Comparative Study of Methods of Fetal Weight Estimation

Comparative Study of Methods of Fetal Weight Estimation INTRODUCTION: Knowledge of fetal weight in utero is important for the obstetrician to decide whether or not to deliver the fetus and also to decide the mode of delivery. Both low birth weight and excessive fetal weight at delivery are associated with increased risk of newborn complications during labor and the puerperium. Various clinical formulae like Johnson’s formula and Dawn’s formula have come into usage for fetal weight estimation. Another formula is the product of symphysiofundal height with abdominal girth in centimeters which gives a fairly good estimate of fetal weight. METHODS: It is a prospective observational study of 200 women at term pregnancy at a hospital.  Patients within 15 days from their Expected Date of Delivery were included in the study. The formulas used in this study are: JOHNSON’S FORMULA SYMPHYSIOFUNDAL HEIGHT X ABDOMINAL GIRTH (AG X SFH) DAWN’S FORMULA HADLOCK’S FORMULA USING ULTRASOUND. RESUTLS: There have been differing results about accuracy of various methods of estimating fetal weight. This study showed that AG X SFH was the best indicator among all other methods assessed followed by Hadlock’s formula by ultrasonographic method. CONCLUSION: Fundal height assessment is an inexpensive method for screening for fetal growth restriction. SFH measurement continues to be used in many countries on large scale because of its low cost, ease of use, and need for little training as the setup for ultrasonographic evaluation is not readily available in rural setups. KEYWORDS: Fetal Weight, At Term Pregnancy, Symphysiofundal Height, Ultrasonography, Newborn Complications INTRODUCTION Knowledge of fetal weight in utero is important for the obstetrician to decide whether or not to deliver the fetus and also to decide the mode of delivery. Both low birth weight and excessive fetal weight at delivery are associated with an increased risk of newborn complications during labor and the puerperium. The perinatal complications associated with low birth weight are attributable to preterm delivery, intrauterine growth restriction (IUGR), or both. For excessively large fetuses, the potential complications associated with delivery include shoulder dystocia, brachial plexus injuries, bony injuries, and intrapartum asphyxia. The maternal risks associated with the delivery of an excessively large fetus include birth canal and pelvic floor injuries and postpartum hemorrhage. The occurrence of cephalopelvic disproportion is more prevalent with increasing fetal size and contributes to both an increased rate of operative vaginal delivery and cesarean delivery for macrosomic fetuses compared with fetuses of normal weight. Estimation of fetal weight being done clinically has received much criticism for less accuracy due to observer variation. Various clinical formulae like Johnson’s formula and Dawn’s formula have come into usage for fetal weight estimation. Another formula is the product of symphysiofundal height with abdominal girth in centimeters which gives a fairly good estimate of fetal weight. AIMS AND OBJECTIVES The aim of this study was to assess the fetal weight in term pregnancies by various methods- abdominal girth (cms) X symphysiofundal height (cms) AG X SFH, Johnson’s formula, Dawn’s formula and Hadlock’s formula using ultrasound, and to compare the methods after knowing the actual weight of the baby after birth. MATERIALS AND METHODS It is a prospective observational study of 200 women at term pregnancy at Dhiraj General Hospital, Vadodara from 1st June 2010 to 31st May 2011. Patients within 15 days from their Expected Date of Delivery were included in the study. Cases of MULTIPLE PREGNANCIES, OLIGO/POLYHYDRAMNIOS, MALPRESENTATIONS AND FIBROID OR ADNEXAL MASSES were excluded THE METHODS JOHNSON’S FORMULA SYMPHYSIOFUNDAL HEIGHT X ABDOMINAL GIRTH. DAWN’S FORMULA HADLOCK’S FORMULA USING ULTRASOUND. JOHNSON’S FORMULA: WEIGHT IN GRAMS = (SYMPHYSIOFUNDAL HEIGHT – x) X 155. Here symphysiofundal height is taken after correcting the dextrorotation, from the upper border of symphysis to the height of the fundus. station of the head was noted: x = 12 when head was at or above the level of the ischial spines x = 11 when head was below the level of ischial spines. AG X SFH: Weight in grams = abdominal girth (AG) x symphysiofundal height (SFH) (AG X SFH) Abdominal girth was measured at the level of umbilicus and symphysiofundal height as described earlier. DAWN’S FORMULA: WEIGHT IN GRAMS = Longitudinal diameter of the uterus x (transverse diameter of the uterus)2 x 1.44 2 HADLOCK’S FORMULA: After head circumference, abdominal circumference and femur length were measured in centimeters, the sonography machine calculated the fetal weight. Fetal weight estimated by the above four methods was compared with the actual weight of the baby after birth. A comparative analysis of the four methods was done. OBSERVATION AND RESULTS TABLE I: WEIGHT WISE DISTRIBUTION TABLE II : AVERAGE ERROR IN CALCULATION OF FETAL WEIGHT IN VARIOUS GROUPS Average error in all fetal weight groups except in >3500 gms was least with AG X SFH closely followed by Hadlock’s ultrasound method. Average error in > 3500 gms group was least with Johnson’s formula. TABLE III : NUMBER OF CASES UNDERESTIMATED AND OVERESTIMATED IN VARIOUS FORMULAS Number of over and under-estimations in all fetal weight groups was calculated. AG X SFH and Dawn’s formula had a tendency to underestimate. The other 2 methods overestimated. In > 3500 gms group, all methods underestimated. TABLE IV : MAXIMUM ERROR IN ALL FETAL WEIGHT GROUPS Most marked with Dawn’s and least with AG X SFH. By both these methods maximum error was in the 3001- 3500 gms group. By Johnson’s formula, maximum error was in the TABLE V: PERCENTAGE ERROR IN VARIOUS METHODS Percentage error was calculated using: x/y x 100 x= error in grams y= birth weight in grams As seen in the table, 85.5% cases came within 15% of actual birth weight by both Hadlock’s and AG X SFH methods. As compared to only 50% and 63.5% by Dawn’s and Johnson’s formula, respectively. TABLE VI: STANDARD DEVIATION OF PREDICTION ERROR The standard deviation of prediction error was least with Hadlock’s formula, closely followed by AG X SFH. It is much higher with Dawn’s and Johnson’s formulae. The variance between the four methods was statistically different. p value DISCUSSION Birth weight is a key variable affecting fetal and neonatal morbidity, particu- larly in preterm and small-for-dates babies. In addition, it is of value in the management of breech presentations, diabetes mellitus, trial of labour, macrosomic fetuses and multiple births. Clinicians’ estimates of birth weight in term pregnancy were as accurate as routine ultrasound estimation in the week before delivery. Furthermore, parous women’s estimates of birth weight were more accurate than either clinical or ultrasound estimation. There have been differing results about the accuracy of the various methods of estimating fetal weight. This study showed that AG X SFH was the best indicator among all of the other methods assessed followed by Hadlock’s formula by ultrasonographic method. Other studies have reported limited accuracy of ultrasound EFW at term, particularly in macrosomic fetuses but over all accuracy of this formula is same for all infants. Equipped with information about the fetal weight the obstetrician managing labour is able to pursue sound obstetric management, reducing perinatal morbidity and mortality. Symphysiofundal height is one of the important clinical parameters taken for fetal weight estimation by AG X SFH, Johnson’s formula, Dawn’s formula. According to my study, Hadlock’s ultrasonographic method was the most accurate for estimating fetal weight. Of the three clinical methods, AG X SFH has better predictable results than the other 2 methods. AG X SFH, a clinical formula can be of great value in a developing country like ours where ultrasound is not available at many health care delivery centres. It is easy and simple, can be used even by midwives. With less errors AG X SFH is easier to apply by paramedical workers for the evaluation of fetal weight even in the rural setup as like our area of this study. By this study the results are suggesting that Hadlock’s formula has least standard deviation but it requires ultrasonographic evaluation. So after it, AG X SFH is the second most formula for estimation of featl weight which is clinically applicable and most reliable method in the absence of sonologic setup. CONCLUSION Fundal height assessment is an inexpensive method for screening for fetal growth restriction.1 Clinicians are biased in their fundal height measurements by knowledge of gestational age and use of a marked measuring tape. This tendency increases with higher patient BMI and with less provider experience.2 While we have yet to establish reliable tests to predict which pregnancies are at risk of developing IUGR, surveillance of fetal growth in the third trimester of pregnancy continues to be the mainstay for the assessment of fetal well-being. Such surveillance is done by regular fundal height assessment, ultrasound biometry or a combination of both methods.3 Relative growth of the SF height seems to be independent of fetal sex, maternal obesity and parity.4 There is disagreement in SFH measurement between observers regarding the ability to separate small fundal heights from those that are not small (Bailey 1989). This becomes an issue especially in a clinical setting where the pregnant woman sees more than one clinician during the course of her pregnancy. Despite this, SFH measurement continues to be used in many countries on a large scale simply because of its low cost, ease of use, and need for very little training.5 Ultrasound evaluation of fetal growth, behavior, and measurement of impedance to blood flow in fetal arterial and venous vessels form the cornerstone of evaluation of fetal condition and decision making.6 REFERENCES 1).Morse K, Williams A, Gardosi J (December 2009). â€Å" Fetal growth screening by fundal height measurment†. 2).Jelks A, Cifuentes R, Ross MG (October 2007) Clinician bias in fundal height measurement. 3).Gardosi Francis 1999, Morse et al 2009.  «Standardised protocol for measurment of symphysio fundal height » 4).Bergman E, Axelsson O, Kieler H, Sonesson C, Petzold M. Relative growth for estimation of intrauterine growth retardation. . Submitted. 2010. 5).Robert Peter J, Ho J, Valliapan J, Sivasangari S. Symphysial fundal measurement (SFH) in pregnancy for detecting abnormal fetal growth (Protocol). The Cochrane Library. 2009(Issue 4). 6).Resnik R. Intrauterine growth restriction. Obstet Gynecol. 2002 March.

Women’s Role in China Essay example -- Women Feminism Chinese Culture

Women’s Role in China "The emotional, sexual, and psychological stereotyping of females begins when the doctor says: 'It's a girl.'" -Shirley Chislom- Women have had changing roles in every society for centuries. Depending on the country, some women have had a harder time achieving equality. One of these countries is China. These women have faced such obstacles as foot binding to concubines. Until the twentieth century women were not considered equals in their society. Many cruel things were done to women in ancient china that are considered unfathomable in other countries. According to Confucius women weren’t equal to men because they were unworthy or incapable of literary education. This was as much as he mentioned women because it was such a natural idea to him that there was no need to mention it, as other early Chinese writers and theorists thought. Women were only considered property and had to obey their brothers and fathers no matter what. Fathers also despised their daughters to the point where instead of being named they were considered daughter number one and daughter number two, etc. Once the woman was married instead of being property to her brother and father, she was now property to her husband and mother in law, whom also despised the girl. It was also common for a husband to have three or four wives. If a woman’s husband were to die she was unable to remarry, sometimes causing women to commit suicide due to no fo od or income. If a woman were to remarry then her skin was peeled of her bones until she died. Another cruel act that was practiced in ancient china against women was foot binding. This tradition started around 1000 when an Emperor believed his concubines small feet were beautiful. This process began when a girl was between three and eleven. â€Å"Her toes were turned under her feet and pressed against the bottom of her foot. The arches were then broken as the foot was pulled straight with the leg, a long narrow cotton bandage would then be tightly wound around the foot from the toes to the ankle to hold to toes in place† (W., Jacob 1). The bandages would then be tightened everyday. This would cause the foot to be around 3 inches long, called lily feet, and sometimes making the toes fall off for lack of blood flow to them. A girl would be considered unacceptable if her feet were ugly and would not be considered f... ...ing it â€Å"voluntarily† so that they can bring the abortion to the countryside. Due to this the ration in China is 118 males to 100 females because there are half a million female abortions a year. Since there are so few females teenage girls are sold for prostitution and $500 mail order brides since the late 1980s. This has also made the literacy rate of women fall, more than 70% of school dropouts are girls. Because of these dropouts more than 70% of China’s semiliterate or illiterate people are women. In conclusion, the role of women in china has made a drastic change from being concubines to being mayors in major cities. Equality was something that took a long time to achieve but through all the hard work they have eventually overcome many obstacles but there are still many more that they need to work on. Perhaps women will always be looked down upon because that is how it started and that is the origin of many people’s thoughts but achieving the status that they have today is a great success. Although the changes came at a later time than that of the west, equality in China took a shorter amount of time. All in all, Chinese women have had great success in their reforms.

Brunelleschi’s Dome

Filippo Brunelleschi was in many senses a modern day entrepreneur in the Middle Ages. He is the architect and innovator responsible for building the Santa Maria del Fiore, arguably the greatest dome ever built. In the years leading up to and during the construction of the dome, his life was surrounded by managerial aspects. There were several critical success factors for the construction of the dome including access to financial resources, raw materials, and product equipment. The building of the Santa Maria del Fiore was not something that could be done overnight, in fact it took the better of two centuries until it was complete. Probably his greatest competitive advantage, Brunelleschi was able to separate himself from his competitors by using technology to create new products and come up with innovative solutions to problems. Seeing as the creation of the dome was the first project of its kind, certain product equipment was required but not available. Brunelleschi himself invented and created much of the equipment needed, such as the ox driven hoist and the pulley. With the Opera del Duomo constantly bidding out the different projects involved with the construction of the Santa Maria del Fiore, Brunelleschi was able to create far more innovative designs than his competitors to win these bids. Another factor that played into Brunelleschi’s competitive advantage was the fact that there wasn’t much work in the city of Florence. Laborers worked for a cheap rate and did not hold any power. When they went on strike, Brunelleschi simply fired them and found a replacement which was in need of work. Filippo Brunelleschi basically held a monopoly on the labor market. The organizational behavior was one that that the capomaestros, or managers, did not have to motivate the workers one bit. The fact that the workers held employment in a city where jobs were in desperate shortage was enough motivation. Something very important to any project’s completion is time management. Entrepreneurs must master time management skills in order to get your product to the market within your budgeted time. When dealing with a new product, time frames are difficult to estimate because of delays and nforeseen circumstances, but Brunelleschi was able to manage his time and reach deadlines productively. When he had to come up with a way to hoist the marble up to the top of the dome, he did it quickly and effectively. When there was an unexpected crack in the wall after it was completed and he needed to come up with a way to fix it without delaying the overall completion of the dome, he was able t o. He did not only manage his time productively with the building of the dome but with other projects as well. Like any good entrepreneur, Brunelleschi did not put all of his time and effort into one project such as the dome, but instead took on many side projects. These little projects were not only a source of income or a way to get more recognition, but most importantly they allowed him to test his techniques and skills intended for use on the dome. He gained much respect and notoriety for his skills and successes on projects other than that of the dome. In a sense, these side projects were a way of marketing for himself, showing his precise skills and abilities through these successful projects. Although he seemed to be very well rounded, Brunelleschi did not excel in the area of communication. He was paranoid, constantly worrying about his designs or plans being stolen which is why he kept to himself. He felt as if his competitors believed the saying, â€Å"instinct tells us to watch what our competitors are doing and simply try to do the same thing better. † During a project, communication is key- the managers and workers need to be on the same page and communicate directions and progress. This is something that was never present during the building of the dome. In a business, knowledge must be shared within all units of the organization, but Brunelleschi did not believe this. If Brunelleschi had known the importance of communication, he could have received feedback from his workers and possibly avoided setbacks such as the cracks in the nave of the church. In addition to his lack of communication, another setback of Brunelleschi’s technique was the poor working environment. The culture of the business created during the building of the dome was not a worker friendly one, with no benefits or accommodations given to the workers. There was no set of directions but rather, workers ‘went with the flow’ as Brunelleschi gave directions on the fly. This was a disadvantage to his progress because things may be forgotten without realizing their importance and crucial role to the project. With his big fear of plagiarism, it’s no surprise the very first patent was issued to Brunelleschi for his boat that was to be used as a transporter known as Il Badalone. Ironically, this was Brunelleschi’s most unsuccessful invention but he felt the need to protect it. Nonetheless, it can be seen that patents are a necessity for entrepreneurs. Brunelleschi was in constant fear of his competitors stealing his ideas and designs and this stands true in today’s society as well. Entrepreneurs need to protect their ideas from their competitors because everyone is looking to get ahead and come up with a new and better idea. Brunelleschi often followed his prime instinct, trusting it would work and that it was the best idea. This stood true for many of his projects and inventions. When he decided to lay the transverse bricks to prevent the dome from collapsing, there was no past documentation stating that this would work but he felt that it was the best way to go about it. Often times, entrepreneurs have to make final decisions based on gut instincts and Brunelleschi was what we may call a master of this. Being a very confident man, Brunelleschi often refused advice or help from other sources. He very rarely collaborated with others on designs or projects, but rather did it all himself. It may be argued that he may not have had the success he did if he teamed up with others. It may also be argued that if he did take advice from others, some of his unsuccessful inventions might have had a different and more successful outcome, such as Il Badalone. Filippo Brunelleschi is one of the most influential architects in history, with success in many areas due to his innovative ideas. He had access to plentiful financial resources and was able to take advantage of a labor force that worked for minimal fees. His ingenuity provided him with the capability to create unique product equipment that could not be found anywhere else. Brunelleschi was a proud and confident man, his confidence helping him in many ways. When his theories were questioned, he simply followed through and proved why his designs were going to work. When problems arose on the job, he trusted his intuition and was able to fix the problems. Although he showed many characteristics of an entrepreneur, Filippo Brunelleschi is not known as one of the greatest managers in history. In order to be successful in today’s world, he would have needed to brush up on a few things, such as his poor communication skills due to his fear of plagiarism of his designs and ideas. Communication is a must when talking about being an effective manager, but this was not all he would have to alter. He was a selfish man, refusing to work with others on projects or reluctantly working on a project with others. Effective managers need to be able to collaborate and work with numerous people at once. Brunelleschi was always more worried about his reputation and image rather than the overall well being of the project. A manager needs to put the overall success of the business first before their own ego and pride.

Fences A Play That Revolves Around The Times Of The...

Alex Cano 11/20/16 EN 113 Research Paper Assignment August Wilson, Fences Fences is a play that revolves around the times of the nineteen fifties in the United States focusing in the city of Philadelphia. This was a time where a number of issues occurred going about the social problems facing the African American community. Many African Americans were denied a number of opportunities within the nation due to the color of their skin. This was due to the Jim Crow laws that were implemented into American society by a number of racist white American that held government positions to prevent the growth and prosperity of the African American community. This problem was one that was heavily present throughout most of American history which was never put down because a number of individuals within government opposed the opposition that wanted to rise up against the system that had kept the institution in charge for decades prior. The nation confronted a social problem between white America which was not ready for the black upheaval that was spreading throughout the country during the nineteen fifties. Many had feared about the changes that were occurring. Knowing that the future that would be heavily affected as a result of the upheaval in America. This fear that had lingered was being expressed came from a number of white conservatives that did not support the civil rights movements during this time.Show MoreRelatedRace is Still a Factor in America Essay1497 Words   |  6 Pagesconsidered to be African- American have made several outstanding achievements since the times of segregation; they have obtained the same suffrage rights, the same job opportunities, and many more privileges that were previously denied to them by their Caucasian counterparts. Though the people of African- American decent have come a long way since the early times of segregation, are they truly seen as equals to the p eople around them? 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