤ 30 mm received vaginal progesterone 200mg/day and they were also randomized to receive cervical pessary or not. We considered data from the CL distribution among asymptomatic twin pregnancies and analyzed CL and its association with PTB generating receiver operating characteristics (ROC) curves and Kaplan-Meier curves. RESULTS: A total of 253 pregnant women with twins were included in the distribution curve. The mean CL was 33.7 mm and median was 35.5mm. The 10th percentile was 17.8mm. We identified a PTB rate of 73.9% (187/253) with 33.6% of sPTB < 37 (85/253) and 15% (38/253) of sPTB < 34 weeks. The best cutoff point to predict sPTB < 37 was 24.15 mm. However, the ROC curve showed a poor performance (0.64). The Kaplan-Meier survival curves identified that only CL values ≤ 20mm were associated to sPTB < 34 weeks. CONCLUSION: A cutoff point of CL ≤ 20 mm can be interesting point to identify short cervix in Brazilian twin pregnancies. However, in Brazilian asymptomatic twin pregnancies, CL does not show a good performance to predict PTB.
OBJETIVO: Descrever uma curva de referência da medida do colo uterino no Segundo trimestre de gestações gemelares através de ultrassonografia transvaginal (TVU) e investigar a correlação entre a medida do colo uterino (CL) e o parto prematuro espontâneo (sPTB) em pacientes assintomáticas. MéTODOS: Foi realizado uma coorte prospectiva multicêntrica em 17 centros de referência do Brasil com mulheres com gestação gemelar entre 18 0/7 a 22 6/7 semanas de gestação que participaram da primeira fase de um ensaio clínico randomizado (P5 trial) entre Julho/2015 a Março/2019. TVU foi realizada para obter a medida do colo uterino em todas as mulheres. A maioria das mulheres com CL ≤30 mm receberam progesterona por via vaginal 200mg/dia e estas foram randomizadas para receber ou não um pessário cervical. Este estudo considerou dados da medida do colo uterino entre mulheres assintomáticas, desenvolvendo uma curva de referência para gestantes gemelares e sua capacidade de predição do parto prematuro através de curva ROC (receiver operating characteristics) e curvas de sobrevida de Kaplan-Meyer. RESULTADOS: O total de 253 gestantes foram incluídos no estudo, A média do CL foi 33.7mm e a mediana 35.5mm. O Percentil 10 do CL foi 17.8mm. A taxa de parto prematuro foi de 73.9% (187/253) com 33.6% de sPTB < 37 (85/253) e 15% (38/253) de sPTB < 34 semanas. O melhor ponto de corte para predizer sPTB < 37 foi 24.15 mm, entretanto a curva ROC demonstrou baixa performance (0.64). A curva de Kaplan-Meier para sPTB identificou que apenas CL ≤ 20 mm estavam associados a sPTB < 34 semanas. CONCLUSãO: Colo uterino ≤20 mm pode ser um interessante ponto de corte para identificar colo curto entre gestações gemelares assintomáticas brasileiras. Entretanto, a medida do colo uterino não apresentou boa performance para predizer parto prematuro.
Subject(s)
Cervix Uteri , Premature Birth , Female , Humans , Infant, Newborn , Pregnancy , Brazil , Cervix Uteri/diagnostic imaging , Prospective Studies , VaginaABSTRACT
BACKGROUND: Short cervical length measured during the second trimester of pregnancy is an important risk factor for spontaneous preterm birth (sPTB). The aim of this study is to identify the association between mid-pregnancy cervical length (CL) and gestational age at birth in asymptomatic singleton pregnant women. METHODS: This is a prospective cohort study involving singleton pregnant women who participated in the screening phase of a Brazilian multicenter randomized controlled trial (P5 trial) between July 2015 and March 2019. Transvaginal ultrasound to measure CL was performed from 18 to 22 + 6 weeks. Women with CL ≤ 30 mm received vaginal progesterone (200 mg/day) until 36 weeks' gestation. For this analysis we considered all women with CL ≤ 30 mm receiving progesterone and a random selection of women with CL > 30 mm, keeping the populational distribution of CL. We obtained prognostic effectiveness data (area under receive operating characteristic curve (AUC), sensitivity and specificity and estimated Kaplan-Meier curves for preterm birth using different CL cutoff points. RESULTS: We report on 3139 women and identified a negative association between cervical length and sPTB. CL ≤ 25 mm was associated with sPTB < 28, sPTB < 34 and sPTB < 37 weeks, whereas a CL 25-30 mm was directly associated with late sPTB. CL by transvaginal ultrasound presented an AUC of 0.82 to predict sPTB < 28 weeks and 0.67 for sPTB < 34 weeks. Almost half of the sPTB occurred in nulliparous women and CL ≤ 30 mm was associated with sPTB at < 37 weeks (OR = 7.84; 95%CI = 5.5-11.1). The number needed to screen to detect one sPTB < 34 weeks in women with CL ≤ 25 mm is 121 and we estimated that 248 screening tests are necessary to prevent one sPTB < 34 weeks using progesterone prophylaxis. CONCLUSIONS: CL measured by transvaginal ultrasound should be used to predict sPTB < 34 weeks. Women with CL ≤ 30 mm are at increased risk for late sPTB.
Subject(s)
Premature Birth , Pregnancy , Female , Infant, Newborn , Humans , Premature Birth/epidemiology , Premature Birth/prevention & control , Premature Birth/diagnosis , Progesterone , Gestational Age , Prospective Studies , Brazil/epidemiology , ParturitionABSTRACT
Abstract Objective To describe a reference curve for cervical length (CL) in mid-trimester twin gestations using transvaginal ultrasound (TVU) and to investigate whether short CL increases spontaneous preterm birth (sPTB) in asymptomatic twin pregnancies. Methods This was a prospective cohort study performed at 17 outpatient antenatal facilities of Brazil with women at 18 0/7 to 22 6/7 weeks of gestation who participated in a randomized clinical trial screening phase (P5 trial) between July 2015 and March 2019. TVU was performed to provide CL measurement in all screened women. Almost all women with CL ≤ 30 mm received vaginal progesterone 200mg/day and they were also randomized to receive cervical pessary or not. We considered data from the CL distribution among asymptomatic twin pregnancies and analyzed CL and its association with PTB generating receiver operating characteristics (ROC) curves and Kaplan-Meier curves. Results A total of 253 pregnant women with twins were included in the distribution curve. The mean CL was 33.7 mm and median was 35.5mm. The 10th percentile was 17.8mm. We identified a PTB rate of 73.9% (187/253) with 33.6% of sPTB < 37 (85/253) and 15% (38/253) of sPTB < 34 weeks. The best cutoff point to predict sPTB < 37 was 24.15 mm. However, the ROC curve showed a poor performance (0.64). The Kaplan-Meier survival curves identified that only CL values ≤ 20mm were associated to sPTB < 34 weeks. Conclusion A cutoff point of CL ≤ 20 mm can be interesting point to identify short cervix in Brazilian twin pregnancies. However, in Brazilian asymptomatic twin pregnancies, CL does not show a good performance to predict PTB.
Resumo Objetivo Descrever uma curva de referência da medida do colo uterino no Segundo trimestre de gestações gemelares através de ultrassonografia transvaginal (TVU) e investigar a correlação entre a medida do colo uterino (CL) e o parto prematuro espontâneo (sPTB) em pacientes assintomáticas. Métodos Foi realizado uma coorte prospectiva multicêntrica em 17 centros de referência do Brasil com mulheres com gestação gemelar entre 18 0/7 a 22 6/7 semanas de gestação que participaram da primeira fase de um ensaio clínico randomizado (P5 trial) entre Julho/2015 a Março/2019. TVU foi realizada para obter a medida do colo uterino em todas as mulheres. A maioria das mulheres com CL ≤30 mm receberam progesterona por via vaginal 200mg/dia e estas foram randomizadas para receber ou não um pessário cervical. Este estudo considerou dados da medida do colo uterino entre mulheres assintomáticas, desenvolvendo uma curva de referência para gestantes gemelares e sua capacidade de predição do parto prematuro através de curva ROC (receiver operating characteristics) e curvas de sobrevida de Kaplan-Meyer. Resultados O total de 253 gestantes foram incluídos no estudo, A média do CL foi 33.7mm e a mediana 35.5mm. O Percentil 10 do CL foi 17.8mm. A taxa de parto prematuro foi de 73.9% (187/253) com 33.6% de sPTB < 37 (85/253) e 15% (38/253) de sPTB < 34 semanas. O melhor ponto de corte para predizer sPTB < 37 foi 24.15 mm, entretanto a curva ROC demonstrou baixa performance (0.64). A curva de Kaplan-Meier para sPTB identificou que apenas CL ≤ 20 mm estavam associados a sPTB < 34 semanas. Conclusão Colo uterino ≤20 mm pode ser um interessante ponto de corte para identificar colo curto entre gestações gemelares assintomáticas brasileiras. Entretanto, a medida do colo uterino não apresentou boa performance para predizer parto prematuro.
Subject(s)
Humans , Female , Pregnancy , Cervix Uteri/anatomy & histology , Pregnancy, Twin , Obstetric Labor, PrematureABSTRACT
OBJECTIVE: Since there are populational differences and risk factors that influence the cervical length, the aim of the study was to construct a populational curve with measurements of the uterine cervix of pregnant women in the second trimester of pregnancy and to evaluate which variables were related to cervical length (CL) ≤25 mm. MATERIALS AND METHODS: This was a multicenter cross-sectional study performed at 17 hospitals in several regions of Brazil. From 2015 to 2019, transvaginal ultrasound scan was performed in women with singleton pregnancies at 18 0/7 to 22 6/7 weeks of gestation to measure the CL. We analyzed CL regarding its distribution and the risk factors for CL ≤25 mm using logistic regression. RESULTS: The percentage of CL ≤ 25mm was 6.67%. Shorter cervices, when measured using both straight and curve techniques, showed similar results: range 21.0-25.0 mm in straight versus 22.6-26.0 mm in curve measurement for the 5th percentile. However, the difference between the two techniques became more pronounced after the 75th percentile (range 41.0-42.0 mm straight x 43.6-45.0 mm in curve measurement). The risk factors identified for short cervix were low body mass index (BMI) (OR: 1.81 CI: 1.16-2.82), higher education (OR: 1.39 CI: 1.10-1.75) and personal history ([one prior miscarriage OR: 1.41 CI: 1.11-1.78 and ≥2 prior miscarriages OR: 1.67 CI: 1.24-2.25], preterm birth [OR: 1.70 CI: 1.12-2.59], previous low birth weight <2500 g [OR: 1.70 CI: 1.15-2.50], cervical surgery [OR: 4.33 CI: 2.58-7.27]). By contrast, obesity (OR: 0.64 CI: 0.51-0.82), living with a partner (OR: 0.76 CI: 0.61-0.95) and previous pregnancy (OR: 0.46 CI: 0.37-0.57) decreased the risk of short cervix. CONCLUSIONS: The CL distribution showed a relatively low percentage of cervix ≤25 mm. There may be populational differences in the CL distribution and this as well as the risk factors for short CL need to be considered when adopting a screening strategy for short cervix.
Subject(s)
Cervix Uteri , Premature Birth , Brazil/epidemiology , Cervical Length Measurement/methods , Cervix Uteri/diagnostic imaging , Cross-Sectional Studies , Female , Humans , Infant, Newborn , Pregnancy , Pregnancy Trimester, Second , Premature Birth/prevention & control , Risk FactorsABSTRACT
This study aimed to evaluate the morphogenic, structural, chemical characteristics, and forage yield of Massai grass, as well as the performance of sheep under three pre-grazing canopy heights. Eighteen Dorper x crossbred sheep (12 males and 6 females) were subjected to three pre-grazing canopy heights of Massai grass (45, 35, and 25 cm). Rotational grazing was adopted, with a fixed rest period of 12 days and occupation of four days. Before placing animals in the paddock, stocking rate was estimated to ensure a reduction of about 50% in the initial height. Morphogenic and chemical characteristics of forage were evaluated, as well as animal intake and performance. Pasture managed at 25 cm height induced reductions in stem and sheath sizes, and phyllochron but an increased leaf: stem ratio. However, the pasture cut at 35 cm above ground promoted an increase in total dry mass and foliar leaf productions, in addition to greater forage availability and daily accumulation. Yet, pastures with a height of 45 cm had a higher percentage of stem and senescent material, decreasing leaf intake by animals. Among the studied heights, 35 cm is the most suitable for Massai grass, when used for rearing sheep for meat production under pasture conditions in the northern Tocantins. This is because this management provided a greater availability of good quality forage and thereby increasing weight gains per area in animals.(AU)
O objetivo foi avaliar as características morfogênicas, estruturais, bromatológicas e de produção do capim Massai, assim como o desempenho de ovinos sob três alturas pré-pastejo. Foram utilizados 18 ovinos (12 machos e seis fêmeas) mestiços Dorper x sem padrão racial definido (SPRD) pastejando em três alturas pré-pastejo em capim Massai, sendo as alturas de 45 cm, 35 cm e 25 cm. Foi adotado o método de lotação rotativa com período de descanso fixo de 12 dias e de ocupação de quatro dias. Antes da entrada dos animais no piquete foi estimada a lotação animal necessária para garantir a redução de aproximadamente 50% da altura inicial. Avaliou-se as características morfogênicas e a composição bromatológica da forragem e avaliou-se o consumo e desempenho dos animais. A altura de 25 cm reduziu o alongamento de colmo, o filocrono e o comprimento da bainha e apresentou maior relação folha:colmo, no entanto, o tratamento com 35 cm de altura pré-pastejo apresentou maior produção de massa seca total e de lâmina foliar, assim como maior oferta de forragem e taxa de acúmulo diária. Já o tratamento com 45 cm aumentou a porcentagem de colmo e de forragem morta acarretando uma menor apreensão de folhas pelos animais. Os maiores teores de proteína e nutrientes digestíveis totais foram observados no tratamento com 35 cm e no tratamento com 25 cm respectivamente. Com base nos resultados apresentados, a altura de 35 cm, entre as alturas de pré-pastejo avaliadas, é a mais indicada para o capim Massai utilizado na criação de ovinos de corte a pasto nas condições do norte do Tocantins, por apresentar maior disponibilidade de alimento, com uma boa qualidade da forrageira e possibilitar maior ganho de peso dos animais por área.(AU)
Subject(s)
Animals , Sheep , Panicum/growth & development , Pasture/analysis , Panicum/physiology , Food Analysis/methods , FertilizersABSTRACT
This study aimed to evaluate the morphogenic, structural, chemical characteristics, and forage yield of Massai grass, as well as the performance of sheep under three pre-grazing canopy heights. Eighteen Dorper x crossbred sheep (12 males and 6 females) were subjected to three pre-grazing canopy heights of Massai grass (45, 35, and 25 cm). Rotational grazing was adopted, with a fixed rest period of 12 days and occupation of four days. Before placing animals in the paddock, stocking rate was estimated to ensure a reduction of about 50% in the initial height. Morphogenic and chemical characteristics of forage were evaluated, as well as animal intake and performance. Pasture managed at 25 cm height induced reductions in stem and sheath sizes, and phyllochron but an increased leaf: stem ratio. However, the pasture cut at 35 cm above ground promoted an increase in total dry mass and foliar leaf productions, in addition to greater forage availability and daily accumulation. Yet, pastures with a height of 45 cm had a higher percentage of stem and senescent material, decreasing leaf intake by animals. Among the studied heights, 35 cm is the most suitable for Massai grass, when used for rearing sheep for meat production under pasture conditions in the northern Tocantins. This is because this management provided a greater availability of good quality forage and thereby increasing weight gains per area in animals.
O objetivo foi avaliar as características morfogênicas, estruturais, bromatológicas e de produção do capim Massai, assim como o desempenho de ovinos sob três alturas pré-pastejo. Foram utilizados 18 ovinos (12 machos e seis fêmeas) mestiços Dorper x sem padrão racial definido (SPRD) pastejando em três alturas pré-pastejo em capim Massai, sendo as alturas de 45 cm, 35 cm e 25 cm. Foi adotado o método de lotação rotativa com período de descanso fixo de 12 dias e de ocupação de quatro dias. Antes da entrada dos animais no piquete foi estimada a lotação animal necessária para garantir a redução de aproximadamente 50% da altura inicial. Avaliou-se as características morfogênicas e a composição bromatológica da forragem e avaliou-se o consumo e desempenho dos animais. A altura de 25 cm reduziu o alongamento de colmo, o filocrono e o comprimento da bainha e apresentou maior relação folha:colmo, no entanto, o tratamento com 35 cm de altura pré-pastejo apresentou maior produção de massa seca total e de lâmina foliar, assim como maior oferta de forragem e taxa de acúmulo diária. Já o tratamento com 45 cm aumentou a porcentagem de colmo e de forragem morta acarretando uma menor apreensão de folhas pelos animais. Os maiores teores de proteína e nutrientes digestíveis totais foram observados no tratamento com 35 cm e no tratamento com 25 cm respectivamente. Com base nos resultados apresentados, a altura de 35 cm, entre as alturas de pré-pastejo avaliadas, é a mais indicada para o capim Massai utilizado na criação de ovinos de corte a pasto nas condições do norte do Tocantins, por apresentar maior disponibilidade de alimento, com uma boa qualidade da forrageira e possibilitar maior ganho de peso dos animais por área.
Subject(s)
Animals , Sheep , Panicum/growth & development , Panicum/physiology , Pasture/analysis , Food Analysis/methods , FertilizersABSTRACT
The effects of phosphate and nitrogen fertilization on aspects of forage composition and ruminal fermentation were separately evaluated pre- and post-grazing, in addition to the dry matter intake and weight gain of sheep grazing Panicum maximum cv. Massai under a rotational system on Quartzipsamment soil. The aim was to evaluate the effect of fertilization with different levels of phosphorous (50 and 200 kg P2 O5 /ha) and nitrogen (100 and 400 kg N/ha) compared to unfertilized control soil. The experiment was conducted at the School of Veterinary Medicine and Animal Science at Universidade Federal do Tocantins UFT, in a randomized complete block design with four replicates in a factorial 2 × 2 design. The study area consisted of 32 paddocks (301 m²), each of which had previously been sown with Panicum maximum cv. Massai. The experimental area was managed under intermittent stocking with a variable stocking rate. Twenty-eight crossbreed sheep were used for grazing management. Evaluations were made before and after grazing, including forage evaluation and measurement of ruminal degradability and intake (using titanium dioxide as the external marker). Regarding the forage composition, a significant difference (P < 0.05) was observed between the control and fertilizer treatments for neutral detergent fiber (NDF), acid detergent fiber, crude protein, lignin and phosphorous content. Fertilization was found to alter the nutritional quality of Panicum maximum cv. Massai grass. Among the nutritional aspects evaluated, fertilization influenced NDF, grass digestibility and dry matter intake. The forage composition of Massai grass is improved by fertilization with nitrogen at 100 kg N/ha and phosphate up to 50 kg P2 O5 /ha, which represents a relevant management practice for increasing quantity and quality.(AU)
Objetivou-se avaliar os efeitos da adubação fosfatada e nitrogenada sobre aspectos bromatológicos e a fermentação ruminal da forrageira, no pré e pós pastejo separadamente, além do consumo de matéria seca e ganho de peso de ovinos em pastagem de capim Panicum maximum cv. Massai em sistema rotacionado em Neossolo Quartezarênico. O experimento foi conduzido na Escola de Medicina Veterinária e Zootecnia UFT, com delineamento em blocos casualizados com quatro repetições, fatorial 2x2, utilizando P (50 e 200 kg ha- ¹ de P2 O5 ) e N (100 e 400 kg ha- ¹ de N) e controle não adubado. A área estudada foi constituída de 32 piquetes cada (301 m2 ), com pastagem já estabelecida de P. maximum cv. Massai. A área experimental foi manejada sob lotação intermitente, com taxa de lotação variável utilizou-se 28 ovinos sem raça definida, para fazer o manejo de altura de pasto. As avaliações foram feitas no pré e pós pastejo quanto a bromatologia, degradabilidade ruminal, e consumo, (utilizando dióxido de titânio como indicador externo de consumo). Para as frações FDN, FDA, PB, Lignina e P existentes na planta observou-se diferença (p<0.05) entre o tratamento controle e o adubado. As adubações empregadas alteram a qualidade nutricional do capim P. maximum cv. Massai. Dentre as variáveis nutricionais avaliados, as adubações influenciam os teores de FDN, a digestibilidade do capim e o consumo de matéria seca dos animais. Os parâmetros para o capim-massai são melhorados pela adubação nitrogenada em uma dose equivalente a 100 kg N kg ha-¹ e fosfatada até 50 kg P2 O5 kg ha-¹, constituindo prática de manejo relevante quando se busca ganho em quantidade e qualidade.(AU)
Subject(s)
Animals , Sheep/growth & development , Sheep/metabolism , Pasture , Phosphorus, Dietary , Nitrogen , Weight GainABSTRACT
The effects of phosphate and nitrogen fertilization on aspects of forage composition and ruminal fermentation were separately evaluated pre- and post-grazing, in addition to the dry matter intake and weight gain of sheep grazing Panicum maximum cv. Massai under a rotational system on Quartzipsamment soil. The aim was to evaluate the effect of fertilization with different levels of phosphorous (50 and 200 kg P2 O5 /ha) and nitrogen (100 and 400 kg N/ha) compared to unfertilized control soil. The experiment was conducted at the School of Veterinary Medicine and Animal Science at Universidade Federal do Tocantins UFT, in a randomized complete block design with four replicates in a factorial 2 × 2 design. The study area consisted of 32 paddocks (301 m²), each of which had previously been sown with Panicum maximum cv. Massai. The experimental area was managed under intermittent stocking with a variable stocking rate. Twenty-eight crossbreed sheep were used for grazing management. Evaluations were made before and after grazing, including forage evaluation and measurement of ruminal degradability and intake (using titanium dioxide as the external marker). Regarding the forage composition, a significant difference (P < 0.05) was observed between the control and fertilizer treatments for neutral detergent fiber (NDF), acid detergent fiber, crude protein, lignin and phosphorous content. Fertilization was found to alter the nutritional quality of Panicum maximum cv. Massai grass. Among the nutritional aspects evaluated, fertilization influenced NDF, grass digestibility and dry matter intake. The forage composition of Massai grass is improved by fertilization with nitrogen at 100 kg N/ha and phosphate up to 50 kg P2 O5 /ha, which represents a relevant management practice for increasing quantity and quality.
Objetivou-se avaliar os efeitos da adubação fosfatada e nitrogenada sobre aspectos bromatológicos e a fermentação ruminal da forrageira, no pré e pós pastejo separadamente, além do consumo de matéria seca e ganho de peso de ovinos em pastagem de capim Panicum maximum cv. Massai em sistema rotacionado em Neossolo Quartezarênico. O experimento foi conduzido na Escola de Medicina Veterinária e Zootecnia UFT, com delineamento em blocos casualizados com quatro repetições, fatorial 2x2, utilizando P (50 e 200 kg ha- ¹ de P2 O5 ) e N (100 e 400 kg ha- ¹ de N) e controle não adubado. A área estudada foi constituída de 32 piquetes cada (301 m2 ), com pastagem já estabelecida de P. maximum cv. Massai. A área experimental foi manejada sob lotação intermitente, com taxa de lotação variável utilizou-se 28 ovinos sem raça definida, para fazer o manejo de altura de pasto. As avaliações foram feitas no pré e pós pastejo quanto a bromatologia, degradabilidade ruminal, e consumo, (utilizando dióxido de titânio como indicador externo de consumo). Para as frações FDN, FDA, PB, Lignina e P existentes na planta observou-se diferença (p<0.05) entre o tratamento controle e o adubado. As adubações empregadas alteram a qualidade nutricional do capim P. maximum cv. Massai. Dentre as variáveis nutricionais avaliados, as adubações influenciam os teores de FDN, a digestibilidade do capim e o consumo de matéria seca dos animais. Os parâmetros para o capim-massai são melhorados pela adubação nitrogenada em uma dose equivalente a 100 kg N kg ha-¹ e fosfatada até 50 kg P2 O5 kg ha-¹, constituindo prática de manejo relevante quando se busca ganho em quantidade e qualidade.