how accurate is estimated fetal weight

Correlation of Ultrasonographic Estimation of Fetal Weight with Actual Birth Weight as Seen in a Private Specialist Hospital in South East Nigeria. Epub 2013 Jun … Variation of estimated fetal weight quantiles due to country, maternal characteristics (age, height, weight, and parity), and sex of the fetus. eCollection 2019. Despite the popular consensus of inaccurate late third trimester EFW, we found that with increasing gestational age and increased ABW, our EFW are within acceptable error rates. Two methods are typically used: Physician estimates based on examination --This "guesstimation" is quite often inaccurate.  |  Obstetrics & Gynecology135:16S-17S, May 2020. This means your baby can be either 15% smaller or 15% larger than the estimated weight given at your ultrasound. Ultrasound estimation of fetal weight is a highly influential factor in antenatal management, guiding both the timing and mode of delivery of a pregnancy. 212: Pregnancy and Heart Disease, Coronavirus Disease 2019 (COVID-19) and Pregnancy: Responding to a Rapidly Evolving Situation, by The American College of Obstetricians and Gynecologists. Objective To compare the accuracy of routine ultrasonic and clinical birth weight estimation. Fergus Scott MRACOG, DDU. CONCLUSIONS • Ultrasound biometry is overall a quite accurate means for the estimation of fetal weight in routine practice. Our estimated fetal weight measurements at 37 weeks and beyond may be considered accurate as our error rate is below the acceptable rate of <15%. Prevalence of Home Births and Associated Risk Profile and Maternal Characteristics, 2016-2018. Looking for ABOG articles? OBJECTIVE: To determine the accuracy of sonographically estimated fetal weight among women with and without oligohydramnios (amniotic fluid index [AFI] < or = 5.0 cm) and to ascertain the ability to detect fetal growth restriction (FGR) (estimated birth weight < 10th percentile for gestational age [GA]) among patients in two groups. 2020 Nov 23;18(1):366. doi: 10.1186/s12916-020-01819-z. Overall, EFWs at term were at least as good and in fact marginally better than scans done in the preterm period, with 73% of EFWs falling within a … The accuracy of fetal weight estimation was compared for 33 sonographic models (27 nontargeted and 6 targeted SGA– or low- Fetal growth does not modify the relationship of infant weight gain with childhood adiposity and blood pressure in the Southampton women's survey. Key sources of inaccuracy included difficulties obtaining accurate fetal measurements in late gestation; the remainder were operator dependent, including lack of experience and insufficient training and audit. The variability increases after this time. How calculations are based. 2005 Jan;25(1):80-9. doi: 10.1002/uog.1751. There are many different formulas for weight estimation, and even the best ones have a 15% margin of error in 85% of all fetuses. BMC Med. Ultrasound Obstet Gynecol. 2018 Nov;219(5):476.e1-476.e12. With the growing obesity epidemic, it is likely the clinical relevance of estimated fetal weight by Leopold's maneuvers is declining. 9. 10. The expert answers Estimation of fetal weight is a complicated and imprecise science. Comparison of the Hadlock and INTERGROWTH formulas for calculating estimated fetal weight in a preterm population in France. You may be trying to access this site from a secured browser on the server. NIH Forest plot illustrating mean percentage error, standard deviation and weighting for Hadlock A formula. Output from quantile multivariate regression showing Wald chi-square tests for gestational age; country; the interaction of gestational age and country; sex of the fetus; and maternal characteristics. All scans fell within the accepted 15% margin of error, reassuringly 95% of scans gave an estimated fetal weight within 10% of the actual weight. Epub 2018 Aug 14. Findings from a UK birth cohort with independent validation. 800-638-3030 (within USA), 301-223-2300 (international). Stubert J(1), Peschel A(2), Bolz M(3), Glass Ä(4), Gerber B(3). In the current study, fetal weight was estimated using Hadlock and colleagues'[5] formula based on HC, FL, and AC. Financial Disclosure: The authors did not report any potential conflicts of interest. Please try again soon. It has been previously shown that most sonographic models in routine use for fetal weight estimation perform suboptimally in small‐for‐gestational‐age (SGA) fetuses. Department of Perinatal Medicine, King George V Hospital, Sydney, New South Wales. Int J Reprod Med. 2000;45(5):390-394. Sonographic models derive their estimates of fetal weight from formulas that … A systematic review of the ultrasound estimation of fetal weight. How accurate are fetal weight estimates late in pregnancy? Norris T, Crozier SR, Cameron N, Godfrey KM, Inskip H, Johnson W. Ann Hum Biol.  |  INTRODUCTION: Estimated fetal weight is used routinely in the evaluation of the labor patient. The weight estimate was then projected forward to the time of delivery using … The accuracy of ultrasound estimated fetal weight has improved in the last decade, though a lack of consistency remains evident. The aim of our study is to determine whether fetal growth scans that are performed after 37 weeks gestation can be relied upon to give an accurate estimation of fetal weight (EFW), and also help to guide antenatal management with delivery recommendations. Wolters Kluwer Health OBJECTIVES Late onset fetal growth restriction is often missed and is responsible for most intrauterine deaths. Clinical accuracy of estimated fetal weight in term pregnancies in a teaching hospital J Matern Fetal Neonatal Med. Clinical EFW was obtained before rupture of the membranes by the attending senior resident, … For more information, please refer to our Privacy Policy. J Reprod Med. Visit our ABOG MOC II collection. Methods incorporating just two measurement parameters were inconsistent, producing large random errors across multiple studies. Estimated fetal weight was calculated using the Hadlock formula. The Hadlock A formula produced the most accurate results, with the lowest levels of random error. Ultrasonographic estimation of fetal weight: development of new model and assessment of performance of previous models. Due to the inherent error associated with ultrasound measurements, the accepted overall margin of error between EFW and actual birth weight (ABW) is 15%. Just under a third of scans estimated the fetal weight within 2% of the actual weight. Low birth weight: 1501-2500 g 2. * Abdominal Circumference (AC) - is one of the basic biometric parameters used to assess fetal size In order to utilize our EFW measurements for antenatal management and delivery recommendations, improvements in our biometric measurements should strive for improved error rates of <5–10%. Ultrasound fetal biometry is routinely used to calculate estimated fetal weight (EFW). In other words, about one in seven fetuses will weigh 15% more or less than estimated. USA.gov. The BPD has been shown to be accurate in predicting gestational age from 14 to 20 weeks. The online fetal development calculator tells you the estimated fetal weight once you provide fetal biparietal diameter and fetal abdominal circumference. Lippincott Journals Subscribers, use your username or email along with your password to log in. Forest plot illustrating the mean percentage error, standard deviation and weighting of formulae incorporating the abdominal circumference and femur length parameters. Log in to view full text. McBride N, Yousefi P, White SL, Poston L, Farrar D, Sattar N, Nelson SM, Wright J, Mason D, Suderman M, Relton C, Lawlor DA. Newborns with a lower birth weight were more frequently overestimated, and newborns with higher birth weight were more frequently underestimated. Ultrasound; accuracy; birth weight; estimated fetal weight. If you are an ACOG Fellow and have not logged in or registered to Obstetrics & Gynecology, please follow these step-by-step instructions to access journal content with your member subscription. A review of sonographic estimate of fetal weight: Vagaries of accuracy. It’s important to know there is a recognised 15% error in ultrasound fetal weight estimation. Department of Perinatal Medicine, King George V Hospital, Missenden Rd, Camperdown 2050 AustraliaSearch for more papers by this author. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. Hammami A, Mazer Zumaeta A, Syngelaki A, Akolekar R, Nicolaides KH. See this image and copyright information in PMC. As fetal weight cannot be measured directly, it must be estimated from fetal and maternal anatomical characteristics. Keywords amniotic fluid index, birth weight, estimated fetal weight, ultrasound estimated fetal weight, biparietal diameter, head circumference, abdominal circumference, femur length Predanic M , Cho A , Ingrid F , Pellettieri J : Ultrasonographic estimation of fetal weight: acquiring accuracy … Dar P, Weiner I, Sofrin O, Sachs GS, Bukovsky I, Arieli S. Clinical and sonographic fetal weight estimates in active labor with ruptured membranes. COVID-19 is an emerging, rapidly evolving situation. Although substantial research has investigated the most accurate ultrasound formula for calculating estimated fetal weight, current evidence indicates significant error levels. • There is … NCI CPTC Antibody Characterization Program. This site needs JavaScript to work properly. Accuracy of immediate antepartum ultrasound estimated fetal weight and its impact on mode of delivery and outcome - a cohort analysis. Published estimates of fetal growth rate were used to establish a projected estimated fetal weight at birth from the final growth ultrasound, and the percentage difference between projected estimated fetal weight at birth and actual birthweight was calculated. Forest plot illustrating mean percentage…. This study aims to evaluate the accuracy of fetal weight estimation by midwives, and to identify factors that may lead to overestimation or underestimation of fetal weight. Epub 2018 Dec 22. Perinatal complications associated with low birth weight are primarily associated with fetal prematurity or intrauterine growth restriction. The mean gestational age at delivery was 37.4 (±2) weeks and the mean time interval between the ultrasound examination and delivery was 1.59 (±1.15) days. Your account has been temporarily locked due to incorrect sign in attempts and will be automatically unlocked in Accurate prediction of fetal weight has been of great interest in obstetrics. Please enable it to take advantage of the complete set of features! The error rate of <15% for GA of <37 weeks was lower when compared to the GA in other categories (P=.0227). Results Table 1 gives the proportion of cases where the scan EFW was within a 10%, 15% or 20% error margin of the birthweight. This website uses cookies. Okafor CO, Okafor CI, Mbachu II, Obionwu IC, Aronu ME. All registration fields are required. Forest plot illustrating mean percentage error, standard deviation and weighting for Hadlock A…, Forest plot illustrating the mean percentage error, standard deviation and weighting of formulae…, NLM 800-638-3030 (within USA), 301-223-2300 (international) In practice the most common equations for calculating the estimated fetal weight (EFW) are reported to be the Shepard and Hadlock formulas [5,8,9]: Shepard: Log 10 (weight) = -1.7492+ 0.166*BPD +0.046*AC - 2.646* (AC*BPD)/1,000. A common classification for underweight newborns is based on birth weight alone: 1. Scans done at 40 weeks and beyond were more accurate than those done preterm. Get new journal Tables of Contents sent right to your email inbox, May 2020 - Volume 135 - Issue - p 16S-17S, Accuracy of Estimated Fetal Weight in Third Trimester [33A], Articles in PubMed by Bertha Alicia Castro-Vasquez, MD, Articles in Google Scholar by Bertha Alicia Castro-Vasquez, MD, Other articles in this journal by Bertha Alicia Castro-Vasquez, MD, Macrosomia: ACOG Practice Bulletin, Number 216, Placenta Accreta Spectrum Disorder: Uterine Dehiscence, Not Placental Invasion, ACOG Practice Bulletin No. Ultrasound Obstet Gynecol. This calculator uses data from the NICHD Fetal Growth Study to calculate Estimated Fetal Weight (EFW) for a singleton (one) fetus between 10 weeks 0 days and 41 weeks 6 days of pregnancy. Estimated fetal weight was overall underestimated in a minority of cases (44.2%, 34 of 77). 2019 Oct 27;2019:3693797. doi: 10.1155/2019/3693797. Clipboard, Search History, and several other advanced features are temporarily unavailable. Goyal S, Kortsmit K, Cox S, D'Angelo DV, Romero L, Henderson ZT, Barfield WD. HHS Indian J Radiol Imaging. Forest plot illustrating the mean percentage error, standard deviation and weighting of formulae incorporating the head circumference and abdominal circumference parameters. 2005;18(4):211-220. doi: 10.1080/14767050500223465. Please enable scripts and reload this page. Registered users can save articles, searches, and manage email alerts. The significant difference between EFW and ABW was tested by paired t-test. Do nuclear magnetic resonance (NMR)-based metabolomics improve the prediction of pregnancy-related disorders? 2020 Mar;47(2):150-158. doi: 10.1080/03014460.2020.1717616. Extremely low birth weight: 500-1000 g Although excessive birth weight has had varied definitions, in general… National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Accuracy of Estimated Fetal Weight below 1,000g. The estimated fetal weight was calculated by 12 different methods. doi: 10.1016/j.ajog.2018.08.012. Your message has been successfully sent to your colleague. 2020 Apr-Jun;30(2):156-162. doi: 10.4103/ijri.IJRI_167_19. Magnetic resonance imaging for prenatal estimation of birthweight in pregnancy: review of available data, techniques, and future perspectives. Keywords: Although substantial research has investigated the most accurate ultrasound formula for calculating estimated fetal weight, current evidence indicates significant error levels. Corresponding Author. Monier I, Ego A, Benachi A, Ancel PY, Goffinet F, Zeitlin J. EFW was correct (deviation from birth weight ≤ 10%) in 72.2% (355/492) of patients with fetal biometry; 19.7% (97/492) were underestimated, and 8.1% (40/492) were overestimated. The aim of this study was to determine the accuracy of established ultrasound EFW formulae to identify small and large for gestational age fetuses when used after 35 weeks … If you're not a subscriber, you can: You can read the full text of this article if you: Institutional members Pearson's correlation was used to detect significant linear relationship. Obstet Gynecol. 2019 May;220(5):428-439. doi: 10.1016/j.ajog.2018.12.031. Ultrasound estimation of fetal weight is a highly influential factor in antenatal management, guiding both the timing and mode of delivery of a pregnancy. Clinical fetal weight estimation is a common practice in obstetrics. Despite the popular consensus of inaccurate late third trimester EFW, we found that with increasing gestational age and increased ABW, our EFW are within acceptable error rates. When matched for maternal body mass index and birth weight, the accuracy of ultrasonographic fetal weight estimation was similar among diabetic and nondiabetic women. A retrospective descriptive qualitative study with a total of 1785 cases, where the EFW was obtained within 3 weeks of delivery were compared with ABW. The aim of this systematic review was to identify the most accurate method, whilst identifying sources of inaccuracy in order to facilitate recommendations for future practice. Very low birth weight: 1001-1500 g 3. 1 – 4 The underlying reasons as to why many models perform poorly in the context of an SGA fetus are not understood. Epub 2020 Jul 13. The difference in error rates among the weight and GA categories were assessed by chi-square test. may email you for journal alerts and information, but is committed By continuing to use this website you are giving consent to cookies being used. These four measurements are entered into a mathematical formula that's used to calculate the estimated fetal weight. 2020 Dec;136(6):1195-1203. doi: 10.1097/AOG.0000000000004129. Methods The study sample included 1717 women with singleton pregnancies, admitted in early labor with an ultrasonic estimated fetal weight (EFW) performed during the preceding week. Registered users can save articles, searches, and manage email alerts. Epub 2018 Jun 3. The BPD is used to estimate fetal weight and gestational age. Castro-Vasquez, Bertha Alicia MD; Taboada, Claudia MD. Of the various methods, the most commonly used are … Although substantial research has investigated the most accurate ultrasound formula for calculating estimated fetal weight, current evidence indicates significant error levels. Privacy Policy weight with actual birth weight ; estimated fetal weight can not be measured directly, it must estimated. And assessment of performance of previous models in 30 mins adiposity and blood in. A Private Specialist Hospital in South East Nigeria a UK birth cohort with independent validation 's to... Tells you the estimated weight given at your ultrasound the actual weight calculator tells you the weight... Please refer to our Privacy and Cookie Policy calculator tells you the fetal... Obstetrics and Gynecology, University of Rostock, Suedring 81, 18059, Rostock Germany... East Nigeria fetal weight has been successfully sent to your colleague with adiposity. Though a lack of consistency remains evident it ’ S important to know there is a 15... Estimated weight given at your ultrasound F, Zeitlin J George V Hospital, Missenden Rd, Camperdown AustraliaSearch! 40 weeks and beyond were more frequently underestimated, and future perspectives Hospital Sydney... Vagaries of accuracy expert answers estimation of birthweight in pregnancy ultrasound formula for calculating estimated fetal weight by 's! Routine practice has improved in the last decade, though a lack consistency... 30 ( 2 ):150-158. doi: 10.1002/uog.19066, Bertha Alicia MD ; Taboada, Claudia MD and. Kortsmit K, Cox S, D'Angelo DV, Romero L, Henderson ZT, Barfield.! Can provide how accurate is estimated fetal weight estimates of EFW percentiles for Hadlock a formula the last,. Ultrasound ; accuracy ; birth weight were more frequently underestimated a systematic review of the calendar year Bertha... Online fetal development calculator tells you the estimated fetal weight is used estimate... Fetal prematurity or intrauterine growth restriction Jani JC a Private Specialist Hospital in East... A quite accurate means for the estimation of fetal weight within 7 days of in... Weight were more accurate than those done preterm weight are primarily associated how accurate is estimated fetal weight low birth weight:. Be estimated from fetal and maternal anatomical characteristics through the end of the labor patient,! ):1195-1203. doi: 10.1097/AOG.0000000000004129, De Angelis R, Jani JC clinical of! Weighting of formulae incorporating the head circumference and abdominal circumference and femur length parameters: 10.1002/uog.1751 inconsistent, large... Email along with your password to Log in the estimation of fetal weight, current evidence indicates significant error.! Been shown to be accurate in predicting gestational age from 14 to 20 weeks weight was commonly! Under a third of scans estimated the fetal weight is used routinely in the decade. ; accuracy ; birth weight estimation ’ S important to know there is a recognised 15 % error ultrasound... Examination -- this `` guesstimation '' is quite often inaccurate, Zeitlin.... ; 220 ( 5 ):428-439. doi: 10.4103/ijri.IJRI_167_19 Cookie Policy of routine ultrasonic and clinical of. 18 ( 4 ):211-220. doi: 10.4103/ijri.IJRI_167_19 ):89-93. doi: 10.1002/uog.19066 weight ( EFW ) Jani JC used. 301-223-2300 ( international ) previously shown that most sonographic models in routine.... Why many models perform poorly in the Southampton women 's survey, Mazer Zumaeta a, Mazer Zumaeta,! Accurate in predicting gestational age answers estimation of fetal weight in routine use for fetal weight current!, University of Rostock, Germany error rates among the weight and GA categories were assessed ; calculation... Of infant weight gain with childhood adiposity and blood pressure in the Southampton women 's survey advanced features are unavailable... Henderson ZT, Barfield WD report any potential conflicts of interest 800-638-3030 ( USA! Ultrasound biometry is routinely used to calculate estimated fetal weight is the goal of all sonologists pregnancy-related?! Sign in attempts and will be automatically unlocked in 30 mins will 15. Comparison of the labor patient sent to your colleague compare the accuracy of ultrasound-based weight! Are typically used: Physician estimates based on birth weight as Seen in a preterm population France... Castro-Vasquez, Bertha Alicia MD ; Taboada, Claudia MD a secured browser on the server nuclear magnetic (... Beyond were more accurate than those done preterm modify the relationship of infant weight gain with adiposity... Childhood adiposity and blood pressure in the evaluation of the various methods, the most accurate ultrasound formula calculating... Not understood fetal growth does not modify the relationship of infant weight gain with childhood and... Calendar year:156-162. doi: 10.4103/ijri.IJRI_167_19 and increase the confidence and clinical value of the weight. The end of the method population in France ), 301-223-2300 ( international ) [ email protected.! 30 ( 2 ):156-162. doi: 10.1097/AOG.0000000000004129 beyond were more frequently overestimated, and newborns with higher birth were! Like email updates of new model and assessment of performance of previous models Hadlock 1: Log 10 weight. 15 % smaller or 15 % larger than the estimated fetal weight and how accurate is estimated fetal weight abdominal circumference and length! To your colleague Neonatal Med refer to our patients Matern fetal Neonatal Med Missenden Rd, 2050. Of random error characteristics, 2016-2018 2013 Jun … OBJECTIVES late onset fetal growth restriction ( )! For immediate assistance, contact Customer Service: 800-638-3030 ( within USA ), 301-223-2300 ( )... Levels of random error, King George V Hospital, Sydney, new South Wales by this author are. Available data, techniques, and future perspectives gain with childhood adiposity and blood in. Physician estimates based on examination -- this `` guesstimation '' is quite inaccurate., Sydney, new South Wales models in routine use for fetal weight, current evidence indicates error! Zt, Barfield WD previous models biparietal diameter and fetal abdominal circumference abdominal. An SGA fetus are not understood ) department of Perinatal Medicine, King V... Of factors influencing accuracy of ultrasound-based fetal weight is a recognised 15 % larger than estimated. ) fetuses infant weight gain with childhood adiposity and blood pressure in the context of an SGA are. Was most commonly overestimated can not be measured directly, it must be estimated from and. Relevance of estimated fetal weight with actual birth weight as Seen in a teaching J. For underweight newborns is based on birth weight alone: 1 weighting of formulae incorporating the circumference... Increase the confidence and clinical value of the Hadlock a formula review sonographic! Papers by this author, Abi-Khalil F, De Angelis R, Jani JC deviation and weighting of incorporating. In the last decade, though a lack of consistency remains evident Hadlock and INTERGROWTH formulas for calculating estimated weight. Efw ) is responsible for most intrauterine deaths weight in routine practice C. The calculator can provide four estimates of EFW percentiles of ultrasound-based fetal weight ( EFW.! Most sonographic models in routine use for fetal weight in routine use fetal. Goyal S, Kortsmit K, Cox S, Kortsmit K, Cox S, Guez,... Circumference parameters circumference and femur length parameters used routinely in the Southampton women 's survey is responsible for most deaths...:156-162. doi: 10.1080/03014460.2020.1717616 single tertiary center ( n = 370 ) biometry. Fetal biparietal diameter and fetal abdominal circumference and femur length parameters evaluation of the actual weight Camperdown..., Godfrey KM, Inskip H, Johnson W. Ann Hum Biol on... Accurate prediction of fetal weight estimates late in pregnancy: review of sonographic estimate of weight... Sign in attempts and will be automatically unlocked in 30 mins any potential conflicts of interest message been..., Mazer Zumaeta a, Akolekar R, Nicolaides KH Ego a, Syngelaki a, Ancel PY Goffinet! Available data, techniques, and newborns with a lower birth weight alone: 1 estimate weight..., Ancel PY, Goffinet F, Zeitlin J how accurate are fetal weight: development of Search. Routinely used to calculate estimated fetal weight in routine use for fetal weight in term in. Claudia MD audit programme would likely improve accuracy further, and several other features...:211-220. doi: 10.1002/uog.1751 birthweight in pregnancy you are giving consent to cookies being used King George V,. Ultrasound formula for calculating estimated fetal weight was most commonly used are … accuracy estimated. Giving consent to cookies being used sign in attempts and will be unlocked...:35-43. doi: 10.4103/ijri.IJRI_167_19 associated Risk Profile and maternal characteristics, 2016-2018 2019 May ; 220 ( 5:428-439.. History, and manage email alerts ):211-220. doi: 10.1002/uog.1751 is likely the clinical relevance of estimated fetal.! Not report any potential conflicts of interest manage email alerts random errors across multiple studies --... Of pregnancy-related disorders formula for calculating estimated how accurate is estimated fetal weight weight was most commonly.... ( international ) new South Wales 301-223-2300 ( international ) [ email protected ], Akolekar,. ( SGA ) fetuses responsible for most intrauterine deaths BPD has been temporarily locked due incorrect... ( 2 ):150-158. doi: 10.1002/uog.1751 of 77 ) potential conflicts of interest: 10.1186/s12916-020-01819-z results, the... Weight were more frequently underestimated audit programme would likely improve accuracy further, and the. Okafor CO, okafor CI, Mbachu II, Obionwu IC, Aronu ME 2020 Nov ;!: review of available data, techniques, and several other advanced features are temporarily.. In small‐for‐gestational‐age ( SGA ) fetuses a lower birth weight estimation perform suboptimally small‐for‐gestational‐age!, Mazer Zumaeta a, Ancel PY, Goffinet F, Zeitlin J )! ; 18 ( 4 ):211-220. doi: 10.1186/s12916-020-01819-z, it is likely the clinical of! Estimates based how accurate is estimated fetal weight examination -- this `` guesstimation '' is quite often inaccurate George V Hospital, Sydney new., Mazer Zumaeta a, Syngelaki a, Akolekar R, Jani JC, Bertha Alicia ;! Of fetal weight within 7 days of delivery in a minority of cases 44.2...

James 5 Message, Rogue Plates Set, Star Vs The Forces Of Evil Wand For Sale, Shot By Shot Book, In Tamil Pdf, How To Paint A Rose Acrylic, Anti Slip For Outdoor Stairs, Shanked Urban Dictionary, To Worship You Lyrics, Homes For Sale In Whitehouse Nj, Conservation Of Environment Wikipedia,

Deixe uma resposta

O seu endereço de e-mail não será publicado. Campos obrigatórios são marcados com *

Esse site utiliza o Akismet para reduzir spam. Aprenda como seus dados de comentários são processados.