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Meternal anthropometry detemines pregnancy outcome.

INTRODUCTION: Placenta nourishes the embryo from early embryonic period by facilitating the nutrition, from the secretion of the uterus by diffusion. As the embryo grows, it becomes structurally complex and it cannot meet its nutritional requirements by simple diffusion. Hence, to meet these nutritional requirements, fetal membranes were evolved namely amnion, chorion, yolk sac, allantois, placenta and umbilical cord. These membranes are of functional importance during the embryonic life, as they are concerned with the supply and storage of the nutrients, respiratory exchange, excretion, passive immunity, production of hormones and mechanical protection of the embryo. (1)

Maternal obesity prior to and during pregnancy is present in 20-34% of all pregnant women. Obesity and high weight gain in pregnancy were correlated with many complications: gestational diabetes, preeclampsia, multifoetal pregnancy, macrosomia, caesarean section, obstetric bleeding, fetal asphyxia at birth. (2,3,4) Pre-pregnancy body size that is adiposity (Overall and central), pre-pregnancy weight gain, and gestational weight gain influence the risk of preterm birth. Maternal obesity may lead to greater placental transfer of nutrients during embryonic and fetal development leading to permanent changes in appetite, metabolism and neuroendocrine function of offspring. Maternal obesity subsequently influences the body composition of offspring mediated through the intra-uterine environment accelerating the intergenerational obesity levels. (5,6,7)

Placental hypertrophy and decreased fetal growth were hypothesized as an adaptation to sustain placental function in underweight pregnant women due to malnutrition. Complications related to underweight mothers were reported as: low APGAR score, low birth weight (LBW), preterm delivery, increase of perinatal mortality. Common life stress during pregnancy is associated with moderately increased placental weight at birth, controlled for length of gestation (4,8). The short maternal height is associated with increased mortality and anthropometric failure among children in India, suggesting intergenerational pathways between a mother's health and social wellbeing during her childhood and her offspring's health. (9)

Mothers with hypertension and anemia were associated with growth restriction of placental weight and chorionic plate area. Pre-pregnancy BMI and pregnancy weight gain were related with an increased possibility of hypertrophy for all three dimensions (Placental weight, thickness, and chorionic plate area) of placental growth. (10)

MATERIALS AND METHODS: The present study was conducted in the Department of Anatomy, Jawaharlal Nehru Medical College, Belgaum. Placentae were collected from Obstetrics and Gynecology Unit of Dr. Prabhakar Kore Charitable Hospital, Belgaum. Data was collected from August 2012 to January 2013. The study was conducted on 391 mothers and their singleton offspring. The study was approved by the KLE University Ethical Clearance Committee. Detailed information about the intended research work was given to the mothers and written consent was obtained from them. A pilot study was carried out before commencing the actual study. This was done to assess the feasibility and practicability of the whole research design. The subjects without antenatal check-up during first trimester and with history of pre-pregnancy systemic and chronic diseases were excluded. Placental morphometry, maternal, and newborn parameters were recorded on predesigned and pretested proforma.

2.1 Methods of Specimen Collection, Preparation, and Assessment of Placental Morphometry (11,12,13):

* Placentae were collected soon after separating the baby from the umbilical cord. The collected placentae were examined thoroughly and washed under running tap water, thereafter, membranes were trimmed.

* The specimens were tagged with numbers for identification, and were transported to the skill lab by placing in a 10% formalin container.

* The weight of each placenta were determined by the digital baby weighing scale CS-8316 (CE certified) and recorded with accuracy of 1 gm.

* The maternal surface area of the placenta was calculated using the formula.

* Surface area = [pi] x dl x ds/4, (Where dl: largest diameter, ds: smallest diameter)

* The Surface area was recorded with accuracy of 1sq cm.

* The volume was recorded using water displacement method, with accuracy of 1 ml.

* The thickness was measured by inserting a calibrated Knitting needle at the center of placenta and measured in centimeter, with accuracy of 0.1cm.

2.2 Parameters of newborn baby assessed were:

* Gestational age, weight of the baby.

* The gestational age was recorded from last menstrual period (LMP) and further confirmed by Ultrasonography (USG); grouped as 28-34, 35-36, 37+ weeks (wk).

* Birth weight was measured by using Digital baby weighing scale CS-8316 (CE certified) with accuracy of 10 gm.

2.3 Maternal Parameters assessed were, (14)

* Maternal pre-pregnancy weight (kg) recorded from antenatal check-up card (i.e., weight recorded within the initial 12 weeks of pregnancy).

* Height (cm)--by using stadiometer.

* Weight before delivery (kg).

Statistical analysis was carried out using SPSS-16. The differences in means were tested using Analysis of Variances and comparisons of means were studied by t-test Differences were considered statistically significant at p value less than 0.05, 0.01 and 0.001. The Box plots were prepared to study the relative distributions placental morphometry and newborn anthropometry.

RESULTS:

Table 1.1: Maternal height distribution

                         Cumulative Percent
               Percent
Height in cm   (n=391)   Observed   Expected

<145             8.2       8.2        9.2
145-149         13.6       21.7       28.0
150-154         29.9       51.7       56.5
155-159         29.9       81.6       81.9
160+            18.4       100       100.00

Total            100

Mean= 153.9, SD=6.7


Maternal height distribution in Table 1.1 and Fig.1.1 reveals that 29.9 percent pregnant women were of height 155-159 cm and 8.2 percent were less than 145 cm. Maternal height followed moderately normal distribution with mean 153.9 and SD 6.7 cm.

Maternal Pre-pregnancy and before delivery weight distributions in Table 1.2 and Fig. 1.2 reveal that in maternal pre-pregnancy weight, a maximum of 27.1 percent were of 50-54.9kg and 14.1 percent were less than 40 kg, whereas, in before delivery maternal weight a maximum 24.3 percent of women were of 55-59.9kg and 5.1 percent were less than 45kg. Cumulative distribution of pre-pregnancy and before delivery weight exhibited weight gain phenomena during pregnancy. Pre pregnancy and before delivery weight followed moderately normal distribution with respective means and SD of 48.4 [+ or -] 8.9 and 58.1 [+ or -] 9.1kg.

Association of birth weight and placental morphometry with maternal height in Table 2 reveal that the birth weight increased consistently and significantly with increasing maternal height groups (p<0.05). Placental weight, volume and surface area did not exhibit any significant difference with increasing maternal height. Though the placental morphometry was higher in third group > (Mean+1SD) as compared to lower two groups [<(Mean-1SD) and (Mean [+ or -] 1SD) ], but their differences were not statistically significant.

Table 3 reveals that birth weight exhibited significant difference with maternal prepregnancy weight at p<0.001. Placental weight and volume increased consistently and significantly with increasing maternal pre-pregnancy weight (p<0.001) while placental surface area was significantly different at p<0.05. Placental thickness did not exhibit any significant difference with maternal pre-pregnancy weight.

Table 4 reveal that birth weight increased consistently and significantly (p<0.05) with three increasing groups of maternal weight gain (< (Mean -1SD), (Mean+1SD) and > (Mean+1SD)). The placental weight and volume increased consistently with maternal weight gain but their differences were not statistically significant, whereas, placental surface area and thickness did not exhibit any consistent and significant differences by maternal weight gain.

DISCUSSION: An Australian study 15 from Brisbane opined the range of pre-pregnancy weight from 50.7-73.2kg with the mean and SD of 61.2 and SD 9.4kg, but in Croatian study (16) the range of prepregnancy weight was 44-116kg with the mean and SD of 64.01 and 9.50kg. Another Australian study from Perth inferred that the mean pre-pregnancy weight was 59.8 and SD 12.3kg. (17) As per the Mysore Parthenon study the mean maternal weight was 56 kg with SD 8.8kg. (18) The range and mean prepregnancy maternal weight of present study was lower than all above mentioned studies, as the mothers were young and from lower socio economic class.

Shivarao et al., (2002) reported that maternal pre-pregnancy weight of Indian mothers was lower (Mean 60.7 with SD 0.1kg) than Chinese (Mean 65.7 with SD 0.1kg) and Malays (Mean 64.3 with SD 0.1kg) at p<0.05. Hence, the authors conclude that pre-pregnancy weight varies with ethnicity and affects the pregnancy outcomes significantly. (19) The variation in anthropometric measures might be due to population migration and gene mixing. Belonging to a particular population group imposes a strong effect on newborn birth weight and birth length, as it is one of the major intrinsic factor in the constitution of anthropologic frame of human beings. (20)

In the present study, birth weight and placental morphometry (Weight, volume and surface area) increased consistently and significantly (p<0.001) with the increasing maternal pre-pregnancy weight. Many other studies support this result to describe the pre-pregnancy weight as surrogate of the nutritional status of mother. (10,16,17,21,19)

In the present study, maternal pre-pregnancy underweight group was associated with lower birth weight and lesser placental morphometry whereas, higher pre-pregnancy weight group was associated with higher birth weight and placental morphometry. These findings were in accordance with earlier studies. (22,23) Therefore, one of the authors has put forth pre-pregnancy weight as one of the most sensitive predictor of birth weight. (24)

Weight gain: Studies from Norway (25), Croatia 16, America10 and Indonesia 24 specified the mean and SD of maternal pregnancy weight gain as 10.6 and 3.5kg, 15.4 and 4.33kg, 9.7 and 5.0kg, and 8.8 and 2.6kg respectively. The mean pre-pregnancy maternal weight gain was lower in present study as compared to the above studies. As many women in the current study were from lower socioeconomic class. Lower socio-economic class, household work, childcare responsibilities and also work outside the home with suboptimal nutrition might result in lower gestational weight gain. The influence of physical activity on birth weight was mediated through gestational weight gain. (26) In the present study, gestational weight gain was significantly (p<0.01) related with birth weight. Hence, current results were in congruence with previous studies. (27,28)

Maternal Height: The range of height in Croatian study was 150-185 cm, with mean height 169.7 and SD 5.81cm (16). In the Mysore Parthenon (18) and Australian17 studies the mean maternal height were 154.6cm with SD 5.4 and 164cm with SD 7.0 respectively. The findings of above studies were higher than current study.

In the present study height exhibited consistent and significant relation with birth weight (p<0.05), similar findings were reported by other studies.161824 Winder et al., (2011) has concluded that height did not show any significant relation with placental morphometry, our study results regarding the association of maternal height and placental morphometry was in congruence with this study. (18) Maternal height indicates the nutritional status of mother in her childhood and pubertal growth i.e., early life. The women with height <145 cm had higher risk of delivering a low birth weight baby (16) and also have lower rate of protein synthesis during pregnancy than tall mothers. (29,30)

CONCLUSION: Maternal pre-pregnancy weight followed moderately normal distribution (mean 48.4 and SD 8.9 kg) with 14.1 percent of women weighing less than 40 kg. Percentiles of birth weight and placental morphometry: weight, volume, and surface area exhibited increasing trend with maternal pre-pregnancy weight. Mean birth weight (p<0.001) and placental morphometry [weight (p<0.001), volume (p<0.001) and surface area (p<0.05)] increased consistently with the increasing maternal pre-pregnancy weight. Gestational weight gain was significantly related with birth weight (p<0.01) however, placental morphometry did not exhibit any significant difference with weight gain. Maternal height followed moderately normal distribution where 8.2 percent of pregnant women had height less than 145cm and 59.8 percent were from height group 150-159cm. The mean maternal height was 153.9cm with SD of 6.7. Percentiles of birth weight exhibited almost increasing trend with maternal height but placental morphometry did not exhibit any consistent relation. Means of birth weight (p<0.05) increased consistently with the increasing maternal height, however, placental morphometry did not show any significant difference.

DOI: 10.14260/jemds/2015/1358

REFERENCES:

(1.) Boyd JD, Hamilton WJ. The Human Placenta, Cambridge, England, W Heffer and sons, 1970, 890, 221p.

(2.) Farley D, Tejero ME, Comuzzie AG. Feto-placental adaptations to maternal obesity in the baboon. Placenta. 2009; 30 (9): 752-60.

(3.) Abrams B, Altman SL, Pickett KE. Pregnancy weight gain: still controversial. Am J Clin Nutr 2000; 71: 1233-41.

(4.) Spinillo A, Capuzzo E, Piazzi G, Ferrati A, Morales V, Matio M. Risk for spontaneous preterm delivery by combined body mass index and gestational weight gain patterns. Acta Obstet Gynecol Scand 1998; 77: 32-6.

(5.) Wise LA, Palmer JR, Heffner LJ, Rosenberg L. Pre-pregnancy body size, gestational weight gain, and risk of preterm birth in African-American women. Epidemiology 2010; 21 (2): 243-52.

(6.) Whitkar RC, Dietz WH. Role of the prenatal environment in the development of obesity. Journal pediatrics 1998; 21:132768-76.

(7.) Levin BE, Govek E. Gestational obesity accentuates obesity in obesity prone progeny. Am J Physiology 1998; 275: 1374-9.

(8.) Marion T, Naomi G, Jorn O, Andrea H, Gunther M. Maternal psychosocial stress during pregnancy and placenta weight: evidence from a national cohort study. PLos One. 2010; 5 (12) e14478.

(9.) Subrmanian SV, Ackerson LK, Davy Smith G, John NA. Association of maternal height with child mortality, anthropometric failure and anemia in India. JAMA 2009; 301 (16): 1691-701.

(10.) Baptiste KR, Salafia CM, Nicholson WK, Anne D, Wang NY, Brancati FL. Maternal risk factor for abnormal placental growth: The National Collaborative Perinatal Project. Pregnancy and Child Birth. 2008; 8: 44.

(11.) Balihallimath RL, Shirol VS, Gan AM, Tyagi NK,.Clinical determinants of placental morphometry and birth weight. IOSR Journal of Dental and Medical Sciences 2013; 10(1): 22-27.

(12.) Scherle WF. A simple method for volumetry of organ in quantitative stereology Mickroskopie 1970; 26: 57-60.

(13.) Barker DJP, Gluckman PD, Godfrey KM, Hardling JE, Ownes JA, Beishre NA, et al. Placental hypertrophy in severe pregnancy anemia. J Obstet Gynecol Br Common W 1970; 77: 398-409

(14.) National Health and Nutrition Examination Survey (NHANES), Anthropometry Procedures Manual Jan-2007.

(15.) Fengxiu O, Parker M, Cerda S, Perason C, Fu L, Gillman MW, et al. Placental weight mediates the effects of prenatal factors on fetal growth: the extent differs by preterm status. Obesity 2013; 21 (13): 609-20.

(16.) Miletic T, Sntoini E, Mikulandra F, Tadin I, Roje D. Effect of parental anthropometric parameters on neonatal birth weight and birth length. Coll Antropol 2007; 31 (4); 993-7.

(17.) Williams LA, Evans SF, Newnham, JP. Prospective cohort study of factors influencing the relative weights of the placenta and newborn infant. BMJ 1997; 314: 1864-8.

(18.) Winder NR, Krishnaveni GV, Veena SR, Hill JC, Karat CL, Thornburg KL, et al. Mother's lifetime nutrition and the size, shape and efficiency of the placenta. Placenta 2011; 32 (11): 806-10.

(19.) Sivarao S, Vidyadaran MK, Jammal ABE, Zainab S, Goh YM, Ramesh KN. Weight, volume and surface area of placenta of normal pregnant women and their relation to maternal and neonatal parameters in Malaya, Chinese, and Indian ethnic groups. Placenta 2002; 23 (8-9): 691-6.

(20.) Miklundra F, Tadin I, Grguric J, Zakanj Z, Perisa M, Mikulandra F. Influence of father's weight and height on weight of male and female newborns. Collegium antropolgicum 2001; 25(1): 59-63.

(21.) Ihunnaya OF, Michelle AW, Anne ES, Diane P. Pre-pregnancy body mass index, gestational weight gain and other maternal characteristics in relation to infant birth weight. Callaway LK, Prins JB, Chang AM, Mcintyre HD. The prevalence and impact of overweight and obesity in an Australian obsetetric population. Med J Aust 2006; 184 (2): 56-9.

(22.) Callaway LK, Prins JB, Chang AM, Mcintyre HD. The prevalence and impact of overweight and obesity in an Australian obsetetric population. Med J Aust 2006; 184 (2): 56-9.

(23.) Chu SY, Bacham DJ, Callahan WM, Whitlock EP, Dietz PM, Berg C, et al. Association between obesity during pregnancy and increased use of health care. N Engl J Med 2008; 358 (14): 1444-53.

(24.) Husaini AM, Husaini YK, Kartono AB, Barizi, Karyadi D. Maternal anthropometry and pregnancy outcomes in Indonesia. WHO Bulletin OMS 1995; 73: 77-9.

(25.) Roland MCP, Fris CM, Voldner N, Godang K, Bollerslev J, Haugen G, et al. Fetal growth versus birth weight: The role of placenta versus other determinants. PLoS ONE 2012; 7 (6): e39324.

(26.) Launer LJ, Villar J, Kestler E, O nis M. The effect of maternal work on fetal growth and duration of pregnancy: a prospective study. Br J Obstet Gynaecol 1990; 97: 62-70.

(27.) Schaefer-Graf UM, Heuer R, Kilavuz O, Pandura A, Henrich W, Vetter K. Maternal obesity not maternal glucose values correlates best with high rates of fetal macrosomia in pregnancies complicated by gestational diabetes. J Perinat Med 2002; 30: 313-21.

(28.) Dietz PM, Callaghan WM, Sharma AJ. High pregnancy weight gain and risk of excessive fetal growth. Am J Obstet Gynecol 2009; 201: 51, e1-6.

(29.) Tanner JM. Growth and development record for head circumference from birth to 16 years. Castlemead publications; Ware: 1983.

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Rupa L. Balihalimath [1], Vijaykumar Shinde [2], Nareshkumar Tyagi [3], Amruta S. Patil [4]

AUTHORS:

[1.] Rupa L. Balihalimath

[2.] Vijaykumar Shinde

[3.] Nareshkumar Tyagi

[4.] Amruta S. Patil

PARTICULARS OF CONTRIBUTORS:

[1.] Tutor, Department of Anatomy, GIMS, Gadag.

[2.] Professor, Department of Anatomy, GIMS, Gadag.

[3.] Professor, Department of Biostatistics, KEL University.

[4.] Senior Resident, Department of Obstetrics & Gynaecology, GIMS, Gadag.

FINANCIAL OR OTHER COMPETING INTERESTS: None

NAME ADDRESS EMAIL ID OF THE CORRESPONDING AUTHOR:

Dr. Rupa L. Balihalimath, KC Rain Road, Gadag. E-mail: rupalb485@gmail.com Date of Submission: 26/06/2015.

Date of Peer Review: 27/06/2015.

Date of Acceptance: 29/06/2015.

Date of Publishing: 03/07/2015.

Table 1.1.2: Maternal pre-pregnancy and before delivery weight
distributions

              Pre-pregnancy weight           Before delivery weight

                    Cumulative Percent              Cumulative Percent
Weight    Percent                         Percent
in Kg     (n=391)   Observed   Expected   (n=391)   Observed   Expected

30-34.9     3.1       3.1        6.6        --         --
35-39.9    11.0       14.1       17.3       0.8       0.8        2.3
40-44.9    19.9       34.0       35.1       4.3       5.1        7.5
45-49.9    17.9       51.9       57.1      13.0       18.2       18.7
50-54.9    27.1       79.0       77.1      18.4       36.6       36.7
55-59.9     9.7       88.7       90.4      24.3       60.9       58.3
60-64.9     6.2       94.9       96.9      17.2       78.0       77.6
65 +        5.1      100.0      100.0      22.0      100.0       100

Total      100.0                  --       100.0                  --

                Mean=48.4, SD=8.9               Mean=58.1, SD=9.1

Table 2: Association of birth weight and placental morphometry with
maternal height

                                                           95%
                                                        Confidence
                                                         Interval
Maternal height
groups                n   Percent  Mean    SD     SE   Lower  Upper

Birth weight in gm; *; [F.sub.2,388]=3.5; p<0.05

< (Mean - 1SD)       59    15.1    2566    474    62   2443   2690
(Mean [+ or -] 1SD)  275   70.3    2654    485    29   2596   2712
> (Mean + 1SD)       57    14.6    2801    499    66   2668   2933

Total                391   100.0   2700    500    25   2613   2711

Placental weight in gm; NS

< (Mean - 1SD)       59    15.1    449.9  97.0   12.6  424.7  475.2
(Mean [+ or -] 1SD)  275   70.3    440.9  93.9   5.7   429.7  452.0
> (Mean + 1SD)       57    14.6    453.7  119.0  15.8  422.1  485.3

Total                391   100.0   440.0  100.0  5.0   434.3  453.9

Placental volume in ml; NS

< (Mean - 1SD)       59    15.1    389.3  91.6   11.9  365.4  413.2
(Mean [+ or -] 1SD)  275   70.3    383.2  95.9   5.8   371.8  394.6
> (Mean + 1SD)       57    14.6    400.4  120.0  15.9  368.5  432.2

Total                391   100.0   384.6  101.0  5.0   376.8  396.5

Placental surface area in cm sq; NS

< (Mean - 1SD)       59    15.1    229.8  49.6   6.5   216.9  242.8
(Mean [+ or -] 1SD)  275   70.3    228.9  48.3   2.9   223.2  234.6
> (Mean + 1SD)       57    14.6    234.3  59.0   7.8   218.7  250.0

Total                391   100.0   229.8  50.1   2.5   224.9  234.8

Placental thickness in cm; NS

< (Mean - 1SD)       59    15.1     2.1    0.4   0.1    2.0    2.2
(Mean [+ or -] 1SD)  275   70.3     2.2    0.4   0.0    2.1    2.2
> (Mean + 1SD)       57    14.6     2.3    0.8   0.1    2.1    2.5

Total                391   100.0    2.1    0.5   0.0    2.1    2.2

Table 3: Association of birth weight and placental morphometry with
maternal pre-pregnancy weight

                                                           95%
                                                        Confidence
                                                         Interval
Pre-pregnancy
weight groups         n   Percent  Mean    SD     SE   Lower  Upper

Birth weight in gm; ***; [F.sub.2,388] = 7.15; p<0.001

< (Mean - 1SD)       55    14.1    2512    506    68   2375   2649
(Mean [+ or -] 1SD)  275   70.3    2652    478    29   2595   2708
> (Mean + 1SD)       61    15.6    2845    471    60   2724   2966

Total                391   100.0   2700    500    25   2613   2711

Placental weight in gm; ***; [F.sub.2,388] = 5.70; p<0.001

< (Mean - 1SD)       55    14.1    415.0  97.6   13.2  388.6  441.4
(Mean [+ or -] 1SD)  275   70.3    442.9  89.8   5.4   432.3  453.6
> (Mean + 1SD)       61    15.6    475.6  124.7  16.0  443.7  507.6

Total                391   100.0   440.0  100.0  5.0   434.3  453.9

Placental volume in ml; ***; [F.sub.2,388] = 5.76; p<0.001

< (Mean - 1SD)       55    14.1    362.5  102.2  13.8  334.8  390.1
(Mean [+ or -] 1SD)  275   70.3    383.6  89.1   5.4   373.1  394.2
> (Mean + 1SD)       61    15.6    421.9  127.7  16.3  389.2  454.6

Total                391   100.0   384.6  101.0  5.0   376.8  396.5

Placental surface area in cm sq; *; [F.sub.2,388] = 4.27; p<0.05

< (Mean - 1SD)       55    14.1    222.2  49.8   6.7   208.7  235.7
(Mean [+ or -] 1SD)  275   70.3    227.7  46.4   2.8   222.2  233.2
> (Mean + 1SD)       61    15.6    246.4  62.3   8.0   230.4  262.3

Total                391   100.0   229.8  50.1   2.5   224.9  234.8

Placental thickness in cm; NS

< (Mean - 1SD)       55    14.1     2.1    0.5   0.1    1.9    2.2
(Mean [+ or -] 1SD)  275   70.3     2.2    0.5   0.0    2.1    2.3
> (Mean + 1SD)       61    15.6     2.1    0.4   0.1    2.0    2.2

Total                391   100.0    2.1    0.5   0.0    2.1    2.2

Table 4: Association of birth weight and placental morphometry with
maternal weight gain

                                                           95%
                                                        Confidence
                                                         Interval

Maternal weight gain  n   Percent  Mean    SD     SE   Lower  Upper

Birth weight in gm; **; [F.sub.2,388] = 4.37; p<0.01

< (Mean - 1SD)       57    14.6    2593    527    70   2453   2733
(Mean [+ or -] 1SD)  281   71.8    2643    476    28   2587   2699
> (Mean + 1SD)       53    13.6    2840    481    66   2707   2972

Total                391   100.0   2700    500    25   2613   2711

Placental weight in gm; NS

< (Mean - 1SD)       57    14.6    430.8  100.3  13.3  404.2  457.4
(Mean [+ or -] 1SD)  281   71.8    442.0  94.0   5.6   431.0  453.1
> (Mean + 1SD)       53    13.6    469.6  114.2  15.7  438.1  501.1

Total                391   100.0   440.0  100.0  5.0   434.3  453.9

Placental volume in ml; NS

< (Mean - 1SD)       57    14.6    374.0  103.0  13.6  346.7  401.4
(Mean [+ or -] 1SD)  281   71.8    383.7  93.0   5.5   372.8  394.6
> (Mean + 1SD)       53    13.6    415.8  120.6  16.6  382.5  449.0

Total                391   100.0   384.6  101.0  5.0   376.8  396.5

Placental surface area in sq cm; NS

< (Mean - 1SD)       57    14.6    228.5  57.8   7.7   213.1  243.8
(Mean [+ or -] 1SD)  281   71.8    228.5  47.9   2.9   222.9  234.2
> (Mean + 1SD)       53    13.6    238.1  52.6   7.2   223.7  252.6

Total                391   100.0   229.8  50.1   2.5   224.9  234.8

Placental thickness in cm; NS

< (Mean - 1SD)       57    14.6     2.2    0.4   0.1    2.1    2.3
(Mean [+ or -] 1SD)  281   71.8     2.1    0.5   0.0    2.1    2.2
> (Mean + 1SD)       53    13.6     2.3    0.8   0.1    2.1    2.5

Total                391   100.0    2.1    0.5   0.0    2.1    2.2
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Title Annotation:ORIGINAL ARTICLE
Author:Balihalimath, Rupa L.; Shinde, Vijaykumar; Tyagi, Nareshkumar; Patil, Amruta S.
Publication:Journal of Evolution of Medical and Dental Sciences
Date:Jul 6, 2015
Words:4212
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