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Maternal MUAC and fetal outcome in an Indian tertiary care hospital: A prospective observational study.

ABSTRACT: Studies to date demonstrated the relatedness of mid-upper arm circumference (MUAC) measurement of pregnant women to their anthropometry/weight. Hence, the objective was to determine whether maternal MUAC at different gestational age predicted birthweight, and if so, to identify which cut-offs provided the best prediction of low birthweight (LBW) in pregnant women cohort. A total of 928 pregnant women, free of any obstetrical and medical complications known to affect fetal growth, were followed from 20 to 24 weeks' gestation till delivery. Weight, height, and MUAC were determined for the pregnant women, and gestational age along with newborns anthropometry was collected. The mean birthweight was 2.6 ± 0.460 kg. Maternal age, height, weight, MUAC (three time points), gestational age at delivery, and post-natal weight showed positive correlation with birthweight, crown heel length, and head circumference of the neonates. The cut-off limit with the best sensitivity-specificity (54.0 and 59.8, respectively) for MUAC was 23 cm, whereas maternal weight of 55 kg had sensitivity and specificity of 62.5 and 59.9 for predicting LBW. Maternal weight of 55 kg and MUAC value of 23 cm had almost similar sensitivity and specificity for predicting LBW. MUAC (?23 cm) can be considered as a potential indicator of LBW where weighing of pregnant women is not feasible or when presentation for antenatal care is late, especially where pre-pregnancy weights are not available.

SUBMITTER: Vasundhara D

PROVIDER: S-EPMC7083480 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Maternal MUAC and fetal outcome in an Indian tertiary care hospital: A prospective observational study.

Vasundhara Donugama D Hemalatha Rajkumar R Sharma Saurabh S Ramalaxmi Baru Anantha BA Bhaskar Varanasi V Babu JagJeevan J Kankipati Vijaya Radha Krishna RK Mamidi RajaSriswan R

Maternal & child nutrition 20191212 2

Studies to date demonstrated the relatedness of mid-upper arm circumference (MUAC) measurement of pregnant women to their anthropometry/weight. Hence, the objective was to determine whether maternal MUAC at different gestational age predicted birthweight, and if so, to identify which cut-offs provided the best prediction of low birthweight (LBW) in pregnant women cohort. A total of 928 pregnant women, free of any obstetrical and medical complications known to affect fetal growth, were followed f ...[more]

PMID: 31833195

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Project description:BackgroundAntimicrobial resistance, which is commonly observed in the management of pneumonia, is a major threat to public health and is driven by inappropriate antimicrobial use. The aim of this study was therefore to assess the current practice of antimicrobial utilization and clinical outcomes in the management of adult pneumonia at Tikur Anbessa Specialized Hospital.MethodA prospective observational study was conducted in the internal medicine wards of Tikur Anbessa Specialized Hospital. The study was conducted from 1 September 2016 to 30 June 2017 and patients aged ≥ 14 years and diagnosed with pneumonia were included. Chart review and self-administered questionnaire were used to collect data regarding pneumonia diagnosis and management as well as clinical outcomes (stable, complications, and in-hospital mortality). Descriptive statistics and binary logistic regressions were performed for data analyses.ResultsOut of 200 enrolled patients, clinical diagnosis was supported by microbiologic testing and imaging in 75 (37.5%) and 122 (61.0%) cases, respectively. The treatment approach in almost all patients (99.5%) was empirical and no de-escalation therapy was made even after acquiring culture results. The total duration of antimicrobial therapy was 12.05±5.09 days and vancomycin was the most commonly prescribed antimicrobial agent (25%), with 70% of the patients receiving this drug empirically. Nearly, 30% of the patients missed their antimicrobial doses during the course of treatment and stock-out (36.7%) was the major reason. Close to 113 (66%) of the treating physicians used reference books to prescribe antimicrobial agents. Patients' outcomes were found to be stable (66%), in-hospital mortality (18.5%), and ending up in complications (17%). Poor clinical outcome (death and complicated cases) was found to be associated with recent antimicrobial use history (p = 0.007, AOR 2.86(1.33-6.13)), cancer (p = 0.023, AOR 3.46(1.18-10.13)), recent recurrent upper respiratory tract infection (p = 0.046, AOR 3.70(1.02-13.40)), respiratory rate >24 breaths/min or <12 breaths/min (p = 0.013, AOR 2.45(1.21-4.95)) and high level of serum creatinine after initiation of antimicrobial therapy (>1.4mg/dl) (p = 0.032, AOR 2.37(1.07-5.20)).ConclusionAntimicrobials are empirically prescribed without sufficient evidence of indication and microbiological or radiological findings. The practice also is not based on local guidelines and no multidisciplinary approach is apparent. [How about: "It is likely that these factors contributed to higher rates of mortality (18.5%) when compared with similar studies in other countries" instead of this "As a result, there were higher rates of mortality (18.5%) when compared with other similar studies"]. Hence, the hospital requires a coordinated intervention to improve rational use of antimicrobials and clinical outcomes through establishing an antimicrobial stewardship program.

Project description:Asymptomatic myocardial injury following noncardiac surgery (MINS) is an independent predictor of 30-day mortality and may go unrecognized based on standard diagnostic definition for myocardial infarction (MI). Given lack of published research on MINS in India, our study aims to determine incidence of MINS in patients undergoing noncardiac surgery at our tertiary care hospital, and evaluate the clinical characteristics including 30-day outcome.The prospective observational study included patients >65 years or >45 years with either hypertension (HTN), diabetes mellitus (DM), coronary artery disease (CAD), cerebrovascular accident (CVA), or peripheral arterial disease undergoing noncardiac surgery. MINS was peak troponin level of ?0.03 ng/dL at 12-hour or 24-hour postoperative. All patients were followed for 30 days postoperatively. Predictors of MINS and mortality were analyzed using multivariate logistic regression. Patients categorized based on peak troponin cut-off values determined by receiver operating characteristic curve were analyzed by Kaplan-Meir test to compare the survival of patients between the groups.Among 1075 patients screened during 34-month period, the incidence of MINS was 17.5% (188/1075). Patients with DM, CAD, or who underwent peripheral nerve block anaesthesia were 1.5 (P?<?.01), 2 (P?<?.001), and 12 (P?<?.001) times, respectively, more likely to develop MINS than others. Patients with heart rates ?96 bpm before induction of anesthesia were significantly associated with MINS (P?=?.005) and mortality (P?=?.02). The 30-day mortality in MINS cohort was 11.7% (22/188, 95% CI 7.5%-17.2%) vs 2.5% (23/887, 95% CI 1.7%-3.9%) in patients without MINS (P?<?.001). ECG changes (P?=?.002), peak troponin values >1 ng/mL (P?=?.01) were significantly associated with mortality. A peak troponin cut-off of >0.152 ng/mL predicted mortality among MINS patients at 72% sensitivity and 58% specificity. Lack of antithrombotic therapy following MINS was independent predictor of mortality (P?<?.001), with decreased mortality in patients who took post-op ASA (Aspirin) or Clopidogrel. Mortality among MINS patients with post-op ASA intake is 6.7% vs 12.1% among MINS patients without post-op ASA intake. Mortality among MINS patients with post-op Clopidogrel intake is 10.5% vs 11.8% among MINS patients without post-op Clopidogrel intake.A higher (17.5%, 95% CI 15-19%) incidence of MINS was observed in our patient cohort with significant association with 30-day mortality. Serial postoperative monitoring of troponin following noncardiac surgery as standard of care, would identify "at risk" patients translating to improved outcomes.

Project description:BACKGROUND:The aims of this study were to determine the prevalence of the different anti-erythrocytic alloantibodies, to describe pregnancy outcomes according to a low-risk and high-risk classification for fetal anemia and to determine the factors that influence adverse perinatal outcomes. METHODS:This retrospective observational study included women referred to our center following the identification of maternal anti-erythrocytic alloantibodies between 2002 and 2017. Pregnancies were classified as high risk for fetal anemia in cases with clinically significant antibodies, no fetal-maternal compatibility and titers ?1:16 or any titration in cases of Kell system incompatibility. In high-risk pregnancies, maternal antibody titration and the fetal middle cerebral artery peak systolic velocity (MCA-PSV) were monitored. Low-risk pregnancies underwent routine pregnancy follow-up. RESULTS:Maternal antibodies were found in 337 pregnancies, and 259 (76.9%) of these antibodies were clinically significant. The most frequent antibodies were anti-D (53%) and anti-K (19%). One hundred forty-three pregnancies were classified as low risk for fetal anemia, 65 (25%) cases were classified as no fetal-maternal incompatibility, 78 had clinically nonsignificant antibodies, 4 (2.8%) resulted in first-trimester pregnancy loss, and 139 (97.2%) resulted in livebirths. Of the 194 high-risk pregnancies, 38 had titers <?1:16 (resulting in 38 livebirths), and 156 had titers ?1:16 or anti-K antibodies. In the last group, 6 cases miscarried before 18?weeks, 93 had a MCA-PSV <?1.5 multiples of the median (MoM), resulting in 3 perinatal deaths that were unrelated to fetal anemia, one termination and 89 livebirths; and 57 had a MCA-PSV >?1.5 MoM, resulting in 3 intrauterine deaths, 6 terminations and 48 livebirths. Ninety-two intrauterine transfusions were performed in 45 fetuses (87% anti-D). Adverse outcomes were related to a MCA-PSV?>?1.5 MoM (p?<?0.001), hydrops (p?<?0.001) and early gestational age at first transfusion (p?=?0.029) CONCLUSION: Anti-D remains the most common antibody in fetuses requiring intrauterine transfusion. A low or high-risk classification for fetal anemia based on the type of antibody, paternal phenotype and fetal antigen allows follow-up of the pregnancy accordingly, with good perinatal outcomes in the low-risk group. In the high-risk group, adverse perinatal outcomes are related to high MCA-PSV, hydrops and early gestational age at first transfusion.

Dataset Information

Maternal MUAC and fetal outcome in an Indian tertiary care hospital: A prospective observational study.

Publications

Maternal MUAC and fetal outcome in an Indian tertiary care hospital: A prospective observational study.

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