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The purpose of this pictorial review was to describe various echocardiographic techniques that can be used for the functional assessment of the fetal heart. The systolic and diastolic assessments of the fetal heart are presented separately, with an emphasis on 2-dimensional Doppler methods and an overview of new technologies. The aim of this summary was to review the tools that can be used by the echocardiographer, and on that basis, to systematize the process of performing a functional assessment.

Two-dimensional (2D) echocardiogram with the aid of color Doppler and pulsed Doppler allows one to record blood flow waveforms in several structures of the heart. The determination of normal values of these flows in the fetus can help understand cardiac hemodynamics. Given this importance, numerous surveys have been conducted with various existing echocardiographic techniques in order to improve the functional evaluation and consequently, planning of delivery. The aim of this review was to discuss the findings of the reference values of blood flows obtained by 2D echocardiography with Doppler, the current trend of the determination of Z-scores in the functional measurements, and their future prospects.

OBJECTIVE: To compare the agreement of multiplanar and rendering modes in the assessment fetal atrioventricular valves (mitral and tricuspid) areas by three-dimensional (3D) ultrasonography using the software spatio-temporal image correlation (STIC). METHODS: We conducted a prospective cross-sectional study with normal pregnant women, with single fetuses, between 18-33 weeks. To measure the areas, we used the plan of four-chamber view. In the case of multiplanar, the plane was rotated on the axis "Z" form the heart to position at 9h. For rendering, the green line (region of interest - ROI) was placed from the atria of the heart perpendicular to the crux. The agreement was assessed by a Bland-Altman (limits of agreement) using the relative difference between the measures: ((rendering mode) - (multiplanar mode)) / (average). RESULTS: 328 fetuses were evaluated. We have not identified the occurrence of systematic error between methods: the average relative difference was 1.62% (-2.07% to 5.32%, confidence interval 95%) in the mitral and 1.77% (- 1.08% to 4.62%) in the tricuspid valve. The limits of agreement between methods were -65.26% to 68.51% for the mitral and -49.91% to 53.45% for the tricuspid. CONCLUSIONS: There was no systematic error between modes and thus the observed values for the area of fetal atrioventricular valves can be used for comparisons needs to be corrected. However, relatively large variations may be observed when repeating the measurement area by different modes.OBJETIVO: Avaliar a concordância entre as medidas das áreas das valvas atrioventriculares (mitral e tricúspide) fetais realizadas por ultrassonografia tridimensional (3D) pelo software spatio-temporal image correlation (STIC) usando os modos multiplanar e renderizado. MÉTODOS: Estudo prospectivo de corte transversal avaliando fetos de gestações únicas, consideradas saudáveis, entre 18 a 33 semanas de idade gestacional. Para a medida das áreas, utilizou-se o plano de quatro câmaras cardíacas. No caso do multiplanar, o plano foi rodado no eixo "z" de forma o coração se dispuser em 9h. Para o renderizado, a linha verde (região de interesse - ROI) foi posicionada a partir dos átrios, perpendicular à cruz do coração. A concordância foi avaliada pelo método de Bland-Altman (limites de concordância) utilizando a diferença relativa entre as medidas: ((modo renderizado) - (modo multiplanar)) / (média).< RESULTADOS: 328 fetos foram avaliados. Não identificamos a ocorrência de erro sistematizado entre os métodos: a diferença relativa média foi de 1,62% (-2,07% a 5,32%, intervalo de confiança de 95%) na mitral e de 1,77% (-1,08% a 4,62%) na tricúspide. Os limites de concordância entre os métodos foram de -65,26% a 68,51% para a mitral e de -49,91% a 53,45% para a tricúspide. CONCLUSÕES: Não foi observado erro sistematizado entre os modos e desta forma os valores observados para a área das valvas atrioventriculares fetais podem ser utilizados para comparações sem necessidades de correções. Entretanto, variações relativamente grandes podem ser observadas ao se repetir a medida da área pelos diferentes modos.

OBJETIVO: Comparar do débito cardíaco (DC) e a fração de ejeção (FE) do coração de fetos masculinos e femininos obtidos por meio da ultrassonografia tridimensional, utilizando o spatio-temporal image correlation (STIC). MÉTODOS: Realizou-se um estudo de corte transversal com 216 fetos normais, entre 20 a 34 semanas de gestação, sendo 108 masculinos e 108 femininos. Os volumes ventriculares no final da sístole e diástole foram obtidos por meio do STIC, sendo as avaliações volumétricas realizadas pelo virtual organ computer-aided analysis (VOCAL) com rotação de 30º. Para o cálculo do DC utilizou-se a fórmula: DC= volume sistólico/frequência cardíaca fetal, enquanto que para a FE utilizou-se a fórmula: FE= volume sistólico/volume diastólico final. O DC (combinado, feminino e masculino) e a FE (masculina e feminina) foram comparadas utilizando-se o teste t não pareado e ANCOVA. Foram criados gráficos de dispersão com os percentis 5, 50 e 95. RESULTADOS: A média do DC combinado, DC direito, DC esquerdo, FE direita e FE esquerda, para feminino e masculino, foram 240,07 mL/min; 122,67 mL/min; 123,40 mL/min; 72,84%; 67,22%; 270,56 mL/min; 139,22 mL/min; 131,34 mL/min; 70,73% e 64,76%, respectivamente; sem diferença estatística (P> 0,05). CONCLUSÕES: O DC e a FE fetal obtidos por meio da ultrassonografia tridimensional (STIC) não apresentaram diferença significativa em relação ao gênero.OBJECTIVE: To compare the cardiac output (CO) and ejection fraction (EF) of the heart of male and female fetuses obtained by 3D-ultrasonography using spatio-temporal image correlation (STIC). METHODS: We conducted a cross-sectional study with 216 normal fetuses, between 20 and 34 weeks of gestation, 108 male and 108 female. Ventricular volumes at the end of systole and diastole were obtained by STIC, and the volumetric assessments performed by the virtual organ computer-aided analysis (VOCAL) rotated 30º. To calculate the DC used the formula: DC = stroke volume / fetal heart rate, while for the FE used the formula: EF = stroke volume / end-diastolic volume. The DC (combined male and female) and EF (male and female) were compared using the unpaired t test and ANCOVA. Scatter plots were created with the percentiles 5, 50 and 95. RESULTS: The average of DC combined, DC left, DC right, FE right and FE left, male and female were 240.07 mL/min, 122.67 mL/min, 123.40 mL/min, 72.84%, 67.22%, 270.56 mL/ min, 139.22 mL/min, 131.34 mL/min, 70.73% and 64.76% respectively, without statistical difference (P> 0.05). CONCLUSIONS: The fetal CO and EF obtained by 3Dultrasonography (STIC) showed no significant difference in relation to gender.

FUNDAMENTO: A detecção precoce de alterações septais, tais como a hipertrofia septal comumente presente em fetos de mães diabéticas, contribuiria para a redução das altas taxas de mortalidade infantil. OBJETIVO: Determinar intervalos de referência para a área do septo interventricular fetal por meio da ultrassonografia tridimensional (US3D) utilizando o método STIC (Spatio-Temporal Image Correlation). MÉTODOS: Realizou-se um estudo de corte transversal com 69 gestantes normais entre a 18ª e 33ª semanas de gestação. Utilizou-se como referência o plano de quatro câmaras com a ROI (Região de Interesse) posicionada a partir dos ventrículos, sendo a área do septo delimitada de modo manual. Para se avaliar a correlação da área do septo interventricular com a idade gestacional (IG), construíram-se diagramas de dispersão e calculou-se o coeficiente de correlação de Pearson (r), sendo o ajuste realizado pelo coeficiente de determinação (R²). Foram calculadas médias, medianas, desvios-padrão (dp), valores máximo e mínimo. Para o cálculo da reprodutibilidade intraobservador, utilizou-se o coeficiente de correlação intraclasse (CCI). Obteve-se a medida da espessura do septo interventricular e ela foi correlacionada com a IG e a área septal obtida pelo modo renderizado em 52 pacientes utilizando-se o CCI. RESULTADOS: A área do septo interventricular foi altamente correlacionada com a idade gestacional (r = 0,81), e a média aumentou de 0,47 cm² na 18ª para 2,42 cm² na 33ª semana de gestação. A reprodutibilidade intraobservador foi excelente com CCI = 0,994. Não se observou correlação significativa entre a medida do septo interventricular e a IG (R² = 0,200), assim como não houve correlação com a área do septo obtida pelo modo renderizado com CCI = 0,150. CONCLUSÃO: Intervalos de referência para a área do septo interventricular entre a 18ª e 33ª semanas de gestação foram determinados e se mostraram altamente reprodutíveis.FUNDAMENTO: La detección precoz de alteraciones septales, tales como la hipertrofia septal comúnmente presente en fetos de madres diabéticas, contribuiría a la reducción de las altas tasas de mortalidad infantil. OBJETIVO: Determinar intervalos de referencia para el área del septo interventricular fetal por medio de la ultrasonografía tridimensional (US3D) utilizando el método STIC (Spatio-Temporal Image Correlation). MÉTODOS: Se realizó un estudio de corte transversal con 69 gestantes normales entre la 18ª y 33ª semanas de gestación. Se utilizó como referencia el plano de cuatro cámaras con la ROI (Región de Interés) posicionada a partir de los ventrículos, siendo el área del septo delimitada de modo manual. Para evaluar la correlación del área del septo interventricular con la edad gestacional (EG), se construyeron diagramas de dispersión y se calculó el coeficiente de correlación de Pearson (r), siendo el ajuste realizado por el coeficiente de determinación (R²). Fueron calculadas medias, medianas, desviaciones-estándar (de), valores máximo y mínimo. Para el cálculo de la reproductibilidad intraobservador, se utilizó el coeficiente de correlación intraclase (CCI). Se obtuvo la medida del espesor del septo interventricular y la misma fue correlacionada con la EG y el área septal obtenida por el modo renderizado en 52 pacientes utilizando el CCI. RESULTADOS: El área del septo interventricular fue altamente correlacionada con la edad gestacional (r = 0,81), y la media aumentó de 0,47 cm² en la 18ª a 2,42 cm² en la 33ª semana de gestación. La reproductibilidad intraobservador fue excelente con CCI = 0,994. No se observó correlación significativa entre la medida del septo interventricular y la EG (R² = 0,200), así como no hubo correlación con el área del septo obtenida por el modo renderizado con CCI = 0,150. CONCLUSIÓN: Intervalos de referencia para el área del septo interventricular entre la 18ª y 33ª semanas de gestación fueron determinados y se mostraron altamente reproducibles. (Arq Bras Cardiol 2011;96(5):386-392)BACKGROUND: Early detection of septal changes such as septal hypertrophy commonly present in fetuses of diabetic mothers would help reduce the high rates of infant mortality. OBJECTIVE: Determine reference ranges for the fetal ventricular septal area through three-dimensional ultrasound (US3D) using the STIC method (Spatio-Temporal Image Correlation). METHODS: We conducted a cross-sectional study with 69 pregnant women between the 18th and 33rd weeks of pregnancy. We used as a reference the four-chamber plane with the ROI (Region of Interest) positioned from the ventricles; the septum area were manually marked. To assess the correlation of the interventricular septum area with gestational age (GA), we constructed scatter plots and calculated Pearson's correlation coefficient (r), and the adjustment was performed by the coefficient of determination (R²). We calculated averages, medians, standard deviations (sd), as well as maximum and minimum values. To calculate the intraobserver reproducibility, we used the intraclass correlation coefficient (ICC). The interventricular septum thickness was measured and it was correlated with gestational age and the septal area rendered in 52 patients using the ICC. RESULTS: The interventricular septum area was highly correlated with gestational age (r = 0.81), and the average increased from 0.47 cm² in the 18th week to 2.42 cm² in the 33rd of gestation. The intraobserver reproducibility was excellent with ICC = 0.994. No significant correlation was observed between the interventricular septum measurement and the GA (R² = 0.200), as well as there was no correlation with the septal area rendered with ICC = 0.150. CONCLUSION: Reference intervals for the interventricular septum area between the 18th and the 33rd pregnancy week were determined to be highly reproducible.

OBJETIVO: determinar os valores de referência para o comprimento e a área do corpo caloso fetal entre a 20ª e 33ª semanas de gestação por meio da ultrassonografia tridimensional (US3D). MÉTODOS: foi realizado um estudo do tipo corte transversal com 70 gestantes normais entre a 20ª e 33ª semanas de gestação. Utilizou-se um aparelho da marca Accuvix XQ, equipado com transdutor convexo volumétrico (3 a 5 MHz). Para a obtenção do corpo caloso fetal, foi utilizado um plano transfrontal, com a sutura metópica como janela acústica. Para o cálculo do comprimento, utilizou-se a distância entre os pontos médios dos polos proximal e distal do corpo caloso. Para o cálculo da área, a delimitação manual da superfície externa do corpo caloso foi realizada. Para o comprimento e a área do corpo caloso, foram calculadas: as médias, as medianas, os desvios padrão e os valores máximo e mínimo. Para a correlação da área e do comprimento do corpo caloso com a idade gestacional e o diâmetro biparietal foram criados diagramas de dispersão, sendo a qualidade dos ajustes verificada pelo coeficiente de determinação (R²). Para a variabilidade intraobservador, utilizou-se o coeficiente de correlação intraclasse (CCI). RESULTADOS: a média do comprimento do corpo caloso variou de 21,7 mm (18,6 - 25,2 mm) a 38,7 mm (32,6 - 43,3 mm) entre a 20ªe 33ª semanas, respectivamente. A média da área do corpo caloso variou de 55,2 mm² (41,0 - 80,0 mm²) a 142,2 mm² (114,0 - 160,0 mm²) entre a 20ªe 33ª semanas, respectivamente. O comprimento e a área do corpo caloso foram fortemente correlacionados com a idade gestacional (R² = 0,7 e 0,7, respectivamente) e com o diâmetro biparietal (R² = 0,7 e 0,6, respectivamente). A variabilidade intraobservador foi adequada com CCI = 0,9 e 0,9 para o comprimento e área, respectivamente. CONCLUSÕES: valores de referência para o comprimento e área do corpo caloso fetal entre a 20ªe 33ª semanas foram determinados. A variabilidade intraobservador foi adequada.PURPOSE: to establish reference values for the length and area of the fetal corpus callosum between the 20th and 33rd weeks of gestation using three-dimensional ultrasound (3DUS). METHODS: this cross-sectional study involved 70 normal pregnancies with gestational age between 20 and 33 weeks. An Accuvix XQ instrument with a convex volumetric transducer (3 to 5 MHz) was used. To assess the corpus callosum, a transfrontal plane was obtained using the metopic suture as an acoustic window. Length was obtained by measuring the distance between the proximal and distal extremities of the corpus callosum. Area was obtained by manual tracing of the external corpus callosum surface. The means, medians, standard deviations, and maximum and minimum values were calculated for the corpus callosum length and area. Scatter graphs were created to analyze the correlation between corpus callosum length and area and gestational age and biparietal diameter, the quality adjustments was verified according to the determination coefficient (R²). The intraclass correlation coefficient (ICC) was used to assess the intraobserver variability. RESULTS: mean corpus callosum length increased from 21.7 (18.6 - 25.2 mm) to 38.7 mm (32.6 - 43.3 mm) between 20 and 33 weeks of pregnancy, respectively. Mean corpus callosum area increased from 55.2 (41.0 - 80.0 mm²) to 142.2 mm² (114.0 - 160.0 mm²), between 20 to 33 weeks of pregnancy, respectively. There was a strong correlation between corpus callosum length and area and gestational age (R² = 0.7 and 0.7, respectively) and biparietal diameter (R² = 0.7 and 0.6, respectively). Intraobserver variability was appropriate, with an ICC of 0.9 and 0.9 for length and area, respectively. CONCLUSIONS: reference values for corpus callosum length and area were established for fetuses between 20 and 33 weeks gestation. Intraobserver variability was appropriate.

OBJETIVO: avaliar as áreas das válvulas atrioventriculares (tricúspide e mitral) de fetos normais por meio da ultrassonografia tridimensional (US3D) utilizando o método STIC (spatiotemporal image correlation). MÉTODOS: realizou-se estudo de corte transversal com 141 mulheres entre a 18ª e a 33ª semana de gestação. As medidas dos volumes cardíacos foram obtidas por um transdutor volumétrico transabdominal acoplado ao aparelho Voluson 730 Expert. Utilizou-se como referência o plano de quatro câmaras com a ROI (região de interesse) posicionada a partir dos ventrículos, sendo a área das valvas delimitada manualmente. Para conhecer a correlação das áreas valvulares com a idade gestacional, foram construídos diagramas de dispersão e calculou-se o coeficiente de correlação de Pearson (r). Foram calculadas médias, medianas, desvios padrão (DP), valores máximo e mínimo. Para se determinar intervalos de referência das áreas valvulares em função da idade gestacional, seguiu-se o modelo de regressão linear simples, utilizando o método de Altman, com nível de significância de pPURPOSE: to evaluate the areas of the atrioventricular valves (tricuspid and mitral) of normal fetuses by the use of three-dimensional ultrasound (3DUS) and the spatiotemporal image correlation (STIC) method. METHODS: a cross-sectional study was conducted on 141 women between the 18th and the 33rd week of pregnancy. Cardiac volumes were measured with a volumetric transabdominal transducer attached to the Voluson 730 Expert equipment. The four chamber plane was used as reference, with the region of interest (ROI) positioned from the ventricles, and the area of the valves was obtained manually. To determine the correlation of the areas with gestational age, scatter plots were constructed and the Pearson correlation coefficient (r) was calculated. Means, medians, standard deviations (SD) and maximum and minimum values were calculated. The simple linear regression model was used to determine reference ranges of valve areas according to the gestational age by the Altman method, with the level of significance set at p

Objective. To describe the experience of a tertiary center in Brazil to which patients are referred whose fetuses are at increased risk for congenital heart diseases (CHDs). Methods. This was a cross-sectional observational study. The data was collected prospectively, during the year 2012, through a screening protocol of the fetal heart adapted from the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) guideline. We performed a fetal echocardiogram screening for all pregnant women who were referred to the fetal cardiology outpatient obstetrics clinic of a university hospital. The exams were classified as normal or abnormal. The cases considered abnormal were undergone to a postnatal echocardiogram. We categorized the abnormal fetal heart according to severity in “complex,” “significant,” “minor,” and “others.” Results. We performed 271 fetal heart screening. The incidence of abnormal screenings was 9.96% (27 fetuses). The structural CHD when categorized due to severity showed 48.1% (n=13) of “complex” cases, 18.5% (n=5) “significant” cases, and 7.4% (n=2) “minor” cases. The most common referral reason was by maternal causes (67%) followed by fetal causes (33%). The main referral indication was maternal metabolic disease (30%), but there was just one fetus with CHD in such cases (1.2%). CHDs were found in 19/29 fetuses with suspicion of some cardiac abnormality by obstetrician (65.5%). Conclusion. We observed a high rate of CHD in our population. We also found that there was higher incidence of complex cases.

Hypospadia is an abnormal development of the corpus spongiosum, that involves cavernosa urethra, as a result of an inadequate fusion of the urethral folds. The incidence ranges from 0.2 to 4.1 per 1,000 live births. Among the markers of hypospadia, isolated ventral or lateral curvature of the penis associated with shortening are the most important markers and, in severe cases, can result in the classic “tulip sign.” The diagnosis of hypospadia is uncommon unless there is a routine of detailed analysis of fetal genitalia morphology. The prenatal diagnosis is of great importance for genetic counseling and allows better planning of postnatal treatment. The three-dimensional ultrasonography (3DUS) in rendering mode enables better comprehension of the pathology by parents, facilitating postnatal planning. We report a case of penoscrotal hypospadia diagnosed at 33 weeks of gestation, suspected due to the absence of testicles in the scrotum and difficulty of penis visualization. We emphasize the findings of 3DUS and its importance in the pathology compression by parents.

Heterotopic pregnancy is a condition characterized by implantation of one or more viable embryos into the uterine cavity while another one is implanted ectopically, particularly into the uterine tube. Its occurrence has increased drastically over the last few years due to assisted reproduction procedures. In general, the diagnosis is made during the first trimester by using endovaginal two-dimensional ultrasound (2DUS), through observing a complex para- or retrouterine mass in association with a viable uterine pregnancy. However, under some conditions such as atypical ultrasonographic presentations, 2DUS does not clarify the situation whereas magnetic resonance imaging (MRI) of the pelvis is able to do so. We present the case of a pregnant woman in her fifth pregnancy, with a clinical condition of lower abdominal pain and pallor. Endovaginal 2DUS showed a complex voluminous mass in the left pelvic region in association with a viable intrauterine pregnancy. 2DUS in power Doppler mode showed “ring” vascularization, compatible with an ectopic gestational sac. MRI was of great importance in that it suggested that the mass had hematic content, which together with the clinical features, indicated that laparotomy should be performed. This surgical choice was essential for the woman to achieve a clinical improvement and for good continuation of the intrauterine pregnancy.

The numbers of syphilis cases have been increasing considerably, especially in eastern europe, thereby contributing towards greater chances of cases of congenital syphilis. Some of the complications of congenital syphilis can be detected on two-dimensional ultrasonography (2DUS), and these are generally manifested in the second trimester of pregnancy. The commonest ultrasonographic signs are hepatosplenomegaly, placentomegaly, and fetal growth restriction, while lower-frequency occurrences include intrahepatic calcifications, ascites, fetal hydrops, and even fetal death. Three-dimensional ultrasonography (3DUS) is a relatively new imaging technique that is adjuvant to 2DUS and enables detailed assessment of the fetal surface anatomy. We present a case of a 21-year-old primigravida with a diagnosis of congenital syphilis, with obstetric 2DUS findings of hepatosplenomegaly, ascites, pericardial effusion and hyperechogenicity of the cerebral parenchyma. 3DUS in rendering mode allowed clear assessment of the fetal limbs, especially the feet, which appeared twisted and lacked some toes. It allowed the parents to understand the pathological condition better and improved prenatal management and neonatal followup. 3DUS can be used routinely for assessing fetal malformations resulting from congenital infections.

OBJETIVO: avaliar a evolução do volume do embrião (VE) entre a sétima e a décima semana de gestação por meio da ultra-sonografia tridimensional. MÉTODOS: realizou-se um estudo de corte transversal com 63 gestantes normais entre a sétima e a décima semana. Os exames ultra-sonográficos foram realizados por meio de um transdutor endocavitário volumétrico. Para o cálculo do VE, utilizou-se o método VOCAL (Virtual Organ Computer-aided Analysis) com ângulo de rotação de 12º, com delimitação de 15 planos seqüenciais. Para o VE foram calculadas médias, medianas, desvios padrão e valores máximo e mínimo em todas as idades gestacionais. Para se avaliar a correlação entre o VE e o comprimento cabeça-nádega (CCN) foi criado gráfico de dispersão, sendo o ajuste realizado pelo coeficiente de determinação (R²). Para se determinarem intervalos de referência do VE em função do CCN, utilizou-se a seguinte fórmula: percentil =VE+K versus dp, com K=1,96. RESULTADOS: o CCN variou de 9,0 a 39,7 mm, com média de 23,9 mm (±7,9 mm), enquanto o VE variou de 0,1 a 7,6 cm³, com média de 2,7 cm³ (±3,2 cm³). O VE foi altamente correlacionado com o CCN, sendo que o melhor ajuste foi obtido com regressão quadrática (VE=0,165 - 0,055 x CCN + 0,005 x CCN²; R²=0,853). O VE médio variou de 0,1 (-0,3 a 0,5 cm³) a 6,7 cm³ (3,8 a 9,7 cm³) no intervalo de 9 a 40 mm do CCN. Neste intervalo o VE aumentou 67 vezes, enquanto o CCN aumentou apenas 4,4 vezes. CONCLUSÕES: o VE é um parâmetro mais sensível que o CCN para avaliar o crescimento embrionário entre a sétima e a décima semana de gestação.PURPOSE: to evaluate the embryo's volume (EV) between the seventh and the tenth gestational week, through tridimensional ultrasonography. METHODS: a transversal study with 63 normal pregnant women between the seventh and the tenth gestational week. The ultrasonographical exams have been performed with a volumetric abdominal transducer. Virtual Organ Computer-aided Analysis (VOCAL) has been used to calculate EV, with a rotation angle of 12º and a delimitation of 15 sequential slides. The average, median, standard deviation and maximum and minimum values have been calculated for the EV in all the gestational ages. A dispersion graphic has been drawn to assess the correlation between EV and the craniogluteal length (CGL), the adjustment being done by the determination coefficient (R²). To determine EV's reference intervals as a function of the CGL, the following formula was used: percentile=EV+K versus SD, with K=1.96. RESULTS: CGL has varied from 9.0 to 39.7 mm, with an average of 23.9 mm (±7.9 mm), while EV has varied from 0.1 to 7.6 cm³, with an average of 2.7 cm³ (±3.2 cm³). EV was highly correlated to CGL, the best adjustment being obtained with quadratic regression (EV=0.2-0.055 versus CGL+0.005 versus CGL²; R²=0.8). The average EV has varied from 0.1 (-0.3 to 0.5 cm³) to 6.7 cm³ (3.8 to 9.7 cm³) within the interval of 9 to 40 mm of CGL. EV has increased 67 times in this interval, while CGL, only 4.4 times. CONCLUSIONS: EV is a more sensitive parameter than CGL to evaluate embryo growth between the seventh and the tenth week of gestation.