Assessment Of Gestational Age Research Articles

Post-natal gestational age assessment using targeted metabolites of neonatal heel prick and umbilical cord blood: A GARBH-Ini cohort study from North India.

Accurate assessment of gestational age (GA) and identification of preterm birth (PTB) at delivery is essential to guide appropriate post-natal clinical care. Undoubtedly, dating ultrasound sonography (USG) is the gold standard to ascertain GA, but is not accessible to the majority of pregnant women in low- and middle-income countries (LMICs), particularly in rural areas and small secondary care hospitals. Conventional methods of post-natal GA assessment are not reliable at delivery and are further compounded by a lack of trained personnel to conduct them. We aimed to develop a population-specific GA model using integrated clinical and biochemical variables measured at delivery. We acquired metabolic profiles on paired neonatal heel prick (nHP) and umbilical cord blood (uCB) dried blood spot (DBS) samples (n = 1278). The master data set consists of 31 predictors from nHP and 24 from uCB after feature selection. These selected predictors including biochemical analytes, birth weight, and placental weight were considered for the development of population-specific GA estimation and birth outcome classification models using eXtreme Gradient Boosting (XGBoost) algorithm. The nHP and uCB full model revealed root mean square error (RMSE) of 1.14 (95% confidence interval (CI) = 0.82-1.18) and of 1.26 (95% CI = 0.88-1.32) to estimate the GA as compared to actual GA, respectively. In addition, these models correctly estimated 87.9 to 92.5% of the infants within ±2 weeks of the actual GA. The classification models also performed as the best fit to discriminate the PTB from term birth (TB) infants with an area under curve (AUC) of 0.89 (95% CI = 0.84-0.94) for nHP and an AUC of 0.89 (95% CI = 0.85-0.95) for uCB. The biochemical analytes along with clinical variables in the nHP and uCB data sets provide higher accuracy in predicting GA. These models also performed as the best fit to identify PTB infants at delivery.

Accuracy of foot length measurement for gestational age assessment in neonates: a prospective observational study in Central India

Background: Gestational age (GA) is a critical-factors in the decision making and predicting mortality and morbidities of neonates. In low resource settings where affordability and availability of first trimester scan is limited, assessment is often done by postnatal methods like expanded new Ballard score (ENBS) which are often clinical skill dependent and complex. Hence, there is a need of a simple and cost-effective method which can be readily adopted by frontline health care workers at periphery. One such method is assessment of foot length (FL). Methods: This prospective cross-sectional study was conducted in the level 3 NICU of Central India over a period of 18 months. Included neonates were assessed for GA by measuring FL by vernier calliper within 48 hours of birth and its validity was tested against ENBS as reference standard. Other anthropometric measurements like birth weight, head circumference and length were obtained within 48 hours of birth. Results: Total 700 neonates were included in the study. For, determining preterm newborn, the potential cut-off of FL of ≤6.86 cm, with a sensitivity of 94.6% and specificity of 73.8%. The area under ROC (receiver operating characteristic) curve is 0.92. Conclusions: FL measurement is a cost-effective and time-saving simple intervention that can facilitate early identification of preterm newborns as well as help in initiating timely interventions and hence improving neonatal outcomes in resource-poor settings.

Developmental coordination disorder in preterm children: A systematic review and meta-analysis.

This study aimed to review the prevalence of developmental coordination disorder (DCD) in individuals born preterm and systematically explore this prevalence according to gestational age and different assessment cut-offs and compare it to full-term peers. The eligibility criteria were observational and experimental studies reporting the prevalence of DCD in preterm individuals. A systematic search was performed in databases from inception until March 2022. Two independent reviewers performed the selection. Study quality assessment was performed using the checklists from Joanna Briggs Institute (JBI). Data analysis was performed on Excel and Review Manager Software 5.4. Among the 1774 studies identified, 32 matched the eligibility criteria. The pooled estimate rate of the DCD rate in preterm was 21% (95% confidence interval [CI] 17.8-24.3). The estimate rates were higher as gestational age decreased, and preterm children are two times more likely to have DCD than their full-term peers risk ratio (RR) 2.2 (95% CI 1.77-2.79). The limitation was high heterogeneity between studies; the assessment tools, cut-off points and age at assessment were diverse. This study provided evidence that preterm children are at higher risk for DCD than full-term children, and the risks increased as gestational age decreased.

Placental Thickness – an alternative to biparietal diameter for assessment of gestational age in cases of unknown last menstrual period: a cross-sectional observational study

Placental Thickness – an alternative to biparietal diameter for assessment of gestational age in cases of unknown last menstrual period: a cross-sectional observational study

Comparison of Parkin Score and New Ballard Score for Gestational Age Assessment in Newborns with Ultrasound Scan as the Standard Reference

Objective: To compare the assessment of gestational age (GA) in newborns using the Parkin Scoring and the New Ballard Scoring methods with the Ultrasound Scan Method as the Standard Reference, conducted at a peripheral military setup.
 Methodology: A descriptive, cross-sectional study was conducted at the Pediatrics department of Combined Military Hospital (CMH), Abbottabad from July 2019 to June 2020. A total of 102 newborns were recruited from the CMH Nursery. GA was assessed using ultrasound scan, Parkin Score (PS), and the New Ballard Score (NBS). Pearson correlation coefficient statistics were calculated to evaluate the strength of associations among the three methods. The significance level (p value) was set at 0.05.
 Results: The study included 47 (46.1%) females and 55 (53.9%) males. The highest GA (days) was calculated by ultrasound scan (268.76 ± 0.83), followed by PS GA (266.65 ± 1.00) and NBS (264.38 ± 1.05). There was no significant difference in GA assessment between PS and the ultrasound scan (2.32 ± 1.37 days; p = 0.208). The GA assessment between NBS and the ultrasound scan was found to be significant (4.38 ± 1.37 days; p = 0.004). However, this difference is not clinically significant. The NBS and PS GA assessment had a strong positive correlation (Pearson Coefficient = 0.80).
 Conclusions: The PS is a reliable method for assessing GA in newborns and is comparable to the NBS. Further research with a larger sample size should be conducted to validate these findings.

Role of Foetal Trans-cerebellar Diameter in the Prediction of Gestational Age in Correlation with other Foetal Biometric Parameter: A Cross-sectional Study in a Secondary Hospital of Bangladesh

Introduction: Uncertain gestational age is associated with higher perinatal mortality rates. Accurate assessment of gestational age is an important parameter in obstetrics for the management of pregnancy and evaluation of foetal development. Objective: To evaluate whether trans-cerebellar diameter (TCD) in singleton uncomplicated gestations can serve as a reliable predictor of gestational age (GA) in fetuses between 18-38 weeks of pregnancy. Methods: This cross-sectional study was carried out in the department of Radiology and Imaging of CMH, Ghatail, from January 2019 to December 2019 among purposively selected 89 outpatient and admitted pregnant women without any complication having regular menstrual cycle and confirmed about last menstrual period (LMP). The transabdominal USG was performed in each patient and trans-cerebellar diameter was taken which was later correlated with other foetal biometric parameters like biparietaldiameter (BPD), femoral length (FL) etc. Results: Most of the patients belonged to 21-25 years age group (32.6%). Mean age of the study subjects was 26.94±5.70 years ranging from 19 to 38 years and were predominantly (51.7%) primipara. Mean gestational age was 220.69±37.30 days by LMP, 216.20±36.06 days by BPD, 219.00±38.43 days by FL and 218.81±39.36 days by TCD. Mean of biparietal diameter, femoral length and transverse cerebellar diameter were 7.59±1.40cm, 5.91± 1.33cm and 3.93±1.00cm respectively. A significant positive linear correlation between GA by LMP with GA by BPD, FL and TCD was observed (p<0.001). Conclusion: Foetal trans-cerebellar diameter is a reliable sonological parameter for the estimation of foetal gestational age and dating of pregnancy can be made depending on TCD in the pregnant women with unsure of their LMP. JAFMC Bangladesh. Vol 18, No 2 (December) 2022: 40-45

Simulation and team training to improve preterm birth knowledge, evidence-based practices, and communication skills in midwives in Kenya and Uganda: Findings from a pre- and post-intervention analysis.

Simulation training in basic and emergency obstetric and neonatal care has previously shown success in reducing maternal and neonatal mortality in low-resource settings. Though preterm birth is the leading cause of neonatal deaths, application of this training methodology geared specifically towards reducing preterm birth mortality and morbidity has not yet been implemented and evaluated. The East Africa Preterm Birth Initiative (PTBi-EA) was a multi-country cluster randomized controlled (CRCT) trial that successfully improved outcomes of preterm neonates in Migori County, Kenya and the Busoga region of Uganda through an intrapartum package of interventions. PRONTO simulation and team training (STT) was one component of this package and was introduced to maternity unit providers in 13 facilities. This analysis was nested within the larger CRCT and specifically looked at the impact of the STT portion of the intervention package. The PRONTO STT curriculum was modified to emphasize prematurity-related intrapartum and immediate postnatal care practices, such as assessment of gestational age, identification of preterm labour, and administration of antenatal corticosteroids. Knowledge and communication techniques were assessed at the beginning and end of the intervention through a multiple-choice knowledge test. Clinical skills and communication techniques used in context were assessed through the use of evidence-based practiced (EBPs) as documented in video-recorded simulations through StudioCodeTM video analysis. Pre-and-post scores were compared in both categories using Chi-squared tests. Knowledge assessment scores improved from 51% to 73% with maternal-related questions improving from 61% to 74%, neonatal questions from 55% to 73%, and communication technique questions from 31% to 71%. The portion of indicated preterm birth EBPs performed in simulation increased from 55% to 80% with maternal-related EBPs improving from 48% to 73%, neonatal-related EBPs from 63% to 93%, and communication techniques from 52% to 69%. STT substantially increased preterm birth-specific knowledge and EBPs performed in simulation.

Assessment of gestational age at antenatal care visits among Kenyan women to inform delivery of a maternal respiratory syncytial virus (RSV) vaccine in low- and middle-income countries.

Background: Maternal respiratory syncytial virus (RSV) vaccines that are likely to be implementable in low- and middle-income countries (LMICs) are in final stages of clinical trials. Data on the number of women presenting for antenatal care (ANC) per day and proportion attending within the proposed gestational window for vaccine delivery, is a prerequisite to guide development of vaccine vial size and inform vaccine uptake in this setting. Methods: We undertook administrative review and abstraction of ANC attendance records from 2019 registers of 24 selected health facilities, stratified by the level of care, from Kilifi, Siaya and Nairobi counties in Kenya. Additional data were obtained from Mother and Child Health (MCH) booklets of women in each of the Health and Demographic Surveillance System (HDSS) areas of Kilifi, Nairobi and Siaya. Data analysis involved descriptive summaries of the number (mean, median) and proportion of women attending ANC within the gestational window period of 28-32 weeks and 24-36 weeks. Results: A total of 62,153 ANC records were abstracted, 33,872 from Kilifi, 19,438 from Siaya and 8,943 from Nairobi Counties. The median (Interquartile range, IQR) number of women attending ANC per day at a gestational age window of 28-32 and 24-36 weeks, respectively, were: 4 (2-6) and 7 (4-12) in dispensaries, 5 (2-9) and 10 (4-19) in health centres and 6 (4-11) and 16 (10-26) in county referral hospitals. In the HDSS areas of Kilifi, Siaya and Nairobi, pregnant women attending at least one ANC visit, within a window of 28-32 weeks, were: 77% (360/470), 75% (590/791) and 67% (547/821), respectively. Conclusions: About 70% of pregnant women across three distinct geographical regions in Kenya, attend ANC within 28-32 weeks of gestation. A multidose vial size with about five doses per vial, approximates daily ANC attendance and would not incur possible wastage in similar settings.

Antenatal multiple micronutrient supplements versus iron-folic acid supplements and birth outcomes: Analysis by gestational age assessment method.

Meta-analyses consistently have found that antenatal multiple micronutrient supplementation (MMS) compared with iron and folic acid (IFA) alone reduce adverse birth outcomes. In 2020, the World Health Organization (WHO) placed a conditional recommendation for MMS and requested additional trials using ultrasounds to establish gestational age, because the evidence on low birthweight (LBW), preterm birth and small for gestational age(SGA) was considered inconsistent. We conducted meta-analyses to determine if the effects of MMS on LBW, preterm birthand SGA differed by gestational age assessment method. Using data from the 16 trials in the WHO analyses, we calculated the effect estimates of MMS versus IFA on birth outcomes (generic inverse variance method and random effects model) stratified by method of gestational age assessment: ultrasound, prospective collection of the date of last menstrual period (LMP) and confirmation of pregnancy by urine testand recall of LMP. The effects of MMS versus IFA on birthweight, preterm birthand SGA appeared consistent across subgroups with no evidence of subgroup differences (p > 0.05). When limited to the seven trials that used ultrasound, the beneficial effects of MMS were demonstrated: risk ratiosof 0.87 (95% confidence interval [CI] 0.78-0.97) for LBW, 0.90 (95% CI, 0.79-1.03) for preterm birth and 0.9 (95% CI, 0.83-0.99) for SGA. Sensitivity analyses indicated consistency in the results. These results, together with recent analyses demonstrating comparable effects of MMS (vs. IFA) on maternal anaemia outcomes, strengthen the evidence to support a transition from IFA to MMS programmes in low- and middle-income countries.

Fetal kidney measurement - additional biometric parameter for accurate gestational age assessment.

Ultrasound examination - recommended in the prenatal period - allows for an assessment of fetal anatomy and well-being and for monitoring its growth trend. Determining gestational age is important in monitoring the developing fetus. Research is increasingly being conducted in search of further biometric components that may improve ultrasound techniques in terms of predicting the gestational age. It should be noted that a fairly large number of publications focus on the accessibility of fetal kidneys to diagnostic imaging during routine ultrasound examination. The reported study was an attempt to answer the question whether fetal kidney dimensions correlated with gestational age. The obtained results are presented as fetal kidney normograms for particular weeks of gestation. The study covered by dissertation was conducted among patients hospitalized at the Provincial Specialist Hospital in Zgierz, Department of Gynecology, Obstetrics and Endoscopic Therapy, in the period from 1st April 2019 to 30th November 2019. The study group included patients in a single pregnancy. The control group was not included in the study. The ultrasound examinations, which are the basis of the study, were carried out using the PHILIPS Affiniti 70 ultrasound device, with a frequency of 3.5 MHz transabdominal transducer. All data were subjected to statistical analysis using the Statistica 13.1 program. Kidney dimensions strongly correlated with gestational age. Fetal kidney growth was a linear process in normal pregnancy. Fetal kidney measurements can provide additional biometric parameters for accurate gestational age assessment.

Assessment of gestational age using anthropometric parameters in newborns

Background: Estimation of gestational age was needed for the measurement of intrauterine growth and associated conditions, such as whether infants with a low birth weight are preterm or growth-retarded, and identifying high-risk status for developmental delay. Menstrual history was unreliable in most of the cases and ultrasound was not feasible in low resource area, so in this study we were used anthropometric measurements as a simple tool for assessment of gestational age. Methods: This study was a cross sectional observational study conducted in 380 babies born in January 2020-December 2022 in department of pediatrics, Rajah Muthiah Medical College and Hospital. The data were collected using semi-structured questionnaire and anthropometric assessment. The Epi info 7 software was used to analyse the data. Results: The mean gestational age among neonates studied was 37.06±2.32 weeks, the mean head circumference was 33.48±1.01 cm and majority of them 141 babies had head circumference 33 cm, the mean chest circumference was 30.69±1.08 cm. and majority of the babies, had chest circumference of 30 cm, the mean foot length was 7.64±0.24 cm, the mean length of the babies was 47.9±1.26 cm. Conclusions: Our study conclude that anthropometeric parameters in combination (head, chest circumference, length, foot length, birth weight) and as single parameters (foot length) was a simple and easy tool for assessing gestational age in low resource setting where we can make quick referral.

ACCURACY OF FETAL KIDNEY LENGTH AND TRANSCEREBELLAR DIAMETER IN DETERMINATION OF FETAL GESTATIONAL AGE IN MID TRIMESTER IN HEALTHY WOMEN

Accurate assessment of gestational age (GA) is pivotal to provide good quality maternity care. Reliability of routinely used ultrasonographic biometric parameters like Biparietal diameter (BPD), Head circumference (HC) and Femur length (FL) decrease with increasing GA.Fetal kidney length (FKL) and transverse cerebellar diameter (TCD) have been shown to strongly correlate with GA in 2nd and 3rd trimester.The present study was conducted on 150 pregnant women at 20 weeks of gestation to evaluate the role of FKL and TCD in estimation of GA and compare their accuracy with other established biometric indices. The GA of the included women was confirmed by early dating scan and exact Last Menstrual Period (LMP).BPD,HC,FL,FKL and TCD were calculated in millimetres (mm) and GA was calculated by using these parameters individually. Standard deviation and standard error of the GA calculated at 20 weeks was lesser for TCD and FKL than BPD, HC and FL with p values of 0.01636 and 0.0129 respectively. It was also observed that values of TCD and FKL in mm correspond to GA in weeks. So it was concluded that FKL and TCD can be used as an individual parameter in estimating GA in mid trimester in patients presenting for the first time with uncertain dates, lack of early dating scan or with IUGR.

Neonates Extended New Ballard Score and Parkin Score Comparison for Gestational Age Assessment

This study aims to estimate the gestational age in neonates admitted to NICU and postnatal wards within the first 24 hours of life using Parkin score. All newborns had their ENBS and PS Scores calculated, and the appropriate GA listed in the chart was assigned. After gathering the aforementioned data, comparisons were done between other sets of data, including the correlation between LMP/USG and ENBS, LMP/USG and Parkin score, ENBS and Parkin score, and the time required for ENBS and PS. The gestational age ranged from 27 to 42 weeks, while the Parkin's score ranged from 1 to 12. The condition, birth weight, and maturity of the infants were evaluated. Parkin score with GA determined by LMP/USG has a Pearson correlation of zero for healthy and ill newborns. The Pearson connection between PS and gestational age as determined by LMP/USG is zero for newborns with AGA, LGA, and SGA. For term and preterm neonates, the LMP/USG-estimated Pearson correlation for PS with GA is 0. The average deviation from LMP, as measured by Parkin Score, was 9 or 10. 5 days, 11 days for babies with AGA, LGA, and SGA. The average deviation from LMP for Preterm, Full Term, and Post Terms, respectively, was 12 days, 8 days, and 9 days while taking PS's definition of maturity into account. Parkin's Score is therefore simple to administer, especially in neonates who are ill, requires little time, and is simple to teach other paramedical workers.

Comparative Study of Gestational Age Using Mean Fetal Kidney Length and Other Sonographic Fetal Parameters in Singleton Pregnancy After 24 Weeks

Introduction: To accurately estimate the fetus age and follow up on the growth of different fetal organs, it is vital to know the accurate date of birth. It also helps to prevent prenatal and postnatal complications for the newborn. It is common for antenatal mothers to be unaware of last menstrual period (LMP). In such situations, it would be difficult to calculate the delivery date. According to various studies, up to 30% of women were not sure of their LMP. The treating obstetricians would have to be very careful when the exact LMP is unknown in order to prevent post maturity and prematurity deliveries. Material And Methods: The present study is prospective comparative study of Department of Obstetrics and Gynaecology in Guntur Medical College and Hospital, Andhra Pradesh, India. After 24 weeks of gestational age are included who are at age between 20-35 yrs which is of 200 sample size in the year 2020-21. Clinical assessment of gestational age was done by palpating the fundal height of the patient. Following this using ultrasound, meam fetal kidney length (FKL) along with other fetal parameters were calculated. Result: In the present study, BPD ranged from 28-40 wks, whereas the mean BPD was 35.25+2.67 HC ranged between 27-40 and the mean BPD was 35.35+2.88 MKL ranged between 27-41 and the mean MKL was 35.93+3.49. Upon the composite of multiple parameters GA ranged between 27.8-39.6 and the mean was 3.5.36+2.7. Conclusion: The FKL is very much useful in assessing the gestational age. From our study we state that there is a significant correlation between fatal kidney length and the gestational age. Hence fetal kidney is appropriate in estimation of gestational age.

Development of a Machine Learning Model for Sonographic Assessment of Gestational Age

Fetal ultrasonography is essential for confirmation of gestational age (GA), and accurate GA assessment is important for providing appropriate care throughout pregnancy and for identifying complications, including fetal growth disorders. Derivation of GA from manual fetal biometry measurements (ie, head, abdomen, and femur) is operator dependent and time-consuming. To develop artificial intelligence (AI) models to estimate GA with higher accuracy and reliability, leveraging standard biometry images and fly-to ultrasonography videos. To improve GA estimates, this diagnostic study used AI to interpret standard plane ultrasonography images and fly-to ultrasonography videos, which are 5- to 10-second videos that can be automatically recorded as part of the standard of care before the still image is captured. Three AI models were developed and validated: (1) an image model using standard plane images, (2) a video model using fly-to videos, and (3) an ensemble model (combining both image and video models). The models were trained and evaluated on data from the Fetal Age Machine Learning Initiative (FAMLI) cohort, which included participants from 2 study sites at Chapel Hill, North Carolina (US), and Lusaka, Zambia. Participants were eligible to be part of this study if they received routine antenatal care at 1 of these sites, were aged 18 years or older, had a viable intrauterine singleton pregnancy, and could provide written consent. They were not eligible if they had known uterine or fetal abnormality, or had any other conditions that would make participation unsafe or complicate interpretation. Data analysis was performed from January to July 2022. The primary analysis outcome for GA was the mean difference in absolute error between the GA model estimate and the clinical standard estimate, with the ground truth GA extrapolated from the initial GA estimated at an initial examination. Of the total cohort of 3842 participants, data were calculated for a test set of 404 participants with a mean (SD) age of 28.8 (5.6) years at enrollment. All models were statistically superior to standard fetal biometry-based GA estimates derived from images captured by expert sonographers. The ensemble model had the lowest mean absolute error compared with the clinical standard fetal biometry (mean [SD] difference, -1.51 [3.96] days; 95% CI, -1.90 to -1.10 days). All 3 models outperformed standard biometry by a more substantial margin on fetuses that were predicted to be small for their GA. These findings suggest that AI models have the potential to empower trained operators to estimate GA with higher accuracy.

Comparative study between trans cerebellar diameter and head circumference in assessment of gestational age

Comparative study between trans cerebellar diameter and head circumference in assessment of gestational age

PAPP-A as a screening tool for assessment of gestational age before medication abortion in an intended-use population.

Introduction: Prior studies indicate that PAPP-A could serve as a marker of gestational age (GA) with the potential to determine eligibility for medication abortion. The authors validated the relationship between PAPP-A and GA in an actual-use population. Materials & methods: The authors collected blood samples, medical histories and ultrasound-determined GA from patients presenting for abortion services. They measured PAPP-A using two immunoassays and assessed diagnostic accuracy for predicting GA ≥71 days. Results: The Ansh Labs and R&D Systems immunoassays produced an area under the ROC curve of 0.982 (95% CI: 0.958-0.994) and 0.986 (95% CI: 0.963-0.996), respectively, for predicting GA ≥71 days. Conclusion: This validation study in an intended-use population confirmed that PAPP-A has a strong ability to distinguish pregnancies above and below 71 days' gestation. Clinical trial registration: NCT04232189 (ClinicalTrials.gov).

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.

Acceptability and Feasibility of a Low-Cost Device for Gestational Age Assessment in a Low-Resource Setting: Qualitative Study

Ultrasound for gestational age (GA) assessment is not routinely available in resource-constrained settings, particularly in rural and remote locations. The TraCer device combines a handheld wireless ultrasound probe and a tablet with artificial intelligence (AI)-enabled software that obtains GA from videos of the fetal head by automated measurements of the fetal transcerebellar diameter and head circumference. The aim of this study was to assess the perceptions of pregnant women, their families, and health care workers regarding the feasibility and acceptability of the TraCer device in an appropriate setting. A descriptive study using qualitative methods was conducted in two public health facilities in Kilifi county in coastal Kenya prior to introduction of the new technology. Study participants were shown a video role-play of the use of TraCer at a typical antenatal clinic visit. Data were collected through 6 focus group discussions (N=52) and 18 in-depth interviews. Overall, TraCer was found to be highly acceptable to women, their families, and health care workers, and its implementation at health care facilities was considered to be feasible. Its introduction was predicted to reduce anxiety regarding fetal well-being, increase antenatal care attendance, increase confidence by women in their care providers, as well as save time and cost by reducing unnecessary referrals. TraCer was felt to increase the self-image of health care workers and reduce time spent providing antenatal care. Some participants expressed hesitancy toward the new technology, indicating the need to test its performance over time before full acceptance by some users. The preferred cadre of health care professionals to use the device were antenatal clinic nurses. Important implementation considerations included adequate staff training and the need to ensure sustainability and consistency of the service. Misconceptions were common, with a tendency to overestimate the diagnostic capability, and expectations that it would provide complete reassurance of fetal and maternal well-being and not primarily the GA. This study shows a positive attitude toward TraCer and highlights the potential role of this innovation that uses AI-enabled automation to assess GA. Clarity of messaging about the tool and its role in pregnancy is essential to address misconceptions and prevent misuse. Further research on clinical validation and related usability and safety evaluations are recommended.

Role of transcerebellar diameter in fetal growth assessment and its correlation with conventional biometry-An institutional study

Background: Accurate assessment of gestational age (GA) for fetal development is of paramount importance in management of pregnancy and for favorable perinatal outcome. The estimation of GA by fetal biometry using Biparietal Diameter (BPD), Head Circumference (HC), Abdominal Circumference (AC) and Femoral Length (FL) in estimation of gestational age (GA) is routinely followed. However, these parameters have limitations. BPD and HC are not reliable in third trimester; FL may be reduced in IUGR and skeletal malformations. Thus we evaluated the Transcerebellar diameter (TCD) as an alternate indicator for fetal growth and GA estimation. Aim: To validate the accuracy of TCD with fetal biometry and calculated ultrasound age (CUA) in assessment of fetal growth and GA in between 18 to 40 weeks of pregnancy. Materials and Methods: The prospective study was carried out with 200 pregnant women between 18 to 40 weeks referred to Radiology department ((JJM Medical College), for antenatal scanning. The subjects were divided into two groups (second and third trimesters). TCD was measured along with other routine parameter for growth assessment. Thus, calculated gestational age (GA) using TCD was compared with GA by Last menstrual period (LMP) and calculated ultrasound age (CUA).