Femur Length Measurements Research Articles

Comparative Study between the Accuracy of Transcerebellar Diameter versus Femur Length and Biparietal Diameter Measurements in Estimation of Gestational Age during Third Trimester

Abstract Background Knowledge of accurate gestational age is of great importance in obstetric practice. Pregnancy complications as low birth weight, preterm labor are very common in pregnancies with unknown and inaccurate estimated gestational age, gestational age estimation is essential for proper prenatal care and determining whether the fetal size is appropriate-for- gestational age. Moreover, it is essential for many prenatal interventions, such as fetal lung maturation, use of magnesium for neuroprophylaxis in preterm infants, induction of delivery and neonatal resuscitation. Optimal assessment requires good judgment by the obstetrician caring for the patient. Objective To compare the accuracy of transcerebellar diameter versus the current fetal biometrics including (femur length and biparietal diameter) in estimation of the gestational age during the third trimester according to last menstrual period. Patients and Methods The study was conducted in clinic of Obstetrics and Gynaecology Department- MUST University Hospital. This study included 120 pregnant females. They were divided equally into three equal groups each contained 40 patients; Group I: Biparietal diameter measured group, Group II: Femur Length measured group, and Group III: Transcerebellar measured group. Results The comparison in 1 week proved that the TCD gave correct assessment of gestational age in 107 patients (89.17%), the BPD gave correct assessment of gestational age in 73 patients (60.83%) and the FL gave correct assessment of gestational age in 97 patients (80.83%). Conclusion Transcerebellar diameter is the most accurate and reliable method for assessment of gestational age in third trimester followed by FL and the least accurate is the BPD.

Principal Component Analysis (PCA) of Body Measurements and Its Relationship with Body Weight in Jowo Super (Bangkok × Layer) Chicken

The aim of this study was aimed to determine the total variation of the body weight (g) by using principal components analyses (PCA) of body measurements (cm) in 156 Joper (Bangkok × Layer) crossbred chickens consisting of 60 males and 96 females. In total twelve traits including body weight (BW), head circumference (HC), neck length (NL), wings length (WL), back length (BL), chest circumference (CC), chest width (CW), femur length (FL), tibia length (TiL), shank length (SL), shank circumference (SC) and third toe length (TL) were measured in each bird. The PCA of body measurements was performed by using a SPSS 16.0 package. Results determined three PC’s in each sex group based on the body measurements. Five body measurements of WL, BL, FL, TiL and SL were included in the first component (PC1) in both sex group which were able to explain the BW variation by 76% in male and 61% in female. The first three PC explained 67.78% and 65.93% of total variance of the morphostructure of male and female birds, respectively. The Kaiser-MeyerOlkin (KMO) value in both sex group was 0.80 which indicated the results of PC analyse were accurate. In conclusion, the body measurements of PC1 were influenced to BW of birds study.

Role of Trans Cerebellar Diameter for Gestational Age Estimation in Intrauterine Growth Restriction Fetuses

Background: Determining gestational age is crucial for quality maternal and fetal care. Ultrasonographic measurements of femur length (FL), crown-rump length (CRL), head circumference (HC), and biparietal diameter (BPD) are used for gestational dating. However, these don't correlate well in Intrauterine growth restriction (IUGR) cases. Studies report that trans cerebellar diameter could be used for gestational age estimation in IUGR cases. Objective: To find the correlation between trans cerebellar diameter and gestational age based on the last menstrual period (LMP) in intrauterine growth restriction fetuses. Methods: It was a cross-sectional study. The data was collected from the Department of Obstetrics and Gynecology, Sir Ganga Ram Hospital Lahore from 20 February 2022 to August 2022. After informed consent 60 women aged 18-40 years and parity <5 with suspected Intrauterine growth restriction (IUGR) were included in the study. Gestational age was determined from the LMP while trans cerebellar diameter was by Ultrasonography. The correlation between gestational age and trans cerebellar diameter was determined and compared across subgroups of the study population based on age, parity, and BMI. Results: The mean age of the study participants was 25.6±6.3 years. The majority of the women were primiparous. The mean BMI was 27.8±3.4 Kg/m2. The mean gestational age was 33.35±2.25 weeks. Trans cerebellar diameter range was 36.3 mm to 49.6 mm. A significant correlation was found between gestation age and trans cerebellar diameter (r=0.979, p-value<0.001) in subgroups based on age, parity, and BMI. Conclusion: A significant positive correlation was observed between Trans cerebellar diameter and gestational age among women with IUGR suggesting its routine use in estimating gestational age among high-risk obstetric care patients

Incidence of neonatal morbidity in small-for-gestational-age twins based on singleton and twin charts.

To compare morbidity, as measured by length of stay in the neonatal intensive care unit (NICU), in twin and singleton gestations classified as small-for-gestational age (SGA) according to estimated fetal weight < 10th percentile on twin or singleton growth charts. NICU length of stay was compared in 1150 twins and 29 035 singletons that underwent ultrasound assessment between 35 + 0 and 36 + 6 weeks' gestation. Estimated fetal weight was obtained from measurements of head circumference, abdominal circumference and femur length using the Hadlock formula. Gestational age was derived from the first-trimester crown-rump length measurement, using the larger of the two twins. Singletons and twins were compared in terms of NICU admission rate and length of stay according to classification as SGA by the Fetal Medicine Foundation singleton and twin reference distributions. The overall proportions of twins and singletons admitted to NICU were similar (7.3% vs 7.4%), but twins tended to have longer lengths of stay in NICU (≥ 7 days: 2.4% vs 0.8%; relative risk (RR), 3.0 (95% CI, 1.6-4.4)). Using the singleton chart, a higher proportion of twins were classified as SGA compared with singletons (37.6% vs 7.0%). However, the proportion of SGA neonates entering NICU was similar (10.2% for twins and 10.1% for singletons) and the proportion of SGA neonates spending ≥ 7 days in NICU was substantially higher for twins compared with singletons (3.7% vs 1.4%; RR, 2.6 (95% CI, 1.4-4.7)). When singleton charts are used to define SGA in twins and in singletons, there is a greater degree of growth-related neonatal morbidity amongst SGA twins compared with SGA singletons. Consequently, singleton charts do not inappropriately overdiagnose fetal growth restriction in twins and they should be used for monitoring fetal growth in both twins and singletons. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Fetal Biometric Parameter Reference Charts of a Central Anatolian Turkish Population.

The assessment of fetal biometry using ultrasound provides accurate pregnancy dating and also screening of fetal growth. Fetal biometry, which is common practice in the second and third trimesters of pregnancy, is fetal morphometry, which involves taking measurements of the different anatomical body parts. These fetal dimensions vary on ethnicity. The aim of this study is to demonstrate fetal biometric parameters measurement results of the Central Anatolia Turkish population with detailed percentile tables and graphs to screen fetal growth more accurately. This cross-sectional study was performed on a total of 1132 fetuses (47% girl, and 53% boy) between 15 and 40 weeks of gestation. Biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL) measurements are performed in a standardized manner every gestational week. BPD and HC were measured at the level of the thalami on the horizontal plane of the fetal head. HC was measured using the ellipse method. AC measurement was taken at the circular cross-section of the upper fetal abdomen. FL was measured along with the ossified diaphysis of the femur. All measurements were taken in millimeters. Pregnant women's mean age was 27.58 (17-43), and the mean body mass index was 27.68 (15.06-50.78) as demographic data. 38.13% of women had their first, 29.74% had their second, and 32.13% had three or more gestations within our study. Percentile data of fetuses for each parameter (BPD, HC, AC, and FL) and for each week were shown as tables and percentile graphics. Fetal 50th percentile measurements were compared between our study and other studies from different countries. The Kruskal-Wallis test results showed that BPD (p = 0.827), HC (p = 0.808), AC (p = 0.846), and FL (p = 0.725) values have a statistically similar mean in all studies. Hierarchical cluster analysis results showed that our results for BPD, HC, AC, and FL percentile curves have been found closer to Italian population results. However, our results were statistically different from Asian, Nigerian, non-Hispanic American, and Brazilian populations for each of the different parameters. The specialization of fetal biometric charts for a particular population can ensure a more accurate assessment of fetal growth rate. We showed fetal biometric percentile tables and graphics of the Central Anatolian Turkish population in this study. These results may provide a valuable contribution to obstetrical practice.Further studies can be conducted in different regions of Turkiye, thus comparisons could be possible over the country.

Fetal Medicine Foundation charts for fetal growth in twins.

To derive reference distributions of estimated fetal weight (EFW) in twins relative to singletons. Gestational-age- and chorionicity-specific reference distributions for singleton percentiles and EFW were fitted to data on 4391 twin pregnancies with two liveborn fetuses from four European centers, including 3323 dichorionic (DC) and 1068 monochorionic diamniotic (MCDA) twin pregnancies. Gestational age was derived using the larger of the two crown-rump length measurements obtained during the first trimester of pregnancy. EFW was obtained from ultrasound measurements of head circumference, abdominal circumference and femur length using the Hadlock formula. Singleton percentiles were obtained using the Fetal Medicine Foundation population weight charts for singleton pregnancies. Hierarchical models were fitted to singleton Z-scores with autoregressive terms for serial correlations within the same fetus and between twins from the same pregnancy. Separate models were fitted for DC and MCDA twins. Fetuses from twin pregnancies tended to be smaller than singletons at the earliest gestational ages (16 weeks for MCDA and 20 weeks for DC twins). This was followed by a period of catch-up growth until around 24 weeks. After that, both DC and MCDA twins showed reduced growth. In DC twins, the EFW corresponding to the 50th percentile was at the 50th percentile of singleton pregnancies at 23 weeks, the 43rd percentile at 28 weeks, the 32nd percentile at 32 weeks and the 22nd percentile at 36 weeks. In MCDA twins, the EFW corresponding to the 50th percentile was at the 36th percentile of singleton pregnancies at 24 weeks, the 29th percentile at 28 weeks, the 19th percentile at 32 weeks and the 12th percentile at 36 weeks. In DC and, to a greater extent, MCDA twin pregnancies, fetal growth is reduced compared with that observed in singleton pregnancies. Furthermore, after 24 weeks, the divergence in growth trajectories between twin and singleton pregnancies becomes more pronounced as gestational age increases. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Comparaison pragmatique des courbes de biométries fœtales élémentaires

IntroductionThe fetal biometrics charts recommended in France for ultrasound screening include measurements of head circumference (HC), biparietal diameter (BIP), abdominal circumference (AC) and femur length (FL). New international growth standards have been recommended since 2022. The aim of this work is to quantitatively describe the differences between these biometric curves. MethodsThe biometry curves from the French College for Fetal Ultrasound, OMS and INTERGROWTH-21 are pragmatically compared based on their original quantile regression equations (superposition and quantification of differences in millimeters and in proportion) for different percentiles of clinical interest. ResultsCompared with the new charts, CFEF underestimates HC<-3DS and AC<10eP. The proportions of differences between the CFEF and INTERGROWTH-21 or WHO curves always remained <5%. The proportions of difference of the 3rd percentile of HC and FL, 10th and 90th percentile of AC were always lower than 2%, 2%, 5% and 4% respectively, between OMS and INTERGROWTH-21. ConclusionThe switch to prescriptive standards suggests an improvement in the detection of fetuses with AC<10th percentile, an improvement in the detection of prenatal onset microcephaly, with no argument for a decrease in the detection rate of severe constitutional bone disease or modification of obstetrical guidelines.

An analytical cross-sectional study: determining gestational age using fetal clavicle length during the second trimester.

To investigate the correlation between fetal clavicle length and gestational age in pregnant patients from 14 and 27weeks of gestation. This was a retrospective cross-sectional study of patients from 14 and 27weeks of gestation. Ultrasonographic measurements such as abdominal circumference (AC), femur length (FL), humerus length (HL), clavicle length (CL), head circumference (HC), biparietal diameter (BPD), estimated fetal weight (EFW), and transverse cerebellum diameter (TCD) were made and compared. A total of 552 patients were evaluated in our clinic and CL was measured properly and successfully in all fetuses. Fetal AC, FL, HL, CL, BPD, HC, EFW and TCD measurements were significantly and strongly correlated with gestational week, and Pearson's correlation values were 0.964, 0.965, 0.959, 0.965, 0.951, 0.917, 0.925, and 0.954, respectively (p < 0.001). In the regression analysis equation, gestational week = 0.894 + CL × 0.961. There was a significant positive correlation between fetal CL (mm) and gestational week. We suggest that the 1mm = 1week rule can be used for patients with anomalies of the cerebellum and vermis, as well as for patients with unknown last menstrual period.

Associations of solar activity and related exposures with fetal growth

BackgroundSolar and geomagnetic activity have been shown to suppress melatonin and to degrade folate levels, important hormones for fetal development. We examined whether solar and geomagnetic activity were associated with fetal growth. MethodsWe included 9573 singleton births with 26,879 routine ultrasounds at an academic medical center in Eastern Massachusetts from 2011 through 2016. Sunspot number and Kp index were obtained from the NASA Goddard Space Flight Center. Three exposure windows were considered, including the first 16 weeks of pregnancy, one month prior to fetal growth measurement, and conception until fetal growth measurement (cumulative). Ultrasound scans from which we extracted biparietal diameter, head circumference, femur length, and abdominal circumference measurements were categorized as anatomic (<24 weeks' gestation) or growth scans (≥24 weeks' gestation) based on clinical practice. Ultrasound parameters and birth weight were standardized, and linear mixed models adjusted for long-term trends were fitted. ResultsPrenatal exposures were positively associated with larger head parameters measured <24 weeks' gestation, negatively associated with smaller fetal parameters measured ≥24 weeks' gestation, and not associated with birth weight. The strongest associations were observed for cumulative exposure in growth scans, where an interquartile range increase in sunspot number (32.87 sunspots) was associated with a −0.17 (95 % CI: −0.26, −0.08), −0.25 (−0.36, −0.15), and −0.13 (95 % CI: −0.23, −0.03) difference in mean biparietal diameter, head circumference, and femur length z-score, respectively. An interquartile range increase in cumulative Kp index (0.49) was associated with a −0.11 (95 % CI: −0.22, −0.01) and −0.11 (95 % CI: −0.20, −0.02) difference in mean head circumference and abdominal circumference z-score, respectively, in growth scans. ConclusionsSolar and geomagnetic activity were associated with fetal growth. Future studies are needed to better understand the impact of these natural phenomena on clinical endpoints.

Standardization and quality control of Doppler and fetal biometric ultrasound measurements in low-income setting.

The aim of this study was to determine the quality of fetal biometry and pulsed-wave Doppler ultrasound measurements in a prospective cohort study in Uganda. This was an ancillary study of the Ending Preventable Stillbirths by Improving Diagnosis of Babies at Risk (EPID) project, in which women enroled in early pregnancy underwent Doppler and fetal biometric assessment at 32-40 weeks of gestation. Sonographers undertook 6 weeks of training followed by onsite refresher training and audit exercises. A total of 125 images for each of the umbilical artery (UA), fetal middle cerebral artery (MCA), left and right uterine arteries (UtA), head circumference (HC), abdominal circumference (AC) and femur length (FL) were selected randomly from the EPID study database and evaluated independently by two experts in a blinded fashion using objective scoring criteria. Inter-rater agreement was assessed using modified Fleiss' kappa for nominal variables and systematic errors were explored using quantile-quantile (Q-Q) plots. For Doppler measurements, 96.8% of the UA images, 84.8% of the MCA images and 93.6% of the right UtA images were classified as of acceptable quality by both reviewers. For fetal biometry, 96.0% of the HC images, 96.0% of the AC images and 88.0% of the FL images were considered acceptable by both reviewers. The kappa values for inter-rater reliability of quality assessment were 0.94 (95% CI, 0.87-0.99) for the UA, 0.71 (95% CI, 0.58-0.82) for the MCA, 0.87 (95% CI, 0.78-0.95) for the right UtA, 0.94 (95% CI, 0.87-0.98) for the HC, 0.93 (95% CI, 0.87-0.98) for the AC and 0.78 (95% CI, 0.66-0.88) for the FL measurements. The Q-Q plots indicated no influence of systematic bias in the measurements. Training local healthcare providers to perform Doppler ultrasound, and implementing quality control systems and audits using objective scoring tools in clinical and research settings, is feasible in low- and middle-income countries. Although we did not assess the impact of in-service retraining offered to practitioners deviating from prescribed standards, such interventions should enhance the quality of ultrasound measurements and should be investigated in future studies. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Stature Estimation by Radiological Length of Femur in Adult Male of Jaipur

Background: Body Stature is defined as height of the body in upright position and is an inherent character, soconsidered as one of the important parameters of personal identification. To know stature of individual, length oflong bones is needed and use of more than one long bone gives accurate result.Aims &amp; objective: Stature Estimation By Radiological Length Of Femur In Adult Male Of Jaipur.Material &amp; methodology: A cross sectional analytical type observational study that used inclusion and exclusioncriteria was conducted. 30 males were taken in the study whose radiological measurement of femur length wasconducted by X-ray imaging of right femur bone. The present study had been conducted in Department of ForensicMedicine in association with Department of Radiology, SMS Medical College and Attached Hospitals, Jaipur.Result &amp; observation: In current study majority of subject having height ranging from 166 cm – 175 cm (MediumStature ) with a mean height of 170.43 cm with a standard deviation of ± 8.14. The mean height in short staturemale is 160.37 ± 3.81 cm, the mean height in Medium stature male is 170.96 ± 3.20 cm and the mean height in Tallstature male is 181 cm ± 3.65 cm.Majority of male subjects had femur length ranging from 44.1 cm – 46.0 cm witha mean femur length of 46.39 cm with a standard deviation of ± 2.71. The regression formula for male of nativepopulation of Jaipur is y = 2.8744x + 36.189.Conclusion:There isa positive correlation between stature and femur length in male native population of Jaipur.

Ambient temperature during pregnancy and fetal growth in Eastern Massachusetts, USA.

Left unabated, rising temperatures pose an escalating threat to human health. The potential effects of hot temperatures on fetal health have been under-explored. Here, we examined the association between prenatal ambient temperature exposure and fetal growth measures in a Massachusetts-based pregnancy cohort. We used ultrasound measurements of biparietal diameter (BPD), head circumference (HC), femur length and abdominal circumference (AC), in addition to birthweight (BW), from 9446 births at Beth Israel Deaconess Medical Center from 2011 to 2016. Ultrasound scans were classified into three distinct gestational periods: 16-23 weeks, 24-31 weeks, 32+ weeks; and z-scores were created for each fetal growth measure using the INTERGROWTH-21st standards. We fitted distributed lag models to estimate the time-varying association between weekly temperature and fetal growth, adjusting for sociodemographic characteristics, seasonal and long-term trends, humidity and particulate matter (PM2.5). Higher ambient temperature was associated with smaller fetal growth measures. The critical window of exposure appeared to be Weeks 1-20 for ultrasound parameters, and high temperatures throughout pregnancy were important for BW. Associations were strongest for head parameters (BPD and HC) in early to mid-pregnancy, AC late in pregnancy and BW. For example, a 5ºC higher cumulative temperature exposure was associated with a lower mean AC z-score of -0.26 (95% CI: -0.48, -0.04) among 24-31-Week scans, and a lower mean BW z-score of -0.32 (95% CI: -0.51, -0.12). Higher temperatures were associated with impaired fetal growth. This has major health implications given that extreme temperatures are more common and escalating.

Bland-Altman Plot: Agreement Between Ultrasound-measured Placenta Thickness and Other Biometric Parameters in the Determination of Gestational Age.

The aim of this article is to evaluate the agreement of placenta thickness (PT) with other foetal biometric parameters in the determination of gestational age (GA) in normal singleton foetuses. The study was a cross-sectional descriptive study conducted among 406 consecutively recruited pregnant women with singleton foetuses at 15-40 weeks of gestation at the National Hospital, Abuja, Nigeria from October to December 2019. Biparietal diameter (BPD), femur length (FL), head circumference (HC), abdominal circumference (AC), and PT were measured using standard measurement protocols. Bland and Altman (BA) plots were used to compare PT and other foetal biometric parameters. The significant statistical level was determined at a critical value of P < 0.05. The mean age of study participants was 31.8 ± 4.8 years. The BA plot of PT and HC demonstrated a normal distribution; the mean difference was around zero (3.968) and 95% of the measurements fell within 2SD of the mean. The BA plot of HC and AC measurements also showed that the 95% limits of agreement for differences fell within 10% of the mean of the measurements (-4.236 to 15.987 with a mean difference of 5.876), indicating good agreement between the two pairs of variables. However, BA plots between PT and BPD as well as PT and FL showed no agreement. This study indicates that there is good agreement or comparability between PT and HC measurements as well as between PT and AC measurements. Hence, either HC or AC measurements may be interchangeable with PT measurements in the ultrasound determination of GA. However, PT measurements did not agree well with BPD and FL measurements, respectively.

Accuracy of the sonographic determination of estimated fetal weight in anhydramnios.

To determine whether the presence of anhydramnios significantly influences the sonographic estimated fetal weight (EFW) compared to a matched cohort with normal amniotic fluid volume. The study sample of this retrospective case-control study consisted of 114 pregnant women who presented to a Tertiary Perinatal Clinic between 2015 and 2020. 57 of them presented with an anhydramnios and a matched cohort of 57 women with normal amniotic fluid volume. At time of admission, gestational age varied between 22 +4 and 42 +6weeks of pregnancy. All women underwent detailed ultrasound assessment for EFW and amniotic fluid index. To determine EFW Hadlock's estimation formula I was used which is based on measurements of biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL). The EFW was compared with the weight at delivery. The maximum time interval between measurement and delivery was 5days. There was neither a significant difference between the case and control group with regard to gestational age at ultrasound in days (median 249days and 246days, p = 0.97), nor to gestational age at birth (median 249days and 247days, p = 0.98). Concerning the newborns parameters, the body length at birth was not significantly different between the case and control group in centimeters (cm) (median 47cm and 47cm, p = 0.79). EFW in gram (g) was lower than birth weight in both groups and did not differ significantly between case and control group (estimated weight median 2247g and 2421g, p = 0.46; birth weight median 2440g and 2475g, p = 0.47). The difference between EFW and birth weight in percent (%) did not differ between the case and control group (median -3.9% and -5.6%, p = 0.70). The maternal parameters showed that the patients in the case group were younger (median 31years and 38years p = 0.20) and had a significantly higher body mass index (BMI) (median 27.3kg/m2 vs 22.0kg/m2, < 0.001) compared to the control group. Our study shows for the first time that EFW in women with anhydramnios can be determined sonographically just as accurately as in a matched cohort with normal amniotic fluid volume. A reliable estimation of fetal weight is crucial for optimal assessment of the newborns prognosis and counseling of the parents especially when advising women in the early weeks of pregnancy at the limit of viability.

The birth weight of macrosomia influence the accuracy of ultrasound estimation of fetal weight at term.

To evaluate and analyze the accuracy of ultrasound estimation of the fetal weight of Macrosomia at term. The instruments used were α6(Aloka; Japan) color Doppler ultrasound imagers, and vinno 80 (feieno; China) with a frequency of 3.5MHz. The formula used to calculate the estimated fetal birth weight (EFW) was that proposed by Hadlock et al. (Hadlock 2). The biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL) measurements were performed strictly following the practice guidelines. Detailed measurement standards are shown in the figure and the table in the text. Macrosomia is typically defined as a birth weight above the 90th percentile for gestational age or >4000 g.Two indexes were used to calculate the error between EFW and birth weight (BW): Simple error (SE=BW - EFW); Absolute percentage error (APE, which reflects this percentage in absolute value, percentage error [PE=SE/BW] × 100). In order to better evaluate the measurement results, we made the following definitions: 1. When APE > 15%, the measurement deviation is significant. 2. The ratio of those cases with APE > 15% to the total number of cases measured by a sonographer was greater than 20%, indicating that the sonographer was prone to significant measurement deviation. A total of 374 cases were analyzed. The mean maternal age was 31.48 (±15.93) years. Each pregnant woman carries only one fetus. The mean gestational age at delivery was 39.93 (±0.84) weeks. There were 245 male infants (65.5%), 129 female infants (34.5%), 214 cesarean section (57.2%), and 160 vaginal delivery (42.7%). 339 cases (90.64%) were estimated to be lower than the actual BW. The estimated weight was higher than the actual weight in 35 cases, accounting for 9.36%.The APE>15% in 56 cases, accounting for 14.97%. The accuracy of estimated fetal weight was closely related to the BW of the fetus and had no significant correlation with the seniority of the physician, the gender of the fetus, and the fetal position. Studies on macrosomia have shown that the BW of macrosomia tends to be underestimated, which is also reflected in the results of this study. The accuracy of estimated fetal weight still needs to be improved. Our study found that the accuracy of estimated fetal weight was closely related to the BW of the fetus and had no significant correlation with the seniority of the physician, the gender of the fetus, and the fetal position. The correlation between the section and calculation formula on the measurement accuracy needs to be studied. Through systematic data analysis, we can find the doctors whose measurements are relatively inaccurate in our department and carry out targeted quality control to improve the measurement accuracy.

The Sonographic Evaluation of Gestational Age: A Comparative Study Utilizing Different Biometric Measurement Indices and Fetal Kidney Length

Objective: Various indices have been introduced for estimating sonographic gestational age and have demonstrated varied diagnostic accuracy. The aim of this study was to evaluate the correlation of fetal kidney length (FKL) with some other traditional measurement parameters in determining an accurate gestational age. Materials and Methods: In this prospective study, healthy pregnant women, who had completed a scheduled and routine obstetrical sonogram, were included. During the sonogram, the measurement indices, biparietal diameter (BPD), abdominal circumference (AC), crown rump length (CRL), head circumference (HC), femur length (FL), and FKL were analyzed. The obstetrical measurements had been taken every 4 weeks from the 20th week of the pregnancy, until the end of the pregnancy (e.g., 20th, 24th, 28th, 32nd, 36th, 40th weeks). After data collection, the measurement data were analyzed with SPSS software. Results: There were significant ( P &lt; .05) high strength of associations between FKL and the routine measurements of BPD ( r = 0.668), AC ( r = 0.770), CRL ( r = 0.792), HC ( r = 0.791), and FL ( r = 0.803). Conclusion: These results suggest possible significant positive relationships between FKL and BPD, AC, CRL, HC, and FL. It can be assumed that FKL might be a suitable index for determining gestational age especially in the late second and third trimester, when other measurement indices are less accurate.

Prenatal Diagnosis of a Lethal Skeletal Dysplasia.

Prenatal Diagnosis of a Lethal Skeletal Dysplasia.

Influence of maternal body mass index on interobserver variability of fetal ultrasound biometry and amniotic-fluid assessment in late pregnancy.

To determine the interobserver reproducibility of fetal ultrasound biometric and amniotic-fluid measurements in the third trimester of pregnancy, according to maternal body mass index (BMI) category. This was a prospective cohort study of women with a singleton gestation beyond 34 weeks, recruited into four groups according to BMI category: normal (18.0-24.9 kg/m2 ), overweight (25.0-29.9 kg/m2) , obese (30.0-39.9 kg/m2 ) and morbidly obese (≥ 40 kg/m2 ). Multiple pregnancies, women with diabetes and pregnancies with a fetal growth, structural or genetic abnormality were excluded. In each woman, fetal biometric (biparietal diameter (BPD), head circumference, abdominal circumference (AC), femur length (FL) and estimated fetal weight) and amniotic-fluid (amniotic-fluid index (AFI) and maximum vertical pocket (MVP)) measurements were obtained by two experienced sonographers or physicians, blinded to gestational age and each other's measurements. Differences in measurements between observers were expressed as gestational age-specific Z-scores. The interobserver intraclass correlation coefficient (ICC) and Cronbach's reliability coefficient (CRC) were calculated. Bland-Altman analysis was used to assess the degree of reproducibility. In total, 110 women were enrolled prospectively (including 1320 measurements obtained by 17 sonographers or physicians). Twenty (18.2%) women had normal BMI, 30 (27.3%) women were overweight, 30 (27.3%) women were obese and 30 (27.3%) women were morbidly obese. Except for AFI (ICC, 0.65; CRC, 0.78) and MVP (ICC, 0.49; CRC, 0.66), all parameters had a very high level of interobserver reproducibility (ICC, 0.72-0.87; CRC, 0.84-0.93). When assessing reproducibility according to BMI category, BPD measurements had a very high level of reproducibility (ICC ≥ 0.85; CRC > 0.90) in all groups. The reproducibility of AC and FL measurements increased with increasing BMI, while the reproducibility of MVP measurements decreased. Among the biometric parameters, the difference between the BMI categories in measurement-difference Z-score was significant only for FL. Interobserver differences for biometric measurements fell within the 95% limits of agreement. Obesity does not seem to impact negatively on the reproducibility of ultrasound measurements of fetal biometric parameters when undertaken by experienced sonographers or physicians who commonly assess overweight, obese and morbidly obese women. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Comparison of anthropometric measurements of foetuses in normal, gestational diabetes-affected, and hypertensive pregnancies

ObjectivesFoetal anthropometry evaluates and monitors foetal development and assesses the nutritional state of the developing foetus. It is a vital indicator of the normalcy of foetal development in-utero. The most relevant parameters in foetal anthropometry are biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL). Gestational diabetes mellitus (GDM) and gestational hypertension (GHTN) are the major reasons for variations in foetal development. In this study, we compare foetal anthropometric measurements taken using ultrasounds of normal, gestational diabetes-affected, and hypertensive pregnancies. MethodIn this study, a total of 615 anomaly scans were done between the gestational ages of 18–22 weeks from 2016 to 2018. The patients’ data were collected from the register of the anomaly scanning room. The foetal anthropometric parameters measured BPD, HC, AC, and FL. ResultsAll the measurements including BPD, HC, and AC were lower in foetuses affected by GHTN, and all the measurements, including FL, were higher in foetuses affected by GDM than in normal pregnancies. A post-hoc analysis using Tukey's test showed that each foetal parameter had a significant correlation with pregnancy-related co-morbidities (p-value < 0.05). ConclusionIt is clear from our study that the foetuses of mothers with GDM showed a consistent variation of 10 mm above the normal average in terms of the BPD, HC, AC, and FL measurements. The GHTN-affected foetuses had averages that were lower than normal for BPD, HC, and AC.

Interval growth across gestation in pregnancies with fetal gastroschisis

Gastroschisis is often complicated by fetal growth restriction, preterm delivery, and prolonged neonatal hospitalization. Prenatal management and delivery decisions are often based on estimated fetal weight and interval growth; however, appropriate interval growth from week to week across gestation for these fetuses is poorly understood. This study aimed to determine the median increase in overall estimated fetal weight and individual biometric measurements across each week of gestation in pregnancies with fetal gastroschisis and to assess whether lower in utero fetal weight gain is predictive of postnatal growth or adverse neonatal outcomes. This was a retrospective cohort study of pregnancies with gastroschisis evaluated at 5 institutions of the University of California Fetal-Maternal Consortium from December 2014 to December 2019. The inclusion criteria were prenatally diagnosed gastroschisis with at least 1 ultrasound performed at a University of California Fetal-Maternal Consortium institution. Estimated fetal weight and individual biometric measurements were recorded for each ultrasound performed at a University of California Fetal-Maternal Consortium institution from the time of gastroschisis diagnosis to delivery. Median estimated fetal weight and biometric measurements were calculated for each gestational age in 1-week increments. Neonatal outcomes collected were birthweight, length of stay, complications of gastroschisis (bowel atresia, bowel stricture, ischemic bowel before closure, or severe pulmonary hypoplasia), and growth failure at discharge. We identified 95 pregnancies with fetal gastroschisis who, in aggregate, had 360 growth ultrasounds at a University of California Fetal-Maternal Consortium institution. The median interval growth was 130 g/wk. The median estimated fetal weight and abdominal circumference in fetal gastroschisis cases were approximately the tenth percentile on the Hadlock growth curve across gestation. Moreover, the median biparietal diameter, head circumference, and femur length measurements remained below the 50th percentile on the Hadlock growth curve across gestation. The median birthweight for neonates with less than the median weekly prenatal weight gain was less than for those with greater than the median weekly prenatal weight gain (2185 g vs 2780 g; P<.01). There was no difference in prenatal weight gain trajectory when comparing neonates who had or did not have bowel complications of gastroschisis. In this multicenter cohort of pregnancies with fetal gastroschisis, the median interval growth was 130 g/wk, and overall, in utero growth closely followed the tenth percentile on the Hadlock curve. Poor prenatal growth in cases of fetal gastroschisis correlates with lower neonatal weights but did not predict a more complicated course.