Abstract
BackgroundFirst trimester growth restriction is associated with an increased risk of adverse birth outcomes (preterm birth, low birth weight and small for gestational age at birth). The differences between normal and abnormal growth in early pregnancy are small if the fetal size is measured by the crown-rump-length. Three-dimensional ultrasound volume measurements might give more information about fetal development than two-dimensional ultrasound measurements. Detection of the fetus with a small fetal volume might result in earlier detection of high risk pregnancies and a better selection of high risk pregnancies.MethodsA prospective cohort study, performed at the Máxima Medical Centre, in Eindhoven-Veldhoven, the Netherlands. During the routine first trimester scan with nuchal translucency measurement 500 fetal volumes will be obtained. The gestational age is based on the first day of the last menstrual period in a regular menstrual cycle and by the crown-rump-length. The acquired datasets are collected and stored on a hard disk for offline processing and volume calculation. The investigator who performs the volume measurements is blinded for the results of the first trimester scan. The manual mode will be used to outline the Region Of Interest, the fetal head and rump, in all cross sections. The fetal volumes are calculated with a rotational step of 9°.First, the relation between fetal volume and gestational age, for a set of participants with normal pregnancies (training set), will be assessed. This model will then be used to determine expected values of fetal volume for a normal pregnancy, which will be referred to as expected normal values. Secondly, for a new set of participants with normal pregnancies and a set of participants with complicated pregnancies (together defined as validation set), the observed fetal volumes (FVobserved) are compared with their expected normal values (FVexpected) and expressed as a percentage of the expected normal value. The mean difference in percentage error between the set of normal versus complicated pregnancies will then be compared using the independent-samples t-test. Finally, logistic regression analysis will be applied to the validation set of participants to analyze the possibility of predicting the pregnancy outcome after fetal volume calculation in the first trimester, using this percentage error.DiscussionAfter this study it is clear whether FV measurement in the first trimester can detect high risk pregnancies. If it is possible to detect these pregnancies, more intensive follow up in these pregnancies might result in fewer complicated pregnancies and fewer fetal morbidities.
Highlights
First trimester growth restriction is associated with an increased risk of adverse birth outcomes
Smith et al was the first to report about the relationship between first trimester fetal twodimensional ultrasound (2DUS) measurements in relation to an increased risk of preterm birth, a low birth weight or being small for gestational age (SGA) at birth [3]
Mook-Kanamori et al recently confirmed these earlier reports. They reported that fetal growth below the 20th percentile in the first trimester of pregnancy is associated with an increased risk of adverse birth outcomes such as preterm birth, low birth weight and SGA [5]
Summary
First trimester growth restriction is associated with an increased risk of adverse birth outcomes (preterm birth, low birth weight and small for gestational age at birth). Smith et al was the first to report about the relationship between first trimester fetal twodimensional ultrasound (2DUS) measurements in relation to an increased risk of preterm birth, a low birth weight or being small for gestational age (SGA) at birth [3]. Bukowski et al confirmed the relation between slow growth in the first trimester of pregnancy and a low birth weight [4] These pregnancies were a result of assisted reproductive technologies excluding delayed ovulation as an explanation for the findings. Mook-Kanamori et al recently confirmed these earlier reports They reported that fetal growth below the 20th percentile in the first trimester of pregnancy is associated with an increased risk of adverse birth outcomes such as preterm birth, low birth weight and SGA [5]
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