Abdominal Circumference Ratio Research Articles

The associations between maternal and fetal exposure to endocrine-disrupting chemicals and asymmetric fetal growth restriction: a prospective cohort study.

Recent evidence has revealed associations between endocrine-disrupting chemicals (EDCs) and placental insufficiency due to altered placental growth, syncytialization, and trophoblast invasion. However, no epidemiologic study has reported associations between exposure to EDCs and asymmetric fetal growth restriction (FGR) caused by placenta insufficiency. The aim of this study was to evaluate the association between EDC exposure and asymmetric FGR. This was a prospective cohort study including women admitted for delivery to the Maternal Fetal Center at Seoul St. Mary's Hospital between October 2021 and October 2022. Maternal urine and cord blood samples were collected, and the levels of bisphenol-A (BPA), monoethyl phthalates, and perfluorooctanoic acid in each specimen were analyzed. We investigated linear and non-linear associations between the levels of EDCs and fetal growth parameters, including the head circumference (HC)/abdominal circumference (AC) ratio as an asymmetric parameter. The levels of EDCs were compared between fetuses with and without asymmetric FGR. Of the EDCs, only the fetal levels of BPA showed a linear association with the HC/AC ratio after adjusting for confounding variables (β = 0.003, p < 0.05). When comparing the normal growth and asymmetric FGR groups, the asymmetric FGR group showed significantly higher maternal and fetal BPA levels compared to the normal growth group (maternal urine BPA, 3.99 μg/g creatinine vs. 1.71 μg/g creatinine [p < 0.05]; cord blood BPA, 1.96 μg/L vs. -0.86 μg/L [p < 0.05]). In conclusion, fetal exposure levels of BPA show linear associations with asymmetric fetal growth patterns. High maternal and fetal exposure to BPA might be associated with asymmetric FGR.

Effect of placental location on intra-uterine growth restriction and gestational hypertension

OBJECTIVES: To evaluate the relationship between uterine placental location and fetal growth restriction and gestational hypertension.&#x0D; MATERIALS AND METHOD: A prospective cross-sectional study done in the Department of Radiology of the University of Calabar Teaching Hospital (UCTH), Calabar, within a 4-month period. The study involved a total of 100 singleton pregnant women between 20 to 40 weeks of gestation who were aged 20 to 39 years. Analysis of the data was done using the statistical package for social science (SPSS) version 20 Inc. Chicago, IL.&#x0D; RESULTS: The frequency distribution of the placental locations were: anterior – 35%, postero-fundal – 36%, antero-fundal – 18% and posterior – 11%. The highest mean head circumference to abdominal circumference ratio (HC/AC) was seen in subjects with posterior placental location (1.03 ± 0.09), lowest mean estimated fetal weight (EFW) was seen in subjects with antero-fundal placental location (1.87 ± 0.92 kg) while the highest mean systolic and diastolic blood pressure were seen in subjects with postero-fundal placental location (113.89 ± 10.50 mmHg and 66.61 ± 7.07 mmHg) respectively. The lowest mean HC/AC was noted in subjects with anterior placental location (1.01 ± 0.08), the highest EFW was noted in subjects with postero-fundal placental location (2.26 ± 1.03 kg) while the lowest mean systolic and diastolic blood pressure were noted in subjects with posterior placental location (109.09 ± 5.39 mmHg and 61.82 ± 4.05 mmHg) respectively. There was no significant correlation between placental location and HC/AC, EFW, systolic blood pressure and diastolic blood pressure (p = 0.744, p = 0.567, p = 0.671, p = 0.936) respectively.&#x0D; CONCLUSION: Placental location in the uterus has no relationship with intrauterine growth restriction and the development of gestational hypertension in the second half of singleton pregnancies.&#x0D;

Assessment of Obstetric Doppler Ultrasound in High-Risk Pregnancy and Its Perinatal Outcome

Background: Intrauterine growth restriction (IUGR) is associated with an increased risk of perinatal mortality &amp; morbidity. It accounts for a sizeable number of future unhealthy children, which is a significant burden to parents and society. IUGR can be minimized to some extent by timely &amp; accurate detection of IUGR. Aims and objectives: To evaluate various waveforms of the umbilical artery, middle cerebral artery, ductus venosus, and cerebroplacental ratio as a predictor of adverse pregnancy outcomes in high-risk pregnancies. Materials and Methods: Eightywomen with a gestational age of 24 to 36 weeks were studied in the department of Radiodiagnosis of SAMC &amp; PGI, Indore, Madhya Pradesh, from April 2021 to September 2022. Subjects were divided into non-complicated pregnancy [Appropriate for gestational age (AGA); n=40) and high-risk pregnancy [Small for gestational age (SGA); n=40; ≥18 years of age, with or without risk factors]. All underwent Doppler interrogation of the uterine arteries, umbilical artery, middle cerebral artery, and ductus venosus between 24-36 weeks of gestation. Results: Elevated head circumference (HC)/ abdominal circumference (AC) ratio, elevated femur length (FL)/AC ratio, presence of oligohydramnios without ruptured membrane, and advanced placental grade was more frequently observed among SGA babies. In this series, among the various risk factors, hypertension was a significant risk factor for IUGR, which other workers also accepted. Pulsatility index (PI), resistive index (RI) and systolic/diastolic (SD) ratio of uterine &amp; umbilical arteries was significantly raised in SGA babies compared to AGA babies. In contrast, middle cerebral artery (MCA)'s PI, RI, and SD ratios were significantly lower in SGA babies than in AGA babies. Uterine artery early Diastolic Notch was seen in 11 cases &amp; all of them delivered SGA babies. Hypertension was present in 8 of these 11 cases. Absent Diastolic Flow was detected in only one case, and the foetus ......

Prediction of Fetal Growth Restriction using Transcerebellar Diameter and Abdominal Circumference Ratio

Objective: To predict fetal growth restriction using transcerebellar diameter and abdominal circumference ratio(TCD/AC) in women with clinically diagnosed FGR.Materials and Methods: A prospective observational cohort study was conducted on women &gt;28 weeks of gestationwith clinically diagnosed fetal growth restriction, at the Tertiary care centre. Total 120 women were enrolled ,overa period of 18 months ,from December 2020 to July 2022 .Biometry was performed using ultrasonography andtranscerebellar diameter and abdominal circumference ratio (TCD/AC) and head circumference and abdominalcircumference ratio (HC/AC) were calculated. All women were followed up till delivery and fetomaternaloutcome was recorded. After birth height, weight and ponderal index of the newborn were also noted. TCD/ACratio was correlated with birth weight and ponderal index, for predicting FGR. TCD/AC ratio was also comparedwith routinely used HC/AC ratio for predicting FGR.Statistical Analysis: The final analysis was done with the use of Statistical Package for Social Sciences (SPSS)software, IBM manufacturer, Chicago, USA, version 21.0®.Results: A cut off value of TCD/AC &gt;0.14 was found to have a sensitivity, specificity, PPV and NPV of 87.36%,75.76%, 90.5% and 69.4% respectively with a diagnostic accuracy of 84.17%, in diagnosing FGR. There was a significantnegative correlation between TCD/AC ratio with birth weight and ponderal index, with a correlation coefficientof 0.463 and 0.501 respectively. (p value &lt; 0.001) TCD/AC was better predictor of fetal growth restriction with adiagnostic accuracy of 84.17% versus 40.83% with HC/AC. Significant positive correlation was observed betweenperiod of gestation (weeks) with transcerebellar diameter (mm),with correlation coefficient of 0.497 (p&lt;0.001).Conclusions: TCD/AC ratio is an effective gestational age independent parameter to predict FGR onultrasonography, with better diagnostic accuracy than routinely used HC/AC. Hence it should be performed forall antenatal women clinically suspected to have FGR.

Accuracy of Transcerebellar Diameter to Abdominal circumference ratio in diagnosis of Asymmetric Intrauterine Growth Restriction after 28 weeks of gestation

Accuracy of Transcerebellar Diameter to Abdominal circumference ratio in diagnosis of Asymmetric Intrauterine Growth Restriction after 28 weeks of gestation

Ultrasound Assessment of Fetal Transcerebellar Diameter to Abdominal Circumference Ratio (Tcd/Ac) and to Femur Length Ratio (Tcd/Fl) in Detection of IUGR

Ultrasound Assessment of Fetal Transcerebellar Diameter to Abdominal Circumference Ratio (Tcd/Ac) and to Femur Length Ratio (Tcd/Fl) in Detection of IUGR

Multivariate analysis of a missense variant in CREBRF reveals associations with measures of adiposity in people of Polynesian ancestries.

The minor allele of rs373863828, a missense variant in CREB3 Regulatory Factor, is associated with several cardiometabolic phenotypes in Polynesian peoples. To better understand the variant, we tested the association of rs373863828 with a panel of correlated phenotypes (body mass index [BMI], weight, height, HDL cholesterol, triglycerides, and total cholesterol) using multivariate Bayesian association and network analyses in a Samoa cohort (n = 1632), Aotearoa New Zealand cohort (n = 1419), and combined cohort (n = 2976). An expanded set of phenotypes (adding estimated fat and fat-free mass, abdominal circumference, hip circumference, and abdominal-hip ratio) was tested in the Samoa cohort (n = 1496). In the Samoa cohort, we observed significant associations (log10 Bayes Factor [BF] ≥ 5.0) between rs373863828 and the overall phenotype panel (8.81), weight (8.30), and BMI (6.42). In the Aotearoa New Zealand cohort, we observed suggestive associations (1.5 < log10 BF < 5) between rs373863828 and the overall phenotype panel (4.60), weight (3.27), and BMI (1.80). In the combined cohort, we observed concordant signals with larger log10 BFs. In the Samoa-specific expanded phenotype analyses, we also observed significant associations between rs373863828 and fat mass (5.65), abdominal circumference (5.34), and hip circumference (5.09). Bayesian networks provided evidence for a direct association of rs373863828 with weight and indirect associations with height and BMI.

The relationship between falling insulin requirements and serial ultrasound measurements in women with preexisting diabetes: a prospective cohort study

Introduction A large fall in insulin requirements (FIR) in women with diabetes is associated with adverse clinical outcomes but previous studies have not examined its relation with serial ultrasound parameters. Objective To determine whether FIR is associated with alteration in umbilical artery Doppler parameters and fetal growth restriction (FGR) in women with preexisting diabetes. Methods Serial obstetric Doppler ultrasounds were conducted 2 weekly from 28 weeks gestation in women with Type 1 and Type 2 diabetes who were being treated with insulin. Estimated fetal weight (EFW), head circumference:abdominal circumference (HC:AC) ratio and umbilical artery doppler parameters (SD ratio) and pulsatility index (PI) were measured. Information on insulin dose was collected prospectively throughout pregnancy and women with FIR ≥ 15% were considered cases. Linear mixed effect models were used to assess the association between FIR and ultrasound parameters. Results One hundred and forty two women were included in the study (type 1 diabetes n = 41, type 2 diabetes n = 101). Thirty women demonstrated FIR ≥ 15%. There was no significant difference in the change of S/D ratio or PI over the third trimester in cases with FIR ≥ 15%, compared to the rest of the cohort, before or after adjusting for type of diabetes. Likewise there was no difference in EFW and HC:AC ratio with advancing gestation before or after adjusting for variables known to influence fetal growth. FGR rates (3.3 vs 8% p = 0.298) and high S/D ratio > 95% (13.3 vs 8%, p = 0.296) were similar between the two groups. Conclusions FIR ≥ 15% was not associated with changes in placental flow or FGR however larger studies are needed to evaluate this further.

Cryolipolysis for abdominal subcutaneous fat reduction: A prospective, multicenter, single arm, clinical study.

Various treatment methods are used for noninvasive body contouring. To evaluate the efficacy and safety of a newly designed cryolipolysis device using a three-dimensional cooling method for abdominal fat reduction. Twenty-five participants with clinically apparent abdominal fat tissue participated in the study. The thickness of fat tissue below the umbilicus level was measured using a caliper at baseline and 12 weeks after the first treatment. The height of abdominal subcutaneous fat tissue on ultrasonography and participant satisfaction were assessed at every visit for 16 weeks. All adverse events (AEs) during the study period were recorded. p values <0.05 were considered statistically significant. Twenty-four participants completed this study; the mean BMI of participants was 29.34 ± 2.36 kg/m2 . The mean thickness of abdominal subcutaneous fat was significantly lower at 12 weeks (40.4 ± 6.8 mm, p < 0.001) than at baseline (49.3 ± 8.5 mm). Differences in the height of abdominal subcutaneous fat compared to that at baseline were 1.02 ± 0.41 cm (12 weeks, p < 0.001) and 1.13 ± 0.44 cm (16 weeks, p < 0.001). Rates of abdominal subcutaneous fat reduction at 12 and 16 weeks compared to that at baseline were 28.45% and 31.13%, respectively. The ratio of abdominal circumference to hip circumference at 12 and 16 weeks was significantly decreased compared to that at baseline. Most participants (95.8%) reported improvement in satisfaction scores at 16 weeks. There were no serious AEs during the entire study period. The study demonstrated the efficacy of a noninvasive cryolipolysis device using a three-dimensional cooling method for reducing abdominal subcutaneous fat.

Study of transcerebellar diameter to abdominal circumference ratio in prediction of foetal growth restriction in high risk pregnancies

Background: The high incidence of IUGR and its low recognition lead to increasing perinatal morbidity and mortality for which prediction of IUGR with timely management decisions is of paramount importance. Many studies have compared the efficacy of several gestational age independent parameters and found that TCD/AC is a better predictor of asymmetric IUGR. Aims: To study the trans cerebellar diameter / abdominal circumference ratio values in clinically suspected FGR and high-risk cases of pregnant women after 28 weeks. Materials and methods: A prospective study consisting of 100 antenatal women was conducted in pregnant women with clinically suspected FGR and high risk pregnancies after 28 weeks. Results: The most common gestational age group taken for evaluation of TCD/AC ratio was in between 30-36 weeks. Preeclampsia is the major predisposing factor of FGR i.e. 46%, and 30 % of cases were under unknown cause. The mean TCD/AC ratio in FGR cases is 17 .33 +/- 0.23. The cut-off value of TCD/AC ratio was 15.77. TCD/AC ratio has 98% positive predictive value when compared to FL/AC and HC/AC. LSCS rate is high in FGR cases (58 %).

Fetal Liver Volume Assessment Using Magnetic Resonance Imaging in Fetuses With Cytomegalovirus Infection†.

ObjectiveTo assess fetal liver volume (FLV) by magnetic resonance imaging (MRI) in cytomegalovirus (CMV)-infected fetuses compared to a group of healthy fetuses.MethodMost infected cases were diagnosed by the evidence of ultrasound abnormalities during routine scans and in some after maternal CMV screening. CMV-infected fetuses were considered severely or mildly affected according to prenatal brain lesions identified by ultrasound (US)/MRI. We assessed FLV, the FLV to abdominal circumference (AC) ratio (FLV/AC-ratio), and the FLV to fetal body volume (FBV) ratio (FLV/FBV-ratio). As controls, we included 33 healthy fetuses. Hepatomegaly was evaluated post-mortem in 11 cases of congenital CMV infection. Parametric trend and intraclass correlation analyses were performed.ResultsThere were no significant differences in FLV between infected (n = 32) and healthy fetuses. On correcting the FLV for AC and FBV, we observed a significantly higher FLV in CMV-infected fetuses. There were no significant differences in the FLV, or the FLV/AC or FLV/FBV-ratios according to the severity of brain abnormalities. There was excellent concordance between the fetal liver weight estimated by MRI and liver weight obtained post-mortem. Hepatomegaly was not detected in any CMV-infected fetus.ConclusionIn CMV-infected fetuses, FLV corrected for AC and FBV was higher compared to healthy controls, indicating relative hepatomegaly. These parameters could potentially be used as surrogate markers of liver enlargement.

Diagnostic Accuracy of TCD/AC Ratio in Predicting Intrauterine Growth Retardation

Background: Fetal growth assessment is necessary for prediction of fetal health during pregnancy. Aim: To determine the diagnostic accuracy of transcerebellar diameter / abdominal circumference ratio in predicting intrauterine growth retardation after 20 weeks gestation taking birth weight as gold standard. Study design: Cross sectional study. Methodology: Present study was conducted at Department of Obstetrics &amp; Gynecology, Combined Military Hospital Kharian. Patients (n=80) with an age range of 18-40 years with singleton pregnancies at 20 weeks gestation were enrolled. All patients were assessed by ultrasound and TCD/AC ratio was calculated. All patients followed till birth and actual birth weight was obtained. All this information was recorded on Performa. Statistical analysis: Data was analyzed using SPSS version 26. Results were presented as frequency and percentage. Age was presented as mean± SD. Results: The mean age of patients was 28.61±5.72 years. The mean gestational age was 21.96±1.50 weeks. For prediction of IUGR, TCD/AC had sensitivity, specificity, PPV, NPV &amp; diagnostic accuracy of 85.29%, 91.3%, 87.88%, 89.36% &amp; 88.75%, respectively. Conclusion: It was concluded that TCD/AC ratio is an accurate diagnostic tool accuracy for prediction of IUGR during pregnancy. Keywords: Transcerebellar Diameter, Abdominal Circumference, Intrauterine Growth Retardation and Birth Weight.

Prevalence of Gestational Diabetes Mellitus in Obstetric patients using Macrosomia and Increased Amniotic Fluid on Ultrasound, as Diagnostic Markers

Aim: To determine the prevalence of gestational diabetes in obstetric patients with the help of ultrasonography and diagnostic biomarkers such as increased amniotic fluid and macrosomia. Methods: In 110 women who failed the glucose tolerance test, longitudinal ultrasound measurements of foetal growth were taken during the first, second and third trimesters with the informed consent of every pregnant women. 524 ultrasound examinations were performed in total, and uncomplicated pregnancies were included as controls for the comparison of our results. Head circumference (HC), abdominal circumference (AC), femur length (FL), and head circumference to abdominal circumference ratio (HC/AC) was evaluated at 17th and 37th weeks of gestation while amniotic fluid was measured and recorded at 13th, 27th and 37th weeks of gestation respectively. Results: The mean HbA1c (%) of the pregnant women in 1st semester recorded was 5.2±0.27SD which increased to 5.31 ±0.24SD in 2nd trimester and later changed to 5.54±0.17SD in 3rd semester. The measured amniotic fluid in ultrasound was 23.23cm ±3.18 SD at 13th weeks of gestation, 15.97cm±2.62SD at 27th weeks and 11.95cm±1.99SD at 37th week. The mean abdominal circumference at 37th week was 347.01mm ±7.28SD, mean head circumference was 1477.50mm±2.88SD, AC/HC ratio at 37th week estimated 0.89 ±0.08SD and femur length was 73.44mm ±2.28SD respectively. Conclusion: The finding suggests that increased amniotic fluid and macrosomia are important biomarkers of gestational diabetes and can be assessed through ultrasonography. Keywords: Gestational diabetes mellitus, obstetrics, macrosomiqa, amniotic fluid

EP460: Diagnostic dilemma in a case of suspected fetal skeletal dysplasia

Intrauterine fetal fractures are a rare finding and can represent lethal skeletal dysplasias such as Osteogenesis Imperfecta, or other metabolic or structural abnormalities. More than 400 skeletal dysplasias have been described; some are associated with classical modes of inheritance, while others are associated with imprinting errors, mosaicism, and teratogen exposure. Accurate prenatal diagnosis is critical for appropriate patient counseling, pregnancy management and expected postnatal outcomes. Prenatal ultrasound (US) remains the standard imaging modality for identifying prenatal structural abnormalities; this, coupled with genetic testing, can aid in establishing diagnoses. Available clinical testing includes chromosome microarray, panel testing, exome, and genome sequencing (ES and GS, respectively). Despite the availability of ES and GS, the genetic or molecular mechanism may remain elusive. Here we present a case of suspected campomelic dysplasia which remains a diagnostic dilemma despite thorough genetic evaluation. A 31-year-old Gravida 2 Para 1-0-0-0 at 20 weeks gestation presented for anatomy US at our Maternal Fetal Medicine clinic. This was an IVF pregnancy. Her obstetric history is complicated by one prior emergency Cesarean delivery for a 35-week fetus with decreased fetal movement and non-reassuring fetal heart tones. The neonate passed 5 days after birth with severe encephalopathy of unknown etiology. The patient and partner are otherwise healthy and have no pertinent medical or surgical history. Family history was non-contributory. Initial anatomy US for current pregnancy revealed a singleton female fetus with severely bowed femurs bilaterally with concern for fracture on the right femur, talipes equinovarus of left foot, with all bones showing normal ossification. The fetus was growth restricted at <10th percentile with all shortened long bones. Markers of lethality of skeletal dysplasia including cardiothoracic (CT) ratio was 53% (normal <50%), and femur length (FL): abdominal circumference (AC) ratio was 0.11 (Normal >0.16). These findings prompted diagnostic genetic work up with amniocentesis sent for FISH, chromosome microarray, and a 700 gene skeletal dysplasia panel; all of which returned normal. Sonographic surveillance continued to show a constellation of findings concerning for skeletal dysplasia including bilateral proximal femoral diaphyseal bowing/fractures, left clubfoot, 11 total ribs, micrognathia, chest-to-abdominal circumference CC/AC ratio 0.87, and FL/AC ratio 0.19 (considered severe when CC/AC <0.60 or FL/AC <0.16). Fetal MRI at 32 weeks demonstrated normal fetal brain structure, short femurs, normal lung volumes, unilateral talipes and micrognathia. The patient underwent prenatal ES, which was negative for pathogenic or likely pathogenic variants associated with the prenatal phenotype. The patient underwent a repeat Cesarean Delivery at 38w2d and delivered a liveborn female neonate weighing 2670 grams with Apgar scores of 7 and 9 at 1 and 5 minutes respectively. ENT was available at bedside for possible neonatal airway compromise. On postnatal physical exam, the neonate was normocephalic with age appropriate fontanelles. There was micrognathia with intermittent airway obstruction and evidence of Pierre Robin sequence. The spine was straight without lesions, both femurs were shortened with clubbing of the left foot. All fingers and toes appeared normal. A skeletal survey revealed 12 ossified rib pairs, hip dislocation, lateral bowing/angulation of the mid femoral diaphyses, as well as club feet bilaterally. No fractures were identified. With exception of hip abduction, she had appropriate movement of her extremities. Postnatal expanded GS was pursued; results revealed no pathogenic, likely pathogenic or variants of uncertain significance. Further research -based testing was pursued through Optical Mapping; this revealed several genomic insertion, deletion, inversion, duplication, and translocation events involving multiple genes. However, after review by our Center for Individualized Medicine (CIM) Genomic Odyssey Board (GOB) team, none of the reported genomic events were felt to be a good fit with the infant’s phenotype. This case remains a diagnostic dilemma. Rapid GS and research based optical mapping failed to identify an underlying genetic etiology. This case illustrates challenges associated with prenatal diagnosis of suspected skeletal dysplasias.

Prevalence of Gestational Diabetes Mellitus in Obstetric patients, using Macrosomia and Increased Amniotic Fluid on Ultrasound as Diagnostic Markers

Aim: To determine the prevalence of gestational diabetes in obstetric patients with the help of ultrasonography and diagnostic biomarkers such as increased amniotic fluid and macrosomia. Methods: In 110 women who failed the glucose tolerance test, longitudinal ultrasound measurements of foetal growth were taken during the first, second and third trimesters with the informed consent of every pregnant women. 524 ultrasound examinations were performed in total, and uncomplicated pregnancies were included as controls for the comparison of our results. Head circumference (HC), abdominal circumference (AC), femur length (FL) and head circumference to abdominal circumference ratio (HC/AC) was evaluated at 17th and 37th weeks of gestation while amniotic fluid was measured and recorded at 13th, 27th and 37th weeks of gestation respectively. Results: The mean HbA1c (%) of the pregnant women in 1st semester recorded was 5.2±0.27SD which increased to 5.31±0.24SD in 2nd trimester and later changed to 5.54±0.17SD in 3rd semester. The measured amniotic fluid in ultrasound was 23.23cm±3.18 SD at 13th weeks of gestation, 15.97cm±2.62SD at 27th weeks and 11.95cm±1.99SD at 37th week. The mean abdominal circumference at 37th week was 347.01mm±7.28SD, mean head circumference was 1477.50mm±2.88SD, AC/HC ratio at 37th week estimated 0.89±0.08SD and femur length was 73.44mm±2.28SD respectively. Conclusion: The finding suggests that increased amniotic fluid and macrosomia are important biomarkers of gestational diabetes and can be assessed through ultrasonography. Keywords: Gestational diabetes, ultrasonograpy, increased antibiotic, macrosomia

Utility of sonographic transcerebellar diameter in the assessment of gestational age in normal and intrauterine growth-retarded fetuses.

The fetal cerebellum has been shown to be least affected by external pressures and molding during pregnancy and therefore might provide more accurate estimation of GA. To study the utility of transcerebellar diameter (TCD) measured by ultrasound for the detection of GA in normal and intrauterine growth-retarded (IUGR) fetuses. This cross-sectional study comprised 500 antenatal patients with a GA between 14 and 39 weeks and who were certain of their last menstrual periods. The TCD was measured ultrasonographically and the corresponding GA was determined. The GA was also determined with other customarily used sonographic parameters such as biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL) and compared with TCD. Data of normal pregnancy patients was used to formulate nomograms by taking the 5th, 50th, and 95th percentile measurements. TCD to AC ratio was also calculated in both normal (n = 424) and IUGR pregnancies (n = 76). TCD showed significant correlation with gestational age (GA) measured by last menstrual period (LMP) as well as with GA calculated with other biometric fetal parameters. TCD also showed significant correlation with GA in normal (R2 = 0.979) as well as with IUGR pregnancies (R2 = 0.942). TCD to AC ratio remained fairly constant in normal pregnancies while it was increased in IUGR pregnancies. TCD and TCD/AC ratio can be employed as an objective parameter to establish the GA in normal as well as IUGR pregnancy cases.

Prediction of late-onset fetal growth restriction using a combined first- and second-trimester screening model

BackgroundPrediction models for early fetal growth restriction (FGR) have been exhibited in many researches. However, prediction models for late FGR are limited. Late-onset FGR is easy to miss clinically because of its insidious onset. This study aimed to develop a simple combined first- and second-trimester prediction model for screening late-onset FGR in fetuses. MethodsThis retrospective study included 2746 women who had singleton pregnancies and received routine ultrasound scans as training dataset. Late FGR is that diagnosed >32 weeks. Multivariate logistic regression was used to develop a prediction model. ResultsOne hundred and twenty-nine fetuses were identified as late-onset FGR. The significant predictors for late-onset FGR were maternal height, weight, and medical history; the first-trimester mean arterial pressure, the second-trimester head circumference/ abdominal circumference ratio; and the second-trimester estimated fetal weight. This model achieved a detection rate (DR........) of 51.6% for late-onset FGR at a 10% false positive rate (FPR) (area under the curve (AUC): 0.80, 95%CI 0.76–0.84). ConclusionsA multivariate model combining first- and second-trimester default tests can detect 51.6% of cases of late-onset FGR at a 10% FPR. Further studies with more screening markers are needed to improve the detection rate.

Comparison of Head Circumference and Abdominal Circumference Ratio in Normotensive and patients with Pregnancy Induced Hypertensive Disorders after 28 weeks of gestation

Background: Hypertensive disorders are an important medical problem of gestation. Hypertensive disorders of pregnancy (HDP) are a significant cause for maternal and fetal morbidity as well as mortality. Intrauterine growth retardation (IUGR) commonly describes the condition of fetus whose size or growth is subnormal. IUGR fetus is frequently described as symmetrical and asymmetrical IUGR in term of their body proportions. Asymmetric growth retardation is typically linked to uteroplacental inadequacy. Hypertension is one of the maternal causes of placental insufficiency. Aim: To compare head circumference and abdominal circumference ratio in normotensive and patients with pregnancy induced hypertensive disorders after 28 weeks of gestation. Methodology: A cross sectional analytical study was carried on 113 pregnant females in which 57 women were normotensive and 56 women were hypertensive. All individuals were scanned by two- dimensional ultrasound following 28 weeks of pregnancy to evaluate sonographic parameters HC and AC. The HC/AC ratio was estimated by dividing head circumference with abdominal circumference. Results: Out of 57 normotensive patients 27 (36.48%) fetuses were diagnosed with IUGR having HC/AC ratio more than 1, while 30 had normal HC/AC ratio. In 56 hypertensive patients 47(63.51%) fetuses were diagnosed with IUGR having HC/AC ratio greater than 1, however 9(23.07%) fetuses had HC/AC ratio within normal range. So out of total 113 patients, 74 fetuses were found with IUGR while 39 fetuses had HC/AC ratio within normal ranges. Our study found that a cut off value of ≥ 1.0974 for HC/AC ratio could be used as diagnostic parameter in predicting IUGR. Conclusion: HC/AC ratio is a useful parameter for the detection of IUGR. Keywords: Head Circumference, Abdominal Circumference, Intra Uterine Growth Retardation

Antenatal prediction of fetal macrosomia in pregnancies affected by maternal pre-gestational diabetes

Aims Higher rates of fetal macrosomia may occur in infants of women with pre-gestational diabetes compared with non-diabetic controls. Antenatal predication of fetal macrosomia remains challenging. Ultrasound over-estimated fetal weight could result in over-classification of fetuses as macrosomic with corresponding inappropriate clinical interventions. Previously we had studied a measurement – the anterior abdominal wall measurement (AAW) – to predict fetal macrosomia in fetal estimation of weight. The purpose of the study was to study whether specific third trimester ultrasound measurements with measures of glycaemic control (HbA1c) predicted macrosomia in babies born to women with pre-gestational diabetes. In particular, a new variant of this measurement (fetal anterior abdominal wall thickness (AAW), abdominal circumference (AC) ratio: AAW:AC) was investigated. Methods This was a prospective cohort study in a tertiary referral maternity hospital. Serial growth scans including measurement of AAW and AC: AAW ratio was performed at 30, 33- and 36-weeks’ gestation. Birth-weight data was collected, and macrosomia was defined as >90th centile based on gestational age and gender of the baby. Serial HbA1c as measured at the first antenatal visit, 14, 20- and 36-weeks’ gestation were reported for this study. Results Of the 416 pregnancies analyzed, mean maternal age was 33.3 years. One in five women were primigravida’s. The mean birthweight was 3548 g (+/− 581 g), of which 142 (34%) babies were classified as macrosomic. The median gestational age at delivery was 383 weeks (314 − 402 weeks). There were 37 (9%) babies born preterm at <37 weeks’ gestation. Mean AC measurements in fetuses that would be born with macrosomia compared with those with a non-macrosomic birth weight were 282 mm vs. 266 mm at 30 weeks, 318.3 mm vs. 297 mm at 33 weeks and 350 mm vs. 325 mm at 36 weeks’ gestation (all p < .001). Mean AAW measurements in macrosomic fetuses compared with normal size fetuses were 3.7 mm vs. 3.3 mm at 30 weeks, 4.9 mm vs 4.3 mm at 33 weeks and 5.9 mm vs. 5.3 mm at 36 weeks’ gestation (all p < .001). The mean AC: AAW was 0.01 for both normal and macrosomic fetuses at 30 weeks. There was no clinical or statistical difference in AC:AAW ratios between non-macrosomic and macrosomic infants. Binary logistic regression showed that AC at 36 weeks was most predictive of macrosomia (76.5%), followed by AAW at 30 weeks (68.5%). Using a combination of HbA1c booking, 14, 20, 36 weeks and AAW 30, 33, 36 weeks and AC 30, 33, 36 weeks predicted macrosomia in 80.9%. The ratio of AC: AAW did not act as a useful antenatal clinical predictor of macrosomia at birth. Conclusions Abdominal circumference at 36 weeks was the single best predictor of fetal macrosomia. A combined model of HbA1c, AC and AAW was the best antenatal predictor of macrosomia, with intriguing clinical possibilities in the possible prevention of maternal and fetal complications of macrosomia.

The abdominal waist circumference and 4-year outcomes following peripheral bypass grafting.

Current literature evaluating the relationship between obesity, utilizing measures other than the Body Mass Index (BMI), and postoperative outcomes following vascular surgery are sparse. This study aimed to investigate any association between abdominal waist circumference (AWC) and waist-hip ratio (WHR) in relation to postoperative morbidity and mortality following peripheral artery bypass graft (PABG) surgery. AWC and hip circumference (HC) were measured from pre-intervention magnetic resonance (MR) and computed tomography (CT) scans of patients undergoing elective and nonelective PABG. The AWC and WHR were assessed in relation to: the need for higher level care (i.e. level 2/3), the duration of higher level care, postoperative limb ischemia, postoperative hospital stay, graft patency on discharge and 30 day readmission, using logistic and linear regression analysis. Mortality was assessed using cox-regression analysis with calculation of hazard ratios at 30 days and 4 years. In total, 177 patient images performed between January 2014 to January 2017 were analyzed. There were no significant intra-observer and interobserver differences in measurements of AWC and HC. Pre-intervention AWC was predictive of the need for higher level care following non-elective PABG (adjusted OR 1.1 [95% CI: 1.0-1.1, P=0.026]). An inverse relationship between AWC and mortality at 4 years was also observed (adjusted HR=0.9, 95% CI: 0.9-1.0, P=0.028). However, pre-intervention WHR failed to predict mortality and morbidity. AWC may potentially be a suitable risk stratification tool in patients undergoing non-elective PABG. The association of AWC with long-term mortality outcomes require further investigation so that suitable cut-off values may be determined.