Preterm delivery is the main cause of neonatal death and ultrasonographic cervical assessment has been shown to be more accurate than digital examination in recognizing a short cervix. This is a crosssectional study, involving 1131 women at 22-24 weeks of pregnancy, designed to determine the distribution of cervical length and to examine which variables of demographic characteristics and obstetric history increase the risk of a short cervix (15 mm or less). The distribution of maternal demographic and obstetric history characteristics among patients with cervical length ≤15 mm was analyzed and compared to the findings for the general population. Risk ratios (RR) between subgroups were generated from this comparison. Median cervical length was 37 mm and in 1.5% of cases it was 15 mm or less. The proportion of women with a short cervix (≤15 mm) was significantly higher among patients with a low body mass index (RR = 3.5) and in those with previous fetal losses between 16-23 weeks (RR = 33.1) or spontaneous preterm deliveries between 24-32 weeks (RR = 14.1). We suggest that transvaginal sonographic measurement of cervical length be performed as part of a routine midtrimester ultrasound evaluation. There are specific variables of demographic characteristics and obstetric history which increase the risk of detecting a short cervix at 22-24 weeks.

Objective: To determine the value of routine transvaginal color Doppler assessment of the uterine arteries at 22–24 weeks of gestation in the prediction of placental insufficiency. Methods: Women with singleton pregnancies scheduled for routine ultrasound scans at 22–24 weeks were offered Doppler assessment of the uterine arteries by transvaginal ultrasound. The pulsatility index (PI) was obtained for each artery and the mean value was calculated. A mean PI >95th percentile was considered increased. Screening characteristics for predicting placental insufficiency, defined as preeclampsia, fetal growth restriction or intrauterine death, were calculated. Results: Doppler examination of the uterine arteries was carried out in 1,057 singleton pregnancies. The mean uterine artery PI was 1.03 and the 95th percentile was 1.55. In 54 cases (5.1%) the mean PI was >1.55 (screen-positive). In the study population there were 48 cases of preeclampsia (5.1%), 72 fetal growth restrictions (7.5%) and 7 intrauterine deaths (0.7%). The screen-positive group showed an incidence of 47.1% of combined adverse results. The relative risks after a positive screening test were 7.3 (CI 4.2–12.6) for pre-eclampsia, 3.9 (CI 2.3 – 6.6) for fetal growth restriction and 4.5 (CI 3.2–6.4) for overall placental insufficiency. Conclusions: Uterine artery Doppler at 22–24 weeks identifies women at higher risk for the development of subsequent complications of placental insufficiency. This test could be used in combination with other markers to stratify the level of care offered in the third trimester of pregnancy.

Introduction: Obesity and obesity-related diseases are increasing globally with the sharpest increases occurring in low and middle-income countries. Economic residential segregation results in increased exposure to adverse neighborhood environments; however, the impact of segregation on markers of obesity have been mostly investigated in US-based samples. Using a novel spatial measure of neighborhood-level economic residential segregation (hereafter, segregation) we examined the association between segregation, obesity and visceral adiposity in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Methods: The sample included 6,104 women and 4,789 men ages 35-74 with complete geocoded information from the baseline examination of ELSA-Brasil (2008-2010). Segregation was based on data from the 2010 IBGE demographic census and calculated for study-defined neighborhoods using the local Gi* statistic— a spatially weighted z-score that represents how much a neighborhood’s income composition deviates from the larger metropolitan area. Body mass index (BMI) was calculated by dividing the participants’ measured weight in kilograms by their measured height in meters squared. Participants were considered “obese” if they had a BMI greater than 30 kg/m 2 . Visceral adiposity was assessed using measured waist circumference (in cm) as a proxy. Based on statistically significant interactions between gender and segregation, gender-stratified multivariable logistic and linear regression models were used to test associations between segregation and obesity status and visceral adiposity, respectively. Results: Approximately 14% of the sample resided in segregated neighborhoods. Blacks and Browns were more likely to reside in segregated neighborhoods than Whites (Blacks: 25.9%; Browns: 20.2%; Whites: 8.2%). The prevalence of obesity in the sample was 24% among women and 20% among men and was highest among Black women living in the most economically segregated neighborhood environments (35%). After adjusting for age, sex, race, education, income, and study site, segregation was positively associated with obesity among women (OR: 1.29, 95% CI: 1.07-1.56). Associations for men were not statistically significant (OR: 1.07; 95% CI: 0.85-1.34). Similar patterns were found for visceral adiposity among women (High Segregation, β=1.94 ± 0.51, p=0.0002; Medium Segregation, β=0.90 ± 0.39, p=0.0192) with no statistically significant findings among men. Conclusion: Women residing in economically segregated neighborhoods in Brazil appear to be at an increased risk of obesity and have higher levels of visceral adiposity. Black women may be at highest risk in these settings. Policies and/or structural interventions designed to improve neighborhood conditions may be viable strategies to mitigate the burden of obesity in this setting.