Fetal Gestational Age Research Articles

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 < 0.05). OASIs were more common in physician compared to midwife births (5.9% vs. 2.0%, p < 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 < 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.

Risque d'acidose en cas de déclenchement pour PAG avant 37 SA

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.

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.

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.

To know or not to know: Effect of third-trimester sonographic fetal weight estimation on outcomes of large-for-gestational age neonates.

The aim of the present study was to evaluate the impact of late third-trimester sonographic estimation of large for gestational age fetuses on pregnancy management and selected fetal and maternal adverse outcomes. A retrospective cohort study was conducted in a tertiary, university-affiliated medical center between 2015 and 2019. All singleton large-for-gestational-age neonates born during this period were included. The cohort was divided into two groups: neonates for whom fetal weight was estimated on late third trimester (<14 days before delivery) sonography and neonates with no recent fetal weight estimation. The groups were compared for pregnancy management strategies, rates of labor induction, cesarean deliveries, and maternal and neonatal outcomes. A total of 1712 neonates were included in the study, among whom 791 (46.2%) had a late third-trimester fetal weight estimation (study group) and 921 (53.8%) did not (control group). Compared to the control group, the study group was characterized by higher rates of maternal primiparity (24.20% vs 19.20%, P = 0.013), higher maternal body mass index (26.0 ± 6.2 kg/m2 vs 24.7 ± 4.5 kg/m2, P = 0.002), more inductions of labor (29.84% vs 16.40%, P < 0.001) and cesarean deliveries (31.0% vs 19.97%, P < 0.001). There were no clinical differences in neonatal birth weight (4041 ± 256 g vs 3984 264 g, P < 0.001) and no significant differences between other neonatal outcomes, as rates of admission to the neonatal intensive care unit, jaundice, hypoglycemia, and shoulder dystocia. Late third-trimester sonographic fetal weight estimation is associated with a higher rate of labor induction and planned and intrapartum cesarean deliveries. In this retrospective cohort study, those interventions did not lead to reduction in maternal or neonatal adverse outcomes.

Association Between Cord Blood Placental Growth Factor Level, Fetal Doppler Parameters and Neonatal Growth Measures

Background: Placental growth factor (PlGF) contributes to fetoplacental circulatory system development, whichever revealed to have an effect on the fetal size and growth. Objectives: To explore the inference between umbilical cord blood [fetal] PlGF, fetal doppler parameters, gestational age and neonatal growth parameters particularly birth weight, birth length, head circumference and mid arm circumference. Research protocol: This cross-sectional investigation was implemented on 50 pregnant women in their third trimester, aged 18-35years and their full term newborns. Full history taking, gestational age, general and obstetric examination and ultrasound investigation, fetal biometrics and doppler ultrasound were carried out. Umbilical cord blood PlGF was quantified using ELISA. All the enrolled neonates were submitted to full clinical examination by pediatrician and their anthropometric parameters were measured before breast feeding started. Results: Umbilical artery pulsatility index (UAPI) revealed significant negative correlation with neonatal weight and PlGF level. Meanwhile, gestational age (GA) showed significant positive correlation with the neonatal anthropometric parameters including mid arm circumference (MAC), head circumference, weight, length, weight Z score, length Z score, head Z score weight to length (W/L) and weight to length Z score (W/L Z Score). Also, significant positive correlation between PlGF and gestational age as well as the neonatal anthropometric measurements was registered except head Z Score. Multiple linear regression analysis for PlGF with UA PI and neonatal weight indicated that UAPI and neonatal weight were significant predictors for fetal PlGF. Conclusions: The current data illuminate the effect of fetal placental growth factor on neonatal adverse growth pattern. Additionally, fetal placental growth factor with fetal doppler parameters could be a promising predictive biomarkers to intervene neonates at risk for adverse childhood outcomes.

Multivariable prediction models for fetal macrosomia and large for gestational age: A systematic review.

The identification of large for gestational age (LGA) and macrosomic fetuses is essential for counselling and managing these pregnancies. To systematically review the literature for multivariable prediction models for LGA and macrosomia, assessing the performance, quality and applicability of the included model in clinical practice. MEDLINE, EMBASE and Cochrane Library were searched until June 2022. We included observational and experimental studies reporting the development and/or validation of any multivariable prediction model for fetal macrosomia and/or LGA. We excluded studies that used a single variable or did not evaluate model performance. Data were extracted using the Checklist for critical appraisal and data extraction for systematic reviews of prediction modelling studies checklist. The model performance measures discrimination, calibration and validation were extracted. The quality and completion of reporting within each study was assessed by its adherence to the TRIPOD (Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis) checklist. The risk of bias and applicability were measured using PROBAST (Prediction model Risk Of Bias Assessment Tool). A total of 8442 citations were identified, with 58 included in the analysis: 32/58 (55.2%) developed, 21/58 (36.2%) developed and internally validated and 2/58 (3.4%) developed and externally validated a model. Only three studies externally validated pre-existing models. Macrosomia and LGA were differentially defined by many studies. In total, 111 multivariable prediction models were developed using 112 different variables. Model discrimination was wide ranging area under the receiver operating characteristics curve (AUROC 0.56-0.96) and few studies reported calibration (11/58, 19.0%). Only 5/58 (8.6%) studies had a low risk of bias. There are currently no multivariable prediction models for macrosomia/LGA that are ready for clinical implementation.

Measurement Of Umbilical Venous Lactate Levels For Predicting Poor Neonatal Outcomes

Objectives: To determine the utility of umbilical venous lactate measurements for predicting poor neonatal outcomes. Method: This observational study was conducted at Kahuta Research Laboratories (KRL) hospital, Islamabad from May 2019 to October 2019. Singleton pregnancies with no known fetal congenital anomalies and gestational age greater than 28 weeks were included. Descriptive statistics were used to analyse the characteristics of study subjects and also composite neonatal outcomes. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. Result: Umbilical venous lactate levels were found to be highest in instrumental deliveries (48.7%) and lowest in those delivered by elective cesarean section (25.7%). Low APGAR score, need for initial resuscitation &amp; neonatal intensive care unit admission, mechanical ventilation and neonatal morbidity were all associated with significantly higher lactate levels. Based on the maximal yield index, the optimal cut-off point for predicting neonatal morbidity was 46.5mg/dl (area under the receiver operating characteristics curve was 0.8). Based on this optimal cut-off point, it has a sensitivity of 62%, specificity of 92%, PPV 51% and NPV 94% for neonatal morbidity. Conclusion: Umbilical venous lactate measurement is a good predictor of poor neonatal outcome especially in situations when umbilical arterial blood cannot be taken due to technical difficulty. Mode of delivery has a strong association with fetal hypoxia and raised umbilical lactate levels. Keywords: lactate, neonatal outcomes, labour ward.

Effect of maternal serum albumin level on birthweight and gestational age: an analysis of 39200 singleton newborns.

Serum albumin plays a pivotal role in regulating plasma oncotic pressure and modulating fluid distribution among various body compartments. Previous research examining the association between maternal serum albumin levels and fetal growth yielded limited and inconclusive findings. Therefore, the specific influence of serum albumin on fetal growth remains poorly understood and warrants further investigation. A retrospective study involved 39200 women who had a singleton live birth at a tertiary-care academic medical center during the period from January 2017 to December 2020. Women were categorized into four groups according to the quartile of albumin concentration during early pregnancy: Q1 group, ≤41.0 g/L; Q2 group, 41.1-42.6 g/L; Q3 group, 42.7-44.3 g/L and Q4 group, >44.3 g/L. The main outcome measures were mid-term estimated fetal weight, birthweight and gestational age. Multivariate linear and logistic regression analysis were performed to detect the independent effect of maternal serum albumin level on fetal growth after adjusting for important confounding variables. In the crude analysis, a significant inverse correlation was found between early pregnancy maternal serum albumin levels and fetal growth status, including mid-term ultrasound measurements, mid-term estimated fetal weight, birthweight, and gestational age. After adjustment for a number of confounding factors, mid-term estimated fetal weight, birthweight, and birth height decreased significantly with increasing albumin levels. Compared to the Q2 group, the Q4 group had higher rates of preterm birth (aOR, 1.16; 95% CI, 1.01-1.34), small-for-gestational-age (aOR, 1.27; 95% CI, 1.11-1.45) and low birthweight (aOR, 1.41; 95% CI, 1.18-1.69), and lower rate of large-for-gestational-age (aOR, 0.85; 95% CI, 0.78-0.94). Moreover, to achieve the optimal neonatal outcome, women with higher early pregnancy albumin levels required a greater reduction in albumin levels in later pregnancy stages. A higher maternal serum albumin level during early pregnancy was associated with poor fetal growth, with the detrimental effects becoming apparent as early as the mid-gestation period. These findings provided vital information for clinicians to predict fetal growth status and identify cases with a high risk of adverse neonatal outcomes early on.

Role of Cerebroplacental Ratio in Predicting Perinatal Outcome.

Objective Doppler velocimetry provides a sensitive, non-invasive, and safe method of surveillance of fetal hemodynamics and fetomaternal circulation. Cerebroplacental ratio (CPR) is an indicator of placental function and fetal maladaptation to placental insufficiency. Cerebroplacental ratio (CPR) is becoming a significant indicator of unfavorable pregnancy outcomes, which has implications for the assessment of fetal well-being. This study aimedto determine the cut-off value of the cerebroplacental ratio (CPR) in appropriate for gestational age (AGA) fetuses in high-risk mothers to predict adverse perinatal outcomes. We also compared the efficacy of CPR, umbilical artery pulsatility index (UmA PI), and middle cerebral artery pulsatility index (MCA PI) for predicting adverse perinatal outcomes. Design and setting This was a prospective observational study conducted at the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. Methods A total of 100 women with singleton high-risk pregnancies were included in this prospective observational study. Obstetric ultrasound was performed at the time of recruitment, and fetal weight and CPR were noted. Based on fetal weight, patients were divided into AGA and fetal growth restriction (FGR) groups; CPR was measured; patients were followed up fortnightly; and outcomes were noted. Main outcome The effectiveness of CPR, UmA PI, and MCA PI for predicting poor perinatal outcomes and identifying the cut-off value of CPR in appropriate for gestational age (AGA) fetuses in high-risk mothers was assessed. Result The values of MCA PI, UmA PI, and CPR were statistically significant between AGA and FGR (p-value =.023, .002 and .0001), respectively. The cut-off value for CPR-detecting adverse outcomes in AGA was 1.49. It has sensitivity, specificity, positive predictive value, and negative predictive value of 67.5%, 68%, 71.69%, and 70.21%, respectively. Conclusion Cerebroplacental ratio (CPR) reflects both circulatory insufficiency of the placenta and adaptive changes of the middle cerebral artery, indicating an important non-invasive surveillance modality.

Artificial intelligence assistance for fetal development: evaluation of an automated software for biometry measurements in the mid-trimester

BackgroundThis study presents CUPID, an advanced automated measurement software based on Artificial Intelligence (AI), designed to evaluate nine fetal biometric parameters in the mid-trimester. Our primary objective was to assess and compare the CUPID performance of experienced senior and junior radiologists.Materials and methodsThis prospective cross-sectional study was conducted at Shenzhen University General Hospital between September 2022 and June 2023, and focused on mid-trimester fetuses. All ultrasound images of the six standard planes, that enabled the evaluation of nine biometric measurements, were included to compare the performance of CUPID through subjective and objective assessments.ResultsThere were 642 fetuses with a mean (±SD) age of 22 ± 2.82 weeks at enrollment. In the subjective quality assessment, out of 642 images representing nine biometric measurements, 617-635 images (90.65-96.11%) of CUPID caliper placements were determined to be accurately placed and did not require any adjustments. Whereas, for the junior category, 447-691 images (69.63-92.06%) were determined to be accurately placed and did not require any adjustments. In the objective measurement indicators, across all nine biometric parameters and estimated fetal weight (EFW), the intra-class correlation coefficients (ICC) (0.843-0.990) and Pearson correlation coefficients (PCC) (0.765-0.978) between the senior radiologist and CUPID reflected good reliability compared with the ICC (0.306-0.937) and PCC (0.566-0.947) between the senior and junior radiologists. Additionally, the mean absolute error (MAE), percentage error (PE), and average error in days of gestation were lower between the senior and CUPID compared to the difference between the senior and junior radiologists. The specific differences are as follows: MAE (0.36-2.53 mm, 14.67 g) compared to (0.64- 8.13 mm, 38.05 g), PE (0.94-9.38%) compared to (1.58-16.04%), and average error in days (3.99-7.92 days) compared to (4.35-11.06 days). In the time-consuming task, CUPID only takes 0.05-0.07 s to measure nine biometric parameters, while senior and junior radiologists require 4.79-11.68 s and 4.95-13.44 s, respectively.ConclusionsCUPID has proven to be highly accurate and efficient software for automatically measuring fetal biometry, gestational age, and fetal weight, providing a precise and fast tool for assessing fetal growth and development.

Congenital cytomegalovirus infection in small for gestational age fetuses – retrospective single-center cohort study

Congenital cytomegalovirus infection in small for gestational age fetuses – retrospective single-center cohort study

The Effect of Adding Vaginal Progesterone to Oral Omega-3 Fatty Acids on the Birth Weight of Constitutionally Small for Gestational Age Fetuses: A Randomized Clinical Trial

The Effect of Adding Vaginal Progesterone to Oral Omega-3 Fatty Acids on the Birth Weight of Constitutionally Small for Gestational Age Fetuses: A Randomized Clinical Trial