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Objective: Sonographic estimated fetal weight (EFW) has an influence on the management of a pregnancy. The Hadlock 4 regression model (Hadlock-4), based on fetal biometry, is widely used. There are significant discrepancies noted between EFW, using Hadlock-4, compared to the actual infant birth weights (ABW) in the author’s clinical practice. The research objective was to compare the EFW, using Hadlock-4, with ABW and determine minor arithmetic modifications needed for this population. Materials and Methods: A prospective observational study was done enrolling women in the third trimester, who underwent sonography and delivered within a week of the examination. The sonographic cases were divided into class intervals by gestational age. The EFW were compared with the ABW, using a Pearson coefficient and mean percentage errors (MPE). The EFW values were increased or decreased, by a certain percentage, to keep the mean percentage error in an acceptable range. Results: The strength of association between the EFW and ABW was 0.69 ( p = .014). The EFW and the MPEs for women delivering at 36-40 weeks and beyond was significantly more (13.2 and 18.2%). The EFWs at 36-40 weeks and beyond 40 weeks were reduced by 3 and 8% respectively, which reduced the MPEs. After this modification 97.6% of ABWs fell within +/-2 standard deviations of the EFWs. Conclusion: A simple 3 and 8% reduction of EFWs, using the Hadlock-4, with those sonographic examinations at 36-40 weeks and beyond 40 weeks gestation respectively, is proposed to increase reliable in this Indian patient practice.

Purpose Fetal biometric measurements face a number of challenges, including the presence of speckle, limited soft-tissue contrast and difficulties in the presence of low amniotic fluid. This work proposes a convolutional neural network for automatic segmentation and measurement of fetal biometric parameters, including biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL) from ultrasound images that relies on the attention gates incorporated into the multi-feature pyramid Unet (MFP-Unet) network. Methods The proposed approach, referred to as Attention MFP-Unet, learns to extract/detect salient regions automatically to be treated as the object of interest via the attention gates. After determining the type of anatomical structure in the image using a convolutional neural network, Niblack's thresholding technique was applied as pre-processing algorithm for head and abdomen identification, whereas a novel algorithm was used for femur extraction. A publicly-available dataset (HC18 grand-challenge) and clinical data of 1334 subjects were utilized for training and evaluation of the Attention MFP-Unet algorithm. Results Dice similarity coefficient (DSC), hausdorff distance (HD), percentage of good contours, the conformity coefficient, and average perpendicular distance (APD) were employed for quantitative evaluation of fetal anatomy segmentation. In addition, correlation analysis, good contours, and conformity were employed to evaluate the accuracy of the biometry predictions. Attention MFP-Unet achieved 0.98, 1.14 mm, 100%, 0.95, and 0.2 mm for DSC, HD, good contours, conformity, and APD, respectively. Conclusions Quantitative evaluation demonstrated the superior performance of the Attention MFP-Unet compared to state-of-the-art approaches commonly employed for automatic measurement of fetal biometric parameters.

Aim of the work: To assess maternal and fetal vascular indices in SLE patients during pregnancy, and the impact of disease activity on these vascular indices. Patients and methods: 30 pregnant SLE patients and 30 age -matched healthy females with uncomplicated pregnancies were assessed during the third trimester using ultrasonography (US) and Doppler study to detect fetal biometry, the uterine, umbilical (UA) and fetal middle cerebral (MCA) arterial resistance (RI) and pulsatility (PI) indices, as well as cerebro-placental ratio (CPR). Disease activity was determined using the SLE Disease Activity Index (SLEDAI). Results: The mean uterine artery PI, RI and the UA-PI in SLE group were significantly higher than controls (p value 0.05). Conclusion: Pregnancies in SLE are associated with abnormal maternal and fetal vascular indices. Doppler US can identify at-risk pregnancies and optimize the time of delivery; confirming a good pregnancy outcome.

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.

Background:Disorders related to hypertension in pregnancy, mainly Pre-eclampsia (PE), and Eclampsia, are the major causes of fetal and maternal morbidity and mortality. The placenta's ischemic blood supply leads to its endothelial dysfunction and reduced glutathione bioavailability involved in its pathogenesis. This study explored maternal serum Glutathione's level and changes and found out its association with fetal growth in pregnancy-induced hypertensive disorders. Methodology:A Multicenter, case-control study was conducted on 240 pregnant females. The investigational group included 180 pregnant females having blood pressure above 140/90 mmHg. The Investigational group was divided into different groups, i.e. Pregnancy-induced hypertension (PIH) group, PE group, and Eclamptic group. 60 normotensive pregnant females were kept in control. The blood samples were obtained to analyze serum Glutathione (GSH) through ELIZA (enzyme-linked immunosorbent assay), while urine samples were obtained for confirmation of the PE status. Fetal well-being and signs of growth restriction were observed using ultrasound. Results:A significant reduction was elucidated in serum glutathione, biparietal diameter, and femur length among all experimental groups p < 0.001. However, no significant difference was observed in the abdominal circumference p=0.122 and Fetal weight p=0.51. A significantly inversely proportional relation was found between serum glutathione and gestational age, fetal weight as well as head circumference in all four groups control (r =-.305 p=0.018) PIH (r =-.618 p =0.000), PE (r=-.707 p=0.000) and Eclampsia (r=-.661 p=0.000). Conclusion:It is to conclude that the fetus's growth was markedly affected by reduced Glutathione in hypertensive disorders of pregnancy with the progression of the disease. Link:http://aeirc-edu.com/ojs14/index.php/IJEHSR/article/view/560/648

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.

Aim:Our study aims to investigate whether there is a difference between the African pregnant population at 14-42 weeks of gestation and standard ultrasonographic fetal biometric measurements.Methods:This study was carried out at Mogadishu Somali Turkey Recep Tayyip Erdoğan Training and Research Hospital, Hodan District, Mogadishu, Somalia from July 2018 to September 2018. Four hundred and eighty-six females at 14-42 weeks’ gestation were evaluated. Obstetrical ultrasound was done using a 3.5 MHz convex transducer on Toshiba Aplio XG Ssa-790a. Biparietal diameter (BPD), head circumference (HC), femur length (FL), and abdominal circumference (AC) were identified and measured.Results:The median maternal age in the study sample was 26 years with the mode value of 30 years. The highest number of participants were in 38 weeks (31, 6.4%) and the lowest number of participants were in weeks 15 and 18 with 1 in each (0.2%). BPD gradually increased from a minimum of 26.0 mm at week 14 to a maximum of 95.9 mm. HC gradually increased from a minimum of 101.1 mm at week 14 to a maximum of 95.9 mm at week 42. AC increased gradually from a minimum of 76.6 mm at week 14 to a maximum of 369.2 mm at week 42. FL increased gradually from a minimum of 15.0 mm at week 14 to a maximum of 79.1 mm at week 42.Conclusion:The frequently used parameters of fetal biometry along with ultrasonographic appearance and measurements in our local population are in agreement with international studies except for HC which was lower than the Hadlock’s measurement by an average of 7.8 mm.

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 compare the predictive ability of estimated fetal weight (EFW) percentiles, according to seven growth standards, to detect fetuses at risk for adverse perinatal outcomes. METHODS: This retrospective cohort study included 3,437 African-American women. Population-based (Hadlock, INTERGROWTH-21st, WHO, FMF), ethnic specific (NICHD), customized (GROW) and African American customized (PRB/NICHD) growth standards were applied to the last available scan prior to delivery. Prediction performance indices and relative risk (RR), carried by an EFW90(th) percentile according to each standard, were calculated for individual and composite adverse perinatal outcomes. The sensitivity at a fixed (10%) false-positive rate (FPR), as well as the partial (FPR90(th)) were also at risk of adverse perinatal outcomes, according to INTERGROWTH-21 (RR=1.4) and Hadlock (RR=1.7) standards, much fewer cases (2–5 fold) were detected by an LGA compared to an SGA screening by the same standards. CONCLUSIONS: Fetuses with an EFW90(th) percentile were at increased risk of adverse perinatal outcomes according to all, or some of the seven standards, respectively. The relative risk carried by an EFW

BackgroundUltrasound is indispensable to gestational age estimation, and thus to quality obstetric care, yet high equipment cost and need for trained sonographers limit its use in low-resource settings.MethodsFrom September 2018 through June 2021, we recruited 4,695 pregnant volunteers in North Carolina and Zambia and obtained blind ultrasound sweeps (cineloops) of the gravid abdomen alongside standard fetal biometry. We trained a neural network to estimate gestational age from the sweeps and, in three test sets, assessed performance of the model and biometry against previously established gestational age.ResultsIn our main test set, model mean absolute error (MAE) was 3.9 days (standard error [SE] 0.12) vs. 4.7 days (SE 0.15) for biometry (difference -0.8 days; 95% CI -1.1, -0.5; pConclusionsOur model estimated gestational age more accurately from blindly obtained ultrasound sweeps than did trained sonographers performing fetal biometry. These results presage a future where all pregnant people – not just those in rich countries – can access the diagnostic benefits of sonography.

There has been no machine learning study with a rich collection of clinical, sonographic markers to compare the performance measures for a variety of newborns’ weight-for-height indicators. This study compared the performance measures for a variety of newborns’ weight-for-height indicators based on machine learning, ultrasonographic data and maternal/delivery information. The source of data for this study was a multi-center retrospective study with 2949 mother–newborn pairs. The mean-squared-error-over-variance measures of five machine learning approaches were compared for newborn’s weight, newborn’s weight/height, newborn’s weight/height2 and newborn’s weight/hieght3. Random forest variable importance, the influence of a variable over average node impurity, was used to identify major predictors of these newborns’ weight-for-height indicators among ultrasonographic data and maternal/delivery information. Regarding ultrasonographic fetal biometry, newborn’s weight, newborn’s weight/height and newborn’s weight/height2 were better indicators with smaller mean-squared-error-over-variance measures than newborn’s weight/height3. Based on random forest variable importance, the top six predictors of newborn’s weight were the same as those of newborn’s weight/height and those of newborn’s weight/height2: gestational age at delivery time, the first estimated fetal weight and abdominal circumference in week 36 or later, maternal weight and body mass index at delivery time, and the first biparietal diameter in week 36 or later. These six predictors also ranked within the top seven for large-for-gestational-age and the top eight for small-for-gestational-age. In conclusion, newborn’s weight, newborn’s weight/height and newborn’s weight/height2 are more suitable for ultrasonographic fetal biometry with smaller mean-squared-error-over-variance measures than newborn’s weight/height3. Machine learning with ultrasonographic data would be an effective noninvasive approach for predicting newborn’s weight, weight/height and weight/height2.

Background: To develop an ultrasonographic dating formula for predicting gestational age (GA) based on fetal crown–rump length (CRL) in a Chinese population, evaluate its systematic prediction error and compare it with existing formulae.Methods: This was a prospective cross-sectional study of spontaneously conceived singleton pregnancies among women with a regular menstrual cycle in the preceding year. Ultrasound examinations were performed at 11–14 weeks according to the date of the last menstrual cycle. The CRL was measured three times for each fetus, and the mean was used to derive the best-fit fractional polynomial regression model for estimation of GA in relation to CRL. For each fetus, the GA was compared with the GA calculated using six established dating formulae based on CRL measurements. The means of the differences between estimated and menstrual age were calculated for each formula. All the women were followed up routinely until the birth of the fetus. Results: Of the 4710 subjects recruited, the mean and standard deviation values of CRL changed linearly with GA. The corresponding regression equation and its correlation coefficient (R2) was GA = 59.361513 + 0.461425 ´ CRL (R2 = 0.8028). The mean difference between estimated and menstrual age was 0.22 days (95% confidence interval 0.05–0.21), lower than that of the six existing CRL dating formulae.Conclusions: We have derived a CRL-based dating formula suitable for naturally conceived pregnancies for GA between 11+0 and 13+6 weeks. The formula has no systematic prediction error, comparing favorably with the existing published dating formulae.

Evaluar el crecimiento fetal y sus desviaciones constituye un reto para el médico que usa la biometría fetal por ultrasonido para estimar la edad gestacional y el peso del feto, resultando que la predicción se aparta en ocasiones de la realidad. Objetivo. Procesar la data aportada por siete autores, aplicando una fórmula de índice biométrico integral, para confirmar la posibilidad de coincidencia entre todos los datos obtenidos. Métodos. Procesamiento de las medidas de circunferencia cefálica (CC), circunferencia abdominal (CA) y longitud del fémur (LF) según la edad gestacional publicadas por 7 autores, para calcular el índice biométrico mediante la fórmula [CAF= (CC + CA) - LF]. Resultados. Se obtuvieron las ecuaciones polinomiales de cada grupo de datos por separado y finalmente la data global, correlacionando los valores del índice y la edad gestacional, consiguiendo el coeficiente de correlación curvilínea, con R² = 0,99 (p < 0,05). Conclusiones. Se propone el índice integral de crecimiento fetal como una herramienta para verificar el crecimiento del feto mediante la evaluación secuencial, independientemente de la procedencia y características de la población en estudio.

Prediction of Fetal Growth Restriction using Combined Fetal Biometry and Maternal Serum [Inhibin A] in Pregnant Women with Type 1 DiabetesAbstractBackground: FGR is a major determinant of perinatal and childhood morbidity and mortality and is associated with the risk of chronic diseases in later life.Objective: to assess the diagnostic value of early detection of fetal growth restriction using combined fetal biometry and maternal serum biomarker inhibin A in type 1 diabetic patients.Patients and Methods: A prospective study on 100 diabetic pregnant women. Maternal Serum Inhibin A, Hemoglobin AIC, fasting glucose serum levels, all done for each patient once in second trimester. Serial fetal ultrasound biometry done as one assessment in second trimester and two assessments in third trimester. Ultrasonic markers for fetal growth restriction were performed. Follow-up was done for 3 antenatal care visits.Results: The IUGR was [66%] and non-IUGR was [34%]. Mean serum inhibin A level in IUGR cases 673.83± 470.43, mean serum inhibin A in NON- IUGR cases 102.06 ± 106.29) P value

The aim of the study. The study of differential peculiarities of echographic monitoring and perinatal results with specific complications in the monochorionic type of placentation.Materials and methods. Consideration of three clinical observations of pregnancy with monochorionic diamniotic twins that had various complications. The features of the ultrasound assessment in each of the observations, which helped to determine the correct diagnosis and choose the best tactics of pregnancy follow-up, were discussed.Results. In clinical cases examined and analysed, three different complications of monochorionic multiple pregnancy with similar diagnostic features were revealed. Such specific complications of monochorionic multiple pregnancy as TTTS, TRAP and TAPS may demonstrate some similarity in echographic manifestations during prenatal ultrasound assessment, but have different perinatal prognosis and require non-similar tactics.Conclusion. Antenatal monitoring, which includes ultrasound fetal biometry, evaluation of amniotic fluid volumes, Doppler velocimetry aspects, assessment of size of twin’s hearts and bladders, and the features of their umbilical cord and middle cerebral artery blood flow, allows to estimate and predict in some cases the level of perinatal risk in monochorionic multiple pregnancy and select the appropriate clinical management.

Background: The exact determination of gestational age is so important in management of the antepartum care, and for adequate planning of proper intervention or therapy. Tanscerebellar diameter has great advantages in prediction of gestational age in cases of uncertain dates or in suspected intrauterine growth retardation. There are minimal data available about the relationship between tanscerebellar diameter and biparietal diameter in third trimester of pregnancy. Objective: The aim of the present study was to assess the accuracy of transcerebellar diameter (TCD) measurement in estimation of the gestational age during the third trimester compared to the current fetal biometric measurements including femur length and biparietal diameter. Patient and Method: The study included 500 pregnant women with sure and reliable dates fulfilling the inclusion criteria at the Department of Obstetrics and Gynecology, Al-Azhar (Bab Alsheria ) university Hospital, (inpatient and outpatient) from May 2018 till November 2018. The entire subjects were in the third trimester of pregnancy seen at 31 – 36 weeks, the transcerebellar diameter, the biparietal diameter and femur length were measured for determination of gestational age. Results: The results showed that the transcerebellar diameter (TCD) is more accurate than the biparietal diameter (BPD). There were insignificant statistical difference between transcerebellar diameter (TCD) and femur length (FL) for determination of gestational age in the third trimester whereas there was a significant difference between the transcerebellar diameter (TCD) and the biparietal diameter (BPD) for determination of gestational age in the third trimester. All those data were compared to the last menstrual period. Conclusion: Transcerebellar diameter is more reliable method of gestational age determination in third trimester of pregnancy than biparietal diameter. Transcerebellar diameter (TCD) and femur length (FL) can be used as a tool to assist in the assessment of gestational age in third trimester

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...

INTRODUCTION: Inconsistent reporting practices in third trimester ultrasound, the choice of reference charts in particular, have the potential to misdiagnose abnormal fetal growth. But this may lead to unnecessary anxiety and confusion amongst patients and clinicians and ultimately influence clinical management. Therefore, we sought to determine the extent of variability in choice of fetal biometry and Doppler reference charts and reporting practices in Australia and New Zealand. METHODS: Clinicians performing and/or reporting obstetric ultrasound were invited to answer questions about fetal biometry and Doppler charts in a web‐based survey. RESULTS: At least four population‐based charts are in current use. The majority of respondents (78%) report the percentile for known gestational age (GA) alongside measurements and 63% using a cut‐off of estimated fetal weight (EFW) < 10(th) percentile when reporting small for gestational age (SGA) and/or fetal growth restriction (FGR). The thresholds for the use of fetal and maternal Doppler in third trimester ultrasound varied in terms of the GA, EFW cut‐off, and how measures were reported. The majority of respondents were not sure of which Doppler charts were used in their practice. CONCLUSION: This survey revealed inconsistencies in choice of reference chart and reporting practices. The potential for misdiagnosis of abnormal fetal growth remains a significant issue.

Objectives: This study aimed to present a statistical method for assessing potential differences between fetal growth standard curves and local curve population. Methods: This was an observational repeated measures longitudinal study. We used a simulation model to generate random distribution of the international population from the IG-21st for fetal AC using the original equations of means and standard deviations (SD) obtained by the fractional polynomial method. A general linear model (GLM) allowed us to calculate new equations originating from simulated intergrowth-21st data (SIM_IG21st) and to compare them, by visual inspection of the estimated coefficients and their 95% CI, with the original published. We used further GLMs for evaluating the goodness of fitting of our local curve and comparing the relative equations of means and SD with those of SIM_IG21st. Finally, the impact of percentile differences between the 2 curves was quantified. Results: SIM_IG21st data yielded very similar coefficients than those of IG-21st reference to such an extent that means and SD and percentiles of interest were identical to the original. The comparison between SIM_IG21st curve and local curves showed a nonsignificant intercept and a slight difference of the 2 slopes (GA and GA3) for the equations of the mean. As a result, the local curve resulted in greater AC values. A difference in the intercept but not in the slopes (GA2, GA3, and GA3 * lnGA) was instead reported for the equations of the SD. In the percentile comparison, the local curve resulted in an overestimation of the 3rd and the 10th percentile that corresponded to the 4th and 12th percentiles of SIM_IG21st, respectively. Conclusion: This statistical method allows sonographers to assess potential differences between standard curves and local curve population, enabling a more proper identification of abnormal growth trajectories.

During pregnancy, ultrasound examination in the second trimester can assess fetal size according to standardized charts. To achieve a reproducible and accurate measurement, a sonographer needs to identify three standard 2D planes of the fetal anatomy (head, abdomen, femur) and manually mark the key anatomical landmarks on the image for accurate biometry and fetal weight estimation. This can be a time-consuming operator-dependent task, especially for a trainee sonographer. Computer-assisted techniques can help in automating the fetal biometry computation process. In this paper, we present a unified automated framework for estimating all measurements needed for the fetal weight assessment. The proposed framework semantically segments the key fetal anatomies using state-of-the-art segmentation models, followed by region fitting and scale recovery for the biometry estimation. We present an ablation study of segmentation algorithms to show their robustness through 4-fold cross-validation on a dataset of 349 ultrasound standard plane images from 42 pregnancies. Moreover, we show that the network with the best segmentation performance tends to be more accurate for biometry estimation. Furthermore, we demonstrate that the error between clinically measured and predicted fetal biometry is lower than the permissible error during routine clinical measurements.

Assessment of the fetal biometry is one of the important tasks during every phase of pregnancy. The fetal biometry obtained from the fetal Ultrasound images demands well trained and skilled sonographers for the accurate measurements. The fetal biometry are obtained by drawing circles and lines using cursor on the images which may lead to inaccurate measurements and results in inter observer variability. In order to overcome these limitations an automated process is developed. This paper focuses on measuring the length of the femur (FL) and abdominal circumference (AC) to measure the gestational age (GA) and to monitor the growth of the baby in mother's womb. The automated process involves a sequence of image processing techniques to measure the FL & AC that includes nonlinear diffusion technique, morphological operations, Hough transform, Thinning algorithm and ellipse fit algorithm. The computed FL & AC are compared with the clinical values of the considered database. The computed FL & AC helps to calculate the fetal age and estimate the weight of the baby in mother's womb.

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.

Introduction: Proper monitoring and treatment for asthma during pregnancy avoids important maternal-fetal consequences. Controversy about the influence of steroid therapy on fetal development has been a source of several studies. Objective: To analyze the influence of inhaled corticosteroids (ICS) during pregnancy in asthmatic patients on fetal biometry according to ultrasound scans. Material and Methods: A group of asthmatic pregnant women who attended a consultation on asthma and pregnancy in a tertiary center was included. We studied different factors, such as the adherence to treatment during pregnancy and fetal biometry data (biparietal diameter-BPD, abdominal circumference-AC and femur length-FL) measured by ultrasound scans at the end of pregnancy. Asthmatic women who had not required any treatment during pregnancy were included as a control group. A correlational analysis was performed to identify the relationship between two variables. Results: 43 patients with a mean age of 33.4 years (17-44) were included. The classification of asthma, according to severity, was: 47% intermittent, 25% mild persistent, 21% moderate persistent and 7% severe asthma. Mean gestational age of patients was 39 weeks. Fetal biometry measured in the third trimester showed mean FL, CA and BDP values of 68 mm, 320 mm and 88 mm respectively. Comparing these outcomes with the control group were not found statistically significant differences. Conclusions: In our study, the use of ICS in pregnancy is not related to alteration of fetal biometry. Although it must be confirmed with larger samples, our results support the safety of ICS in the management of bronchial asthma during pregnancy.

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.

OBJECTIVES: Public health and clinical recommendations should be based on results from multiple studies, however trials often have outcomes that are not defined in the same way. This project aims to harmonize selected protocols, outcome definitions, and data analysis across five randomized trials of antenatal balanced energy-protein supplementation being conducted in Burkina Faso, Ethiopia, India, Nepal, and Pakistan. METHODS: Harmonization efforts include a range of activities from reviewing detailed protocols, biospecimen collection plans, data dictionaries, and data analysis plans to proposing best practices and acceptable practices based on field limitations. Most studies have not begun or are early in enrollment, an ideal time frame to make changes. A two-day workshop of lead investigators, content experts and advisors will be held in late February, and harmonization activities will continue thereafter. RESULTS: All studies are examining anthropometry at birth as a primary outcome, however the timing of birth measurements (hours since birth) and types of measurements taken differ across trials. All studies are estimating gestational age by ultrasound measurements, but the gestational age at ultrasound differs (in part due to differences in timing of antenatal care by country) as well as the number of fetal biometry measures. Finally, stillbirth is a key outcome across trials, but initial definitions had slight differences that will now be harmonized. We are also able to add new, important maternal and child health outcomes to each trial that will have the same protocols from inception (e.g., microbiome). CONCLUSIONS: Efforts thus far have resulted in communication between study investigators, consideration of improved protocols, and addition of new outcomes to collect across all sites. Further results are forthcoming after the February workshop, which will include documentation of how much definitions vary across studies and the challenges of standardization. We expect the harmonization process to improve overall reporting within each study and provide opportunities for better meta-analyses. FUNDING SOURCES: The Bill and Melinda Gates Foundation.

International audience; Purpose: To compare fetal ultrasound measurements performed by two observers with different levels of experience and evaluate the potential contribution of the use of three-dimensional (3D) ultrasound on repeatability, reproducibility and agreement of two-dimensional (2D) and 3D-derived measurements. Materials and methods: Two observers (one senior and one junior) measured head circumference (HC), abdominal circumference (AC) and femur length (FL) in 33 fetuses (20 to 40 weeks of gestation). Each observer performed two series of 2D measurements and two series of 3D measurements (i.e., measurements derived from triplane volume processing). Measurements were converted into Z-scores according to gestational age. Variability between the different series of measurements was studied using Bland–Altmann plots and intra-class correlation coefficients (ICC). Results: Agreement with the 2D measurements of the senior observer was higher in 3D than in 2D for the junior observer (systematic differences of −0.4, −0.2 and −0.8 Z-score vs. −0.1, −0.1 and −0.6 for HC, AC and FL on 2D and 3D datasets, respectively). The use of 3D ultrasound improved junior observer repeatability (ICC = 0.94, 0.88, 0.90 vs. 0.94, 0.94 and 0.96 for HC, AC and FL in 2D and 3D, respectively). The reproducibility was greater using the junior observer 3D datasets (ICC = 0.75, 0.60 and 0.45 vs. 0.79, 0.89 and 0.63 for HC, AC and FL, respectively). Conclusion: The use of 3D ultrasound improves the consistency of the measurements performed by a junior observer and increases the overall repeatability and reproducibility of measurements performed by observers with different levels of experience.

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.

To assess whether assessment with ultrasound could improve the detection of emergency cesarean section (ECS) in laboring women.Women who presented with symptoms of active labor or women in need of labor induction were invited to participate in the study. Women included in the study were evaluated with ultrasonography for fetal biometry and vaginal examinations for Bishop score assessment. The main aim in this study was determining factors associated with ECS due to fetal distress and obstructed labor.No fetal biometry variable was associated with ECS due to any indication (fetal distress and obstructed labor combined) in the univariate analysis. In multivariate analyses, biometry variables were adjusted for Bishop score at admission and only abdominal circumference percentile showed a significant association with the odds of ECS due to any indication (OR:1.02, 95% CI: 1.01-1.03). Biparietal diameter and abdominal circumference variables were associated with the odds of ECS due to obstructed labor in both univariate and multivariate analyses (Ultrasound assessment at admission, in addition to Bishop score assessment, did not significantly improve the prediction of ECS. Also, the fetal biometry alone had poor predictive capability for ECS. Routine ultrasound assessment at labor admission appears to be ineffective for predicting ECS.PrecisFetal biparietal diameter and abdominal circumference showed an association with emergency cesarean due to obstructed labor but the predictive accuracy of fetal biometry was low. Routine ultrasound examination at admission, in addition to Bishop score assessment, may not useful for assessing the risk of emergency section in unselected populations.

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.

Intertwin size discordance is an independent risk factor for adverse neonatal outcomes in twin pregnancies. However, size discordance at a given point in gestation fails to take into consideration information, such as the timing of onset and the rate of progression of discordance, that may be of prognostic value.In this study, we aimed to identify distinct patterns of discordant fetal growth in twin pregnancies and to determine whether these patterns are predictive of adverse pregnancy outcomes.This was a retrospective cohort study of women with twin pregnancies in a single tertiary referral center between January 2011 and April 2020, who had at least 3 ultrasound examinations during pregnancy that included assessment of fetal biometry. Size discordance was calculated at each ultrasound examination, and pregnancies were classified into 1 of 4 predetermined patterns based on the timing of onset and the progression of discordance: pattern 1, no significant discordance group (referent); pattern 2, early (24 weeks' gestation) progressive discordance group; pattern 3, early discordance with plateau group; or pattern 4, late (≥24 weeks' gestation) discordance group. The associations of discordance pattern (using pattern 1 as referent) with preterm birth, preeclampsia, size discordance at birth, and birthweight10th percentile were expressed as adjusted relative risk with 95% confidence intervals and were compared with those observed for a single measurement of size discordance at 32 weeks' gestation.Of 2075 women with a twin gestation who were identified during the study period, 1059 met the study criteria. Of the 1059 women, 599 (57%) were classified as no significant discordance (pattern 1), 23 (2%) as early progressive discordance (pattern 2), 160 (15%) as early discordance with plateau (pattern 3), and 277 (26%) as late discordance (pattern 4). The associations of discordance pattern with preterm birth at34 weeks' gestation and preeclampsia were strongest for pattern 2 (rates of 43% [adjusted relative risk, 3.43; 95% confidence interval, 2.10-5.62] and 17% [adjusted relative risk, 5.81; 95% confidence interval, 2.31-14.60], respectively), intermediate for pattern 3 (rates of 23% [adjusted relative risk, 1.82; 95% confidence interval, 1.28-2.59] and 6% [adjusted relative risk, 2.08; 95% confidence interval, 1.01-4.43], respectively), and weakest for pattern 4 (rates of 12% [adjusted relative risk, 0.96; 95% confidence interval, 0.65-1.42] and 4% [adjusted relative risk, 1.41; 0.68-2.92], respectively). In contrast, a single measurement of size discordance at 32 weeks' gestation showed no association with preeclampsia and only a weak association with preterm birth at34 weeks' gestation.We identified 4 distinct discordance growth patterns among twins that demonstrated a dose-response relationship with adverse outcomes and seemed to be more informative than a single measurement of size discordance.

PURPOSE To examine the interobserver variability for fetal biometry parameters and to investigate whether this variability affects the second-trimester maternal serum screening test (STMSS) results. MATERIALS AND METHODS A total of 60 singleton pregnancies who were scheduled for STMSS were investigated. Two experienced sonographers performed all examinations at the same visit. The risk calclations of screening were performed according to the each operator's biometric measurements separately. Interobserver variability in measurements of fetal biometrics and the effect of this interobserver variability on the screening results were assessed. RESULTS inter-observer reliability for biparietal diameter (BPD) and femur length (FL) were 0.904 and 0.888 (p < 0.00 1), respectively. interobserver reliability coefficients for trisomy 21, trisomy 13/18, and neural tube defect were 0.887, 0.999, and 0.920 (p < 0.0001), respectively. CONCLUSION The present results demonstrate that the interobserver reliability and agreement of ultrasound measurements of fetal biometry in cases of routine prenatal screening are highly reliable.

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.

Background and Objectives: Ultrasonography is the most effective way to date pregnancy and to estimate the fetal weight in obstetric clinics. Currently, the diaphyseal length of humerus is used as a new parameter to estimate gestational age. The study evaluates the diaphyseal length of humerus as a parameter to estimate the gestational age of the fetus at the time of examination and to assess the growth pattern of humerus with advancing gestational age. Methods: The study was done on 152 antenatal women aged between 20 to 30 years of gestational ages from 15 to 40 weeks from the district of Dharwad, Karnataka, Subjects with maternal disease known to affect normal fetal growth were excluded. The diaphyseal length of humerus was measured by radiologist in a standardized manner. The study describes the relationship of the diaphyseal length of humerus in centimeters, with the advancing gestational age in weeks. Results: It was observed that the diaphyseal length of humerus gradually increased from 15 weeks to 40 weeks of gestation and that the relationship is linear and direct. Normograms of diaphyseal lengths of humerus can be constructed by the formula derived by this study for this particular geographical area. Conclusion: The relationship between the diaphyseal length of humerus and the gestational age is linear and direct. The measurement of the diaphyseal lengths of humerus [in cm] can be an important additional parameter for estimating gestational age along with other parameters.