Fetal Assessment Research Articles

Fetal kidney length: A likely sole index for gestational age determination in late pregnancy and certain abnormalities

Background: The Obstetric management of a pregnancy relies on the knowledge of an accurate gestational age especially in unregistered cases. Aims: The aim of this study was to sonographically evaluate the fetal kidney length as a potentially dependable direct measurement parameter, to estimate gestational age in the second and third trimesters. Patients, Materials and Methods: The study involved 236 participants with 20 to 34 weeks pregnancies, referred to the Radiology department of the University of Calabar teaching hospital for obstetric ultrasound scan, within a three-month period. The fetal kidney lengths were measured, in addition to the routine parameters, which included head circumference and femur length. The estimated gestational ages derived from the routine parameters, were correlated with the kidney and femur lengths and head circumference. The data were analyzed using SPSS version 22.0. Results: Fetal kidney length increased in direct proportion to gestational age. It had a significant positive correlation coefficient (0.982) with the estimated gestational age, similar to the head circumference and femur length. Fetal kidney lengths in millimeters were nearly equal to the estimated gestational ages in weeks, especially from the thirtieth week. Conclusion: Fetal kidney length is a viable, simple and direct method for determination of gestational age of pregnancies in the second and third trimesters. Since fetal kidney length assessment is said to remain reliable after 34 weeks, unlike the head circumference and femur length, it can serve as the sole index of gestational age assessment late in pregnancy, especially in fetal structural abnormalities.

Sonography Cervical Assessment in Twin Pregnancy Correlation with Gestational Age at Delivery

Objective: Observe and correlate the funneling of upper cervical canal by ultrasound and likelihood of cervical incompetence and premature delivery in twin pregnancy. Materials and methods: Retrospective study in twin pregnancies deliveries in 1997, in king Faisal specialist hospital and research center, Riyadh, Saudi Arabia. A total of 67 twin pregnancies underwent routine ultrasound for fetal assessment, when the cervix closed, long; and short, funneling. The time of ultrasound was divided in three groups by gestational age: from 18 to 22 weeks; from 22 to 26 weeks and from 26 to 30 weeks. The gestational age at delivery was our outcome parameter and subdivided the patients in 4 groups, group 1: patients delivered before 24 weeks (n = 4); group 2: delivered between 24 and 34 weeks (n = 16); group 3: delivered between 34 weeks and 36 weeks and 6 days (n = 18); and group 4: delivered with gestational age equal or above 37 weeks (n = 29). The data was analyzed statistically using Pearson chi square method and p value below 0.05 was considered significant. Results: There was no significant difference among the 4 subgroups in maternal age, body mass index, parity, previous history of preterm delivery or presence of urinary/vaginal infection in actual pregnancy. There was stronger history of mid trimester abortion in patients delivered before 34 weeks of gestational age. Considering the cervical sonographic findings, the diagnosis of funneling between 18 - 22 weeks was higher among the group delivered before 34 weeks of gestational age (1 and 2) comparing to other groups (3 and 4) with p value equal to 0.016. The finding in ultrasound justifies the results of higher aggressive management in patients from groups 1 and 2 comparing with groups 3 and 4; admission to hospital (p = 0.007); emergency cerclage (p = 0.04), complete hospital bed rest (p = 0.002). Conclusion: Cervical assessment during routine ultrasound in twins pregnancy seems to be useful for prediction of preterm delivery and counseling the patient without risk factors regarding cervical cerclage. Because of restricted number of patients, especially group 1 (11 = 4), we suggest further study with bigger sample and prospective trial for valued conclusion.

Sonography Cervical Assessment in Multiple Pregnancy in Correlation with Gestational Age

Objective: Observe and correlate the cervical length by ultrasound and likelihood of cervical incompetence and premature delivery in multiple gestations. Materials and Methods: Retrospective study in multiple pregnancy (twin, triplet, quadruplet) delivered between 2002-2003, in King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. A total of 68 multiple pregnancies underwent routine ultrasound for fetal assessment between 16 - 32 weeks when the cervix was observed. The sonographic measurements included cervix > 2.5 cm and - 20 weeks, 21 - 24 weeks, 25 - 26 weeks, 29 - 32 weeks and >32 weeks. The gestational age at delivery was our outcome parameter. The data was analyzed statistically using Fisher’s exact test and P-value below 0.05 was considered significant. Results: Endovaginal ultrasongoraphic cervical measurement in multiple pregnancies predicted increased preterm delivery risk regardless of maternal age, previous history of preterm deliveries or presence of vaginal infection. It was found that spontaneous preterm labor > 25 mm; this majority reached > 32 weeks while the patient who had cervix Conclusion: Cervical assessment during routine ultrasound in multiple gestations seems to be useful for prediction of preterm delivery and counseling the patient without risk factors regarding cervical cerclage. Because of restricted number of patients, we suggest further study with bigger sample and prospective trial for valued conclusions.

Umbilical artery Doppler assessment in fetuses with a congenital heart disease

Current data is conflicting regarding the utility of umbilical arterial (UA) Doppler assessment as a predictor of adverse perinatal outcomes in fetuses with congenital heart disease (CHD). We describe a cohort of fetuses with CHD who underwent serial UA Doppler surveillance. We performed a retrospective chart review of singleton fetuses with CHD who received prenatal care at our academic center between June 2018 and September 2020. Fetuses with chromosomal abnormality or fetal growth restriction were excluded. Serial UA Doppler data and perinatal outcomes were collected and fetuses with normal versus abnormal UA Doppler assessments were compared. Abnormal UA Doppler assessment was defined as elevated end diastolic flow >95th percentile or absent/reversed end diastolic flow. Of 310 fetuses with CHD identified, 55% (171/310) met inclusion criteria. Of these, 154 (90%) had normal UA Doppler assessment throughout pregnancy, 47% (73/154) of whom had isolated CHD without extracardiac anomalies. Additionally, 17 fetuses had abnormal UA Doppler assessment, 71% (12/17) of whom had isolated CHD. Maternal characteristics did not differ between groups except for maternal race and history of preeclampsia (Table 1). CHD lesions varied, with the most common being isolated VSD (N=39, 23%), hypoplastic left heart syndrome (N=28, 16%), and Tetralogy of Fallot (N=20, 12%), but CHD type did not differ significantly between groups. Of those with normal UA Doppler assessment, 14% (21/154) had an adverse perinatal outcome (defined as fetal demise, neonatal demise, or infant death) compared to 24% (4/17) with abnormal UA Doppler assessment (p=.28, Table 2). We describe UA Doppler and adverse perinatal outcomes in a cohort of normally grown, euploid singleton fetuses with CHD. We did not find a statistically significant difference when comparing those with normal versus abnormal UA Doppler assessment. UA Doppler assessment alone is unlikely to predict adverse perinatal outcome in fetuses with CHD.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Can fetal genetic risk score for birth weight be accurately predicted using parental genotype?

The cumulative effect of single nucleotide polymorphisms (SNPs) at genetic loci can be calculated to generate genetic risk scores (GRSs) for birth weight (BW). While fetal GRSs have the potential to individualize fetal growth assessment, it is difficult to obtain fetal DNA antenatally. However, parental DNA is readily accessible. Our objective was to determine whether fetal GRS for birthweight (GRS-BW) can be predicted from parental DNA, and secondarily whether predicted fetal GRS-BW is associated with actual BW.

Deriving a sex-specific fetal growth standard

Fetal sex is routinely assessed on prenatal ultrasound but is not accounted for in the Hadlock standard. We evaluated whether fetal growth assessment should account for sex and derived a new sex-specific singleton growth standard.

Impact of mild COVID-19 infection on fetal growth during pregnancy

During pregnancy, certain viral infections are known to significantly affect fetal development. Data regarding the impact of COVID-19 viral infection in pregnancy, specifically in asymptomatic or mild cases, remains limited. This presents a challenge in providing prenatal counseling and antepartum surveillance in pregnancies complicated by COVID-19 infection. Placenta studies have demonstrated that vascular malperfusion patterns attributed to COVID appear to depend on the timing of infection. Given reported placenta changes, we aim to evaluate the impact of COVID-19 on fetal growth in pregnant patients with asymptomatic or mild disease, stratified by trimester of infection. We hypothesize that COVID-19 infection, especially early in pregnancy, increases the risk of fetal growth restriction (FGR). This is a single institution, retrospective cohort study of patients with asymptomatic or mild COVID-19 disease, and without disease. All patients age 16-55 years old with a singleton delivery between December 10, 2020, and April 19, 2021 were included. The number of patients diagnosed with and without FGR in each group were evaluated. Group differences were assessed using Chi-Square test with significance at p< 0.05. A total of 1971 patients were enrolled; 208 with COVID-19 and 1763 without. There was no difference in demographics and gestational age at delivery in both groups. There was no difference in the rate of FGR in patients with and without COVID-19, (3.4% vs 4.8%, p=0.36). Within the COVID-19 group, 7 patients met criteria for diagnosis of FGR (p=0.205), with distribution of 2, 1 and 4 patients within 1st, 2nd and 3rd trimester infection respectively. Mild COVID-19 infection in pregnancy, regardless of timing of infection, does not appear to be associated with FGR. Routine serial fetal growth assessment may not be warranted solely for history of COVID-19 infection.

Single sporadic deceleration during reactive nonstress test – clinical significance and risk for cesarean delivery

The nonstress test (NST) is a widely applied technique for antepartum fetal assessment despite a high false-positive rate. The evidence regarding the clinical significance of a single sporadic variable deceleration (SSD) in fetal heart rate (FHR) during reactive NST is scarce, and therefore, the optimal management of SSD in a term pregnancy without other signs of fetal compromise has not been established. Thus, we aim to evaluate whether SSD during a reactive NST at term is associated with a higher risk for FHR decelerations during labor and need for intervention.

Investigating the interpretability of fetal status assessment using antepartum cardiotocographic records

BackgroundCardiotocography (CTG) interpretation plays a critical role in prenatal fetal monitoring. However, the interpretation of fetal status assessment using CTG is mainly confined to clinical research. To the best of our knowledge, there is no study on data analysis of CTG records to explore the causal relationships between the important CTG features and fetal status evaluation.MethodsFor analyses, 2126 cardiotocograms were automatically processed and the respective diagnostic features measured by the Sisporto program. In this paper, we aim to explore the causal relationships between the important CTG features and fetal status evaluation. First, we utilized data visualization and Spearman correlation analysis to explore the relationship among CTG features and their importance on fetal status assessment. Second, we proposed a forward-stepwise-selection association rule analysis (ARA) to supplement the fetal status assessment rules based on sparse pathological cases. Third, we established structural equation models (SEMs) to investigate the latent causal factors and their causal coefficients to fetal status assessment.ResultsData visualization and the Spearman correlation analysis found that thirteen CTG features were relevant to the fetal state evaluation. The forward-stepwise-selection ARA further validated and complemented the CTG interpretation rules in the fetal monitoring guidelines. The measurement models validated the five latent variables, which were baseline category (BCat), variability category (VCat), acceleration category (ACat), deceleration category (DCat) and uterine contraction category (UCat) based on fetal monitoring knowledge and the above analyses. Furthermore, the interpretable models discovered the cause factors of fetal status assessment and their causal coefficients to fetal status assessment. For instance, VCat could predict BCat, and UCat could predict DCat as well. ACat, BCat and DCat directly affected fetal status assessment, where ACat was the important causal factor.ConclusionsThe analyses revealed the interpretation rules and discovered the causal factors and their causal coefficients for fetal status assessment. Moreover, the results are consistent with the computerized fetal monitoring and clinical knowledge. Our approaches are conducive to evidence-based medical research and realizing intelligent fetal monitoring.

Abstract 10723: Fetal Echocardiographic Assessment of Right Ventricular and Tricuspid Valve Function in Hypoplastic Left Heart Syndrome: Correlation with Postnatal Outcomes

Introduction: Hypoplastic left heart syndrome (HLHS) carries significant morbidity and mortality. Transthoracic echocardiogram (echo) assessment of right ventricular (RV) function and tricuspid regurgitation (TR) correlate with HLHS outcomes. There are limited reports on RV function and TR in fetal HLHS and postnatal outcomes. We aim to correlate RV function and TR on fetal-echo (F-echo) with transplant-free survival (survival), hospital length of stay after initial surgery (LOS), and timing of Glenn (BDG) in HLHS patients. Methods: Imaging and clinical data of fetuses diagnosed with HLHS between February 2014 and September 2020 at our institution were retrospectively reviewed. Measurements of RV myocardial performance index (MPI) and fractional area change (FAC) were made on initial F-echo. The RV shortening fraction (SF), presence/degree of TR, and RV size by diastolic short-axis dimension were recorded. Postnatal outcomes included survival, LOS and age at BDG. Early BDG was a repair at &lt;4 months. Mann-Whitney U test correlated F-echo measures and postnatal outcomes. Results: F-echo was available in 69 subjects; 22 excluded for termination/fetal demise, 9 for genetic syndromes, resulting in 38 subjects. Mean age at initial F-echo was 31.4±0.9wks, 11 referred &gt;30 weeks from regional cardiologists (adjusted mean age 23.1±0.4wks). Subject age at time of review ranged from 7 months to 6.5 years. Eight subjects died (median age 2 months) and 3 required transplant (median age 8 months). F-echo RV MPI was significantly higher (0.372±0.09;p=0.005) and RV FAC was significantly lower (43%±6.4%;p=0.016) in HLHS non-survivors versus survivors. Fetal RV size and presence of TR were not significantly different. Subjects with initial LOS &gt;30 days were more likely to have fetal TR (p&lt;0.001) and RV dilation (p=0.019), but no significant RV MPI and FAC difference. No fetal measures correlated with need for an early BDG. Conclusion: F-echo evaluation of RV MPI and FAC in HLHS correlates with transplant-free survival. Presence of fetal TR and RV dilation correlate with a longer LOS. F-echo measures of RV function and TR function may inform prenatal counseling and postnatal outcomes for fetal HLHS.

Care Pathway for Foetal Joint Contractures, Foetal Akinesia Deformation Sequence, and Arthrogryposis Multiplex Congenita

Introduction: The majority of arthrogryposis multiplex congenita (AMC) and lethal forms of AMC such as foetal akinesia deformation sequence (FADS) cases are missed prenatally. We have demonstrated the additional value of foetal motor assessment and evaluation in a multidisciplinary team for the period 2007–2016. An applied care pathway was developed for foetuses presenting with joint contracture(s) in one anatomic region (e.g., talipes equinovarus [TEV]), more than one body part with non-progressive contractures and motility (AMC) and with deterioration over time (FADS). Methods: The multidisciplinary team of Amsterdam University Medical Centre Expertise Centre FADS and AMC developed the care pathway. Additional tools are provided including a motor assessment by ultrasound examination and a post-mortem assessment form. Results: An eight-step care pathway is presented with a proposed timing for prenatal sonographic examination, genetic examinations, multidisciplinary meetings, prenatal and postnatal counselling of the parents by a specialist also treating after birth, and the follow-up of prenatal and postnatal findings with counselling for future pregnancies. Discussion/Conclusion: The scheduled serial structural and motor sonograpahic assessment together with follow-up examinations and genetic analysis should be tailored per prenatal centre per available resources. The multidisciplinary care pathway may pave the way to increase the detection rate and diagnosis of isolated contracture(s), TEV with underlying genetic causes, and the rare phenotypes AMC/FADS and prompt treatment after birth within expertise teams.

Prenatal cardiac biometry and flow assessment in fetuses with bicuspid aortic valve at 20 weeks' gestation: multicenter cohort study.

To investigate prenatal changes in cardiac biometric and flow parameters in fetuses with bicuspid aortic valve (BAV) diagnosed neonatally compared with controls with normal cardiac anatomy. This analysis was conducted as part of the Copenhagen Baby Heart Study, a multicenter cohort study of 25 556 neonates that underwent second-trimester anomaly scan at 18 + 0 to 22 + 6 weeks' gestation and neonatal echocardiography within 4 weeks after birth, in Copenhagen University Hospital Herlev, Hvidovre Hospital and Rigshospitalet in greater Copenhagen, between April 2016 and October 2018. From February 2017 (Rigshospitalet) and September 2017 (Herlev and Hvidovre hospitals), the protocol for second-trimester screening of the heart was extended to include evaluation of the four-chamber view, with assessment of flow across the atrioventricular valves, sagittal view of the aortic arch and midumbilical artery and ductus venosus pulsatility indices. All images were evaluated by two investigators, and cardiac biometric and flow parameters were measured and compared between cases with BAV and controls. All cases with neonatal BAV were assessed by a specialist. Maternal characteristics and first- and second-trimester biomarkers were also compared between the two groups. Fifty-five infants with BAV and 8316 controls with normal cardiac anatomy were identified during the study period and assessed using the extended prenatal cardiac imaging protocol. There were three times as many mothers who smoked before pregnancy in the group with BAV as in the control group (9.1% vs 2.7%; P = 0.003). All other baseline characteristics were similar between the two groups. Fetuses with BAV, compared with controls, had a significantly larger diameter of the aorta at the level of the aortic valve (3.1 mm vs 3.0 mm (mean difference, 0.12 mm (95% CI, 0.03-0.21 mm))) and the pulmonary artery at the level of the pulmonary valve (4.1 mm vs 3.9 mm (mean difference, 0.15 mm (95% CI, 0.03-0.28 mm))). Following conversion of the diameter measurements of the aorta and pulmonary artery to Z-scores and Bonferroni correction, the differences between the two groups were no longer statistically significant. Pregnancy-associated plasma protein-A (PAPP-A) multiples of the median (MoM) was significantly lower in the BAV group than in the control group (0.85 vs 1.03; P = 0.04). Our findings suggest that fetuses with BAV may have a larger aortic diameter at the level of the aortic valve, measured in the left-ventricular-outflow-tract view, and a larger pulmonary artery diameter at the level of the pulmonary valve, measured in the three-vessel view, at 20 weeks' gestation. Moreover, we found an association of maternal smoking and low PAPP-A MoM with BAV. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Association of Maternal History of Spontaneous Abortion and Stillbirth With Risk of Congenital Heart Disease in Offspring of Women With vs Without Type 2 Diabetes

The associations of maternal history of spontaneous abortion (SA) and stillbirth with congenital heart disease (CHD) remain elusive. To evaluate the associations of maternal history of pregnancy loss with CHD in offspring and the role of maternal type 2 diabetes. This population-based cohort study included singleton live offspring born between January 1, 1977, and December 31, 2016, identified through Danish national health registries. Statistical analysis was performed from October 1, 2019, through September 1, 2021. Maternal history of SA, with frequency varying from 1 or 2 to 3 or more episodes, and maternal history of single and multiple stillbirths. Overall CHD identified by hospital diagnosis. Cox proportional hazard regression was used to estimate the hazard ratio (HR) of CHD. Diabetes was evaluated as a potential confounder and a potential effect modifier. Among 1 642 534 included offspring (mean [SD] age, 14.11 [8.39] years; 843 265 male [51.35%]), 246 669 (15.02%) were born to mothers with a history of SA and 9750 (0.59%) were born to mothers with a history of stillbirth. The HRs of CHD were 1.16 (95% CI, 1.13-1.20) for offspring with a maternal history of SA and 1.49 (95% CI, 1.32-1.68) for offspring with a maternal history of stillbirth. Significant dose-response associations were observed among offspring with a maternal history of 3 or more episodes of SA (HR, 1.60; 95% CI, 1.39-1.84) and those with maternal history of multiple stillbirths (HR, 2.75; 95% CI, 1.63-4.65). If only inpatient CHD cases were included, the risk of CHD was higher than that found in the main analysis, with HRs of 1.24 (95% CI, 1.19-1.30) for maternal history of SA and 1.78 (95% CI, 1.51-2.11) for maternal history of stillbirth. The observed associations were strengthened by maternal prepregnancy type 2 diabetes (HR for maternal history of SA, 1.65 [95% CI, 1.37-1.97]; HR for maternal history of stillbirth, 1.74 [95% CI, 1.06-2.85]). These findings suggest that offspring born to mothers with a previous SA or stillbirth, especially multiple episodes, or with prepregnancy type 2 diabetes were at a higher risk of being diagnosed with CHD. These findings may help identify women at increased risk in whom detailed fetal heart assessment may be cost-effective and highlight the importance of screening for type 2 diabetes in women of reproductive age.

Multi-Detector Heart Rate Extraction Method for Transabdominal Fetal Pulse Oximetry.

Intrapartum fetal well-being assessment relies on fetal heart rate (FHR) monitoring. Studies have shown that FHR monitoring has a high false-positive rate for detecting fetal hypoxia during labor and delivery. A transabdominal fetal pulse oximeter device that measures fetal oxygen saturation non-invasively through NIR light source and photodetectors could increase the accuracy of hypoxia detection. As light travels through both maternal and fetal tissue, photodetectors on the surface of mother's abdomen capture mixed signals comprising fetal and maternal information. The fetal information should be extracted first to enable fetal oxygen saturation calculation. A multi-detector fetal signal extraction method is presented in this paper where adaptive noise cancellation is applied to four mixed signals captured by four separate photodetectors placed at varying distances from the light source. As a result of adaptive noise cancellation, we obtain four separate FHR by peak detection. Weighting, outlier rejection and averaging are applied to these four fetal heart rates and a mean FHR is reported. The method is evaluated in utero on data collected from hypoxic lamb model. Ground truth for FHR is measured through hemodynamics. The results showed that using multi-detector fetal signal extraction gave up to 18.56% lower root-mean-square FHR error, and up to 57.87% lower maximum absolute FHR error compared to single-detector fetal signal extraction.

Inpatient vs. outpatient management of uncomplicated preterm premature rupture of membranes: a clinical trial

Background: Preterm premature rupture of membranes (PPROM) is spontaneous rupture of fetal membranes before 37 weeks of gestation. PPROM cases that are clinically stable with no sign or symptom of intrauterine infection and normal fetal assessment are usually managed expectantly in hospital settings or at home. This study aimed at comparing the inpatient and outpatient management among women with uncomplicated PPROM.Methods: This non-randomized clinical trial was performed in an academic hospital, Mashhad University of Medical Sciences in 2017-2018. Women with confirmed PPROM who received initial treatments during the primary 72 hours of hospitalization were assigned into inpatient (n=45) or outpatient (n=35) management groups according to the patient's decision. The obstetrical, maternal and neonatal outcomes under the focus of this study included latency period, gestational age at delivery, delivery route, delivery reason, WBC and neutrophil count, neonates’ weight, Apgar score, NICU admission, and death in the first 28 days after delivery. Data were analyzed by Statistical Package for Social Science (IBM SPSS) version 23. P 0.05). Neonatal Apgar score, death, and NICU admission rate or period were not significantly different between the two groups (p>0.05).Conclusion: Homecare for the selected PPROM women could be a suitable expectant strategy without compromising neonatal or maternal outcomes.

Assessment of OB/Gyn Residents’ Knowledge of Basic Obstetric Sonography and Psychomotor Skills Posttraining on a Computer-Based Simulator

Objective: This study sought to evaluate how a high-fidelity computer-based sonography simulator (FCBSS) can be used in training obstetrics and gynecology residents and evaluate efficacy of high-fidelity CBSS in enhancing resident’s sonographic knowledge, psychomotor skills, and level of confidence in performing sonographic fetal assessments. Materials and Methods: Eleven postgraduate year 1 residents (PGY1s) and ten PGY2s were assessed on sonographic performance by measuring psychomotor skills and evaluating the accuracy of the sonographic images. PGY2s received traditional sonography training while PGY1s received three individualized training sessions on a high-fidelity CBSS. At the conclusion, all residents received feedback and completed a survey to establish their current confidence level in performing and interpreting sonograms. Results: PGY2s scored a median of 33/66 points on the assessment, while PGY1s scored a median of 64/66 points. Statistical analysis performed from motion analysis metrics between cohorts revealed a statistically significant difference, with PGY1s demonstrating higher psychomotor skills. Interquartile ranges of PGY1s’ scores were smaller than PGY2s’, revealing consistency in knowledge and skills among the PGY1 cohort. Conclusion: Findings suggests that high-fidelity CBSS can be used effectively in training residents. It also demonstrates that implementation of formalized sonography training, using a high-fidelity CBSS, can be achieved and potentially expedite and enhance the learning of novice learners.

Role of prenatal magnetic resonance imaging in fetuses with isolated severe ventriculomegaly at neurosonography: A multicenter study

ObjectiveThe aim of this study was to report the rate of additional anomalies detected exclusively at prenatal magnetic resonance imaging (MRI) in fetuses with isolated severe ventriculomegaly undergoing neurosonography. MethodMulticenter, retrospective, cohort study involving 20 referral fetal medicine centers in Italy, United Kingdom, Spain and Denmark. Inclusion criteria were fetuses affected by isolated severe ventriculomegaly (≥15 mm), defined as ventriculomegaly with normal karyotype and no other additional central nervous system (CNS) and extra-CNS anomalies on ultrasound. In all cases, a multiplanar assessment of fetal brain as suggested by ISUOG guidelines on fetal neurosonography had been performed. The primary outcome was the rate of additional CNS anomalies detected exclusively at fetal MRI within two weeks from neurosonography. Subgroup analyses according to gestational age at MRI (<vs ≥ 24 weeks of gestation) and the laterality of ventriculomegaly (unilateral vs bilateral) were also performed. Univariate and multivariate logistic regression analysis was used to analyze the data. Results187 fetuses with a prenatal diagnosis of isolated severe ventriculomegaly on neurosonography were included in the analysis. Additional structural anomalies were detected exclusively at prenatal MRI in 18.1% of cases. When considering the type of anomaly, malformations of cortical development were detected on MRI in 32.4% cases, while midline or acquired (hypoxemic/hemorrhagic) lesions were detected in 26.5% and 14.7% of cases, respectively. There was no difference in the rate of additional anomalies when stratifying the analysis according to either gestational age at MRI or laterality of the lesion. At multivariate logistic regression analysis, the presence of additional anomalies only found at MRI was significantly higher in bilateral compared versus unilateral ventriculomegaly (OR: 4.37, 95% CI 1.21–15.76; p = 0.04), while neither maternal body mass index, age, severity of ventricular dilatation, interval between ultrasound and MRI, nor gestational age at MRI were associated with the likelihood of detecting associated anomalies at MRI. ConclusionThe rate of associated anomalies detected exclusively at prenatal MRI in fetuses with isolated severe ventriculomegaly is lower than previously reported, but higher compared to isolated mild and moderate ventriculomegaly. Fetal MRI should be considered as a part of the prenatal assessment of fetuses presenting with isolated severe ventriculomegaly at neurosonography.

Role of thigh circumference in predicting the fetal weight: Comparison with other ultrasound methods-A prospective observational study.

We aimed to evaluate the addition of fetal thigh circumference (TC) to other ultrasound parameters to predict fetal weight compared to two standard formulae (Hadlock's and Vintzileos methods). We conducted this prospective study on pregnant women between November 2018 and September 2019. The actual fetal weight was estimated within 48 h of delivery; then, it was compared to the estimated fetal weight by ultrasound. We used the Statistical Package for the Social Sciences (SPSS) software version 20.0 to perform the statistical analysis. A total of 123 pregnant women, with a mean age of 26.68 (5.24) years and a mean gestational age of 38.78 (0.85) weeks, were included in our study. We detected a significant positive correlation between different ultrasound parameters and actual weight (all p≤ 0.001). The highest correlation was observed between TC and actual fetal weight (r= 0.685). Regarding both formulae, the correlation coefficient was higher in the Vintzileos formula than the Handlock formula (0.976 vs. 0.823). Our linear regression analysis showed that fetal TC could be an indicator for estimating fetal weight (p < 0.001). There was a statistically significant difference between the actual weight and the weight estimated by the Hadlock formula (p < 0.001). We detected no statistically significant difference between the estimated TC by ultrasound and the actual TC (p= 0.0602). Fetal TC can help accurately measure fetal birth weight when incorporated with other fetal parameters. The inclusion of fetal TC assessment in routine ultrasound examination is suggested to improve the birth estimates.

An interrater reliability study on the Gothenburg obstetric triage system- a new obstetric triage system

BackgroundTriage, identifying patients with critical and time-sensitive disorders, is an integrated process in general emergency medicine. Obstetric triage is more specialised, requiring assessment of both woman, fetus and labour status. Failure to identify severely ill obstetric patients has repeatedly led to maternal morbidity and mortality. Reliable triage systems, adapted to obstetric patients as well as local conditions, are thus essential. The study aims to assess the interrater reliability (IRR) of the Gothenburg Obstetric Triage System (GOTS).MethodsMidwives (n = 6) and registered nurses with no experience in managing obstetric patients (n = 7), assessed 30 paper cases based on actual real-life cases, using the GOTS. Furthermore, a reference group consisting of two midwives and two obstetricians, with extensive experience in obstetric care, determined the correct triage level in order to enable analysis of over- and undertriage. IRR was assessed, both with percentage of absolute agreement and with intra-class correlation coefficients (ICC) with 95% confidence intervals (CI).ResultsA total of 388 assessments were performed, comprising all five levels of acuity in the GOTS. Absolute agreement was found in 69.6% of the assessments. The overall IRR was good, with a Kappa value of 0.78 (0.69–0.87, 95% CI) for final triage level. Comparison with reference group assessments established that over- and undertriage had occurred in 9% and 21% of the cases, respectively. The main reasons for undertriage were “not acknowledging abnormal vital sign parameters” and “limitations in study design”.ConclusionThe GOTS is a reliable tool for triaging obstetric patients. It enables a standardized triage process unrelated to the assessors’ level of experience in assessing and managing obstetric patients and is applicable for triaging obstetric patients presenting for emergency care at obstetric or emergency units.

Factors influencing partograph recording among skilled birth attendants at Mzuzu Central Hospital, Northern Malawi

Background/Aims Malawi has very high maternal and neonatal mortality rates, often resulting from complications during labour and delivery. Complete recording of a partograph during labour monitoring has been associated with a reduction and prompt management of fatal complications. Although the partograph is an essential tool for monitoring women during labour, there is limited evidence on the status of its recording and associated factors among skilled birth attendants in northern Malawi. The aim of this study was to assess partograph recording and explore factors affecting its recording among skilled birth attendants at the Mzuzu Central Hospital in Malawi. Methods The study used a descriptive cross-sectional design with mixed methods. The study involved a retrospective review of 369 patient partographs, using a data extraction sheet to gather quantitative data, which were analysed using descriptive statistics. Qualitative data were collected through individual in-depth interviews with seven skilled birth attendants working at the hospital, using a semi-structured interview guide and analysed by content analysis. Results Of the 369 partographs that were reviewed, recording was complete in only 12.7% of fetal assessments, 13.3% of maternal assessments and 24.7% of sections recording the progress of labour. The most completely recorded parameter was liquor (71.8%), followed by cervical dilatation (70.5%). The least completely recorded parameters were temperature (13.6%) and urine protein (2.2%). Factors that influenced the recording of a partograph included skilled birth attendants' general knowledge on the partograph, the availability of equipment for assessments, supportive supervision, staffing levels, attendance to in-service training and clients' perception of the frequency of assessments. Conclusions Skilled birth attendants at Mzuzu Central Hospital partially complete partographs during labour. Staffing levels, availability of equipment for assessments, in-service training and supportive supervision are all factors that affect complete partograph recording. Therefore, it is essential to implement strategies that can promote complete partograph recording in order to reduce maternal and newborn morbidity and mortality at this health facility.