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The TOT outside-in procedure can be easily, safely, and effectively performed in low-resource settings using a generic polypropylene tape.

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Aim: Asymmetric intrauterine growth restriction (IUGR) carries increased intrauterine and neonatal risks. Since most cases are idiopathic, identifying a predictive test remains an ideal prevention management. Maternal serum ferritin level is a potential predictor of later developing asymmetric IUGR. Patients and Methods: Blood samples were drawn, at 30-32 gestational weeks, from 450 women who were then followedup resulting in 32 term pregnancies with asymmetric IUGR. The control group included the first recruited 32 women delivering adequate for gestational age neonates at term. Serum ferritin was then measured in the stored serum samples. Ultrasound scanning was performed at 30-32 weeks then at 37 weeks. Umbilical and middle cerebral artery Doppler scans were added at 37 weeks. Results: Serum ferritin, at 30-32 weeks, was higher in women delivering IUGR babies (19.3±6.83 vs 14±5.18, p<0.01). At 37 weeks, pregnancies with asymmetric IUGR had significantly (p<0.01) higher umbilical artery resistance and pulsatility indices (0.71±0.06 vs 0.59±0.07 and 1.24±0.17 vs 0.86±0.09, respectively). Their middle cerebral artery RI and PI were significantly (p<0.01) lower than controls (0.74±0.09 vs 0.81±0.05 and 1.64±0.07 vs 1.9±0.15, respectively). Ferritin level correlated significantly with neonatal birthweight. A cutoff level >18.2 ng/mL had a sensitivity of 59.4% and a specificity of 90.6%. The area under curve showed an accuracy of 76.8%. Women with ferritin >18.2 ng/ml were 10.23 times more likely to get asymmetrically growth restricted neonates (CI 2.89-36.17, p<0.001). Conclusion: This study presents further evidence that maternal serum ferritin may be a useful test in the prediction of asymmetric IUGR.