Crown-rump Length Measurements Research Articles

No independent associations between preconception paternal dietary patterns and embryonic growth; the Predict Study

Several studies show the importance of periconceptional maternal dietary patterns on human embryonic growth. Healthy paternal nutrition has been associated with better semen quality and fecundability, however, evidence on the impact on pregnancy outcome is limited. Therefore, the aim of this study was to investigate the association between preconception paternal dietary patterns and first trimester embryonic growth using the parameters longitudinal crown-rump length (CRL) and embryonic volume (EV). A total of 638 couples were enrolled in the Rotterdam Periconceptional Cohort and received longitudinal three dimensional transvaginal ultrasound scans from 7+0 up to 12+0 weeks of gestation. Virtual reality software was used to perform offline measurements of the embryonic CRL and EV. Food frequency questionnaires (FFQ) were used to estimate habitual food intake in couples. Principal component analysis (PCA) was performed to identify paternal and maternal dietary patterns. Linear mixed models adjusted for potential confounders were applied to analyze associations between paternal and maternal dietary patterns and embryonic growth parameters. The paternal dietary patterns retrieved were identified as "Whole wheat grains and Vegetables", "Sauces and Snacks Refined Grains", "Fish and Legumes" and explained 27.5% of the total variance of the dietary intake. No significant additional effects, independent of maternal dietary patters and other maternal and paternal potential confounders, were shown of these paternal dietary patterns on embryonic growth in spontaneous or IVF/ICSI pregnancies. No significant effects of paternal dietary patterns independent of maternal dietary patters and other parental potential confounders on embryonic growth parameters could be established in spontaneous or IVF/ICSI pregnancies. The biological importance of paternal nutrition on semen quality, however, supports the need of periconceptional tailored nutritional counselling of couples trying to conceive.

Effects of trimester-specific exposure to vanadium on ultrasound measures of fetal growth and birth size: a longitudinal prospective prenatal cohort study

Identification of windows of heightened vulnerability to environmental factors has substantial public health implications. Prenatal exposure to vanadium has been linked to adverse birth outcomes; however, critical windows for such exposure during fetal growth remain unknown. We aimed to assess trimester-specific associations of vanadium exposure with ultrasound measures of fetal growth and birth size in a Chinese longitudinal cohort. The present study was embedded in our ongoing prospective prenatal cohort study at the Wuhan Women and Children Medical Care Center (Wuhan, Hubei, China). Pregnant women were eligible for inclusion if they provided signed informed consent and were less than 16 weeks pregnant with a single gestation, and agreed to take in-person interviews, undergo ultrasound examinations, and provide blood and urine samples. We collected urine samples and measured urinary vanadium concentrations using inductively coupled plasma mass spectrometry. We calculated SD scores for ultrasound-measured biparietal diameter, head circumference, occipitofrontal diameter, abdominal circumference, femur length, and estimated fetal weight at 16, 24, and 31 weeks of gestation. We applied linear regressions with generalised estimating equations to estimate associations of urinary vanadium concentrations in each trimester with ultrasound-measured fetal growth parameters or neonatal size at birth. As of Oct 12, 2016, we recruited 3075 women who were non-smokers and non-drinkers during pregnancy, provided up to three urine samples during the first, second, and third trimesters, and gave birth to live singletons without birth defects. We excluded women who did not provide information on ultrasound measurements (n=20) or who only had one ultrasound measurement of fetal crown-rump length at the first trimester (n=14). We excluded another 16 women because they had missing values for confounding variables, leaving 3025 women retained in the study. Every doubling of urinary vanadium concentration in the first trimester was associated with a significant increase in femur length (adjusted percentage change 6·4%, 95% CI 0·7 to 12·1) at 16 weeks of gestation and reductions in biparietal diameter (-4·2%, -8·2 to -0·1), head circumference (-6·0%, -10·1 to -1·9), occipitofrontal diameter (-5·7%, -9·9 to -1·5), and abdominal circumference (-5·3%, -9·4 to -1·2) at 31 weeks of gestation. Every doubling of urinary vanadium concentration in the second trimester was significantly associated with reductions in SD scores for head circumference (-7·2%, -14·1 to -0·3) and abdominal circumference (-6·9%, -13·8 to -0·1) at 31 weeks of gestation. The highest quartile of urinary vanadium concentration (>1·18 μg/L) in the first trimester, when compared with the lowest quartile (≤0·60 μg/L), was associated with a mean decrease in birthweight of 12·6 g (95% CI 2·5-22·8; ptrend=0·0055) and a mean decrease in ponderal index of 0·07 kg/m3 (0·01-0·12; ptrend=0·0053). Moreover, newborns with restricted birth size had higher vanadium exposure in the first and third trimesters. Vanadium might be toxic to humans and impair fetal growth. The first, early second, and late third trimesters could be critical windows for heightened vulnerability to vanadium for fetal growth. Our findings require further investigation in other populations. National Key R&D Plan of China, National Natural Science Foundation of China, and Fundamental Research Funds for the Central Universities, Huazhong University of Science and Technology.

Reference values of the ductus venosus pulsatility index for pregnant women between 11 and 13+6 weeks of gestation

Purpose: The ductus venosus pulsatility index velocity (DV PIV) has become a popular ultrasonographic measurement during the first trimester of pregnancy. The value of the DV PIV has been the topic of ongoing discussion in the literature, and its reference value in the normal population has not yet been established. Therefore, we aimed to determine a reference value for the DV PIV.Materials and Methods: We retrospectively evaluated our records of first-trimester ultrasonography performed between 2016 and 2017. Our inclusion criteria were as follows: singleton pregnancy; crown-rump length (CRL) between 45 and 84 mm; absence of structural abnormalities on the ultrasound examination; and absence of chromosomal abnormalities. Records of 820 patients were evaluated. According to the inclusion criteria, records of 458 patients were included in this study. All ultrasound examinations were performed by a single operator with the Voluson E8 (5- to 8-MHz 3 D transducer; General Electric Healthcare, Little Chalfont, UK) via the transabdominal route. Gestational weeks were designated according to CRL measurements at the beginning of the examination. Nuchal translucency (NT), nasal bone visualization (NB), tricuspid valve regurgitation (TR), “a”-wave pattern, DV PIV, S-wave (peak systolic velocity), D-wave (peak diastolic velocity), a-wave (atrial contraction in late diastole), and time-averaged maximum velocity (TAMXV) measurements were performed. To evaluate the DV Doppler images, a mid-sagittal view of the fetal profile was obtained. Color Doppler and pulse Doppler gate were used in the distal portion of the umbilical sinus, and at least three typical DV waveforms were detected. The SPSS 21.0 statistical program (IBM, Armonk, NY) was used to analyze variables.Results: The mean age, body mass index, CRL, gestational age, and NT values were 30.3 years (range, 18–45), 23.9 kg/m2 (range, 15.5–46.6), 59.5 mm (range, 45–79), 12.3 weeks (range, 11.2–13.6), and 1.58 mm (range, 0.73–2.62), respectively. The median gravidity and parity were 2 (1–8) and 0 (0–4), respectively. The “a”-wave pattern was identified in all cases, but TR was not detected in any of the cases. Measurements of DV PIV with a Gaussian distribution were suitable according to the Shapiro–Wilk test (p = .252). The mean DV PIV was 0.98, and the fifth and 95th percentiles were 0.73 and 1.22 (±2 SD), respectively. A statistical analysis of our cohort revealed that DV PIV values less than 0.73 and more than 1.22 were beyond the normal range. The mean S-wave, D-wave, a-wave, and TAMXV values were 31.18, 25.64, 8.68, and 22.72 cm/s, respectively.Conclusions: The value of DV PIV measurements is debated in the literature. Using our cohort, we defined the means and ranges of DV PIV. Determining the normal ranges of DV PIV could be helpful to anticipate congenital or chromosomal abnormalities. Further studies are needed to demonstrate the clinical importance of DV PIV, especially for patients with abnormal DV PIV measurements.

Automated measurement of fetal head circumference using 2D ultrasound images.

In this paper we present a computer aided detection (CAD) system for automated measurement of the fetal head circumference (HC) in 2D ultrasound images for all trimesters of the pregnancy. The HC can be used to estimate the gestational age and monitor growth of the fetus. Automated HC assessment could be valuable in developing countries, where there is a severe shortage of trained sonographers. The CAD system consists of two steps: First, Haar-like features were computed from the ultrasound images to train a random forest classifier to locate the fetal skull. Secondly, the HC was extracted using Hough transform, dynamic programming and an ellipse fit. The CAD system was trained on 999 images and validated on an independent test set of 335 images from all trimesters. The test set was manually annotated by an experienced sonographer and a medical researcher. The reference gestational age (GA) was estimated using the crown-rump length measurement (CRL). The mean difference between the reference GA and the GA estimated by the experienced sonographer was 0.8 ± 2.6, −0.0 ± 4.6 and 1.9 ± 11.0 days for the first, second and third trimester, respectively. The mean difference between the reference GA and the GA estimated by the medical researcher was 1.6 ± 2.7, 2.0 ± 4.8 and 3.9 ± 13.7 days. The mean difference between the reference GA and the GA estimated by the CAD system was 0.6 ± 4.3, 0.4 ± 4.7 and 2.5 ± 12.4 days. The results show that the CAD system performs comparable to an experienced sonographer. The presented system shows similar or superior results compared to systems published in literature. This is the first automated system for HC assessment evaluated on a large test set which contained data of all trimesters of the pregnancy.

Application of First Trimester Screening in the Prognostication of Small for Gestational Age

Background: Fetal growth restriction is defined as the failure of the fetus to achieve its full growth potential. The present study aimed to investigate the application of first trimester screening in the prediction of small for gestational age (SGA).Methods: This cohort study was conducted on the consecutive and unselected women with singleton pregnancies undergoing routine first-trimester examinations in a health center affiliated to Neyshabur University of Medical Sciences in Razavi Khorasan Iran during February 2014-March 2016. Subjects received a first-trimester visit by a physician, which included the entry of basic maternal characteristics, medical history, measurement of maternal weight and height, ultrasound examination for fetal anatomy, and measurement of crown-rump length to assess gestational age.Results: SGA was significantly correlated with maternal age, parity, and body mass index. Furthermore, a significant association was observed between SGA and smoking habits in the mothers.Conclusion: According to the results, first trimester screening was a useful method for the prediction of SGA.

Measurement error of mean sac diameter and crown-rump length among pregnant women at Mulago hospital, Uganda

BackgroundUltrasonography is essential in the prenatal diagnosis and care for the pregnant mothers. However, the measurements obtained often contain a small percentage of unavoidable error that may have serious clinical implications if substantial. We therefore evaluated the level of intra and inter-observer error in measuring mean sac diameter (MSD) and crown-rump length (CRL) in women between 6 and 10 weeks’ gestation at Mulago hospital.MethodsThis was a cross-sectional study conducted from January to March 2016. We enrolled 56 women with an intrauterine single viable embryo. The women were scanned using a transvaginal (TVS) technique by two observers who were blinded of each other’s measurements. Each observer measured the CRL twice and the MSD once for each woman. Intra-class correlation coefficients (ICCs), 95% limits of agreement (LOA) and technical error of measurement (TEM) were used for analysis.ResultsIntra-observer ICCs for CRL measurements were 0.995 and 0.993 while inter-observer ICCs were 0.988 for CRL and 0.955 for MSD measurements. Intra-observer 95% LOA for CRL were ± 2.04 mm and ± 1.66 mm. Inter-observer LOA were ± 2.35 mm for CRL and ± 4.87 mm for MSD. The intra-observer relative TEM for CRL were 4.62% and 3.70% whereas inter-observer relative TEM were 5.88% and 5.93% for CRL and MSD respectively.ConclusionsIntra- and inter-observer error of CRL and MSD measurements among pregnant women at Mulago hospital were acceptable. This implies that at Mulago hospital, the error in pregnancy dating is within acceptable margins of ±3 days in first trimester, and the CRL and MSD cut offs of ≥7 mm and ≥ 25 mm respectively are fit for diagnosis of miscarriage on TVS. These findings should be extrapolated to the whole country with caution. Sonographers can achieve acceptable and comparable diagnostic accuracy levels of MSD and CLR measurements with proper training and adherence to practice guidelines.

Assessment of gestational age in goats by Real-Time Ultrasound measuring the fetal crown rump length, and bi-parietal diameter

The aim of the present study was to specify the relationship of gestational period with measurement of Crown-Rump length and Bi-parietal diameter via trans-abdominal ultrasonography in goats. This study was conducted in the Faculty of Veterinary Medicine in Diyala University. The study was carried out on twelve multiparous does, their ages were between 2-5 years. Does were synchronized for estrus with PGF2α (Estrumate) at 11 days apart and naturally served to obtain pregnancy (estrus day=day 0), and subsequently Ultrasonic scanned. Weekly ultrasonographic examinations were performed using 3.5-5MHz sector transducer, from week (5-10) and (6-14) of pregnancy for measuring the Crown-Rump length and Bi-parietal diameter, respectively. The results clearly demonstrated that the relationship between gestational age and Crown-Rump length or Bi-parietal diameter were highly significant (P<0.01). The Crown-Rump length was strongly positively correlated with gestational age (R2=0.99) followed by the Bi-parietal diameter (R2=0.95). In conclusion, the gestational age of goats can be accurately estimated by trans-abdominal ultrasonography measuring of fetal Crown-Rump length and Bi-parietal diameter during first and second trimester of pregnancy.

Assessing the accuracy of ultrasound estimation of gestational age during routine antenatal care in invitro fertilization (IVF) pregnancies.

In the UK an accurate gestational age is confirmed by ultrasound measured foetal crown rump length (CRL) at 11 + 2-14 + 1 weeks of gestation. The currently recommended Robinson and Fleming crown rump length reference chart was develop in 1975. Advances in ultrasound technology and standardized crown rump length measurement training could mean this is now out of date. Our study aimed to assess its accuracy in current routine antenatal care. Retrospective data from 178 IVF pregnancies seen for routine antenatal care at a UK Regional Maternity Unit between 1 January 2006 and 1 January 2016 was retrieved. We compared ultrasound calculated crown rump length gestational age taken at the routine First Trimester Screening Clinic (FTSC) with the 'true' gestational age calculated from the known IVF fertilization date. We identified a systematic overestimation of gestational age by ultrasound using the currently recommended crown rump length reference chart when compared to IVF gestational age. The mean overestimation was 3.0 days (95% CI: 2.7 to 3.4), p < 0.001. A range of alternative ultrasound reference charts also generated a systematic overestimation, ranging from 1.6 to 2.9 days (p < 0.001, for each). The current crown rump length reference chart systematically overestimates gestational age by an average of three days when assessed in IVF pregnancies. A systematic overestimation was also identified in alternative crown rump length reference charts. These differences, although slight, were systematic with implications for the accuracy of gestational age estimation particularly in pregnancies at risk of pre-term delivery or growth restriction. Our findings need confirming in larger, non IVF cohorts and could lead to the need for an updated crown rump length reference chart.

First trimester pregnancy ultrasound findings as a function of method of conception in an infertile population.

The aim of this study was to determine whether first trimester ultrasound measurements of crown rump length (CRL) and gestational sac diameter (GSD) differ depending on the method of conception among infertile women. Infertile women, ages 21-50years old, who conceived viable, singleton pregnancies via fresh embryo transfer (ET), frozen ET, non-in vitro fertilization (IVF) fertility treatment, or spontaneously were included in this observational cohort study at an academic fertility practice. Embryonic growth trajectories defined by the CRL and GSD at 6 and 8 weeks' gestation were analyzed and compared among the methods of conception. Crown rump length at 6weeks' gestation was smaller for conceptions achieved via fresh ET compared with frozen ET in a natural cycle (1.50 vs. 2.50mm, p = 0.017). Crown rump length was smaller at 8weeks' gestation in conceptions achieved via fresh ET compared to frozen ET in a programmed cycle (16.13 vs. 17.02mm, p = 0.039). Among infertile women, embryo growth may differ between fresh and frozen ET as early as 6 and 8weeks' gestation.

Diagnostic échographique de grossesse arrêtée précoce : étude de la qualité des clichés

ObjectiveUltrasound examination plays a central role in case of suspected non-viable pregnancy. A wrong diagnosis might have major consequence in terms of inadequate care, especially in cases of false positive non-viable pregnancy diagnosis. Ultrasound criterions are today well defined. Our objective was to evaluate the feasibility and reproducibility of a novel image-quoting method of first-trimester non-viable pregnancy. MethodsThirty images of non-viable pregnancy were twice evaluated with blinded proofreading. Two quotations were evaluated: the first for the images of gestational sacs without embryo (gestational sac score), the second for the images with embryo (embryo score). ResultsThe ICC (interclass correlation coefficient) was>0.75 for inter- and intra-observer reproducibility both for the quotations of the gestational sac and for the embryo with a low variability. Reproducibility of quoting crown rump length measurements <5mm was low at first proofreading but after adjustment of the quoting modalities, ICC was also>0.75. ConclusionThe inter- and intra-observer reproducibility of our quoting methods is high with a low variability. They might be a useful tool in current practice in the future.

Determination of gestational age by measuring defined embryonic and foetal indices with ultrasonography in Abaza and Gurcu goats

The aim of this study was to determine gestational age in Abaza and Gurcu goats by measuring certain embryonic and foetal indices with ultrasonography. A 5–7.5 MHz linear probe was used to obtain ultrasound measurements from 30 pregnant goats (10 Abaza and 20 Gurcu). Heart diameter (HD), biparietal diameter (BPD), crown-rump length (CRL), trunk diameter (TD) and placentome diameter (PD) were measured to determine gestational age. The mean of embryonic and foetal indices were calculated and linear regression was performed. Heart diameter measurements for Abaza and Gurcu goats were significantly different on days 45 (P= 0.048) and 60 (P= 0.019). Biparietal diameter values were significantly different on day 45 (P= 0.035). Crown-rump length measurements were significantly different at days 30 (P= 0.003) and 60 (P= 0.002). We determined that HD and TD were the best predictors of gestational age for Abaza goats (R2= 0.952, R2= 0.949, respectively), whereas HD and CRL were the best predictors of gestational age for Gurcu goats (R2= 0.933, R2= 0.942, respectively). Based upon our study results, these specific indices could be applied during ultrasonographic examinations of Abaza and Gurcu goats to confirm gestational age when the day of mating is unknown.

Critical Evaluation of various Sonologic Parameters of Early Foetal Growth Discrepancies in Predicting Adverse Pregnancy Outcomes

Introduction: It is well established that adverse perinatal outcomes such as Small for Gestational Age (SGA), preterm delivery, and pre-eclampsia are associated with higher incidence of neonatal complications and death. Evidence suggests that these adverse outcomes may have their origins dating back to early pregnancy growth discrepancies. Aim: To establish an association between early fetal growth discrepancies and occurrence of adverse obstetric outcomes such as pre- clampsia and SGA. Materials and Methods: This is a prospective observational study done in the Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India, between Jan 2015 to May 2016 involving 314 pregnant women, using Crown Rump Length (CRL) measurements at the time of early anomaly (11-14 week scan). Pregnancies with congenital and chromosomal defects, multifetal gestation and non viable foetuses were excluded from the study. The biometric parameters mainly Biparietal Diameter (BPD), Head Circumference (HC), Abdominal Circumference (AC), Femur Length (FL), and Estimated Foetal Weight (EFW) at the time of targeted organ scan (between 18 to 20 weeks) were recorded and reverse calculations were done to convert these parameters to corresponding GA based on published regression formulae. The GA at the time of targeted scan was also calculated based upon the first trimester CRL values. The growth discrepancy was calculated by deducting CRL based GA from biometrically estimated GA for each individual growth parameters. Fisher’s-exact test was used to compare the means of biometric lags in SGA vs. Appropriate for Gestational Age (AGA) fetuses and also in Pre-eclampsia vs. normotensive groups. For each biometric parameter, the best cut-off for discrepancy value was determined using Receiver Operator Characteristic (ROC) analysis along with their diagnostic ability to predict occurrence of SGA in terms of sensitivity, specificity, positive and negative likelihood ratio with their 95% confidence intervals. The Area Under Curve (AUC) and z-test statistics were taken into account to decide the best parameter to predict adverse outcome. A p-value of <0.05 was considered statistically significant.Results: Out of 314 women studied, 62 (19.7%) delivered an SGA neonate, and 30 (9.5%) had pre-eclampsia. All biometric parameters of SGA babies showed growth lag compared to AGA babies which was statistically significant (BPD p<0.001, HC p<0.001, AC p<0.001, FL p<0.01, and EFW p<0.001). However, we could not establish similar associations between early growth discrepancies and onset of pre-eclampsia.Conclusion: Models of second trimester growth discrepancies can be used to predict SGA babies. Earlier anticipation of adverse perinatal outcome may add to quality of antenatal care and timely delivery to prevent late stillbirths associated with SGA.

Periconceptional maternal 'high fish and olive oil, low meat' dietary pattern is associated with increased embryonic growth: The Rotterdam Periconceptional Cohort (Predict) Study.

To investigate the association between periconceptional maternal dietary pattern and first-trimester embryonic growth. This was a prospective cohort study of 228 women with a singleton ongoing pregnancy, of which 135 were strictly dated spontaneous pregnancies and 93 were pregnancies achieved after in-vitro fertilization or intracytoplasmatic sperm injection (IVF/ICSI). All women underwent serial transvaginal three-dimensional ultrasound (3D-US) examinations from 6 + 0 to 13 + 0 weeks' gestation. Crown-rump length (CRL) and embryonic volume (EV) measurements were performed using a virtual reality system. Information on periconceptional maternal dietary intake was collected via food frequency questionnaires. Principal component analysis was performed to identify dietary patterns. Associations between dietary patterns and CRL and EV trajectories were investigated using linear mixed models adjusted for potential confounders. A median of five (range, one to seven) 3D-US scans per pregnancy were performed. Of 1162 datasets, quality was sufficient to perform CRL measurements in 991 (85.3%) and EV measurements in 899 (77.4%). A dietary pattern comprising high intake of fish and olive oil and a very low intake of meat was identified as beneficial for embryonic growth. In strictly dated spontaneous pregnancies, strong adherence to the 'high fish and olive oil, low meat' dietary pattern was associated with a 1.9 mm (95% CI, 0.1-3.63 mm) increase in CRL (+14.6%) at 7 weeks and a 3.4 mm (95% CI, 0.2-7.81 mm) increase (+6.9%) at 11 weeks, whereas EV increased by 0.06 cm3 (95% CI, 0.01-0.13 cm3 ) (+20.4%) at 7 weeks and 1.43 cm3 (95% CI, 0.99-1.87 cm3 ) (+14.4%) at 11 weeks. No significant association was observed in the total study population or in the IVF/ICSI subgroup. Periconceptional maternal adherence to a high fish and olive oil, low meat dietary pattern is positively associated with embryonic growth in spontaneously conceived pregnancies. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Monitoring of Early Pregnancy Fetometry in Egyptian Buffaloes Using High Frequency Transrectal B-Mode and Color Doppler Ultrasonography

The current study aimed to screen the growth and viability of embryo from Day 21 to Day 56 post-breeding in Egyptian buffaloes. Twenty buffaloes were synchronized and examined serially by means of real-time B-mode ultrasound equipped with 12 MHz endorectal transducer. The developing embryonic sac diameter (ESD), crown rump length (CRL), head diameter (HD), trunk diameter (TD), and eye ball diameter (EBD) were measured. The heart rate and cardiac blood flow were sequentially examined to verify the fetal viability using color Doppler mode. Data showed the feasibility of first detection and measurement of ESD, CRL, HD, TD and EBD from Day 24.33 ± 0.67, 27.00 ± 1.73, 34.67 ± 1.76, 34.67 ± 0.88 and 33.67 ± 0.88, respectively. The fetal heart rate was 232.00 ± 12.35 beat/min at the day of first examination (Day 24.50 ± 1.30) after breeding. The cardiac blood flow was examined from Day 27 onwards. A highly significant (P< 0.0001) correlations were recorded between the ESD (r2=0.55), CRL (r2=0.85), HD (r2=0.85), TD (r2=0.93) and EBD (r2=0.85) and fetal age in buffaloes. It could be concluded that the high-frequency ultrasonography is a valuable diagnostic tool for the detection of early pregnancy from Day 24-26 post-breeding in Egyptian buffaloes. Verification of fetal heart beating (starting from Day 24-26) and cardiac blood flow (starting from Day 26-27) provide a reliable non-invasive promising technique for the fetal viability evaluation. The high correlation between TD and fetal age signified its clinical value, over other estimated fetometric parameters, in determining gestation period in Egyptian buffaloes during early pregnancy.

Do Early Fetal Measurements and Nuchal Translucency Correlate With Term Birth Weight?

Traditionally, physiological variation in fetal weight is believed to emerge during the latter half of pregnancy. Although recent evidence suggests that crown-rump length (CRL) and nuchal translucency (NT) measured at 11-14 weeks correlate with abnormal fetal growth, findings have been limited by dating accuracy in spontaneous gestations. Therefore, we sought to determine whether CRL or NT measurements correlated with term birth weight (BW) or BW ratio in a cohort of IVF pregnancies, in which the date of conception is precisely known. This retrospective cohort study included 227 term, singleton IVF pregnancies. Subjects were included if they had an early first-trimester ultrasound examination and subsequent nuchal translucency (NT) screening. The difference between the measured and the expected CRL and the biparietal diameter (BPD) and NT measurement were calculated and correlated with the actual term BW or BW ratio. The BW ratio was calculated using the actual BW and the expected BW for GA. The difference between measured and expected mid-first-trimester CRL, and the BPD at NT assessment, correlated with BW ratio at delivery (rSpearman= 0.15, P= 0.023 and rSpearman= 0.27, P< 0.001, respectively). Absolute NT measurements and NT percentiles (adjusted for CRL) correlated with BW ratio at delivery (rSpearman= 0.18, r= 0.14, and P= 0.005 and 0.038, respectively). In this well-dated IVF population, we report a significant correlation between BW ratio and first-trimester CRL, BPD, and NT measurements. These findings support the hypothesis that physiological variation in BW can be reflected by variation in first-trimester fetal measurements.

The chromosome analysis of the miscarriage tissue. Miscarried embryo/fetal crown rump length (CRL) measurement: A practical use.

ObjectiveTo investigate whether miscarried embryo/fetal crown rump length (CRL) measurement may yield a practical application for predicting a conclusive result at the cytogenetic analysis of miscarriage tissue. Our study might help in improving the cytogenetic method, the results of which may be affected by maternal cell contamination (MCC). In particular, we aimed at establishing whether the miscarried embryo/fetal CRL measurement shows accuracy in predicting the possibility of MCC and the scan cut-off value useful to this purpose and, as a result, suggest a multi-step procedure for the genetic ascertainment.MethodsWomen experiencing at least two miscarriages of less than 20 weeks size at the Pregnancy Loss Unit at Fondazione Policlinico A. Gemelli underwent a scan before surgery. The CRL value was recorded. After the dilatation and courettage (D&C) procedure, miscarriage tissue was processed through the proposed multi-step procedure before performing oligo-nucleotide-based and SNP (single nucleotide polymorphisms)-based comparative genomic hybridization (CGH+SNP) microarray analysis.Results63 women and 63 miscarriages met the criteria. By using the Receiving Operator Characteristic (ROC) curves, CRL showed an AUC of 0.816 (95%CI:0.703–0.928,p<0.001). A CRL≥24.5 mm cut-off value showed a higher positive likelihood ratio (5.27) but, conversely, a higher negative likelihood ratio (0.64) in predicting the possibility of MCC. Microarray analysis was successful in the totality of cases in which the embryo/fetal origin of miscarriage tissues was proven.ConclusionsThe 24.5 mm CRL value emerges as the most suitable cut-off enabling the identification of cases in which the embryo-fetal component can be isolated in the absence of MCC and the chromosomal array provide informative results.

Sonographic detection of open spina bifida in the first trimester: review of the literature.

In the beginnings, sonographic diagnosis of open spina bifida (OSB) relied on the meticulous scanning of the fetal vertebrae for abnormalities but many defects were missed. After the mid-1980s, however, with the description of the intracranial findings in the second trimester (the "lemon sign" and the "banana sign"), the prenatal diagnosis of OSB was enhanced. In the last 2 decades, there has been widespread uptake of routine ultrasound examination in the first trimester of pregnancy with the purpose of the measurement of fetal crown-rump length to determine gestational age, to screen for trisomy 21 and other aneuploidies, mainly with the nuchal translucency, and for diagnosis of many major abnormalities. Many papers were published focusing on early diagnosis of myelomeningocele (MMC), and the objective of this review is to summarize the different techniques described regarding prenatal diagnosis of OSB in the first trimester of pregnancy.

Comparison of ultrasound fetal biometry of singleton fetuses with a reference chart in pregnant women with normal nutritional and health status

The aim of this study was to compare fetal biometry of singleton fetuses in pregnant women with normal nutritional and health status in the Ampara district, with a commonly used reference chart. A cross sectional study was carried out in the Ampara District. Women with normal nutritional and health status and minimal environmental constraints on fetal growth (n=714) were enrolled during the first trimester and gestational age was confirmed by fetal crown-rump length measurement between 11 weeks + 0 days and 13 weeks + 6 days. For this study, each mother was considered only once for measurement of fetal biometry, at gestations between 11 and 41 weeks. Fetal bi-parietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL) were measured using standard techniques, and separate regression models were fitted to estimate the means and standard deviations and derive gestation specific centiles for each parameter, assuming that the measurements have a normal distribution at each gestational age. The fetal biometry results obtained from the current study were compared with a commonly used reference chart. The fitted 10th, 50th and 90th centiles at 40 weeks of gestation were, 87.9 mm, 93.2 mm and 98.5 mm for BPD, 313.8 mm, 328.9 mm and 344.0 mm for HC; 298.2 mm, 322.5 mm and 346.9 mm for AC and 69.7 mm, 75.0 mm and 80.2 mm for FL. When compared with the reference chart, significant differences of fetal biometry were seen in the third trimester but not in the second trimester. Ultrasound fetal biometry of singleton fetuses in pregnant women with normal nutritional and health status in the Ampara District were significantly different in the third trimester, from a routinely used reference chart.

Prediction of fetal loss by first-trimester crown-rump length in IVF pregnancies.

To evaluate the association between small crown-rump length (CRL) and fetal loss ≤22weeks in IVF pregnancies. A retrospective analysis of prospectively collected data at a university-affiliated medical center. All singleton IVF pregnancies within a 5-year period, with a live embryo on first-trimester ultrasound and verified pregnancy outcome were included. Rates of fetal loss ≤22weeks were compared between pregnancies with a CRL ≤tenth percentile and above the tenth percentile of our population. Overall, 397 pregnancies met inclusion criteria. Ninety-five percent of CRL measurements were performed at 40-80 gestational days. All live-embryo's CRL measurements, from 40 to 80mm, were plotted against expected gestational age (in 5-day clusters), with calculation of the tenth percentile for every gestational age. Total of 64 pregnancies had CRL ≤tenth percentile for gestational age. The rate of fetal loss in this group was significantly higher than in pregnancies with CRL >tenth percentile (17.2 vs. 6.6%, p=0.005, OR=2.93, 95% CI 1.2-6.7). In both groups, the majority of fetal losses occurred ≤10weeks of gestation. In IVF pregnancies with a live embryo, a small CRL at 40-80days' gestation may predict fetal loss. Repeated ultrasound should be considered after 1-2weeks.

Periconceptional maternal biomarkers of one-carbon metabolism and embryonic growth trajectories: the Rotterdam Periconceptional Cohort (Predict Study)

To study the associations between the periconceptional maternal biomarkers of one-carbon metabolism and embryonic growth. Prospective, periconceptional hospital-based birth cohort. Tertiary medical care center. Between 2010 and 2014, 236 women with early singleton ongoing pregnancies that resulted in 139 strictly dated spontaneous pregnancies and 97 pregnancies conceived after assisted reproductive technology. None. Maternal serum vitamin B12 and plasma total homocysteine (tHcy) assessed at enrollment, and longitudinal first-trimester crown-rump length (CRL), embryonic volume (EV), and absolute growth rates obtained via three-dimensional ultrasound (3D-US) and virtual reality. In early pregnancy, we performed a median of five 3D-US scans (range: 1-7). Vitamin B12 concentrations were positively associated with CRL and EV measurements in the total population (CRL: β 5ˆ10-4 (1ˆ10-4 to 9ˆ10-4) √mm; EV: β 2ˆ10-4 (0ˆ10-4 to 4ˆ10-4) 3√cm3) and in the strictly dated spontaneous pregnancy subgroup. The tHcy concentration was negatively associated with embryonic growth in all study groups. High tHcy concentrations (+2 standard deviation [SD], 10.3μmol/L) were associated with a 1.7mm smaller CRL (-13.4%) at 7weeks and a 3.6-mm smaller CRL (-7.1%) at 11weeks compared with -2 SD tHcy (-3.0μmol/L). A high tHcy concentration was also associated with a 0.10cm3 smaller EV (-33.3%) at 7weeks and a 1.65cm3 smaller EV (-16.1%) at 11weeks. The embryonic growth rate was positively associated with vitamin B12 and negatively associated with tHcy. Minor variations in periconceptional maternal concentrations of one-carbon metabolism biomarkers are associated with human embryonic growth.