Risk stratification for early-onset fetal growth restriction in women with abnormal serum biomarkers: a retrospective cohort study.

Abnormal maternal serum biomarkers (AMSB), identified through the aneuploidy screening programme, are frequent incidental findings in pregnancy. They are associated with fetal growth restriction (FGR), but previous studies have not examined whether this association is with early-onset (< 34 weeks) or late-onset (> 34 weeks) FGR; as a result there is no consensus on management. The aims of this study were to determine the prevalence and phenotype of FGR in women with AMSB and test the predictive value of placental sonographic screening to predict early-onset FGR. 1196 pregnant women with AMSB underwent a 21-24 week "placental screen" comprising fetal and placental size, and uterine artery Doppler. Multivariable regression was used to calculate a predictive model for early-onset FGR (birthweight centile < 3rd/< 10th with absent umbilical end-diastolic flow, < 34 weeks). FGR prevalence was high (10.3%), however early-onset FGR was uncommon (2.3%). Placental screening effectively identified early-onset (area under the curve (AUC) 0.93, 95% confidence interval (CI) 0.87-1.00), but not late-onset FGR (AUC 0.70, 95% CI 0.64-0.75). Internal validation demonstrated robust performance for detection/exclusion of early-onset FGR. In this cohort, utilisation of our proposed algorithm with targeted fetal growth and Doppler surveillance, compared with universal comprehensive surveillance would have avoided 1044 scans, potentiating significant cost-saving for maternity services.

Third trimester placental volume and biometry measurement: A method-development study.

OBJECTIVES: To test the hypothesis that third trimester placental biometry and volume can be measured by two-dimensional (2D) and three-dimensional (3D) ultrasound in utero, determining which method of measurement was most strongly correlated with true placental size ex vivo. METHODS: Singleton pregnancies underwent placental ultrasound within seven days of delivery (n = 87, 29(+3)-41(+5) weeks). Length and width (linear and curvilinear) and depth were estimated. Placental volume (PV) was estimated using 2D ellipse and shell techniques and 3D rotational (15° and 30° rotation angles) and multiplanar (5 and 10 mm slicing intervals) techniques. Measurements were compared to their true correlates following delivery. Intra- and inter-observer reliabilities of candidate placental size estimates were assessed by intraclass correlation coefficient (ICC). RESULTS: Curvilinear placental length (Rs = 0.24, p = 0.031), width (Rs = 0.27, p = 0.013) and depth (Rs = 0.31, p = 0.0056) correlated well with ex vivo measurements. All methods of PV estimation were related to ex vivo volume (Rs ≥ 0.32, p < 0.01) but not placental weight (p > 0.05); 30° rotational estimation demonstrated the strongest biological correlation (Rs = 0.40, p = 0.0004). Intra- and inter-observer placental size measurements intraclass correlation coefficients were suboptimal (0.59-0.70 and 0.10-0.58 respectively). DISCUSSION: We have demonstrated that it is possible to obtain information about the size of the third trimester placenta in utero using 2D and 3D ultrasound. However it is essential that the reliability (particularly interobserver reliability) of these estimates is improved prior to prospective studies to determine their predictive value.

Blood pressure levels of active pilots compared with those of air traffic controllers.

Currently some 15,212 active airmen are certified to fly with a diagnosis of hypertension. Federal Aviation Administrative blood pressure standards for certification of airmen are considered to be quite liberal. A systematic sample of pre-strike air traffic controllers was extracted from automated medical files maintained by the Aeromedical Certification Branch of the Civil Aeromedical Institute for comparison with airman data. Distributions of blood pressure by age were compared by using conventional non-parametric techniques for 10-year age intervals. Data were also compared with general population findings. Prevalence of hypertension is greater in the general United States population than found with any of the groups reported here. Prevalence of borderline and definite hypertension is seen to increase with age for all groups studied. Prevalence of any degree of hypertension is lower for airline pilots than either the all-airmen group or the air traffic controller group.