Early fetal growth: concepts and pitfalls

Abstract

Background: Postpancreatectomy haemorrhage (PPH) is a major cause of morbidity and mortality after pancreaticoduodenectomy (PD). It remains unclear whether performance of a pancreatogastrostomy (PG) instead of a pancreatojejunostomy (PJ) improves outcomes owing to better endoscopic accessibility. Methods: A large retrospective analysis was undertaken to compare outcomes of PPH, depending on whether a PG or PJ was performed. The primary outcome was the rate of successful endoscopy. A secondary outcome was the therapeutic success after adding surgery. Results: Of 944 patients who had a PD, 8·4 per cent developed PPH. Endoscopy was the primary intervention in 21 (81 per cent) of 26 patients with a PG and 34 (64 per cent) of 53 with a PJ; it identified the bleeding site in 35 and 25 per cent respectively (P = 0·347). Successful endoscopic treatment was more common in the PG group (31 versus 9 per cent; P = 0·026). Surgery was performed for PPH in 15 patients (58 per cent) with a PG and 35 (66 per cent) with a PJ (P = 0·470). The majority of haemorrhages that required surgery were non‐anastomotic intra‐abdominal haemorrhages (12 of 15 versus 21 of 35; P = 0·171). Endoscopic or conservative treatment for PPH was successful in 42 per cent of patients with a PG and 32 per cent with a PJ (P = 0·520). The success rate increased to 85 and 91 per cent respectively when surgery was included in the algorithm (P = 0·467). Conclusion: The type of pancreatic anastomosis and its inherent effect on endoscopic accessibility had very little impact on the outcome of PPH. This was because haemorrhage frequently occurred from intra‐abdominal or non‐anastomotic intraluminal lesions. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Is first-trimester crown-rump length associated with birthweight?

“…Indeed, a fetus conceived earlier than assumed will be larger than expected on ultrasound examination, and gestational age will be underestimated at birth. Such a neonate may therefore be considered to be LGA, leading to a spurious association between faster than expected growth in early pregnancy and the risk of macrosomia 29 . The association between early growth and BW persisted when we used a definition of abnormal growth that was independent of gestational age, such as a BW of more than 4000 g, and even when gestational age was estimated from the measured CRL.…”

“…The association between early growth and BW persisted when we used a definition of abnormal growth that was independent of gestational age, such as a BW of more than 4000 g, and even when gestational age was estimated from the measured CRL. Because CRL is subject to measurement errors, 29 larger CRL values will, on average, have a positive measurement error and therefore overestimate gestational age, whereas smaller values will, on average, have a negative measurement error and therefore underestimate gestational age. These measurement errors would ‘protect’ against spurious statistical associations.…”

“…A major strength of our study is that we included only patients examined by FMF‐certified operators, as measurement errors may have an impact on the quality of CRL measurements 29 . These sonographers had been evaluated previously and demonstrated a good intra‐ and inter‐observer variability for CRL measurements 24 .…”

Effects of ultrasound pregnancy dating on neonatal morbidity in late preterm and early term male infants: a register-based cohort study

“…However, one should bear in mind that even such assessments can be biased by early growth restriction [33]. A large discrepancy between the estimates derived from US-examination and the date of LMP might constitute an indication for a repeat scan, as it suggests higher odds for adverse outcomes such as early growth restriction [34]. …”

Comment déterminer la date de début de grossesse ?

“…Principalement dans des populations issues de PMA, pour lesquelles la DDG est connue, il a été montré qu'une LCC plus petite qu'attendue était associée à un risque majoré de retard de croissance voire de mort foetale in utero et, à l'inverse, qu'une LCC plus grande qu'attendue était associée à un risque accru de macrosomie, de disproportion foeto-pelvienne et de dystocie (NP3) [48][49][50][51][52][53][54][55][56][57][58][59][60][61]. Il n'y a toutefois à ce jour pas de consensus sur la gestion de telles discordances.…”