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BMC Pregnancy and Childbirth Feb 2015Fetal growth restriction is among the most common and complex problems in modern obstetrics. Symphysis-fundus (SF) height measurement is a non-invasive test that may... (Review)
Review
BACKGROUND
Fetal growth restriction is among the most common and complex problems in modern obstetrics. Symphysis-fundus (SF) height measurement is a non-invasive test that may help determine which women are at risk. This study is a systematic review of the literature on the accuracy of SF height measurement for the prediction of small-for-gestational-age (SGA) status at birth in unselected and low-risk pregnancies.
METHODS
The Medline, Embase, Cinahl, SweMed, and Cochrane Library databases were searched with no limitation on publication date (through September 2014), which returned 722 citations. Two reviewers then developed a short list of 51 publications of possible relevance and assessed them using the following inclusion criteria: cohort study of test accuracy performed in a routine prenatal care setting; SF height measurement for all participants; classification of SGA, defined as birth weight (BW) < 10th, 5th, or 3rd percentile or ≥ one or two standard deviations below the mean; study conducted in Northern, Western, or Central Europe; USA; Canada; Australia; or New Zealand; and sufficient data for 2 × 2 table construction. Quality of the included studies was assessed in duplicate using criteria suggested by the Cochrane Collaboration. Review Manager 5.3 software was used to analyze the data, including plotting of summary receiver operating curve spaces.
RESULTS
Eight studies were included in the final dataset and seven were included in summary analyses. The sensitivity of SF height measurement for SGA (BW < 10(th) percentile) prediction ranged from 0.27 to 0.76 and specificity ranged from 0.79 to 0.92. Positive and negative likelihood ratios ranged from 1.91 to 9.09 and from 0.29 to 0.83, respectively.
CONCLUSIONS
SF height can serve as a clinical indicator along with other clinical findings, information about medical conditions, and previous obstetric history. However, SF height has high false-negative rates for SGA. Clinicians must understand the limitations of this test. The protocol has been registered in the international prospective register of systematic reviews, PROSPERO (Registration No. CRD42014008928, http://www.crd.york.ac.uk/prospero/display_record.asp?ID=CRD42014008928 ).
Topics: Adult; Female; Fetal Growth Retardation; Humans; Infant, Newborn; Infant, Small for Gestational Age; Predictive Value of Tests; Pregnancy; Pubic Symphysis; Ultrasonography, Prenatal
PubMed: 25884884
DOI: 10.1186/s12884-015-0461-z -
Journal of Obstetrics and Gynaecology :... Oct 2020Bivariate diagnostic meta-analysis was performed to evaluate the diagnostic value of symphysis-fundal height (SFH) for identifying large-for-gestational- age (LGA) (i.e.... (Meta-Analysis)
Meta-Analysis
Bivariate diagnostic meta-analysis was performed to evaluate the diagnostic value of symphysis-fundal height (SFH) for identifying large-for-gestational- age (LGA) (i.e. birth weight >90th centile according to gestational age) and macrosomia (i.e. birth weight >4000 g). Ten databases, e.g. PubMed (MEDLINE), were searched to include English-language studies providing true- and false-positive and true- and false-negative results for this identification. Study quality was assessed using the revised Quality Assessment of Diagnostic Accuracy Studies tool. Synthetic evidence from good quality studies suggested that SFH to identify LGA and macrosomia ( = 23 and 3, respectively) provided a low sensitivity (0.76 and 0.30, respectively), specificity (0.67 and 0.80, respectively) and diagnostic odds ratio (6 and 4, respectively) and 'neither exclusion nor confirmation' strategy (positive and negative likelihood ratios <10 and >0.1, respectively). In conclusion, there is no evidence that SFH is useful to identify LGA or macrosomia.Impact Statement Synthetic evidence has shown that symphysis-fundal height (SFH) is not useful for the detection of low birth weight and small-for-gestational-age babies mainly in developing countries. In the present study bivariate diagnostic meta-analysis was carried out to evaluate the diagnostic value of SFH for identifying large-for-gestational age (LGA) and macrosomia. SFH to identify LGA and macrosomia provided a low sensitivity (0.76 and 0.30, respectively), specificity (0.67 and 0.80, respectively) and diagnostic odds ratio (6 and 4, respectively) and 'neither exclusion nor confirmation' strategy (positive and negative likelihood ratios <10 and >0.1, respectively).There is no evidence that SFH is useful to identify LGA or macrosomia. Further studies are required to provide more generalisable findings to evaluate the identification of LGA or macrosomia and whether the results can be extrapolated toward the subpopulations that subgroup analysis did not evaluate in this meta-analysis.
Topics: Anthropometry; Birth Weight; False Negative Reactions; False Positive Reactions; Female; Fetal Macrosomia; Gestational Age; Humans; Infant, Newborn; Pregnancy; Pubic Symphysis; Reference Values; Sensitivity and Specificity; Uterus
PubMed: 31814480
DOI: 10.1080/01443615.2019.1673713 -
PloS One 2022In low- and middle-income countries (LMIC), measurement of symphysis fundal height (SFH) is often the only available method of estimating gestational age (GA) in... (Meta-Analysis)
Meta-Analysis
In low- and middle-income countries (LMIC), measurement of symphysis fundal height (SFH) is often the only available method of estimating gestational age (GA) in pregnancy. This systematic review aims to summarize methods of SFH measurement and assess the accuracy of SFH for the purpose of GA estimation. We searched PubMed, EMBASE, Cochrane, Web of Science, POPLINE, and WHO Global Health Libraries from January 1980 through November 2021. For SFH accuracy, we pooled the variance of the mean difference between GA confirmed by ultrasound versus SFH. Of 1,003 studies identified, 37 studies were included. Nineteen different SFH measurement techniques and 13 SFH-to-GA conversion methods were identified. In pooled analysis of five studies (n = 5838 pregnancies), 71% (95% CI: 66-77%) of pregnancies dated by SFH were within ±14 days of ultrasound confirmed dating. Using the 1 cm SFH = 1wk assumption, SFH underestimated GA compared with ultrasound-confirmed GA (mean bias: -14.0 days) with poor accuracy (95% limits of agreement [LOA]: ±42.8 days; n = 3 studies, 2447 pregnancies). Statistical modeling of three serial SFH measurements performed better, but accuracy was still poor (95% LOA ±33 days; n = 4 studies, 4391 pregnancies). In conclusion, there is wide variation in SFH measurement and SFH-to-GA conversion techniques. SFH is inaccurate for estimating GA and should not be used for GA dating. Increasing access to quality ultrasonography early in pregnancy should be prioritized to improve gestational age assessment in LMIC.
Topics: Developing Countries; Female; Gestational Age; Humans; Pregnancy; Pubic Symphysis; Ultrasonography, Prenatal; Uterus
PubMed: 36007078
DOI: 10.1371/journal.pone.0272718 -
Frontiers in Pediatrics 2022Avulsion fractures of the pelvis and hip region are typical injuries in adolescent athletes. Avulsion sites include the muscle tendon origin or insertion, and treating...
Avulsion fractures of the pelvis and hip region are typical injuries in adolescent athletes. Avulsion sites include the muscle tendon origin or insertion, and treating these injuries surgically or conservatively remains a debated issue. The main goals of this review were to assess and summarize injury types and sites, treatment-related clinical outcomes, and return to sport for adolescent patients with a pelvis avulsion fracture and to provide support for making treatment decisions. The PubMed database was searched in November 2021 to identify all published articles from 2000 to 2021 that reported the outcome and return to sport after conservative or surgical treatment. Eighteen studies with 453 patients were included in this review. The age range was 13.6-16.8 years. The most common injury site the was anterior superior iliac spine (37%), followed by the anterior inferior iliac spine (31%), ischial tuberosity (14%), lesser trochanter (9%), iliac crest (8%), and superior corner of the pubic symphysis (1%). Overall complications were lower in the surgical group compared to the conservative group. The rate of return to pre-injury activity level was greater in patients who underwent surgical treatment ( < 0.05). In conclusion, surgery is preferred for major dislocation and fragment size, providing a better return-to-sport rate and decreasing the risk of complications.
PubMed: 36210934
DOI: 10.3389/fped.2022.947463 -
BMC Musculoskeletal Disorders Apr 2017Avulsion fractures of the pelvic apophyses typically occur in adolescent athletes due to a sudden strong muscle contraction while growth plates are still open. The main... (Comparative Study)
Comparative Study Meta-Analysis Review
Operative versus conservative treatment of apophyseal avulsion fractures of the pelvis in the adolescents: a systematical review with meta-analysis of clinical outcome and return to sports.
BACKGROUND
Avulsion fractures of the pelvic apophyses typically occur in adolescent athletes due to a sudden strong muscle contraction while growth plates are still open. The main goals of this systematic review with meta-analysis were to summarize the evidence on clinical outcome and determine the rate of return to sports after conservative versus operative treatment of avulsion fractures of the pelvis.
METHODS
A systematic search of the Ovid database was performed in December 2016 to identify all published articles reporting outcome and return to preinjury sport-level after conservative or operative treatment of avulsion fractures of the pelvis in adolescent patients. Included studies were abstracted regarding study characteristics, patient demographics and outcome measures. The methodological quality of the studies was assessed with the Coleman Methodology Score (CMS).
RESULTS
Fourteen studies with a total of 596 patients met the inclusion criteria. The mean patient age was 14.3 ± 0.6 years and 75.5% of patients were male. Affected were the anterior inferior iliac spine (33.2%), ischial tuberosity (29.7%), anterior superior iliac spine (27.9%), iliac crest (6.7%) lesser trochanter (1.8%) and superior corner of the pubic symphysis (1.2%). Mean follow-up was 12.4 ± 11.7 months and most of the patients underwent a conservative treatment (89.6%). The overall success rate was higher in the patients receiving surgery (88%) compared to the patients receiving conservative treatment (79%) (p = 0,09). The rate of return to sports was 80% in conservative and 92% in operative treated patients (p = 0,03). Overall, the methodological quality of the included studies was low, with a mean CMS of 41.2.
CONCLUSION
On the basis of the present meta-analysis, the overall success and return to sports rate was higher in the patients receiving surgery. Especially in patients with fragment displacement greater 15 mm and high functional demands, surgical treatment should be considered.
Topics: Adolescent; Athletic Injuries; Clinical Decision-Making; Conservative Treatment; Female; Fractures, Avulsion; Humans; Male; Orthopedic Procedures; Pelvic Bones; Return to Sport; Treatment Outcome
PubMed: 28420360
DOI: 10.1186/s12891-017-1527-z -
Forensic Science International Aug 2021Forensic age estimation is routinely applied in investigations involving identification of individuals. Over the past century a myriad of methods have been devised for... (Meta-Analysis)
Meta-Analysis
Forensic age estimation is routinely applied in investigations involving identification of individuals. Over the past century a myriad of methods have been devised for age estimation. One such method, proposed by Suchey and Brooks in 1990, groups the observed changes occurring in the pubic symphysis into six phases, each defined by a corresponding age range. The present study was piloted with the focussed question being to empirically determine the accuracy of the Suchey-Brooks method in computed tomographic age estimation by analysing morphological changes occurring in the pubic symphysis. Original articles pertaining to the use of the Suchey-Brooks method for CT based age estimation were extracted from four different databases- PubMed, CENTRAL, Google Scholar and ScienceDirect. Research papers which were answering the focussed question were selected for data analysis. After assessing the risk of bias of the selected articles, the data was subjected to Meta-analysis. Pooled analysis of correctly/accurately aged individuals/remains using the random and fixed effect models yielded a prediction percentage of 78% and 86%, respectively. Higher percentages were obtained for phase-wise and subgroup analysis, indicating that the Suchey-Brooks method is a reliable method for age estimation.
Topics: Age Determination by Skeleton; Forensic Anthropology; Humans; Pubic Symphysis; Tomography, X-Ray Computed
PubMed: 34229142
DOI: 10.1016/j.forsciint.2021.110811 -
Medicine, Science, and the Law Jan 2023Age estimation is one of the essential criteria in the identification process. The method of age estimation employed depends on the availability of skeletal material... (Meta-Analysis)
Meta-Analysis
Age estimation is one of the essential criteria in the identification process. The method of age estimation employed depends on the availability of skeletal material brought for forensic examination. McKern and Stewart's method constitutes one of the principal approaches towards pubic symphyseal age estimation. The method entails evaluating morphological changes within the pubic symphysis and subsequently allotting a specific score corresponding to the observed changes. Based on the obtained scores, an age range is then assigned to the remains presenting for examination. The present systematic review was undertaken to ascertain the applicability of the McKern-Stewart method for age estimation. Studies pertaining to the use of the McKern-Stewart method for age estimation in skeletal remains were retrieved by keying in a combination of MeSH terms and other free terms from four databases. The retrieved articles were subjected to a stringent inclusion and exclusion criteria, following which the risk of bias was assessed and the overall quality of evidence was established. Once the final tally of relevant articles was obtained, data specific to the mean age corresponding to each score was extracted. Non-parametric tests and boxplots were employed to compare the mean ages reported across multiple studies. The present systematic review concludes that the McKern-Stewart method can be applied for the purpose of age estimation in skeletal remains. Broader age cohorts for higher scores, as well as, overlapping values for age ranges in relation to the cumulative scores, however, can be considered a limitation for its applicability in forensic case work.
Topics: Humans; Pubic Symphysis; Body Remains; Forensic Anthropology; Age Determination by Skeleton; Forensic Medicine
PubMed: 35392731
DOI: 10.1177/00258024221092196