Fetal growth restriction (FGR) diagnosed before 32 weeks is identified by fetal smallness associated with Doppler abnormalities and is associated with significant perinatal morbidity and mortality and maternal complications. Recent studies have provided new insights into pathophysiology, management options and postnatal outcomes of FGR. In this paper we review the available evidence regarding diagnosis, management and prognosis of fetuses diagnosed with FGR before 32 weeks of gestation.

Background There is an increasing interest in first trimester risk prediction models for pre-eclampsia.Objectives To systematically review and critically assess the building and reporting of methods used to develop first trimester risk prediction models for pre-eclampsia.Search strategy Search of PubMed and EMBASE databases from inception to July 2013.Selection criteria Logistic regression model for predicting the risk of pre-eclampsia in the first trimester, including uterine artery Doppler among independent variables.Data collection and analysis We extracted information on study design, outcome definition, participant recruitment, sample size and number of events, risk predictors and their selection and treatment, model-building strategies, missing data, overfitting and validation.Main results The initial search identified 80 articles. A total of 24 studies were eligible for review, from which 38 predictive models were identified. The median number of study participants was 697 [interquartile range (IQR) 377-5126]. The median number of cases of pre-eclampsia per model was 37 . The median number of risk predictors was 5 (IQR 3.75-7). In 22% of the models, the number of events per variable was fewer than the commonly recommended value of 10 events per predictor; this proportion increased to 94% in models for early pre-eclampsia. Treatment and handling of missing data were not reported in 37 models. Only three models reported model validation.Conclusions We found frequent methodological deficiencies in studies reporting risk prediction models for pre-eclampsia. This may limit their reliability and validity.Keywords First trimester, logistic regression, model, prediction, pre-eclampsia, screening, prognosis uterine artery Doppler, validation.Please cite this paper as: Brunelli VB, Prefumo F. Quality of first trimester risk prediction models for pre-eclampsia: a systematic review. BJOG 2015; 122:904-914.

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IntroductionPatients with poor-grade subarachnoid hemorrhage (SAH) admitted to the intensive care unit (ICU) often require prolonged invasive mechanical ventilation due to prolonged time to obtain neurological recovery. Impairment of consciousness and airway protective mechanisms usually require tracheostomy during the ICU stay to facilitate weaning from sedation, promote neurological assessment, and reduce mechanical ventilation (MV) duration and associated complications. Percutaneous dilatational tracheostomy (PDT) is the technique of choice for performing a tracheostomy. However, it could be associated with particular risks in neurocritical care patients, potentially increasing the risk of secondary brain damage.MethodsWe conducted a single-center, prospective, observational study aimed to assess PDT-associated variations in main cerebral, hemodynamic, and respiratory variables, the occurrence of tracheostomy-related complications, and their relationship with outcomes in adult patients with SAH admitted to the ICU of a neurosurgery/neurocritical care hub center after aneurysm control through clipping or coiling and undergoing early PDT.ResultsWe observed a temporary increase in ICP during early PDT; this increase was statistically significant in patients presenting with higher therapy intensity level (TIL) at the time of the procedural. The episodes of intracranial hypertension were brief, and appeared mainly due to the activation of cerebral autoregulatory mechanisms in patients with impaired compensatory mechanisms and compliance.DiscussionThe low number of observed complications might be related to our organizational strategy, all based on a dedicated “tracheo-team” implementing both PDT following a strictly defined protocol and accurate follow-up.