Estimated Fetal Weight Research Articles

Maternal Prenatal Depressive Symptoms and Fetal Growth During the Critical Rapid Growth Stage

Fetal growth in the critical rapid growth stage (CRGS) before delivery, approximately between 30 to 37 gestational weeks, carries significant implications for subsequent overweight, obesity, and arterial health. Previous evidence has demonstrated the association between maternal depressive symptoms and fetal growth trajectories from early to late pregnancy, but there remains limited understanding of the association of these symptoms with the longitudinal fetal growth change within the CRGS. To investigate the association between maternal depressive symptoms and fetal growth during the CRGS before delivery. This prospective birth cohort study was conducted from January 2018 to December 2020. Volunteer pregnant women were enrolled in their first trimester of prenatal visits. Women with severe disease before pregnancy and multiple births, fetuses with congenital anomalies, and preterm or postterm births were excluded. This multicenter study was based in 13 hospitals covering 81 counties across 12 cities in Sichuan Province, China. Follow-up visits were performed at the second trimester, the third trimester, and 24 hours after delivery. The analysis was conducted from January to May 2023. Maternal depressive symptoms, as a continuous variable, measured by the Edinburgh Postpartum Depression Scale (EPDS) at a median gestational week of 24 (range, 14 to 27) weeks of gestation. A higher score on the EPDS indicates worse depressive symptoms. The main outcomes included ultrasonography-measured biparietal diameter (BPD), femur length (FL), and abdominal circumference (AC), along with calculated estimated fetal weight (EFW). These parameters were evaluated longitudinally at a median gestational week of 30 (range, 28 to 32) and 37 (range, 35 to 39) weeks. Linear mixed models were used to estimate the associations between maternal depressive symptoms and fetal growth parameters. A total of 2676 mother-offspring dyads were included, in which the mean (SD) age of mothers was 28.0 (4.4) years, and 1294 (48.4%) of the offspring were female. The median (IQR) maternal EPDS score was 5.0 (4.0 to 9.0). After adjustment for confounders, a significant correlation was found between a higher score of depressive symptoms in mothers and a slower rate of fetal growth across FL (β = -0.40; 95% CI, -0.58 to -0.22), AC (β = -1.97; 95% CI, -2.90 to -1.03), and EFW (β = -50.11; 95% CI, -68.46 to -31.75). These associations were stronger in female fetuses or those with better family socioeconomic conditions. In this prospective cohort study, maternal depressive symptoms were associated with slower fetal growth rate in the CRGS before delivery. Early screening for depressive disorders in pregnant women appears to be essential for fetal growth and later health.

Predictive value of fetal growth trajectory from 20 weeks of gestation onwards for severe adverse perinatal outcome in low-risk population: secondary analysis of IRIS study.

The placental dysfunction underlying fetal growth restriction (FGR) may result in severe adverse perinatal outcome (SAPO) related to fetal hypoxia. Traditionally, the diagnostic criteria for FGR have been based on fetal size, an approach that is inherently flawed because it often results in either over- or underdiagnosis. The anomaly ultrasound scan at 20 weeks' gestation may be an appropriate time at which to set a benchmark for growth potential of the individual fetus. We hypothesized that the fetal growth trajectory from that point onwards may be informative regarding third-trimester placental dysfunction. The aim of this study was to investigate the predictive value for SAPO of a slow fetal growth trajectory between 18 + 0 to 23 + 6 weeks and 32 + 0 to 36 + 6 weeks' gestation in a large, low-risk population. This was a post-hoc data analysis of the IUGR Risk Selection (IRIS) study, a Dutch nationwide cluster-randomized trial assessing the (cost-)effectiveness of routine third-trimester sonography in reducing SAPO. In the current analysis, for the first ultrasound examination we used ultrasound data from the routine anomaly scan at 18 + 0 to 23 + 6 weeks' gestation, and for the second we used data from an ultrasound examination performed between 32 + 0 and 36 + 6 weeks' gestation. Using multilevel logistic regression, we analyzed whether SAPO was predicted by a slow fetal growth trajectory, which was defined as a decline in abdominal circumference (AC) and/or estimated fetal weight (EFW) of more than 20 percentiles or more than 50 percentiles or as an AC growth velocity (ACGV) < 10th percentile (p10). In addition, we analyzed the combination of these indicators of slow fetal growth with small-for-gestational age (SGA) (AC or EFW < p10) and severe SGA (AC/EFW < 3rd percentile) at 32 + 0 to 36 + 6 weeks' gestation. Our sample included the data of 6296 low-risk singleton pregnancies, among which 82 (1.3%) newborns experienced at least one SAPO. Standalone declines in AC or EFW of > 20 or > 50 percentiles or ACGV < p10 were not associated with increased odds of SAPO. EFW < p10 between 32 + 0 and 36 + 6 weeks'gestation combined with a decline in EFW of > 20 percentiles was associated with an increased rate of SAPO. The combination of AC or EFW < p10 between 32 + 0 and 36 + 6 weeks' gestation with ACGV < p10 was also associated with increased odds of SAPO. The odds ratios of these associations were higher if the neonate was SGA at birth. In a low-risk population, a slow fetal growth trajectory as a standalone criterion does not distinguish adequately between fetuses with FGR and those that are constitutionally small. This absence of association may be a result of diagnostic inaccuracies and/or post-diagnostic (e.g. intervention and selection) biases. We conclude that new approaches to detect placental insufficiency should integrate information from diagnostic tools such as maternal serum biomarkers and Doppler ultrasound measurements. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Accuracy of sonographic fetal weight estimation and prediction of birth-weight discordance in twin pregnancy: large single-center study.

To determine the accuracy of sonographic fetal weight estimation in predicting birth weight (BW) and BW discordance in twin gestations, and to evaluate maternal and fetal characteristics that may affect the accuracy of this assessment. This was a retrospective cohort study of all twins delivered at a single tertiary medical center between 2010 and 2021. Twin gestations for which sonographic estimation of fetal weight was performed within the week preceding delivery were included. Statistical analysis was performed to evaluate the strength of the correlation between sonographic estimated fetal weight (EFW) and BW, and to determine the impact of maternal and fetal factors on the accuracy of sonographic estimation. The study included 2154 twin pregnancies. There was a strong correlation between sonographic EFW and corresponding BW for all twins (r = 0.922; P < 0.001). Strong correlations were observed for both the presenting and non-presenting cotwin (r = 0.921 and r = 0.922, respectively; both P < 0.001), as well as the larger and smaller cotwin (r = 0.928 and r = 0.934, respectively; both P < 0.001). The overall mean ± SD absolute error of sonographic EFW was 7.41 ± 6.81%. This error was greater for the non-presenting cotwin compared with the presenting cotwin (7.99 ± 6.12% vs 7.17 ± 5.64%; P < 0.001), and for the smaller cotwin compared with the larger cotwin (8.56 ± 7.50% vs 6.58 ± 5.47%; P < 0.001). Advanced gestational age at scanning was correlated inversely with the mean absolute error of sonographic EFW. Multivariate logistic regression indicated that an earlier gestational age at scanning, being the non-presenting cotwin and being the smaller cotwin were independent risk factors for sonographic EFW inaccuracy. Pregnancies in which the presenting twin was estimated to be the smaller cotwin had twice the rate of false-positive BW discordance compared with pregnancies in which the presenting twin was estimated to be the larger cotwin (36.0% vs 13.0% for BW discordance > 15%, 35.0% vs 17.0% for BW discordance > 20% and 37.7% vs 12.1% for BW discordance > 25%; all P < 0.001). The error in sonographic EFW discordance was not related to chorionicity, the position of the presenting fetus or gestational age at the time of fetal weight estimation. Sonographic estimation of fetal weight within 7 days before delivery accurately predicts BW in twin pregnancy. Sonographic EFW accuracy is reduced for the non-presenting twin, the smaller cotwin and when delivery occurs at an earlier gestational age. Sonographic estimation of fetal weight discordance is less accurate when the presenting twin is the smaller cotwin. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Antenatal fetal growth patterns in uncomplicated pregnancies according to mode of conception and placental location

Newborns resulting from in-vitro fertilisation (IVF) had a significantly (P= 0.002) higher birthweight centile than those resulting from spontaneous conception (SC) but no significant changes were found in ultrasound estimated fetal weight (EFW) centile between 20-22 and 32–34 weeks between the IVF and SC groups. When stratified for the IVF methods used, significant (P = 0.02) fastest in-utero fetal growth (mean increase in centile of 5 between 2nd to 3rd trimester) was observed in the frozen embryo transfer (FET) subgroup compared to SC, and to IVF pregnancies resulting from fresh blastocyst transfer (FBT) or from oocyte donation (OD). Low placentation was significantly (P < 0.001) more common in the IVF group than in the SC group but was not associated with a change in growth pattern suggesting that fetal growth in-utero is independent of placental location but may be influenced by embryo freezing.

Predelivery sonographic predictors of obstetric anal sphincter injury among nulliparous women.

Data available at admission to delivery of nulliparous has rarely been investigated for prediction of obstetric anal sphincter injury (OASI). The aim of the present study was to study risk factors for OASI in nulliparous based on information available at admission. A retrospective study of all nulliparous women undergoing labor, during March 2011 to January 2021 was performed. We compared women with OASI following delivery to those without by univariate and multivariable regression. A total of 30 262 deliveries were included and 4181 (13.4%) of those were delivered by an emergent cesarean delivery. OASI followed 453 (1.5%) deliveries. Women in the OASI group were younger 29 ± 4.4 versus 30 ± 4.8, P = 0.001. In a multivariable regression analysis, higher sonographic estimated fetal weight was positively associated with OASI occurrence (aOR, 95% CI: 1.13 [1.00-1.29]). Maternal age was inversely associated with OASI occurrence (adjusted odds ratio [aOR], 95% confidence interval [CI] 0.95 [0.92-0.97]). Sonographic fetal weight estimation is an independent risk factor for OASI occurrence that may be available at admission for delivery among nulliparous women.

Performance of fetal ultrasound and magnetic resonance imaging in predicting birthweight according to the test-to-delivery interval: A cohort study

ObjectiveTo assess the influence of the test-to-delivery interval (TDI) on the performance of ultrasound (US) and magnetic resonance imaging (MRI) for predicting birthweight (BW). Study designThis is a secondary analysis of a prospective, single center, blinded cohort study that compared MRI and US for the prediction of BW ≥ 95th percentile in singleton pregnancies. Patients that were included in the initial study underwent US and MRI for estimation of fetal weight between 36 + 0/7 and 36 + 6/7 weeks of gestation (WG). The primary outcome of the current study was to report the changes of US and MRI sensitivity and specificity in the prediction of BW > 95th percentile, BW > 90th percentile, BW < 10th percentile, and BW < 5th percentile, according to the TDI. The secondary outcome was to represent the performance of both tools in the prediction of BW > 90th percentile when TDI is<2 weeks, between 2 and 4 weeks, and>4 weeks. Receiver operating characteristic (ROC) curves were constructed accordingly. Results2378 patients were eligible for final analysis. For the prediction of BW > 95th or 90th percentile, the sensitivity of MRI remains high until 2 weeks, and it decreases slowly between 2 and 4 weeks, in contrast to the sensitivity of US which decreases rapidly 2 weeks after examination (p < 0.001). For the prediction of BW < 10th or 5th percentile, the sensitivity of both tools decreases in parallel between 1 and 2 weeks. The specificities of both tools remain high from examination till delivery. These findings are reproducible with the use of the antenatal customized and the postnatal national growth charts. ConclusionThe performance of MRI in the prediction of BW, especially in large-for-gestational age, is maximal when delivery occurs within two weeks of the examination, decreasing slightly thereafter, in contrast with the performance of US which decreases drastically over time.

A prediction tool for mode of delivery in twin pregnancies—a secondary analysis of the Twin Birth Study

One of the controversies regarding the management of twin gestations relates to the mode of delivery. Currently, counseling regarding the mode of delivery and the chance of successful vaginal twin delivery is based on the average risk for intrapartum cesarean delivery in the general population of twin pregnancies. Decision support tools that provide an individualized risk for intrapartum cesarean delivery based on the unique characteristics of each patient can improve counseling and decision-making regarding the choice of mode of delivery in twin pregnancies. This study aimed to develop and validate a prediction model to determine the risk for intrapartum cesarean delivery in twin pregnancies. In this secondary analysis of the Twin Birth Study, a multicenter randomized controlled trial, we considered the subgroup of individuals who underwent a trial of vaginal delivery. Candidate predictors included maternal age, parity, previous cesarean delivery, conception method, chorionicity, diabetes and hypertension in pregnancy, gestational age at birth, the onset of labor, presentation of the second twin, sonographic fetal weight estimation, and fetal sex. The co-primary outcomes were overall intrapartum cesarean delivery and cesarean delivery of the second twin. Multivariable logistic regression models were used to estimate the probability of the study outcomes. Model performance was evaluated using measures of discrimination (the area under the receiver operating characteristic curve), calibration, and predictive accuracy. Internal validation was performed using the bootstrap resampling technique. A total of 1221 individuals met the study criteria. The rate of overall intrapartum cesarean delivery and cesarean delivery for the second twin was 25.4% and 5.7%, respectively. The most contributory predictor variables were nulliparity, term birth (≥37 weeks), a noncephalic presentation of the second twin, previous cesarean delivery, and labor induction. The models for overall intrapartum cesarean delivery and cesarean delivery of the second twin had good overall discriminatory accuracy (area under the receiver operating characteristic curve, 0.720; 95% confidence interval, 0.688-0.752 and 0.736; 95% confidence interval, 0.669-0.803, respectively) and calibration (as illustrated by the calibration plot and Brier scores of 0.168; 95% confidence interval, 0.156-0.180 and 0.051; 95% confidence interval, 0.040-0.061, respectively). The models achieved good specificity (66.7% and 81.6%, respectively), high negative predictive value (86.0% and 96.9%, respectively), and moderate sensitivity (68.1% and 57.1%, respectively). The prediction models developed in this study may assist care providers in counseling individuals regarding the optimal timing and mode of delivery in twin pregnancies by providing individualized estimates of the risk for intrapartum cesarean delivery.

Small estimated placental volume (EPV) in the setting of decreased fetal movement

Although 60.5 % of clinically unexplained stillbirths can be attributed to placental insufficiency and/or fetal growth restriction, clinicians rarely calculate estimated placental volume (EPV). We present a scenario in which EPV was used to inform patient care of a 28-year-old with decreased fetal movement at 32 weeks and 1 day gestation. Although estimated fetal weight (EFW), amniotic fluid index (AFI), and nonstress test (NST) were normal, EPV was low (<0.1st percentile), which prompted more frequent patient follow-up. Oligohydramnios was detected at 38 weeks and 1 day, and labor was induced. An infant with birthweight in the 12th percentile for gestational age was born. We learned that EPV can precede intrauterine growth restriction (IUGR), oligohydramnios, and low birthweight.

Afferent venous perfusion of fetal liver: umbilical and portal blood-flow volumes in fetuses born small-for-gestational age.

To quantify the dynamic changes in the afferent venous flow volume of the liver in low-risk pregnancies with fetuses born small-for-gestational age. This was a prospective study of low-risk singleton pregnancies with estimated fetal weight (EFW) and birth weight ≤ 10th centile attending for a routine second- or third-trimester ultrasound examination. Their umbilical and portal blood-flow volumes were compared with those of a control group of fetuses born appropriate-for-gestational age from which normal reference ranges were constructed. Absolute and Z-score differences between the groups were assessed. In total, 133 fetuses were included in the study group and 362 in the control group. The mean umbilical blood-flow volume in the study group, both absolute and normalized per kg of EFW, was below that of the appropriate-for-gestational-age fetuses for most of the period of pregnancy studied (overall mean Z-score, -0.82 and -0.84, respectively). In contrast, the mean portal blood-flow volume, per kg of EFW, showed the opposite trend (overall mean Z-score, +0.86), reaching its maximum level (+1.43) in the late third trimester. This resulted in a steep decrease in the mean placental-to-portal-blood-flow volume ratio, from 14.4 at 24 weeks of gestation (above the 60th centile) to 4.7 at 38 weeks of gestation (15th centile), corresponding to Z-scores of +0.4 and -1.02, respectively. In fetuses born small-for-gestational age, the ratio of blood-flow volume in the umbilical vein to that in the portal vein decreases consistently during pregnancy, and to a greater extent compared with those born appropriate-for-gestational age, reaching a lower nadir in the third trimester. This additional redistribution of liver perfusion affects negatively fetal growth even in low-risk pregnancy, and should be taken into account when planning delivery. We suggest considering liver venous perfusion as an ancillary tool for monitoring small-for-gestational-age pregnancies. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

A conditional standard for the customized fetal growth trajectory in twin pregnancy

BackgroundThe difference between the birthweights of twins and singletons grows with advancing gestation. Although many fetal weight standards based on ultrasound have been created for tracking fetal growth in twin pregnancies, their applicability to other groups is limited by the fact that they are population-specific. ObjectivesTo generate conditional centiles of growth assessment in twin fetuses and compare them with other population-based growth standards for singleton and twin fetuses. Study DesignA retrospective longitudinal study of the ultrasound-based estimated fetal weight (EFW) dataset of normal twin fetuses delivered after 34 weeks of gestation was conducted. Linear mixed effects models, which adjusted for maternal characteristics, fetal gender, and chorionicity, were used to construct the relationship between EFW and gestational age. The EFW reference values were calculated using conditional centile based on the EFW at an earlier gestational age. To compare our results with previous studies, fetal growth curves were generated using a formula we created which included maternal characteristics and the EFW at 24 weeks of gestation in these studies. In a subgroup analysis of our low-risk twin babies born at full term, we calculated the number of fetuses that were reclassified as being in the bottom 10th percentile using each of the previous population-based standard. Results2644 ultrasounds with a median of 4 scans per fetus from 572 twin pregnancies were included in this analysis. Thirty six percent of the fetuses were monochorionic. Maternal age, body mass index, and the interaction between fetal gender and chorionicity were significantly associated with EFW. The predicted growth curves matched the growth standard for twins. In our low-risk group, when the singleton standard was used, the incidence of EFW 10th percentile was above 20% from gestational week 24–38, and this incidence varied when reclassified using other population-based twin standards. ConclusionsThis conditional growth chart was specifically designed to assess fetal growth in twins, but it is generalizable to other populations.

The influence of insulin-related genetic variants on fetal growth, fetal blood flow, and placental weight in a prospective pregnancy cohort

The fetal insulin hypothesis proposes that low birthweight and type 2 diabetes (T2D) in adulthood may be two phenotypes of the same genotype. In this study we aimed to explore this theory further by testing the effects of GWAS-identified genetic variants related to insulin release and sensitivity on fetal growth and blood flow from week 20 of gestation to birth and on placental weight at birth. We calculated genetic risk scores (GRS) of first phase insulin release (FPIR), fasting insulin (FI), combined insulin resistance and dyslipidaemia (IR + DLD) and insulin sensitivity (IS) in a study population of 665 genotyped newborns. Two-dimensional ultrasound measurements with estimation of fetal weight and blood flow were carried out at week 20, 25, and 32 of gestation in all 665 pregnancies. Birthweight and placental weight were registered at birth. Associations between the GRSs and fetal growth, blood flow and placental weight were investigated using linear mixed models. The FPIR GRS was directly associated with fetal growth from week 20 to birth, and both the FI GRS, IR + DLD GRS, and IS GRS were associated with placental weight at birth. Our findings indicate that insulin-related genetic variants might primarily affect fetal growth via the placenta.

Predictive ability of fetal growth charts in identifying kindergarten-age developmental challenges: a cohort study

BackgroundThe Society for Maternal-Fetal Medicine recommends defining fetal growth restriction as an estimated fetal weight or abdominal circumference below the 10th percentile of a population-based reference. However, as multiple references are available, an understanding of their ability to identify infants at increased risk due to fetal growth restriction is critical. Previous studies have focus on the ability of different population references to identify short-term outcomes, but fetal growth restriction also has longer-term consequences for child development. ObjectivesTo estimate the association between estimated fetal weight (EFW) percentiles on the INTERGROWTH-21st and WHO fetal growth charts and kindergarten-age childhood development, and establish the charts’ discriminatory ability in predicting kindergarten-age developmental challenges. Study DesignWe conducted a retrospective cohort study linking obstetrical ultrasound scans conducted at BC Women's Hospital, Vancouver, Canada, with population-based standardized kindergarten test results.The cohort was limited to non-anomalous, singleton fetuses scanned ≥ 28 weeks’ gestation, 2000-2011, with follow-up to 2017.We classified EFWs into percentiles using the INTERGROWTH-21st and WHO charts. We used generalized additive modelling to link EFW percentile with routine province-wide kindergarten readiness test results. We calculated the area under the receiver-operating characteristic curve (AUC), as well as other measures of diagnostic accuracy with 95% confidence intervals (CI) at select percentile cut-points of the charts. We repeated analyses using the Hadlock chart to help contextualize findings.The main outcome measure was the total Early Development Instrument (EDI) score (/50). Secondary outcomes were EDI sub-domain scores for language and cognitive development, and for communication skills and general knowledge; designation of ‘developmentally vulnerable’ or ‘special needs’. ResultsAmong 3418 eligible fetuses, those with lower EFW percentiles had systematically lower EDI scores and increased risks of developmental vulnerability. However, the clinical significance of differences was modest in magnitude: e.g., total EDI score -2.8 [95% CI: -5.1, -0.5] in children with an EFW 3-9th percentile of INTERGROWTH chart (vs. reference of 31-90th). The charts’ predictive abilities for adverse child development were limited (e.g., AUC<0.53 for all 3 charts). ConclusionsLower EFW percentiles on the INTERGROWTH-21st and WHO charts indicate increased risks of adverse kindergarten-age child development at the population level, but are not accurate individual-level predictors of adverse child development.

Outcome-based comparative analysis of five fetal growth velocity models to define slow growth.

Fetal growth surveillance includes assessment of size as well as rate of growth, and various definitions for slow growth have been adopted into clinical use. The aim of this study was to evaluate the effectiveness of different models to identify stillbirth risk, in addition to risk represented by the fetus being small-for-gestational age (SGA). This was a retrospective analysis of a routinely collected and anonymized dataset of pregnancies that had two or more third-trimester ultrasound measurements of estimated fetal weight (EFW). SGA was defined as EFW < 10th customized centile, and slow growth was defined according to five published models in clinical use: (1) a fixed velocity limit of 20 g per day (FVL20 ); (2) a fixed > 50 centile drop, regardless of scan-measurement interval (FCD50 ); (3) a fixed > 30 centile drop, regardless of scan interval (FCD30 ); (4) growth trajectory slower than the third customized growth-centile limit (GCL3 ); and (5) EFW at second scan below the projected optimal weight range (POWR), based on partial receiver-operating-characteristics-curve-derived cut-offs specific to the scan interval. The study cohort consisted of 164 718 pregnancies with 480 592 third-trimester ultrasound scans (mean ± SD, 2.9 ± 0.9). The last two scans in each pregnancy were performed at an average gestational age of 33 + 5 and 37 + 1 weeks. At the last scan, 12 858 (7.8%) EFWs were SGA, and of these, 9359 were also SGA at birth (positive predictive value, 72.8%). The rate at which slow growth was defined varied considerably (FVL20 , 12.7%; FCD50 , 0.7%; FCD30 , 4.6%; GCL3 , 19.8%; POWR, 10.1%), and there was varying overlap between cases identified as having slow growth and those identified as SGA at the last scan. Only the POWR method identified additional non-SGA pregnancies with slow growth (11 237/16 671 (67.4%)) that had significant stillbirth risk (relative risk, 1.58 (95% CI, 1.04-2.39)). These non-SGA cases resulting in stillbirth had a median EFW centile of 52.6 at the last scan and a median weight centile of 27.3 at birth. Subgroup analysis identified methodological problems with the fixed-velocity model because it assumes linear growth throughout gestation, and with the centile-based methods because the non-parametric distribution of centiles at the extremes does not reflect actual difference in weight gain. Comparative analysis of five clinically used methods to define slow fetal growth has shown that only the measurement-interval-specific POWR model can identify non-SGA fetuses with slow growth that are at increased risk of stillbirth. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Correlation between Pulmonary Artery Doppler with Neonatal Outcome in Patients with Placenta Accreta Spectrum Disorders

Objective: The purpose of this study was to correlate fetal main pulmonary artery (PA) Doppler indices with the neonatal outcome in the late preterm and early term pregnancies in placenta accreta spectrum (PAS) patients Methods: A prospective cross-sectional study was conducted on 71 patients with PAS disorders singleton pregnancies undergoing elective or emergency termination of pregnancy under general anesthesia at or after 34 weeks. A full obstetrics ultrasound scan was performed within 24 hours before delivery and after corticosteroids administration to confirm the eligibility criteria and to measure PA Doppler indices in the main PA (pulsatility index (PI), resistance index (RI), systolic to diastolic (S/D) ratio, peak systolic velocity (PSV) and acceleration to ejection time (At/Et) ratio). Results: Twenty-three neonates needed respiratory support and neonatal intensive care unit (NICU) admission. Fetuses that needed respiratory support had a significantly lower gestational age at delivery (36±1.2 versus 36.8±0.5), lower estimated fetal weight (EFW) (2770±475 versus 3096±328), lower birth weight (2782±595 versus 3152±337) and also lower Apgar score than those who did not need. None of the PA Doppler parameters correlated with the neonatal need for respiratory support. The need for respiratory support was more in the neonates who were terminated on emergency basis (39.1% versus 60.9%). The depth of placental invasion correlated with maternal morbidity. Conclusions: PA Doppler parameters do not correlate with the need for respiratory support in patient with PAS disorders.

Diagnostic Yield of Exome Sequencing in Isolated Fetal Growth Restriction: Systematic Review and Meta-analysis

(Abstracted from Prenat Diagn 2023;43:596–604) An estimate of fetal weight below a certain percentile is defined as fetal growth restriction (FGR); different medical organizations define the threshold for FGR differently. Regardless of the definition used, long-term adverse outcomes have been associated with FGR, such as an increased risk of neurodevelopmental delay, along with other, short-term adverse outcomes.

Novel approach to prenatal predictors of outcomes for fetuses with severe Ebstein anomaly

Objective Ebstein anomaly (EA) is a cardiac malformation with highly variable presentation and severity with limited perinatal management options. We present incorporation of fetal lung measurements into a multidisciplinary evaluation for counseling and predicting postnatal outcomes in patients with severe EA. Methods Five fetuses with severe fetal EA were reviewed. Third trimester sonographic observed/expected total lung area (O/E TLA) and lung to head ratio (O/E LHR), fetal MRI total fetal lung volume ratio (O/E-TFLV), echocardiographic cardio-thoracic ratio (CT ratio), sonographic estimated fetal weight (EFW) by Hadlock formula and presence of hydrops, were used to guide perinatal management. Results Three of five had appropriate fetal growth, were delivered at term in a cardiac operative suite, and underwent immediate intervention with good neonatal outcomes. Two had severe fetal growth restriction (FGR), CT ratios > 0.8 and O/E LHR and TLA < 25%. One of which delivered prematurely with neonatal demise and one suffered in utero demise at 34 weeks. Conclusions FGR, hydrops, increased CT ratio and reduced O/E LHR and TFLV are potential prognosticators of poor outcomes in severe EA, and should be validated in larger cohorts that would allow for a statistical analysis of the predictive utility of these measurements.

The impact of gestational diabetes on the development of fetal frontal lobe: A case-control study from a tertiary center.

To determine the effects of gestational diabetes mellitus (GDM) on fetal frontal lobe development. This study was conducted prospectively between May 2023 and August 2023 in Ankara City Hospital perinatology clinic. Maternal age, maternal body mass index (BMI), gestational week (GW), biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL), estimated fetal weight (EFW), frontal antero-posterior diameter (FAPD), occipito-frontal diameter (OFD), FAPD/OFD ratio, and FAPD/HC ratio, were compared between GDM (n = 40) and low risk controls (n = 56). The mean maternal age was found higher in the GDM group compared to control group (p = 0.002). Maternal BMI was significantly higher in the GDM group than the control group (p = 0.01). Abdominal circumference (AC) was significantly higher in the GDM group compared to control group (p = 0.04). EFW was significantly higher in the GDM group compared to control group (p = 0.04). FAPD/OFD ratio was found to be higher in the GDM group than in the control group (p = 0.001). Among GDM patients, no statistically significant difference was found in the ultrasound measurements between the groups receiving insulin treatment and those without treatment. According to the correlation analysis results a moderate, positive, and statistically significant correlation was present between FAPD/OFD and GDM. In perinatal outcomes, the rate of neonatal intensive care unit admission was significantly higher in the GDM group. Fetal frontal lobe development seems to be affected by GDM.

Accuracy of Estimated Fetal Weight by Ultrasound Versus Leopold Maneuver.

Estimated fetal weight (EFW) is frequently used for clinical decision-making in obstetrics. The goals of this study were to determine the accuracy of EFW assessments by Leopold and ultrasound and to investigate any associations with maternal characteristics. Postgraduate years 1 and 2 obstetrics and gynecology resident physicians from Harbor-UCLA Medical Center from 2014 to 2020 performed EFW assessments on 10 preterm (<37 weeks' gestational age) fetuses by ultrasound biometry and 10 full-term (≥37 weeks' gestational age) fetuses by ultrasound biometry and Leopold maneuver. Assessments were included if the patients delivered within 2 weeks of the assessments. One thousand six hundred ninety-seven EFW assessments on 1183 patients performed by 33 residents were analyzed; 72.6% of sonographic full-term EFWs, 69% of Leopold full-term EFWs, and 61.5% of sonographic preterm EFWs were within 10% of the neonatal birth weight (BW). The lowest estimation error in our study occurred when actual BW was 3600 to 3700 g. After adjusting for BW, residents were found to have lower accuracy when the mother had a higher body mass index (BMI) for full-term estimation methods (Leopold and ultrasound, β = 0.13 and 0.12, P = 0.001 and 0.002, respectively). Maternal BMI was not related to estimation error for preterm fetuses ( β = 0.01, P = 0.75). Clinical and sonographic EFW assessments performed by obstetrics and gynecology junior residents are within 10% of neonatal BW much of the time. In our cohort, they tended to overestimate EFWs of lower-BW infants and underestimate EFWs of higher-BW infants. Accuracy of full-term EFW assessments seems to decrease with increasing maternal BMI.

The role of the PLGF in the prediction of the outcome in pregnancies with a small for gestational age fetus.

To explore the value of measuring maternal serum PLGF in the prediction of the outcome of small for gestational age fetuses (SGA). Singleton pregnancies referred with suspicion of SGA in the third trimester were included if they had: no indication for nor signs of imminent delivery, fetal abdominal circumference (AC) at or below the 10th centile and/or estimated fetal weight (EFW) at or below the 10th centile and/or umbilical artery pulsatility index (Umb-PI) at or above the 90th centile for gestation. Women with pre-eclampsia at presentation were excluded. Maternal blood was drawn at the first (index) visit and analyzed retrospectively. Fifty-one fetuses were examined. Multiple regression analysis showed that family history of microsomia, index EFW and PLGF were significant predictors of the birthweight centile; index femur length centile and PLGF were significant predictors of pre-eclampsia; PLGF and index systolic blood pressure were significant predictors of iatrogenic preterm delivery < 37 weeks, whereas PLGF and index EFW were significant predictors of birthweight ≤ 5th centile and admission to the neonatal intensive care unit. For all outcomes, the addition of maternal-fetal parameters did not improve the prediction compared to PLGF alone. Using a cutoff of 0.3 MoM for PLGF would identify 94.1% of the pregnancies with iatrogenic preterm delivery and/or intra-uterine death and all of the cases that developed pre-eclampsia, for a screen positive rate of 54.9%. Women with PLGF ≤ 0.3 MoM had a poor fetal/maternal outcome (iatrogenic preterm delivery, pre-eclampsia, intra-uterine death) in 61.5% of cases. In pregnancies complicated by SGA, PLGF identifies a very high-risk group that may benefit from intense surveillance.

Comparative study of fetal weight estimation by various methods at term and its correlation with the actual birth weight

&#x0D; &#x0D; &#x0D; INTRODUCTION: Modern obstetrics aims to achieve the best quality of life for both mother and her unborn child. Birth weight is an important predictor of neonatal outcome, and its prenatal estimation plays a significant role in the comprehensive evaluation and management of high- risk pregnancies. This study aims to estimate fetal weight using different clinical methods and ultrasonography and compare these methods with the actual birth weight.&#x0D; METHODS: A prospective cross-sectional comparative study of 200 full-term pregnant women admitted to the Northern Railway Central Hospital, New Delhi, between June 2014 and June 2015 was conducted. Patients in whom delivery was anticipated and completed within 1 week were included. Fetal weights were estimated clinically using Insler’s and Johnson’s formula and ultrasound using Hadlock’s formula. Estimates were then compared with actual birth weight. RESULTS: Both the clinical methods showed underestimation of fetal weight, while ultrasound estimation of fetal weight showed overestimation. Clinical methods had a lower average error in fetal weight estimation than ultrasonography methods. Reliability statistics showed a better prediction of fetal weight if all three methods were used in conjunction.&#x0D; CONCLUSION: Clinical methods were found to be better than the ultrasonography method for fetal weight estimation. Clinical methods are easy and cost-effective for the patients, so all relevant health workers should be taught how to undertake this skill competently. However, all the methods must be used in conjunction.&#x0D; &#x0D; &#x0D;