Fetal Femur Research Articles

Which ultrasound or biochemical markers are independent predictors of small‐for‐gestational age?

To investigate which ultrasound or biochemical markers in both the first and the second trimesters are the best predictors for fetal growth and small-for-gestational age (SGA). This was a prospective study of 619 Chinese women with a singleton pregnancy. At 11 to 13 + 6 weeks, fetal crown-rump length (CRL), placental volume (PlaV), uterine artery pulsatility index (UtA-PI), and the maternal serum levels of pregnancy-associated plasma protein-A (PAPP-A) and free beta-human chorionic gonadotropin (beta-hCG) were measured. Fetal biparietal diameter, femur length, abdominal and head circumference, PlaV and UtA-PI were then measured at 18-22 weeks. All markers were transformed to gestational age-specific Z-scores or multiples of the median (MoM). Birth weights were also transformed to Z-scores using the individualized gestational age-related optimal weight based on a locally derived nomogram. The relationship between all markers and the customized birth weight were examined, and their predictive powers for SGA were examined by regression analysis. Univariate analysis revealed that all markers except free beta-hCG correlated with birth weight Z-score. After multiple linear regression analysis, only PlaV, UtA-PI and CRL in the first trimester, and PlaV and UtA-PI in the second trimester, stood out as independent markers. Logistic regression analysis showed that PlaV was the only independent first-trimester predictor of SGA, and in the second trimester both PlaV and UtA-PI were independent predictors. The sensitivity of these first- and second-trimester markers in predicting SGA were 41% and 45%, respectively, at a false-positive rate of 20%. Combining them did not significantly improve prediction of SGA. Among the various known ultrasound and biochemical markers, only the first-trimester PlaV and the second-trimester PlaV plus UtA-PI are independent predictors for SGA.

1368: Gestational Age Prediction by Femur Length in Bangladesh

Fetal femur length is an important parameter for determining gestational age. If we use tables based on our own population, gestational age estimation will be more accurate. This study was therefore designed to determine the gestational age by fetal femur length measurement in our country. Healthy gravid patients with optimal dates were included in a prospective study. Fetal femur length along with other parameters was measured. A table and a graph were prepared by Polynomial regression model. Previously established nomograms were compared with it. The gestational age estimated from the femur length measurements of 1223 healthy gravid momen, from 13 to 40 weeks are presented here in a tabulated form. 3rd. 10th, 50th, 90th and 97th Percentiles, mean and standard deviations were also derived. The quadratic model showed a good fit to the data when superimposed on the scater diagram. It gave 95% confidence interval. Also model was fitted seperately to standard deviations as a function of gestational age. There was a gradual increase of the femur length measurements up to 37th week. From 13 to 27 weeks gestation, there was no clinically important difference between this and western nomograms for predicting gestational age but after 32 weeks the difference with western nomograms became significant. This nomogram is unique for Bangladeshi population. It will give more accurate gestational age assessment than the western tables that are still followed in our country, especially in the 3rd trimester.

1369: Fetal Femur Length and Abdominal Circumference Ratio in Bangladesh

The ratio of fetal femur length and abdominal circumference is one of the important ratios. But we do not have any study on it in our country so far. Therefore a study was conducted to prepare a table based on Bangladeshi population.

Fetal and postnatal growth and blood pressure at the age of 2 years. The Generation R Study

To examine which fetal and postnatal growth characteristics are associated with blood pressure (BP) in children at the age of 2 years. This study was embedded in the Generation R Study, a population-based prospective cohort study from early fetal life onwards. Fetal ultrasound examinations were carried out at the visits in one of the research centers in early, mid- and late pregnancy. Fetal femur length standard deviation scores (SDS) were used as a proxy for body length SDS in the prenatal data. BP measurements were performed at the age of 2 years. Analyses were performed in 566 children. Inverse tendencies for fetal femur length and estimated fetal weight in mid-pregnancy and late pregnancy with SBP at the age of 2 years were found. The association was only significant for femur length in late pregnancy [-1.22 {95% confidence interval (CI), -2.09, -0.34} mmHg/femur length SDS score]. Length change from late pregnancy to the age of 2 years was positively associated with SBP and DBP [0.97 (95% CI, 0.27, 1.66) mmHg and 0.82 (95% CI, 0.09, 1.55) mmHg per SDS length change, respectively]. A similar association between weight change and SBP was found. Increased skeletal and nonskeletal growth rates from late pregnancy to the age of 2 years are associated with somewhat higher SBP and DBP in early childhood. Replication of these findings and studies examining the underlying biological pathways and the long-term consequences are needed.

Prenatal diagnosis of achondroplasia: new specific signs

Achondroplasia is one of the most common forms of short limb dwarfism. It is usually suspected on third trimester routine ultrasound because of very shortened long bones. We have described two new prenatal sonographic signs of achondroplasia visible at the proximal femoral metaphysis. Over 5 years, five fetuses were diagnosed with achondroplasia at the Grenoble Prenatal Diagnosis Centre. Ultrasound and tomographic examinations were performed by specialists. To study the proximal metaphysis, the ultrasound transducer was positioned at a 45 degree angle to the diaphyseal axis. Postnatal diagnosis was confirmed. On computed tomography and postnatal X-ray, proximal femoral metaphysis appeared rounded, with poor, uneven ossification. Connexion to diaphysis was abnormal, with relative overgrowth of the periosteum, creating a new diagnostic sign that we called the 'collar hoop' sign. On ultrasound, all fetuses had a very rounded metaphyseal-epiphyseal interface, with an angle connexion to diaphysis wider than expected. The 'collar hoop' sign was obvious on four of the fetuses. During the same period, proximal femoral metaphyses appeared normal in 653 healthy fetuses, suggesting high specificity of those two new signs. Metaphysis examination is recommended if fetal femur length measures below the fifth percentile, as normal aspect may rule out achondroplasia.

Parathyroid hormone (PTH) values, Vitamin D status, Fetal bone Growth and Placental RANK‐L expression among Pregnant Adolescents

Pregnant adolescents may be at risk for suboptimal vitamin D status and bone loss across pregnancy. RANK/RANK‐L/OPG interactions are integral to osteoclast activity and alterations in RANK‐L expression may be associated with the critical balance between maternal bone loss and fetal bone growth during pregnancy. To assess these issues, vitamin D status (25‐hydroxyvitamin D) was monitored in pregnant adolescents (<18 years old) and their neonates in relation to longitudinal measures of fetal femur and humerus growth, and placental expression of RANK‐L. Fetal femur and humerus length was obtained by sonogram three times across gestation to assess fetal bone growth. Blood samples were collected from each adolescent mid‐gestation and at parturition when cord blood and placental tissue were also obtained. In 25 adolescents studied to date, expression of soluble RANK‐L in the placenta approached significance as a predictor of fetal bone growth (p=.066). At delivery, 71% (n=17) of teens had elevated PTH (>46 pg/mL). 41% (n=43) of teens and 63% of neonates (n=38), had suboptimal vitamin D levels (<20 ng/mL). Recruitment and analyses are on‐going and additional relationships between serum osteoprotegerin (OPG), maternal bone loss, and fetal bone accrual across pregnancy will be explored.Grant Funding SourceUSDA Grant No: 2008‐01857

The Monocarboxylate Transporter 8 and L-Type Amino Acid Transporters 1 and 2 Are Expressed in Mouse Skeletons and in Osteoblastic MC3T3-E1 Cells

Several plasma membrane transporters have been shown to mediate the cellular influx and/or efflux of iodothyronines, including the sodium-independent organic anion co-transporting polypeptide 1 (OATP1), the sodium taurocholate co-transporting polypeptide (NTCP), the L-type amino acid transporter 1 (LAT1) and 2 (LAT2), and the monocarboxylate transporter 8 (MCT8). The aim of this study was to investigate if the mRNAs of these transporters were expressed and regulated by thyroid hormone (TH) in mouse calvaria-derived osteoblastic MC3T3-E1 cells and in the fetal and postnatal bones of mice. The mRNA expression of the iodothyronine transporters was investigated with real-time polymerase chain reaction analysis in euthyroid and hypothyroid fetuses and litters of mice and in MC3T3-E1 cells treated with increasing doses of triiodothyronine (T(3); 10(-10) to 10(-6) M) or with 10(-8) M T(3) for 1-9 days. MCT8, LAT1, and LAT2 mRNAs were detected in fetal and postnatal femurs and in MC3T3-E1 cells, while OATP1 and NTCP mRNAs were not. LAT1 and LAT2 mRNAs were not affected by TH status in vivo or in vitro or by the stage of bone development or osteoblast maturation (analyzed by the expression of osteocalcin and alkaline phosphatase, which are key markers of osteoblastic differentiation). In contrast, the femoral mRNA expression of MCT8 decreased significantly during post-natal development, whereas MCT8 mRNA expression increased as MC3T3-E1 cells differentiated. We also showed that MCT8 mRNA was up-regulated in the femur of hypothyroid animals, and that it was down-regulated by treatment with T(3) in MC3T3-E1 cells. This is the first study to demonstrate the mRNA expression of LAT1, LAT2, and MCT8 in the bone tissue of mice and in osteoblast-like cells. In addition, the pattern of MCT8 expression observed in vivo and in vitro suggests that MCT8 may be important to modulate TH effects on osteoblast differentiation and on bone development and metabolism.

Sonographic fetal weight estimation in prolonged pregnancy: comparative study of two‐ and three‐dimensional methods

To compare two-dimensional (2D) and three-dimensional (3D) ultrasound techniques, including volumetry of fetal thigh, for fetal weight (FW) estimation in prolonged pregnancy, and to develop a new FW estimation formula. This prospective comparative study initially included 176 pregnant women. FW estimation was performed at >or= 287 days of gestation within <or= 4 days of delivery. Fetal head, abdomen and femur were measured using 2D ultrasound techniques, and fetal thigh volume was estimated using 3D techniques. The formula of Persson and Weldner (2D) was compared with two 3D formulae published by Lee and colleagues. In a subgroup of 63 fetuses, volumetry of the abdomen was performed and a new formula was developed; this formula was tested prospectively, along with the previously published formulae, on a further 50 women (Test Group). In the initial group of 176 pregnancies, the SD of the mean percentage error (MPE) was 6.3% for both the 2D Persson and Weldner formula and for the better performing 3D formula of Lee et al., but the MPE of this Lee formula differed significantly from zero. Significantly more FW estimations were within +/- 10% of the birth weight when the 2D formula was used than when the 3D formulae were applied. The new formula gave a SD of MPE of 5.6% when applied to the data from which it was derived. In the Test Group, the SD of MPE was similar for the 2D formula, the second formula of Lee et al. and the new formula, with values of 7.0, 7.0 and 7.1, respectively, but only the Persson and Weldner formula showed a MPE that did not differ significantly from zero. FW in prolonged pregnancies can be estimated using 2D sonography with the same accuracy as with 3D sonography. 3D ultrasound techniques require technically advanced and expensive equipment, special operator training and skills, and are time consuming. It does not seem reasonable to abandon the 2D ultrasound methods in favor of 3D ultrasound imaging for FW estimation.

OC192: Ultrasound weight estimation of large fetuses: A comparative study of two‐ and three‐dimensional methods

Objectives: To compare two-dimensional (2D) and threedimensional (3D) ultrasound techniques, including volumetry of fetal thigh, for weight estimation of large fetuses, and to develop a new fetal weight (FW) estimation formula. Methods: In a prospective comparative study FW estimation was done on 176 pregnant women at ≥287 days of gestation ≤ 4 days before delivery. Fetal head (BPD or HC), abdomen (AD) and femur were measured with 2D ultrasound technique and the volume of fetal thigh (Tvol) was estimated with 3D technique. The 2D formula of Persson and Weldner (1) was compared with the 3D formula of Lee et al(2). A new formula was developed in a subgroup of 63 fetuses where volumetry of abdomen (Abdvol) was done and the formula (FW = 2088.4904 + 81.0519 × HC − 0.1214 × HC × HC − 69.0966 × AD + 0.4741 × AD × AD + 6.4044 × Tvol + 0.0534 × Abdvol) was tested on another 50 women. Results: Standard deviation (SD) of the mean percent error (MPE) was 6.3% for both the 2D and 3D formulas, and 5.6% for the new formula. Significantly more FW estimated by the 2D formula and the new formula than by the 3D formulas were within both ±5% and ±10% of the birth weight, 50 and 86% (Persson and Weldner), 52 and 86% (new formula), 41 and 73% (Lee), respectively. In the independent Test group the SD of MPE was similar for the 2D, 3D and new formulas, 7.02, 7.04 and 7.09%, respectively. Conclusion: FW of large fetuses was estimated using 2D ultrasound method with same accuracy as with 3D ultrasound. 3D ultrasound technique requires technically advanced and expensive equipment, special operator training and skills, and it is time consuming. At present, to abandon the 2D ultrasound method in favour of 3D ultrasound for FW estimation seems not reasonable.

Effect of fasting during Ramadan on fetal development and maternal health

The aim of the present study was to determine whether fasting during Ramadan causes ketonemia and/or ketonuria and their effects on fetal intrauterine development. Thirty-six consecutive healthy women with uncomplicated pregnancies of >or=20 weeks of gestation who were fasting during Ramadan were included in the study group (group 1). The control group (group 2) consisted of 29 healthy pregnant women who were not fasting. Doppler ultrasonography was performed in all subjects in the beginning and at the end of Ramadan to evaluate the changes in the following measurements: fetal biparietal diameter; fetal femur length; and estimated fetal body weight. Fetal biophysical profile, amniotic fluid index, and umbilical artery systole/diastole ratio were measured in the beginning and at the end of Ramadan. Effects of fasting on the mother were evaluated by measuring serum concentrations of 3ss hydroxybutyrate and glucose, and urinary concentration of ketone. Subjects with any of the followings were excluded: diabetes; thyroid dysfunction; Cushing's syndrome; adrenal disease; pre-eclampsia; and multiple pregnancy. The mean duration of fasting in the study group was 18 +/- 2.1 days. The mean maternal glucose level was significantly lower in the study group than in the control group (P = 0.003). No statistically significant differences were found between the two groups in the comparisons of other parameters. We concluded that fasting during Ramadan does not lead to maternal ketonemia or ketonuria in pregnant women. In addition, fasting during Ramadan has no significant adverse effect on intrauterine fetal development or the fetus's health.

Fetal size in the second trimester is associated with the duration of pregnancy, small fetuses having longer pregnancies

BackgroundConventionally, the pregnancy duration is accepted to be 280–282 days. Fetuses determined by ultrasound biometry to be small in early pregnancy, have an increased risk of premature birth. We speculate that the higher rate of preterm delivery in such small fetuses represents a pathological outcome not applicable to physiological pregnancies. Here we test the hypothesis that in low-risk pregnancies fetal growth (expressed by fetal size in the second trimester) is itself a determinant for pregnancy duration with the slower growing fetuses having a longer pregnancy.MethodsWe analysed duration of gestation data for 541 women who had a spontaneous delivery having previously been recruited to a cross-sectional study of 650 low-risk pregnancies. All had a regular menses and a known date of their last menstrual period (LMP). Subjects were examined using ultrasound to determine fetal head circumference (HC), abdominal circumference (AC) and femur length (FL) at 10–24 weeks of gestation. Length of the pregnancy was calculated from LMP, and birth weights were noted. The effect of fetal size at 10–24 weeks of gestation on pregnancy duration was assessed also when adjusting for the difference between LMP and ultrasound based fetal age.ResultsSmall fetuses (z-score -2.5) at second trimester ultrasound scan had lower birth weights (p < 0.0001) and longer duration of pregnancy (p < 0.0001) than large fetuses (z-score +2.5): 289.6 days (95%CI 288.0 to 291.1) vs. 276.1 (95%CI 273.6 to 278.4) for HC, 289.0 days (95%CI 287.4 to 290.6) vs. 276.9 days (95%CI 274.4 to 279.2) for AC and 288.3 vs. 277.9 days (95%CI 275.6 to 280.1) for FL. Controlling for the difference between LMP and ultrasound dating (using HC measurement), the effect of fetal size on pregnancy length was reduced to half but was still present for AC and FL (comparing z-score -2.5 with +2.5, 286.6 vs. 280.2 days, p = 0.004, and 286.0 vs. 280.9, p = 0.008, respectively).ConclusionFetal size in the second trimester is a determinant of birth weight and pregnancy duration, small fetuses having lower birth weights and longer pregnancies (up to 13 days compared with large fetuses). Our results support a concept of individually assigned pregnancy duration according to growth rates rather than imposing a standard of 280–282 days on all pregnancies.

Outcome of Fetuses With Antenatally Diagnosed Short Femur

Short femur-below the fifth centile for gestational age might reflect inaccurate dating or may be a normal variant in a constitutionally small fetus, but it also has been associated with skeletal dysplasias and chromosomal abnormalities. Recent studies have reported an association between isolated short femur in the second trimester and delivery of a small-for-gestational age infant, possibly as the result of uteroplacental insufficiency. This retrospective study reviewed all pregnancies seen at a tertiary referral unit at 18-24 weeks' gestation with a fetal femur length below the fifth centile for gestational age. The gestational age and the size of the fetal nuchal translucency had been determined as part of a Down syndrome screening test at 11-14 weeks' gestation. Repeated fetal measurements identified 11 fetuses who did not have short femur. Of the 118 remaining cases, detailed ultrasonographic examination demonstrated associated abnormalities in 46, or 39%. Among these cases, the associated conditions were skeletal dysplasia (35%), chromosomal abnormalities (22%), and genetic syndromes (9%). In 35% of cases, the fetus had multiple anomalies without a specific diagnosis. In 72 instances, 61% of the total, short femur was an isolated finding. In 46% of isolated cases, evaluation revealed early, severe intrauterine growth restriction with abnormal umbilical artery Doppler findings, and delivery took place before 37 weeks' gestation. In 90% of these cases, abnormal uterine artery Doppler findings were apparent at the time of presentation. Preeclampsia developed in 36% of these pregnancies, and the rate of intrauterine death was 33%. Both of these events were considerably less frequent when uterine artery Doppler imaging was normal. In pregnancies with short fetal femur, the major determinants of outcome are the presence of other fetal abnormalities and abnormal uterine artery Doppler findings.

Correlação entre medidas ultra-sonográficas do coração e o deficit de hemoglobina em fetos de gestantes aloimunizadas

to verify the correlation between ultrasonography heart measures and hemoglobin deficit in fetuses of alloimmunized pregnant women. a transversal study, including 60 fetuses, with 21 to 35 weeks of gestational age, from 56 isoimmunized pregnant women. A number of 139 procedures were performed. Before cordocentesis for the collection of fetal blood, cardiac measures and femur length (FL) were assessed by ultrasonography. The external biventricular diameter (EBVD) was obtained by measuring the distance between the epicardic external parts at the end of the diastole, with the M-mode cursor perpendicular to the interventricular septum, in the atrioventricular valves. The measure of the atrioventricular diameter (AVD) was obtained by positioning the same cursor along the interventricular septum, evaluating the distance between the heart basis and apex. The FL was determined from the trochanter major to the distal metaphysis. The cardiac circumference (CC) was also calculated. To adjust the cardiac measure to the gestational age, each of these measures were divided by the FL measure. Hemoglobin concentration has been determined by spectrophotometry with the Hemocue system. Hemoglobin deficit calculation was based in the Nicolaides's normality curve. direct and significant correlations were observed between the cardiac measures evaluated and the hemoglobin deficit. To predict moderate and severe anemia, the sensitivity and specificity found were 71.7 and 66.3% for EBVD and FL, 65.8 and 62.4% for AVD and FL, and 73.7 and 60.4% for CC and FL, respectively. ultrasonography cardiac measures assessed from fetuses of isoimmunized pregnant women correlate directly with hemoglobin deficit.

Effects of voucher‐based incentives on abstinence from cigarette smoking and fetal growth among pregnant women

This study examined whether voucher-based reinforcement therapy (VBRT) contingent upon smoking abstinence during pregnancy is an effective method for decreasing maternal smoking during pregnancy and improving fetal growth. A two-condition, parallel-groups, randomized controlled trial was conducted in a university-based research clinic. A total of 82 smokers entering prenatal care participated in the trial. Participants were assigned randomly to either contingent or non-contingent voucher conditions. Vouchers exchangeable for retail items were available during pregnancy and for 12 weeks postpartum. In the contingent condition, vouchers were earned for biochemically verified smoking abstinence; in the non-contingent condition, vouchers were earned independent of smoking status. Smoking outcomes were evaluated using urine-toxicology testing and self-report. Fetal growth outcomes were evaluated using serial ultrasound examinations performed during the third trimester. Contingent vouchers significantly increased point-prevalence abstinence at the end-of-pregnancy (41% versus 10%) and at the 12-week postpartum assessment (24% versus 3%). Serial ultrasound examinations indicated significantly greater growth in terms of estimated fetal weight, femur length and abdominal circumference in the contingent compared to the non-contingent conditions. These results provide further evidence that VBRT has a substantive contribution to make to efforts to decrease maternal smoking during pregnancy and provide new evidence of positive effects on fetal health.

The effect of Ramadan fasting on maternal serum lipids, cortisol levels and fetal development

To determine the effects of fasting during the month of Ramadan on fetal development and maternal serum cortisol and lipid profile. This study was performed in Obstetrics and Gynecology Department of Gaziantep University Hospital, between 23 September 2006 and 23 October 2006 (during the month of Ramadan). Thirty-six consecutive healthy women with uncomplicated pregnancies of 20 weeks or more, who were fasting during Ramadan, were included in the study group (group 1). The control group (group 2) consisted of 29 healthy pregnant women, who were not fasting during the study period. For evaluating Ramadan's effect on fetus, Doppler ultrasonography was performed on all subjects in the beginning and then once a week until the end of Ramadan for the following measurements: increase of fetal biparietal diameter (BPD), increase of fetal femur length (FL), increase of estimated fetal body weight (EFBW), fetal biophysical profile (BPP), amniotic fluid index (AFI), and umbilical artery systole/diastole (S/D) ratio. Maternal serum cortisol, triglyceride, total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), very low density lipoprotein (VLDL), and LDL/HDL ratio were also evaluated before and after Ramadan. No significant difference was found between the two groups for the fetal age, maternal weight gain (kilogram), estimated fetal weight gain (EFWG), fetal BPP, AFI, and umbilical artery S/D ratio. In the fasting group, the maternal serum cortisol levels on day 20 were significantly higher than the initial levels obtained 1 week prior to Ramadan (p < 0.05). Although no significant increases were observed in total cholesterol and triglyceride levels in the fasting group, these increases were significantly higher than those in the control group (p < 0.05). LDL and VLDL levels showed a non-significant decrease at the end of the Ramadan. HDL levels showed a slight increase, but LDL/HDL ratios were significantly decreased in fasting group (p < 0.05). The results of this study showed that maternal serum cortisol level was elevated while LDL/HDL ratio were decreased in healthy women with uncomplicated pregnancies of 20 weeks or more, who were fasting during Ramadan. No untoward effect of Ramadan was observed on intrauterine fetal development.

Association of isolated short femur in the mid‐trimester fetus with perinatal outcome

To evaluate the prevalence of fetal isolated short femur in a cohort of women screened for Down syndrome by the integrated test, and to compare the outcome of fetuses with isolated short femur in the mid-trimester with that of fetuses with normal femur length (controls). This was a retrospective cohort study of 1262 women booked for antenatal care and delivery at University College London Hospital. All women had integrated testing in the late first and early second trimesters and a detailed anomaly scan in the mid-trimester. All scan reports, screening results and neonatal data were analyzed statistically. The fetal femur was short (< 5(th) percentile) in 5.1% of patients and 4.7% had isolated short femur. In pregnancies with isolated short femur, the birth weight was significantly lower and there were higher rates of small-for-gestational age (SGA) and low birth weight (LBW) infants, compared with controls (P < 0.01). The odds ratios for SGA and LBW in pregnancies with isolated short femur were 3.0 (95% CI, 1.5-5.9) and 2.60 (95% CI, 1.1-6.2), respectively. Isolated short femur was associated significantly with low levels of pregnancy-associated plasma protein-A (P = 0.001). Isolated short femur in the mid-trimester fetus is associated with fetal growth restriction and SGA. In the context of normal Down syndrome screening and a normal anomaly scan, this marker should be regarded as a predictor for SGA, and fetal growth should be monitored during these pregnancies.

Outcome of fetuses with antenatally diagnosed short femur

To examine the outcome of fetuses diagnosed with short femur length at the time of the routine anomaly scan. This was a retrospective review of all pregnancies referred to a tertiary referral unit with fetal femur length below the 5(th) centile for gestation at 18-24 weeks of gestation. All patients had undergone pregnancy dating and assessment of the risk of chromosomal abnormalities by measurement of fetal nuchal translucency at 11 to 13 + 6 weeks. Over 5 years, 129 cases were evaluated. Detailed ultrasound examination showed associated fetal abnormalities in 46 (36%) cases, and these were classified as non-isolated. In this group, skeletal dysplasias (n = 16), chromosomal abnormalities (n = 10) and genetic syndromes (n = 4) were the most common associations. In contrast, there were no cases of chromosomal abnormalities or skeletal dysplasia in the 83 (64%) isolated cases. Early severe intrauterine growth restriction (IUGR) with abnormal umbilical artery Doppler findings and delivery before 37 weeks occurred in 33/83 (40%) cases with isolated short femur, and 90% of these had abnormal uterine artery Doppler findings at the time of presentation. These pregnancies also had high rates of pre-eclampsia (36%) and intrauterine death (33%). Those with normal uterine artery Doppler imaging were at low risk for these complications. In a population previously screened by first-trimester fetal nuchal translucency measurement, the finding of isolated short femur at 18-24 weeks is unlikely to be due to aneuploidy. Severe IUGR associated with high mortality occurs in 40%, making uterine artery Doppler evaluation a useful clinical tool.

Fetal extremity kinetics quantified with Doppler ultrasonography

To assess the responsive fetal extremity movement to vibro-acoustic stimulation test (VAST). The moving velocity of fetal femur was assessed after VAST by pulsed Doppler device. The ultrasonic beam was insonated at a right angle to the fetal femur. The following parameters were determined: limb retreat velocity in accelerative slope (Pk1); limb replenishment velocity in decelerative slope (Pk2); mean flexion to extension velocity; and the response time to VAST. Among 80 normal singleton pregnancies in 33-41 weeks, 68 were weekly evaluated and the others were assessed for two or more times during the study period, for a total of 680 studies of fetal kinetics. The Pk1 declined from 9.6 to 6.26 cm/s; Pk2 decreased from 2.6 to 1.3 cm/s; mean velocity was reduced from 6.0 to 4.25 cm/s; whereas the response time increased from 0.1 to 0.3 s throughout the study period, i.e., fetal response reduces and the response time increases as maturation progresses. The pulsed Doppler may assess fetal activity in any body structure. Reflex responses become slow and complex on both the velocity and response time as maturation increases with gestational age. Our observations have resulted in a novel and easy method for the quantitative assessment of fetal reflex reactivity to external stimuli.

The Effect of Ambient Air Pollution during Early Pregnancy on Fetal Ultrasonic Measurements during Mid-Pregnancy

BackgroundOver the past decade there has been mounting evidence that ambient air pollution during pregnancy influences fetal growth.ObjectivesThis study was designed to examine possible associations between fetal ultrasonic measurements collected from 15,623 scans (13–26 weeks gestation) and ambient air pollution during early pregnancy.MethodsWe calculated mothers’ average monthly exposures over the first 4 months of pregnancy for the following pollutants: particulate matter < 10 μm aerodynamic diameter (PM10), ozone, nitrogen dioxide, and sulfur dioxide. We examined associations with fetal femur length (FL), biparietal diameter (BPD), head circumference (HC), and abdominal circumference (AC). Final analyses included scans from only those women within 2 km of an air pollution monitoring site. We controlled for long-term trend, season, temperature, gestation, mother’s age, socioeconomic status, and fetal sex.ResultsA reduction in fetal AC was associated with O3 during days 31–60 [−1.42 mm; 95% confidence interval (CI), −2.74 to −0.09], SO2 during days 61–90 (−1.67 mm; 95% CI, −2.94 to −0.40), and PM10 during days 91–120 (−0.78 mm; 95% CI, −1.49 to −0.08). Other results showed a reduction in BPD (−0.68 mm; 95% CI, −1.09 to −0.27) associated with SO2 during days 0–30, a reduction in HC (−1.02 mm; 95% CI, −1.78 to −0.26) associated with PM10 during days 91–120, and a reduction in FL associated with PM10 during days 0–30 (−0.28 mm; 95% CI, −0.48 to −0.08) and 91–120 (−0.23; 95% CI, −0.42 to −0.04).ConclusionWe found strong effects of ambient air pollution on ultrasound measures. Future research, including more individually detailed data, is needed to confirm our results.

COMPARISON OF MORPHOLOGICAL-BASED SEGMENTATION METHODS FOR FETAL FEMUR LENGTH MEASUREMENTS

Measurement of fetal femur length is crucial for the estimation of fetal age and growth pattern. Due to the noisy nature of ultrasound images and the variation in image acquisition and measurement techniques, manual measurements are subject to interobserver and intraobserver variability. The motivation of this paper is to study the efficiency of automated methods used in the femur endpoint detection module of our proposed computer-assisted processing and analysis system, which is employed to determine the gestational age for promoting the standardization of fetal femur measurements, thus resulting in more reliable age estimates. The proposed methods are based on the morphological operators methods5and the morphological watershed segmentation method. We applied these methods on a set of 100 digitized fetal femur images of size 287 × 224 pixels with 256 gray-level images and a resolution of 100 pixels per inch (ppi) horizontally and vertically. The results showed that the watershed method was the more efficient one and gave reliable results for every femur image tested.