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Our study aims to present the preliminary findings of an ongoing prospective cohort study that assesses the trainees' ability to perform foetal biometry during the third trimester of pregnancy. Sixty-three women with third-trimester singleton pregnancies were included. A biometry scan was performed byboth residents and a foetal medicine specialist in the Third department of Obstetrics and Gynaecology of Attikon University Hospital. For each case, the ultrasonographic measurements of the two operator groups were compared. The mean difference of the resident group compared to the specialist group was: for the biparietal diameter +1.3 mm (CI 95%, range -10.6 to +13,3, ±1.96 SD), for the occipitofrontal diameter -2.6 mm (CI 95%, range -31.5 to +26.2), for the anterior-posterior abdominal diameter -2.6 mm (CI 95%, range -17.9 to +12.8), for the transverse abdominal diameter -0.7 mm (CI 95%, range -17.1 to +15.7) and for the femur length -1.1 mm (CI 95%, range -11.7 to +9.6). We observed that, among all biometric parameters, the most accurate -based on the specialist group were the head circumference measurements. The highest discrepancy was noted for the abdominal assessment. Given that foetal biometry is of utmost importance in obstetrical clinical evaluation and management, a study that highlights the weaknesses of residents in this field could open new horizons in optimising the learning procedure.Impact statementWhat is already known on this subject? After review of the literature, we found only a few studies on inter- and intra-observer discrepancy in foetal biometry measurements among specialists.What the results of this study add? To our knowledge, our study is the first to evaluate residents' capacity of performing a biometry scan, by comparing their measurements to those of MFM specialists.What the implications are of these findings to clinical practice and/or further research? The need for constant evaluation of residents is indisputable. Our study could help to improve their ultrasound skills by giving emphasis on residents' weaknesses. With further research on this subject, a standard system of evaluation could be formed and determine the duration and type of training required for each resident. [ABSTRACT FROM AUTHOR]

Introduction: Placenta is a foeto-maternal organ playing a crucial role in endocrine, immunological, excretory, respiratory, and nutritional functions for the foetus. Gestational age estimation is usually based on the last menstrual period and ultrasonography. Many females having irregular menstruation present with unreliable last menstrual period and hence ultrasonography comes into play for correctly estimating the gestation. Various sonologically derived foetal parameters used for gestational age estimation are Crown Rump Length (CRL), Biparietal Diameter (BPD), Head Circumference (HC), and Abdominal Circumference (AC). The placental thickness measurement shows a direct correlation with the gestational age of the foetus till certain weeks of pregnancy, therefore could be utilised as a new and simple parameter in scenarios like term pregnancy where other parameters are unreliable. Aim: To study the relationship between sonographic placental thickness measurement and gestational age of the foetus and also correlating other biometric parameters i.e., BPD, AC, femur length with placental thickness. Materials and Methods: The present study was a crosssectional study conducted in the Department of Radiodiagnosis, in collaboration with the Department of Obstetrics and Gynaecology, Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India. Sample size constituted of 200 normal antenatal women in whom the placental thickness for various gestational age and correlation between placental thickness measurement with the gestational age of the foetus was done. Analysis of the relationship between placental thickness and other foetal parameters like BPD, femur length and AC was also assessed using Pearson correlation coefficient. Results: Placental thickness measurements for gestational age 11-39 weeks were calculated; it gradually increased from 11.29 mm (mean) at 11 weeks to 35 millimeters (mm) (mean) at 39 weeks of gestation. Correlation coefficient was 0.9685 and p-value

The association patterns between maternal age and foetal growth parameters as well as newborn size were analysed using a dataset of 4737 singleton term births taking place at the Viennese Danube hospital. Foetal growth patterns were reconstructed by the results of three ultrasound examinations carried out at the 11th/12th, 20th/21th and 32th/33thweek of gestation. In detail, crown-rump length, biparietal diameter, fronto-occipital diameter, head circumference, abdominal transverse diameter, abdominal anterior-posterior diameter, abdominal circumference, and femur length were determined. Birth weight, birth length and head circumference were measured immediately after birth. Young teenage mothers (≤15 years), older adolescent mothers (16-19 years), mothers of optimal age range (20-35 years) and mothers of advanced age (>35 years) differed significantly in body height, pre-pregnancy weight status and gestational weight gain. Surprisingly, the foetuses of young adolescent mothers were the largest ones during first trimester. During the second and third trimester however, the foetuses of mothers of optimal age range (20-35 years) and mothers older than 35 years showed larger biometric dimensions than adolescent mothers. According to multiple regression analyses, maternal age was significantly related to Foetal head size (ß =-0.04; 95% CI = -0,08 - 0.01; p=0.034) and abdominal dimensions (ß= 0.03; 95% CI = 0.01-0.05; p=0,011) during the second trimester and to birthweight (ß= -0.03; 95% CI= -4.40 - 0.04; p=0.050). The associations however, are quite weak and the statistical significance is maybe due to the large sample size. At the time of birth, offspring of mothers of optimal age range (20 to 35 years) is significantly larger than that of adolescent mothers and mothers of advanced age. Mothers of advanced age showed the significantly highest (p=

Background: Intrauterine growth restriction represents a fetal life treating condition in obstetrics. Diagnosis and appropriate management during pregnancy is essential because of the considerable morbidity and mortality to which restricted new-borns are exposed. Implementation of diagnostic criteria could potentially determine an optimized outcome in these patients. Material and methods: The article reflects a study of 728 cases of patients delivered to the Obstetrical department of Municipal Hospital No1, Chisinau, the Republic of Moldova during January-December 2016. A special protocol for clinical and paraclinical data collection was used. From these 728 cases, 50 histories of low birth weight fetuses (

Introduction: Determination of gestational age is important in obstetrics for management of pregnancy and evaluation of foetal development. An error in the gestational age estimation results in prematurity and post maturity and, if expected date of delivery is not known, higher perinatal mortality is the obvious outcome. Aim: To evaluate accuracy of transcerebellar diameter in gestational age estimation, to determine the ratio between transcerebellar diameter and abdominal circumference as a gestational age independent parameter, and to study the change in ultrasonographic appearance of the foetal cerebellum with advancing gestation and its grading. Materials and Methods: In 100 normal singleton pregnant women between 15 to 37 weeks of gestation, Biparietal Diameter (BPD), Head Circumference (HC), Abdominal circumference (AC) and Femur Length (FL) and Transcerebellar Diameter (TCD) were measured for assessing the sonological gestational age. TCD/AC ratio was also calculated and simultaneously, the ultrasonographic appearance of the foetal cerebella with advancing gestation were noted and grouped into three grades. Results: In the present study, statistically significant linear relationship between TCD and gestational age in normal pregnancies was noted. TCD measured in millimeters was almost equal to gestational age up to 23 weeks. The TCD/AC ratio remained fairly constant throughout gestational age with a mean ± SD of 13.76 ± 0.77. As with advancing gestation, foetal cerebellum showed a gradual change in US appearance of the progressing from Grade I to Grade III. Conclusion: Correlation and regression analysis indicated a good correlation of TCD with gestational age and other. Hence, TCD can be used as a single growth parameter to predict the gestational age in cases where LMP (Last Menstrual Period) is uncertain. TCD/AC ratio can be used as a good tool to diagnose asymmetric Intra Uterine Growth Retardation (IUGR) in those with ratio exceeding 2 SDs as it is gestational age independent factor which remained fairly constant throughout gestation. We observed a gradual and progressive change in ultrasound appearance of foetal cerebellum from Grade 1 to Grade 3 with advancing gestation.

Introduction: It is well established that adverse perinatal outcomes such as Small for Gestational Age (SGA), preterm delivery, and pre-eclampsia are associated with higher incidence of neonatal complications and death. Evidence suggests that these adverse outcomes may have their origins dating back to early pregnancy growth discrepancies. Aim: To establish an association between early fetal growth discrepancies and occurrence of adverse obstetric outcomes such as pre-eclampsia and SGA. Materials and Methods: This is a prospective observational study done in the Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India, between Jan 2015 to May 2016 involving 314 pregnant women, using Crown Rump Length (CRL) measurements at the time of early anomaly (11-14 week scan). Pregnancies with congenital and chromosomal defects, multifetal gestation and non viable foetuses were excluded from the study. The biometric parameters mainly Biparietal Diameter (BPD), Head Circumference (HC), Abdominal Circumference (AC), Femur Length (FL), and Estimated Foetal Weight (EFW) at the time of targeted organ scan (between 18 to 20 weeks) were recorded and reverse calculations were done to convert these parameters to corresponding GA based on published regression formulae. The GA at the time of targeted scan was also calculated based upon the first trimester CRL values. The growth discrepancy was calculated by deducting CRL based GA from biometrically estimated GA for each individual growth parameters. Fisher’sexact test was used to compare the means of biometric lags in SGA vs. Appropriate for Gestational Age (AGA) fetuses and also in Pre-eclampsia vs. normotensive groups. For each biometric parameter, the best cut-off for discrepancy value was determined using Receiver Operator Characteristic (ROC) analysis along with their diagnostic ability to predict occurrence of SGA in terms of sensitivity, specificity, positive and negative likelihood ratio with their 95% confidence intervals. The Area Under Curve (AUC) and z-test statistics were taken into account to decide the best parameter to predict adverse outcome. A p-value of

Introduction: It is well established that adverse perinatal outcomes such as Small for Gestational Age (SGA), preterm delivery, and pre-eclampsia are associated with higher incidence of neonatal complications and death. Evidence suggests that these adverse outcomes may have their origins dating back to early pregnancy growth discrepancies. Aim: To establish an association between early fetal growth discrepancies and occurrence of adverse obstetric outcomes such as pre-eclampsia and SGA. Materials and Methods: This is a prospective observational study done in the Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India, between Jan 2015 to May 2016 involving 314 pregnant women, using Crown Rump Length (CRL) measurements at the time of early anomaly (11-14 week scan). Pregnancies with congenital and chromosomal defects, multifetal gestation and non viable foetuses were excluded from the study. The biometric parameters mainly Biparietal Diameter (BPD), Head Circumference (HC), Abdominal Circumference (AC), Femur Length (FL), and Estimated Foetal Weight (EFW) at the time of targeted organ scan (between 18 to 20 weeks) were recorded and reverse calculations were done to convert these parameters to corresponding GA based on published regression formulae. The GA at the time of targeted scan was also calculated based upon the first trimester CRL values. The growth discrepancy was calculated by deducting CRL based GA from biometrically estimated GA for each individual growth parameters. Fisher'sexact test was used to compare the means of biometric lags in SGA vs. Appropriate for Gestational Age (AGA) fetuses and also in Pre-eclampsia vs. normotensive groups. For each biometric parameter, the best cut-off for discrepancy value was determined using Receiver Operator Characteristic (ROC) analysis along with their diagnostic ability to predict occurrence of SGA in terms of sensitivity, specificity, positive and negative likelihood ratio with their 95% confidence intervals. The Area Under Curve (AUC) and z-test statistics were taken into account to decide the best parameter to predict adverse outcome. A p-value of <0.05 was considered statistically significant. Results: Out of 314 women studied, 62 (19.7%) delivered an SGA neonate, and 30 (9.5%) had pre-eclampsia. All biometric parameters of SGA babies showed growth lag compared to AGA babies which was statistically significant (BPD p<0.001, HC p<0.001, AC p<0.001, FL p<0.01, and EFW p<0.001). However, we could not establish similar associations between early growth discrepancies and onset of pre-eclampsia. Conclusion: Models of second trimester growth discrepancies can be used to predict SGA babies. Earlier anticipation of adverse perinatal outcome may add to quality of antenatal care and timely delivery to prevent late stillbirths associated with SGA. [ABSTRACT FROM AUTHOR]

We aimed to identify the growth patterns in polyhydramnios, and therefore evaluated 108 singleton pregnancies complicated with polyhydramnios according to the changes in biparietal diameter (BPD), abdominal circumference (AC) and femur length (FL) percentiles. The pregnancy outcomes according to the growth features were analysed. In the study population, BPD and AC percentiles exhibited a significant increase (p = 0.023 and 0.05, respectively), although FL percentiles showed a significant decrease (p = 0.006) according to the changes in third trimester relative to second trimester. In the overgrown group (n = 52), the FL/BPD ratio was lower (p < 0.001), with more foetuses with FL/BPD ratios below 71 (p = 0.05). In conclusion, there was a significant increase in BPD and AC percentiles and a decrease in FL percentiles in third trimester relative to second trimester in foetuses with polyhydramnios. However, we observed a shorter FL and a lower FL/BPD ratio without associated skeletal dysplasia in overgrown foetuses. [ABSTRACT FROM AUTHOR]

Background: Malaria during pregnancy is associated with an increased risk for low birth weight (<2500 grams). Distinguishing infants that are born premature (< 37 weeks) from those that are growth-restricted (less than the 10th percentile at birth) requires accurate assessment of gestational age. Where ultrasound is accessible, sonographic confirmation of gestational age is more accurate than menstrual dating. The goal was to pilot the feasibility and utility of adding ultrasound to an observational pregnancy malaria cohort. Methods: In July 2009, research staff (three mid-level clinical providers, one nurse) from The Blantyre Malaria Project underwent an intensive one-week ultrasound training to perform foetal biometry. Following an additional four months of practice and remote image review, subjects from an ongoing cohort were recruited for ultrasound to determine gestational age. Gestational age at delivery established by ultrasound was compared with postnatal gestational age assessment (Ballard examination). Results: One hundred and seventy-eight women were enrolled. The majority of images were of good quality (94.3%, 509/540) although a learning curve was apparent with 17.5% (24/135) images of unacceptable quality in the first 25% of scans. Ultrasound was used to date 13% of the pregnancies when menstrual dates were unknown and changed the estimated gestational age for an additional 25%. There was poor agreement between the gestational age at delivery as established by the ultrasound protocol compared to that determined by the Ballard examination (bias 0.8 weeks, limits of agreement -3.5 weeks to 5.1 weeks). The distribution of gestational ages by Ballard suggested a clustering of gestational age around the mean with 87% of the values falling between 39 and 41 weeks. The distribution of gestational age by ultrasound confirmed menstrual dates was more typical. Using ultrasound confirmed dates as the gold standard, 78.5% of preterm infants were misclassified as term and 26.8% of small-for gestational age infants misclassified as appropriately grown by Ballard. Conclusion: Ultrasound should be strongly considered in prospective malaria studies with obstetric endpoints to confirm gestational age and avoid misclassification of infants as premature or growth-restricted. The use of ultrasound does require a significant investment of time to maintain quality image acquisition. [ABSTRACT FROM AUTHOR]

Intrauterine growth restriction is a major risk factor for perinatal morbidity and mortality. Ultrasonic foetal biometry is an important tool to monitor foetal growth. Therefore, the quality of these biometry scans is vital to achieve good diagnostic accuracy. We assessed the quality of foetal biometry during a nationwide trial and explored its association with sonographer's characteristics. Four scans from every sonographer (n = 154), performed at 29 and 35 weeks gestational age were collected. Two assessors scored these scans according to a national audit system. A quality score ≥ 65% was considered 'adequate'. We compared the quality scores per scoring criterion (i.e. foetal head measurements, abdominal circumference and femur length with regard to magnification, correctness of the plane and calliper placement) and gestational age. We analysed the associations between characteristics of the sonographers and their scores. In a subsample of scans of 30 sonographers we determined the interrater agreement on the quality scores given by the two assessors independently. The mean score was 81.3%. Thirteen sonographers (8.4%) failed to achieve 'adequate quality'. Scores for femur length (83.8%) were significantly higher than those for head (77.9%) and abdominal circumference (78.6%) (both P < 0.05). Scores for correctness of the plane (73.4%) were lower than those for magnification (81.2%) and calliper placement (85.7%) (both P < 0.05). Gestational age did not affect the quality scores. Only the number of scans performed in the previous year was positively associated with the scores (β = 0.01; P < 0.05). The mean interrater difference in quality scoring was 11.1%, with 77.6% agreement on scans of 'adequate quality', but with no agreement on scans with 'insufficient quality'. Most sonographers achieved an 'adequate quality' score. Highest quality scores were attained for femur length, lowest quality scores for the correct plane. The number of scans one performs is associated with the quality scores, yet the minimum number of scans to perform for guaranteed quality still needs to be determined. Further research is needed to develop a standardized method to assess and maintain good ultrasonic foetal biometry quality. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this pilot study is to compare the 2D scanning measurement of the foetal femoral diaphysis using anterior or lateral/external incidence at ultrasound., Methods: In August 2016, 30 consecutive patients underwent a second trimester morphology ultrasound between 21 and 24 weeks of gestation by a senior sonographist. In each case, the femur length was measured either with an anterior angle, estimating the straight aspect of the diaphysis or with a lateral angle, assessing its curved aspect. The two measures were collected prospectively. The difference between paired measurements was calculated and expressed in percentage (mm) and in percentile., Results: The median difference between the two ultrasound angles in terms of femur length was 3,55% and in terms of percentile variation was 17,16., Conclusion: An anterior angle of measurement of the femur length seems to allow an optimal measure of the straight and longest aspect of the diaphysis. According to our results, this angle should be considered when scoring the quality of a morphological ultrasound, but further and larger studies should be done to confirm our hypothesis., Competing Interests: Declaration: The author report no financial or commercial conflicts of interest.

Objective: The objective of this study is to assess progress made in the ultrasound (US) measurement of femur length (FL) by students after one hour of training on US obstetric simulators., Materials and Methods: Medical residents and midwives registered for the 2016 French national foetal US diploma were invited to a 1-hour US training course with simulators. The time to acquire the FL plane with changing foetal presentation was prospectively measured before and after the training. Every image was recorded, and quality criteria were assessed., Results: Thirty new learners trained in foetal US were evaluated. The time needed to measure the FL was significantly shorter in the post-test versus the pre-test (86s versus 125, P=0.015). The quality criteria were statistically similar before and after training regarding the angle to horizontal (10.0° versus 9.6°, P=0.84) and FL (31.3mm versus 32.0mm, P=0.15)., Conclusion: The time needed to obtain the FL plane was reduced by 30% after a 1-hour US simulation training session., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)