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Background: The precise determination of gestational age is essential for effectively managing and prognosis of all pregnancies. Through careful biometry, timely interventions can be implemented, leading to positive outcomes for both the mother and fetus. In routine fetal biometry, parameters such as biparietal diameter (BPD), femur length (FL), head circumference (HC), and abdominal circumference (AC) have been traditionally used. This study aims to evaluate the usefulness of fetal kidney length (FKL) as a marker for fetal biometry. Methodology: This prospective, observational, and cross-sectional study was conducted in the Radiodiagnosis and Obstetrics and Gynaecology departments, including a diverse group of pregnant women from various socio-economic backgrounds, with adherence to ethical standards. Women with singleton pregnancies between 22 and 40 weeks of gestation who met the inclusion and exclusion criteria were examined through ultrasound. The data collected were subsequently analyzed. Result: In the current study, 280 participants with an average age of 26.71 ± 3.6 years were included. The agreement between the mean fetal kidney length and standard biometry parameters was almost perfect, with a strength of agreement exceeding 0.99. A strong and statistically significant positive correlation existed between fetal kidney length and the estimated gestational period calculated using DLMP/standard biometric measurements. Conclusion: Fetal kidney length is a reliable indicator of gestational age and can supplement standard biometric measurements to provide a more precise estimation of gestational age, especially in the later stages when obtaining such standard measurements may be challenging. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the correlation between fetal clavicle length and gestational age in pregnant patients from 14 and 27 weeks of gestation. Methods: This was a retrospective cross-sectional study of patients from 14 and 27 weeks of gestation. Ultrasonographic measurements such as abdominal circumference (AC), femur length (FL), humerus length (HL), clavicle length (CL), head circumference (HC), biparietal diameter (BPD), estimated fetal weight (EFW), and transverse cerebellum diameter (TCD) were made and compared. Results: A total of 552 patients were evaluated in our clinic and CL was measured properly and successfully in all fetuses. Fetal AC, FL, HL, CL, BPD, HC, EFW and TCD measurements were significantly and strongly correlated with gestational week, and Pearson's correlation values were 0.964, 0.965, 0.959, 0.965, 0.951, 0.917, 0.925, and 0.954, respectively (p < 0.001). In the regression analysis equation, gestational week = 0.894 + CL × 0.961. Conclusion: There was a significant positive correlation between fetal CL (mm) and gestational week. We suggest that the 1 mm = 1 week rule can be used for patients with anomalies of the cerebellum and vermis, as well as for patients with unknown last menstrual period. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the accuracy of two portable ultrasound machines (PUM) in assessing fetal biometry and estimated gestational age (EGA). Methods: This was a secondary analysis of data from the Fetal Age Machine Learning Initiative, an observational study of pregnant women in the USA and Zambia. Each participant underwent ultrasound assessment by an experienced sonographer using both a high‐specification ultrasound machine (HSUM) and a PUM (Butterfly iQ or Clarius C3) to measure fetal biometry and calculate EGA at each visit. By comparing paired PUM and HSUM scans, we estimated agreement between individual biometry measurements and aggregate gestational age estimates by reporting mean difference, intraclass correlation coefficient (ICC) and Bland–Altman plots, adjusting for trend. Results: Between April and December 2021, 818 participants contributed 1386 paired PUM–HSUM ultrasound investigations, of which 991 PUM scans were obtained using the Butterfly iQ device and 395 using the Clarius C3 device. Gestational age at scan ranged from 7 to 38 weeks. Compared with HSUM, the Butterfly iQ PUM had a mean difference of −0.20 (95% CI, −0.60 to 0.20) days in the first trimester and −0.68 (95% CI, −0.93 to −0.44) days in the second/third trimesters. Compared with HSUM, the Clarius C3 PUM had a mean difference of −0.47 (95% CI, −1.11 to 0.18) days in the first trimester and −1.67 (95% CI, −2.10 to −1.25) days in the second/third trimesters. ICCs were 0.989 or greater throughout. Increasing gestational age was associated with increasing error and absolute error in EGA and fetal biometry. Both PUM devices demonstrated a modest trend toward underestimation of EGA with advancing gestational age in second/third‐trimester scans, compared with HSUM. Conclusion: The Butterfly iQ and Clarius C3 PUM devices were highly accurate in performing fetal biometry in a diverse population from the USA and Zambia. © 2023 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

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Background: To explore the relationship between fetal Transverse Cerebellar Diameter (TCD) and menstrual gestational age (GA) and to generate normative references (nomogram) of the fetal TCD in some pregnant women in Southwest Nigeria. Methods: Four hundred pregnant women with a singleton fetus between 14 and 38 weeks GA were enrolled. The TCD and other biometric parameters (biparietal diameter, head circumference, abdominal circumference, and femur length) as well as the cerebellar appearance were analyzed and correlated with the GA. Results: The mean TCD increased from 13.3 ± 0.3 mm at 14 weeks to 52.3 ± 3.3 mm at 38 weeks of pregnancy. A strong positive correlation was observed between TCD and GA, which was best represented by a linear regression equation: Predicted GA = 0.557 × TCD + 8.840. The regression analysis indicated a statistically significant strong positive relationship between TCD and GA (r = 0.972 and P < 0.001). The cerebellar appearance based on shape and echogenicity was graded into Grade I: 230 fetuses (57.5%); Grade II: 74 fetuses (18.5%) and Grade III: 96 fetuses (24.0%). Median GA and TCD were 21 weeks and 21.2 mm for Grade I; 29 weeks and 35.5 mm for Grade II; and 35 weeks and 48.1 mm for Grade III, respectively. Conclusion: The TCD increased in a linear fashion with advancing GA in the evaluated fetuses. The TCD is, therefore, a good marker for GA estimation. There is a gradual ultrasonographic change in fetal cerebellar appearance with advancing gestation.

Objective: To assess the reproducibility of ultrasound measurements of fetal biometry using a 'focus point' to assist the acquisition of the relevant plane. Methods: This was a study of 80 women with a singleton non‐anomalous pregnancy who attended University College London Hospital, London, UK, between 18 and 37 weeks' gestation. Planes to measure head circumference (HC), abdominal circumference (AC) and femur length (FL) were obtained four times by two different sonographers with different levels of experience, who were blinded to one another; the first set of images was obtained with reference to a standard image, and the second set of images was obtained using the focus point technique. The focus point was defined as a unique fetal anatomical landmark in each plane (cavum septi pellucidi for HC, two‐thirds of the umbilical vein for AC and one of the two extremities of the diaphysis for FL). Once identified, the focus point was maintained in view while the sonographer rotated the probe along three axes (x, y, z) to acquire the relevant plane. Sonographers were either in training or had > 3000 scans worth of experience. Intra‐ and interobserver reproducibility were assessed using Bland–Altman plots, and absolute values and percentages for mean difference and 95% limits of agreement (LoA) were reported. Results: Overall reproducibility was good, with all 95% LoA < 8%. Reproducibility was improved by use of the focus point compared with the standard technique for both intraobserver comparison (95% LoA, < 4% vs < 6%) and interobserver comparison (95% LoA, < 7% vs < 8%). These findings were independent of sonographer seniority and plane acquired. Conclusions: Reproducibility of fetal biometry assessment is improved with use of the focus point for plane acquisition, regardless of sonographer experience. We propose that this method should be implemented in clinical practice and training programs in fetal biometry. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objective: Adequate reference ranges of size of the corpus callosum (CC) are necessary to improve characterization of CC abnormalities and parental counseling. The objective of this study was to evaluate the methodology used in studies developing references charts for CC biometry. Methods: We conducted a systematic review of studies on fetal CC biometry using a set of predefined quality criteria of study design, statistical analysis and reporting methods. We included observational studies whose primary aim was to create ultrasound or magnetic resonance imaging charts for CC size in a normal population of fetuses. Studies were scored against a predefined set of independently agreed methodological criteria, and an overall quality score was given for each study. Results: Twelve studies met the inclusion criteria. Quality scores ranged between 17.4% and 95.7%. The greatest potential for bias was noted for the following items: sample selection and sample‐size calculation, as only 17% of the studies were population‐based and had consecutive or random recruitment of patients and with a justification of the sample size; number of measurements obtained for CC biometry, as only 17% of the studies performed more than one measurement per fetus and per scan; and description of characteristics of the study population, as only 8% of the studies clearly reported a minimum dataset of demographic characteristics. Conclusions: Our review demonstrates substantial heterogeneity in methods and final biometric values of the fetal CC across the evaluated studies. The use of uniform methodology of the highest quality is essential in order to define a 'short' CC and provide appropriate parental counseling. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Assessment of fetal well-being is one of the key aims of obstetric care. This article reviews various tools and interventions that are currently available to assess fetal well-being, including the ongoing assessment of risk factors (leading to the triaging of women into appropriate pathways of care) through to the assessment of fetal well-being with the computerised CTG. Included is a brief overview of screening, symphysis fundal height measurements, growth and Doppler scanning, and perception of fetal movements. A good history, clinical assessment, and appropriate use and interpretation of investigations form a holistic approach for assessment of fetal well-being. [ABSTRACT FROM AUTHOR]

Nonhuman primates are important preclinical models for translational, reproductive, and developmental science. Clinical evaluation of human fetal development is performed using standard sonographic‐derived fetal biometry, assessments of amniotic fluid, and uteroplacental hemodynamics. These noninvasive in utero measurements provide important information regarding fetal growth and pregnancy well‐being. Abnormalities in fetal growth, amniotic fluid volume, or placental vascular function are associated with placental insufficiency and adverse perinatal outcomes including stillbirth. The fetal biometric parameters most commonly assessed are biparietal diameter, head circumference, abdominal circumference, and femur diaphysis length. Evaluation of amniotic fluid volume includes measuring the fluid in four quadrants of the uterus to generate an Amniotic Fluid Index. Measures of uteroplacental hemodynamics typically include doppler assessment of the umbilical artery and ductus venosus, but can also include interrogation of the uterine artery and umbilical vein. In this study, we compile prenatal ultrasound data of fetal biometry, amniotic fluid measurements, and uteroplacental hemodynamics obtained from pregnancy studies conducted at the Oregon National Primate Research Center. The data included are from control unperturbed pregnant animals who have not undergone in utero experimental manipulations. This is the first report of comprehensive sonographic measurements following standardized clinical obstetric protocols utilized in rhesus macaques. The outcome is a large, prenatal ultrasound resource to be used by laboratory animal researchers in future nonhuman primate pregnancy studies for antenatal assessment. Research highlights: Nonhuman primates are important preclinical models for translational, reproductive, and developmental science.Clinical evaluation of human fetal development is performed using standard sonographic‐derived fetal biometry, assessments of amniotic fluid, and uteroplacental hemodynamics.Nomograms generated by this study can be used in nonhuman primate pregnancies to determine if there is concern for fetal growth restriction or placental insufficiency.This is the first report of comprehensive sonographic measurements following standardized clinical obstetric protocols utilized in rhesus macaques. [ABSTRACT FROM AUTHOR]

Fetal Magnetic Resonance Imaging (MRI) is an important noninvasive diagnostic tool to characterize the central nervous system (CNS) development, significantly contributing to pregnancy management. In clinical practice, fetal MRI of the brain includes the acquisition of fast anatomical sequences over different planes on which several biometric measurements are manually extracted. Recently, modern toolkits use the acquired two-dimensional (2D) images to reconstruct a Super-Resolution (SR) isotropic volume of the brain, enabling three-dimensional (3D) analysis of the fetal CNS. We analyzed 17 fetal MR exams performed in the second trimester, including orthogonal T2-weighted (T2w) Turbo Spin Echo (TSE) and balanced Fast Field Echo (b-FFE) sequences. For each subject and type of sequence, three distinct high-resolution volumes were reconstructed via NiftyMIC, MIALSRTK, and SVRTK toolkits. Fifteen biometric measurements were assessed both on the acquired 2D images and SR reconstructed volumes, and compared using Passing-Bablok regression, Bland-Altman plot analysis, and statistical tests. Results indicate that NiftyMIC and MIALSRTK provide reliable SR reconstructed volumes, suitable for biometric assessments. NiftyMIC also improves the operator intraclass correlation coefficient on the quantitative biometric measures with respect to the acquired 2D images. In addition, TSE sequences lead to more robust fetal brain reconstructions against intensity artifacts compared to b-FFE sequences, despite the latter exhibiting more defined anatomical details. Our findings strengthen the adoption of automatic toolkits for fetal brain reconstructions to perform biometry evaluations of fetal brain development over common clinical MR at an early pregnancy stage. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to develop a pipeline using state-of-the-art deep learning methods to automatically delineate and measure several of the most important brain structures in fetal brain ultrasound (US) images. Methods: The dataset was composed of 5,331 images of the fetal brain acquired during the routine mid-trimester US scan. Our proposed pipeline automatically performs the following three steps: brain plane classification (transventricular, transthalamic, or transcerebellar plane); brain structures delineation (9 different structures); and automatic measurement (from the structure delineations). The methods were trained on a subset of 4,331 images and each step was evaluated on the remaining 1,000 images. Results: Plane classification reached 98.6% average class accuracy. Brain structure delineation obtained an average pixel accuracy higher than 96% and a Jaccard index higher than 70%. Automatic measurements get an absolute error below 3.5% for the four standard head biometries (head circumference, biparietal diameter, occipitofrontal diameter, and cephalic index), 9% for transcerebellar diameter, 12% for cavum septi pellucidi ratio, and 26% for Sylvian fissure operculization degree. Conclusions: The proposed pipeline shows the potential of deep learning methods to delineate fetal head and brain structures and obtain automatic measures of each anatomical standard plane acquired during routine fetal US examination. [ABSTRACT FROM AUTHOR]

Background: Evaluating fetal development and growth is essential in prenatal care. While standard fetal biometric parameters have been traditionally used, non-standard parameters offer additional insights. This study aims to assess the value and utility of non-standard fetal biometric parameters, specifically Krukenberg's spindle length (KL) and femur length (FtL), in normal and fetal growth restriction (FGR) pregnancies. Methods: A prospective observational study was conducted in a multi-disciplinary hospital. A total of 200 patients with normal singleton pregnancies were included. Measurements of KL and FtL were obtained using ultrasound. Pearson correlation coefficients (r), coefficients of determination (R2), and p-values were calculated to determine the correlations between these parameters and gestational age (GA), as well as other standard biometric measurements. Results: In normal pregnancies, KL exhibited a mean of 28.31 mm and a standard deviation of 7.758 mm, while FtL had a mean of 49.29 mm and a standard deviation of 18.555 mm. In FGR pregnancies, KL had a mean of 31.69 mm and a standard deviation of 2.651 mm, while FtL had a mean of 61.56 mm and a standard deviation of 6.429 mm. Significant positive correlations were observed between GA and KL, FtL, and other standard biometric parameters in both normal and FGR pregnancies (p < 0.0001). TCD showed the highest correlation with GA in normal pregnancies (r = 0.994), while BPD demonstrated the highest correlation in FGR pregnancies (r = 0.963). FL exhibited the lowest correlation with GA in both normal (r = 0.988) and FGR pregnancies (r = 0.881). Conclusion: Non-standard fetal biometric parameters, including KL and FtL, showed significant positive correlations with GA in both normal and FGR pregnancies. These parameters have the potential to enhance the assessment of fetal growth and development. Incorporating them into routine clinical practice can improve the accuracy of prenatal care and aid in appropriate management. Further research and validation are needed to establish standardized guidelines for their utilization. [ABSTRACT FROM AUTHOR]

Objective: To assess in a group of ultrasound operators of various levels of experience the predictive value of systematic quality scoring to assess estimated fetal weight (EFW) validity. Methods: Screenshots, sonographer experience, and neonate birth weight were collected for 131 ultrasound examinations in the 7 days before birth. The difference (EFW error) between projected birth weight (EFW + [30 g × interval in days to birth]) and actual birth weight was then assessed (absolute value). Three senior sonographers rated all the screenshots (International Society of Ultrasound in Obstetrics and Gynecology 16‐point score for image quality) and interobserver reproducibility was assessed concomitantly. The impact of the score on EFW accuracy was then assessed (univariate analysis). Receiver operating characteristic curves allowed us to assess the score's positive predictive value (PPV) for accurate EFW. Results: Mean birth weight was 2998 ± 954 g and mean EFW error was 8.6% ± 7.1%. Both the sonographer's experience and score significantly impacted the EFW error (P < 0.05). The PPVs of systematic image scores for identifying an EFW error greater than 10% and greater than 15% were appropriate for clinical use (areas under the curve 0.61 and 0.70, respectively). Score reproducibility was modest. Conclusion: Low image scores and limited ultrasound expertise are associated with an increased risk of inaccurate EFW. Synopsis: Poor quality of fetal ultrasound biometric images is associated with an increased risk of inaccurate estimated fetal weight and might affect care decision making. [ABSTRACT FROM AUTHOR]

Introduction: the increase of abdominal adipose tissue in early pregnancy causes metabolic changes that promote insulin resistance, which is linked to alterations in fetal growth detectable by ultrasonography. Objective: to determine the association of the variation of the adipose strata of the anterior abdominal wall with the presence of insulin resistance and with fetal biometry. Methods: longitudinal analytical study in a population of 144 normopoietic pregnant women, apparently healthy, with optimal reproductive age, nulliparous, belonging to the Polyclinic "Chiqui Gómez Lubián" of Santa Clara City. The sample was 123. Theoretical, empirical and statistical methods were used. Results: subcutaneous fat decreases as preperitoneal fat increases from the first to the second trimester, both expressed with greater intensity in pregnant women who did not have insulin resistance at the beginning of gestation. In the pregnant women who did not have insulin resistance, all the biometric variables decreased in the classification of fetuses appropriate for gestational age from the second to the third trimester and increased the frequencies of small and large fetuses, while in those who had insulin resistance, the cephalic circumference and the abdominal circumference showed stability in the identification of large fetuses. Conclusions: the lower variation of the adipose strata of the anterior abdominal wall is related to the presence of insulin resistance at the beginning of gestation in pregnant women in whom the biometric variable abdominal circumference is associated with the identification of large fetuses for gestational age from the second trimester. [ABSTRACT FROM AUTHOR]

Background: The world has changed radically because of the worldwide COVID-19 pandemic. SARS-CoV-2, a unique strain of large, enveloped single-stranded RNA viruses, that has spread around the world. The primary objective of this research was to assess the fetal growth velocity in pregnancies complicated by SARS-CoV-2 infection and those that were not. The secondary objective was to determine if SARS-CoV-2 infection may affect maternal and fetal Doppler readings. Methods and Results: A total of 250 pregnant women diagnosed with SARS-CoV-2 (Case group) were compared to 300 healthy pregnant women (Control group) in a prospective case-control study in Mosul from February 20 to October 20, 2021. Infections during pregnancy were detected and verified using the real-time reverse transcriptase-polymerase chain reaction (RT-PCR). All ultrasound exams were done from 24 to 40 weeks. Measuring parameters using Doppler ultrasonography included plasticity and resistive indices (PI, RI), as well as cerebroplacental ratio computed according to gestational age. Fetal development in utero was assessed by measuring biometric markers, such as parietal diameter, head size, belly circumference, leg length, and estimated fetal weight every four weeks. The US scans in the second and third trimester of pregnancy showed no evidence of congenital abnormalities (P=0.7047). There was a significant incidence of cesarean delivery (P=0.0000) and lower fetal activity at birth (P=0.0000) in the Case group, compared to the Control group. Anticoagulant treatment during pregnancy was not associated with an increased risk of postpartum hemorrhage in women of the Case group. Also, there were no significant differences in fetal biparietal diameter and femur length between groups in the second and third trimesters, and both fetal and maternal Doppler studies throughout the second and third (35-37 weeks) trimesters of pregnancy yielded no significant differences in the PI and RI indices.

Background: Accurate estimation of gestational age is important not only for appropriate antenatal care but also is crucial for undertaking various diagnostics tests such as chorionic villous sampling and amniocentesis. In certain conditions, where biometry cannot be entirely relied on for estimation of gestational age placental thickness (PT) that can be used for estimation of gestational age. Aims and Objectives: The aims of this study were as follows: (1) To analyze relationship between PT and gestational age as determined by fetal biometry in second and third trimester of pregnancy. (2) To find out cutoff PT value for differentiating between preterm and term gestations. Materials and Methods: This was a cross-sectional, in which 140 patients, in 2nd and 3rd trimester, were included on the basis of a predefined inclusion and exclusion criteria. PT was measured in mm along with their respective standard deviation. The correlation between PT and gestational age as determined by biometry. Results: The mean age of the studied cases was found to be 4.15±3.5 years. At 12 weeks of gestation, the mean PT was 14.36 mm. There was a strong positive correlation between gestational age and PT in 2nd (r=0.9943) and 3rd (r=0.9973) trimesters. After 37 weeks of gestation, there was no significant correlation between PT and gestational age (P=0.469). Conclusion: PT has a significant positive correlation with gestational age in 2nd and 3rd trimester of pregnancy (up to 37 weeks of gestation) and can be reliably used for determination of gestational age independent of fetal biometry.

Objective: The purpose of this study was to establish a new reference chart and growth standards for fetal biometry in Taiwan. Materials and methods: 2047 singleton pregnancies were enrolled in this study with 15,813 fetal scans between 18 and 40 gestational weeks. A reference chart and normal range for fetal biparietal diameter (BPD), abdominal circumference (AC) and femur length (FL) was established by longitudinal quantile regression model. 330 women with comorbidities including gestational hypertension, preeclampsia and gestational diabetes were excluded and 1717 pregnant women were enrolled for the growth standard. Results: The new reference values were significantly larger across all gestational ages compared with the prior National Taiwan University reference chart in 1983. Compared with Intergrowth-21st, the BPD was larger at 18–23 weeks, the AC was larger at 18–24 weeks and the FL was larger at 18–36 weeks whereas they were all smaller at 29–40 weeks for the BPD, at 32–40 weeks for the AC and at 38–40 weeks for the FL. A quantile regression equation of biometry was established. BPD, AC, and FL had weekly growth of 2.5, 9.87 and 2.15 mm. Prepregnancy body weight, height, age, and gestational diabetes increased fetal size. Both gestational and chronic hypertension decreased fetal size. Conclusion: To promote maternal-fetal safety, a new reference chart and growth standard for fetal biometry is necessary to measure fetal growth.

Aim: To evaluate the changes in fetal intracranial structures in pregnant women with pregestational diabetes mellitus (DM) and gestational diabetes mellitus (GDM). Methods: The study was conducted prospectively with patients who were grouped as pregestational DM (n = 110), GDM (n = 110), and control (n = 110). Fetal ultrasonographic measurements of widths of posterior lateral ventricles (PLV), cavum septum pellucidi (CSP), cisterna magna (CM), thalamus and transcerebellar diameter (TCD) were recorded and compared. Results: Fetal PLV, CSP, and CM widths were higher in pregestational DM and GDM groups than in control group, and also higher in pregestational DM group compared to GDM group (p < 0.001). Fetal TCD in the PGDM group was found to be less than both control and GDM groups (p < 0.001). No difference was found between three groups in terms of fetal thalamus size (p = 0.801). Fetal PLV, CSP, and CM values were positively correlated with maternal hyperglycemia, fetal abdominal circumference (AC), and deepest vertical pocket of amniotic fluid (DVP) (p < 0.001). Fetal TCD was negatively correlated with HbA1c and DVP (p = 0.002, p = 0.38, respectively). The optimal cut‐off points to identify pregestational DM and GDM were 5.55 and 5.83 mm for PLV, 5.83 and 6.32 mm for CSP, and 7.26 and 6.62 mm for CM. Conclusion: Maternal hyperglycemia was significantly associated with an increase in the widths of fetal PLV, CSP, and CM and a decrease in fetal TCD. [ABSTRACT FROM AUTHOR]

Ultrasound examinations offer the possibility to monitor fetal growth and estimate fetal weight, but reference data for such techniques in pigs are rare. The aim of this study was therefore to identify suitable anatomical fetal structures for monitoring physiological growth dynamics by ultrasound examinations and to estimate fetal weight using appropriate mathematical models. For this purpose, 198 fetuses of 15 primiparous Landrace sows were examined by ultrasound on days 36, 50, 64, 79 and 92 of gestation in live sows and in utero after slaughter. Biparietal distance (BPD), rostro-occipital distance (ROD), corpus vitreum diameter, heart length, abdominal circumference (AC) and transverse and sagittal abdominal diameter were determined by ultrasound in utero, and the fetuses were subsequently ex uteri determined and weighed. Reference curves for the continuous increase in fetal parameters over the pregnancy were established. Weight estimation could be performed with linear models at a known stage of pregnancy using one or a combination of parameters. Cubic equations were developed to describe the relationships between body measurements and weight over the course of gestation. BPD, ROD and AC have been shown to be the most suitable parameters for fetal weight estimation, but in live sows, only the fetal head parameters could be easily and reliably determined. These techniques could initially be of interest for research into fetal growth, but future application in veterinary practice is also conceivable. [ABSTRACT FROM AUTHOR]

Background: The estrogenic endocrine disruptor bisphenol A (BPA), which is used in plastics and resins, may have an impact on the fetus’s growth and development and can modify postnatal development. This study aims to assess how bisphenol A affects fetal biometry. Methods: This analytical cross-sectional study included 384 healthy Egyptian women in their third trimester during childbearing (15–44 years). They were selected from the outpatient Clinic of Obstetrics and Gynecology at Kasr El-Ainy Hospital, Cairo, Egypt. Fetal biometry was measured and urine samples were collected to estimate BPA levels. Results: Fetal weight, centile, and corrected bisphenol A levels were significantly higher in the studied age groups (P0.05). Conclusion: Fetal exposure to BPA is associated with higher estimated fetal weight and centile commonly in the maternal age range 25 to 35 years.

Purpose: To find a method that could improve the accuracy of fHC evaluation at term. Material and methods: This retrospective cohort study was based on data from the University Hospital of Zürich (USZ). Study population included singleton fetuses and newborns at term between 2015 and 2017. Fetal biometry was performed within 1 week prior to delivery. Study data consisted of two cohorts with 200 ultrasound measurements each: 200 performed by an expert, 200 by residents. fHC were compared with the newborn's head circumference (nHC). fHC was estimated using two methods: (1) fHC based on sonographically estimated frontooccipital diameter (FOD) and biparietal diameter (BPD). (2) Expected FOD was calculated as a fixed mean FOD/BPD relation, derived from biometry standards as the 50th percentile. If BPD was < 99 mm, FOD was calculated according to the formula BPD × 1.268557, If BPD was ≥ 99 mm, FOD was calculated according to the formula BPD × 1.20641443. Results: fHC was underestimated compared with nHC in the expert group: percentage error (PE = − 3.68%, SD = 2.79), as well as in the group of residents (PE = − 3.78%, SD = 3.20) using method 1. fHC measurement was significantly more accurate using method 2. In the expert group PE = − 1.17%, SD = 3.08, in the group of residents PE = − 0.95%, SD = 3.33. Bland–Altman analysis showed limits of agreement (LOA) between − 2.41338 and 0.5537828 cm for fHC. Conclusions: Accuracy of fHC estimation could be improved by extrapolation of FOD when real-time FOD cannot be measured. [ABSTRACT FROM AUTHOR]

Objectives: To assess the intra‐ and interobserver reproducibility of fetal biometry measurements obtained by trainee (junior) and experienced sonographers (senior) in the contest of two training programs in obstetric ultrasound. Methods: This was a prospective study on 192 women recruited ensuring an even distribution throughout gestation (18–41 weeks), at University College London Hospital (UCLH), England (87 cases), and at Maternité Regionale Universitaire de Nancy (MRUN), France (105 cases). The training took place in two training centers with experience in ultrasound training and subspecialist training in fetal medicine. Measurements for head circumference (HC), abdominal circumference (AC), and femur length (FL) were obtained twice by junior and senior sonographers, blind to their own and each other's measurements. Differences between and within sonographers were expressed in millimeters and as a percentage of fetal dimensions. Reproducibility was assessed using Bland–Altman plots. Results: Reproducibility was overall high with 95% confidence intervals (CI) within <6% for intraobserver and <8% for interobserver reproducibility. Intraobserver reproducibility was lower within junior than within senior sonographers' measurements for HC (95% CI: <4% versus <3%) and FL (95% CI: <6% and < 5%). Intraobserver reproducibility was similar between the two centers/training programs (AC 95% CI: <6%). Cumulative interobserver reproducibility in both centers was similar to the reproducibility within a single site (95% CI: <5%, <8%, and <7% for HC, AC, and FL, respectively). Conclusions: Reproducibility of fetal biometry measurement was high in centers with structured training programs regardless of sonographers' experience. Reproducibility was higher in sonographers who completed the training. [ABSTRACT FROM AUTHOR]

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. Z-scores were calculated for each biometry according to CFEF and IG-21. The estimated fetal weight and its Z-score were calculated using the Hadlock formula and IG-21 formula. 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. [ABSTRACT FROM AUTHOR]

Background: Accurate estimation of gestational age is important not only for appropriate antenatal care but also is crucial for undertaking various diagnostics tests such as chorionic villous sampling and amniocentesis. In certain conditions, where biometry cannot be entirely relied on for estimation of gestational age placental thickness (PT) that can be used for estimation of gestational age. Aims and Objectives: The aims of this study were as follows: (1) To analyze relationship between PT and gestational age as determined by fetal biometry in second and third trimester of pregnancy. (2) To find out cutoff PT value for differentiating between preterm and term gestations. Materials and Methods: This was a cross-sectional, in which 140 patients, in 2nd and 3rd trimester, were included on the basis of a predefined inclusion and exclusion criteria. PT was measured in mm along with their respective standard deviation. The correlation between PT and gestational age as determined by biometry. Results: The mean age of the studied cases was found to be 4.15±3.5 years. At 12 weeks of gestation, the mean PT was 14.36 mm. There was a strong positive correlation between gestational age and PT in 2nd (r=0.9943) and 3rd (r=0.9973) trimesters. After 37 weeks of gestation, there was no significant correlation between PT and gestational age (P=0.469). Conclusion: PT has a significant positive correlation with gestational age in 2nd and 3rd trimester of pregnancy (up to 37 weeks of gestation) and can be reliably used for determination of gestational age independent of fetal biometry. [ABSTRACT FROM AUTHOR]

Objective To evaluate the clinical significance of soft markers for aneuploidy screening in Korean women. Methods We retrospectively reviewed the medical records of 5,428 singleton pregnant women who underwent sonography during the second trimester at seven institutions in South Korea. We evaluated the prevalence of the following soft markers: intracardiac echogenic focus, choroid plexus cysts, pyelectasis, echogenic bowel, and mild ventriculomegaly. We developed best-fitted regression equations for the fetal femur and humerus length using our data and defined a short femur and humerus as both long bones below the fifth centile. The results of genetic testing and postnatal outcomes were investigated in patients who had been diagnosed with aforementioned soft markers. Results The median maternal age of our study population was 33 years, and the median gestational age at the time of ultrasonographic examination was 21 weeks. We detected soft markers in 10.0% (n=540) of fetuses: 9.3% (n=504) were isolated cases and 0.7% (n=36) of cases had two or more markers. We identified only two aneuploides (trisomy 18, 46,XX,t[8;10][q22.1;p13]), of which one was clinically significant. We presented the neonatal outcomes of the fetuses with the respective soft markers. Preterm delivery, low birth weight, and small-for-gestational-age (SGA) were significantly more common in women with a shortened fetal femur (P

Introduction: Objectives were to analyze changes in fetal cephalic biometry and fetoplacental circulation throughout pregnancy in fetuses with congenital heart defects. Material and methods: Prospective study conducted on three university tertiary referral hospitals. Fetuses with the diagnosis of isolated congenital heart defects attending between 2014 and 2018 were included. Congenital heart defects were divided into two groups according to the oxygen supply to the central nervous system: group I (expected low placental blood content and low oxygen delivery to the brain) and group II (expected intermediate and high placental blood content). Fetal biometry and Doppler parameters were collected between 25–30 weeks of gestation and 34–40 weeks of gestation and transformed into Z scores. The results were compared with healthy controls. Finally, general linear modeling was performed to analyze repeated measurements. Results: In all, 71 fetuses met the inclusion criteria. Fetuses with congenital heart defects had significantly smaller head (biparietal diameter [p < 0.001], head circumference [p = 0.001]) and abdominal circumference (p < 0.001), and lower estimated fetal weight (p < 0.001) than controls. When analyzing according to congenital heart defects type, head size was significantly smaller in group I compared with group II (p = 0.04). Regarding Doppler parameters, fetuses with congenital heart defects showed higher umbilical artery pulsatility index (p < 0.001) and lower cerebroplacental ratio (p = 0.044) than controls. In group I, umbilical artery pulsatility index was above the 95th centile in 15.4% of fetuses compared with 6.7% in group II and 1.9% in controls (p < 0.001); moreover, middle cerebral artery pulsatility index was below the 5th centile in 5.4% of group I fetuses compared with 0% in group II and 1.2% in controls (p = 0.011). General linear model for two measurements showed significant longitudinal changes in biometric parameters. Growth rate of fetal head through pregnancy (head circumference Z score) was lower in fetuses with congenital heart defects compared with controls (p = 0.043). In group I, the head circumference Z score longitudinal decrease was significantly higher than in group II (p < 0.001). Conclusions: Fetuses with congenital heart defects are at risk of smaller head size and Doppler changes. Growth rate of fetal head throughout pregnancy is also affected. These findings are mainly associated with cardiac defects with expected low oxygen supply to the central nervous system. [ABSTRACT FROM AUTHOR]

Objective: Gestational diabetes mellitus (GDM) is the most common metabolic complication of pregnancy. The incidence of GDM is increasing worldwide and 5-25% of pregnancies are diagnosed with GDM depending on screening strategies and diagnostic criteria. GDM may lead to obstetric complications and increases the risk of adult metabolic disease in the offspring. Timely identification of GDM allows for regulation of maternal glucose levels which may reduce the obstetric complications considerably. The aim of this study is to investigate the association between second trimester ultrasound biometrics and GDM.Study Design: This is a retrospective cohort study including 2697 singleton pregnancies attending second trimester ultrasound scan at 20 + 0 to 20 + 6 weeks' gestation and giving birth at Aalborg University Hospital in the year 2020. Ultrasound measurements included head circumference (HC), abdominal circumference (AC), femur length (FL) and estimated fetal weight (EFW) by Hadlock's formula. Women with pregestational diabetes were excluded. GDM screening was performed on indication using oral-glucose-tolerance-test (OGTT) including 75 g glucose and a 2-hour serum glucose value ≥ 9 mmol/L was considered diagnostic. The association between fetal biometrics and GDM was investigated by logistic regression.Results: A total of 174 (6.5 %) were diagnosed with GDM. The incidence of GDM in pregnancies with biometrics above the 90th centile was; FL: 10.5 %, HC: 8.8 %, AC: 7.6 %, EFW: 9.3 %. Fetal biometrics above the 90th centile was significantly associated with GDM; ORFL = 2.07, p = 0.001; ORHC = 1.89, p = 0.001; ORAC = 1.63, p = 0.033; OREFW = 1.64, p = 0.036. This association remained significant for HC and FL when adjusted for maternal obesity (Body Mass Index ≥ 27): ORHC(adj)=1.56, p = 0.019; ORFL(adj) = 1.57, p = 0.049.Conclusion: At the second trimester scan, fetal biometrics above the 90th centile increase the risk of GDM. In pregnancies that are later diagnosed with GDM fetal growth is increased already at the second trimester scan. Such knowledge underlines the importance of early identification of GDM. [ABSTRACT FROM AUTHOR]

The aim of this study was to identify growth-restricted fetuses using biometric parameters and to assess the validity and clinical value of individual ultrasound parameters and ratios, such as transcerebellar diameter/abdominal circumference (TCD/AC), head circumference/abdominal circumference (HC/AC), and femur length/abdominal circumference (FL/AC). In a retrospective single-center cross-sectional study, the biometric data of 9292 pregnancies between the 15th and 42nd weeks of gestation were acquired. Statistical analysis included descriptive data, quantile regression estimating the 10th and 90th percentiles, and multivariable analysis. We obtained clinically noticeable results in predicting small-for-gestational-age (SGA) and fetal growth restriction (FGR) fetuses at advanced weeks of gestation using the AC with a Youden index of 0.81 and 0.96, respectively. The other individual parameters and quotients were less suited to identifying cases of SGA and FGR. The multivariable analysis demonstrated the best results for identifying SGA and FGR fetuses with an area under the curve of 0.95 and 0.96, respectively. The individual ultrasound parameters were better suited to identifying SGA and FGR than the ratios. Amongst these, the AC was the most promising individual parameter, especially at advanced weeks of gestation. However, the highest accuracy was achieved with a multivariable model. [ABSTRACT FROM AUTHOR]

Introduction: Our aim was to develop and evaluate the performance of population-based sex-specific and unisex prescriptive fetal abdominal circumference growth charts in predicting small-for-gestational-age (SGA) birthweight, severe SGA (sSGA) birthweight, and severe adverse perinatal outcomes (SAPO) in a low-risk population., Methods: This is a post hoc analysis of the Dutch nationwide cluster-randomized IRIS study, encompassing ultrasound data of 7,704 low-risk women. IRIS prescriptive unisex and IRIS sex-specific abdominal circumference (AC) fetal growth charts were derived using quantile regression. As a comparison, we used the descriptive unisex Verburg chart, which is commonly applied in the Netherlands. Diagnostic parameters were calculated based on the 34-36 weeks' ultrasound., Results: Sensitivity rates for predicting SGA and sSGA birthweights were more than twofold higher based on the IRIS prescriptive sex-specific (respectively SGA 43%; sSGA 59%) and unisex (SGA 39%; sSGA 55%) charts, compared to the Verburg chart (SGA 16%; sSGA 23% both p &lt; 0.01). Specificity rates were highest for Verburg (SGA 99%; sSGA 98%) and lowest for IRIS sex-specific (SGA 94%; sSGA 92%). Results for predicting SGA with SAPO were similar for the prescriptive charts (44%), and again higher than the Verburg chart (20%). The IRIS sex-specific chart identified significantly more males as SGA and sSGA (respectively, 42%; 60%, p &lt; 0.001) than the IRIS unisex chart (respectively, 35%; 53% p &lt; 0.01)., Conclusion: Our study demonstrates improved performance of both the IRIS sex-specific and unisex prescriptive fetal growth compared to the Verburg descriptive chart, doubling detection rates of SGA, sSGA, and SGA with SAPO. Additionally, the sex-specific chart outperformed the unisex chart in detecting SGA and sSGA. Our findings suggest the potential benefits of using prescriptive AC fetal growth charts in low-risk populations and emphasize the importance of considering customizing fetal growth charts for sex. Nevertheless, the increased sensitivity of these charts should be weighed against the decrease in specificity., (© 2024 The Author(s). Published by S. Karger AG, Basel.)

Introduction: The emergence of handheld ultrasound devices capable of connecting to cell phones or tablets heralds a significant advancement in medical technology, particularly within the field of obstetrics. These devices offer the promise of immediate bedside ultrasound examinations, potentially revolutionizing patient care by enabling fetal assessments in diverse settings., Material and Methods: This prospective study aimed to validate the reliability of non-piezo, chip-based handheld ultrasound devices in clinical obstetric practice. Conducted in a university hospital obstetric ward, the study included 100 pregnant women between 17 and 41 weeks of gestation. Participants underwent ultrasound examinations using both conventional and portable point-of-care ultrasound (POCUS) devices to compare the accuracy in estimating fetal weight and other parameters, such as cardiac activity, fetal presentation, placental location, and amniotic fluid volume. The reliability and agreement between the devices were assessed using intraclass correlation coefficients, Bland-Altman plots, and Pearson correlation coefficients., Results: The results show a near-perfect agreement (0.98) and correlation (r = 0.98, p < 0.001) for estimated fetal weight and most biometry measurements between the two types of ultrasound devices, with slight deviations in head circumference and amniotic fluid index measurements. Subgroup analysis revealed variations in agreement and correlation rates with higher BMI and advanced gestational age, indicating areas for further refinement., Conclusions: These findings affirm the high reliability of handheld ultrasound devices for basic obstetric ultrasound evaluations, supporting their integration into daily clinical practice. This technology improves the flexibility and immediacy of prenatal care, although further research is needed to optimize its application across patient populations and treatment settings., (© 2024 The Author(s). Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).)

Aims: To monitor fetal size and identify predictors for birthweight in women with gestational diabetes (GDM) and normal glucose tolerance (NGT)., Methods: Cohort study of 1843 women universally screened for GDM, with routine ultrasounds each trimester. Women with GDM and NGT were categorized in subgroups by birthweight centile., Results: Of the total cohort, 231 (12.5%) women were diagnosed with GDM. Fetal size, incidence of large-for-gestational age (LGA: 12.3% of GDM vs. 12.9% of NGT, p = 0.822) and small-for-gestational age (SGA) neonates (4.8% of GDM vs. 5.1% of NGT, p = 0.886) were similar between GDM and NGT. GDM women with LGA neonates were more insulin resistant at baseline and had more often estimated fetal weight (EFW) ≥ P90 on the 28-33 weeks ultrasound (p = 0.033) than those with AGA (appropriate-for-gestational age) neonates. Compared to NGT women with AGA neonates, those with LGA neonates were more often obese and multiparous, had higher fasting glycemia, a worse lipid profile, and higher insulin resistance between 24 -28 weeks, with more often excessive gestational weight gain. On the 28-33 weeks ultrasound, abdominal circumference ≥ P95 had a high positive predictive value for LGA neonates in GDM (100%), whereas, in both GDM and NGT, EFW ≥ P90 and ≤ P10 had a high negative predictive value for LGA and SGA neonates (> 88%), respectively., Conclusions: There were no differences in fetal size throughout pregnancy nor in LGA incidence between GDM and NGT women. EFW centile at 28-33 weeks correlated well with birthweight. This indicates that GDM treatment is effective and targeted ultrasound follow-up is useful. TRIAL REGISTRATION CLINICALTRIALS.GOV: NCT02036619. Registration date: January 15, 2014. https://clinicaltrials.gov/ct2/show/NCT02036619 ., (© 2024. Springer-Verlag Italia S.r.l., part of Springer Nature.)

Background: Pregnancy-induced hypertensive (PIH) disorder represented the primary cause of maternal and fetal morbidity and mortality. The cause of pre-eclampsia is unknown, but ischemic blood supply to the placenta stimulates the inflammatory process which leads to endothelial dysfunction and oxidative stress. Antioxidants like Selenium altered concentration involve in its pathogenesis. This study was proposed to find out the significance of Selenium as a biomarker in the pathophysiology of PIH disorders and its association with fetal outcomes. Methodology: This case-control study was conducted on 240 pregnant women, 20-40 weeks of gestation, divided into four groups equally. Normotensive control, investigational group 1 PIH, 2 Pre-eclamptic, and 3 Eclamptic. A structured questionnaire was administered and arterial blood pressure was measured and the blood sample was done for serum Selenium assessment through ELISA. A urine sample was collected and the level of proteinuria was assessed. Fetal wellbeing and signs of growth restriction were observed using ultrasound reports. Results: The mean age of the studied participants was 27.6 ± 5.3 years with the gestational age of 32.11 ± 4.56 weeks. The mean Serum Selenium levels (ng/ml) were significantly lower in investigational groups 67.93 ± 10.54 in PIH, 44.6 ± 13.19 in PE, and 36.38 ± 10.3 in Ec than 78.5 ± 8.2 control (p0.00), Ec (r=0.559, p=0.019) than control (r = 0.817, p

Background: Ultrasonographic estimation of gestational age is done routinely by using fetal biometric parameters, such as the biparietal diameter (BPD), femur length (FL), abdominal circumference (AC), and head circumference (HC). Gestational dating by ultrasound is reliable in the 1st trimester, but discrepancies increase to more than 3 weeks in the 3rd trimester. Aims and objectives: To study the accuracy of gestational age estimation by the transcerebellar diameter (TCD) in the 3rd trimester of singleton pregnancies whose gestational age is known. Materials and methods: A prospective study was carried out in the Department of Obstetrics and Gynecology at NDMC Medical College and Hindu Rao Hospital, Delhi, India, from October 2017 to May 2019 after obtaining clearance from the ethical committee. The study included 100 women aged 18–35 years with singleton pregnancies in the 3rd trimester with a gestational age ≥ 28 weeks; the women provided informed consent and filled in an F-form to rule out any sex determination of the baby. Only those women who had regular menstrual cycles 6 months before conception, who were sure of their last menstrual period (LMP), who had a gestational dating scan done up to 14 weeks, and for whom congenital malformation of the fetus had been ruled out by mid-trimester ultrasound were included. Gestational age was obtained for the measured BPD, HC, AC, FL, and TCD. A paired t-test was used for the comparison between the period of gestation (POG) by the 1st ultrasonography (USG) and that by the AC, BPD, FL, HC, and TCD. Results: The estimation of gestational age by the BPD becomes gradually less reliable after 32 weeks of pregnancy, that by the HC and FL after 36 weeks, and that by the AC after 28 weeks. Regression analysis was used to find a correlation of the various parameters, such as the POG by the 1st USG, BPD, HC, AC, FL, and TCD, with the POG by LMP. The correlation coefficient (r), coefficient of determination (R2), and p values were calculated. Of all the sonographic parameters for the estimation of gestational age, the TCD showed the highest correlation (r = 0.979; p < 0.0001) and the AC the lowest correlation. Conclusion: The mean difference between the estimate of gestational age by the TCD and that by the 1st trimester USG increased from ± 1 day at weeks 28–32 to ± 1–2 days at weeks 32–36 and further increased to ± 6 days after 36 weeks of pregnancy, which was statistically significant. This indicated that the TCD could estimate gestational age within 6 days of near-term pregnancy. Thus, the TCD was a reliable parameter for the estimation of gestational age within 6 days of near-term pregnancy along with routine biometry and an alternative parameter for the evaluation of gestational age when the LMP is not known. [ABSTRACT FROM AUTHOR]

Small for gestational age (SGA) is defined as a newborn with a birth weight for gestational age < 10th percentile. Routine third-trimester ultrasound screening for fetal growth assessment has detection rates (DR) from 50 to 80%. For this reason, the addition of other markers is being studied, such as maternal characteristics, biochemical values, and biophysical models, in order to create personalized combinations that can increase the predictive capacity of the ultrasound. With this purpose, this retrospective cohort study of 12,912 cases aims to compare the potential value of third-trimester screening, based on estimated weight percentile (EPW), by universal ultrasound at 35–37 weeks of gestation, with a combined model integrating maternal characteristics and biochemical markers (PAPP-A and β-HCG) for the prediction of SGA newborns. We observed that DR improved from 58.9% with the EW alone to 63.5% with the predictive model. Moreover, the AUC for the multivariate model was 0.882 (0.873–0.891 95% C.I.), showing a statistically significant difference with EPW alone (AUC 0.864 (95% C.I.: 0.854–0.873)). Although the improvements were modest, contingent detection models appear to be more sensitive than third-trimester ultrasound alone at predicting SGA at delivery. [ABSTRACT FROM AUTHOR]

Problem: The objective of this study was to examine levels of cytokines across normal term pregnancy in an Indian population. Additionally we have also explored for possible associations between inflammatory markers and fetal growth parameters. Method of Study: A multiplex panel of 24 analytes was used to examine levels of inflammatory markers in maternal serum at three time points during pregnancy and in cord blood from women with no reported comorbidities who delivered a singleton live baby at term (N = 23), enrolled in the GARBH‐Ini pregnancy cohort. Linear mixed models were applied to construct longitudinal cytokine trajectories with gestational age. Pearson correlation was used to calculate intra‐visit correlation between cytokines. Principal component analysis (PCA) was performed to examine cytokine combinations prevalent across pregnancy, and their association with fetal growth parameters was determined by multivariable regression. Results: Significant increase in sFLT‐1, Flt3L, PLGF, IL‐4, and IL‐18 and a decrease in VCAM‐1 concentrations was seen across pregnancy. The cytokine concentrations in cord blood differed substantially as compared to maternal levels across gestation. Some cytokines were closely correlated with each other in distinct patterns across pregnancy. Gestational age specific combination of cytokines were seen to be associated with different fetal growth parameters. Conclusions: This study for the first time provides reference concentrations for the longitudinal expression of immune markers across pregnancy in an Indian population providing a much needed baseline to compare with pregnancies leading to adverse outcomes. Growth factors showed maximum longitudinal variation with gestational age and strong correlations were identified between various cytokines at all time points across pregnancy. [ABSTRACT FROM AUTHOR]

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 weight <10th percentile for gestational age; macrosomia was defined as birth weight >4000 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 by >15% 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. [ABSTRACT FROM AUTHOR]

Purpose: The study was done to measure the placental thickness (PT) in pregnant women and find its correlation with the gestational age (GA) of the fetus by ultrasonography. Comparisons were also made with the other fetal biometry parameters, and baseline data were generated with respect to the gestational weeks and placental position. Materials and Methods: The study was a cross-sectional one with a sample size of 134 singleton pregnancies. About 11–40 weeks of gestation were studied for the measurement of PT and other fetal parameters. Informed consent was obtained before recording the data on the preformed questionnaire. All measurements were done in mm and during the relaxed phase of the uterus. Results: As per the study, PT (in mm) increases with an increase in GA (in weeks) and almost matches it from 12 to 34 weeks of gestation. PT had a strong correlation with GA (r = 0.966). The correlation was statistically significant, with a P < 0.001. Conclusion: Thus, the estimation of the thickness of the placenta at the cord insertion site by means of ultrasonography is a relatively simple, safe, and cheap modality for accurate estimation of GA, fetal growth, and placental abnormalities and thus can significantly affect the management and outcome of pregnancy. [ABSTRACT FROM AUTHOR]

• Abdominal ultrasonography allows for assessment of morphometric parameters in the Shetland fetus. • Fetal morphometric measurements predict gestational age and days until parturition. • Combined rib and intercostal distance (CRID) and aortic diameter are most accurate. Transrectal and transabdominal ultrasonography is an established method to monitor pregnancy, fetal growth and wellbeing in different species. Growth charts with multiple bio-morphometric parameters to estimate days of gestation and days before parturition exist in small companion animals, sheep and goats, riding type horses and large ponies but not in small horse breeds like Shetland ponies. The aim of this study was to apply fetal biometric assessment and detailed description of physiologic fetal development to mid and late term pregnancies in Shetland mares and to generate reference data for clinical practice and for future research. Fetal parameters were collected starting on day 101 of pregnancy in five Shetland mares. The fetal biometric parameters determined consisted of aortic diameter, eye diameter, combined rib and intercostal distance (CRID), stomach length and width and different heart morphology parameters in sagittal and frontal plane. Additionally, fetal activity and organ development in terms of differentiation and changes in echogenicity were recorded. Considering reliably assessable parameters, fetal CRID was the best predictor for gestational age with ± 13.6 days and fetal aortic diameter the most accurate for prediction of days until parturition with ± 16.2 days. [ABSTRACT FROM AUTHOR]

Objective: To examine the distribution of birth weight according to gestational age in pregnancies complicated by pre‐eclampsia (PE) and assess the potential value of sonographic estimated fetal weight (EFW) at mid‐gestation as a predictor of PE. Methods: The data for this study were derived from prospective screening for adverse obstetric outcome in 93 911 women with a singleton pregnancy attending for routine pregnancy care at 19 + 0 to 24 + 6 weeks' gestation in two UK maternity hospitals. This visit included recording of maternal demographic characteristics and medical history, sonographic EFW and measurement of mean arterial pressure (MAP) and uterine artery pulsatility index (UtA‐PI). The distribution of birth weight of pregnancies with and those without PE was assessed. The competing‐risks model was used to estimate the individual, patient‐specific risk of delivery with PE at < 32 and < 37 weeks' gestation and at any gestational age. The areas under the receiver‐operating‐characteristics curves and detection rates (DRs) of delivery with PE, at a 10% false‐positive rate (FPR), were assessed for various combinations of maternal risk factors, EFW, MAP and UtA‐PI. McNemar's test was used to determine the significance of difference in DR at a 10% FPR between screening with vs without EFW. Results: The study population contained 2843 (3.0%) pregnancies that subsequently developed PE, including 148 (0.2%) that delivered with PE at < 32 weeks' gestation and 654 (0.7%) that delivered with PE at < 37 weeks. Birth weight was < 10th percentile in 82% of pregnancies with PE delivering at < 32 weeks' gestation and this decreased to 21% of those with PE delivering at ≥ 37 weeks. In screening for delivery with PE at < 32 and < 37 weeks' gestation, the DR, at a 10% FPR, achieved by maternal risk factors (51% and 46%, respectively) was improved by addition of EFW (69% and 51%, respectively). Similarly, addition of EFW improved the performance of screening by a combination of maternal risk factors and MAP from 72% to 80% for PE < 32 weeks and from 57% to 60% for PE < 37 weeks. EFW did not improve the predictive performance of screening by a combination of maternal risk factors, MAP and UtA‐PI. Conclusions: In pregnancies complicated by preterm PE, a high proportion of neonates are small‐for‐gestational age, and sonographic EFW at mid‐gestation can improve the prediction of early and preterm PE provided by maternal risk factors and MAP but not the prediction provided by a combination of maternal risk factors, MAP and UtA‐PI. © 2021 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

This study reviewed the literature about the diagnosis, antepartum surveillance, and time of delivery of fetuses suspected to be small for gestational age or growth restricted. Several guidelines have been issued by major professional organizations, including the International Society of Ultrasound in Obstetrics and Gynecology and the Society for Maternal-Fetal Medicine. The differences in recommendations, in particular about Doppler velocimetry of the ductus venosus and middle cerebral artery, have created confusion among clinicians, and this review has intended to clarify and highlight the available evidence that is pertinent to clinical management. A fetus who is small for gestational age is frequently defined as one with an estimated fetal weight of <10th percentile. This condition has been considered syndromic and has been frequently attributed to fetal growth restriction, a constitutionally small fetus, congenital infections, chromosomal abnormalities, or genetic conditions. Small for gestational age is not synonymous with fetal growth restriction, which is defined by deceleration of fetal growth determined by a change in fetal growth velocity. An abnormal umbilical artery Doppler pulsatility index reflects an increased impedance to flow in the umbilical circulation and is considered to be an indicator of placental disease. The combined finding of an estimated fetal weight of <10th percentile and abnormal umbilical artery Doppler velocimetry has been widely accepted as indicative of fetal growth restriction. Clinical studies have shown that the gestational age at diagnosis can be used to subclassify suspected fetal growth restriction into early and late, depending on whether the condition is diagnosed before or after 32 weeks of gestation. The early type is associated with umbilical artery Doppler abnormalities, whereas the late type is often associated with a low pulsatility index in the middle cerebral artery. A large randomized clinical trial indicated that in the context of early suspected fetal growth restriction, the combination of computerized cardiotocography and fetal ductus venosus Doppler improves outcomes, such that 95% of surviving infants have a normal neurodevelopmental outcome at 2 years of age. A low middle cerebral artery pulsatility index is associated with an adverse perinatal outcome in late fetal growth restriction; however, there is no evidence supporting its use to determine the time of delivery. Nonetheless, an abnormality in middle cerebral artery Doppler could be valuable to increase the surveillance of the fetus at risk. We propose that fetal size, growth rate, uteroplacental Doppler indices, cardiotocography, and maternal conditions (ie, hypertension) according to gestational age are important factors in optimizing the outcome of suspected fetal growth restriction. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: To examine the performance of a model combining maternal risk factors, uterine artery pulsatility index (UtA-PI) and estimated fetal weight (EFW) at 19-24 weeks' gestation, for predicting all antepartum stillbirths and those due to impaired placentation, in a training dataset used for development of the model and in a validation dataset.Methods: The data for this study were derived from prospective screening for adverse obstetric outcome in women with singleton pregnancy attending for routine pregnancy care at 19 + 0 to 24 + 6 weeks' gestation. The study population was divided into a training dataset used to develop prediction models for placental dysfunction-related antepartum stillbirth and a validation dataset to which the models were then applied. Multivariable logistic regression analysis was used to develop a model based on a combination of maternal risk factors, EFW Z-score and UtA-PI multiples of the normal median. We examined the predictive performance of the model by, first, the ability of the model to discriminate between the stillbirth and live-birth groups, using the area under the receiver-operating-characteristics curve (AUC) and the detection rate (DR) at a fixed false-positive rate (FPR) of 10%, and, second, calibration by measurements of calibration slope and intercept.Results: The study population of 131 514 pregnancies included 131 037 live births and 477 (0.36%) stillbirths. There are four main findings of this study. First, 92.5% (441/477) of stillbirths were antepartum and 7.5% (36/477) were intrapartum, and 59.2% (261/441) of antepartum stillbirths were observed in association with placental dysfunction and 40.8% (180/441) were unexplained or due to other causes. Second, placental dysfunction accounted for 80.1% (161/201) of antepartum stillbirths at < 32 weeks' gestation, 54.2% (52/96) at 32 + 0 to 36 + 6 weeks and 33.3% (48/144) at ≥ 37 weeks. Third, the risk of placental dysfunction-related antepartum stillbirth increased with increasing maternal weight and decreasing maternal height, was 3-fold higher in black than in white women, was 5.5-fold higher in parous women with previous stillbirth than in those with previous live birth, and was increased in smokers, in women with chronic hypertension and in parous women with a previous pregnancy complicated by pre-eclampsia and/or birth of a small-for-gestational-age baby. Fourth, in screening for placental dysfunction-related antepartum stillbirth by a combination of maternal risk factors, EFW and UtA-PI in the validation dataset, the DR at a 10% FPR was 62.3% (95% CI, 57.2-67.4%) and the AUC was 0.838 (95% CI, 0.799-0.878); these results were consistent with those in the dataset used for developing the algorithm and demonstrate high discrimination between affected and unaffected pregnancies. Similarly, the calibration slope was 1.029 and the intercept was -0.009, demonstrating good agreement between the predicted risk and observed incidence of placental dysfunction-related antepartum stillbirth. The performance of screening was better for placental dysfunction-related antepartum stillbirth at < 37 weeks' gestation compared to at term (DR at a 10% FPR, 69.8% vs 29.2%).Conclusions: Screening at mid-gestation by a combination of maternal risk factors, EFW and UtA-PI can predict a high proportion of placental dysfunction-related stillbirths and, in particular, those that occur preterm. Such screening provides poor prediction of unexplained stillbirth or stillbirth due to other causes. © 2021 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

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 140/90mmHg. 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

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.

Objective: To determine the interobserver reproducibility of fetal ultrasound biometric and amniotic‐fluid measurements in the third trimester of pregnancy, according to maternal body mass index (BMI) category. Methods: This was a prospective cohort study of women with a singleton gestation beyond 34 weeks, recruited into four groups according to BMI category: normal (18.0–24.9 kg/m2), overweight (25.0–29.9 kg/m2), obese (30.0–39.9 kg/m2) and morbidly obese (≥ 40 kg/m2). Multiple pregnancies, women with diabetes and pregnancies with a fetal growth, structural or genetic abnormality were excluded. In each woman, fetal biometric (biparietal diameter (BPD), head circumference, abdominal circumference (AC), femur length (FL) and estimated fetal weight) and amniotic‐fluid (amniotic‐fluid index (AFI) and maximum vertical pocket (MVP)) measurements were obtained by two experienced sonographers or physicians, blinded to gestational age and each other's measurements. Differences in measurements between observers were expressed as gestational age‐specific Z‐scores. The interobserver intraclass correlation coefficient (ICC) and Cronbach's reliability coefficient (CRC) were calculated. Bland–Altman analysis was used to assess the degree of reproducibility. Results: In total, 110 women were enrolled prospectively (including 1320 measurements obtained by 17 sonographers or physicians). Twenty (18.2%) women had normal BMI, 30 (27.3%) women were overweight, 30 (27.3%) women were obese and 30 (27.3%) women were morbidly obese. Except for AFI (ICC, 0.65; CRC, 0.78) and MVP (ICC, 0.49; CRC, 0.66), all parameters had a very high level of interobserver reproducibility (ICC, 0.72–0.87; CRC, 0.84–0.93). When assessing reproducibility according to BMI category, BPD measurements had a very high level of reproducibility (ICC ≥ 0.85; CRC > 0.90) in all groups. The reproducibility of AC and FL measurements increased with increasing BMI, while the reproducibility of MVP measurements decreased. Among the biometric parameters, the difference between the BMI categories in measurement‐difference Z‐score was significant only for FL. Interobserver differences for biometric measurements fell within the 95% limits of agreement. Conclusion: Obesity does not seem to impact negatively on the reproducibility of ultrasound measurements of fetal biometric parameters when undertaken by experienced sonographers or physicians who commonly assess overweight, obese and morbidly obese women. © 2021 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]