Femur Diaphysis Length Research Articles

Differences in Femoral Medullary Canal Dimensions in the USA and East Asian Populations

With emerging technologies and improved operative techniques, cementless total hip arthroplasty is becoming more popular and showing better results. The femoral prosthesis and intramedullary nail should precisely fit in the medullary canal to prevent micromotion and loosening. Most of the femoral prosthesis and nail designs are made from the data obtained from Caucasian femur and may not press fit if used in Asian populations. This study compares the femoral medullary canal diameter in American and Oriental populations at different bony levels. A total of 245 dry femora were collected which included 47 from United States, 77 from China, 44 from Japan, 50 from Korea and 27 from Taiwan, and plan radiographs were taken. Radiographs were digitized to measure the medullary canal width at 20% (lesser trochanter; LT), 35% (supra-isthmus; SI), 50% (mid-isthmus; MI), 65% and 80% of the total femur length. The results revealed significant differences in the medullary canal width between the US and East Asian Oriental populations. The medullary canal in the US population was significantly larger at the LT, SI, MI, and 65% but significantly smaller at 80% of the femoral shaft length compared to the East Asian populations. Among the East Asian populations, significant differences were obse4rved between the Chinese and Taiwanese populations as well as the Japanese and Taiwanese populations. The Taiwanese population had the smallest femoral medullary canal size among the east Asian populations. We conclude that there are significant differences in the femoral medullary width between the American and East Asian populations. These results will be useful for surgeons operating on the proximal or distal femur.

Comparative analysis of quality scores images between second- and third-trimester ultrasound scan

ObjectivesTo evaluate whether the quality scores validated for second-trimester ultrasound scan can be used for third-trimester ultrasound scan. MethodsProspective multicenter ancillary study using data from the RECRET study. Nulliparous women, with no reported history, with second- and third-trimester ultrasound examinations performed by the same ultrasonographer and using the same ultrasound machine were recruited. The global score and the individual score of each ultrasound image were compared between second- and third-trimester ultrasound scan. The sample size was calculated for a non-inferiority (one-sided) paired Student t test. Results103 women with 1606 anonymized ultrasound images were included. The median term at second- and third-trimester ultrasound scan was 22.2 weeks gestation (22.0–22.7) and 31.6 weeks gestation (30.7–34.7), respectively. The mean global score of ultrasound images was comparable between the second- and the third-trimester ultrasound examination (32.37 ± 2.62 versus 31.80 ± 3.27, p = 0.13). Means scores for each biometric parameters i.e. head circumference, abdominal circumference, and femur diaphysis length were comparable. The scores for the four-chamber view (5.11 ± 0.91 versus 5.36 ± 0.75, p = 0.02) and the spine (4.18 ± 1.17 versus 5.22 ± 1.02, p < 0.001) were significantly lower in the third trimester compared to the second trimester. The score for the kidney image was significantly higher for third trimester images compared to second trimester images (4.73 ± 0.51 versus 4.32 ± 0.67, p < 0.001. ConclusionsBiometrics parameters quality scores images previously validated for the second trimester ultrasound scan can be also used for the third trimester scan. However, anatomical quality scores images performances may vary between the second and the third trimester scan.

Radiographic Landmark Measurements for the Femoral Footprint of the Medial Patellofemoral Complex May Be Affected by Visible Femoral Shaft Length on Lateral Knee Radiographs

To assess the effect of visible femoral shaft length on the accuracy of radiographic landmarks of the medial patellofemoral complex (MPFC). In 9 cadaveric knees, the MPFC footprint was exposed on the medial femur, and its proximal and distal boundaries were marked. Lateral fluoroscopic images of the knee were assessed in 1-cm length increments, beginning 1 cm proximal to the medial condyle and continuing proximally to 8 cm. The MPFC midpoint was described on each image relative to the posterior cortical line of the femur and a line perpendicular to this line through the proximal margin of the medial condyle. In addition, the MPFC midpoint was assessed relative to a line from the proximal posterior cortex to the midpoint of Blumensaat line. Using the posterior cortical line as a reference, the MPFC radiographic landmark moved anteriorly with decreasing visible femoral shaft on radiographs, particularly at 4 cm and less. However, no proximal-distal change was noted. Linear regression analysis demonstrated a relationship between visible femoral shaft and MPFC position on radiographs (R= 0.461, R2= 0.212, B= -0.636, P < .001). For every centimeter decrease in the visible femoral shaft, the radiographic MPFC footprint moved anteriorly by 0.636 mm. Receiver operating characteristic curve analysis revealed that a minimum of 4 cm of femoral shaft on lateral radiographs is required for accurate MPFC footprint localization (area under the curve= 0.80; sensitivity= 76.7%; specificity= 69.0%; P < .001). In contrast, no anterior-posterior change was seen when referencing a line from the proximal posterior cortex to the midpoint of Blumensaat line. When using the posterior cortical line to identify the midpoint of the MPFC, at least 4 cm of femoral shaft should be visible for accurate assessment. If less than 4 cm of shaft is visible, a line through the midpoint of Blumensaat line and the proximal posterior cortex can be used as an alternative method to estimate the position of the femoral footprint. As fluoroscopy is frequently used intraoperatively for MPFC reconstruction, our findings may serve as a guide when assessing femoral tunnel placement on fluoroscopy.

Ultrasound evaluation of normal rhesus macaque fetal biometry and uteroplacental hemodynamics.

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

Second-trimester growth velocities in twin and singleton pregnancies.

Previous small studies used individualized growth assessment (IGA) to characterize prenatal growth velocities of singletons and twins. We aimed to compare second-trimester growth velocities of individual anatomical parameters between monochorionic diamniotic (MCDA) twins, dichorionic diamniotic (DCDA) twins and singleton fetuses in a larger study. This was a study of a novel cohort of 222 MCDA twins and previously published cohorts of 40 DCDA twins and 118 singletons with serial ultrasound data. Fetal biometric measurements of biparietal diameter, head circumference, abdominal circumference and femur diaphysis length from prenatal ultrasound examinations were used to calculate second-trimester growth velocities using direct calculation or linear regression analysis. Linear fit was assessed based on the coefficient of determination (R2 ). Mean growth velocities and variances were compared among the three groups. The majority of cases underwent three second-trimester ultrasound examinations with fetal biometry available. All fetuses had linear growth, with R2 > 99% for all parameters. Only 1-2% of all MCDA and DCDA anatomical parameters had abnormal growth velocity scores outside the 95% reference range for singletons. There were no significant differences in mean growth velocity for any parameter between MCDA twins and singletons. Femur diaphysis length growth velocity was significantly lower in DCDA twins than in both MCDA twins and singletons. There were no other significant differences among the groups. Expanding on prior work using IGA, we found that second-trimester growth velocity of the four major anatomical parameters overall was similar between twins and singletons and between MCDA and DCDA twins, supporting the use of singleton-derived growth standards for IGA in twins. Twin growth potential appears to be similar to that of singletons in the second trimester, suggesting that subsequent growth divergence may be due to third-trimester physiological or pathological changes in twin pregnancies. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Establishment of a New Equation for Ultrasonographic Estimated Foetal Weight in Chongqing: A Prospective Study

Background: Variations in foetal growth between populations should not be ignored, and a single universal standard is not appropriate for everyone. Therefore, it is necessary to develop a new ultrasound estimation equation that adapts better to regional population characteristics. The purpose of this study was to create a new equation for ultrasound estimation of foetal weight according to the local population in Chongqing and compare it with representative equations. Methods: This prospective study included data on pregnant women who gave birth to a child at full term in our hospital from December 2016 to November 2019. Foetal ultrasound parameters included biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur diaphysis length (FDL). The foetal weight compensation model was established by using the second-order linear regression model, and then, the foetal weight equation was established by utilizing the multiple reverse elimination regression technique. Last, the absolute error and relative error were used to compare the accuracy of the equations established in this study with representative equations. Results: Through the foetal weight compensation equation, the new equation suitable for Chongqing foetuses was successfully established with the variables of BPD, HC, AC, and FDL. The following foetal weight prediction equation was established in this study: Log10(EFW) = 3.002741 + 0.00005944 × (BPD2) + 0.00000222 × (HC2) – 0.000002078 × (AC2) + 0.00004262 × (FDL2) – 0.008753 × BPD – 0.000884 × HC + 0.003206 × AC – 0.002894 × FDL (BPD: mm; HC: mm; AC: mm; FDL: mm). In the sets established by the 1925 data, the mean absolute error and standard deviation of the estimation error of the new equation were 178.9 g and 140.3 g respectively. In the validation sets established with 300 data points, the mean absolute error and standard deviation of the new equation were 173.08 g and 128.59 g respectively. Compared with representative equations, the mean absolute error and the standard deviation of the new equation were the lowest. The equation established in this study better predicted foetal weight (p &lt; 0.001). Conclusions: According to the local population characteristics of Chongqing, this study created a foetal weight estimation equation that is more accurate and suitable. This equation is clinically valuable for the monitoring and management of foetal weight.

Effect of Length Stability on Complications in the Treatment of Preadolescent Diaphyseal Femur Fractures Treated With Elastic Stable Intramedullary Nailing.

To examine the effectiveness and complication rates in age- and size-appropriate patients with either stable or unstable fracture patterns treated with elastic stable intramedullary nailing (ESIN). Retrospective case series. Academic tertiary care children's hospital. This was a consecutive series of 106 preadolescent children with femoral shaft fractures. The mean age of the patients was 8.0 years (range, 4.0-16.0 years). All children were treated by retrograde ESIN. Fractures were categorized as either length stable or unstable. Length stability and complications were assessed. A subset of patients with final full-length, standing x-rays was also evaluated. We analyzed 63 stable and 43 length unstable fractures. The mean age and weight of the patients with stable and unstable fractures were similar. There was no difference in complication rates between groups (χ2(1) = 0.00, P = 0.99). There was no difference (t(96.93) = 0.53, P = 0.59) in femoral shaft length change. Leg length discrepancies as assessed by full-length standing radiographs at follow-up were similar (χ2(2) = 1.52, P = 0.47). Preadolescent children younger than 10 years do not experience increased complications after ESIN of length unstable femur fractures [odds ratio (OR) = 1.68 (0.18-16.87), P = 0.65]. Length unstable femur fractures are not at increased risk of more complications [OR = 0.90 (0.26-2.92), P = 0.87], early femoral shortening [OR = (0.42-2.02), P = 0.85], or leg length discrepancy [OR = (0.13-1.56), P = 0.21] when treated with ESIN. Prognostic Level III. See Instructions for Authors for complete description of levels of evidence.

Investigating the relationship between Vitamin D level and Polycystic ovarian syndrome- A case control study

Accurate gestational age estimation improves other and foetal care. Most commonly employed fetal parameters for estimation of gestational age, intrauterine growth and fetal weight are biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur diaphysis length (FL). The objective of the present study was to evaluate the correlation of BPD and FL with gestational age in the population of Chhattisgarh state of India. In present study, 380 pregnant women of second and third trimester of pregnancy with known last menstrual period (LMP) had undergone routine ultrasonography for evaluation of Biparietal Diameter and Foetal Length. Biparietal Diameter and Foetal length was noted and correlation with gestational age was calculated. We observed a total of 158 cases in 2nd trimester and 220 cases were in 3rd trimester of pregnancy and they were aged between 18 and 35 years (two cases excluded). Mean of Biparietal diameter and FL observed was 73.1mm (±12.8 standard deviation and 11.6 standard error) and 56.2 (±0.63 standard deviation and 0.57 standard error) respectively. There was a strong positive correlation between gestational age and BPD (0.980). Correlation was maximum between 20 to 24 weeks of gestation (r=0.987) and minimum between 35 to 38 weeks of gestation (r=0.947). Ultrasonographic measurements of BPD and FL corelates with gestational age in second and third trimester (r value 0.980, 0.987 for, BPD and FL respectively). Correlation between Biparietal Diameter (BPD) and Gestational age consequently decreases according to gestation age from 20 weeks to 38 weeks. Correlation is maximum between.

Factors Influence on the Broaching Hammering Sound during Cementless Total Hip Arthroplasty

Background: The aim of this study is to identify the factors influence on the broaching hammering sound character during cementless total hip arthroplasty. Methods: We analyzed frequency spectrum of the hammering sound for 49 cases of uncomplicated cementless THAs using two types of proximal-coated stem performed by experienced surgeons. Normalized sound pressure (NSP) of each 0.5 kHz frequency band in final stage of broach procedure was determined by the fast Fourier transform analysis. The relationships between those sound characteristics and femoral morphology such as canal calcar ratio (CCR), Canal flare index (CFI), morphological cortical index (MCI) and femoral shaft length (FSL) in different cementless stem were investigated. Results: In Accolade 2, CCR was positively related to NSP in several bands [Frequency band (kHz); r: 2.0 - 2.5; 0.37, 4.5 - 5.0; 0.37, 9.5 - 10.0; 0.44], and negatively related to 7.5 - 8.0 kHz (r = -0.39). Negative correlations were observed among CFI and MCI in specific frequency bands (4.5 - 5.0, 5.0 - 5.5, and 7.5 - 8.0 kHz). In Taperloc Microplasty, strong correlations were found between FSL and the NSP of 7.5. - 8.0 kHz (r = 0.78) and CCR and the 7.5 - 8.0 kHz bands. There was significant difference of NSPs between high and low group divided by morphological parameters. Acoustic characteristics of NSPs between Accolade 2 and Microplasty were significantly different in 9 frequency bands. Conclusions: The hammering sound correlated with four parameters of the femoral morphology and differed in different types of proximal-coated stem. Those novel five factors are important to consider when to predict complications using acoustic analysis.

Morfometrijski parametri proksimalnog okrajka butne kosti i njihov uticaj na zglob kuka

Introduction: The femur is a long bone (ossa longa) that forms the hip and knee joints, supporting the weight of almost the entire body. This study is based on analyzing certain angles on the proximal femur that represent anthropometrically and surgically significant parameters, with clinical significance in diseases such as metabolic and degenerative bone disorders, arthritis, various hip trauma and disease. Aim: Determining the significance of certain morphometric parameters of the proximal femur and exploration of their impact on the hip joint. Material and methods: This cross-sectional study encompasses measuring four parameters: shaft length, the collodiaphyseal angle (CDA), the medial proximal femoral angle (MPFA) and the lateral proximal femoral angle (LPFA), on adult femora belonging to the archive of the Institute of anatomy "Niko Miljanić" of the Univerisity of Belgrade, Faculty of Medicine. A digital goniometer precise to two decimal places was used for all measurements. Results: Forty-seven femora were examined, 25 of which were left and 22 right femora of unknown gender and age, since none of the examined parameters could be used in procuring such information. The average femoral shaft length was 39.9 ± 2.7 cm, the shortest 34.8 cm and the longest 45.7 cm. The Collodiaphyseal angle (CDA) was 127.64 ± 4.25° on average, with the minimum being 119.1° and the maximum 137.7°. Average LPFA was 87.21 ± 3.07°, the lowest 81.6 and the highest 93.0°. Finally, MPFA was 86.9 ± 3.73° on average, with the smallest being 78.7° and the largest 94.5°. The Medial proximal femoral angle of right femora was significantly lower than the MPFA of left femora (p = 0,016). Conclusion: Eleven samples had a CDA below normal (&lt; 124°), with three being defined as coxa vara (CDA &lt; 120°). One had a CDA above normal (&gt; 135°), being defined as coxa valga. Outside of reference values, LPFA was determined on 11 samples, being below normal (&lt;85°) in all of them, whilst MPFA had 13 with only one of them being below normal (&lt; 80°).

Fetal growth velocity references from a Chinese population\u2013based fetal growth study

BackgroundFetal growth velocity standards have yet to be established for the Chinese population. This study aimed to establish such standards suitable for the Chinese population.MethodsWe performed a multicenter, population–based longitudinal cohort study including 9075 low–risk singleton pregnant women. Data were collected from the clinical records of 24 hospitals in 18 provinces of China. Demographic characteristics, reproductive history, fetal ultrasound measurements, and perinatal outcome data were collected. The fetal ultrasound measurements included biparietal diameter (BPD), abdominal circumference (AC), head circumference (HC), and femur diaphysis length (FDL). We used linear mixed models with cubic splines to model the trajectory of four ultrasound parameters and estimate fetal weight. Fetal growth velocity was determined by calculating the first derivative of fetal size curves. We also used logistic regression to estimate the association between fetal growth velocities in the bottom 10th percentile and adverse perinatal outcomes.ResultsFetal growth velocity was not consistent over time or among individuals. The estimated fetal weight (EFW) steadily increased beginning at 12 gestational weeks and peaked at 35 gestational weeks. The maximum velocity was 211.71 g/week, and there was a steady decrease in velocity from 35 to 40 gestational weeks. The four ultrasound measurements increased in the early second trimester; BPD and HC peaked at 13 gestational weeks, AC at 14 gestational weeks, and FDL at 15 gestational weeks. BPD and HC also increased from 19 to 24 and 19 to 21 gestational weeks, respectively. EFW velocity in the bottom 10th percentile indicated higher risks of neonatal complications (odds ratio [OR] = 2.23, 95% confidence interval [CI]: 1.79–2.78) and preterm birth < 37 weeks (OR = 3.68, 95% CI: 2.64–5.14). Sensitivity analyses showed that EFW velocity in the bottom 10th percentile was significantly associated with more adverse pregnancy outcomes for appropriate–for–gestational age neonates.ConclusionsWe established fetal growth velocity curves for the Chinese population based on real–world clinical data. Our findings demonstrated that Chinese fetal growth patterns are somewhat different from those of other populations. Fetal growth velocity could provide more information to understand the risk of adverse perinatal outcomes, especially for appropriate–for–gestational age neonates.

Soft tissue assessment for fetal growth restriction.

Contemporary clinical practice heavily relies on interpretation of population-based birth weight standards to evaluate neonatal nutrition status. Obstetricians have adopted the use of estimated fetal weight in a similar manner to estimate fetal nutritional status. However, most fetal weight prediction models overemphasize skeletal parameters such as biparietal diameter, head circumference, and femur diaphysis length. Although most EFW calculations also include abdominal circumference, this 2D growth parameter is largely defined by liver size and a small rim of subcutaneous fat. Advances in 3D ultrasound imaging and the development of more robust image analysis tools have now made it possible to reliably add a soft tissue component for fetal nutritional assessment. This chapter explains why fetal soft tissue evaluation is clinically relevant, describes different techniques for evaluating these sonographic parameters, and outlines future directions for their practical utility in the care of malnourished fetuses.

Individualized growth assessment in pregnancies complicated by fetal gastroschisis

Objective Prenatal ultrasound (US) has been shown to overestimate the incidence of suspected fetal growth restriction (FGR) in gastroschisis cases. This is largely because of altered sonographic abdominal circumference (AC) measurements when comparing gastroschisis cases with population nomograms. Individualized Growth Assessment (IGA) evaluates fetal growth using serial US measurements that allow consideration of the growth potential for a given case. Our goal was to assess the utility of IGA for distinguishing normal and pathological fetal growth in gastroschisis cases. Study design Pregnancies with prenatally diagnosed fetal gastroschisis were managed and delivered at a single academic medical center. US fetal biometry including head circumference (HC), abdominal circumference (AC), and femur diaphysis length (FDL), and neonatal measurements including birthweight and HC were collected and analyzed for 32 consecutive fetal gastroschisis cases with at least two 2nd and two 3rd trimester measurements. Second trimester growth velocities were compared to a group of 118 non-anomalous fetuses with normal neonatal growth outcomes. Gastroschisis cases were classified into groups based on fetal growth pathology score (FGPS9) patterns. Agreement between IGA (FGPS9) and serial conventional estimated fetal weight (EFW) measurements for determining growth pathology was evaluated. Neonatal size outcomes were compared between conventional birthweight classifications for determining small for gestational age (SGA) and IGA Growth Potential Realization Index (GPRI) for weight and head circumference measurements. Results Fetal growth pathology score (FGPS9) measurements identified three in-utero growth patterns: no growth pathology, growth restriction and recovery, and progressive growth restriction. In the no growth pathology group (n = 19), there was 84% agreement between IGA and conventional methods in determining pathological growth in both the 3rd trimester and at birth. In the growth restriction and recovery group (n = 7), there was 71% agreement both in the 3rd trimester and at birth between IGA and conventional methods. In the progressive growth restriction group (n = 5), there was 100% agreement in the 3rd trimester and 60% agreement at birth between IGA and conventional methods. Conclusion We present the first study using IGA to evaluate normal and pathological fetal growth in prenatally diagnosed gastroschisis cases. IGA was able to delineate two 3rd trimester growth pathology patterns – one with persistent growth restriction and another with in-utero growth recovery. Further validation of these initial findings with larger cohorts is warranted.

FEATURES OF ULTRASOUND IMAGING IN FETAL INTRAUTERINE GROWTH RETARDATION

Fetal growth retardation complicates an average of 10% of all pregnancies. Today, ultrasound examination is used in obstetrics for diagnosis. Therefore, early detection of this complication is the key to adequate treatment and reduction of perinatal consequences. A deeper understanding of the early accompanying ultrasound parameters will allow timely detection or prevention of intrauterine fetal development. The aim of the research was to conduct an ultrasound antenatal examination of women with intrauterine growth retardation. Ultrasound fetometry and placentometry were conducted in women with intrauterine growth retardation (the main group, n-41) and women in the comparison group with the physiological course of pregnancy (n-12). At the initial ultrasound examination, among women in the main group, fetuses below the 10th percentile were probably more common and had a decrease in biparietal head size and abdominal circumference (p = 0.001, p = 0.08). With repeated ultrasound examination, the frequency of detecting decreased indicators of biparietal head size, head circumference, abdominal circumference, femoral shaft length below the 10th percentile among women in the main group increases by 1.5 times, and significantly differs from the indicators of the comparison group. (p = 0.0002, p = 0.001). A decrease in the biophysical profile of the fetus to 6-7 points accompanies 63.4% of pregnancies with intrauterine growth retardation. The amniotic fluid index below the 5th percentile in relation to the gestational age in women at the initial examination was 2.4%, and at the second examination - 7.3%. The placental ultrasound marker of premature maturation by gestational age 21.4%, the presence of petrification in 58.5%. In case of timely detection of the fetometric and placentometric changes, it is possible, from the standpoint of modern obstetrics, to start etiopathogenetic therapy and prevention of this complication of pregnancy.

Semiautomatic Assessment of Fetal Fractional Limb Volume for Weight Prediction in Clinical Praxis: How Does It Perform in Routine Use?

Semiautomatic fractional limb volume (FLV) models have recently produced promising results for fetal birth weight (BW) estimation. We tested those models in a more unselected population hypothesizing that the FLV models would improve accuracy and precision of fetal BW estimation compared to the Hadlock model. We compared the performance of different BW prediction models: Hadlock (biparietal diameter [BPD], abdominal circumference (AC), femur diaphysis length) and modified Lee thigh volume (TVol) and arm volume (AVol) (BPD, AC, automated fractional TVol, and AVol). Accuracy (systematic errors, mean percent differences) and precision (random errors, ± 1 SD of percent differences) were calculated. A total of 75 fetuses were included for final analysis. The Hadlock model showed the most consistent results with accurate BW estimation not significantly different from zero (-0.37 ± 8.53%). The modified fractional thigh and arm volume models were less accurate but trended toward more precise results (-2.63 ± 7.69% and -3.85 ± 7.47%, respectively). In addition, the modified TVol model showed the trend to predict more BWs within ±10% of the actual BW compared to the Hadlock model (81.3 versus 74.67%, ns). Based on our results, fetal weight estimation using the modified semiautomatic FLV models generates less accurate results in third-trimester fetuses compared to the Hadlock model. Those models recently published might improve the results of BW prediction by showing a higher precision than conventional models, especially in small and large fetuses. Further studies are needed to investigate the clinical usefulness of the new models.

Associations between molybdenum exposure and ultrasound measures of fetal growth parameters: A pilot study

Previous studies have suggested the association of molybdenum (Mo) exposure with some adverse outcomes. However, limited epidemiological studies have been performed to explore the association between maternal Mo exposure level and fetal growth. This study recruited 220 pregnant women during their second trimester. The mother’s urinary Mo concentration was measured by inductively coupled plasma mass spectrometry (ICP-MS). The fetal biometric parameters, including head circumference (HC), biparietal diameter (BPD), femur diaphysis length (FL), and abdominal circumference (AC) were assessed by prenatal ultrasound. Estimated fetal weight (EFW) was evaluated using the formula of Hadlock. Multivariable linear regression models were applied to estimate the relationships between Mo level and fetal biometric parameters, and potential confounders were adjusted. A one-unit increment in natural-logarithm transformed urinary Mo level was significantly associated with reductions in fetal AC of −0.34 cm (95%CI: −0.63, −0.04), and was negatively related to EFW (β = −18.2, 95%CI: −40.5, 4.2). Furthermore, when participants were stratified by copper (Cu) level, the results showed that the magnitude of negative association between Mo and AC (β = −0.55, 95%CI: −1.13, 0.04) was greater in pregnant women with Cu level below median value, comparing with those with Cu level above median value (β = −0.08, 95%CI: −0.57, 0.42), and a similar pattern was found for EFW, although the interaction between Mo and Cu was not significant. Our data suggested an inverse association of maternal urinary Mo level with fetal AC and EFW during the second trimester of pregnancy. These associations might be stronger in pregnant women with relatively lower Cu levels.

Differences in fetal fractional limb volume changes in normal and gestational diabetic pregnancies: an exploratory observational study.

Fetal fractional limb volume has been proposed as a useful measure for quantifying fetal soft tissue development. The aim of this study was to investigate the growth of fractional arm volume (AVol) and fractional thigh volume (TVol) of fetuses with maternal gestational diabetes (GDM) compared with those of fetuses with normal glucose tolerance (NGT). We hypothesised fetal fractional limb volume would be larger in the GDM group than in the NGT group in late gestation. Exploratory observational study. Saitama Municipal Hospital. A total of 165 (125 NGT and 40 GDM) singleton Japanese pregnant women. AVol and TVol were assessed between 20 and 37weeks' gestation as cylindrical limb volumes based on 50% of the fetal humeral or femoral diaphysis length. Women were diagnosed as GDM based on the criteria of the Japan Society of Obstetrics and Gynecology. AVol and TVol were compared between women with NGT and those with GDM at each gestational age period (2-week intervals from 20 to 37weeks' gestation). Overall, 287 ultrasound scans were performed (NGT group, 205 scans; GDM group, 82 scans). There was no significant difference of AVol between the groups before 32weeks' gestation. AVol was significantly larger in the GDM group than in the NGT group after 32weeks' gestation (P<0.05). TVol was not statistically different between the groups across gestation. Detection of variations in fetal AVol may provide greater insight into understanding the origins of altered fetal body proportion in GDM. AVol, but not TVol, is significantly larger in fetuses with GDM than in those with NGT after 32weeks' gestation.

Short Femur in the Second Trimester Scan Is Related to Maternal Preeclampsia and Small for Gestational Age Newborns

Objective: To determine the contribution of short femur diaphysis length (FDL) at 19–22 weeks of gestation in the prediction of adverse pregnancy outcomes. Methods: The study included singleton pregnant women who underwent a routine anomaly scan at 19–22 weeks of gestation at the Virgen de la Arrixaca University Clinical Hospital (Murcia, Spain) between August 2011 and August 2012. Fetal biometry and Doppler ultrasound of uterine arteries were assessed as part of the anomaly scan, and the mean pulsatility index of both uterine arteries was recorded. Maternal obstetric characteristics, such as ethnicity, age, weight, parity, cigarette smoking, and medical history including hypertension and diabetes mellitus were collected from our database system. Results: A total of 6,366 women were included in the study after excluding cases with abnormal karyotype, major fetal abnormalities, or termination of pregnancy. There were 88 cases of preeclampsia (PE) (1.4%). Logistic regression was performed including maternal and fetal characteristics. Short FDL at 19–22 weeks was significantly associated with subsequent development of PE (OR = 0.89, 95% CI: 0.80–0.99, p = 0.025). The best model to predict PE from our sample included gestational age at scan, parity, maternal weight, chronic hypertension, mean pulsatility index in the uterine arteries, and FDL (AUC = 0.78, 95% CI: 0.71–0.84). Regarding small for gestational age (SGA) neonates, there were also significant differences in FDL and FDL <5th centile between the control group and SGA newborns below the 3rd, 5th, and 10th centile. In the groups of preterm births (delivery before 32, 34, and 37 weeks), there were no differences in FDL compared with the control group (term births). Discussion: Our results suggest that FDL at 19–22 weeks of gestation is an independent predictor of PE and SGA newborns.

Fetal Weight Estimation Using Automated Fractional Limb Volume With 2-Dimensional Size Parameters: A Multicenter Study.

To develop new fetal weight prediction models using automated fractional limb volume (FLV). A prospective multicenter study measured fetal biometry within 4 to 7 days of delivery. Three-dimensional data acquisition included the automated FLV that was based on 50% of the humerus diaphysis (fractional arm volume [AVol]) or 50% of the femur diaphysis (fractional thigh volume [TVol]) length. A regression analysis provided population sample-specific coefficients to develop 4 weight estimation models. Estimated and actual birth weights (BWs) were compared for the mean percent difference ± standard deviation of the percent differences. Systematic errors were analyzed by the Student t test, and random errors were compared by the Pitman test. A total of 328 pregnancies were scanned before delivery (BW range, 825-5470 g). Only 71.3% to 72.6% of weight estimations were within 10% of actual BW using original published models by Hadlock et al (Am J Obstet Gynecol 1985; 151:333-337) and INTERGROWTH-21st (Ultrasound Obstet Gynecol 2017; 49:478-486). All predictions were accurate by using sample-specific model coefficients to minimize bias in making these comparisons (Hadlock, 0.4% ± 8.7%; INTERGROWTH-21st, 0.5% ± 10.0%; AVol, 0.3% ± 7.4%; and TVol, 0.3% ± 8.0%). Both AVol- and TVol-based models improved the percentage of correctly classified BW ±10% in 83.2% and 83.9% of cases, respectively, compared to the INTERGROWTH-21st model (73.8%; P < .01). For BW of less than 2500 g, all models slightly overestimated BW (+2.0% to +3.1%). For BW of greater than 4000 g, AVol (-2.4% ± 6.5%) and TVol (-2.3% ± 6.9%) models) had weight predictions with small systematic errors that were not different from zero (P > .05). For these larger fetuses, both AVol and TVol models correctly classified BW (±10%) in 83.3% and 87.5% of cases compared to the others (Hadlock, 79.2%; INTERGROWTH-21st, 70.8%) although these differences did not reach statistical significance. In this cohort, the inclusion of automated FLV measurements with conventional 2-dimensional biometry was generally associated with improved weight predictions.

537: Sonographic evaluation of fetal fractional limb volume across gestation in gestational diabetes

Fractional limb volume has recently been proposed as a useful parameter of fetal growth, quantifying fetal soft tissue volume of upper arm and thigh. However, the investigation about the growth characteristics of fractional limb volume in mothers with gestational diabetes is limited. The aim of this study was to investigate the difference in growth trajectory of fractional arm volume and thigh volume between fetuses of gestational diabetes (GDM) and normal glucose tolerance (NGT) mothers. Fetal fractional limb volume was prospectively assessed in 158 singleton pregnancies (121 NGT and 37 GDM) between 20 and 37 weeks gestation. Fractional arm volume and thigh volume were measured as cylindrical limb volume based on 50% of humeral or femoral diaphysis length using a 5-slice technique. First, Student’s t-test was performed to compare fractional arm volume and thigh volume between NGT and GDM group across gestation. Multiple regression analyses were then performed to investigate the difference of fractional limb volume between NGT and GDM group, with adjustment for potential confounding factors (maternal age, parity, pregravid body mass index and fetal sex). Maternal and neonatal characteristics of each group are shown in Table 1. A total of 276 ultrasound scans were obtained, a mean of 1.7 scans (range: 1 - 4) per pregnancy. Fractional arm volume was not different between NGT and GDM group before 32 weeks gestation. However, fractional arm volume of GDM group was significantly larger than NGT group after 32 weeks gestation (Figure 1). These results remained significant even after controlling for the confounding factors. Fractional thigh volume was not statistically different between the two groups across gestation. Fetalfractional arm volume is significantly greater in women with GDM compared with NGT, particularly after 32 weeks gestation. This finding is consistent with the characteristic soft tissue accrual (including fat deposition) in the upper part of the fetal body in GDM, which possibly explains the higher occurrence of shoulder dystocia at delivery.View Large Image Figure ViewerDownload Hi-res image Download (PPT)