Fetal Gestational Age Research Articles

<i>IGF1R</i> rs907806 and <i>GHSR</i> rs572169 genetic variants in fetal macrosomia

BACKGROUND: Being strongly affected by maternal and fetal genetic factors, intrauterine environment plays a critical role in fetal growth. Intrauterine conditions, in turn, are largely determined by the genetic factors. AIM: The aim of this study was to evaluate the effect of the IGF1R rs907806 and GHSR rs572169 genetic variants on the weight of newborns. MATERIALS AND METHODS: This prospective study included 221 mother-newborn pairs. The inclusion criteria were singleton pregnancy and informed consent to participate in the study. The exclusion criteria were severe somatic, oncological and acute illnesses three months prior or during pregnancy, gestational diabetes mellitus, refusal to participate in the study at any stage, and insufficient data. The study groups included patients with type 1 diabetes mellitus (group I), type 2 diabetes mellitus (group II), and no carbohydrate metabolism disorders (group III). Cord blood samples were obtained after delivery. The IGF1R rs907806 and GHSR rs572169 genotypes were determined by polymerase chain reaction with restriction fragment length polymorphism analysis. The main outcomes were delivery of a large for gestational age fetus (weight of more than the 90th percentile INTERGROWTH-21st). The secondary outcomes were diabetic fetopathy, diabetic cardiomyopathy, and neonatal hypoglycemia. RESULTS: In group III, the minor G allele of the IGF1R rs907806 variant was more frequent in large-for-gestational-age newborns (p = 0.017; odds ratio 3.039; 95% confidence interval 1.244–7.424) than in those with a weight of less than 90th percentile. For the GHSR rs572169 variant, no similar trend was observed. This pattern was pronounced in the male newborns only (rs907806 AA vs. AG+GG; p = 0.046; odds ratio 4.229, 95% confidence interval 1.181–15.139). In newborns with hypoglycemia, a higher frequency of the GG genotype of the GHSR rs572169 (GA) variant was observed in the total sample (p = 0.004) and the type 1 diabetes mellitus group (p = 0.0496). CONCLUSIONS: The IGF1R rs907806 variant may affect birthweight in the male newborns of mothers without carbohydrate metabolism disorders. The observed association of neonatal hypoglycemia with the GG genotype of the GHSR rs572169 variant requires further investigation. Genetic factors can contribute to prognostic models of perinatal complications, while improving their early diagnosis opportunities.

Fetal Gestational Age Prediction in Brain Magnetic Resonance Imaging Using Artificial Intelligence: A Comparative Study of Three Biometric Techniques

Accurately predicting a fetus’s gestational age (GA) is crucial in prenatal care. This study aimed to develop an artificial intelligence (AI) model to predict GA using biometric measurements from fetal brain magnetic resonance imaging (MRI). We assessed the significance of using different reference standards for interpreting GA predictions. Measurements of biparietal diameter (BPD), fronto-occipital diameter (FOD), and head circumference (HC) were obtained from 52 normal fetal MRI cases from Rush University. Both manual and AI-based methods were utilized, and comparisons were made using three reference standards (Garel, Freq, and Bio). The AI model showed a strong correlation with manual measurements, particularly for HC, which exhibited the highest correlation with actual values. Differences between GA predictions and picture archiving and communication system (PACS) records varied by reference, ranging from 0.47 to 2.17 weeks for BPD, 0.46 to 2.26 weeks for FOD, and 0.75 to 1.74 weeks for HC. Pearson correlation coefficients between PACS records and GA predictions exceeded 0.97 across all references. In conclusion, the AI model demonstrated high accuracy in predicting GA from fetal brain MRI measurements. This approach offers improved accuracy and convenience over manual methods, highlighting the potential of AI in enhancing prenatal care through precise GA estimation.

Placental biophysical model for prediction of early onset fetal growth restriction in first and second trimester of pregnancy: A prospective cohort study

IntroductionTo assess the placental biometry, placental biomarkers and uterine artery Doppler in each trimester of pregnancy for prediction of early-onset fetal growth restriction (EO FGR). MethodsIn this prospective cohort study placental biometry; biomarkers PAPP-A, sFLT-1, and PlGF along with the uterine artery blood flow evaluation was done serially at 11–14, 20–24 and 28–32 weeks of gestation. The above parameters were compared between women with early onset FGR and controls. ResultsOut of 1008 fully followed cases, the small for gestational age fetuses were 227/1008 (22.5 %), and EO FGR were 84/1008(8.3 %).The placental length, volume, and PlGF levels were significantly lower, whereas the uterine artery PI(Ut PI) was significantly higher at all time points among cases. The sFLT-1 level showed a significant increase among cases, whereas it decreased among controls from the first to the second trimester. The detection rate using PV/UtA PI was 60 % in the first trimester and 66.7 % in the second trimester at 30 % FPR. ConclusionThe PV/Ut PI in first and the second trimester was a good marker for the prediction of pregnancies at increased risk of developing EO FGR.

P-288 How do pregnancy complications, intrapartum, and neonatal risks differ in bicornuate and didelphys uteri. A population-based study

Abstract Study question Are there differences between didelphys and bicornuate uteri regarding obstetrical and neonatal outcomes based on an analysis of a population database? Summary answer Didelphys uteri present higher risks of preeclampsia, preterm delivery, PPROM, and cesarean delivery; while bicornuate uteri present higher risks of placenta previa, and placental abruption. What is known already Didelphys and bicornuate uteri are similar congenital anomalies with duplication of the uterine corpus. It is thought that both defects are similar when it comes to pregnancy complications, with increased risks of preterm delivery (PTD), malpresentation, and cesarean delivery, when compared to women without uterine anomalies. The didelphys uterus has two cervixes and a double vagina while the bicornuate uterus has one cervix and a single vagina. This minor difference may or may not alter the risks of pregnancy complications in these groups. However, obstetric and perinatal outcomes for didelphys and bicornuate uteri have never been directly compared. Study design, size, duration This retrospective population-based cohort study utilized data from the Healthcare-Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) from 2010 to 2014, inclusively. There were 3,846,342 births between 2010 and 2014, 1146 women with didelphys uteri and 6327 women with bicornuate uteri were included in the database and the study. Women were included only once per pregnancy. Participants/materials, setting, methods HCUP-NIS is the largest inpatient database in the USA and is comprised of hospitalizations throughout the USA. It provides information relating to seven-million inpatient stays yearly, includes 20% of admissions, and represents over 96% of Americans. Multivariate logistic regression was conducted to explore associations between bicornuate uteri and delivery outcomes while controlling for confounding effects. According to the Tri-Council Policy Statement (2018), IRB approval was not required, given data was anonymous and publicly available. Main results and the role of chance No significant difference was seen between the groups in regard to age, income, medical insurance plan, rates of obesity, illicit drug use, chronic hypertension, diabetes, thyroid disease, HIV, tobacco smoking during pregnancy, previous cesareans, pregnancy from IVF, and multiple gestations (P > 0.05). The only difference was in racial distribution, which was controlled for in the subsequent analysis (p < 0.05).In comparison to pregnant women with bicornuate uteri, patients with didelphys uteri were more likely to experience preeclampsia (aOR 1.38 95%CI: 1.05-1.80 P = 0.020), preterm premature rupture of membranes (PPROM) (aOR 1.76 95%CI1.32-2.34 P = 0.000), preterm delivery (aOR 1.39 95% CI1.18-1.64P=0.000), and higher chances of cesarean delivery (aOR 1.41 95% CI1.20-1.64 P = 0.000), after controlling for confounding demographics. Additionally, women with didelphys uteri have less risks of developing placenta previa (aOR 0.26 95%CI: 0.08-0.84 P = 0.024) and Abruptio placenta (aOR 0.52 95%CI 0.31-0.87 P = 0.013). No significant difference was seen between the groups regarding pregnancy induced hypertension, eclampsia, gestational diabetes, chorioamnionitis, operative vaginal delivery, hysterectomy, post-partum hemorrhage, wound complications, blood transfusion, maternal death, maternal infection, venous thromboembolism, pulmonary embolism or DIC (P > 0.05). Moreover, there was no significant difference between the two groups when comparing neonatal outcomes, including small for gestational age fetuses and intrauterine fetal demise (P > 0.05). Limitations, reasons for caution The limitation of our study are related to its retrospective nature and use of administrative database, which relies on the accuracy, and consistency of the individual coding the data, and the masking of undetected bias. Wider implications of the findings The present study demonstrates that women with bicornuate and didelphys uteri have certain differences when it comes to pregnancy, and intrapartum complications, including rates of preeclampsia, placenta previa, placental abruption, cesarean section, PPROM, and preterm delivery. These findings emphasize the importance of individualized perinatal care in these two cases. Trial registration number not applicable

Identifying First-Trimester Risk Factors for SGA-LGA Using Weighted Inheritance Voting Ensemble Learning.

The classification of fetuses as Small for Gestational Age (SGA) and Large for Gestational Age (LGA) is a critical aspect of neonatal health assessment. SGA and LGA, terms used to describe fetal weights that fall below or above the expected weights for Appropriate for Gestational Age (AGA) fetuses, indicate intrauterine growth restriction and excessive fetal growth, respectively. Early prediction and assessment of latent risk factors associated with these classifications can facilitate timely medical interventions, thereby optimizing the health outcomes for both the infant and the mother. This study aims to leverage first-trimester data to achieve these objectives. This study analyzed data from 7943 pregnant women, including 424 SGA, 928 LGA, and 6591 AGA cases, collected from 2015 to 2021 at the Third Affiliated Hospital of Sun Yat-sen University in Guangzhou, China. We propose a novel algorithm, named the Weighted Inheritance Voting Ensemble Learning Algorithm (WIVELA), to predict the classification of fetuses into SGA, LGA, and AGA categories based on biochemical parameters, maternal factors, and morbidity during pregnancy. Additionally, we proposed algorithms for relevance determination based on the classifier to ascertain the importance of features associated with SGA and LGA. The proposed classification solution demonstrated a notable average accuracy rate of 92.12% on 10-fold cross-validation over 100 loops, outperforming five state-of-the-art machine learning algorithms. Furthermore, we identified significant latent maternal risk factors directly associated with SGA and LGA conditions, such as weight change during the first trimester, prepregnancy weight, height, age, and obstetric factors like fetal growth restriction and birthing LGA baby. This study also underscored the importance of biomarker features at the end of the first trimester, including HDL, TG, OGTT-1h, OGTT-0h, OGTT-2h, TC, FPG, and LDL, which reflect the status of SGA or LGA fetuses. This study presents innovative solutions for classifying and identifying relevant attributes, offering valuable tools for medical teams in the clinical monitoring of fetuses predisposed to SGA and LGA conditions during the initial stage of pregnancy. These proposed solutions facilitate early intervention in nutritional care and prenatal healthcare, thereby contributing to enhanced strategies for managing the health and well-being of both the fetus and the expectant mother.

Placentome size in Bos taurus x Bos indicus crosses in the mexican tropics differs from the source breeds

The objective of the present study is to verify the size of placentomes, through ultrasonography, at different gestational ages in Bos indicus x Bos taurus crosses located in the tropics.Placentome size in cows can vary in response to many factors, including crossbreeding. Placentome measurents were taken by averaging the length and width of the placentome.We measured placentome size at different gestational ages in Bos taurus x Bos indicus cows raised in the tropics. Uteruses were collected immediately after slaughter from 102 cows with gestations ≥ 30 days and processed in the abattoir. All cows were Swiss Brown x Zebu phenotypes. Fetus gestational age was estimated by measuring from the crown to the tail base. Five placentomes were randomly chosen from each uterus (n= 510), and diameter (cm) measured for each. Gestational age was classified into nine categories (days): a) ≤45, b) >45 ≤60, c) >60 ≤90, d) >90 ≤120, e) >120 ≤150, f) >150 ≤180, g) >180 ≤210, h) >210 ≤240 and i) >240. Placentome size data was grouped by these categories. Descriptive statistics were generated for diameter for each gestational age category. All statistical analyses were run with the SAS program (2013). In all nine categories, placentome size was larger than reported for Bos taurus cows and smaller than reported in Bos indicus cows. In conclusion, placentome size in the sampled Bos taurus x Bos indicus cows was intermediate between that of the two source breeds. This confirms that existing reference tables for Bos taurus and Bos indicus purebreds are not accurate for crossbreeds.

Immunohistochemical localization of HCA1 receptor in placenta in presence of fetal growth restriction

IntroductionGlucose metabolism produces lactate and hydrogen ions in an anaerobic environment. Fetuses with intrauterine growth restriction are considered to become progressively lactacidemic as well as hypoxic. Roles of lactate in the placenta in the presence of fetal growth restriction (FGR) remain to be clarified. MethodsImmunohistochemical localization of lactate-related substances, such as a receptor for lactate (hydroxy-carboxylic acid 1 receptor (HCA1 receptor/GPR81)), monocarboxylate transporters (MCTs) for lactate, lactate dehydrogenases (LDHs), and proteins expressed in syncytiotrophoblasts or cytotrophoblasts was examined in placentas of appropriate weight for gestational age (AGA) fetus and those showing FGR. ResultsImmunoreactivity for the HCA1 receptor was present in the cytoplasm of some trophoblasts, predominantly localized to their basal (fetus-facing) side, and was frequently colocalized with that for E-cadherin or serine peptidase inhibitor, Kunitz type 1 (SPINT1), a marker protein of cytotrophoblasts. Immunoreactivity for MCT1 and MCT4 was present on the basal and the microvillous (maternal-facing) membranes of trophoblasts in both groups, respectively. Clear immunoreactivity for LDHA and LDHB was also observed in the cytoplasm of trophoblasts, mainly localized to their basal side. However, there were no significant differences in immunohistochemically stained areas of lactate-related substances between AGA and late-onset FGR groups. On the other hand, there were correlations between coefficients of the presence of chorioamnionitis and the values of LDHB and E-cadherin. DiscussionImmunohistochemical localization of the HCA1 receptor was predominantly observed in the cytoplasm located on the basal side of trophoblasts, suggesting a role of lactate in human placental development, including syncytialization.

Reduced gyrification in fetal growth restriction with prenatal magnetic resonance images.

Placental-related fetal growth restriction, resulting from placental dysfunction, impacts 3-5% of pregnancies and is linked to elevated risk of adverse neurodevelopmental outcomes. In response, the fetus employs a mechanism known as brain-sparing, redirecting blood flow to the cerebral circuit, for adequate supply to the brain. In this study we aimed to quantitatively evaluate disparities in gyrification and brain volumes among fetal growth restriction, small for gestational age and appropriate-for gestational-age fetuses. Additionally, we compared fetal growth restriction fetuses with and without brain-sparing. The study encompassed 106 fetuses: 35 fetal growth restriction (14 with and 21 without brain-sparing), 8 small for gestational age, and 63 appropriate for gestational age. Gyrification, supratentorial, and infratentorial brain volumes were automatically computed from T2-weighted magnetic resonance images, following semi-automatic brain segmentation. Fetal growth restriction fetuses exhibited significantly reduced gyrification and brain volumes compared to appropriate for gestational age (P < 0.001). Small for gestational age fetuses displayed significantly reduced gyrification (P = 0.038) and smaller supratentorial volume (P < 0.001) compared to appropriate for gestational age. Moreover, fetal growth restriction fetuses with BS demonstrated reduced gyrification compared to those without BS (P = 0.04), with no significant differences observed in brain volumes. These findings demonstrate that brain development is affected in fetuses with fetal growth restriction, more severely than in small for gestational age, and support the concept that vasodilatation of the fetal middle cerebral artery reflects more severe hypoxemia, affecting brain development.

Prenatal diagnosis of a skeletal disorder characterized by rhizomelic shortening of limbs caused by compound heterozygous variants in the PKDCC gene: Case report and literature review.

The protein kinase domain containing cytoplasmic (PKDCC) gene (OMIM#618821) is associated with bone development. Biallelic variants in the PKDCC gene can cause rhizomelic limb shortening with dysmorphic features. A fetus was found to be rhizomelic limb shortening at 16 weeks of gestation and amniocentesis was performed at 19 weeks of gestation. Genomic DNA extracted from the amniotic fluid was subjected to chromosomal microarray analysis (CMA), and Trio-total whole-exome sequencing (Trio-WES). Sanger sequencing was used to verify the candidate pathogenic variants. CMA was normal, while Trio-WES identified two compound heterozygous variants in the PKDCC gene, namely c.417_c.423delCGGCGCG insTCATGGGCTCAGTACAC(p.G140fs*35) and c.345G>A (p.W115*,379). Then the fetus was aborted and the development of its bone cells were compared with that of a normal fetus of similar gestational age by histopathological examination. Clinical findings of the fetus were shortening humerus and femur, synophrys, much hair on the side face, simian line on the right palm, etc. Histopathological examination showed that the affected fetus had increased proliferative chondrocytes, widened proliferative bands, and delayed bone mineralization. We reported a prenatal case of rhizomelic shortening of limbs caused by compound heterozygous variants in the PKDCC gene, which emphasized the important role of Trio-WES for diagnosis of skeletal dysplasia in fetuses.

Study of Correlation between Fetal Bowel Dilation and Congenital Gastrointestinal Malformation.

Ultrasound serves as a valuable tool for the early detection of fetal bowel dilatation, yet the correlation between fetal bowel dilatation and gastrointestinal malformations remains to be further investigated. This study aims to explore the relationship by conducting a follow-up and analysis of fetuses with bowel dilation. A retrospective analysis was conducted on 113 fetuses with bowel dilatation at our center from July 2014 to December 2019. The location and degree of bowel dilatation were analyzed. ROC curves were constructed based on the diameter of the bowel and its ratio to fetal gestational age. In total, 40 of 41 cases (97.6%) with upper gastrointestinal dilatation (double-bubble sign) and 46 of 72 cases (63.9%) with lower gastrointestinal dilatation were diagnosed with gastrointestinal malformations postnatally. The AUC of the dilatation diameter was 0.854 with a cutoff value of 18.05 mm in patients with lower gastrointestinal dilatation. The ratio of the diameter to gestational age (D/GA) showed a higher AUC of 0.906 with a cutoff value of 0.4931. The presence of the double-bubble sign in fetuses indicates a close association with duodenal obstruction. The risk of gastrointestinal malformations increases when the bowel diameter exceeds 18.05 mm, particularly when the D/GA surpasses 0.4931.

Fetal Brain-Derived Exosomal miRNAs from Maternal Blood: Potential Diagnostic Biomarkers for Fetal Alcohol Spectrum Disorders (FASDs).

Fetal alcohol spectrum disorders (FASDs) are leading causes of neurodevelopmental disability but cannot be diagnosed early in utero. Because several microRNAs (miRNAs) are implicated in other neurological and neurodevelopmental disorders, the effects of EtOH exposure on the expression of these miRNAs and their target genes and pathways were assessed. In women who drank alcohol (EtOH) during pregnancy and non-drinking controls, matched individually for fetal sex and gestational age, the levels of miRNAs in fetal brain-derived exosomes (FB-Es) isolated from the mothers' serum correlated well with the contents of the corresponding fetal brain tissues obtained after voluntary pregnancy termination. In six EtOH-exposed cases and six matched controls, the levels of fetal brain and maternal serum miRNAs were quantified on the array by qRT-PCR. In FB-Es from 10 EtOH-exposed cases and 10 controls, selected miRNAs were quantified by ddPCR. Protein levels were quantified by ELISA. There were significant EtOH-associated reductions in the expression of several miRNAs, including miR-9 and its downstream neuronal targets BDNF, REST, Synapsin, and Sonic hedgehog. In 20 paired cases, reductions in FB-E miR-9 levels correlated strongly with reductions in fetal eye diameter, a prominent feature of FASDs. Thus, FB-E miR-9 levels might serve as a biomarker to predict FASDs in at-risk fetuses.

Risk of Obstetric Anal Sphincter Injury by Delivering Provider

Introduction and Hypothesis: Obstetric anal sphincter injuries (OASIs) complicate 5.8% of vaginal deliveries. Our objective was to assess if the primary delivery provider, a nurse-midwife versus physician obstetrician, is associated with OASIs. Methods: We performed a secondary analysis of the Consortium of Safe Labor, a multicenter, retrospective cohort study. Included were nulliparous women with singleton, vaginal delivery at ≥37 weeks from 2002 to 2008. Women were excluded if delivery was complicated by shoulder dystocia or from sites without midwife deliveries. Student’s t-tests, chi-squared analysis, and Fisher’s exact test were used as appropriate. Multivariable logistic regression and propensity score-matching analyses were performed. Results: Of 228,668 births at 19 sites, 2735 births from 3 sites met the inclusion criteria: 1551 physician and 1184 midwife births. Of all births, 4.2% (n = 116) were complicated by OASIs. Physician patients were older, more often White, privately insured, with higher BMI, more medical co-morbidities, and labor inductions/augmentations. Midwife patients had higher fetal gestational age and infant birth weights (all p &lt; 0.05). OASIs were more common in physician compared to midwife births (5.9% vs. 2.0%, p &lt; 0.0001). This difference persisted in multivariable logistic regression. OASIs were 2.4 (95%CI 1.5–3.9) times more likely with physician delivery when controlling for maternal heart disease, episiotomy, increasing maternal age, decreasing maternal BMI, non-White race, and increasing birthweight. The AUC was 0.78. With propensity score matching, OASI rates remained higher amongst physician births (6.6% vs. 1.8%, p &lt; 0.0001; aOR 3.8 (95%CI 2.0–7.1)). Conclusion: OASIs were more common in physician compared to midwife deliveries even when controlling for other associated factors.

Comparison Between Fetal Abdominal Subcutaneous Tissue Thickness and Abdominal Circumference to Predict Large for Gestational Age Neonate in Gestational Diabetes.

Increased subcutaneous fat deposition in abdomen in large for gestational age (LGA) fetuses of mothers with gestational diabetes mellitus can be measured by fetal abdominal subcutaneous tissue thickness (FASTT) using ultrasound. The current study aimed to evaluate the correlation between FASTT and birth weight and compare FASTT and abdominal circumference (AC) for prediction of LGA babies in gestational diabetes. 150 term GDM women were enrolled into the study. FASTT was measured weekly. Birth weight was measured immediately after delivery and categorized into SGA, AGA and LGA according to International growth charts. The last FASTT and AC values were recorded for analysis. Correlation statistics was used to determine the relation between FASTT with birth weight and ROC curves were used to compare FASTT and AC for prediction of LGA fetuses. There was weak positive correlation between FASTT and birth weight with Pearson's co-efficient (r) of 0.375. The cut-off value for FASTT to predict LGA fetuses obtained by ROC curve was ≥8.05 mm with sensitivity and specificity of 68.8% and 68.7%. The mean values of FASTT for small for gestational age (SGA), appropriate for gestational age (AGA) and LGA fetuses were significantly different. AUC for FASTT was 0.692 and for AC was 0.755. FASTT had a positive but weak correlation with birth weight. The utility of FASTT as a screening tool may not be impressive. FASTT can discriminate between SGA, AGA and LGA fetuses. AC is a better predictor than FASTT for LGA neonates.

Accuracy of antenatal ultrasound in predicting large-for-gestational-age babies: population-based cohort study

Pregnancies with large for gestational age fetuses are at increased risk of adverse maternal and neonatal outcomes. There is uncertainty about how to manage birth in such pregnancies. Current guidelines recommend a discussion with women of the pros and cons of options including expectant management, induction of labour and caesarean birth. For women to be able to make an informed decision about birth, antenatal detection of large for gestational age is essential. To investigate the ability of antenatal ultrasound scans to predict large for gestational age at birth. In this retrospective cohort study, we analysed data from a routinely collected database from the West Midlands, United Kingdom. We included pregnancies that had an antenatal ultrasound estimated fetal weight between 35+0 and 38+0 weeks gestation for any indication, as well as a subgroup where the reason for scan was that the fetus was suspected to be big. Large for gestational age was defined as >90th customized GROW centile, for estimated fetal weight as well as for neonatal weight. We also tested performance of an uncustomized standard, with Hadlock fetal weight >90th centile and neonatal weight >4kg. We calculated diagnostic characteristics for the whole population as well as groups with different maternal body mass indices. The study cohort consisted of 26,527 pregnancies which on average had a scan at 256 days gestation and delivered 20 days later at a median of 276 days (interquartile range 15). In total 2241 (8.4%) of neonates were large for gestational age by customized centiles, of which 1459 (65.1%) had a scan estimated fetal weight >90th centile, with a false positive rate of 8.6% and a positive predictive value of 41.0%. In the subgroup of 912 (3.4%) pregnancies scanned for a suspected large fetus, 293 (32.1%) babies were large for gestational age at birth, giving a positive predictive value of 50.3%, with sensitivity of 77.1% and false positive rate 36.0%. When comparing subgroups from low (<18.5kg/m2) to high body mass index (>30kg/m2), sensitivity increased from 55.6 to 67.8%, false positive rate from 5.2 to 11.5% and positive predictive value from 32.1 to 42.3%. A total of 2585 (9.7%) babies were macrosomic (birthweight >4kg), and of these 1058 (40.9%) were large for gestational age (>90th centile) antenatally by Hadlock's growth standard, with a false positive rate of 4.9% and a positive predictive value 41.0%. Analysis within subgroups showed better performance by customized compared to uncustomized standards for low body mass index (<18.5; diagnostic odds ratio 23.0 vs 6.4) and high body mass index (>30; diagnostic odds ration 16.2 vs 8.8). Late third trimester ultrasound estimation of fetal weight for any indication has good ability to identify and predict large for gestational age at birth, and improves with the use of a customised standard. Detection rate is better when ultrasound is performed for a suspected large fetus, however at the risk of higher false positive diagnosis. Our results provide information for women and clinicians to aid antenatal decision making about birth of a fetus suspected of being large for gestational age.

Maternal serum vasohibin-1 and vasohibin-2 concentrations in pregnant women diagnosed with late fetal growth restriction or small for gestational age fetus

Aims: Vasohibin 1, a member of the vasohibin family, is an inhibitor of angiogenesis, while vasohibin 2 stimulates angiogenesis. Placental expressions of vasohibins and their relationship with preeclampsia have been investigated, but their effects on intrauterine fetal growth are unknown. In this context, we aimed to investigate the concentrations of vasohibin 1 and 2 in the serum of pregnant women diagnosed with late fetal growth restriction (FGR) or small for gestational age (SGA) in the third trimester. Methods: This prospective non-interventional cohort study was conducted on 81 pregnant women, 26 of whom were diagnosed with late FGR, 28 were SGA, and 27 were healthy controls. Three groups were compared in terms of serum vasohibin 1 and 2 concentrations in the third trimester. Results: Three groups were similar in terms of demographic characteristics and gestational age at blood sampling for vasohibin 1 and 2 (p &lt; 0.05). The median vasohibin 1 concentration was determined as 1227.41 ng/mL in the late FGR group, 1311.15 ng/mL in the SGA group, and 1391.38 ng/mL in the control group (p = 0.139). The median vasohibin 2 concentration was determined as 11.24 ng/mL in the late FGR group, 11.86 ng/mL in the SGA group, and 14.34 ng/mL in the control group (p = 0.198). Conclusion: Serum vasohibin 1 and 2 concentrations were found to be similar in pregnant women diagnosed with late FGR and SGA and pregnant women with AGA fetuses. Vasohibin 1 and 2 are involved in the regulation of placental angiogenesis, but their roles in intrauterine fetal growth remain unclear.

Development of a technique for postmortem CT angiography of fetuses with a lipophilic contrast agent

Background and objectivesPostmortem examinations of fetuses play a crucial role in confirming abnormalities, especially vascular and cardiac malformations leading to fetal demise. This study aims at developing and assessing a method for acquiring Post-Mortem CT-Angiography (PMCTA) with the injection of a lipophilic contrast agent (CA) to better visualize the great vessels of the trunk and head. Materials and methods25 human fetuses (gestational age at death between 106 days and 28 weeks) were included. Examinations were performed using a dual-energy Multidetector Computed Tomography (MDCT) scanner. Three imaging sequences were acquired, before CA injection, after injection of 7mL of CA through umbilical artery (arterial phase), and after an injection of 15mL of CA through umbilical vein (venous phase). CA-induced vascular opacification was scored per-vessel in both phases as follows: 0 = none, 1 = partial, 2 = complete. Total opacification was defined as the sum of the per-vessel opacification scores. ResultsIn 23/25 subjects, CA injection into the umbilical vessels was feasible manually using flexible catheters. After the first injection, at least a partial opacification of the arterial network was achieved in 15/23 (65%) subjects. After the second injection, a complete opacification of the venous network was achieved in 18/23 (78%) subjects. Failures occurred in 10/25 (40%) subjects and were mostly due to the preservation status. ConclusionPMCTA performed with a two-phase intra-umbilical injection of a lipophilic CA enabled to visualize the vascular network, even after a significant a postmortem interval. This protocol may help in detecting vascular malformations, improving clinical diagnoses and prenatal counselling.

Correlation between cerebroplacental doppler ratio and neonatal respiratory disorders: A reference marker of fetal lung maturation.

The aim of this study was to investigate the role of cerebroplacental ratio (CPR) in the final prenatal care for neonatal respiratory diseases and to analyze the risk of relevant factors associated with neonatal respiratory disorders. A prospective cohort study of 795 singleton pregnancies was conducted. The pulsatility indices (PI) of the umbilical artery (UA) and the middle cerebral artery (MCA) were measured, and the MCA to UA ratio (CPR) was determined. The severity of the case is determined by whether or not the newborn has respiratory problems. Compare the CPR correlation between the two groups and examine the illness prediction factors through a binary logistic regression method. Of the 795 participants, 124 had neonatal respiratory disorders. The mean values of CPR between neonatal respiratory diseases group and control group were 1.78±0.6, 1.97±0.9, respectively (P < 0.001). Maternal age, abortion history, cesarean section history, placental thickness, placental maturity, and amniotic fluid index (AFI) were determined to have no significant link between the two groups after comparison analysis (P > 0.05). It could be found that compared with the control group, CPR MoM indicators of neonatal respiratory distress syndrome, neonatal pneumonia and wet lung disease all show significant decreases. In binary logistic regression analysis, among the variables included in the model, CPR (OR:2.90, P = 0.015), fetal heart monitoring (OR:5.26, P < 0.001), delivery mode (OR:2.86, P < 0.001) and gestational age of delivery (OR:0.92, P < 0.001) were statistically significant in both groups. The findings of this study showed that infant respiratory problems were substantially related to CPR value. The correlation indicates that CPR was a powerful reference marker for respiratory disorders.

Association of global cardiac sphericity index and neonatal outcomes of appropriate for gestational age fetuses, small for gestational age fetuses, and growth-restricted fetuses delivered at term in Dr. Jose Fabella Memorial Hospital: A prospective cohort study

OBJECTIVE: The objective of this study was to evaluate and compare the global cardiac sphericity index (GCSI) of appropriate for gestational age (AGA) fetuses, small for gestational age (SGA) fetuses, and growth-restricted fetuses scanned at term in a government tertiary hospital, maternal high risk (MHR) and to determine the association between the GCSI of these three groups of fetuses and their neonatal outcomes. METHODOLOGY: The study prospectively evaluated and compared the GCSI of AGA, SGA, and growth-restricted fetuses. Pregnant women at term seen at the outpatient department and scanned at the MHR clinic then eventually delivered in the same hospital from March to May 2022 were included in this study. RESULTS: GCSIs were measured with 147 fetuses (106 AGA, 38 SGA, and 3 growth-restricted fetuses). The result indicated that the GCSI of AGA fetuses was higher than that of the SGA and growth-restricted fetuses. This study found that there is a significantly higher frequency of abnormal GSCI among SGA and growth-restricted fetuses. This study also found that there is no statistically significant correlation between the GCSI measurements of these three groups of fetuses and their neonatal outcomes. CONCLUSIONS: Abnormal GCSIs were found in fetuses with an estimated fetal weight &lt;10th percentile (more specifically in growth-restricted fetuses than in those who are just SGA) as compared with AGA fetuses. However, the correlation between an abnormal GCSI in any of these three groups of fetuses and their neonatal outcomes needs further investigation.

Chances d'accouchement par voie basse chez les fœtus PAG sévère déclenchés avant terme : une étude observationnelle

ObjectiveIf a small for gestational age (SGA) foetus needs to be delivered because of severity (<3rd centile) attempting induction of labor theoretically increases the risk of caesarean section and neonatal acidosis, but these risks are poorly understood. This article aims to assess the risk of caesarean section and neonatal acidosis in attempted vaginal birth of a moderately preterm foetus in the setting of severe SGA. MethodA single-centre hospital-based observational study conducted over a period of 17 consecutive years in mothers with a single foetus in cephalic presentation with severe SGA (<3rd centile) needing foetal extraction. Neonatal acidosis was considered moderate if pH<7.10 and severe if pH<7.0. The degree of severity of SGA was estimated according to the birth weight ratio. ResultsFour hundred and thirty-four foetuses with severe SGA were included during the period, 140 of whom were born after induction (32.3%). In this group, 66.4% of women achieved a vaginal birth (66.4%; 95% CI [58.0-74.2]) and the risk of moderate or severe acidosis was doubled compared with the group of foetuses who had undergone a planned caesarean section (7.9% vs. 3.1%, OR=2.7 [1.1-6.7]). Neither gestational age nor the degree of growth restriction was significantly related to the risk of caesarean section or to the risk of moderate or severe neonatal acidosis. ConclusionIn cases of severe SGA before 37weeks' gestation, induction of labour allows vaginal delivery in two-thirds of cases. It is accompanied by a doubling of the risk of moderate or severe neonatal acidosis.

Anatomical and functional changes of the fetal adrenal gland in intrauterine growth restriction.

The aim of this study was to demonstrate the establishment of adrenal sparing in intrauterine growth restricted (IUGR) human fetuses. IUGR fetuses are a subgroup of small for gestational age (SGA) fetuses that are unable to reach their own growth potential because of chronic hypoxia and undernutrition. We hypothesized that in IUGR fetuses the adrenal gland is relatively larger and secretion of noradrenaline (NA), adrenaline (A), and cortisol is increased. This is a prospective observational study including 65 singleton pregnancies (42 IUGR and 23 controls). Using two-dimensional ultrasound, we measured fetal adrenal diameters and adrenal/abdominal circumference (AD/AC) ratio between 25 and 37 weeks. We considered only one measurement per fetus. In 21 pregnancies we also measured NA, A, and cortisol levels in arterial and venous fetal cord blood collected at the time of delivery. The AD/AC ratio was significantly higher in IUGR fetuses than in controls. Cord NA and A levels were significantly higher in IUGR fetuses than in controls. An increase in cortisol secretion in IUGR fetuses was observed but the difference was not statistically significant. Adrenal sparing correlates with a relative increase in adrenal measurements and function.