François Mrcog Gardeil

To determine if measuring fetal abdominal fat antenatally using ultrasound can predict fetal growth restriction (FGR). One hundred thirty-seven unselected women with singleton pregnancies had serial ultrasound scans at 20, 26, 31, and 38 weeks' gestation. Subcutaneous fat in the fetal abdomen was measured using the same section as the abdominal circumference (AC). Outcome measures were birth weight, neonatal morbidity, and ponderal index. Infants with subcutaneous fat less than 5 mm at 38 weeks (n = 51) were almost five times more likely to have a birth weight below the 10th centile than those with subcutaneous fat of 5 mm or more (n = 75). The incidence of neonatal morbidity was significantly higher in infants with subcutaneous fat less than 5 mm, compared with those with subcutaneous fat of 5 mm or more (20% versus 8%, P < .05). Decreased subcutaneous fat was also associated with a high prevalence of low ponderal index, regardless of birth weight category. Measurement of fat in the abdominal wall is a simple technique with a sensitivity for predicting low birth weight similar to that of conventional sonography and might potentially predict FGR irrespective of fetal weight.

Objective To determine if measuring fetal abdominal fat antenatally using ultrasound can predict fetal growth restriction (FGR). Methods One hundred thirty-seven unselected women with singleton pregnancies had serial ultrasound scans at 20, 26, 31, and 38 weeks' gestation. Subcutaneous fat in the fetal abdomen was measured using the same section as the abdominal circumference (AC). Outcome measures were birth weight, neonatal morbidity, and ponderal index. Results Infants with subcutaneous fat less than 5 mm at 38 weeks (n = 51) were almost five times more likely to have a birth weight below the 10th centile than those with subcutaneous fat of 5 mm or more (n = 75). The incidence of neonatal morbidity was significantly higher in infants with subcutaneous fat less than 5 mm, compared with those with subcutaneous fat of 5 mm or more (20% versus 8%, P < .05). Decreased subcutaneous fat was also associated with a high prevalence of low ponderal index, regardless of birth weight category. Conclusion Measurement of fat in the abdominal wall is a simple technique with a sensitivity for predicting low birth weight similar to that of conventional sonography and might potentially predict FGR irrespective of fetal weight.

Previous studies on large loop excision of the transformation zone (LLETZ) report a high incidence of negative histology on the LLETZ specimens. Overtreatment may occur when there is a low threshold to treat at the first visit. In 1993, we performed LLETZ on 276 patients: in 97 (35 percent) the treatment was undertaken at the first visit. The diagnosis of neoplasia was not confirmed in 10 (3·7 percent) patients. Our study shows that a policy of selective ‘see and treat’ may minimise overtreatment of patients referred for colposcopy. We recommend that the negative histology rate after LLETZ is used as an index of the quality of care in colposcopy services.

A series of hysterectomies performed during labor or shortly after delivery, all as emergencies is reported. The study covered the ten years 1982-1991, during which 65,488 deliveries resulted in infants with a birth weight of 500 g or more. There were no hysterectomies among the 21,998 primipara, the incidence in multipara being 1 per 3,954 deliveries. Five operations were performed for rupture of the uterus and six for cataclysmic bleeding. Seven of the 11 patients had history of caesarean section. In multipara, the existence of a caesarean scar multiplied the risk of emergency hysterectomy by a factor of 18. There were no maternal deaths but all patients required transfusion with more than 6 units of packed cells. These results emphasize the fact that a history of caesarean is the principal etiologic factor in patients experiencing complications of pregnancy which require emergency peri-partum hysterectomy.