Philip Owen

How useful is uterine artery Doppler flow velocimetry in the prediction of pre-eclampsia, intrauterine growth retardation and perinatal death? An overview.

Objective To evaluate the clinical usefulness of Doppler analysis of the uterine artery velocity waveform in the prediction of pre‐eclampsia and its associated complications of intrauterine growth retardation and perinatal death.

Validity of ultrasound estimation of fetal weight.

Objective To assess the validity of ultrasound estimation of fetal weight at term. Methods We conducted a prospective observational study whereby all ultrasonic biometric measurements were done by a single observer. Fifty pregnant women at term had ultrasonic measurement of various fetal biometric parameters performed within a week of delivery. Fetal weight was estimated by the use of four reported methods (Aoki, Campbell, Shepard, and Hadlock formulas). We compared estimated weight with the birth weight after the estimated fetal weight was adjusted by adding 25 g for each day between the ultrasound measurements and delivery. Results The adjusted estimated fetal weight obtained from all four formulas tended to be lower than measured birth weight. The smallest mean difference was obtained with the Shepard and Aoki formulas (51.4 g and 60.5 g, respectively), whereas the Campbell and Hadlock formulas produced larger mean differences (141.8 g and 190.7 g, respectively). The Aoki formula generated the smallest range between the limits of agreement (−324.2 to 445.2 g) whereas the Campbell formula produced the largest range (−286.5 to 570.1 g). The range between the limits of agreement generated with the Shepard and Hadlock formulas were intermediate between those produced by the Aoki and Campbell formulas. The intraclass correlation coefficients generated with the Aoki and Shepard formulas were identical (0.90). The intraclass correlation coefficients obtained with the Hadlock (0.84) and Campbell formulas (0.85) were lower. Conclusion The validity of ultrasonic estimation of fetal weight at term with all four formulas was high.

The diagnostic accuracy of cervico‐vaginal fetal fibronectin in predicting preterm delivery: an overviev

Objective To determine the accuracy with which cervico‐vaginal fetal fibronectin predicts preterm delivery using systematic quantitative overview of the available literature.

Is there any value in the long term follow up of women treated for endometrial cancer

Objective To evaluate the clinical benefit of routine follow up of women after treatment for endometrial adenocarcinoma.

Fetal growth velocity in the prediction of intrauterine growth retardation in a low risk population

Objective To determine whether fetal growth velocity derived from two antenatal ultrasound measurements in the third trimester, 28 days apart, can identify infants born with anthropometric features of intrauterine growth retardation.

Relationship between customised birthweight centiles and neonatal anthropometric features of growth restriction

Objective To determine the relationship between customised birthweight centiles (adjusted for maternal and fetal physiological variables) and neonatal anthropometric features of intrauterine growth restriction (IUGR).

Fetal size and growth velocity in the prediction of intrapartum caesarean section for fetal distress

Objective To evaluate and compare third trimester ultrasound measurements of fetal size and growth velocity in the prediction of intrapartum operative delivery for fetal distress and admission to the special care baby unit in a low risk antenatal population undergoing labour at term.

Interval between fetal measurements in predicting growth restriction.

Objective To determine the influence of the interval between fetal measurements on performance of fetal growth velocity for predicting infants with anthropometric features of fetal growth restriction (FGR). Methods Two hundred seventy-four low-risk women had serial fetal biometry at scheduled intervals. Growth velocity of the fetal abdominal area for each was calculated with 2-, 4-, and 6-week scan intervals in which the second measurement was the last scan before delivery. Fetal abdominal area velocity over a 4-week interval in the early third trimester also was included. Fetal growth restriction was defined as skinfold thickness under the tenth percentile, ponderal index under the 25th percentile, midarm circumference–to–occipitofrontal circumference ratio of under 21 standard deviation (SD). Test performance was expressed as likelihood ratios with 95% confidence intervals (CI). Results Fetal abdominal area velocity calculated over a 4-week interval predicted FGR with a likelihood ratio of 10.4 (95% CI 3.9, 26) for skinfold thickness; 9.5 (95% CI 4.6, 19) for ponderal index; and 4.7 (2.3, 8.4) for midarm circumference–to–occipitofrontal circumference ratio. Intermeasurement intervals of 6 weeks had a likelihood ratio of 8.5 (95% CI 4, 17) for skinfold thickness; 7.5 (95% CI 3.4, 16.1) for ponderal index; and 14 (6.7, 28) for midarm circumference–to–occipitofrontal circumference ratio. The likelihood ratios for the 2-week interval and the early third trimester 4-week interval were all less than 5. Conclusion Four- and 6-week measurement intervals were useful for predicting infants with FGR and were superior to a 2-week interval. Fetal growth velocity is influenced by proximity of the last fetal measurement to date of delivery, which adversely affects clinical use of growth velocity for predicting FGR.

Prediction of intrauterine growth restriction with customised estimated fetal weight centiles

Objectives 1.To determine the value of third trimester customised estimated fetal weight centile ranking in the prediction of infants born with anthropometric features of intrauterine growth restriction (IUGR). 2. To compare the performance of customised centiles with fetal growth velocity in the prediction of IUGR.

A critical evaluation of follow-up of women treated for endometrial adenocarcinoma.

A retrospective review of all women diagnosed with endometrial adenocarcinoma over a 5-year period was performed. One hundred and eleven women had not defaulted from follow-up and were thought to be disease-free following primary treatment. Seventeen (15.3%) of this group of women developed recurrent disease; four of these being detected in asymptomatic patients at routine follow-up visits. Women with asymptomatic recurrences had a significantly better survival than those presenting with symptoms (25% vs. 8%, P = 0.048). On the basis of previous findings, a limited hospital surveillance protocol was applied retrospectively to these patients with an estimated financial saving of over 2500 per annum. However, as one asymptomatic recurrence was detected by vault cytology during the 2 years after primary treatment, it may be worthwhile continuing to perform vault cytology during this period.