AbstractTo evaluate the accuracy of ultrasound in early detection of chorionicity and amnionicity in twin pregnancies and evaluate the role of operator-experience, a prospective follow up of 87 consecutive twin pregnancies was performed. Chorionicity and amnionicity were determined by 17 different observers, divided in 2 groups on the basis of their experience, using a composite of US markers at the first US examination confirming a viable intrauterine twin pregnancy. Accuracy of prediction was determined for both groups by comparison with postnatal pathology. From the 87 pregnancies examined at 10.1 (minimum 5.5 weeks, maximum 26.0) weeks of gestation, pathology was available in 82 cases and a correct prediction of chorionicity was made in all but two cases, both being diagnosed as monochorionic while dichorionic by observers belonging the more experienced group. No monochorionic pregnancy was missed and amnionicity was correctly diagnosed in all cases, including two monoamniotic twins. We conclude that use of a composite of ultrasound markers for early detection of chorionicity and amnionicity is reliable in a clinical setting where physicians with a variable degree of experience perform ultrasound examination.
Context: Interventions targeting maternal obesity are a healthcare and public health priority. Objective: The objective of this review was to evaluate the adequacy and effectiveness of the methodological designs implemented in dietary intervention trials for obesity in pregnancy. Data Sources: A systematic review of the literature, consistent with PRISMA guidelines, was performed as part of the International Weight Management in Pregnancy collaboration. Study Selection: Thirteen randomized controlled trials, which aimed to modify diet and physical activity in overweight and obese pregnant women, were identified. Data Synthesis: There was significant variability in the content, delivery, and dietary assessment methods of the dietary interventions examined. A number of studies demonstrated improved dietary behavior in response to diet and/or lifestyle interventions. Nine studies reduced gestational weight gain. Conclusion: This review reveals large methodological variability in dietary interventions to control gestational weight gain and improve clinical outcomes in overweight and obese pregnant women. This lack of consensus limits the ability to develop clinical guidelines and apply the evidence in clinical practice. ; National Institute for Health Research Health Technology Assessment UK program ; European Union ; EarlyNutrition ; Tommy's Charity ; Kings Coll London, Womens Hlth Acad Ctr, Sch Med, Diabet & Nutr Sci Div, London, England ; Kings Coll London, Womens Hlth Acad Ctr, Div Womens Hlth, London, England ; Early Life Nutr, Nutricia, Trowbridge, Wilts, England ; Univ London Imperial Coll Sci Technol & Med, Dept Cardiovasc Med, London, England ; Kings Coll London, Sch Med, Diabet & Nutr Sci Div, London, England ; Queen Mary Univ London, Barts & London Sch Med & Dent, Womens Hlth Res Unit & Multidisciplinary Evidence, London, England ; Vrije Univ Amsterdam, Med Ctr, EMGO Inst Hlth & Care Res, Dept Publ & Occupat Hlth, Amsterdam, Netherlands ; Queen Mary Univ London, Barts & London Sch Med & Dent, Womens Hlth Res Unit, London, England ; Univ N Carolina, Sch Nursing, Chapel Hill, NC USA ; Univ Politecn Madrid, Fac Ciencias Actividad Fis & Deporte INEF, Madrid, Spain ; Univ Coll Leuven Limburg, Dept Obstet & Gynaecol, Div Mother & Child, Antwerp, Belgium ; Univ Antwerp, Fac Med & Hlth Sci, B-2020 Antwerp, Belgium ; Univ Estadual Campinas, Sch Med Sci, Dept Obstet & Gynecol, Campinas, Brazil ; Univ Adelaide, Sch Paediat & Reprod Hlth, Robinson Inst, Adelaide, SA 5005, Australia ; Katholieke Univ Leuven, Dept Dev & Regenerat, Leuven, Belgium ; Univ Hosp Leuven, Dept Obstet & Gynecol, Leuven, Belgium ; Monash Univ, Sch Publ Hlth, Monash Ctr Hlth Res & Implementat, Melbourne, Vic 3004, Australia ; Norwegian Sch Sport Sci, Dept Sports Med, Oslo, Norway ; Mazandaran Univ, Fac Phys Educ & Sport Sci, Dept Sport Physiol, Babol Sar, Iran ; Oslo Univ Hosp, Dept Obstet & Gynaecol, N-0450 Oslo, Norway ; UKK Inst Hlth Promot Res, Tampere, Finland ; Univ Western Australia, Sch Sport Sci Exercise & Hlth, Perth, WA 6009, Australia ; Univ Modena & Reggio Emilia, Mother Infant Dept, Modena, Italy ; Calif Polytech State Univ San Luis Obispo, Dept Kinesiol, San Luis Obispo, CA 93407 USA ; Sao Paulo Fed Univ Unifesp, Dept Hlth Sci, Phys Therapy Course, Santos, Brazil ; Tech Univ Munich, Klinikum Rechts Isar, Inst Nutr Med, D-80290 Munich, Germany ; Univ Copenhagen, Hvidovre Hosp, Dept Obstet, Copenhagen, Denmark ; Univ Copenhagen, Hvidovre Hosp, Dept Gynecol, Copenhagen, Denmark ; Univ Southern Denmark, Odense Univ Hosp, Dept Obstet & Gynecol, Odense, Denmark ; Sorlandet Hosp, Dept Obstet & Gynecol, Kristiansand, Norway ; Norwegian Univ Sci & Technol, Fac Med, Dept Publ Hlth & Gen Practice, N-7034 Trondheim, Norway ; Univ Copenhagen, Fac Sci, Dept Nutr Exercise & Sports, Copenhagen, Denmark ; Copenhagen Univ Hosp, Nutr Res Unit, Herlev, Denmark ; Natl Matern Hosp, Univ Coll Dublin, Sch Med & Med Sci, UCD Obstet & Gynaecol, Dublin 2, Ireland ; Sao Paulo Fed Univ Unifesp, Dept Hlth Sci, Phys Therapy Course, Santos, Brazil ; EarlyNutrition: 289346 ; Tommy's Charity: 1060508 ; Web of Science
