Fetal growth assessment - decision support

Valutazione dello stato di Salute Fetale - supporto decisionale

Programma ideato e scritto da DJR Hutchon (trad. D Spagnolo-HSRaffaele Milano)copyright Per operare regolarmente su PC richiede Internet Explorer 4.0 o superiore (o equivalente) Programma adattato all'anno 2000. Se i dati dello Screening del siero o della Translucenza Nucale non fossero disponibili (o inferiore a 1mm.) lasciare in bianco lo spazio. Valido solo per il calcolo del rischio di sindrome di Down per CRL tra 38 - 84mm o BPD 28 to 50mm. Per la correttezza del calcolo l'assunto č che le mesure della Tanslucenza Nucale (NT) siano state eseguite utilizzando lo stesso protocollo della Fetal Medicine Foundation, and for BPD as described by Benacerraf et al (1987). Istruzione per l'uso OFFLINE

CRL calcolato in accordo alla formula di Smith e Coll. Data in GG/MM/AAAA(anno - 4 digits)
Cognome paziente (Opzionale) Data di Nascita (Obbligatorio)
Data ultima mestruazione Data certa? Si - Lunghezza di un ciclo regolare Di default 28 giorni
Dat dell'esame Translucenza nucale mm. Multiplo mediana= Rischio Down allo screening con siero 1/
Inserire CRL mm o BPD mm (SOLE UNO DIE DUE) Pari a sett + giorni
Frequenza Cardiaca Fetale al momento dell'esame /min
Rischio Down (DS) in base alla sola eta'alla nascita 1/ Rischio Down integrato alla nascita 1/
Rischio Down in base all solo eta', gravidanza in corso 1/ Rischio Down integrato, gravidanza in corso 1/ (includes Frequenza Cardiaca Fetale if entered)
Data prevista parto secondo ultima mestruazione secondo ultrasuoni
42a settimana il
Data parto probabile
Parta elettivo sconsigliabile prima di 14% di rischio di travaglio prima di questa data
Rischio trisomia 18 a 9-14 sett= 1 su a 15-20 sett= 1 su alla nascita= 1 su
Rischio trisomia 13 a 9-14 sett= 1 su a 15-20 sett= 1 su alla nascita= 1 su
Epoca gestazionale mediante U.S in data e' sett +giorni.

Valutazione della salute fetale - sistema esperto

Inserire la data dell'ecografia, le misure, l'AFI e il valore RI dell'arteria ombelicale, se disponibile

Prima || Seconda || Terza Normale
ecogrfia per crescita Z || ecogrfia per crescita Z || ecogrfia per crescita Z +1.645 to
Data punteggio || Data punteggio || Data punteggio -1.645
BPD || BPD || BPD
CC || CC || CC
CA || CA || CA
Femore || Femore || Femore
Gestation sett || sett || sett
Stima peso fetale Kg || Kg || Kg
RI art. ombelicale
AFI
PARERE ESPERTO
..................................
..................................

Il range normale per il punteggio "Z" va da -1.645 a + 1.645. Se fossero disponibili solo due misurazioni, inserire i dettagli dell'esame negli spazi della seconda e teza ecogrfia. Questo calcolatrore č per uso didattico. Si ritiene essere preciso ma l'autore declina ogni responsabilitā circa l'accuratezza del risultato. David J R Hutchon BSc, MB, ChB, FRCOG Consultant Obstetrician, Memorial Hospital, Darlington, England.

OBGYN.net Hot Find
Go to paper on proposal for valid customised charts generation ("Back to the future for Hermanni Boerhaave" published by OBGYN.NET)

Comments and suggestions are welcome and will be included in the comments section.


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REFERENCES
1. Smith GCS, Smith MFS, McNay MB and Flemming JEE First-trimester growth and the risk of low birth weight New England Journal of Medicine 1998;339:1817-22

2. Kurmanavicius J, Wright EM, Royston P, Zimmermann R, Huch R, Huch A, Wisser J. Fetal ultrasound Biometry: 1. Head reference values. British Journal of Obstetrics and Gynaecology. 1999 106:126-135
3. Kurmanavicius J, Wright EM, Royston P, Zimmermann R, Huch R, Huch A, Wisser J. Fetal ultrasound Biometry: 2. Abdomen and femur length reference values. British Journal of Obstetrics and Gynaecology. 1999 106:136-143

4. Moore T R and Cayle J E. The amniotic fluid index in normal human pregnancy. American Journal of Obstetrics and Gynecology 1990;162:1168-73
5. Cuckle H S, & Schmi I Calculating correct Down's syndrome risks. British Journal of Obstetrics and Gynaecology 1999;106:371-372
6. Wald N J, Watt H C, & Hackshaw A K. Integrated screening for Down's Syndrome based on tests performed during the first and second trimester The New England Journal of Medicine 1999;341(7):461-467
7. Pandya P P, Johnson S, Malligianis P, and Nicolaides K H. First Trimester fetal nuchal translucency and screening for chromosomal abnormalities. Ultrasound and early pregnancy Chapter 7
8. Snijders R J M, Holzgreve W, Cuckle H and Nicolaides K H. Maternal age-specific risks for trisomies at 9-14 weeks gestation. Prenatal Diagnosis (1994) 13:543-552 For the purposes of the calculator I have assumed a uniform loss of pregnancies with trisomy 13 and 18 as a result to miscarriage between 9 and 14 weeks and 15 and 20 weeks.
9. Snijders R J M, Sundberg K, Holzgreve W, Henry G, and Nocolaides K H. Maternal age- and gestation specific risk for trisomy 21. Ultrasound in Obstetrics and Gynaecology 1999;13:167-170
10. Zosmer N, Souter V L, Chan C S Y, Huggon I C and Nicolaides K H. Early diagnosis of major cardiac defects in chromosomally normal fetuses with increased nuchal translucency. Brtish Journal of Obstetrics and Gynaecology 1999;106:829-833
11. Madar J, Richmond S & Hey E. surfactant deficient respiratory distress after elective delivery at 'term'. Northern Region Maternity Survey Meeting 1999. Accepted for publication in Acta Paediatrica
12. Hyett J A, Noble P L, Snijders R J M, Montenegro N, & Nicolaides K H. Fetal heart rate in trisomy 21 and other chromosomal abnormalities at 10 - 14 weeks of gestation. Ultrasound Obstet Gynecol 7 (1996) 239-244
13. Hecht C A & Hook EB the imprecision in rates of Down syndrome. (1994) Prenatal Diag 14:729-738
14. Larsen T, Nguyen T H, Greisen G, Engholm G & Moller H. does discrepancy between gestational age determined by biparietal diameter and last menstrual period sometimes signify early intrauterine groath retardation? BJOG 2000,107(2) 235-244
15. Gardosi & Francis A. Early pregnancy predictors of preterm birth: the role of a prolonged menstruation-conception interval. BJOG 2000,107(2),228-237
16. Stiller R J, Lieberson D, Herzlinger R, Siddiqui D, Laifer S A, & Whetham J C G. The association of increased nuchal translucency and spinal muscular atrophy type 1. Prenatal Diagnosis 1999;19:587-589
17. Locatelli A, Piccoli M G, Vergani P, Mariani E, Ghidini A, Mariani S, Pezzullo J. Critical appraisal of the use of nuchal thickness measurements for the predicition of Down syndrome. Am J Obstet Gynecol 2000;182:192-197 The authors point out that caution should be used in the use of the proposed liklihood ratios until other markers such as serum tests are proved to be independent of each other.
18. Nicholaides K H, Snijders R J M, and Cuckle H S Correct estimation of parameters for ultrasound nuchal translucency screening. Prenatal Diagnosis 1998 18;511-523
19. Benacerraf BR, Gelman R, Frigoletto Jr FD Sonographic identification of second-trimester fetuses with Down's syndrome. 1987;