Stage-based approach to the management of fetal growth restriction

Fetal growth restriction (FGR) is among the obstetrical entities with the greatest variation in clinical practice. The first clinically relevant step in the management of FGR is the distinction of ‘true’ FGR, associated with signs of abnormal feto-placental function and poorer perinatal outcome, from small for gestational age fetuses, which do not present abnormal Doppler and have near normal perinatal outcome. Such distinction should not be only relied on umbilical artery Doppler, as this parameter identifies only severe, early-onset, forms of placental insufficiency. Instead, FGR should be diagnosed in the presence of any of the factors associated with a poorer perinatal outcome, including Doppler cerebroplacental ratio and uterine artery Doppler, a growth centile below the third centile. Upon diagnosis, differentiating into early-onset and late-onset FGR is useful to distinguish two clear phenotypes, with differences in severity, association with preeclampsia, and sequence of fetal deterioration. Finally, management of FGR aims at an optimal balance between minimizing fetal injury or death versus the risks of iatrogenic preterm delivery. We propose a protocol that integrates current evidence to classify stages of fetal deterioration, and establishes follow-up intervals and optimal delivery timings, which may facilitate decision-making and minimize variability in the clinical management. © 2014 John Wiley & Sons, Ltd.     

Levels of chemical and microbiological pollutants in the vicinity of a waste incineration plant and human health risks: temporal trends

In 2007, a program was initiated to monitor air levels of volatile organic compounds (VOCs) and bioaerosols in the vicinity of a municipal solid waste incinerator (MSWI) (Tarragona, Catalonia, Spain). To investigate the temporal trends of chemical and microbiological pollutants, four 6-monthly campaigns were performed. Air samples were collected at different distances and directions from the facility, as well as in reference sites. In general terms, the concentrations of microbiological agents were very similar to those found in urban zones worldwide. The seasonal evaluation of the results showed higher levels of gram-negative bacteria in winter, contrasting with the increase of the airborne amount of total bacteria in summer. On the other hand, the concentrations of VOCs (mean range: 7.6-18.2 μgm⁻³) were typical of suburban zones. The current exposure to those compounds should not mean additional health risks for the population living nearby.     

Volatile organic compounds and bioaerosols in the vicinity of a municipal waste organic fraction treatment plant. Human health risks

Purpose  

The aim of this study was to analyze air concentrations of chemical and microbiological pollutants in the vicinity of an organic waste treatment plant, Ecoparc-2, located in Montcada i Reixac (Catalonia, Spain), as well as to determine the seasonal trends. The human health risks due to the presence of those agents were also assessed.     

Saharan dust episodes and pregnancy

Desert dust is one of the natural contributors to atmospheric particulate matter worldwide. Although particulate pollution has been shown to adversely affect pregnancy, the available evidence on the impact of dust episodes on pregnancy is very scarce. The aim of this study was to evaluate the impact of Saharan dust episodes on pregnancy complications (preeclampsia and bacteriuria) and outcomes (birth weight and gestational age at delivery). This study was based on a cohort of births (N = 3565) that occurred in a major university hospital in Barcelona during 2003-2005. To determine Saharan dust episodes, we developed a two-stage approach based on meteorological evidence of the presence of Saharan dust cloud over the region and unusually high levels of particulate levels on the ground while taking account of traffic sources. The associations between the number of Saharan dust episodes during whole pregnancy as well as each pregnancy trimester and pregnancy complications and outcomes were analysed. There were 152 days (out of 838 days) with Saharan dust cloud over the region from which 45 days were determined as episodic days. We did not observe any statistically significant harmful effect of Saharan dust episodes on our included pregnancy complications and outcomes. However, we observed a small but statistically significant increase in gestational age at delivery in association with the number of episodic days during the third trimester and whole pregnancy (0.8 and 0.5 days respectively). Our findings were not suggestive for any adverse effect of Saharan dust episodes on our included pregnancy complications and outcomes.     

Baseline levels of bioaerosols and volatile organic compounds around a municipal waste incinerator prior to the construction of a mechanical-biological treatment plant

New waste management programs are currently aimed at developing alternative treatment technologies such as mechanical–biological treatment (MBT) and composting plants. However, there is still a high uncertainty concerning the chemical and microbiological risks for human health, not only for workers of these facilities, but also for the population living in the neighborhood. A new MBT plant is planned to be constructed adjacently to a municipal solid waste incinerator (MSWI) in Tarragona (Catalonia, Spain). In order to evaluate its potential impact and to differentiate the impacts of MSWI from those of the MBT when the latter is operative, a pre-operational survey was initiated by determining the concentrations of 20 volatile organic compounds (VOCs) and bioaerosols (total bacteria, Gram-negative bacteria, fungi and Aspergillus fumigatus) in airborne samples around the MSWI. The results indicated that the current concentrations of bioaerosols (ranges: 382–3882, 18–790, 44–926, and <1–7 CFU/m³ for fungi at 25 °C, fungi at 37 °C, total bacteria, and Gram-negative bacteria, respectively) and VOCs (ranging from 0.9 to 121.2 μg/m³) are very low in comparison to reported levels in indoor and outdoor air in composting and MBT plants, as well in urban and industrial zones. With the exception of total bacteria, no correlations were observed between the environmental concentrations of biological agents and the direction/distance from the facility. However, total bacteria presented significantly higher levels downwind. Moreover, a non-significant increase of VOCs was detected in sites closer to the incinerator, which means that the MSWI could have a very minor impact on the surrounding environment.