Fetal Biometric Measurements Research Articles

Assessing Fetal Circulatory Changes in Gestational Diabetes via Aortic Isthmus Doppler

Background: Gestational diabetes mellitus (GDM) is a common complication during pregnancy that can negatively impact fetal heart function and structure. This study aimed to investigate the hemodynamic characteristics of the fetal aortic isthmus in patients with GDM using Doppler ultrasound parameters. Methods:This was a cross-sectional observational study including 47 pregnant patients with GDM and 47 healthy pregnant patients as controls. Fetal biometric measurements and umbilical artery Doppler values were obtained. Aortic isthmus Doppler was used to measure systolic and diastolic flow velocity time integrals (S and D), peak systolic velocity (PSV), and systolic nadir (Ns) to calculate the isthmus flow index (IFI) = (S + D)/S and isthmus systolic index (ISI) = Ns/PSV. A generalized additive model was used to analyze the relationship between IFI, ISI and gestational age. Results: Compared to controls, the GDM group had significantly lower D (2.39 cm vs. 2.76 cm), Ns (11.48 cm/s vs. 14.06 cm/s), IFI (1.24 vs. 1.27) and ISI (0.14 vs. 0.16). Curve fitting showed IFI was lower in the GDM group for most gestational weeks and decreased with advancing weeks, while ISI remained constantly lower and decreased linearly. Conclusions: Fetal aortic isthmus Doppler parameters IFI and ISI were altered in GDM pregnancies, suggesting earlier changes in aortic arch hemodynamics compared to the umbilical artery. Combining IFI and ISI may provide more comprehensive assessment of fetal circulatory changes in GDM. These findings could enhance our understanding of the pathophysiologic impacts of maternal diabetes.

Artificial Intelligence-Based Estimation of Fetal Head Circumference With Biparietal and Occipitofrontal Diameters Using Two-Dimensional Ultrasound Images

Abstract One of the most essential biometrics for measuring fetal growth during prenatal ultrasound exams is the head circumference (HC). However, manual measurement of this biometric by doctors often needs substantial experience. Manual measurement of fetal head circumference during prenatal ultrasound exams requires significant expertise, posing limitations in accuracy and consistency, which can impact clinical decision-making and fetal health assessments. We developed a state-of-the-art image processing algorithm that utilizes biometry and segmented images and employed a fast ellipse fitting method to measure the HC, head orientation (angle) along with biparietal (BPD), and occipitofrontal (OFD) diameter automatically. Our approach offers automation and precision in measuring fetal biometrics, surpassing the limitations of manual measurement by ensuring consistent and accurate assessments, thus enhancing clinical efficiency and facilitating timely interventions for optimal fetal health management. Additionally, to the best of our knowledge, this is the first work that adopts a segmented image from any model or technique and provides significant fetal parameters during ultrasonography in a single shot. The suggested technique is lightweight, real-time, and easily integrate with any segmentation model or technique. We have used three well-known segmentation models for demonstration and compared their performance using dice scores as an evaluation parameter. Among the three, HRNet shows the best results with an average dice score of 0.96; due to the high dice score, we have chosen HRNet over the other two models and proceeded further and implemented our novel algorithm on that to predict the required fetal key measurements. The findings of this study benefit prenatal care by enhancing the accuracy and efficiency of fetal biometric measurements, thereby facilitating improved clinical decision-making and optimizing fetal health assessments.

Prospective evaluation of ultrasonographic fetal cardiac morphometry and functions in the third trimester of pregnancies with gestational diabetes mellitus.

This study aimed to compare cardiac morphological and functional changes in fetuses of patients with diet-regulated gestational diabetes mellitus (GDM-A1), insulin-regulated GDM (GDM-A2), and a control group. A prospective cohort study included pregnant women aged 18-40 years with singleton pregnancies. Fetal biometric, cardiac morphological, and functional measurements were recorded using Z-scores at 34-37 weeks of gestation. The study included 87 patients. Both right and left ventricular wall thicknesses were significantly different between the three groups (p < 0.001 and p < 0.001, respectively). Z-scores of the mitral valve, left and right EDD were significantly lower in GDM-A1 and GDM-A2 groups compared to the control group (p < 0.001, p < 0.001, p = 0.002, respectively). Right and left ventricular areas were decreased only in GDM-A2 group compared to the control group (p = 0.003 and p = 0.001, respectively). MPI and IVRT values were also significantly higher in the same groups (p = 0.016, p < 0.001, respectively). Gestational diabetes increased IVS and ventricular wall thicknesses in both right and left ventricles, irrespective of whether it was controlled by diet or insulin. Cardiac functional changes were observed in the GDM-A2 group.

Alterations in maternal cardiovascular parameters and their impact on uterine and fetal circulation in hypertensive pregnancies and fetal growth restriction

ObjectiveTo examine potential alterations in maternal cardiovascular parameters in hypertensive pregnancies with or without fetal growth restriction (FGR) in comparison to uncomplicated normotensive pregnancies, and to determine the correlation between maternal cardiovascular parameters and changes in umbilical and uterine artery circulation. Materials and methodsThis study enrolled 73 pregnant women starting from the 20th week of gestation, categorized into three groups: hypertensive conditions (pregnancy-induced hypertension, preeclampsia or eclampsia, n = 30), hypertensive conditions with FGR (n = 8) and a control group of healthy normotensive pregnant women (n = 35). All participants underwent echocardiography to assess cardiac output and calculate peripheral vascular resistance. Additionally, fetal biometric measurements and Doppler ultrasound examinations of the uterine and umbilical artery were performed. The results were standardized into gestational age-adjusted z-scores. ResultsThe mean pulsatility index (PI) of the uterine artery (1.36, p < 0.001) and umbilical artery PI z-scores (1.32, p < 0.001) showed significant increases in the hypertensive conditions + FGR group. Maternal cardiac output z-scores were notably lower in both the hypertensive + FGR group (−2.62, p = 0.001) and the hypertensive group (−2.49, p < 0.001). Peripheral vascular resistance was significantly elevated in the hypertensive + FGR group (7.43, p < 0.001) and the hypertensive group (6.06, p < 0.001). There was a positive correlation between maternal peripheral vascular resistance and uterine artery PI (R2 = 0.172; p = 0.0004), and a negative correlation between cardiac output and uterine artery PI (R2 = 0.067; p = 0.031). However, significant correlation between maternal cardiovascular parameters and umbilical artery PI was not identified. ConclusionsMaternal cardiac output exhibits a significant decrease whereas peripheral vascular resistance increases in hypertensive pregnancies, irrespective of the presence of FGR. Both uterine and umbilical artery PI notably increase when hypertensive pregnancies are accompanied by FGR. A positive correlation exists between maternal peripheral vascular resistance and uterine artery PI, as well as a negative correlation between maternal cardiac output and uterine artery PI. However, changes in maternal cardiovascular parameters do not exhibit significant correlations with umbilical artery PI.

O-191 Delayed fetal growth in pregnant women with polycystic ovary syndrome using serial ultrasonographic biometry

Abstract Study question To investigate the effect of maternal polycystic ovary syndrome (PCOS) on intrauterine growth and perinatal outcome of offspring. Summary answer Maternal PCOS might have an adverse impact on fetal growth, represented by serial biometric measurements, and consequently lower the birth weight. What is known already Women with PCOS often have low fertility and high risk of certain pregnancy complications, including miscarriage, gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP) and preterm birth (PTB). In addition, the offspring of PCOS mothers are susceptible to short- and long-term health consequences, such as metabolic diseases and neuropsychiatric disorders. And the suboptimal intrauterine environment caused by maternal PCOS condition might be the origin of impaired long-term health of the offspring. Study design, size, duration A total of 1153 pregnant women with pregestational diagnosis of PCOS and 1383 non-PCOS controls were included in the retrospective case-control study for clinical record and ultrasonographic database at women’s hospital, school of medicine, Zhejiang university over a 6-year period. Participants/materials, setting, methods Maternal demographic data, fetal biometric measurements with ultrasound, obstetrical and neonatal outcomes were analyzed. A meta-analysis of birth weight in PCOS offspring in the literature was performed to assess the relationship between the maternal PCOS and neonatal growth. Main results and the role of chance After adjustment for potential confounding variables, we found that biparietal diameter (BPD) and femur length (FL) were notably smaller in fetuses of women with PCOS than controls across the entire gestation. This effect still existed after excluding three major pregnancy complications of PCOS, including GDM, HDP and PTB. Although other fetal biometry including estimated fetal weight and birth weight in PCOS offspring were comparable with controls in our study, the meta-analysis of 22 studies showed that the birth weight in offspring of women with PCOS was lower than controls (WMD -37.813, 95%CL [-69.713, -5.913]), especially for offspring in South America (WMD -84.69, 95%CL [-166.69, -2.68]). Limitations, reasons for caution First, data of other fetal parameters like abdominal and head circumference was scanty. Second, neonatal anthropometric parameters apart from the birth weight were not included. Lastly, we did not have the long-term follow-up results of the offspring to explore the potential effect of delayed fetal biometry in their later life. Wider implications of the findings More attention needs to be paid to the smaller-than-average fetuses in PCOS mothers, and proper management may be needed during and after pregnancy. Further studies are needed to confirm the intrauterine growth pattern of the PCOS offspring and its clinical significance in the neonatal period and beyond. Trial registration number N/A

Fetal Biometric Parameter Reference Charts of a Central Anatolian Turkish Population.

The assessment of fetal biometry using ultrasound provides accurate pregnancy dating and also screening of fetal growth. Fetal biometry, which is common practice in the second and third trimesters of pregnancy, is fetal morphometry, which involves taking measurements of the different anatomical body parts. These fetal dimensions vary on ethnicity. The aim of this study is to demonstrate fetal biometric parameters measurement results of the Central Anatolia Turkish population with detailed percentile tables and graphs to screen fetal growth more accurately. This cross-sectional study was performed on a total of 1132 fetuses (47% girl, and 53% boy) between 15 and 40 weeks of gestation. Biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL) measurements are performed in a standardized manner every gestational week. BPD and HC were measured at the level of the thalami on the horizontal plane of the fetal head. HC was measured using the ellipse method. AC measurement was taken at the circular cross-section of the upper fetal abdomen. FL was measured along with the ossified diaphysis of the femur. All measurements were taken in millimeters. Pregnant women's mean age was 27.58 (17-43), and the mean body mass index was 27.68 (15.06-50.78) as demographic data. 38.13% of women had their first, 29.74% had their second, and 32.13% had three or more gestations within our study. Percentile data of fetuses for each parameter (BPD, HC, AC, and FL) and for each week were shown as tables and percentile graphics. Fetal 50th percentile measurements were compared between our study and other studies from different countries. The Kruskal-Wallis test results showed that BPD (p = 0.827), HC (p = 0.808), AC (p = 0.846), and FL (p = 0.725) values have a statistically similar mean in all studies. Hierarchical cluster analysis results showed that our results for BPD, HC, AC, and FL percentile curves have been found closer to Italian population results. However, our results were statistically different from Asian, Nigerian, non-Hispanic American, and Brazilian populations for each of the different parameters. The specialization of fetal biometric charts for a particular population can ensure a more accurate assessment of fetal growth rate. We showed fetal biometric percentile tables and graphics of the Central Anatolian Turkish population in this study. These results may provide a valuable contribution to obstetrical practice.Further studies can be conducted in different regions of Turkiye, thus comparisons could be possible over the country.

Comparison of the ratio of second trimester fetal biometric measurements to fetal nasal bone length in fetuses with normal karyotype and trisomy 21.

In this study, we compared the ratio of second trimester fetal biometric measurements to nasal bone length (NBL) in fetuses with normal karyotype and trisomy 21 to determine their diagnostic prognostic value. The study included 148 pregnant women who obtained second-trimester ultrasonographic fetal anatomy and had amniocentesis (AS) for fetal karyotyping. The fetal karyotype results divided the groups into normal and trisomy 21 fetuses. Age, obstetric history, first and/or second trimester screening test risk ratios, fetal biometric measurements, and NBL mm, median (MoM) multiples, and percentile values were recorded and compared between groups. BPD/NBL ratios above 9.26 predict trisomy 21 in fetuses with 77.6% sensitivity and 86.1% specificity (p = 0.001). HC/NBL ratios above 34.50 predict trisomy 21 in fetuses with 77.8% sensitivity and 88.8% specificity (p = 0.001). FL/NBL ratios above 6.02 predict trisomy 21 in fetuses with 69.6% sensitivity and 72.2% specificity (p = 0.001). HL/NB ratios above 6.56 predict trisomy 21 in fetuses with 95.5% sensitivity and 47.2% specificity (p = 0.001). The NBL MoM value demonstrated a high diagnostic accuracy for normal-karyotype fetuses (p = 0.021). We found that BPD/NBL, HC/NBL, FL/NBL, and HL/NBL ratios differed between fetuses with a normal karyotype and those with trisomy 21, specifically the HC/NBL ratio, which predicted trisomy 21 with good diagnostic accuracy. In identifying normal-karyotype fetuses, the NBL MoM was highly accurate.

EP15.10: Effect of maternal demographics and clinical characteristics on fetal biometric measurements: a pilot study

EP15.10: Effect of maternal demographics and clinical characteristics on fetal biometric measurements: a pilot study

A system-on-chip solution for deep learning-based automatic fetal biometric measurement

Ultrasound assessment of fetal biometry is widely used for gestational age prediction and abnormal fetal growth diagnosis. However, manual biometric measurements require time-consuming procedures and current automated measurement approaches remain challenging in terms of accuracy and computational complexity. This paper proposes deep learning-based efficient automatic fetal biometry measurement method for system-on-chip (SoC) solution. For end-to-end automated measurements, a hardware-friendly bilateral segmentation network (H-BiSeNet) was designed and optimized for multiple fetal objects (i.e., head, abdomen and femur), and fetal biometric parameters were then calculated with a robust multiple keypoint detection algorithm. For hardware implementation with a SoC, a deep learning processing unit (DPU) was employed to accelerate the proposed segmentation network, and biometric measurements with image pre- and postprocessing were conducted on an application processing unit (APU). A total of 6000 fetal ultrasound images in the three regions were collected from 2568 subjects, and the dataset was utilized to train the proposed network. In the performance evaluation, the proposed segmentation network with optimal quantization (H-BiSeNet-Q) outperformed other segmentation networks (i.e., U-Net, U-Net++, Attention U-Net, U-Net3+, DeepLabv3 + and BiSeNetv2) in terms of the average Dice coefficient, and automated measurements with H-BiSeNet-Q were highly correlated with manual measurements (r ≥ 0.983, p < 0.01 for all parameters, i.e., biparietal diameter, head circumference, abdominal circumference and femur length). In the execution time analysis, H-BiSeNet-Q ran at 4.25 frames per second (FPS) with parallelism corresponding to 80% resource utilization in the SoC. These results showed feasibility in low-resource hardware settings such as portable ultrasound systems.

Reference Ranges and Development Patterns of Fetal Myocardial Function Using Speckle Tracking Echocardiography in Healthy Fetuses at 17 to 24 Weeks of Gestation.

The purposes of the study were to develop reference ranges and maturation patterns of fetal cardiac function parameters measured by speckle tracking echocardiography (STE) using multiple biometric variables at 17 to 24 weeks' gestation among Thai fetuses and to compare with other previous reports. The four-chamber view of the fetal heart in 79 healthy fetuses was suitably analyzed by STE to establish the best-fit regression model. The 95% reference intervals and Z-score equations of fetal cardiac function parameters were computed. The fractional area change of both ventricles, left ventricular (LV) end-diastolic and end-systolic volumes, LV stroke volume, LV cardiac output (CO), and LV CO per kilogram were all increased according to gestational age (GA) and five fetal biometric measurements. However, the global longitudinal strain, basal-apical length fractional shortening (BAL-FS), BAL annular free wall and septal wall FS, BAL free wall and septal wall annular plane systolic excursions, 24-segment transverse width FS, as well as LV ejection fraction were all independent of GA or other somatic characteristics. There were varying development patterns between fetal right and left ventricles of these cardiac function indices across the gestation period. Our study created Z-score and corresponding centile calculators, 5th and 95th centile reference tables, and corresponding graphs and determined the normal evolution across gestation using multiple somatic growth and age variables between 17 and 24 gestational weeks. These nomograms serve as an essential prerequisite for quantitatively evaluating fetal cardiac contractility and allow for precisely detecting early changes in the fetal heart function. · Most fetal cardiac function measurements were correlated with all the independent variables.. · Fetal ventricular function parameters have their own characteristic maturation changes.. · Racial variability may not occupy an important place for fetal myocardial function during these GA..

Can prenatal ultrasound predict adverse neonatal outcomes in SARS-CoV-2–affected pregnancies?

On the basis of available data, at least 1 ultrasound assessment of pregnancies recovering from SARS-CoV-2 infection is recommended. However, reports on prenatal imaging findings and potential associations with neonatal outcomes following SARS-CoV-2 infection in pregnancy have been inconclusive. This study aimed to describe the sonographic characteristics of pregnancies after confirmed SARS-CoV-2 infection and assess the association of prenatal ultrasound findings with adverse neonatal outcomes. This was an observational prospective cohort study of pregnancies diagnosed with SARS-CoV-2 by reverse transcription polymerase chain reaction between March 2020 and May 2021. Prenatal ultrasound evaluation was performed at least once after diagnosis of infection, with the following parameters measured: standard fetal biometric measurements, umbilical and middle cerebral artery Dopplers, placental thickness, amniotic fluid volume, and anatomic survey for infection-associated findings. The primary outcome was the composite adverse neonatal outcome, defined as ≥1 of the following: preterm birth, neonatal intensive care unit admission, small for gestational age, respiratory distress, intrauterine fetal demise, neonatal demise, or other neonatal complications. Secondary outcomes were sonographic findings stratified by trimester of infection and severity of SARS-CoV-2 infection. Prenatal ultrasound findings were compared with neonatal outcomes, severity of infection, and trimester of infection. A total of 103 SARS-CoV-2-affected mother-infant pairs with prenatal ultrasound evaluation were identified; 3 cases were excluded because of known major fetal anomalies. Of the 100 included cases, neonatal outcomes were available in 92 pregnancies (97 infants); of these, 28 (29%) had the composite adverse neonatal outcome, and 23 (23%) had at least 1 abnormal prenatal ultrasound finding. The most common abnormalities seen on ultrasound were placentomegaly (11/23; 47.8%) and fetal growth restriction (8/23; 34.8%). The latter was associated with a higher rate of the composite adverse neonatal outcome (25% vs 1.5%; adjusted odds ratio, 22.67; 95% confidence interval, 2.63-194.91; P<.001), even when small for gestational age was removed from this composite outcome. The Cochran Mantel-Haenszel test controlling for possible fetal growth restriction confounders continued to show this association (relative risk, 3.7; 95% confidence interval, 2.6-5.9; P<.001). Median estimated fetal weight and birthweight were lower in patients with the composite adverse neonatal outcome (P<.001). Infection in the third trimester was associated with lower median percentile of estimated fetal weight (P=.019). An association between placentomegaly and third-trimester SARS-CoV-2 infection was noted (P=.045). In our study of SARS-CoV-2-affected maternal-infant pairs, rates of fetal growth restriction were comparable to those found in the general population. However, composite adverse neonatal outcome rates were high. Pregnancies with fetal growth restriction after SARS-CoV-2 infection were associated with an increased risk for the adverse neonatal outcome and may require close surveillance.

Standardization and quality control of Doppler and fetal biometric ultrasound measurements in low-income setting.

The aim of this study was to determine the quality of fetal biometry and pulsed-wave Doppler ultrasound measurements in a prospective cohort study in Uganda. This was an ancillary study of the Ending Preventable Stillbirths by Improving Diagnosis of Babies at Risk (EPID) project, in which women enroled in early pregnancy underwent Doppler and fetal biometric assessment at 32-40 weeks of gestation. Sonographers undertook 6 weeks of training followed by onsite refresher training and audit exercises. A total of 125 images for each of the umbilical artery (UA), fetal middle cerebral artery (MCA), left and right uterine arteries (UtA), head circumference (HC), abdominal circumference (AC) and femur length (FL) were selected randomly from the EPID study database and evaluated independently by two experts in a blinded fashion using objective scoring criteria. Inter-rater agreement was assessed using modified Fleiss' kappa for nominal variables and systematic errors were explored using quantile-quantile (Q-Q) plots. For Doppler measurements, 96.8% of the UA images, 84.8% of the MCA images and 93.6% of the right UtA images were classified as of acceptable quality by both reviewers. For fetal biometry, 96.0% of the HC images, 96.0% of the AC images and 88.0% of the FL images were considered acceptable by both reviewers. The kappa values for inter-rater reliability of quality assessment were 0.94 (95% CI, 0.87-0.99) for the UA, 0.71 (95% CI, 0.58-0.82) for the MCA, 0.87 (95% CI, 0.78-0.95) for the right UtA, 0.94 (95% CI, 0.87-0.98) for the HC, 0.93 (95% CI, 0.87-0.98) for the AC and 0.78 (95% CI, 0.66-0.88) for the FL measurements. The Q-Q plots indicated no influence of systematic bias in the measurements. Training local healthcare providers to perform Doppler ultrasound, and implementing quality control systems and audits using objective scoring tools in clinical and research settings, is feasible in low- and middle-income countries. Although we did not assess the impact of in-service retraining offered to practitioners deviating from prescribed standards, such interventions should enhance the quality of ultrasound measurements and should be investigated in future studies. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

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.

Accuracy of Trans-Cerebellar Diameter and Placental Thickness in Third Trimesteric Pregnant Women for Calculation of Gestational Age: A Cross Sectional Study

Background: Accurate determination of gestational age has become important for deciding the appropriate time for termination of the pregnancy as well as to monitor the fetal growth during the entire period of pregnancy. Objective: The aim of the study was to assess whether the trans-cerebellar diameter, placental thickness or combining both of them is more accurate for assessment of gestational age in the 3rd trimester of pregnancy. Patients and Methods: This is a cross sectional study conducted at outpatient Clinic and Obstetric ward, Ain Shams University Maternity Hospital, over a period of six months from March 2019 to September 2019. One hundred pregnant women were recruited according to inclusion criteria either from outpatient clinic or were admitted in obstetric ward Ain Shams Maternity Hospital to find out the most accurate fetal biometric measurement in the third trimester either trans-cerebellar diameter placental thickness or both compared to reliable LMP (last menstrual period) dates confirmed by crown rump length (CRL) in the first trimester. Results: Trans-cerebellar diameter mean ± SD was 46.0 ± 3.5 with range 38.2 - 51.7. The mean of placental thickness was 39.6 ± 7.1 with range 22.8 - 54.3. Placental thickness had highest determination (0.813) for last menstrual period followed by trans-cerebellar diameter (0.802). Combining trans-cerebellar diameter and placental thickness increased determination (0.902) for last menstrual period. Conclusion: Combined use of trans-cerebellar diameter and placental thickness in the third trimester of pregnancy is a reliable indicator for gestational age in women whose last menstrual period is unreliable or unknown, but placental thickness had higher accuracy than trans-cerebellar diameter.

Evaluation of Fetal Head Circumference (HC) and Biparietal Diameter (BPD (Biparietal Diameter)) in Ultrasound Images Using Multi-Task Deep Convolutional Neural Network

Introduction: Ultrasound imaging is a standard examination during pregnancy that can measure specific biometric parameters towards prenatal diagnosis and estimating gestational age. Fetal head circumference (HC) is a significant factor in determining fetus growth and health. Methods: This paper proposes a multi-task deep convolutional neural network for automatic segmentation and estimation of HC (Fetal head circumference) ellipse by minimizing a compound cost function composed of segmentation dice score and MSE of ellipse parameters. Ultrasound-based fetal biometric measurements, such as head circumference (HC) and biparietal diameter (BPD (BIPARIETAL DIAMETER)), are commonly used to evaluate the gestational age and diagnose fetal central nervous system (CNS) pathology. Since manual measurements are operator-dependent and time-consuming, there have been numerous researches on automated methods. However, existing computerized methods still are not satisfactory in terms of accuracy and reliability, owing to difficulties in dealing with various artefacts in ultrasound images. Results: This paper focuses on fetal head biometry and develops a deep-learning-based method for estimating HC (Fetal head circumference) and BPD (BIPARIETAL DIAMETER) with a high degree of accuracy and reliability. Conclusion: The proposed method effectively identifies the head boundary by differentiating tissue image patterns concerning the ultrasound propagation direction. The proposed method was trained with 102 labelled data set and tested to 70 ultrasound images. We achieved a success rate of 92.31% for HC (Fetal head circumference) and BPD (BIPARIETAL DIAMETER) estimations and an accuracy of 87.14% for the plane acceptance check.

Maternal Serum Gasdermin D Concentrations in Pregnancies Complicated by Isolated Intrauterine Growth Restriction.

We aimed to investigate the relationship between the isolated intrauterine growth restriction (IUGR) and maternal serum gasdermin D (GSDMD) concentration. This cross-sectional study was conducted with 80 pregnant women who applied to the Umraniye Training and Research Hospital Gynecology and Obstetrics Clinic between January 2022 and May 2022. The IUGR group consisted of 40 pregnant women diagnosed with IUGR in the third trimester, and the control group consisted of 40 healthy pregnant women matched with the IUGR group in terms of age and BMI. Demographic characteristics, ultrasound findings, and neonatal outcomes were noted. The two groups were compared in terms of maternal serum GSDMD concentrations. Both groups were similar in terms of demographic characteristics. Fetal biometric measurements were found to be significantly lower in the IUGR group compared to the control group, and umbilical artery Doppler PI and SD were found to be higher. Gestational age, newborn birth weight, birth height, and Apgar scores were significantly lower and NICU admission rate was higher in the IUGR group. Gestational age at blood sampling for GSDMD was similar in both groups (p=0.805). While maternal serum GSDMD concentration was 11.14 ng/ml in the IUGR group, it was 6.66 ng/ml in the control group (p=0.000). ROC analysis was performed to determine the value of GSDMD concentration in terms of IUGR estimation. AUC analysis of GSDMD for IUGR estimation was 0.88 (p<.001, 95% CI=0.80-0.95). The optimal cutoff value for GSDMD concentration was determined as 8.84 ng/ml with 80% sensitivity and 75% specificity. Maternal serum GSDMD concentrations were found to be higher in pregnant women whose pregnancy was complicated by isolated IUGR. We think that high GSDMD concentrations may be a reflection of increased GSDMD-mediated pyroptosis in placental tissue in isolated IUGR cases.

Student Competency for Midtrimester Obstetrics Scan upon Completion of the Master's Degree in Medical Sonography.

To evaluate the competency of medical sonographer students who have completed training to estimate the gestational age (GA) and perform fetal biometric measurements compared to obstetricians. We conducted a cross-sectional observational study at the end of the medical sonographer students' practice sessions. In total, 80 midtrimester (18-28 weeks) pregnant women were recruited, and an ultrasound was performed according to the International Society of Sonography in Obstetrics and Gynecology (ISUOG) guideline. Estimated GA calculated from fetal biometric measurements was compared between medical sonographer students and qualified obstetricians. Subsequently, images were randomly evaluated by maternal-fetal medicine specialists to assess the measurement performance. There was no significant difference in the estimated GA between the medical sonographer students and obstetricians (mean difference, 0.01 ± 2.92 day, p = 0.89). However, there was a significant difference in the measurement of the head circumference (HC) and abdominal circumference (AC) (p < 0.001). The overall image quality of the fetal head, abdomen, and femur was considered a good to excellent score (77.5%-80%). There was a perfect and nearly perfect agreement regarding the presence of the placenta previa, adequacy of amniotic fluid, and position of the placenta (k = 0.9-1.0). The medical sonographer students demonstrated competency in GA estimation by fetal biometry measurement similar to obstetricians. However, the quality of the acquired images, according to the ISUOG recommendation, needs improvement, and this should be emphasized in the sonography course curriculum. The results suggest that medical sonographers can relieve obstetricians' workload for ultrasound screening in midtrimester pregnancies.

Three-versus Two-Dimensional Sonographic Biometry for Predicting Birth Weight at Term

Because aberrant intrauterine growth is related with increased newborn morbidity and death, an accurate estimate of foetal weight is a crucial issue in perinatal treatment. Fetal biometric measures were taken using a 2D ultrasound to determine the birth weight of the baby. The purpose of this study is to compare the reliability of the traditional two-dimensional Hadlock formula for predicting foetal weight to that of three-dimensional ultrasound measurements of foetal thigh volume. Methods: One hundred pregnant women who presented to the Obstetrics and Gynecology department at Benha University Hospital with a singleton live pregnancy between weeks 37 and 40 and no foetal abnormality were included in the research. Patients carrying more than one child, who were in active labour, or who were pregnant with a medical condition were not included in the research. Before anybody took part in the research, they signed informed consent forms. The ranges for anticipated weight using 2D and 3D sonography are (2540–4010) and (2670–3810), respectively. Variations in 3D sonographic thigh volume were seen between (59.62 to 92.52). Comparing the weight predicted by 2D sonography and 3D sonography yielded similar results (P=0.883). Two-dimensional sonography could not accurately predict birth weight (P = 0.582). The discrepancy between the 3D sonographer's estimate and the actual birth weight was not statistically significant (P = 0.403). Actual birth weight was positively correlated with 2D sonography prediction (P 0.001). The actual birth weight was also positively correlated with the anticipated birth weight using 3D sonography (P 0.001). Predicting an expected birth weight for a foetus is aided by measuring the fractional TVol, the authors conclude. Measurements of fractional limb volume may be used to assess foetal size and growth at various stages of pregnancy, and future quantitative investigations should provide light on this topic. Exploring the best birth weight algorithm that adds TVol into conventional birth weight formulas requires large prospective research. Before this indicator may be used in clinical practise, further prospective studies are needed to determine whether or not soft tissue alterations, as measured by TVol, are associated with foetal growth limitation or macrosomia.

Relationships between intrauterine fetal growth trajectories and markers of adiposity and inflammation in young adults

BackgroundThere is now good evidence that events during gestation significantly influence the developmental well-being of an individual in later life. This study aimed to investigate the relationships between intrauterine growth trajectories determined by serial ultrasound and subsequent markers of adiposity and inflammation in the 27-year-old adult offspring from the Raine Study, an Australian longitudinal pregnancy cohort.MethodsUltrasound fetal biometric measurements including abdominal circumference (AC), femur length (FL), and head circumference (HC) from 1333 mother-fetal pairs (Gen1–Gen2) in the Raine Study were used to develop fetal growth trajectories using group-based trajectory modeling. Linear mixed modeling investigated the relationship between adult body mass index (BMI), waist circumference (WC), and high-sensitivity C-reactive protein (hs-CRP) of Gen2 at 20 (n = 485), 22 (n = 421) and 27 (n = 437) years and the fetal growth trajectory groups, adjusting for age, sex, adult lifestyle factors, and maternal factors during pregnancy.ResultsSeven AC, five FL and five HC growth trajectory groups were identified. Compared to the average-stable (reference) group, a lower adult BMI was observed in two falling AC trajectories: (β = −1.45 kg/m2, 95% CI: −2.43 to −0.46, P = 0.004) and (β = −1.01 kg/m2, 95% CI: −1.96 to −0.05, P = 0.038). Conversely, higher adult BMI (2.58 kg/m2, 95% CI: 0.98 to 4.18, P = 0.002) and hs-CRP (37%, 95% CI: 9–73%, P = 0.008) were observed in a rising FL trajectory compared to the reference group. A high-stable HC trajectory associated with 20% lower adult hs-CRP (95% CI: 5–33%, P = 0.011).ConclusionThis study highlights the importance of understanding causes of the unique patterns of intrauterine growth. Different fetal growth trajectories from early pregnancy associate with subsequent adult adiposity and inflammation, which predispose to the risk of diabetes and cardiometabolic disease.

Increased fetal epicardial fat thickness: A reflecting finding for GDM and perinatal outcomes.

To study the value of fetal epicardial fat thickness (EFT) in gestational diabetes mellitus in the third trimester of pregnancy and its relationship with clinical parameters and perinatal outcomes. A total of 80 participants, including 40 with diagnosed GDM and 40 healthy pregnant women, were included in the study. Demographic data were obtained from medical records. Sonographic examinations were performed, such as amniotic fluid value, fetal biometric measurements, and Doppler parameters of the umbilical artery. Fetal EFT values were measured at the free wall of the right ventricle using a reference line with echocardiographic methods. Correlation tests were performed to evaluate the relationship between fetal EFT and clinical and perinatal parameters. p<.05 were interpreted as statistically significant. The fetal EFT value was statistically higher in the GDM group than in the control group (p: .000). Spearman and Pearson correlation tests revealed statistically significant but weak positive correlations between fetal EFT value, 1-h 100-g OGTT, birth weight, and BMI (r: .198, p: .047; r: .395, p: .012; r: .360, p: .042, respectively). The optimal fetal EFT threshold for predicting GDM disease was found as 1.55mm, with a specificity of 74.4% and sensitivity of 75.0%. Statistically significant differences between the two groups in umbilical artery Doppler resistance index (RI), pulsatility index (PI), and systolic/diastolic ratio (S/D) were not found (p: .337; p: .503; p: .155;). BMI and amniotic fluid volume were higher in the GDM group compared to the control group (p: .009; p<.01). This study demonstrated that increased fetal EFT may occur as a reflection of changes in glucose metabolism in intrauterine life. Future studies with larger series, including the study of neonatal metabolic parameters, will contribute to the understanding of the importance of fetal EFT in determining the metabolic status of the fetus.