Fetal Gestational Age Research Articles

Maternal and fetal outcomes in those with autoimmune connective tissue disease.

Autoimmune CTDs like systematic lupus erythematosus (SLE), systemic sclerosis (SSc), and rheumatoid arthritis (RA)predominantly affect women during reproductive years and are linked to maternal and fetal complications. We conducted a population-based, retrospective cohort study using the national inpatient data sample to compare maternal and fetal outcomes in patients with and without CTD delivering between October 2015 and December 2020. Regression analysis was performed and adjusted for multiple patient characteristics to compare outcomes. Our study comprised of 18,866,050 deliveries, of which 50,450 (0.02%) had autoimmune CTD, including 25,340 with SLE, 23,945 with RA, and 1,165 with SSc. Patients with CTDs had significantly higher odds of maternal death (aOR 3.898; 95% CI: 1.462-10.389, p = 0.007), hypertensive disorders (aOR 1.554; 95% CI: 1.456-1.659, p < 0.001), acute kidney injury (aOR 4.886; 95% CI: 3.934-6.069, p < 0.001), blood transfusions (aOR 1.853; 95% CI: 1.628-2.109, p < 0.001), peripartum cardiomyopathy (aOR 2.709; 95% CI: 1.492-4.917, p = 0.001), sepsis (aOR 2.112; 95% CI: 1.430-3.119, p < 0.001), and ARDS (aOR 1.623; 95% CI: 1.076-2.449, p = 0.021). Fetal outcomes were also worse, with higher odds of small for gestational age fetuses (aOR 1.926; 95% CI: 1.779-2.086, p < 0.001), stillbirth (aOR 1.644; 95% CI: 1.352-2.000, p < 0.001), and preterm labor (aOR 1.702; 95% CI: 1.574-1.841, p < 0.001). Patients with RA, SS, and SLE experience varying degrees of complications. Our study shows that pregnant patients with autoimmune CTDs have worse maternal and fetal outcomes compared to those without CTDs. The rates of adverse outcomes varies among CTD subtypes. Comprehensive preconception counseling and tailored management strategies are essential for optimizing outcomes in these patients. Key Points • Increased Maternal Complications: Patients with autoimmune CTDs had significantly higher odds of maternal death, hypertensive disorders, acute kidney injury, blood transfusions, peripartum cardiomyopathy, sepsis, and ARDS. • Adverse Fetal Outcomes: Higher odds of small for gestational age fetuses, stillbirth, and preterm labor were observed in patients with CTDs compared to those without. • CTD Subtype Variations: Complication rates varied among CTD subtypes, with SLE, RA, and SSc each presenting varying risks and outcomes.

Accuracy of fetal kidney length and transcerebellar diameter in assessment of gestational age in normal and growth restricted fetuses

Background: Accurate monitoring of fetal gestational age is one of the most critical components of prenatal care. Aim: This study intends to determine the accuracy of fetal gestational age estimation using mean fetal kidney length and transcerebellar diameter and comparing their efficacy with other biometric measurements in normal and growth restricted fetuses. Subjects and Methods: Our prospective study was conducted on 251 pregnant women seeking for routine ultrasound examination during the second half of pregnancy at Al-Hussein and Al-Zaharaa university hospitals starting from November 2021 till November 2022 and the following fetal biometric parameters were measured transabdominally during each ultrasound examination including the transcerebellar diameter (TCD), fetal kidney length (FKL), biparietal diameter (BPD), head circumferences (HC), abdominal circumferences (AC) and femur length (FL). Results: The FKL and TCD in the present study correlated well with the assigned GA. The relationship of fetal kidney growth and TCD with GA is statistically significant. The present study hence validates the recommendation that FKL and TCD can be used as an important sonographic parameter for accurate prediction of fetal gestation age especially in IUGR fetuses. Conclusion: Fetal kidney length and TCD are accurate parameters for assessment of gestational age in 2nd half of normal pregnancy. In addition, fetal kidney length and TCD are highly accurate for detection of gestation age in IUGR suspected pregnancies.

Fetal gestational age prediction via shape descriptors of cortical development.

Gyrification is the intricate process through which the mammalian cerebral cortex develops its characteristic pattern of sulci and gyri. Monitoring gyrification provides valuable insights into brain development and identifies potential abnormalities at an early stage. This study analyzes the cortical structure in neurotypical and pathological (spina bifida) fetuses using various shape descriptors to shed light on the gyrification process during pregnancy. We compare morphometric properties encoded by commonly used scalar point-wise curvature-based signatures-such as mean curvature (H), Gaussian curvature (K), shape index (SI), and curvedness (C)-with multidimensional point-wise shape signatures, including spectral geometry processing methods like the Heat Kernel Signature (HKS) and Wave Kernel Signature (WKS), as well as the Signature of Histograms of Orientations (SHOT), which combines histogram and signature techniques. These latter signatures originate from computer graphics techniques and are rarely applied in the medical field. We propose a novel technique to derive a global descriptor from a given point-wise signature, obtaining GHKS, GWKS, and GSHOT. The extracted signatures are then evaluated using Support Vector Regression (SVR)-based algorithms to predict fetal gestational age (GA). GSHOT better encodes the GA to other global multidimensional point-wise shape signatures (GHKS, GWKS) and commonly used scalar point-wise curvature-based signatures (C, H, K, SI, FI), achieving a prediction R 2 of 0.89 and a mean absolute error of 6 days in neurotypical fetuses, and a R 2 of 0.64 and a mean absolute error of 10 days in pathological fetuses. GSHOT provides researchers with an advanced tool to capture more nuanced aspects of fetal brain development and, specifically, of the gyrification process.

Cerebellar Diameter as A Predictor of Gestational Age of Fetus: Comparison With Other Biometry Parameters

Objective: The aim of this study was to determine if the fetal cerebellum can be used as a predictor of gestational age (GA), in comparison with other biometric parameters, such as fetal head circumference (HC), biparietal diameter (BPD), abdominal circumference (AC), and femur length (FL). Materials and Methods: A grayscale sonographic examination was completed on a cohort of 200 pregnant participants, during their second and third trimester. A descriptive analysis was used to determine the fetal GA, utilizing the transcerebellar diameter (TCD), while comparing it with other biometry metrics. The mean and standard deviation were provided for quantitative variables, while frequencies were determined for categorical variables. A multivariate regression was used to construct models for determining the fetal GA by using the fetal TCD. Results: Paired sample statistics of this fetal data showed that the mean GA (i.e., fetal GA based on BPD, FL, HC, and AC) and TCD-GA have approximately the same mean values of 27.59. Moreover, the strength of correlation was 0.941 and a significance of P &lt; .001, respectively. Based on the paired sampling, the analysis indicated that there was a very strong significant positive linear relationship between mean fetal GA and TCD-GA and strong reliability. Conclusion: This cohort study demonstrated a very strong significant positive linear relationship between mean fetal GA and TCD-GA, with strong reliability. This may suggest that it is possible to determine fetal GA by measuring TCD.

Pregnancy dating: Determining gestational age through fetal kidney length-what do we observe?

Accurate gestational age is crucial for obstetric care, pregnancy management, and preterm labor decisions. Ultrasound, based on fetal biometric parameters, is a reliable method for this purpose. This study aims to estimate gestational age in the third trimester using ultrasonographic methods, focusing on fetal kidney length. Gestational age is estimated in the third trimester by measuring fetal kidney length and comparing it with gestational age derived from other biometric parameters (bi-parietal diameter, head circumference, abdominal circumference, and femur length) and the last menstrual period (LMP). A nine-month prospective study was conducted Kozhikode, Kerala, from September 2016 to May 2017. The study involved 200 women in their third trimester of pregnancy, utilizing third-trimester ultrasound to measure and document kidney length along with other biometric parameters (BPD, HC, AC, and FL). Subsequently, the collected data was reviewed and analyzed.: The study revealed a strong positive correlation between fetal kidney lengths (FKL) measured in millimeters and gestational age in weeks during the third trimester. The correlation was significant, with a Pearson's correlation coefficient of 0.87 (p &amp;#60; 0.001). Additionally, FKL exhibited positive correlations with other variables, including abdominal circumference (r = 0.832), head circumference (r = 0.845), bi-parietal diameter (r = 0.838), and femur length (r = 0.837). These findings demonstrated a strong Pearson’s correlation (r= 0.87-0.96, P &amp;#60;0.05) for all the biometric parameters including FKL. A linear relationship exists between fetal kidney length (FKL) and gestational age, allowing FKL to serve as an effective parameter for estimating gestational age during the third trimester. Given its positive correlation with other fetal biometric parameters such as bi-parietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL), incorporating FKL alongside these measurements enhances the accuracy of gestational dating in the third trimester. This combination of parameters improves the prediction of gestational age during this stage of pregnancy.

Methodology Used in Studies Aimed at Measuring Fetal Soft Tissues by 2D Ultrasound for the Screening of Large for Gestational Age Fetuses: A Systematic Review.

Management of suspected large for gestational age (LGA) fetuses remains unclear because ultrasound-estimated fetal weight (EFW) is not accurate. This was a systematic review of observational studies on fetal soft tissues measurements used alone or in combination to create a new EFW formula, to improve the screening for LGA fetuses. Studies were scored using a predefined set of independently agreed methodological criteria and an overall quality score was assigned for study design, statistical analysis, and reporting methods. There is a need to standardize methodologies for soft fetal tissue measurements. We propose a set of suggestions for this purpose.

Fetal growth ultrasound in obese patients for the detection of growth abnormalities.

To examine the impact of maternal obesity on fetal growth abnormalities including fetal growth restriction (FGR) and large for gestational age (LGA) fetuses. Secondary analysis from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b). The study excluded individuals with pregestational or gestational diabetes, chronic hypertension, and other major maternal medical conditions. Ultrasound assessments were performed at 16 - 21 and 22 - 29 weeks of gestation. Our exposure was the presence of pre-pregnancy obesity. Our primary outcome was rates of fetal growth abnormalities identified by ultrasound, defined as FGR (estimated fetal weight [EFW] or abdominal circumference < 10th percentile) or LGA (EFW > 90 th percentile) among obese compared to non-obese women. A secondary analysis was performed after limiting ultrasound performed from 28-29 weeks. To estimate adjusted relative risks (aRR) with 95% confidence intervals (95%CIs), we used generalized linear models with Poisson distribution and log link using robust error variance, adjusting for the predefined covariates. Of 7,354 participants, 1,443 (19.6%) had pre-pregnancy obesity while 5,911 (80.4%) did not. Pre-pregnancy obesity compared with normal weight was associated with an increased risk of fetal growth abnormalities both at 16-21 weeks (16.0% vs. 13.2%; aRR 1.23; 95%CI 1.06-1.42) and 22-29 weeks (16.0% vs. 12.1%; aRR 1.33; 95%CI 1.14-1.54). Furthermore, pre-pregnancy obesity compared with normal weight was associated with an increased risk of LGA both at 16-21 weeks (12.5% vs. 10.3%; aRR 1.24; 95%CI 1.05-1.47) and 22-29 weeks (10.6% vs. 6.9%; aRR 1.66; 95%CI 1.38-2.01). In a secondary analysis limited to the ultrasound 28-29 weeks, both fetal growth abnormalities and LGA were associated with the presence of obesity. In any of the analyses, pre-pregnancy obesity was not associated with FGR compared to normal weight. Maternal obesity is associated with an increased risk of fetal growth abnormalities and LGA fetuses.

Gestational age assessment by ultrasound cerebellar measurements in fetal and perinatal deaths

BackgroundPerinatal mortality remains high in low- and middle-income countries. Accurate assessment of fetal gestational age (GA) is crucial to distinguish between prematurity and intrauterine growth restriction, two conditions commonly associated with perinatal mortality that require different preventive strategies and management. Ultrasound measurements of the cerebellum have been shown to be accurate in assessing GA during pregnancy, but their post-mortem performance has not yet been evaluated. ObjectiveWe aimed to explore the feasibility and validity of GA estimation in fetal and perinatal deaths by ultrasound measurements of the cerebellum. Study designThis is an observational cross-sectional study. Between August 2020 and November 2022 post-mortem cerebellar ultrasound measurements were conducted in a tertiary referral hospital in Barcelona, Spain. Extrauterine assessment included transcerebellar diameter, cerebellar vermis height and cerebellar vermis. Moreover, intrauterine ultrasound and autopsy direct cerebellar assessments were undertaken in a subset of cases. A total of 137 fetal and perinatal deaths [63 (46.0%) fetal deaths, 69 (50.4%) stillbirths and 5 (3.6%) neonates] were included. First, we correlated different types of transcerebellar diameter measurements between them (intrauterine, extrauterine and autopsy-based). Then, we evaluated the relationship between the extrauterine cerebellar ultrasound measurements and GA, and their performance across trimesters of gestation and in different abnormalities. ResultsGA ranged from 15.2 to 40.6 weeks. High correlation was observed between extrauterine, intrauterine, and autopsy transcerebellar measurements (p<0.001), and between all extrauterine cerebellar measurements and GA (p<0.001). Extrauterine transcerebellar diameter was identified as the strongest predictor of GA (R2=0.88; p<0.001), and its accuracy was not affected by the trimester of gestation, intrauterine growth restriction or central nervous system alterations. ConclusionsThis study shows the feasibility and accuracy of post-mortem GA evaluation by extrauterine ultrasound measurements of the cerebellum, especially of transcerebellar diameter. Implementation of this method as part of post-mortem assessment could improve cause of death attribution, especially in resource-constrained settings.

COMPARISON OF PLGF LEVELS, AMONG SMALL FOR GESTATIONAL AGE AND APPROPRIATE FOR GESTATIONAL AGE MOTHERS

Objective. Early detection of small for gestational age fetuses can prevent infant morbidity and mortality. The objective of this study was to compare the levels of Placental Growth Factor among small for gestational age with appropriate for gestational age mothers and to identify the predictive value of PlGF in detecting pregnancies with Intra uterine growth retardation in local population. Design. Quasi experimental (comparative cross-sectional) study. Place &amp; duration of study. Gynecological department of Ayub Medical complex, Abbottabad from August 2021 to January 2022. Methodology. The studied population included total 68 mothers in last trimester with 34 in each group, i.e. appropriate for gestational age and small for gestational age. Fetal size was estimated either by clinical examination (symphysis fundal height) or estimated fetal weight by ultrasound examination. Sociodemographic along with reproductive history were recorded and blood samples analyzed for PlGF difference in both groups. Results. The median age of mothers was 32.5 years. The PlGF in small for gestational age was observed in the below normal concentration (mean value = 126.7 pg/mL) while it was observed in normal ranges in appropriate for gestational age mothers (mean value = 24.2 pg/ml) with P-value (&lt;0.001). Conclusion. Mothers with small for gestational age were having significantly lower placental growth factor levels compared to mothers with appropriate for gestational age.

Retraction Note: An approach for automatic detection of fetal gestational age at the third trimester using kidney length and biparietal diameter

Retraction Note: An approach for automatic detection of fetal gestational age at the third trimester using kidney length and biparietal diameter

Impact of letrozole co-treatment in an antagonist protocol for IVF/ICSI: a retrospective study

ObjectiveThe present study aimed to investigate the impact of combined use of letrozole in an antagonist protocol during IVF on live birth outcomes and to assess the safety of letrozole in terms of maternal and neonatal complications.MethodsThis retrospective cohort study included women undergoing IVF/ICSI and fresh embryo transfer (ET) treatment with and without letrozole co-treatment from 2007 to 2021 at Shanghai Ninth People’s Hospital (Shanghai, China). The primary outcome was the live birth rate, while the incidences of maternal and neonatal complications were secondary outcomes. Logistic regression models were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for the analyzed outcomes. Sensitivity analysis was performed using a propensity score-based patient-matching (PSM) model, an inverse probability weighting (IPW) model, logistic regression models with women undergoing their first IVF-ET cycle, and subgroup analysis.ResultsOf the 4780 women enrolled in the study, 3887 underwent an antagonist protocol for ovarian stimulation, while 893 received letrozole co-treatment. In this cohort, letrozole co-treatment demonstrated comparable live birth rates to the use of antagonist protocol alone (logistic regression: aOR, 0.88; 95% CI, 0.71–1.08; PSM: aOR, 0.97; 95% CI, 0.77–1.22; IPW: aOR, 0.88; 95% CI, 0.71–1.10). Notably, individuals with a body mass index (BMI) exceeding 24 and those with high ovarian response experienced higher live birth rates under the letrozole co-treatment regimen (BMI ≥ 24: aOR, 1.85; 95% CI, 1.14-3.00; high response: aOR, 1.60; 95% CI, 1.02–2.50). Letrozole co-treatment was also associated with decreased risks of gestational diabetes (aOR, 0.34; 95% CI, 0.15–0.69) and small for gestational age (SGA) fetuses (aOR, 0.42; 95% CI, 0.22–0.75) in fresh ET cycles. These finding were robust in both PSM and IPW models.ConclusionsOur findings suggested that letrozole co-treatment in antagonist protocol for IVF/ICSI was associated with a comparable live birth rate following fresh ET. Further prospective randomized studies are needed to verify our results.

Evaluation of Fetal Heart Using Fetal Heart Quantification (fetalHQ) Technique in an Indian Cohort.

To evaluate the intra- and interobserver reproducibility of parameters used to determine cardiac morphometry and deformation using FetalHQ in Indian population. Two operators blinded to each other performed FetalHQ analysis independently on 35 normal fetuses of gestational age between 18 + 0 and 37 + 0 weeks and days. Intra- and interobserver correlation coefficient and limits of agreement were ascertained for parameters obtained from HQ analysis. Excellent reproducibility (ICC > 0.9) was observed for global morphometric parameters. Ejection fraction, stroke volume, stroke volume/kg demonstrated excellent reliability (ICC > 0.9), cardiac output, fractional area change showed a lower correlation (ICC < 0.8), and right and left ventricular global strain showed no correlation. Twenty-four segment sphericity index of left ventricle (LV) and right ventricle (RV) showed low to moderate correlation (LV-ICC 0.48-0.79; RV-ICC 0.43-0.82). Fractional shortening (FS) showed poor intraobserver reliability in RV. FetalHQ provides reliable estimates of the global cardiac morphometry but not for global cardiac strain. Regional transverse contractility represented by FS has poor correlation in right ventricle, especially in the apical region, possibly due to moderator band. Nevertheless, it is a promising tool which requires technical advancements and validation to improve its accuracy and reliability.

Does Insulin Treatment Affect Umbilical Artery Doppler Indices in Pregnancies Complicated by Gestational Diabetes?

Background/Objectives: Gestational diabetes mellitus (GDM) is one of the most common morbidities of pregnancy. The impact of increased maternal blood glucose on fetoplacental hemodynamics is not fully elucidated, especially in patients with uncontrolled GDM necessitating insulin therapy. The objective of this study was to assess the impact of insulin therapy on the umbilical artery dopplers in GDM pregnancies adequate for gestational-age fetuses. Methods: Retrospective observational study among 447 GDM pregnant women, divided according to their treatment (nutritional therapy (NT), long acting (LA) insulin, combined insulin) and 100 healthy controls with the same gestational age. The umbilical artery pulsatility index (UA-PI) was recorded at 28, 32 and 36 weeks. Results: UA-PI values declined in both GDM and healthy controls at all three time intervals. The combined insulin group showed reduced UA-PI values in comparison to the LA insulin group, but the difference never reached statistical significance. The combined insulin group exhibited significantly reduced UA-PI values at 32- and 36-weeks' gestation compared to the NT groups. Conclusions: A decreased impedance to blood flow in the umbilical artery of diabetic mothers on insulin therapy was observed. This was more pronounced during the last trimester. The extent to which umbilical artery PI can predict unfavorable outcomes has yet to be determined. Further additional studies are necessary to confirm the precise impact of glucose levels and medical interventions on the circulation of both the fetus and the mother.

Foramen Ovale Pulsatility Index as an Early Affected Doppler Study among Abnormal Growth Fetuses: A Recent Insight for Practice Based on a Prospective Study.

Routine Doppler study is a common tool for early diagnosis of Fetal Growth Restriction (FGR) and Small for Gestational Age (SGA) patients. It aimed to determine the role of the Foramen Ovale Pulsatility Index (FOPI) study beside routine Doppler study among patients with FGR and SGA fetuses. This prospective study was conducted on 35 FGR, 32 SGA, and 33 Appropriate for Gestational Age (AGA) fetuses. Demographic data, amniotic fluid index, neonatal outcome, and Doppler velocimetry, including Umbilical Artery Pulsatility Index (UMAPI), Uterine Artery Pulsatility Index (UTAPI), Middle Cerebral Artery Pulsatility Index (MCAPI), Ductus Venosus Pulsatility Index (DVPI), and FOPI were documented. Kolmogorov-Smirnov normality test, one-way ANOVA, Mann-Whitney U, Kruskal-Wallis, non-parametric pairwise comparisons adjusted for Bonferroni correction, Pearson correlation test, Chi square, Fisher's exact test, and Receiver Operating Characteristic Curve (ROC) analysis with Youden's Index (sensitivity+specificity-1) to estimate cut-off point were used to analyze the data at significance level <0.05 for all tests. FOPI cut-off points were 2.24 (sensitivity=77%, specificity=94%) and 1.15 (sensitivity=90%, specificity=20%) to predict FGR and SGA, respectively. FOPI showed a positive correlation with UMAPI and UTAPI (r=0.52 and r=0.30, P<0.001 and P=0.006, respectively), but not with MCAPI and DVPI (r=0.08 and r=0.12, P=0.50 and P=0.30, respectively). Besides, UMAPI, UTAPI, and FOPI were altered among patients with stages I and II FGR. Umbilical cord potential hydrogen (umbilical cord pH), 1- and 5-min Apgar score significantly increased by Birth weight centile; however, UMAPI, FOPI, and UTAPI significantly decreased. UMAPI is recommended to predict short-term neonatal morbidities and demonstrate the early or late onset FGR. Besides, FOPI is suggested as the first-line Doppler study to detect abnormal growth velocity. More studies are warranted, especially considering long-term neonatal morbidities.

Antenatal Ultrasound Measurement of Fetal Abdominal Subcutaneous Tissue Thickness as a Predictor of Fetal Birth Weight

Abstract Objectives To correlate fetal abdominal subcutaneous tissue thickness (FASTT) measured by transabdominal ultrasound and birth weight measured immediately after delivery and to obtain cut-off values for FASTT to predict small and large for gestational age babies in the Egyptian population. Background Fetal weight estimation is a crucial part of antenatal and intrapartum care as it forms the basis for decision making in obstetric care. Various studies compared the accuracy of different ultrasound fetal weight estimation formulas to determine the most accurate one, but current evidence still indicates significant error levels. FASTT measurement can be used to improve ultrasonographic fetal weight assessment reducing potential perinatal complications associated with small and large for gestational age fetuses. Patients and Methods A prospective cohort study conducted in Ain Shams University Hospitals on 86 pregnant women with normal singleton pregnancies between 24 and 40 weeks of gestation. FASTT was measured in millimeters at the anterior third of the abdominal circumference and birth weight was recorded immediately after delivery. Results This study concluded that FASTT showed high statistically significant correlation with EFW by Hadlock formula IV (1985) (r = 0.624, p- value = &amp;lt;0.001) and BW (r = 0.749, p- value = &amp;lt;0.001). FASTT showed higher sensitivity (84.09%) than specificity (64.29%) as a predictor of both SGA and LGA, but it showed higher sensitivity and specificity in LGA (sensitivity 100%, specificity 97.5%) compared to SGA (sensitivity 81.1%, specificity 73.5%). The best cut-off value of FASTT for LGA was 7.1 mm and that of SGA was 4.9 mm. No statistically significant correlation was found between FASTT and any of the maternal age, fetal gender or mode of delivery. Conclusion FASTT can be used as a predictor for birth weight; it is a better indicator of LGA than SGA. FASTT can be incorporated into fetal weight estimation formulas as a method to increase their accuracy especially at birth weight extremes. A study on a larger scale of Egyptian population should be conducted to generate fetal weight estimation formulas based on the Egyptian ethnicity to be the reference for medical practice in Egypt.

Comparative characteristics of the dimensions of the pons with the dimensions of the head in human fetes of different gestational age

Annotation. Malformations of human fetuses brains occur in 2-3 cases per 1000 pregnancies and are one of the most common reasons for termination of pregnancy, therefore prenatal diagnosis is extremely important and is aimed at further genetic testing of the fetus and detailed counseling of parents regarding the risk of recurrence. Anthropometric parameters of human fetuses heads allow monitoring the growth of the fetus, estimating the term of pregnancy and determining the method of birth of a pregnant woman. Therefore, the parameters of the head of human fetuses are one of the most important biological characteristics during prenatal research. The purpose of our scientific work is to determine the dimensions of the pons in human fetuses of different gestational ages and compare them with the dimensions of the head. Anatomical research was conducted on 146 human fetuses from 9-10 to 39-40 weeks of gestation. The material for the study was obtained from the maternity hospitals of the city of Vinnytsia and from the communal non-profit enterprise “Vinnytsia Regional Pathological Bureau of the Vinnytsia Regional Council”, and the study was conducted on stillborns who died from various causes not related to brain diseases in relatively healthy mothers. Head circumference, head height, longitudinal and transverse dimensions of the head, pons height, pons width, pons thickness were measured using a ShTs-125 caliper. Statistical processing of digital values was performed using the standard Statsoft software package “Statistica 6.0” on a personal computer using Microsoft Excel 2016, Kolmagorov-Smirnov and Shapiro-Wilk test indicators were determined and histograms were built based on them for visual assessment of the distribution of features. The head circumference of human fetuses of 39-40 weeks compared to fetuses of 9-10 weeks became 5.2 times larger, the longitudinal size of the head – 5 times, the transverse size of the head – 4.9 times, the height of the head – 3.6 times (p&lt;0.01). The height of the pons in human fetuses of 39-40 weeks compared to fetuses of 9-10 weeks became 3.8 times greater, thickness – 3.6 times, width – 3.1 times (p&lt;0.01).

Accuracy Evaluation of Fetal Foot Length and Correlation with Biparietal Diameter for Ultrasonographic Fetal Age Estimation in Uncomplicated Pregnant Women of Chattogram, Bangladesh

Background: Prediction and visual representation of developmental milestones of a growing fetus is most accurately done by ultrasonography. The present study was aimed to evaluate the correlation and accuracy of fetal foot length with fetal biparietal diameter to estimate fetal gestational age in Bangladeshi uncomplicated pregnant women of Chattogram district. Materials and methods: This cross-sectional observational study was conducted on 200 uncomplicated pregnant women of 15th to 28th weeks of gestation during the period from October 2021 to September 2022 in the Department of Anatomy, Chittagong Medical College, Chattogram. Fetal biometric parameters such as fetal foot length and biparietal diameter were measured by ultrasonography. For statistical analysis, Pearson’s correlation test and correlation-regression analysis was done and p-value was considered significant if it was &lt;0.05 at 95% level of confidence. Results: Pearson’s correlation test showed that gestational age had strong positive and highly significant (p=0.000) correlation with both fetal foot length and biparietal diameter. The relation between gestational age and fetal foot length(r=0.986) is less strong than the relation between gestational age and biparietal diameter(r=0.988). Conclusion: This study revealed relationship between fetal foot length and gestational age regarding accuracy. Ultrasonographic measurement of fetal foot length can be practiced alongside traditional biometric parameters for pregnancy dating in modern medical science. IAHS Medical Journal Vol 6(2), December 2023; 35-39

Prediction of fetal brain gestational age using multihead attention with Xception

Accurate gestational age (GA) prediction is crucial for monitoring fetal development and ensuring optimal prenatal care. Traditional methods often face challenges in terms of precision and prediction efficiency. In this context, leveraging modern deep learning (DL) techniques is a promising solution. This paper introduces a novel DL approach for GA prediction using fetal brain images obtained via magnetic resonance imaging (MRI), which combines the strength of the Xception pretrained model with a multihead attention (MHA) mechanism. The proposed model was trained on a diverse dataset comprising 52,900 fetal brain images from 741 patients. The images encompass a GA ranging from 19 to 39 weeks. These pretrained models served as feature extraction components during the training process. The extracted features were subsequently used as the inputs of different configurable MHAs, which produced GA predictions in days. The proposed model achieved promising results with 8 attention heads, 32 dimensionality of the key space and 32 dimensionality of the value space, with an R-squared (R2) value of 96.5 %, a mean absolute error (MAE) of 3.80 days, and a Pearson correlation coefficient (PCC) of 98.50 % for the test set. Additionally, the 5-fold cross-validation results reinforce the model's reliability, with an average R2 of 95.94 %, an MAE of 3.61 days, and a PCC of 98.02 %. The proposed model excels in different anatomical views, notably the axial and sagittal views. A comparative analysis of multiple planes and a single plane highlights the effectiveness of the proposed model against other state-of-the-art (SOTA) models reported in the literature. The proposed model could help clinicians accurately predict GA.

Seeking the optimal gestational weight gain according to the pre-pregnancy body mass index: a cross-sectional study from Shanghai, China.

Maternal nutritional status is closely related to fetal intrauterine development and an abnormal birth weight increases various disease risks across life stages. To better guide pregnancy weight gain, we aimed to explore the optimal weight gain for pregnant women with different body mass indexes (BMIs). This retrospective cohort study included 68,981 women with singleton live birth between January 2017 and October 2021 in maternity centres in Shanghai, China. The fluctuations of the incidence of small and large for gestational age (small for gestational age (SGA) and LGA, respectively) were recorded at different maternal pre-pregnancy BMI (p-BMI) and different gestational weight gain (GWG) groups to find the lowest point of abnormal fetal weight incidence. The optimal GWG was then determined using a linear regression equation. The lowest risk of LGA/SGA was associated with a maternal p-BMI of 19.46 kg/m2. For pregnant women with maternal p-BMI below 24 kg/m2, we confirmed an optimal GWG linear equation: opt GWG (kg) = -1.94 × p-BMI (kg/m²) + 51, which showed an excellent degree of fit. Women who were overweight and obese could not achieve the lowest risk of LGA/SGA despite controlling their GWG; hence, their BMI should be normalized before pregnancy. By merely using the pre-pregnancy BMI, this study has established the optimal GWG equation, with the goal of achieving the appropriate fetal gestational age. It is a practical measure to ensure desirable pregnancy outcomes and meet the health economics requirements.

Mobil Monitoring Doppler Ultrasound (MoMDUS) study: protocol for a prospective, observational study investigating the use of artificial intelligence and low-cost Doppler ultrasound for the automated quantification of hypertension, pre-eclampsia and fetal growth restriction in rural Guatemala

IntroductionUndetected high-risk conditions in pregnancy are a leading cause of perinatal mortality in low-income and middle-income countries. A key contributor to adverse perinatal outcomes in these settings is limited access...