In the second or third trimester a standard ultrasound is done to evaluate several features of the pregnancy, including fetal anatomy. We did not achieve our required sample size of 15 000 women. The remaining 13 520 women were enrolled in mid-pregnancy (mean 22.8 (SD 2.4) weeks’ gestation) and provided baseline characteristics. Flow chart of IRIS study. (1) The study showed no difference in neonatal outcomes among women undergoing ultrasound scans versus women undergoing standard care. Royal College of Obstetricians and Gynaecologists. Umbilical vein varix « Back to Listing Author(s) : Sunil Kabra, MD Presentation A 26 year old primigravida presented for a routine third trimester ultrasound. As the study condition (intervention versus usual care) and time of inclusion were strongly correlated (Pearson’s r=0.73, P<0.001), indicating collinearity,30 we did not include this fixed factor in the multilevel multivariable logistic (or linear) regression analyses. Study design: Two university clinics using routine ultrasound screening in the third trimester were compared with seven county or district hospitals with no routine screening. This strategy was not, however, associated with a reduction in the incidence of severe adverse perinatal outcomes in low risk pregnancies compared with usual care including clinically indicated ultrasonography. Routine third trimester biometry ultrasound scans predict SGA at birth substantially better than care as usual, i.e. This exam is typically done between weeks 18 and 20 of pregnancy. Skråstad RB, Eik-Nes SH, Sviggum O, Johansen OJ, Salvesen KÅ, Romundstad PR, Blaas HG. In a multilevel multivariable logistic regression analysis, routine ultrasonography in the third trimester was not associated with a significant reduction in severe adverse perinatal composite outcome (adjusted odds ratio 0.88, 95% confidence interval 0.70 to 1.20). View Record in Scopus Google Scholar. If the exam-ination cannot be performed completely in accordance with adopted guidelines, the scan should be repeated, at least in part, at a later time, or the patient can be … 11-2008. Antenatal care for uncomplicated pregnancies. Fetal Ultrasound www.healthlinkbc.ca [Accessed March 2019] Le Ray C, Morin L. 2009. But we do not expect that this has biased the comparison between the two strategies as the incidence of adverse outcomes was similar to our estimations. Results Between 1 February 2015 and 29 February 2016, 60 midwifery practices enrolled 13 520 women in mid-pregnancy (mean 22.8 (SD 2.4) weeks’ gestation). Routine Ultrasound in Pregnancy [Internet]. Prenatal ultrasound screening: false positive soft markers may alter maternal representations and mother-infant interaction [correction in: Performance of the ATLAS trigger system in 2015, Screening for fetal growth restriction using ultrasound and the sFLT1/PlGF ratio in nulliparous women: a prospective cohort study, Fetal movement counting for assessment of fetal wellbeing, Anatomopathological changes of the cardiac conduction system in sudden cardiac death, particularly in infants: advances over the last 25 years, Editorial: New approaches to the pathogenesis of sudden intrauterine unexplained death and sudden infant death syndrome, Effectiveness of routine third trimester ultrasonography to reduce adverse perinatal outcomes in low risk pregnancy (the IRIS study): nationwide, pragmatic, multicentre, stepped wedge cluster randomised trial, http://creativecommons.org/licenses/by-nc/4.0/, Lincolnshire Partnership NHS Foundation Trust: CAMHS Consultant Psychiatrist, Cambridgeshire and Peterborough NHS Foundation Trust: Consultant General Adult Community Psychiatry, Hertfordshire Partnership University NHS Foundation Trust: Consultant Perinatal Psychiatrist, Hertfordshire Partnership University NHS Foundation Trust: Consultant Psychiatrist in General Adult Community, Women’s, children’s & adolescents’ health. Design Pragmatic, multicentre, stepped wedge cluster randomised trial. We cannot therefore completely rule out that the study lacked the statistical power to determine if routine ultrasonography has a beneficial or harmful effect on perinatal outcomes compared with usual care. The first theme, the third trimester routine ultrasound as a bonus, showed that the third trimester routine ultrasound plays a different role for women than the routine ultrasounds in the first two trimesters. Acta Obstet Gynecol Scand. Please note: your email address is provided to the journal, which may use this information for marketing purposes. But this approach did not result in a significantly lower incidence of severe adverse perinatal outcomes. The remaining 59 practices participated in the study until 29 February 2016. In a multilevel multivariable logistic regression adjusted for confounders, routine ultrasonography in the third trimester was associated with a higher incidence of induction of labour (1.16, 1.04 to 1.30) and a lower incidence of augmentation of labour (0.78, 0.71 to 0.85). In the intervention and control strategies, we used prenatal SGA and slow fetal abdominal growth as indicators for suspected fetal growth restriction. Authors. Routine ultrasonography was associated with a higher incidence of induction of labour. View options for downloading these results. Minimal changes were made. Manegold G(1), Tercanli S, Struben H, Huang D, Kang A. The positive predictive value of an abdominal circumference below the 10th centile was higher for the second routine scan (59%) at 34-36 weeks’ gestation than for the first scan at 28-30 weeks’ gestation (37%), whereas negative predictive values were similar, in line with the findings of the POP study.11 Thus late third trimester scans seem to have more diagnostic accuracy than earlier ones. Is a routine ultrasound in the third trimester justified? Table 2 shows the personal and clinical baseline characteristics of the participants. Fetal growth restriction is a risk factor for perinatal mortality and morbidity and cardiovascular disease and neurodevelopmental disorders in adulthood, Routine ultrasonography in the third trimester detects neonates who are small for gestational age (SGA) significantly more often than usual care using serial fundal height measurements combined with clinically indicated ultrasonography, Evidence that routine ultrasonography in the third trimester reduces the incidence of severe adverse perinatal outcomes is lacking, In low risk pregnancies, routine ultrasonography in the third trimester combined with clinically indicated ultrasonography was associated with greater antenatal detection of SGA neonates and induction of labour but was not associated with a reduction in severe adverse perinatal outcomes compared with usual care, Based on these findings, routine ultrasonography has no benefit (or harm) to the neonate but was associated with a moderately increased incidence of induction of labour, These findings do not support routine ultrasonography in the third trimester for low risk pregnancies. Time of inclusion, divided into four groups according to the crossover from usual care to the intervention strategy, was considered as a fixed factor. A randomized controlled study to assess the role of routine third trimester ultrasound in low-risk pregnancy on antenatal interventions and perinatal outcome. Nineteen practices performed biometry scans and the others referred women to one of the 18 sonography centres involved in the study. Data are numbers (percentages) unless stated otherwise. As estimated fetal weight and abdominal circumference alone are not good markers of fetal growth restriction, more sensitive methods are needed. Sonographers met predefined quality criteria, and a multidisciplinary protocol was developed for detecting and managing fetal growth restriction to achieve the best quality care possible in a pragmatic nationwide study.1320. Suspected fetal growth restriction was detected and managed based on a protocol specifically developed for this study in a Delphi study incorporating recommendations from national and international guidelines (see appendix 1).13141725. The IRIS study group: Anneloes L van Baar, Utrecht University, Utrecht, Netherlands; Joke M J Bais, Medical Centre Alkmaar, Alkmaar, Netherlands; Gouke J Bonsel, University Medical Centre Utrecht, Utrecht, Netherlands; Judith E Bosmans, VU University Amsterdam, Amsterdam, Netherlands; Jeroen van Dillen, Radboud University Medical Centre, Nijmegen, Netherlands; Noortje T L van Duijnhoven, Radboud University Medical Centre, Nijmegen, Netherlands; William A Grobman, Northwestern University, Chicago, IL, USA; Henk Groen, University of Groningen, Groningen, Netherlands; Chantal W P M Hukkelhoven, Wageningen University and Research, Wageningen, Netherlands; Trudy Klomp, Amsterdam University Medical Centre/AVAG, Amsterdam, Netherlands; Marjolein Kok, Amsterdam University Medical Centre, Amsterdam, Netherlands; Marlou L de Kroon, University of Groningen, Groningen, Netherlands; Maya Kruijt, Dutch Society of Obstetrics and Gynaecology NVOG, Utrecht, Netherlands; Anneke Kwee, University Medical Centre Utrecht, Utrecht, Netherlands; Sabina Ledda, Midwifery practice het Palet/BEN, Rotterdam, Netherlands; Harry N Lafeber, Amsterdam University Medical Centre, Netherlands; Jan M M van Lith, Leiden University Medical Centre, Leiden, Netherlands; Ben Willem Mol, University of Adelaide, Adelaide, Australia; Bert Molewijk, Amsterdam University Medical Centre, Amsterdam, Netherlands; Marianne Nieuwenhuijze, Academie Verloskunde Maastricht, Maastricht, Netherlands; Guid Oei, Maxima Medical Centre, Eindhoven, Netherlands; Cees Oudejans, Amsterdam University Medical Centre, Amsterdam, Netherlands; K Marieke Paarlberg, Gelre Hospitals, location Apeldoorn, Netherlands; Aris T Papageorghiou, University of Oxford, Oxford, UK; Uma M Reddy, Yale University, New Haven, CT, USA; Paul De Reu, Prenataal Screenigscentrum “de Meierij,” Eindhoven, Netherlands; Marlies Rijnders, TNO, Leiden, Netherlands; Alieke de Roon-Immerzeel, Royal Dutch Organisation of Midwives, Netherlands; Connie Scheele, University Medical Centre Utrecht/BEN, Utrecht, Netherlands; Sicco A Scherjon, University Medical Centre Groningen, Groningen, Netherlands; Rosalinde Snijders, Amsterdam University Medical Centre, Amsterdam, Netherlands; Marc E Spaanderman, University Medical Centre Maastricht, Maastricht, Netherlands; Pim W Teunissen, Amsterdam University Medical Centre, Amsterdam, Netherlands; Hanneke W Torij, Rotterdam University of Applied Sciences, Rotterdam, Netherlands; Tanja G Vrijkotte, Amsterdam University Medical Centre, Amsterdam, Netherlands; Myrte Westerneng, Amsterdam University Medical Centre, Amsterdam, Netherlands Kristel C Zeeman, University of Amsterdam, Amsterdam, Netherlands; and Jun Jim Zhang, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Statistical analyses were performed with the Statistical Package for Social Science (SPPS V.22; IBM, Chicago, IL) and R (V.3.4.3). Presentation This 18 year old woman, primigravida, presented for a routine antenatal scan at 31 weeks of gestation. In this stepped wedge cluster randomised trial we evaluated the effectiveness of routine ultrasonography in the third trimester combined with usual care (ie, serial fundal height measurements with clinically indicated ultrasonography) in reducing severe adverse perinatal outcomes in low risk pregnancies compared with usual care alone. As recruitment was slower than anticipated, the predefined recruitment period of one year was extended, and hence the second group of midwifery practices crossed over to the intervention strategy one month later than planned (fig 1). Performed weekly if FGR is noted on ultrasound. Although higher numbers of births were observed in obstetrician led care in the intervention strategy compared with usual care strategy (65.0% v 63.3%; table 5), this association was not significant in a multilevel multivariable logistic regression adjusted for confounders (1.05, 0.96 to 1.14). Even if the quality of ultrasonography is improved, the most appropriate screening test for fetal growth restriction is not clear. Effectiveness and cost-effectiveness of routine third trimester ultrasound screening for intrauterine growth restriction: study protocol of a nationwide stepped wedge cluster-randomized trial in The Netherlands (The IRIS Study), New charts for ultrasound dating of pregnancy and assessment of fetal growth: longitudinal data from a population-based cohort study. Inclusion criteria for women with a low risk pregnancy were: antenatal care in a participating midwifery practice at enrolment, age 16 years or older, a singleton pregnancy, no major obstetric or medical risk factors, and a reliable expected date of delivery based on a dating scan or a reliable first day of the last menstrual period.14 Participants provided written informed consent for data usage. A randomized controlled study to assess the role of routine third trimester ultrasound in low-risk pregnancy on antenatal interventions and perinatal outcome. Data from hospital files on fetuses with a suspected severe adverse perinatal outcome were used to analyse the level of adherence to the multidisciplinary protocol for diagnosing and managing fetal growth restriction. Which third trimester screening strategy is most effective in detecting fetal growth restriction is controversial. Of the pregnant women (n=107) referred to obstetrician led care because of a fetal abdominal circumference below the 10th centile, 97% (74 of 76) in the intervention strategy had additional ultrasound scans compared with 97% (30 of 31 women) receiving usual care. The third trimester ultrasound is called a Growth scan or a fetal wellbeing scan. The psychological burden of routine prenatal ultrasound on women's state anxiety across the three trimesters of pregnancy Caterina Businelli , Stefano Bembich , Cristina Vecchiet, Caterina Cortivo, Alessia Norcio, Maria Francesco Risso, Mariachiara Quadrifoglio, Tamara Stampalija We therefore conducted a large pragmatic trial, the IUGR Risk Selection (IRIS) study, to evaluate the effects of offering routine ultrasonography in the third trimester to low risk pregnant women in the Netherlands. Policies for routine third trimester obstetrical ultrasound examinations differ among countries. Another explanation for our findings might be that the quality of ultrasound scans was too low. While occasional false contractions are expected, regular contractions should wait until close to your due date. 1;31(2):113-9. Because of the cluster randomised design, we included midwifery practice as a random effect in the multilevel regression models. I've had an uneventful and easy pregnancy so far (31 weeks). Author information: (1)Obstetrics and Gynecology, Ultrasound Unit, University Women's Hospital of Basel, Basel, Switzerland. For suspected severe adverse perinatal outcomes based on the Perined database, five trained research assistants retrieved detailed clinical data from hospital files using standard case report forms. Would you like email updates of new search results? Drukker et al (BJOG 2020 xxxx) present a very interesting systematic review and meta-analysis examining the prevalence and type of fetal anomalies detected during routine third-trimester scans. The second composite outcome was spontaneous labour and birth, defined as a spontaneous vaginal birth with no induction or augmentation of labour, no drug pain relief, no vacuum or forceps assisted birth, and no caesarean section. Is that normally the case? This chapter was last updated: March 2008. Use Of Ultrasound As A Screening Test; Level 1 Versus Level 2 Ultrasound; Clinical Application Of Obstetric Ultrasound; Summary; References; This chapter should be cited as follows: Watson, W, Seeds, J, Glob. Some sonographers worked in both primary care centres and hospitals and others worked in primary care only. Salomon, J.-P. Bernard, Y. Ville. J SAFOG, 6 (2014), pp. The routine use of 3rd trimester Doppler Ultrasound studies resulted in the identification of an additional 30.28% fetuses in the EFW 10-50th centile or 11.26% of overall screened population (n=76 of 675 fetuses) to be at risk for adverse perinatal outcomes. Nevertheless, our findings are in line with a previous meta-analysis, which failed to show better perinatal outcomes in women who received routine ultrasound scans after 24 weeks’ gestation, based on 13 previous trials (n=34 980).15. View Record in Scopus Google Scholar. Optimal risk assessment of small-for-gestational-age fetuses … Of 5049 women (84.4% of 5979 women) receiving usual care, who were not referred to obstetrician led care before 37 weeks’ gestation, 41.0% (n=2072) did not receive a third trimester ultrasound scan. Previous research suggests that most of these babies are likely to be constitutionally small rather than growth restricted and would not be at increased risk of severe adverse perinatal outcomes.11 Women assigned to the usual care strategy had one clinically indicated ultrasound scan on average in the third trimester of pregnancy. We performed a multilevel analysis only if the expected number of events per cluster was at least one, as advocated previously.33 We used an intention to treat approach. OBJECTIVE: To evaluate whether serial ultrasound ex-aminations in the third trimester increase identification of a composite of growth or amniotic fluid abnormalities when compared with routine care among pregnancies that are uncomplicated between 24 0/7 and 30 6/7 weeks of gestation. What A Third Trimester Ultrasound Cannot Reveal? Table 3 shows the diagnostic accuracy for detecting SGA at birth (birth weight <10th centile) for both screening strategies. both the second and third trimesters are necessary. routine ultrasound in the third trimester after two normal. Interventions 60 midwifery practices offered usual care (serial fundal height measurements with clinically indicated ultrasonography). Routine third trimester ultrasonography: avoiding “too much too soon”. Clinical guideline [CG62], 2008. www.rcog.org.uk/en/guidelines-research-services/guidelines/antenatal-care/. Fetal gestational age corresponded to 34 weeks. As a first step, we conducted univariable logistic regression analyses to see if routine ultrasonography in the third trimester was associated with a reduction in severe adverse perinatal outcomes and adverse secondary neonatal and maternal outcomes. This funding source had no role in study design, data collection, data analysis, data interpretation, writing of the scientific article, or the decision to submit the paper for publication. | This will have limited the … The manuscript’s guarantor (AdJ) affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained. We recommend to examine the psychological impact of third trimester routine ultrasounds in future studies. Funding: This study was supported by a grant from the Netherlands Organisation for Health Research and Development (ZonMw; grant No 209030001). Systematic review of first-trimester ultrasound screening for detection of fetal structural anomalies and factors that affect screening performance. So far, a consensus on the best charts for fetal growth and birth weight has not been reached.37 A recent large retrospective study showed an increase in identifying the risk of stillbirth when customised fetal growth charts were used.38 Nonetheless, in the prospective POP study, compared with universal charts, customised charts did not result in an increased association between estimated fetal weight below the 10th centile and neonatal morbidity.11 Before the start of our study, the Royal Dutch Association of Midwives issued guidelines on fetal growth restriction and recommended customised fetal growth curves. Women remained in the strategy that their midwifery practice was allocated to on enrolment. •An additional ultrasound for fetal structural anomalies in the 3rd trimester seems important for many reasons ????? We defined prenatal SGA as a fetal abdominal circumference below the 10th centile based on a population based Dutch reference growth curve.24 Slow fetal abdominal growth was defined as a decrease in abdominal circumference of at least 20 centiles (eg, from the 70th to 50th centile, with a minimum interval of two weeks) on the Dutch reference curve.1324 A volume of amniotic fluid of less than 2 cm in the deepest vertical pocket was also an indication of suspected fetal growth restriction. *Crossover postponed after one month because of fewer than expected inclusions †One midwifery practice dropped out in April 2015, after the first randomisation, The logistics of the study and enrolment procedures were piloted in January 2015. In this large, pragmatic, nationwide, stepped wedge cluster randomised trial in low risk pregnant women, using a multidisciplinary protocol for detecting and managing fetal growth restriction, routine ultrasonography in the third trimester improved prenatal detection of neonates who were small for gestational age (SGA) compared with usual care. A patient representative was a member of the project group that drafted the grant proposal and design of the IRIS study and of the sounding board of the IRIS study providing feedback to design aspects and discussing study results. Our trial addressed important shortcomings of previous studies.15 Modern ultrasound equipment was used, sonographers met predefined quality criteria, and a multidisciplinary protocol was applied. The overall incidence of error in data entry was 3.2% (2.6% for neonatal data and 3.7% for maternal data). Similarly, ultrasound cannot penetrate bone, but may be used for imaging bone fractures or for infection surrounding a bone. 2013 Dec;92(12):1353-60. doi: 10.1111/aogs.12249. Pregnant women seem to appreciate a third trimester routine ultrasound, but it does not seem to reduce anxiety or to improve bonding with their baby. With this design, each practice first applied usual care and then switched to offering routine ultrasonography in the third trimester at a defined moment during the study, depending on the randomisation scheme. With an α of 5% and 80% power, inclusion of 13 536 women was required. The findings do not support routine ultrasonography in the third trimester for low risk pregnancies. We also examined the effect of the intervention on maternal outcomes and obstetric interventions. Deliveries between 1985 and 1996 were included. In a multilevel multivariable logistic regression analysis, routine ultrasonography in the third trimester was not related to the composite outcome of maternal peripartum morbidity or mortality (1.06, 0.95 to 1.18), or spontaneous labour and birth (1.00, 0.92 to 1.08). J.J. Stirnemann, G. Benoist, L.J. Perined. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. The maternal cervix and adnexa should be examined as clinically appropriate when technically feasible. Moreover, nearly one in five women in the intervention and usual care strategies had an indication for an ultrasound scan in the third trimester that was identified at inclusion in the study. This study should not, however, mean the end of routine third trimester ultrasound. Data sharing: No additional data available. One of the authors (MW), who carried out all the interviews, first conducted a pilot interview to become familiar with the topic-list and to test the questions. ultrasonography, if clinically indicated. This site needs JavaScript to work properly. Aim The aim of this study was to assess the diagnostic performance of this routine scan in obese women (body mass index (BMI) ≥ 35 kg/m 2). Sugar in urine could indicate gestational diabetes. The non integration of colour Doppler studies and reliance only on fetal biometry and estimated fetal weight will have led us to miss the diagnosis of Stage 1 FGR. Contributors: JH and VV contributed equally to the manuscript and are first authors. Additional fetal anomalies diagnosed after two previous unremarkable ultrasound examinations. Possible explanations for our findings are: routine ultrasound fetal biometry is ineffective in detecting fetal growth restriction and preventing subsequent adverse outcomes in low risk pregnancies; adding routine ultrasound scans in the third trimester to usual care does not yield major benefits because women receiving such care already undergo one clinically indicated ultrasound scan on average in the third trimester; the quality of ultrasonography was insufficient; and using fetal abdominal circumference below the 10th centile (in combination with biometric measures of slow growth) on a population based curve is ineffective in detecting fetal growth restriction, and better methods are required. METHODS: Women without complications between 24 Third, to define the predictive performance for a LGA neonate of different EFW cut-offs on routine ultrasound examination at 35+0to36+6weeks’ gestation. Technical difficulties prevented integration of this approach into many midwifery practices, whereas hospitals did not use customised curves. B. For this trial, we developed a multidisciplinary protocol based on consensus for detecting and managing suspected fetal growth restriction.13 We chose a cluster randomised design to roll-out the intervention and to avoid contamination bias due to the women’s preferences for or against ultrasound scans.20 The stepped wedge design facilitated the participation of a large number of midwifery practices, even if they had a preference for one of the screening strategies. Oxytocin would, however, have been used as part of the induction of labour strategy but this would not have been recorded separately in the Perined database. Prediction of large for gestational age neonates by routine third trimester ultrasound Naila KHAN,1,2 Anca CIOBANU,3 Argyro SYNGELAKI,3 Ranjit AKOLEKAR,1,2 Kypros H. NICOLAIDES.3 Short title: Third trimester screening for LGA Key words: Third trimester screening; Large for gestational age; Estimated fetal weight; Fetal biometry; Symphysial-fundal height; Pyramid of … In some units in Sweden, a second ultrasound screening examination is offered in the third trimester to identify small‐for‐gestational age fetuses (SGA). Because of the inherent limitations of these data, several outcomes might have been misclassified as normal, resulting in an underestimation of the primary outcome for both strategies. Also, we used registration data as an initial screening for potential severe adverse perinatal outcomes. Description: A well defined, anechoic rounded cystic structure is seen in the fetal lower abdomen. Neonates of the participating women were born between June 2015 and August 2016. Furthermore, because of the collinearity of time of inclusion period and study condition, we were unable to adjust for time. Standard Second- or Third-Trimester Examination A standard obstetric sonogram in the second or third trimester includes an evaluation of fetal presentation, amniotic fluid volume, cardiac activity, placental position, fetal biome-try, and fetal number, plus an anatomic survey. See: http://creativecommons.org/licenses/by-nc/4.0/. Karim JN, Roberts NW, Salomon LJ, Papageorghiou AT. Clipboard, Search History, and several other advanced features are temporarily unavailable. 139-143. Additional fetal anomalies diagnosed after two previous unremarkable ultrasound examinations. The scan is largely similar to the ones you had during the first and/or second trimesters of pregnancy. Ultrasound is not as useful for imaging air-filled lungs, but it may be used to detect fluid around or within the lungs. Second, data from 14,497 singleton pregnancies that had undergone routine ultrasound examination at 35+0 - 36+6 weeks’ gestation and had a previous scan at 30+0 – 34+6 weeks were used to determine, through multivariable logistic regression analysis, whether addition of growth velocity, defined by a difference in EFW and AC Z-scores between the early and late third trimester … AJOG MFM 2020. a. | Description: A well defined, anechoic rounded cystic structure is seen in the fetal lower … Although the trial is underpowered for assessment of … A randomized controlled trial of third-trimester routine ultrasound in a non-selected population. Obstetrics » Obstetrics 2nd And 3rd Trimester. Some growth charts are universal and prescriptive, which means they show optimal growth in a healthy population, whereas others are customised for maternal characteristics, such as parity and ethnicity. The complete set of features: what is the evidence 1.91 ( SD 0.8 ) scans the. 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