Estimated Fetal Weight Research Articles

A descriptive study to assess the difference between estimated fetal weight using Johnsons formula and the actual birth weight of newborn babies born to women availing maternity services in a tertiary care hospital, Haryana

Introduction: Knowledge about weight of the fetus in-utero is important for the health care professionals to decide upon the antepartum as well as intrapartum initiatives and thereby reducing fetal complications. Johnson’s formula is one of the important and easiest methods of clinical estimation of fetal weight. The aim of the study was to assess the difference between estimated fetal weight calculated by Johnson’s formula and actual birth weight of newborns, to associate and correlate selected maternal and fetal variables with the estimated fetal weight and actual birth weight. Methods: The study sample was 110 term pregnant women in labour and their just born babies. Research approach - quantitative non-experimental descriptive. Tool - data sheet. Data analyzed using descriptive and inferential statistics.Result: The difference between estimated fetal weight and Actual birth weight had a mean of 774.9 and SD ± 403.21. Study revealed that the estimated fetal weight using Johnson’s formula had a difference in comparison with the actual birth weight of babies (371.69 to 1178.1).Discussion: Obstetric Score (OS) Mean 1.59 SD ± 0.76, Period of Gestation (POG) Mean 39 SD ± 1.2. Pre-delivery Weight Mean 64.5 SD ± 9.839. Post-delivery Weight Mean 61.4 SD ± 9.28. Estimated fetal weights (EFW) range 2945 to 4340gms. (Mean 3800.7 SD ± 295.9), Actual birth weight (ABW) range 2120gms to 4145gms (Mean 3025.8 SD± 388.5). Placental Weight Mean 516 SD ± 112.7. Chi square test revealed that there was no association between obstetric score, period of gestation and estimated fetal weight. Similarly Fisher’s exact test revealed that there was no association between obstetric score, period of gestation and actual birth weight.

A descriptive study to assess the difference between estimated fetal weight using Johnsons formula and the actual birth weight of newborn babies born to women availing maternity services in a tertiary care hospital, Haryana

Introduction: Knowledge about weight of the fetus in-utero is important for the health care professionals to decide upon the antepartum as well as intrapartum initiatives and thereby reducing fetal complications. Johnson’s formula is one of the important and easiest methods of clinical estimation of fetal weight. The aim of the study was to assess the difference between estimated fetal weight calculated by Johnson’s formula and actual birth weight of newborns, to associate and correlate selected maternal and fetal variables with the estimated fetal weight and actual birth weight. Methods: The study sample was 110 term pregnant women in labour and their just born babies. Research approach - quantitative non-experimental descriptive. Tool - data sheet. Data analyzed using descriptive and inferential statistics.Result: The difference between estimated fetal weight and Actual birth weight had a mean of 774.9 and SD ± 403.21. Study revealed that the estimated fetal weight using Johnson’s formula had a difference in comparison with the actual birth weight of babies (371.69 to 1178.1).Discussion: Obstetric Score (OS) Mean 1.59 SD ± 0.76, Period of Gestation (POG) Mean 39 SD ± 1.2. Pre-delivery Weight Mean 64.5 SD ± 9.839. Post-delivery Weight Mean 61.4 SD ± 9.28. Estimated fetal weights (EFW) range 2945 to 4340gms. (Mean 3800.7 SD ± 295.9), Actual birth weight (ABW) range 2120gms to 4145gms (Mean 3025.8 SD± 388.5). Placental Weight Mean 516 SD ± 112.7. Chi square test revealed that there was no association between obstetric score, period of gestation and estimated fetal weight. Similarly Fisher’s exact test revealed that there was no association between obstetric score, period of gestation and actual birth weight.

Late-Onset Severe Fetal Growth Restriction and Isolated Severely Small Abdominal Circumference: Do Neonatal Outcomes Differ? [ID: 1377666

INTRODUCTION: Updated guidelines from the Society for Maternal-Fetal Medicine (SMFM) define severe fetal growth restriction (sFGR), or an estimated fetal weight (EFW) less than 3rd percentile, as a distinct entity due to higher perinatal morbidity in this group. Whether an isolated abdominal circumference (AC) less than 3rd percentile similarly portends adverse outcomes remains unclear. METHODS: This is a single-institution, retrospective cohort study of singleton gestations with late-onset FGR and normal Doppler studies from 2012 to 2022. Pregnancies affected by AC less than 3rd percentile (but EFW≥3rd percentile) and EFW less than 3rd percentile were compared using univariable analysis and multivariable logistic regression. The primary outcome was neonatal intensive care unit (NICU) admission. RESULTS: Among eligible participants, 78 (63%) had an isolated AC less than 3rd percentile and 45 (37%) had sFGR. Neonates prenatally diagnosed with sFGR were more likely to be admitted to the NICU than those with isolated AC less than 3rd percentile (68.9% versus 23.1%, P<.001). After adjusting for gestational age, birth weight, race, maternal age, and medical comorbidities, sFGR was still associated with an increased odds of NICU admission (adjusted odds ratio 4.9, 95% CI 1.37–17.48, P=.014). Rates of cesarean delivery (46.7% versus 26.9%; P=.03), small for gestational age (86.7% versus 67.9%, P=.02), and 5-minute Apgar score less than 7 (6.7% versus 0.0%, P=.02) were also higher in the sFGR group. There were no significant differences in NICU length of stay or perinatal death between groups. CONCLUSION: Adverse neonatal outcomes were more prevalent in pregnancies affected by sFGR compared with isolated AC less than 3rd percentile, providing support for the updated SMFM guidelines.

Risk of Cesarean Delivery Varies by Race and Ethnicity Among Pregnancies Complicated by Fetal Growth Restriction [ID: 1377645

INTRODUCTION: Cesarean delivery (CD) rates differ between non-Hispanic White (NHW) and Hispanic/non-White (H/NW) patients, although the relationship varies by indication. We examined CD rates among NHW and H/NW patients in pregnancies complicated by fetal growth restriction (FGR). METHODS: This was an IRB-approved secondary analysis of a retrospective cohort of singleton live births 2003–2012 with an estimated fetal weight (EFW) less than 10th centile for gestational age on the last ultrasound prior to delivery. RESULTS: Of 563 pregnancies, 270 (46.88%) were to NHW patients and 306 (53.12%) to H/NW patients. NHW were older (27.92 versus 26.04 years), taller (160.42 versus 158.58 cm), and more likely to have private insurance (51.30% versus 20.26%) and be admitted to a private practice (70.00% versus 44.41%) (P<.01 for all). There was no difference in umbilical artery Doppler findings, EFW, proportion of CD performed because of nonreassuring fetal status, maternal body mass index, gestational age at FGR diagnosis or delivery, or maternal comorbidities. Apgar scores, arterial cord pH, neonatal intensive care unit admission, hypoglycemia, need for respiratory support, and neonatal death were similar (P>.05 for all). However, NHW patients were more likely to undergo CD (35.71% versus 22.90%, P<.01) including prelabor cesarean (21.48% versus 13.75%, P<.01). After adjusting for maternal age, height, insurance status, and delivering team, risk of CD remained higher among NHW patients (relative risk 1.56, 95% CI 1.20–2.03; adjusted relative risk 1.48, 95% CI 1.12–1.96). CONCLUSION: Despite similar neonatal outcomes, NHW are more likely than H/NW patients to deliver by CD, particularly prelabor CD, when the EFW is below the 10th centile.

Effect of the New Diagnostic Criteria of Fetal Growth Restriction on Obstetric and Neonatal Outcomes [ID: 1376466

INTRODUCTION: The diagnostic criteria of fetal growth restriction (FGR) was modified by the Society of Maternal-Fetal Medicine in 2020 to include both an abdominal circumference (AC) and estimated fetal weight (EFW) less than the 10th percentile as opposed to previous definition using only the EFW. We sought to evaluate the outcomes of this criteria modification. METHODS: This retrospective study compared the incidence, obstetrical and neonatal outcomes before (group 1, 2020) and after (group 2, 2021) the implementation of the modified diagnostic criteria at a single institution. This is an IRB-approved study. RESULTS: Of the 459 pregnancies with FGR included in this study, 100 were diagnosed in 2020 (group 1) and 359, in 2021 (group 2). An increase in the incidence of FGR was noted after the modification, 1.5% versus 5.3% (P<.05). Median gestational age (weeks) at delivery decreased from 38.1 (Q1, 37.1; Q3, 39.1) in 2020 to 37.4 (Q1, 36.1; Q3, 38.3) in 2021 (P<.05). There were no statistically significant differences in obstetrical outcomes. An increase in the frequency of respiratory distress syndrome was observed, 6 (6%) versus 51 (14.2%), P<.05, and median length of neonatal stay 2.0 (Q1, 1.0; Q3, 3.0) and 2.0 (Q1, 2.0; Q3, 12.0) in group 1 compared to group 2 (P<.05). CONCLUSION: The new diagnostic criteria for FGR is associated with increased incidence of diagnosis, neonatal respiratory distress, longer neonatal hospital admissions, and lower gestational age of delivery with no difference in obstetrical outcomes. It remains uncertain whether this modification will translate to improved outcomes, and larger multicenter prospective studies are needed.

Cerebroplacental ratio assessment after age of fetal maturity in normotensive and hypertensive pregnancies and prediction of perinatal outcome

Background: At or after 37 weeks of pregnancy, the decreased cerebroplacental ratio (CPR) denotes high risk of fetal complication. when low-risk foetuses with lower CPR have intrapartum distress within 72 hours after the start of labour, the prevalence of obstetric intervention is greater. This work aimed to assess CPR as evaluated during term pregnancy and before onset of the labor in normotensive and hypertensive pregnancies and its relationship with perinatal outcomes with reference to Intrauterine growth restriction (IUGR), fetal distress, APGAR score, birth weight and admission at Neonatal Intensive Care Unit (NICU). Methods: This prospective observational study was performed on 40 pregnant cases, their age ranging in years from 20 to 35, singleton living pregnancy, gestational age (37-40) weeks and before onset of labor and cephalic-presenting fetus. Participants were divided into two equal groups: normotensive cases and hypertensive cases. Results: Significant difference between two studied group regarding abdominal circumference (AC), Amniotic fluid index (AFI), estimated fetal weight (EFW), Umbilical Artery pulsatility index (UAPI), middle cerebral arterial pulsatility index (MCAPI), CPR, APGAR scores at one and five minutes were substantially reduced while rates of cesarean sections and NICU admissions were significantly higher in hypertensive compared with normotensive women. The cutoff value was 1.1 for CPR yielded a sensitivity of 90%, a specificity of 70%, a PPV of 75% and a NPV of 88% with 83% accuracy and with AUC of 0.955. Conclusions: CPR has high predictive value of perinatal outcome as Apgar score and rate of NICU admission in hypertensive pregnant women.

Cerebroplacental ratio assessment after age of fetal maturity in normotensive and hypertensive pregnancies and prediction of perinatal outcome

Background: At or after 37 weeks of pregnancy, the decreased cerebroplacental ratio (CPR) denotes high risk of fetal complication. when low-risk foetuses with lower CPR have intrapartum distress within 72 hours after the start of labour, the prevalence of obstetric intervention is greater. This work aimed to assess CPR as evaluated during term pregnancy and before onset of the labor in normotensive and hypertensive pregnancies and its relationship with perinatal outcomes with reference to Intrauterine growth restriction (IUGR), fetal distress, APGAR score, birth weight and admission at Neonatal Intensive Care Unit (NICU). Methods: This prospective observational study was performed on 40 pregnant cases, their age ranging in years from 20 to 35, singleton living pregnancy, gestational age (37-40) weeks and before onset of labor and cephalic-presenting fetus. Participants were divided into two equal groups: normotensive cases and hypertensive cases. Results: Significant difference between two studied group regarding abdominal circumference (AC), Amniotic fluid index (AFI), estimated fetal weight (EFW), Umbilical Artery pulsatility index (UAPI), middle cerebral arterial pulsatility index (MCAPI), CPR, APGAR scores at one and five minutes were substantially reduced while rates of cesarean sections and NICU admissions were significantly higher in hypertensive compared with normotensive women. The cutoff value was 1.1 for CPR yielded a sensitivity of 90%, a specificity of 70%, a PPV of 75% and a NPV of 88% with 83% accuracy and with AUC of 0.955. Conclusions: CPR has high predictive value of perinatal outcome as Apgar score and rate of NICU admission in hypertensive pregnant women.

Estimation of Fetal Weight at Term by Clinical Method Using Symphysio Fundal Height and Abdominal Girth and Ultrasound Using Hadlock Formula and Its Correlation with Actual Birth Weight

Estimation of Fetal Weight at Term by Clinical Method Using Symphysio Fundal Height and Abdominal Girth and Ultrasound Using Hadlock Formula and Its Correlation with Actual Birth Weight

Neonatal outcomes following early fetal growth restriction: a subgroup analysis of the EVERREST study

ObjectiveTo quantify the risks of mortality, morbidity and postnatal characteristics associated with extreme preterm fetal growth restriction (EP-FGR).DesignThe EVERREST (Does vascular endothelial growth factor gene therapy safely improve outcome in...

Analysis of typing conversion and perinatal outcomes in twins with selective intrauterine growth restriction of different subtypes

Objective: To retrospectively analyze the clinical data of different types of selective intrauterine growth restriction (sIUGR) pregnant women under expectant management, including the natural evolution, typing conversion and perinatal outcomes. Methods: The clinical data of 153 pregnant women with sIUGR under expected treatment in Women's Hospital, Zhejiang University School of Medicine from January 2014 to December 2018 were collected. Maternal characteristics including maternal age, gravidity, parity, method of conception, pregnancy complication, gestational age at delivery, indication for delivery, birth weight, the rate of intrauterine and neonatal death and neonatal outcomes were recorded. Pregnant women with sIUGR were divided into three types according to end-diastolic umbilical artery flow Doppler ultrasonography, and the differences of typing conversion and perinatal outcomes of sIUGR pregnant women based on the first diagnosis were compared. Results: (1) Clinical characteristics and pregnancy outcomes: among 153 pregnant women with sIUGR, 100 cases (65.3%) were diagnosed with type Ⅰ, 35 cases (22.9%) with type Ⅱ, and 18 cases (11.8%) with type Ⅲ. There were no significant differences in age, conception mode, pregnancy complications, first diagnosis gestational age, characteristics of umbilical cord insertion, delivery indications, fetal intrauterine mortality and neonatal mortality among three types of sIUGR pregnant women (all P>0.05). The average gestational age at delivery of type Ⅰ sIUGR was (33.5±1.9) weeks, which was significantly later than those of type Ⅱ and Ⅲ [(31.3±1.8), (31.2±1.1) weeks, P<0.001]. The percentage disordance in estimated fetal weight (EFW) of type Ⅰ sIUGR was significantly lower than those of type Ⅱ and type Ⅲ (P<0.001). The incidence rate of neonatal intensive care unit (NICU) admission, cerebral leukomalacia and respiratory complications of both fetus and necrotizing enterocolitis of large fetus in type Ⅰ were significantly lower than those in type Ⅱ and type Ⅲ (all P<0.05). (2) Typing conversion: in 100 cases of type Ⅰ sIUGR, 18 cases progressed to type Ⅱ and 10 cases progressed to type Ⅲ. Compared with 72 stable type Ⅰ sIUGR, those with progressed type Ⅰ sIUGR had higher incidence of NICU admission and lung disease in both fetuses, and cerebral leukomalacia and necrotizing enterocolitis in large fetus (all P<0.05). The proportion of inconsistent cord insertion was significantly higher in those type Ⅰ progressed to type Ⅲ (6/10) than in those with stable type Ⅰ (19.4%, 14/72) and type Ⅰ progressed to type Ⅱ sIUGR [0 (0/18), P=0.001]. Four cases of type Ⅱ sIUGR reversed to type Ⅰ and 6 cases reversed to type Ⅲ. Compared with type Ⅱ reversed to type Ⅰ sIUGR, those stable type Ⅱ and type Ⅱ reversed to type Ⅲ sIUGR had a higher incidence of NICU admission in large fetus (P<0.05). Two cases of type Ⅲ sIUGR reversed to type Ⅰ and 6 cases progressed to type Ⅱ. There were no significant differences in fetal serious complications in type Ⅲ sIUGR with or without doppler changes (all P>0.05). Conclusions: The different types of sIUGR could convert to each other. The frequency of ultrasound examinations should be increased for patients with the type Ⅰ sIUGR, especially when the percentage discordance in EFW is substantial or with discordant cord insersion.

Association between antenatal diagnosis of late fetal growth restriction and educational outcomes in mid-childhood: A UK prospective cohort study with long-term data linkage study

Fetal growth restriction (FGR) is associated with a suboptimal intrauterine environment, which may adversely impact fetal neurodevelopment. However, analysing neurodevelopmental outcomes by observed birthweight fails to differentiate between true FGR and constitutionally small infants and cannot account for iatrogenic intervention. This study aimed to determine the relationship between antenatal FGR and mid-childhood (age 5 to 7 years) educational outcomes. The Pregnancy Outcome Prediction Study (2008-2012) was a prospective birth cohort conducted in a single maternity hospital in Cambridge, United Kingdom. Clinicians were blinded to the antenatal diagnosis of FGR. FGR was defined as estimated fetal weight (EFW) <10th percentile at approximately 36 weeks of gestation, plus one or more indicators of placental dysfunction, including ultrasonic markers and maternal serum levels of placental biomarkers. A total of 2,754 children delivered at term were divided into 4 groups: FGR, appropriate-for-gestational age (AGA) with markers of placental dysfunction, healthy small-for-gestational age (SGA), and healthy AGA (referent). Educational outcomes (assessed at 5 to 7 years using UK national standards) were assessed with respect to FGR status using regression models adjusted for relevant covariates, including maternal, pregnancy, and socioeconomic factors. Compared to healthy AGA (N = 1,429), children with FGR (N = 250) were at higher risk of "below national standard" educational performance at 6 years (18% versus 11%; aOR 1.68; 95% CI 1.12 to 2.48, p = 0.01). By age 7, children with FGR were more likely to perform below standard in reading (21% versus 15%; aOR 1.46; 95% CI 0.99 to 2.13, p = 0.05), writing (28% versus 23%; aOR 1.46; 95% CI 1.02 to 2.07, p = 0.04), and mathematics (24% versus 16%; aOR 1.49; 95% CI 1.02 to 2.15, p = 0.03). This was consistent whether FGR was defined by ultrasound or biochemical markers. The educational attainment of healthy SGA children (N = 126) was comparable to healthy AGA, although this comparison may be underpowered. Our study design relied on linkage of routinely collected educational data according to nationally standardised metrics; this design allowed a high percentage of eligible participants to be included in the analysis (75%) but excludes those children educated outside of government-funded schools in the UK. Our focus on pragmatic and validated measures of educational attainment does not exclude more subtle effects of the intrauterine environment on specific aspects of neurodevelopment. Compared to children with normal fetal growth and no markers of placental dysfunction, FGR is associated with poorer educational attainment in mid-childhood.

Perinatal and Maternal Outcomes According to the Accurate Term Antepartum Ultrasound Estimation of Extreme Fetal Weights.

(1) Background: The accuracy of ultrasound estimation of fetal weight (EFW) at term may be useful in addressing obstetric complications since birth weight (BW) is a parameter that represents an important prognostic factor for perinatal and maternal morbidity. (2) Methods: In a retrospective cohort study of 2156 women with a singleton pregnancy, it is verified whether or not perinatal and maternal morbidity differs between extreme BWs estimated at term by ultrasound within the seven days prior to birth with Accurate EFW (difference < 10% between EFW and BW) and those with Non-Accurate EFW (difference ≥ 10% between EFW and BW). (3) Results: Significantly worse perinatal outcomes (according to different variables such as higher rate of arterial pH at birth < 7.20, higher rate of 1-min Apgar < 7, higher rate of 5-min Apgar < 7, higher grade of neonatal resuscitation and need for admission to the neonatal care unit) were found for extreme BW estimated by antepartum ultrasounds with Non-Accurate EFW compared with those with Accurate EFW. This was the case when extreme BWs were compared according to percentile distribution by sex and gestational age following the national reference growth charts (small for gestational age and large for gestational age), and when they were compared according to weight range (low birth weight and high birth weight). (4) Conclusions: Clinicians should make a greater effort when performing EFW by ultrasound at term in cases of suspected extreme fetal weights, and need to take an increasingly prudent approach to its management.

Comparison of the Diagnostic Accuracy of Doppler Cerebroplacental Ratio Versus Standard Fetal Biometry for Fetal Growth Restriction

Objective: To assess the diagnostic accuracy of the Doppler Cerebroplacental ratio for fetal growth restriction keeping fetal biometry as the reference standard.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Department of Radiology, Combined Military Hospital, Multan Pakistan, from May to Oct 2020.&#x0D; Methodology: Two hundred and fifty-six-singleton pregnancies ≥ 30 weeks were included and underwent fetal biometry, including estimated fetal weight (EFW) by trans-abdominal ultrasound. The umbilical artery and middle cerebral artery resistive indices were evaluated using Doppler ultrasound, and Cerebroplacental ratio (CPR) was calculated. The presence or absence of fetal growth restriction (FGR) was noted using cut-off EFW of 10th centile and CPR of 1.0. &#x0D; Results: Cerebroplacental ratio showed FGR in 145(56.64%) patients. Fetal biometry showed FGR in 141 (55.08%) patients,whereas 115(44.92%) patients revealed none. Of 145 CPR-positive patients, 127(87%) were true positive, while 18(12%) were false positive. Among 111 CPR-negative patients, 14(0.12%) were false negative, while 97(87%) were true negative. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of the Cerebroplacental ratio were 90.07%, 84.35%, 87.59%, 87.39% and 87.50%, respectively.&#x0D; Conclusions: Doppler Cerebroplacental ratio is sensitive for diagnosing fetal growth restriction; however, its role as a stand alone test needs further evaluation and may be enhanced with other tools such as estimated fetal weight.

Intrauterine Growth Restriction-Prediction and Peripartum Data on Hospital Care.

Background and Objectives: We aimed to prospectively obtain data on pregnancies complicated with intrauterine growth restriction (IUGR) in the Prenatal Diagnosis Unit of the Emergency County Hospital of Craiova. We collected the demographic data of mothers, the prenatal ultrasound (US) features, the intrapartum data, and the immediate postnatal data of newborns. We aimed to assess the detection rates of IUGR fetuses (the performance of the US in estimating the actual neonatal birth weight), to describe the prenatal care pattern in our unit, and to establish predictors for the number of total hospitalization days needed postnatally. Materials and Methods: Data were collected from cases diagnosed with IUGR undergoing prenatal care in our hospital. We compared the percentile of estimated fetal weight (EFW) using the Hadlock 4 technique with the percentile of weight at birth. We retrospectively performed a regression analysis to correlate the variables predicting the number of hospitalization days. Results: Data on 111 women were processed during the period of 1 September 2019-1 September 2022. We confirmed the significant differences in US features between early- (Eo) and late-onset (Lo) IUGR cases. The detection rates were higher if the EFW was lower, and Eo-IUGR was associated with a higher number of US scans. We obtained a mathematical formula for estimating the total number of hospitalization days needed postnatally. Conclusion: Early- and late-onset IUGR have different US features prenatally and different postnatal outcomes. If the US EFW percentile is lower, a prenatal diagnosis is more likely to be made, and a closer follow-up is offered in our hospital. The total number of hospitalization days may be predicted using intrapartum and immediate postnatal data in both groups, having the potential to optimize the final financial costs and to organize the neonatal department efficiently.

Outcomes among Neonates after a Diagnosis of Persistent or Transient Fetal Growth Restriction Delivered at Term.

This study aimed to evaluate whether transient fetal growth restriction (FGR) that resolves prior to delivery confers a similar risk of neonatal morbidity as uncomplicated FGR that persists at term. This is a secondary analysis of a medical record abstraction study of singleton live-born pregnancies delivered at a tertiary care center between 2002 and 2013. Patients with fetuses that had either persistent or transient FGR and delivered at 38 weeks or later were included. Patients with abnormal umbilical artery Doppler studies were excluded. Persistent FGR was defined as estimated fetal weight (EFW) <10th percentile by gestational age from diagnosis through delivery. Transient FGR was defined as EFW <10th percentile on at least one ultrasound, but not on the last ultrasound prior to delivery. The primary outcome was a composite of neonatal morbidity: neonatal intensive care unit admission, Apgar's score <7 at 5 minutes, neonatal resuscitation, arterial cord pH <7.1, respiratory distress syndrome, transient tachypnea of the newborn, hypoglycemia, sepsis, or death. Baseline characteristics and obstetric and neonatal outcomes were compared using Wilcoxon's rank-sum and Fisher's exact test. Log binomial regression was used to adjust for confounders. Of 777 patients studied, 686 (88%) had persistent FGR and 91 (12%) had transient FGR. Patients with transient FGR were more likely to have a higher body mass index, gestational diabetes, diagnosed with FGR earlier in pregnancy, have spontaneous labor, and deliver at later gestational ages. There was no difference in the composite neonatal outcome (relative risk = 1.03, 95% confidence interval [CI] 0.72, 1.47) for transient versus persistent FGR after adjusting for confounders (adjusted relative risk = 0.79, 95% CI 0.54, 1.17). There were no differences in cesarean delivery or delivery complications between groups. Neonates born at term after transient FGR do not appear to have differences in composite morbidity compared with those where uncomplicated FGR persists at term. · No differences in neonatal outcomes in uncomplicated persistent versus transient FGR at term.. · Transient FGR pregnancies more likely to deliver at later gestational ages.. · No differences in mode of delivery or obstetric complications in persistent versus transient FGR at term..

Maternal urinary bisphenols and phthalates in relation to estimated fetal weight across mid to late pregnancy

BackgroundBisphenols and phthalates are high production volume chemicals used as additives in a variety of plastic consumer products leading to near ubiquitous human exposure. These chemicals have established endocrine disrupting properties and have been linked to a range of adverse reproductive and developmental outcomes. Here, we investigated exposure in relation to fetal growth. MethodsParticipants included 855 mother-fetal pairs enrolled in the population-based New York University Children’s Health and Environment Study (NYU CHES). Bisphenols and phthalates were measured in maternal urine collected repeatedly during pregnancy. Analyses included 15 phthalate metabolites and 2 bisphenols that were detected in 50 % of participants or more. Fetal biometry data were extracted from electronic ultrasonography records and estimated fetal weight (EFW) was predicted for all fetuses at 20, 30, and 36 weeks gestation. We used quantile regression adjusted for covariates to model exposure-outcome relations across percentiles of fetal weight at each gestational timepoint. We examined sex differences using stratified models. ResultsFew statistically significant associations were observed across chemicals, gestational time periods, percentiles, and sexes. However, within gestational timepoints, we found that among females, the molar sums of the phthalates DiNP and DnOP were generally associated with decreases in EFW among smaller babies and increases in EFW among larger babies. Among males, the opposite trend was observed. However, confidence intervals were generally wide at the tails of the distribution. ConclusionIn this sample, exposure to bisphenols and phthalates was associated with small sex-specific shifts in fetal growth; however, few associations were observed at the median of fetal weight and confidence intervals in the tails were wide. Findings were strongest for DiNP and DnOP, which are increasingly used as replacements for DEHP, supporting the need for future research on these contaminants.

Low-Grade Inflammation in Gestational Diabetes Mellitus and Its Correlation with Maternal Insulin Resistance and Fetal Growth Indices.

Chronic low-grade inflammation (LGI) plays a role in the pathogenesis of gestational diabetes mellitus (GDM). LGI, on the one hand, promotes insulin resistance and at the same time, affects fetal development. The study aimed to use clinically feasible means to evaluate the association between maternal LGI and maternal insulin resistance and fetal growth indices by ultrasound in the third trimester. A crossectional and descriptive study on 248 first-time diagnosed GDM in Vietnam. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte (PLR) indices were significantly higher in GDM than in normal glucose-tolerant pregnancies (p = 0.048 and 0.016, respectively). GDM with LGI witnessed significantly higher systolic blood pressure, BMI, HbA1c, and significantly lower quantitative Insulin Sensitivity Check Index (QUICKI) than those without LGI. After adjusting for maternal BMI, fasting plasma glucose (FPG), age, and parity, C-reactive protein (CRP) was positively correlated with HOMA2-IR (B=0.13, p<0.01) and Mathews index (B=0.29, p<0.01). Regarding fetal characteristics, LGI was associated with fetal growth indices in the third trimester of GDM. NLR was negatively correlated with estimated fetal weight (EFW) (B=-64.4, p<0.05) after adjusting for maternal BMI and FPG. After adjusting for maternal BMI, FPG, age, and parity, PLR was negatively correlated with biparietal diameter (B=-0.02, p<0.01) and abdominal circumference (AC) (B=-0.16, p<0.05), and EFW (B=-1.1, p<0.01), and head circumference (HC) (B=-0.06, p<0.01); CRP was negatively correlated with AC (B=-0.16, p<0.001), EFW (B=-85.3, p<0.001), and HC (B=-5.0, p<0.001). In the third trimester, LGI was associated with maternal glucose and insulin resistance in GDM. Moreover, LGI was associated with fetal characteristics in ultrasonic images. There were negative correlations between LGI and fetal developmental characteristics.

Prediction of dual survival following fetoscopic laser photocoagulation for twin-twin transfusion syndrome.

To develop a model based on factors available at the time of diagnosis of twin-twin transfusion syndrome (TTTS) for predicting the probability of dual twin survival following fetoscopic laser photocoagulation (FLP) using a machine-learning algorithm. This was a retrospective study of data collected at two university-affiliated tertiary fetal centers between 2012 and 2021. The cohort included monochorionic diamniotic twin pregnancies complicated by TTTS that underwent FLP. Data were stratified based on survival 30 days after delivery, and cases with dual survival were compared to those without dual survival. A random forest machine-learning algorithm was used to construct a prediction model, and the relative importance value was calculated for each parameter that presented a statistically significant difference between the two study groups and was included in the model. The holdout method was applied to check overfitting of the random forest algorithm. A prediction model for dual twin survival 30 days after delivery was presented based on the test set. The study included 537 women with monochorionic diamniotic twin pregnancy, of whom 346 (64.4%) had dual twin survival at 30 days after delivery and were compared with 191 (35.6%) cases that had one or no survivors. Univariate analysis demonstrated no differences in demographic parameters between the groups. At the time of diagnosis, the dual-survival group had lower rates of estimated fetal weight (EFW) < 10th centile for gestational age in the donor twin (56.4% vs 69.4%; P = 0.004), intertwin EFW discordance > 25% (40.8% vs 56.5%; P = 0.001) and anterior placenta (40.5% vs 50.0%; P = 0.034). Comparison of Doppler findings between the two groups demonstrated significant differences in the donor twin, with a lower rate of pulsatility index (PI) > 95th centile in the umbilical artery and ductus venosus and a lower rate of PI < 5th centile in the fetal middle cerebral artery in the dual-survival group. Relative importance values for each of these six parameters were calculated, allowing the construction of a prediction model with an area under the receiver-operating-characteristics curve of 0.916 (95% CI, 0.887-0.946). We developed a predictive model for dual survival in monochorionic twin pregnancies following FLP for TTTS, which incorporates six variables obtained at the time of diagnosis of TTTS, including donor EFW < 10th centile, intertwin EFW discordance > 25%, anterior placenta and abnormal PI in the umbilical artery, ductus venosus and middle cerebral artery of the donor twin. This clinically applicable tool may improve treatment planning and patient counseling. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Contribution of amniocentesis in fetuses small for gestational age without other sonographic signs.

Our study evaluated the contribution of amniocentesis in the diagnostic approach of small-for-gestational-age fetuses (SGA) without morphological abnormality identified on ultrasound by studying FISH (fluorescence in situ hybridization) for chromosomes 13, 18 and 21, CMV PCR (cytomegalovirus polymerase chain reaction), karyotype and CGH (genomic hybridization array) METHODS: Our single-center retrospective cohort study included pregnant women referred for prenatal diagnosis for a SGA fetus in whom amniocentesis was performed between 2016 and 2019. A SGA fetus was defined as a fetus with an estimated fetal weight (EFW) below the 10th percentile according to referral growth curves in use. We evaluated the number of amniocenteses with an abnormal result and identified factors that may be associated with this outcome. Among the 79 amniocenteses performed, there were 5 (6.3%) abnormalities: karyotype (1.3%) and CGH (5.1%). No complications were described. We did not find any statistically significant factors associated with abnormal amniocentesis findings even if some elements seemed reassuring such as late discovery (p=0.31), moderate SGA (p=0.18), normal head, abdomen and femur measurements (p=0.57), but without statistically significant difference. Our study found 6.3% pathological analysis of amniocenteses, of which several would have been missed by conventional karyotyping. Patients must be informed about the risk of detecting abnormalities of low severity, with low penetrance or with unknown fetal consequences that could be source of anxiety.

Estimation of gestational age specific amniotic fluid index in normal pregnancy in Nepalese women

Amniotic fluid volume (AFV) is estimated in almost all the antenatal scans referred for ultrasonography (USG). It has proven to be a very good predictor for poor pregnancy outcomes. Several standard text books have quoted normal range of amniotic fluid index (AFI). These reference range may not be applicable to all the population as over the years different studies have shown that it varies among different population. Since such variations has been postulated, our aim is to formulate a reference range of gestational age specific AFI in normal pregnancy among Nepalese women. Therefore, a cross-sectional study was carried out among 537 normal pregnancies who attended the out-patient department of Nepal Medical College Teaching Hospital. Women with any maternal and fetal complications were excluded from the study. Subsequently median, the 5th, 50th and the 95th percentile values were calculated for each gestational week and were compared with studies among other population. Among the 537 women enrolled in the study, the mean maternal age was 26.5 years with the estimated fetal weight (EFW) at term pregnancy ranged from 2372 grams to 3750 grams with the mean being 3261 grams. The mean AFI at preterm was found to be 12.6 cm ± 2.36 and at term 11.0 cm ± 2.82. The percentiles values for first to 99th percentile of the entire data was calculated and the normal range of the AFI was estimated to be between 6 – 17 cm. As studies have shown the variance in AFI range among different population. It is imperative to formulate a reference of AFI among different population. In our study we found they are lower as compared to the Caucasian population, similar to Indian population and higher than the Chinese population.