- Email: [email protected]
Response to comment on “Pregnancy outcome after early detection of bacterial vaginosis” [Eur. J. Obstet. Gynecol. Reprod. Biol. 128 (2006) 40–45]
130
Letters to the Editor / European Journal of Obstetrics & Gynecology and Reproductive Biology 132 (2007) 129–135
Response to comment on ‘‘Pregnancy outcome after early detection of bacterial vaginosis’’ [Eur. J. Obstet. Gynecol. Reprod. Biol. 128 (2006) 40–45] To the Editor, We really appreciate the interest shown by Dr. Morency and Dr. Bujold in commenting on our paper. As suggested by our study and further highlighted by the above-mentioned authors, the crucial time for understanding or affecting the natural history of premature labour is very early pregnancy. After the 1st trimester the inflammation pathway arising from lower genital tract infection and possibly leading to premature labour or miscarriage is on its way and it is extremely difficult to counteract. Irrespective of past experiences, we should therefore focus on the early pregnancy group to be able to detect those who are at significantly higher risk of adverse pregnancy outcome. A randomised controlled trial on the early screening and treatment of bacterial vaginosis in the general population is certainly the best way to investigate if this is finally the right way to go. Tullio Ghi* Brunella Guerra University of Bologna, Department of Obstetrics and Gynecology, Italy *Corresponding author. Fax: +39 051 301994 E-mail address: [email protected] (T. Ghi) 25 November 2006 doi:10.1016/j.ejogrb.2006.11.018
DOIs of original articles: 10.1016/j.ejogrb.2006.11.019.
Comment on ‘‘Predicting term birth weight using ultrasound and maternal characteristics’’ [Eur. J. Obstet. Gynecol. Reprod. Biol. 128 (2006) 231–235] To the Editors, Halaska recently published an intriguing comparison of the accuracy of various equations designed to predict fetal birth weight at term [1]. The authors seemed surprised to find that an equation we developed – which derives its predictions entirely from maternal characteristics [2] – was equal in accuracy to the popular Shepard equation [3], which is based exclusively on ultrasonographic fetal measurements.
DOI of original article: 10.1016/j.ejogrb.2006.12.008.
The maternal characteristics equation used by Halaska et al. is only 1 of a set of 61 patented equations that is currently available for birth weight prediction [4]. The equations use five different kinds of information (maternal characteristics, paternal factors, pregnancy-specific information, laboratory data, and fetal ultrasonographic measurements) to make birth weight predictions, as each type of information explains a unique portion of the variance in fetal weight that the other types cannot. For primigravidas, 38 of the 61 equations combine maternal characteristics information with sonographically derived fetal measurements for prediction purposes. All 61 equations are capable of predicting term birth weight with a high degree of accuracy up to 3 months before delivery. Currently, an Internet-based system at http://www.BabyWeightFinder.com automatically selects the best equation to provide the greatest accuracy given the maternal and ultrasonographic data that are available [5]. As is well known to practitioners, a complete set of patient information often is not available when a birth weight prediction is desired. Collectively, the new system of equations can accommodate this situation, as it is versatile enough to allow birth weight predictions to be made when only limited types of information are available. By using integrated information from different sources, the equations provide prospective birth weight estimates that are far more accurate than those that rely on ultrasound-based information alone. In a retrospective analysis of 218 term pregnancies [6], our combination equations yielded predictions that were 20% more accurate than those derived from the Hadlock equation that Halaska et al. suggested was optimal for detecting fetal macrosomia [1,7]. If Halaska et al. had tested our combination algorithms, they would have found our algorithms superior to the other equations they evaluated. In fact, the high degree of accuracy demonstrated by the BabyWeightFinder.com system of equations (up to 75% sensitivity and 93% specificity for fetal macrosomia, with corresponding positive and negative predictive values of 67% and 95%, respectively) enables practitioners to use sonographic fetal measurements obtained as long as 11 weeks before delivery to reliably identify evolving fetal macrosomia up to 3 months before birth. As such, both the accuracy and advance timing of these birth weight predictions are far better than for any other methodology. Because the results can be obtained far in advance of delivery, they provide both practitioners and patients with an opportunity to either avoid the occurrence of fetal macrosomia entirely (by reducing caloric intake, effecting earlier delivery, or both) or minimize the potentially adverse consequences to the mother and fetus associated with a macrosomic birth (by delivering the fetus via cesarean section). Thus, by using the new system of versatile birth weight prediction equations, both the timing and mode of delivery for oversized fetuses can be managed optimally so as to successfully minimize the risk of adverse outcomes.
Letters to the Editor / European Journal of Obstetrics & Gynecology and Reproductive Biology 132 (2007) 129–135
Response to comment on ‘‘Pregnancy outcome after early detection of bacterial vaginosis’’ [Eur. J. Obstet. Gynecol. Reprod. Biol. 128 (2006) 40–45] To the Editor, We really appreciate the interest shown by Dr. Morency and Dr. Bujold in commenting on our paper. As suggested by our study and further highlighted by the above-mentioned authors, the crucial time for understanding or affecting the natural history of premature labour is very early pregnancy. After the 1st trimester the inflammation pathway arising from lower genital tract infection and possibly leading to premature labour or miscarriage is on its way and it is extremely difficult to counteract. Irrespective of past experiences, we should therefore focus on the early pregnancy group to be able to detect those who are at significantly higher risk of adverse pregnancy outcome. A randomised controlled trial on the early screening and treatment of bacterial vaginosis in the general population is certainly the best way to investigate if this is finally the right way to go. Tullio Ghi* Brunella Guerra University of Bologna, Department of Obstetrics and Gynecology, Italy *Corresponding author. Fax: +39 051 301994 E-mail address: [email protected] (T. Ghi) 25 November 2006 doi:10.1016/j.ejogrb.2006.11.018
DOIs of original articles: 10.1016/j.ejogrb.2006.11.019.
Comment on ‘‘Predicting term birth weight using ultrasound and maternal characteristics’’ [Eur. J. Obstet. Gynecol. Reprod. Biol. 128 (2006) 231–235] To the Editors, Halaska recently published an intriguing comparison of the accuracy of various equations designed to predict fetal birth weight at term [1]. The authors seemed surprised to find that an equation we developed – which derives its predictions entirely from maternal characteristics [2] – was equal in accuracy to the popular Shepard equation [3], which is based exclusively on ultrasonographic fetal measurements.
DOI of original article: 10.1016/j.ejogrb.2006.12.008.
The maternal characteristics equation used by Halaska et al. is only 1 of a set of 61 patented equations that is currently available for birth weight prediction [4]. The equations use five different kinds of information (maternal characteristics, paternal factors, pregnancy-specific information, laboratory data, and fetal ultrasonographic measurements) to make birth weight predictions, as each type of information explains a unique portion of the variance in fetal weight that the other types cannot. For primigravidas, 38 of the 61 equations combine maternal characteristics information with sonographically derived fetal measurements for prediction purposes. All 61 equations are capable of predicting term birth weight with a high degree of accuracy up to 3 months before delivery. Currently, an Internet-based system at http://www.BabyWeightFinder.com automatically selects the best equation to provide the greatest accuracy given the maternal and ultrasonographic data that are available [5]. As is well known to practitioners, a complete set of patient information often is not available when a birth weight prediction is desired. Collectively, the new system of equations can accommodate this situation, as it is versatile enough to allow birth weight predictions to be made when only limited types of information are available. By using integrated information from different sources, the equations provide prospective birth weight estimates that are far more accurate than those that rely on ultrasound-based information alone. In a retrospective analysis of 218 term pregnancies [6], our combination equations yielded predictions that were 20% more accurate than those derived from the Hadlock equation that Halaska et al. suggested was optimal for detecting fetal macrosomia [1,7]. If Halaska et al. had tested our combination algorithms, they would have found our algorithms superior to the other equations they evaluated. In fact, the high degree of accuracy demonstrated by the BabyWeightFinder.com system of equations (up to 75% sensitivity and 93% specificity for fetal macrosomia, with corresponding positive and negative predictive values of 67% and 95%, respectively) enables practitioners to use sonographic fetal measurements obtained as long as 11 weeks before delivery to reliably identify evolving fetal macrosomia up to 3 months before birth. As such, both the accuracy and advance timing of these birth weight predictions are far better than for any other methodology. Because the results can be obtained far in advance of delivery, they provide both practitioners and patients with an opportunity to either avoid the occurrence of fetal macrosomia entirely (by reducing caloric intake, effecting earlier delivery, or both) or minimize the potentially adverse consequences to the mother and fetus associated with a macrosomic birth (by delivering the fetus via cesarean section). Thus, by using the new system of versatile birth weight prediction equations, both the timing and mode of delivery for oversized fetuses can be managed optimally so as to successfully minimize the risk of adverse outcomes.