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Resume Objectifs Developper et evaluer la pertinence clinique d’une version du score generique OSAUS (Objective Structured Assessment of Ultrasound Skills) dediee a la biometrie fœtale. Materiel et methodes Cinq competences cibles specifiques a la biometrie fœtale ont ete definies pour chaque item thematique du score generique permettant d’etablir une grille d’evaluation OSAUS-METHOD sur 5 points (MEasurements TeacHing in Obstetrics Design). Le niveau de competence de 43 etudiants a ete evalue a l’aide grille OSAUS-METHOD (MEasurements TeacHing in Obstetrics Design) lors d’examens pratiques. Les notes des etudiants debutants (experience pratique Resultats Le score moyen au sein du groupe « debutants » (n = 29) etait significativement plus faible que celui au sein du « intermediaires » (n = 14) (1,87 ± 0,75 et 3,31 ± 0,83 respectivement, p = 1,855) (I). Une proportion plus importante de competences non validee a permis d’identifier l’item « documentation de l’examen » comme axe de progression prioritaire (II). La pertinence du score seuil pour discriminer les etudiants en fonction du niveau d’expertise est confortee mais un minime chevauchement entre les groupes de niveau est observe (III). Conclusion La faisabilite et la pertinence de l’utilisation d’un score OSAUS dedie a la biometrie sont confirmees ainsi que la possibilite de comparaisons avec le score OSAUS generique.

Ultrasound assessment of fetal growth is essential to reduce adverse pregnancy outcomes. Intergrowth-21st developed international standards. Currently, we use in France chart based on Hadlock's formula. This study aims to evaluate, the impact of switching from national curves to IG-21 curves or a combination of IG-21 with Hadlock.The study population consisted of 3 697 singleton pregnancies with fetal biometry measured between 22 and 38 weeks of gestation.We observed 21% of head circumference, 9% of abdominal circumference and 7% of femoral length below the 10th centile with Intergrowth-21. Concerning estimated fetal weight, IG-21 classified 13.8% fetuses as SGA, IG-21/Hadlock 10.8% and CFEF 16.1%. Between 36 and 38 weeks of gestation, IG-21 classified more fetuses as SGA than IG-21/Hadlock and CFEF, respectively 18%, 14.1% and 13.3%.The use of IG-21 or IG-21/Hadlock in the general population would lower the number of fetuses classified as SGA except for fetuses between 36 and 38 weeks. During this period, many decisions of induced early delivery or specific management are established to prevent adverse perinatal outcome. Those results must be supplemented by a comparison to newborns' weight.

International audience; Background: Fetal biometry quality directly influences obstetrical care relevance. However, obstetrician proficiencies are heterogeneous in particular during initial training. Objectives: To assess the predictive value of OSAUS scale to identify operators with enough command to perform a valid estimation of fetal weight (EFW) (I). This study also assesses OSAUS intra-operator inter-exams variability (II) and pass/fail score relevancy (III). Methods: Lecturers in Nancy University Hospital assessed trainees’ proficiency for EWF systematically and prospectively through OSAUS scale. The trainee assessment was performed right after the one of the senior operator (reference EFW) on three consecutive patients during standard care ultrasounds. To ensure variability in proficiency within the sample, previous practice was taken into account during enrollment (“novices” and “intermediates” for < 20 and 20 past exams, respectively). Correlation between mean OSAUS and validity of EFW (a valid EFW was defined by a difference with the reference EWF < 0.8 Z-score) and variability between consecutive assessments were assessed. Results: The study population was constituted of 8 “novice” and 8 “intermediate” trainees. Association between OSAUS and EFW validity was significant (P < 0.03) (I). Intra-operator inter-exams variability was majored in the “novice” group (coefficients of variation were 25% vs. 10% in “novice” and “intermediate” group respectively) (II). Within the sample, specificity and positive predictive value of a pass/fail score OSAUS > 3.5 to predict EFW validity were 77% and 71%, respectively (III). Conclusion: A 3.5 OSAUS pass/fail score could provide a relevant threshold to estimate operator proficiency in assessing fetal biometry in an autonomous and secure way.

To investigate clinical and sonographic features associated with sonographic accuracy for the prediction of small for gestational age (SGA) and macrosomia at birth.The database of a tertiary medical center was retrospectively searched for women who gave birth at term to a singleton healthy neonate in 2007-2014 and underwent sonographic estimated fetal weight (sEFW) evaluation within 3 d before delivery. Fetal growth restriction (FGR) and SGA were defined as sEFW or birth weight10th percentile for gestational age; macrosomia was defined as birth weight4000 grams. Data on maternal age, parity, gestational age, fetal gender, presentation, placental location, diabetes, hypertension, and oligo/polyhydramnios were compared between pregnancies with a false-negative and false-positive diagnosis of SGA or macrosomia.Of the 5425 fetal weight evaluations, 254 (4.7%) deviated by15% from the actual birth weight. Nulliparity, absence of diabetes, neonatal female gender, anterior placenta, lower birth weight, and oligohydramnios were associated with a high deviation. We identified 482 SGA neonates (8.9%) and 633 macrosomic neonates (11.7%). A false-positive diagnosis of FGR was associated with oligohydramnios, absence of diabetes, and posterior placenta, and a false-negative diagnosis, with older maternal age, nulliparity, and male gender. A false-positive diagnosis of macrosomia was associated with older maternal age, multiparity, polyhydramnios, anterior placenta, and lack of hypertensive complications, and a false-negative diagnosis, with diabetes, hypertension, oligohydramnios, and vertex presentation.The accuracy of sEFW is affected by clinical and sonographic pregnancy characteristics. Further analyses should focus on improving accuracy especially at the fetal weight extremes.

To evaluate the association of sonographic fetal head circumference (HC) with obstetric anal sphincter injury (OASIS) occurrence among primiparous women who underwent vacuum-assisted delivery (VAD). A retrospective study of all primiparous women who delivered at term by VAD between 2011 and 2019 and underwent ultrasound with fetal biometry within 1 week prior to delivery. Women who suffered OASIS were compared to women without OASIS. Overall, 74 of 3222 (2.3%) primiparous women suffered an OASIS. As compared with control, women with OASIS were younger (median 28 vs. 30 years, p = 0.001), had higher BMI (median 28.2 vs. 26.9 kg/m2, p = 0.03), and had a longer second stage of labor (median 190 vs. 168 min, p = 0.01). Fetal head circumference was larger in the OASIS group (mean 334 vs. 330 mm, p = 0.03), occiput posterior fetal head position was more prevalent (12 (16%) vs. 232 (7.4%), OR [95% CI]: 2.43 (1.29–4.57), p = 0.004), and the rate of mediolateral episiotomy performed was lower (58 (78.0%) vs. 2777 (88.2%), OR [95% CI]: 0.48 (0.27–0.85), p = 0.01). Multivariate regression modeling identified higher fetal HC (aOR [95% CI] 1.03 (1.001–1.06), p = 0.04) and occiput posterior (aOR [95% CI] 2.5 (1.16–5.71), p = 0.01) as independently positively associated with OASIS. Mediolateral episiotomy and maternal age were independently negatively associated with an OASIS (aOR [95% CI] 0.39 (0.18–0.85), p = 0.01); aOR [95% CI] 0.4 (0.17–0.60), p = 0.001). Sonographic large fetal HC is associated with OASIS occurrence during VAD. The only modifiable predictor of OASIS detected was mediolateral episiotomy, found to be protective against OASIS.

Objective To develop and validate birthweight prediction models using fetal fractional thigh volume (TVol) in an Indian population, comparing them with existing prediction models developed for other ethnicities. Methods A prospective observational study was conducted among 131 pregnant women (>36 weeks) attending a tertiary hospital in New Delhi, India, for prenatal care between December 1, 2014, and November 1, 2016. Participants were randomly divided into formulating (n=100) and validation (n=31) groups. Multiple regression analysis was performed to generate four models to predict birthweight using various combinations of two-dimensional (2D) ultrasonographic parameters and a three-dimensional (3D) ultrasonographic parameter (TVol). The best fit model was compared with previously published 2D and 3D models. Results The best fit model comprised biparietal diameter, head circumference, abdominal circumference, and TVol. This model had the lowest mean percentage error (0.624 ± 8.075) and the highest coefficient of determination (R2 =0.660). It correctly predicted 70.2% and 91.6% of birthweights within 5% and 10% of actual weight, respectively. Compared with previous models, attributability for the 2D and 3D models was 0.65 and 0.55, respectively. Accuracy was -0.05 ± 1.007 and -2.54 ± 1.11, respectively. Conclusion Models that included TVol provided good prediction of birthweight in the target population.

Background and Objectives: The aim of this study was to evaluate the value of adding fetal growth velocity and first trimester maternal biomarkers to baseline screening, for the prediction of small-for-gestational age (SGA) and adverse neonatal outcomes. Method: A retrospective cohort study was conducted of singleton pregnancies in the Maastricht University Medical Centre between 2012 and 2016. The biomarkers PAPP-A, β-hCG, PlGF, and sFlt-1 were measured at 11–13 weeks of gestational age (GA) and two fetal growth scans were performed (18–22 and 30–34 weeks of GA). Differences in biomarkers and growth velocities were compared between appropriate-for-gestational age (AGA; birth weight percentile 10–90) and SGA (birth weight percentile Results: We included 296 singleton pregnancies. Compared to AGA (n = 251), SGA neonates (n = 45) had significantly lower growth velocities in the abdominal circumference (mm/week): 10.1 ± 0.98 versus 10.8 ± 0.98, p = 0.001. Compared with AGA, the SGA neonates had higher sFlt-1 multiples of the median (MoM): 0.89 (0.55) versus 0.76 (0.44), p = 0.023, and a higher sFlt-1/PlGF MoM ratio: 1.09 (1.03) versus 0.90 (0.64), p = 0.027. For a 15% false-positive rate, the prediction of SGA neonates increased from 44.8% for the baseline screening model to 56.5% after the addition of fetal growth velocities, and to 73.9% after the further addition of maternal biomarkers (PPV 9.6%, NPV 82.4%). The corresponding AUC for the three models were 0.722, 0.804, and 0.839, respectively. In addition, AGA neonates with reduced fetal growth velocity had more adverse neonatal outcomes compared to the AGA reference group (12.4 vs. 3.9%, p = 0.013). Conclusions: Combining fetal growth velocity with first trimester biomarkers resulted in a better prediction of SGA compared to baseline screening parameters alone. This approach could possibly result in reduced adverse neonatal outcomes in neonates, who are at a potential risk due to late mild placental dysfunction.

Objective: The aim of our study was to assess charts proposed for international use in the Intergrowth-21st Project. Methods: Ultrasound data were collected from 43,923 healthy singleton pregnancies examined at 18–23 weeks of gestation in the Netherlands. Fetal measurements were converted into Z-scores using previous and current Dutch reference charts and Intergrowth charts. The distributions of the Z-scores were compared with the expected standard normal distribution. Results: In the Dutch population, Intergrowth curves perform well for head circumference and biparietal diameter, but not for abdominal circumference (AC, Z- score = 0.43) and femur length (FL, Z-score = 0.26). Similar findings have been reported in other European countries. Compared with the population in the Intergrowth study, Dutch women are relatively tall (170 vs. 162 cm) and sturdy (67 vs. 61 kg) with a moderately high BMI. Maternal size, in particular maternal height, is positively correlated with birthweight. Conclusions: Whilst the establishment of the Intergrowth charts is an important step towards worldwide uniformity, for now locally derived charts still perform better, especially for AC and FL. Results from our validation study indicate that distinction between normal and pathologically small babies may be improved by taking maternal size into account.

Introduction: The aim of this secondary analysis was to investigate the relationship between maternal body mass index (BMI) and fetal biometry, body composition, and velocity measurements at 28 and...

Objectives: Most of the ultrasound machines include a tool allowing real-time display of the standard value of the biometric measurement being taken. Our hypothesis was that this tool influences the sonographer as measurements are taken, by inducing a normalization, thus a tendency towards the 50th percentile. The objective of this study was to evaluate the impact of a real-time display of the standard value in prenatal ultrasound screening. Methods: We conducted an observational, prospective, controlled and open study including all patients who underwent a prenatal ultrasound scan in the 2nd or 3rd trimester at the University Hospitals in Strasbourg between December 2017 and June 2018. Exclusion criteria were the presence of a fetal morphological abnormality or a karyotypic abnormality. The tool being tested was the real-time display on screen of the gestational age, of which the measurement corresponds to the 50th percentile. The measurements were retrospectively transformed into Z-scores. The main end-point was to compare the distribution of Z-scores between the groups. Results: We included 3551 ultrasound examinations: 696 performed with the tool and 2796 performed without. Fifty-nine scans were excluded due to morphological abnormalities. There was no statistically significant difference between the Z-scores distributions of measurements performed with or without the tool, regardless of the parameter studied. There was also no difference in the detection of pathological measurements: below the 10th percentile or above the 90th percentile. Conclusion: The use of such a tool does not seem to be detrimental to biometric screening, but on the other hand does not seem useful either. Keywords: Contrôle qualité; Dépistage prénatal; Fetal biometry; Prenatal ultrasonography; Quality Control; Z-scores; Échographie.

Background Ultrasound scanning during the 2nd or the 3rd trimester of pregnancy for fetal size disturbances screening is heavily dependent of the choice of the reference chart. This study aimed to assess the agreement of Salomon and the Intergrowth 21st equations in evaluating fetal biometric measurements in a rural area of Burkina Faso, and to measure the effect of changing a reference chart. Methods Data collected in Nazoanga, Burkina Faso, between October 2010 and October 2012, during a clinical trial evaluating the safety and efficacy of several antimalarial treatments in pregnant women were analyzed. We included singleton pregnancies at 16–36 weeks gestation as determined by ultrasound measurements of fetal bi-parietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL). Expected mean and standard deviation at a given gestational age was computed using equations from Salomon references and using Intergrowth 21st standard. Then, z-scores were calculated and used subsequently to compare Salomon references with Intergrowth 21st standards. Results The analysis included 276 singleton pregnancies. Agreement was poor except for HC: mean difference − 0.01, limits of agreement − 0.60 and 0.59. When AC was used as a surrogate of fetal size, switching from the reference of Salomon to the standards of Intergrowth 21st increased ten times the proportion of fetuses above the 90th percentile: 2.9 and 31.2%, respectively. Mean differences were larger in the third trimester than in the second trimester. However, agreement remained good for HC in both trimesters. Difference in the proportion of AC measurements above the 90th percentile using Salomon and Intergrowth 21st equations was greater in the second trimester (2.6 and 36.3%, respectively) than in the third trimester (3.5 and 19.8%, respectively). The greatest difference between the two charts was observed in the number of FL measurements classified as large in the second trimester (6.8 and 54.2%, using Salomon and Intergrowth 21st equations, respectively). Conclusion The agreement between Intergrowth 21st and Salomon equations is poor apart from HC. This would imply different clinical decision regarding the management of the pregnancy.

Purpose of Review This paper discusses the current issues in the development of foetal charts and is informed by a scoping review of studies constructing charts between 2012 and 2018. Recent Findings The scoping review of 20 articles revealed that there is still a lack of consensus on how foetal charts should be constructed and whether an international chart that can be applied across populations is feasible. Many of these charts are in clinical use today and directly affect the identification of at risk newborns that require treatment and nutritional strategies. However, there is no agreement on important design features such as inclusion and exclusion criteria; sample size and agreement on definitions such as what constitutes a healthy population of pregnant women that can be used for constructing foetal standards. Summary This paper therefore reiterates some of these current issues and the scoping review showcases the heterogeneity in the studies developing foetal charts between 2012 and 2018. There is no consensus on these pertinent issues and hence if not resolved will lead to continued surge of foetal reference and standard charts which will only exacerbate the current problem of not being able to make direct comparisons of foetal size and growth across populations.

ContextVariability in 2D ultrasound (US) is related to the acquisition of planes of reference and the positioning of callipers and could be reduced in combining US volume acquisitions and anatomical structures recognition.ObjectivesThe primary objective is to assess the consistency between 3D measurements (automated and manual) extracted from a fetal US volume with standard 2D US measurements (I). Secondary objectives are to evaluate the feasibility of the use of software to obtain automated measurements of the fetal head, abdomen and femur from US acquisitions (II) and to assess the impact of automation on intraobserver and interobserver reproducibility (III).Methods and analysis225 fetuses will be measured at 16–30 weeks of gestation. For each fetus, six volumes (two for head, abdomen and thigh, respectively) will be prospectively acquired after performing standard 2D biometry measurements (head and abdominal circumference, femoral length). Each volume will be processed later by both a software and an operator to extract the reference planes and to perform the corresponding measurements. The different sets of measurements will be compared using Bland-Altman plots to assess the agreement between the different processes (I). The feasibility of using the software in clinical practice will be assessed through the failure rate of processing and the score of quality of measurements (II). Interclass correlation coefficients will be used to evaluate the intraobserver and interobserver reproducibility (III).Ethics and disseminationThe study and related consent forms were approved by an institutional review board (CPP SUD-EST 3) on 2 October 2018, under reference number 2018–033 B. The study has been registered inhttps://clinicaltrials.govregistry on 23 January 2019, under the numberNCT03812471. This study will enable an improved understanding and dissemination of the potential benefits of 3D automated measurements and is a prerequisite for the design of intention to treat randomised studies assessing their impact.Trial registration numberNCT03812471; Pre-results.

This study was conducted to establish a new reference chart and equation for femur length (FL) based on Saudi pregnant women in Dammam, and to compare it with references from different populations. This cross-sectional study involved 400 women with singleton pregnancies who attended the Maternal and Children Hospital in Dammam in 2018, which confirmed their gestational age (GA). For this study, each woman was scanned once only, between 14th to 40th completed weeks ofgestation using Ultrasound machine Voluson E10 (GE Healthcare, Austria) with a 2–5 MHz convex abdominal probe. The SPSS software version 24 (descriptive, regression analysis, and paired t-test) was used for analysis. The mean maternal age was 29 ± 5.92 years. The mean value of FL in second trimesters was 33.75 mm while it reaches to 62.80 mm in third trimesters. At 14th and 40th weeks, mean values (±SD) for FL were 14.85 (±2.58) mm and 78.75 (±1.97) mm. The quadratic regression models were fitted to estimate the mean and separate linear regression to estimate the standard deviation at each GA. The comparison of the FL values of Saudi chart shows a significant difference with the common references used. The FL values in this study were significantly higher than the corresponding values of USA, French, UK, German, Japan, Korea, Malaysia, Iran, Bangladesh, Egypt, and Thailand but lower than China and Nigerian. Thus, these new FL values are highly recommended to be used by the medical practitioner as the reference range of fetus biometry for Saudi Arabia population regarding providing better healthcare and wellbeing of the maternal and fetuses.

OBJECTIVE: To utilise image score‐based criteria for second‐trimester fetal biometry as an educational tool to improve biometry quality. METHODS: Five sonographers regularly performing obstetric ultrasound examinations were recruited for this study. Biometry images were collected from fifteen second‐trimester examinations for each sonographer prior to participating in a biometry education session, and another set of biometry images were collected from fifteen second‐trimester examinations following the education session. The education session was a one‐hour presentation that explained image score‐based criteria to evaluate and grade the quality of the bi‐parietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL) and humeral length (HL) biometry parameters. Each of the five sonographers performed a total of 30 examinations (15 pre‐ and 15 post‐education session). From these examinations, a total of 150 images were collected for each biometry parameter (75 pre‐ and 75 post‐education). A total of 600 biometry images were evaluated. Images from both the pre‐ and post‐education session were assessed by an obstetrician sonologist using the same image score‐based criteria. Pre‐ and post‐image scores were compared using paired t‐tests. RESULTS: Improvement in the mean image scores for all biometry parameters was observed after the education session. The difference between pre‐ and post‐education image quality scores was significant for the AC (P = 0.01), FL (P = 0.002) and for the overall score (P = 0.001). CONCLUSION: Implementing an image score‐based criteria evaluation technique is a simple and useful method to improve fetal biometry precision.

Fetal growth restriction is a major determinant of perinatal morbidity and mortality. Screening for fetal growth restriction is a key element of prenatal care but it is recognized to be problematic. Screening using clinical risk assessment and targeting ultrasound to high-risk women is the standard of care in the United States and United Kingdom, but the approach is known to have low sensitivity. Systematic reviews of randomized controlled trials do not demonstrate any benefit from universal ultrasound screening for fetal growth restriction in the third trimester, but the evidence base is not strong. Implementation of universal ultrasound screening in low-risk women in France failed to reduce the risk of complications among small-for-gestational-age infants but did appear to cause iatrogenic harm to false positives. One strategy to making progress is to improve screening by developing more sensitive and specific tests with the key goal of differentiating between healthy small fetuses and those that are small through fetal growth restriction. As abnormal placentation is thought to be the major cause of fetal growth restriction, one approach is to combine fetal biometry with an indicator of placental dysfunction. In the past, these indicators were generally ultrasonic measurements, such as Doppler flow velocimetry of the uteroplacental circulation. However, another promising approach is to combine ultrasonic suspicion of small-for-gestational-age infant with a blood test indicating placental dysfunction. Thus far, much of the research on maternal serum biomarkers for fetal growth restriction has involved the secondary analysis of tests performed for other indications, such as fetal aneuploidies. An exemplar of this is pregnancy-associated plasma protein A. This blood test is performed primarily to assess the risk of Down syndrome, but women with low first-trimester levels are now serially scanned in later pregnancy due to associations with placental causes of stillbirth, including fetal growth restriction. The development of "omic" technologies presents a huge opportunity to identify novel biomarkers for fetal growth restriction. The hope is that when such markers are measured alongside ultrasonic fetal biometry, the combination would have strong predictive power for fetal growth restriction and its related complications. However, a series of important methodological considerations in assessing the diagnostic effectiveness of new tests will have to be addressed. The challenge thereafter will be to identify novel disease-modifying interventions, which are the essential partner to an effective screening test to achieve clinically effective population-based screening.

OBJECTIVES To analyze the influence of examiners and their experience on the quality of biometric measurements via the evolution of z scores in a longitudinal multicenter study. METHODS This retrospective study included 4607 sonographic fetal biometric examinations performed by 18 examiners at the beginning of their sonography training. To analyze the quality of biometric measurements, z scores comparing the individual measurements with the expected values from a standard population were computed. To investigate the effect of examiners and their experience, we applied a multivariable regression analysis via generalized additive mixed models. RESULTS Mean z scores for biparietal diameter, abdominal circumference, and femur length were statistically different from the expected value of 0 (P

OBJECTIVES: To determine the longitudinal behavior of fetal biometric measures and cerebroplacental hemodynamics throughout gestation in fetuses with congenital heart disease (CHD). METHODS: Fetal biometry and Doppler hemodynamics (uterine artery (UtA), umbilical artery (UA) and fetal middle cerebral artery (MCA)) were measured serially in a cohort of consecutive fetuses diagnosed with CHD. Evaluations were made at various time points, from diagnosis (20-25 weeks) to delivery, with at least two measurements per fetus that were at least 2 weeks apart. Fetuses were classified into three groups according to the pattern of blood supply to the brain (placental vs systemic) that would be expected on the basis of the type of CHD. All parameters were transformed into Z-scores. A linear mixed model to analyze repeated measurements was constructed for each parameter to assess its behavior throughout gestation. RESULTS: Four hundred and forty-four ultrasound examinations were performed in 119 CHD fetuses, with a median of two measurements per fetus. The fetuses presented a small head at diagnosis (biparietal diameter (BPD) Z-score, -1.32 ± 0.99; head circumference (HC) Z-score, -0.79 ± 1.02), which remained small throughout gestation. UtA and UA pulsatility indices (PI) showed a significant increase towards the end of pregnancy, whereas no significant changes were observed in MCA-PI or cerebroplacental ratio (CPR) with gestational age. Both MCA and CPR presented significant differences in longitudinal behavior between CHD groups, while BPD and HC did not. CONCLUSIONS: CHD fetuses have a relatively small head from the second trimester of pregnancy, regardless of the type of CHD anomaly, and increasing resistance in the UtA and UA as pregnancy progresses, suggestive of increasing degree of placental impairment. Our findings indicate the early onset of mechanisms that could lead to poorer neurodevelopment later in life. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Objectives To evaluate the performance of screening for all stillbirths and those due to impaired placentation and unexplained or other causes by a combination of maternal factors, fetal biometry and uterine artery pulsatility index (UT-PI) at 19–24 weeks’ gestation and compare this performance to that of screening by UT-PI alone. Methods This was a prospective screening study of 70,003 singleton pregnancies including 69,735 live births and 268 (0.38%) antepartum stillbirths; 159 (59%) were secondary to impaired placentation and 109 (41%) were due to other or unexplained causes. Multivariate logistic regression analysis was used to develop a model for prediction of stillbirth based on a combination of maternal factors, fetal biometry and UT-PI. Results Combined screening predicted 55% of all stillbirths, including 75% of those due to impaired placentation and 23% of those that were due to other causes or unexplained, at false positive rate of 10%; within the impaired placentation group the detection rate of stillbirth at

OBJECTIVES: Operators performing fetal growth scans are usually aware of the gestational age of the pregnancy, which may lead to expected‐value bias when performing biometric measurements. We aimed to evaluate the incidence of expected‐value bias in routine fetal growth scans and assess its impact on standard biometric measurements. METHODS: We collected prospectively full‐length video recordings of routine ultrasound growth scans coupled with operator eye tracking. Expected value was defined as the gestational age at the time of the scan, based on the estimated due date that was established at the dating scan. Expected‐value bias was defined as occurring when the operator looked at the measurement box on the screen during the process of caliper adjustment before saving a measurement. We studied the three standard biometric planes on which measurements of head circumference (HC), abdominal circumference (AC) and femur length (FL) are obtained. We evaluated the incidence of expected‐value bias and quantified the impact of biased measurements. RESULTS: We analyzed 272 third‐trimester growth scans, performed by 16 operators, during which a total of 1409 measurements (354 HC, 703 AC and 352 FL; including repeat measurements) were obtained. Expected‐value bias occurred in 91.4% of the saved standard biometric plane measurements (85.0% for HC, 92.9% for AC and 94.9% for FL). The operators were more likely to adjust the measurements towards the expected value than away from it (47.7% vs 19.7% of measurements; P CONCLUSIONS: During routine third‐trimester growth scans, expected‐value bias frequently occurs and significantly changes standard biometric measurements obtained. © 2019 the Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

Fetuses at the extremes of growth abnormalities carry a risk of perinatal morbidity and death. Their identification traditionally is done by 2-dimensional ultrasound imaging, the performance of which is not always optimal. Magnetic resonance imaging superbly depicts fetal anatomy and anomalies and has contributed largely to the evaluation of high-risk pregnancies. In 1994, magnetic resonance imaging was introduced for the estimation of fetal weight, which is done by measuring the fetal body volume and converting it through a formula to fetal weight. Approximately 10 studies have shown that magnetic resonance imaging is more accurate than 2-dimensional ultrasound imaging in the estimation of fetal weight. Yet, despite its promise, the magnetic resonance imaging technique currently is not implemented clinically. Over the last 5 years, this technique has evolved quite rapidly. Here, we review the literature data, provide details of the various measurement techniques and formulas, consider the application of the magnetic resonance imaging technique in specific populations such as patients with diabetes mellitus and twin pregnancies, and conclude with what we believe could be the future perspectives and clinical application of this challenging technique. The estimation of fetal weight by ultrasound imaging is based mainly on an algorithm that takes into account the measurement of biparietal diameter, head circumference, abdominal circumference, and femur length. The estimation of fetal weight by magnetic resonance imaging is based on one of the 2 formulas: (1) magnetic resonance imaging-the estimation of fetal weight (in kilograms)=1.031×fetal body volume (in liters)+0.12 or (2) magnetic resonance imaging-the estimation of fetal weight (in grams)=1.2083×fetal body volume (in milliliters)ˆ0.9815. Comparison of these 2 formulas for the detection of large-for-gestational age neonates showed similar performance for preterm (P=.479) and for term fetuses (P=1.000). Literature data show that the estimation of fetal weight with magnetic resonance imaging carries a mean or median relative error of 2.6 up to 3.7% when measurements were performed at

Background: Young maternal age is associated with poorer birth outcomes, but the mechanisms are incompletely understood. Using data from a prospective cohort of pregnant women living in Mumbai slums, India, we tested whether lower maternal age was associated with adverse fetal growth. Methods: Fetal crown-rump length (CRL) was recorded at a median (interquartile range, IQR) of 10 weeks' gestation (9-10 weeks). Head circumference (HC), biparietal diameter (BPD), femur length (FL), and abdominal circumference (AC) were recorded at 19 (19-20) and 29 (28-30) weeks. Newborns were measured at a median (IQR) of 2 days (1-3 days) from delivery. Gestation was assessed using prospectively collected menstrual period dates. Results: The sample comprised 1653 singleton fetuses without major congenital abnormalities, of whom 1360 had newborn measurements. Fetuses of younger mothers had smaller CRL (0.01 standard deviation [SD] per year of maternal age; 95% confidence interval CI: 0.00-0.02(1); P = .04), and smaller HC, FL, and AC at subsequent visits. Fetal growth of HC (0.04 cm; 95% CI: 0.02-0.05; P < .001), BPD (0.01 cm; 95% CI: 0.00-0.01; P = .009), FL (0.04 cm; 95% CI: 0.02-0.06; P < .001), and AC (0.01 cm; 95% CI: 0.00-0.01; P = .003) up to the third trimester increased with maternal age. Skinfolds, head, and mid-upper arm circumferences were smaller in newborns of younger mothers. Adjusting for maternal prepregnancy socioeconomic status, body mass index, height, and parity attenuated the associations between maternal age and newborn size but did not change those with fetal biometry. Conclusion: Fetuses of younger mothers were smaller from the first trimester onward and grew slower, independently of known confounding factors.

OBJECTIVE: To evaluate the effect of fetal sex on singleton pregnancy growth charts customized for parental characteristics, race, and parity Methods: In a multicentric cross-sectional study, 8070 ultrasonographic examinations from low-risk singleton pregnancies between 16 and 40 weeks of gestation were considered. The fetal measurements obtained were biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL). Quantile regression was used to examine the impact of fetal sex across the biometric percentiles of the fetal measurements considered together with parents' height, weight, parity, and race. RESULTS: Fetal gender resulted to be a significant covariate for BDP, HC, and AC with higher values for male fetuses (p ≤ 0.0009). Minimal differences were found among sexes for FL. Parity, maternal race, paternal height and maternal height, and weight resulted significantly related to the fetal biometric parameters considered independently from fetal gender. CONCLUSION: In this study, we constructed customized biometric growth charts for fetal sex, parental, and obstetrical characteristics using quantile regression. The use of gender-specific charts offers the advantage to define individualized normal ranges of fetal biometric parameters at each specific centile. This approach may improve the antenatal identification of abnormal fetal growth.

Objective: The aim of this study was to derive reference charts between the 15th and 20th week of gestation for biparietal diameter (BPD), occipito-frontal diameter (OFD), head circumference (HC), abdominal circumference (AC) and femur length (FL) compared to commonly used curves and to evaluate the impact of maternal body mass index (BMI), ultrasound equipment, fetal gender and nicotine abuse. Methods: In a cross-sectional study of 4,265 low-risk pregnancies, biometric data were obtained between the 15th and 20th week of gestation. The statistical analysis included descriptive data, fitting regression curves for the 5th, 50th and 95th quantile as well as multivariate quantile regression analyses. Results: Reference curves for BPD, OFD, HC, AC and FL showed a linear increase between the 15th and 20th week of gestation. New equations and reference charts are presented in this study. In a comparison of influence factors sex, BMI and ultrasound systems have an impact. Conclusion: As a result of the study, we determined current growth curves for BPD, OFD, HC, AC and FL for both sexes as well as for males and females separately. The updated growth curves for all biometric parameters differ from the curves used commonly in the last two decades.

The acquisition of fetal biometric measurements via 2-D B-Mode ultrasound (US) scans is crucial for fetal monitoring. However, acquiring standardised head, abdominal and femoral image planes is challenging due to variable image quality. There remains a significant discrepancy between the way automated computer vision algorithms and human sonographers perform this task; this paper contributes to the attempt to bridge this gap by building knowledge of US image perception into a pipeline for classifying images obtained during 2-D fetal US scans. We record the eye movements of 10 participants performing 4 2-D US scans each, on a phantom fetal model at varying orientations. We analyse their eye movements to establish which high-level constraints and visual cues are used to localise the standardised abdominal plane. We then build a vocabulary of visual words trained on SURF descriptors extracted around eye fixations, and use the resulting bag of words model to classify head, abdominal and femoral image frames acquired during 10 clinical US scans and 10 further phantom US scans. On phantom data, we achieve classification accuracies of 89%, 87% and 85% for the head, abdominal and femoral images respectively. On clinical data, we achieve classification accuracies of 76%, 68% and 64% for the head, abdominal and femoral images respectively. This constitutes the first insight into image perception during real time US scanning, and a proof of concept for training bag of words models for US image analysis on human eye movements.

Background: Many centers in Sudan use the reference data for fetal biometry. The recently published population-based reference either overestimated or underestimated the weight of the fetuses. Objective: To establish a national reference for fetal biometry, and weight by gestational age for singleton fetuses in Sudan. Methods: Data were collected on all singleton live births documented in the data collection sheet done at Saudi Hospital from 2015 to 2016 (n = 225). Gestational age estimation was based on the last menstrual period and fetal ultrasound thereafter. Fetal biometry and weight and other 6 fetal weight formulae were assessed. Reference data for fetal growth by gestational age were created. Results: New charts and reference equations are reported in Sudanese population for fetal biparietal diameter, head circumference, abdominal circumference and femur length and fetal weight. Conclusion: We advocate that these reference charts and equations for fetal biometry and weight might be valuable in the clinical use for appropriate ethnic Sudanese.

Objective To evaluate whether an automated tool can recognize a structure of interest and measure fetal head circumference (HC), abdominal circumference (AC) and femur length (FL) on frozen two-dimensional ultrasound images. Methods Ultrasound examinations were performed in 100 singleton pregnancies between 20 and 40 weeks of gestation, ensuring an even distribution throughout gestational age. In each pregnancy, three standard biometric variables (HC, AC, FL) were measured each in three different images obtained for this purpose (i.e. nine independent image acquisitions). An algorithm (Philips Research) was used to detect the structure of interest and automatically place calipers for measurement. Caliper placement was assessed in two ways. First, subjective clinical assessment was performed to determine whether the caliper placement was correct, and caliper position was classified as 'acceptable for clinical use', 'minor adjustment required' or 'major adjustment required'. Second, the resulting automatic measurements were compared with manual measurements, taken in real time. Mean difference errors were calculated and expressed as percentages to correct for fetal growth with advancing gestation. Results After exclusion of one pregnancy due to missing images, a total of 891 images (297 for each biometric variable) from 99 pregnancies were analyzed. The algorithm failed to place calipers for the AC in nine images, whereas there were no failures in caliper placement for measurement of HC and FL. On subjective quality assessment of automatic caliper placement, in 475 (53.3%) images position of the calipers was judged to be clinically acceptable and did not require any adjustment, while in 317 (35.6%) and 90 images (10.1%) minor and major adjustments were required, respectively. The mean error between manual and automatic measurement of HC was -0.21 cm corresponding to a percentage error of -0.81% with 95% limits of agreement (LOA) between -3.73% and 2.12%. For AC and FL measurements, the mean error was, respectively, 0.72 cm (percentage error, 2.40%) with LOA between -9.48% and 14.27%, and 0.21 cm (percentage error, 3.76%) with LOA between -8.38% and 15.91%. Conclusions The automated tool identified correctly the biometric variable of interest in 99% of frozen images. The resulting measurements had a high degree of accuracy and compared well with previously published manual-to-manual agreement. The measurements exhibited bias, with the automated tool underestimating biometry; this could be overcome by further improvements in the algorithm. Nevertheless, adjustable calipers for manual correction remains a requirement. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Purpose To evaluate the feasibility and reproducibility of artificial intelligence software (Smartplanes®) to automatically identify the transthalamic plane from 3D ultrasound volumes and to measure the biparietal diameter (BPD) and head circumference (HC) in fetus. Material and methods Thirty fetuses were evaluated at 17–30 weeks’ gestation. For each fetus two three-dimensional (3D) volumes of the fetal head along with one conventional two-dimensional (2D) image of the transthalamic plane were prospectively acquired. The Smartplanes® software identified the transthalamic plane from the 3D volumes and performed BPD and HC measurements automatically (3D auto). Two experienced sonographers also measured BPD and HC from 2D images and from the 3D volumes. Measurements were compared using Bland-Altman plots. Interclass correlation coefficient (ICC) was used to evaluate intra- and interobserver reproducibility. Results For each series of measurements, intra- and interobserver reproducibility rates were high with ICC values > 0.98. The 95% confidence intervals between the BPD measurements were 2 mm (3D versus 2D) and 4 mm (3D auto versus 2D) and the HC measurements were 7.5 mm (3D versus 2D) and 11 mm (3D auto versus 2D). Conclusion Fetal head measurements obtained automatically by Smartplanes® software from 3D volumes show good agreement with those obtained by two experienced sonographers from conventional 2D images and 3D volumes. The reproducibility of these measurements is similar to that observed by experienced sonographers.

To create current fetal biometry reference ranges and to compare them with references published in 1999, from the same local area in order to generate data for secular trend in fetal size. Applying the same methodology as previously published, we calculated reference ranges for biparietal diameter (BPD), occipitofrontal diameter (OFD), head circumference (HC), abdominal circumference (AC) and femur length (FL) in 7863 patients examined at the obstetric clinics in a cross-sectional, prospective study in a university setting from January 2008 to December 2014. In order to compare the new reference ranges with our previously published data, we used Z-Scores and displayed the pick-up of fetal biometry data below the 5 The comparison of the charts showed a minimal but clinically relevant increase in mean fetal body measures (BPD, HC, AC). Applying the 1999 charts to the new dataset, we would classify only 162 of 339 fetuses (47.8 %) to be correctly below the 5 Applying a similar methodology, study collective and clinical setting, our new charts showed clinically relevant differences compared to the 1999 charts. The data suggest that within one generation fetuses are getting bigger and regular updates of fetal reference charts are needed.ZIEL: In der Arbeit werden aktuelle Referenzwerte der fetalen Biometrie generiert und diese mit den 1999 publizierten Referenzwerten verglichen. Beide Datensätze wurden an der gleichen Institution erhoben, um Daten für eine Einschätzung eines Langzeittrends zu erhalten. In einer prospektiven Querschnittsstudie wurden Ultraschallmessungen von 7863 Einlingsschwangerschaften zwischen Januar 2008 und Dezember 2014 in einem universitären Perinatalzentrum durchgeführt. Um Vergleichbarkeit herzustellen, wurden die Referenzwerte nach der 1999 publizierten Methodik kalkuliert. Die biometrischen Referenzwerte für biparietalen Durchmesser (BPD), okzipitofrontalen Durchmesser (OFD), Kopfumfang (HC), Abdomenumfang (AC) und Femurlänge (FL) wurden berechnet. Zum Vergleich der aktuellen Referenzwerte mit den publizierten Kurven wurden Z-Scores erstellt und die Detektion fetaler biometrischer Daten unter der 5. und über der 95. Perzentile unter Verwendung der publizierten Referenzkurven berechnet. Der Vergleich der alten und neuen Referenzwerte ergab einen Anstieg der durchschnittlichen fetalen Körpermaße (BPD, HC, AC). Verwendet man anstelle der aktuellen Referenzwerte die 1999 publizierten Kurven, erkennt man nur 162 statt 339 Feten (47,8 %) unter der 5. Perzentile für AC und 134 statt 349 (38,4 %) Feten unter der 5. Perzentile für HC. Andererseits führt die Verwendung der alten Referenzwerte in 426 statt 332 Feten (28,3 %) die über der 95. Perzentile für den AC liegen zur einer vermeintlichen Überschätzung. Mittels gleicher Methodik, vergleichbaren Studienkollektivs und klinischen Bedingungen konnten neue Referenzwerte generiert werden, die klinisch relevante Unterschiede im Vergleich zu den alten Referenzwerten zeigten. Unsere Daten legen den Verdacht nahe, dass Feten innerhalb einer Generation größer werden und regelmäßige Updates von Referenzwerten notwendig sind.

This study aimed to construct new reference charts and equations for fetal biometry from Chinese fetuses at 15-40 weeks and to compare them with previous references.This was a prospective, cross-sectional study of singleton pregnancies in patients with a confirmed gestational age who underwent ultrasound examinations between the 15th and 40th weeks of gestation. Each woman was selected only once for this study. Biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL) were recorded. For each measurement, separate regression models were fitted to estimate the mean and standard deviation at each menstrual age. Z-scores were calculated with our reference equations for comparison with other references.New charts and reference equations involving 7553 Chinese women were created for BPD, HC, AC, and FL. Reference equations were cubic models. Prediction intervals for the new reference charts were similar to those of previous references, but with some slight differences. The main difference in our fetal biometric measurements compared with those of Korea and Hong Kong was the FL.We report new Chinese reference charts and equations for fetal biometry. These reference charts and equations are available for clinical use in obstetric ultrasound studies for the Chinese population.

BACKGROUND There are global concerns regarding excessive caesarean rates, which could be reduced by identification of risk factors leading to preventative measures such as induction of labour. AIMS This study aims to describe the association between antenatal ultrasound and emergency caesarean section for: (i) failure to progress; (ii) other indications; and (iii) any indication. MATERIALS AND METHODS Women who had an ultrasound in pregnancy between 36(+0/7) to 38(+6/7) weeks at Royal Prince Alfred Hospital from January 2005 to June 2009 were included. Ultrasound parameters were linked to clinical parameters from the maternity database. Missing clinical data were imputed and multiple logistic regression performed. RESULTS Fetal biometry data were available for 2006 pregnancies. After adjusting for maternal age, height, body mass index, parity, previous caesarean section and diabetes, caesarean section for failure to progress was associated with estimated fetal weight (odds ratio (OR) 2.24 (95% CI: 1.76-2.84) per 500 g increase); or biparietal diameter (OR 1.51 (1.16-1.97) per 5 mm increase) and abdominal circumference (OR for the 4th quartile (>75th centile) compared with the 10-25th centile group was 2.09 (1.13-3.85)).* There were also non-linear associations between components of fetal biometry and caesarean section for fetal distress and for any indication. CONCLUSIONS Components of fetal biometry in the third trimester are associated with intrapartum caesarean section for failure to progress. These parameters could be incorporated into models to predict emergency caesarean section which could lead to implementation of preventative strategies. *[Corrections added on 29 January 2018, after first online publication, '(OR for the 4th quartile (>7th centile)' has been changed to '(OR for the 4th quartile (>75th centile)'.].

Ultrasound assessment of fetal size is central to modern practice of prenatal care. It facilitates accurate pregnancy dating and screening for fetal growth disorders. This article discusses evidence-based recommended methods for pregnancy dating and biometric measurements. We address some confusing terms such as fetal growth "standards" and fetal growth "references" along with explaining the differences between prescriptive and descriptive charts and between growth charts based on estimated fetal weight vs those based on birth weight. Opinions remain divided on which charts are best to use; however, since the publication of the Intergrowth 21st study, we are now in a position to be able to assess growth and development in an internationally standardized fashion, from fetal life up to 5 years of age. A universal quality control policy can help maintain the high standard of ultrasonography required to achieve an acceptable level of diagnostic accuracy for fetal growth disorders.

OBJECTIVES: To assess a comprehensive package of ultrasound quality control in a large multicentre study of fetal growth - the Fetal Growth Longitudinal Study of the INTERGROWTH-21(st) Project. METHODS: We performed quality control (QC) measures on 20,313 ultrasound scan images taken prospectively from 4,321 fetuses at 14-41 weeks' gestation in eight geographical locations. At the time of each ultrasound examination, three fetal biometric variables were measured in triplicate on separately generated images: head circumference (HC), abdominal circumference (AC) and femur length (FL). All measurements were taken in a blinded fashion. QC had two elements: 1) qualitative QC: visual assessment by sonographers at each study site of their images based on specific criteria with 10% of images being re-assessed at the Oxford-based Ultrasound Quality Unit (compared using an adjusted kappa statistic), and 2) quantitative QC: measurement data were assessed by (a) comparing the first, second and third measurement (intraobserver variability); (b) re-measurement of caliper replacement in 10% (interobserver variability), both by Bland-Altman plots, and (c) plotting frequency histograms of the SDs of triplicate measurements and assessing how many were above or below 2SDs of the expected distribution. The system allowed the sonographers' performance to be regularly monitored. RESULTS: A high level of agreement between the self- and external scoring was demonstrated for all measurements (kappa = 0.99 [95% confidence interval: 0.98, 0.99] for HC, 0.98 [0.97, 0.99] for AC, and 0.96 [0.95, 0.98] for FL. Intraobserver variability (95% limits of agreement (LoA)) of ultrasound measures for HC, AC and FL were ±3%, ±6% and ±6%, respectively; the corresponding values for interobserver variability were ±4%, ±6% and ±6%. The SD distribution of triplicate measurements for all biometric variables showed excessive variability for three of 31 sonographers, allowing prompt identification and retraining. CONCLUSIONS: Qualitative and quantitative QC monitoring was feasible and highly reproducible in a large multicentre research study, which facilitated the production of high-quality ultrasound images. We recommend that the QC system we developed is implemented in future research studies and clinical practice.

Background The aim of the study was to investigate the accuracy of ultrasound-derived estimated fetal weight (EFW) and to determine its impact on management and outcome of delivery. Methods In this single-center cohort analysis, women with a singleton term pregnancy in the beginning stages of labor were included. Women with immediately antepartum EFW (N = 492) were compared to women without ultrasound (N = 515). Results 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. Newborns with a lower birth weight were more frequently overestimated, and newborns with higher birth weight were more frequently underestimated. The mean difference between EFW and real birth weight was − 114.5 g (standard deviation ±313 g, 95% confidence interval 87.1–142.0). The rate of non-reassuring fetal heart tracing (9.8% vs. 1.9%, P

OBJECTIVES: To compare the performance of third-trimester screening, based on estimated fetal weight centile (EFWc) vs a combined model including maternal baseline characteristics, fetoplacental ultrasound and maternal biochemical markers, for the prediction of small-for-gestational-age (SGA) neonates and late-onset fetal growth restriction (FGR). METHODS: This was a nested case-control study within a prospective cohort of 1590 singleton gestations undergoing third-trimester (32 + 0 to 36 + 6 weeks' gestation) evaluation. Maternal baseline characteristics, mean arterial pressure, fetoplacental ultrasound and circulating biochemical markers (placental growth factor (PlGF), lipocalin-2, unconjugated estriol and inhibin A) were assessed in all women who subsequently delivered a SGA neonate (n = 175), defined as birth weight < 10(th) centile according to customized standards, and in a control group (n = 875). Among SGA cases, those with birth weight < 3(rd) centile and/or abnormal uterine artery pulsatility index (UtA-PI) and/or abnormal cerebroplacental ratio (CPR) were classified as FGR. Logistic regression predictive models were developed for SGA and FGR, and their performance was compared with that obtained using EFWc alone. RESULTS: In SGA cases, EFWc, CPR Z-score and maternal serum concentrations of unconjugated estriol and PlGF were significantly lower, while mean UtA-PI Z-score and lipocalin-2 and inhibin A concentrations were significantly higher, compared with controls. Using EFWc alone, 52% (area under receiver-operating characteristics curve (AUC), 0.82 (95% CI, 0.77-0.85)) of SGA and 64% (AUC, 0.86 (95% CI, 0.81-0.91)) of FGR cases were predicted at a 10% false-positive rate. A combined screening model including a-priori risk (maternal characteristics), EFWc, UtA-PI, PlGF and estriol (with lipocalin-2 for SGA) achieved a detection rate of 61% (AUC, 0.86 (95% CI, 0.83-0.89)) for SGA cases and 77% (AUC, 0.92 (95% CI, 0.88-0.95)) for FGR. The combined model for the prediction of SGA and FGR performed significantly better than did using EFWc alone (P < 0.001 and P = 0.002, respectively). CONCLUSIONS: A multivariable integrative model of maternal characteristics, fetoplacental ultrasound and maternal biochemical markers modestly improved the detection of SGA and FGR cases at 32-36 weeks' gestation when compared with screening based on EFWc alone. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Monitoring fetal growth via ultra-sound requires modeling fetal biometry in terms of gestation age. In this study we compare Response Modeling Methodology (RMM) to current models, in three stages. First, RMM is used to approximate 47 empirical mean models that have appeared in the literature resulting in models with negligible loss in accuracy (unlike two other commonly applied models). Next, RMM models are fitted to sample averages of the Singaporean population and compared to a formerly published model. A similar simulation-based analysis is performed in the last stage for raw data of the British population. Altogether over seventy comparisons had been performed resulting in RMM consistently delivering better performing models.

To create crown-rump length (CRL)-based biometric chart for fetus in the first trimester among the Indian population.Cross-sectional data were obtained from 400 singleton pregnancies between 11 and 14 weeks gestation with a normal outcome. Linear regression models were constructed; the mean and SD were derived as a function of CRL.There was a positive correlation of CRL with nuchal translucency (NT) (y = 0.0102x + 0.6307 RThe first-trimester centile charts of fetal parameters can be used as a reference for Indian population in the determination of gestational age or other adverse outcomes.

Objective To determine the correlation between pre-pregnancy body mass index (BMI) and maternal visceral adiposity with fetal biometry during the second trimester. Methods A cross-sectional observational study was conducted among pregnant women who received prenatal care at a center in Recife, Brazil, between October 3, 2011, and September 27, 2013. Pre-pregnancy BMI was determined at the first prenatal care visit. Maternal visceral adiposity and fetal biometry were measured at the same ultrasonography session. The associations between maternal and fetal variables were evaluated using the Pearson correlation coefficient (R). The Student t test was used to test the null hypothesis of adjusted correlation coefficients. Results Overall, 740 women were included. No correlation was found between pre-pregnancy BMI and any of the fetal biometric variables assessed. By contrast, maternal visceral adiposity positively correlated with fetal abdominal circumference (R=0.529), estimated fetal weight (R=0.524), head circumference (R=0.521), femur length (R=0.521), and biparietal diameter (R=0.524; P

Introduction: To evaluate various sonographic estimated fetal weight (sEFW) formulas’ accuracy for small- and large-for-gestational age (SGA/LGA) prediction in breech-presenting fetuses. Materials and methods: A retrospective analysis of all ultrasound-based fetal biometrical measurements performed within 3 days of delivery in term pregnancies, in one medical center (2007–2014). Overall, 274 breech-presenting fetuses (study group) were compared to 274 vertex-presenting fetuses (control group) matched by gender, gestational age and birth weight. sEFW was calculated by six previously published formulas. Accuracy was compared utilizing systematic error and random error for every formula. Prediction precision of SGA and LGA was evaluated by calculating each formula’s sensitivity, specificity, +/− predictive value, and the area under the receiver-operating characteristic (ROC) curve (AUC). Results: Systematic error and random error varied greatly between formulas, ranging from −7.4% to 3.1%, 7.3% to 8.3% for the vertex-presenting fetuses and −8.9% to 1.9%, 7.9% to 8.6% for the breech-presenting fetuses, respectively. There was no statistical difference in small- or large-for-gestational age prediction parameters between the groups. The highest sensitivity and specificity for prediction was achieved by same formula regardless of presentation. Conclusion: In our cohort, overall accuracy was slightly superior among vertex-presenting fetuses without difference in prediction accuracy for small- and large-for-gestational age neonates.

Previous studies have suggested an association between fetal growth restriction and the risk of spontaneous preterm birth (sPTB). However, addressing this association is methodologically challenging. We conducted a prospective cohort study of nulliparous women with a singleton pregnancy in Cambridge, United Kingdom (2008–2012). Ultrasonic fetal biometry was performed at 20 weeks of gestation as per routine clinical care. Participants also had blinded research ultrasonography performed at approximately 28 weeks. Biometric measurements were expressed as gestational-age-adjusted z scores. Fetal growth velocity was quantified by change in z score between 20 weeks and 28 weeks. Risk of sPTB, defined as delivery at ≥28 weeks and

Ultrasound imaging in obstetrics and gynecology dates back to 1958 when The Lancet published the first article about the use of ultrasonography for fetal and gynecological assessments. It is now almost inconceivable, 60 years later, to think of effective performance in obstetrics and gynecology without the variety of ultrasound, for example, real time imaging, power and color Doppler, 3D/4D ultrasonography, etc. Such examinations facilitate the assessment of intrauterine fetal growth and development during pregnancy, provide alerts about the risk of pre-eclampsia and preterm birth, help identify anatomic reasons for infertility, diagnose ectopic pregnancies, uterine, ovary and tubal pathology. Ultrasonography is also used for diagnostic and treatment procedures during pregnancy or for the treatment of infertility. This article is an overview of the development of fetal ultrasound, the methodology and interpretation of ultrasound in the assessment of intrauterine fetal growth and fetal biometry standards both worldwide and in Lithuania. Keywords: Fetal biometry, Ultrasound, Intrauterine growth restriction

Objective: To determine predictive values of maternal serum PAPP-A (msPAPP-A) levels, uterine artery Doppler velocimetry, and fetal biometric measurements (FBMs) for poor pregnancy and poor neonatal outcomes. Material and Methods: This prospective cohort study was conducted on singleton pregnancies followed until delivery. Pregnancy and neonatal outcomes were evaluated with respect to the msPAPP-A level at the 11th-14th weeks, uterine artery Doppler velocimetry at the 15th-18th weeks, and FBMs at the 20th-24th and 28th-32nd weeks of pregnancy. Results: One hundred fifty-eight women constituted the study group; 17 (10.75%) of them had at least one poor pregnancy outcome. The cut-off point of 0.72 multiple of the median (MoM) for the PAPP-A level achieved a sensitivity of 82.4% and a specificity of 29.8% for poor pregnancy outcomes. The mean birth weight was significantly lower in the subgroup with a higher mean pulsatility index of uterine arteries (UAPImean >= 1.19) (p=0.025) as well as in the subgroup with a higher mean resistance index of uterine arteries (UARImean >= 0.62) (p=0.013). When the subgroup of pregnant women under the risk of early-onset IUGR according to FBMs was compared to the low-risk group, statistically significant differences were seen in terms of pregnancy outcomes (p=0.045) and birth weight (p=0.011). Conclusion: Maternal serum PAPP-A level and FBMs could be used for predicting pregnancy outcomes, while uterine artery Doppler velocimetry and FBMs could be used for predicting neonatal outcomes, specifically the birth weight.

Introduction In Stockholm County, new guidelines for predicting the day of delivery were introduced in 2010. Recent clinical use has indicated that the predictive quality might be suboptimal. This study compares the accuracy of three equations applied during the first (crown–rump length or bi-parietal diameter) and second trimesters (bi-parietal diameter or bi-parietal diameter combined with femur length). Material and methods The accuracy of estimated delivery date was compared in 14 239 ultrasound exams using median deviations from actual birth date, proportion of postterms, births within ±seven days of estimated delivery date, accuracy variations depending on fetal size, alternative fetal measurements obtained on the same occasion, and menstrual age. Results The bi-parietal diameter and crown–rump length formulae overestimated pregnancy length by two and three days respectively, causing 7–8% of pregnancies to be labelled postterm. A combined bi-parietal diameter+femur length formula overestimated by one day, with 5.1% postterms. No significant difference was found in the proportion of births within ±seven days. Second trimester estimated delivery date assessment had larger median variations than did first trimester assessment and suffered from shifting deviations across fetal size. The comparison of different biometry formulae in the same individual demonstrated one day extra deviation for bi-parietal diameter and three days extra deviation for crown–rump length compared with the combined bi-parietal diameter+femur length formula. Conclusions The algorithms and dating occasions tested seem inappropriate for the present 280-day term definition. Alternative formulae ought to be sought, and the assumed duration of pregnancy reconsidered; 283 days corresponds to the observed pregnancy length calculated from last menstrual period, and would better fit the observed results for first trimester ultrasound scans.

Objetivo: Las mediciones orbitofaciales y orbitales del feto pueden ser útiles para el diagnóstico precoz prenatal de malformaciones craneofaciales. La mayoría de los estudios anteriores se basan en la ecografía y sólo hay unos cuantos estudios basados en autopsias fetales. El Análisis detallado de los distintos parámetros puede proporcionar una base de datos útil para una rápida referencia. Métodos: En cincuenta fetos normales de edades gestacionales diferentes, se midieron los siguientes parámetros: las distancias cantales externa e interna, la longitud de la hendidura palpebral, la longitud oropalpebral, la profundidad y la anchura de la órbita y la distancia interorbital. Resultados: El análisis estadístico reveló una correlación positiva significativa de todos estos parámetros con la edad gestacional y con el diámetro biparietal. Los patrones de crecimiento de los pará-metros orbitales y orbitofacial también demostraron una correlación significativa entre sí. Conclusión: Nuestros resultados muestran que el aumento de las partes laterales de la cara y de la longitud facial vertical se produce a un ritmo más rápido en comparación con la parte media de la cara. Las desviaciones de los datos normativos generados para los parámetros orbitales y orbitofacial ayudarán en la detección precoz de síndromes genéticos específicos. Objective: Fetal orbitofacial and orbital measurements may be helpful in early prenatal diagnosis of craniofacial malformation. Most of the earlier studies are ultrasound based and there are only a few studies based on fetal autopsies. Comprehensive analysis of various parameters can provide useful database for easy reference. Methods: In fifty normal fetuses of different gestational ages, the following parameters were measured: outer and inner canthal distances, palpebral fissure length, oropalpebral length, depth and width of orbit and inter orbital distance. Results: Statistical analysis revealed significant positive correlation of all these parameters with gestational age and biparietal diameter. The growth patterns of the orbitofacial and orbital measurements also demonstrated significant correlation between these parameters. Conclusion: Our results demonstrate that the lateral parts of the face and the vertical facial length grow at a faster rate than the median part of the face. Deviations from the normative data generated for the orbitofacial and orbital parameters will help in early detection of specific genetic syndromes.

In this study, a new reference range of biparietal diameter (BPD) is developed based on Saudi Arabia population. A number of 2075 pregnant women who attend the maternity check up in 2013 to 2015 at Department of Obstetrics and Gynecology, Hospital Maternity and Children of Dammam, Saudi Arabia, were involved in this study. The data were recorded from 12th to 40th weeks of gestational age (GA). The BPD was measured using Sony Corporation 1-7-1 Konan Minator-K. On-screen caliper is used to measure the BPD parameter on the frozen image using linear method. The SPSS software version 22.0 was used for analysis, with statistical analysis were performed such as compare means, regression analysis and paired sample t-test. Results show that higher BPD growth rate was found in second trimester (12th to 25th weeks of GA) with 2.90 mm/week compared to third trimester (26th to 40th weeks of GA) with only 1.68 mm/week, proved that the rapid growth of fetus head in second trimester than third trimester. Further analysis on maternal age, number of gravid and gender of the fetus were found no significant impact on the BPD values (p values ≥ 0.05). The BPD value of this study shows no significant difference with the BPD values of USA [1], Norway [2], Australia [3], Zimbabwe [4], India [5], China [6] and Malaysia [7]. Thus, this new BPD values are highly recommended to be used by the medical practitioner as the reference range of fetus biometry for Saudi Arabia population, in regards to provide a better healthcare and well being of the maternal and fetuses.

Introduction: To evaluate the relative value of mid trimester fetal growth, uterine artery Doppler indices and maternal demographics in prediction of stillbirth. Material and methods: Retrospective cohort study; 23894 singleton pregnancies routinely scanned between 19 and 24weeks’ gestation. Maternal characteristics included age, body mass index, ethnicity and medical history. Fetal biometry indices, birthweight and uterine artery pulsatility index values were converted to percentiles and multivariable logistic regression analysis was performed. The predictive accuracy was assessed using receiver operating characteristic curves analysis. The main outcome was prediction of preterm and term stillbirths. Results: Non-Caucasian ethnicity, femur length centile and uterine artery pulsatility index were significantly associated with the risk of stillbirth (all p&nbsp

OBJECTIVES: The purpose of this study was to construct fetal biometric charts between 16 and 40 weeks' gestation that were customized for parental characteristics, race, and parity, using quantile regression analysis. METHODS: In a multicenter cross-sectional study, 8070 sonographic examinations from low-risk pregnancies between 16 and 40 weeks' gestation were analyzed. The fetal measurements obtained were biparietal diameter, head circumference, abdominal circumference, and femur diaphysis length. Quantile regression was used to examine the impact of parental height and weight, parity, and race across biometric percentiles for the fetal measurements considered. RESULTS: Paternal and maternal height were significant covariates for all of the measurements considered (P < .05). Maternal weight significantly influenced head circumference, abdominal circumference, and femur diaphysis length. Parity was significantly associated with biparietal diameter and head circumference. Central African race was associated with head circumference and femur diaphysis length, whereas North African race was only associated with femur diaphysis length. CONCLUSIONS: In this study we constructed customized biometric growth charts using quantile regression in a large cohort of low-risk pregnancies. These charts offer the advantage of defining individualized normal ranges of fetal biometric parameters at each specific percentile corrected for parental height and weight, parity, and race. This study supports the importance of including these variables in routine sonographic screening for fetal growth abnormalities.