Occipitofrontal Diameter Research Articles

Repeatability and reproducibility of artificial intelligence-acquired fetal brain measurements (SonoCNS) in the second and third trimesters of pregnancy

Artificial Intelligence (AI)-based algorithms are increasingly entering clinical practice, aiding in the assessment of fetal anatomy and biometry. One such tool for evaluating the fetal head and central nervous system structures is SonoCNS™, which delineates appropriate planes for measuring head circumference (HC), biparietal diameter (BPD), occipitofrontal diameter (OFD), transcerebellar diameter (TCD), width of the posterior horn of the lateral ventricle (Vp), and cisterna magna (CM) based on a 3D volume acquired at the level of the fetal head’s thalamic plane. This study aimed to evaluate the intra- and interobserver variability of measurements obtained using this software. The study included 381 patients, 270 in their second trimester of pregnancy (70%) and 111 in the third trimester. Each patient underwent manual biometric measurements of the aforementioned structures and twice using the SonoCNS software. We calculated the intraobserver variability between the manual measurements and the average of the automated measurements, as well as the interobserver variability for automated measurements. We also compared the median examination time for manual and automated measurements. The interclass correlation coefficients (ICC) for interobserver and intraobserver variability for parameters BPD, HC, and OFD ranged from good to excellent reproducibility in the general population and subgroups (> 0.75). CM and Vp measurements, both in the general population and subgroups, fell into the category of moderate (0.5–0.75) and poor reproducibility (< 0.5). TCD measurements showed moderate (> 0.5) to good reproducibility (0.75–0.9), and OFD showed good and excellent reproducibility. The assessment of the biometry of fetal head structures using SonoCNS took an average of 63 s compared to 14 s for manual measurement (p < 0.001). The SonoCNS™ software is characterized by good to excellent reproducibility and repeatability in the measurement of fetal skull biometry (BPD, HC, and OFD), with poorer performance in measurements of intracranial structures (CM, Vp, TCD). Apart from biometric parameters, the software is useful in clinical practice for delineating appropriate planes from the acquired volume of the fetal head and shortening examination time.

214. THORACIC CAVITY/ CAGE RATIO IS PREDICTOR FOR SURGICAL DIFFICULTY OF MINIMALLY INVASIVE ESOPHAGECTOMY

Abstract Background Esophagectomy for esophageal cancer is highly invasive surgery. Minimally invasive esophagectomy (MIE) was introduced as a less invasive surgery, and conventional MIE (C-MIE) is being increasingly performed worldwide. Recently, robot-assisted MIE (RAMIE) was developed with the aim of further minimization of invasiveness, and is expected to spread in the future. When performing MIE, we sometimes experienced difficult cases. In this study, we aimed to clarify the factors related to surgical difficulty of MIE. Methods We evaluated 362 patients who underwent MIE (285 C-MIEs and 77 RAMIEs) for esophageal squamous cell carcinoma between April 2010 and February 2023. We used computed tomography to evaluate the occipitofrontal diameter of thoracic cavity and cage at brachiocephalic vein (BV), tracheal bifurcation (TB) and inferior right pulmonary vein (IRPV) levels, respectively. We calculated the thoracic cavity/cage ratio (TRRC) at each level. The cut-off values of TCCR at each level for thoracic procedure time were calculated using the receiver operating characteristic. Furthermore, total score consisted of four degrees (0,1,2,3) by the TCCR at three levels was calculated. We assessed clinicopathological and anatomical factors and determined the independent factors influencing the thoracic procedural time as parameter of difficulty in MIE. Results We divided the patients into C-MIE group and RAMIE group. Patients in each group were divided into two cohorts according to median thoracic procedure time (C-MIE: 307 and RAMIE: 409 minutes, respectively). In the C-MIE group, univariate analysis demonstrated that sex, body mass index (BMI), and the TCCR at BV, TB and IRPV levels were correlated with thoracic procedure time. The total TRRC score was also correlated with thoracic procedure time in univariate analysis. Next, multivariate analysis was done using sex, BMI, and the total TCCR score. Multivariate analyses demonstrated that BMI (p = 0.0005) and the total score (p = 0.0069) were independent factors for thoracic procedure time. In the RAMIE group, univariate analysis demonstrated that BMI and the TCCR at BV and TB levels were correlated with thoracic procedure time. Multivariate analyses demonstrated that the TCCR at TB level (p = 0.0187) was only independent factor for thoracic procedure time. Conclusions The TCCR and the total score based on it could be useful in assessing surgical difficulty of both C-MIE and RAMIE. C-MIE was affected by the diameter at all levels of the thoracic cavity due to restricted mobilities of thoracoscopic instruments. On the other hand, RAMIE’s articulated forceps prevent it from being affected by entire thoracic cavity. Consequently, only the TCCR at TB level, which is one of the most less flexible field, affects the difficulty in RAMIE.

Artificial Intelligence-Based Estimation of Fetal Head Circumference With Biparietal and Occipitofrontal Diameters Using Two-Dimensional Ultrasound Images

Abstract One of the most essential biometrics for measuring fetal growth during prenatal ultrasound exams is the head circumference (HC). However, manual measurement of this biometric by doctors often needs substantial experience. Manual measurement of fetal head circumference during prenatal ultrasound exams requires significant expertise, posing limitations in accuracy and consistency, which can impact clinical decision-making and fetal health assessments. We developed a state-of-the-art image processing algorithm that utilizes biometry and segmented images and employed a fast ellipse fitting method to measure the HC, head orientation (angle) along with biparietal (BPD), and occipitofrontal (OFD) diameter automatically. Our approach offers automation and precision in measuring fetal biometrics, surpassing the limitations of manual measurement by ensuring consistent and accurate assessments, thus enhancing clinical efficiency and facilitating timely interventions for optimal fetal health management. Additionally, to the best of our knowledge, this is the first work that adopts a segmented image from any model or technique and provides significant fetal parameters during ultrasonography in a single shot. The suggested technique is lightweight, real-time, and easily integrate with any segmentation model or technique. We have used three well-known segmentation models for demonstration and compared their performance using dice scores as an evaluation parameter. Among the three, HRNet shows the best results with an average dice score of 0.96; due to the high dice score, we have chosen HRNet over the other two models and proceeded further and implemented our novel algorithm on that to predict the required fetal key measurements. The findings of this study benefit prenatal care by enhancing the accuracy and efficiency of fetal biometric measurements, thereby facilitating improved clinical decision-making and optimizing fetal health assessments.

Frontal Lobe Growth impairment in fetuses with congenital heart disease using Ultrasound parameters; A Comparative Cross-sectional study

Introduction and the Αim: 2D and 3D biometry measures can record the increased development of the fetal brain in the later part of gestation. The objective of this study is to determine whether or not the frontal brain regions of fetuses with congenital heart disease (CHD) are smaller than those of healthy controls. Patients and Μethods: The fetal Medicine unit of the Ain Shams University Maternity Hospital carried out a comparative cross-sectional study, including 140 normal fetuses and 140 fetuses with isolated CHD evaluated between 20 and 39 gestational weeks at our fetal medicine unit in the period November 2021–September 2023 Results: Our results showed the occipito-frontal diameter (OFD) and frontal antero-posterior diameter (FAPD) utilising ultrasonography. FAPD Mean±SD: 26.53 ± 10.44, OFD Mean±SD: 89.14 ± 28.34, and FAPD/OFD Mean±SD: 0.29 ± 0.05. The OFD Mean±SD was found to be 82.18 ± 18.42, the FAPD Mean±SD to be 31.68±6.58, and the FAPD/OFD Mean±SD to be 38.70±2.15. Our results showed that 0.7% of patients exhibited anomalies related to the central nervous system, such as dilated posterior fossa, vermis = 25 mm, and aberrant posterior cranial fossa. The percentage of those with a history of CHD was 3.9%.The history of CHD showed a statistically significant difference between the research groups. When examining comorbidities, surgical history, and the relationship between the other parameters and FAPD, OFD, and FAPD/OFD, there was no statistically significant difference between the groups under investigation, except for CNS abnormalities and gestational age. Conclusion, compared to normal fetuses, fetuses with CHD had shorter FAPDs and a lower FAPD/OFD ratio. Despite the fact that different types of CHD affect hemodynamics differently, there appears to be a common deficiency in the development of the frontal cortex.

Integrative network analysis of differentially methylated regions to study the impact of gestational weight gain on maternal metabolism and fetal-neonatal growth.

Integrative network analysis (INA) is important for identifying gene modules or epigenetically regulated molecular pathways in diseases. This study evaluated the effect of excessive gestational weight gain (EGWG) on INA of differentially methylated regions, maternal metabolism and offspring growth. Brazilian women from "The Araraquara Cohort Study" with adequate pre-pregnancy body mass index were divided into EGWG (n=30) versus adequate gestational weight gain (AGWG, n=45) groups. The methylome analysis was performed on maternal blood using the Illumina MethylationEPIC BeadChip. Fetal-neonatal growth was assessed by ultrasound and anthropometry, respectively. Maternal lipid and glycemic profiles were investigated. Maternal triglycerides-TG (p=0.030) and total cholesterol (p=0.014); fetus occipito-frontal diameter (p=0.005); neonate head circumference-HC (p=0.016) and thoracic perimeter (p=0.020) were greater in the EGWG compared to the AGWG group. Multiple linear regression analysis showed that maternal DNA methylation was associated with maternal TG and fasting insulin, fetal abdominal circumference, and fetal and neonate HC. The DMRs studied were enriched in 142 biological processes, 21 molecular functions,and 17 cellular components with terms directed for the fatty acids metabolism. Three DMGMs were identified:COL3A1, ITGA4 and KLRK1. INA targeted chronic diseases and maternal metabolism contributing to an epigenetic understanding of the involvement of GWG in maternal metabolism and fetal-neonatal growth.

The impact of gestational diabetes on the development of fetal frontal lobe: A case-control study from a tertiary center.

To determine the effects of gestational diabetes mellitus (GDM) on fetal frontal lobe development. This study was conducted prospectively between May 2023 and August 2023 in Ankara City Hospital perinatology clinic. Maternal age, maternal body mass index (BMI), gestational week (GW), biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL), estimated fetal weight (EFW), frontal antero-posterior diameter (FAPD), occipito-frontal diameter (OFD), FAPD/OFD ratio, and FAPD/HC ratio, were compared between GDM (n = 40) and low risk controls (n = 56). The mean maternal age was found higher in the GDM group compared to control group (p = 0.002). Maternal BMI was significantly higher in the GDM group than the control group (p = 0.01). Abdominal circumference (AC) was significantly higher in the GDM group compared to control group (p = 0.04). EFW was significantly higher in the GDM group compared to control group (p = 0.04). FAPD/OFD ratio was found to be higher in the GDM group than in the control group (p = 0.001). Among GDM patients, no statistically significant difference was found in the ultrasound measurements between the groups receiving insulin treatment and those without treatment. According to the correlation analysis results a moderate, positive, and statistically significant correlation was present between FAPD/OFD and GDM. In perinatal outcomes, the rate of neonatal intensive care unit admission was significantly higher in the GDM group. Fetal frontal lobe development seems to be affected by GDM.

Does diabetes mellitus affect the development of fetal brain structures and spaces including corpus callosum, subarachnoid space, insula, and parieto-occipital fissure?

We investigated the impact of pregestational and gestational diabetes mellitus (PGDM and GDM) on the development of fetal intracranial structures and spaces. This prospective cross-sectional study involved singleton pregnancies between 20 and 32 weeks of gestation. The study comprised a control group (n = 65) of healthy pregnant women without diabetes mellitus (DM); a PGDM group (n = 43) of pregnant women having type 2 DM in a controlled diabetic state; and a GDM group (n = 26) of pregnant women with GDM diagnosed with 2-h 75-g oral glucose tolerance test and received intervention to reduce the diabetic impact on fetus. During neurosonographic evaluation, the simultaneous measurements of corpus callosum (CC) width and depth in the midsagittal image; and lateral craniocortical and posterior craniocortical widths of the subarachnoid space and insular and parieto-occipital fissure depths in the axial image were performed. Before statistical analysis, these values were carefully adjusted for the occipitofrontal diameter. The DM groups displayed substantially higher frequencies of family history of DM and obstetric history of GDM compared to the control group (p < 0.05). Regarding the neurosonographic parameters, the CC length and insular and parieto-occipital fissure depths were significantly increased in the GDM group but not in the PGDM group (p < 0.05). No significant difference was found among the study groups regarding other neurosonographic parameters (p > 0.05). The results of neurosonographical evaluation of fetal brain structures and spaces reveal that diabetic impact may not be seen in the presence of PGDM, especially in pregnant women receiving prenatal interventions to reduce or avoid diabetic adverse effects on fetal brain development. The effect of GDM on neurosonographically assessed fetal brain development should be evaluated in further studies with subjects matched for gestational weeks and antenatal care conditions.

Can the Pfannenstiel skin incision length be adjusted according to the fetal head during elective cesarean delivery?

The study aims to determine whether the Pfannenstiel skin incision can be adjusted according to the fetal head's occipitofrontal diameter (OFD) during primary cesarean delivery. Eligible 114 nulliparous women delivered at term by cesarean section in which Pfannenstiel skin incision was performed according to the OFD of the fetal head between June 2017 and September 2021 were included. Excluded cases were non-vertex presentations, all emergency cesarean sections, severe preeclampsia, women in an active phase of the first stage of labor and second stage of labor, placenta previa and low-lying placenta, multiple pregnancies, and uncontrolled gestational diabetes mellitus. Among 114 eligible nulliparous women, the mean OFD was 116.1 ± 7.2 (99-138) mm, and the measurement of the Pfannenstiel skin incision length, which was performed according to the OFD was found to be 122.8 ± 9.2 (100-155) mm. The difference between OFD and Pfannenstiel incision kept remained within 10 mm in 90 (82.5.2%), 10-20 mm in 17 (15.5%), and more than 20 mm in two women (1.8%). This technique was successful in 109 (95.6%) out of 114 women without extending the skin incision. In five women, skin incision needed to be extended up to 38 mm. In 10 women (8.7%), the rectus abdominis muscle was cut partially to deliver the fetal head. The mean fetal umbilical artery pH was 7.33 ± 0.05. No neonatal hypoxia was encountered in the study. Pfannenstiel skin incision can be adjusted according to the OFD with minimal margins of error. This technique may provide better cosmetic results by avoiding unnecessarily prolonged incisions with similar newborn outcomes. Clinicaltrials.gov, identifier [NCT05632796].

The relationship between obesity-related H19DMR methylation and H19 and IGF2 gene expression on offspring growth and body composition.

Imprinted genes are important for the offspring development. To assess the relationship between obesity-related H19DMR methylation and H19 and IGF2 gene expression and offspring growth and body composition. Thirty-nine overweight/obese and 25 normal weight pregnant women were selected from the "Araraquara Cohort Study" according to their pre-pregnancy BMI. Fetal growth and body composition and newborn growth were assessed, respectively, by ultrasound and anthropometry. The methylation of H19DMR in maternal blood, cord blood, maternal decidua and placental villi tissues was evaluated by methylation-sensitive restriction endonuclease qPCR, and H19 and IGF2 expression by relative real-time PCR quantification. Multiple linear regression models explored the associations of DNA methylation and gene expression with maternal, fetal, and newborn parameters. H19DMR was less methylated in maternal blood of the overweight/obese group. There were associations of H19DMR methylation in cord blood with centiles of fetal biparietal diameter (BPD) and abdominal subcutaneous fat thickness and newborn head circumference (HC); H19DMR methylation in maternal decidua with fetal occipitofrontal diameter (OFD), HC, and length; H19DMR methylation in placental villi with fetal OFD, HC and abdominal subcutaneous fat thickness and with newborn HC. H19 expression in maternal decidua was associated with fetal BPD and femur length centiles and in placental villi with fetal OFD and subcutaneous arm fat. IGF2 expression in maternal decidua was associated with fetal BPD and in placental villi with fetal OFD. To our knowledge, this is the first study to demonstrate associations of imprinted genes variations at the maternal-fetal interface of the placenta and in cord blood with fetal body composition, supporting the involvement of epigenetic mechanisms in offspring growth and body composition.

Automatic Deep Learning-Based Pipeline for Automatic Delineation and Measurement of Fetal Brain Structures in Routine Mid-Trimester Ultrasound Images

Introduction: The aim of this study was to develop a pipeline using state-of-the-art deep learning methods to automatically delineate and measure several of the most important brain structures in fetal brain ultrasound (US) images. Methods: The dataset was composed of 5,331 images of the fetal brain acquired during the routine mid-trimester US scan. Our proposed pipeline automatically performs the following three steps: brain plane classification (transventricular, transthalamic, or transcerebellar plane); brain structures delineation (9 different structures); and automatic measurement (from the structure delineations). The methods were trained on a subset of 4,331 images and each step was evaluated on the remaining 1,000 images. Results: Plane classification reached 98.6% average class accuracy. Brain structure delineation obtained an average pixel accuracy higher than 96% and a Jaccard index higher than 70%. Automatic measurements get an absolute error below 3.5% for the four standard head biometries (head circumference, biparietal diameter, occipitofrontal diameter, and cephalic index), 9% for transcerebellar diameter, 12% for cavum septi pellucidi ratio, and 26% for Sylvian fissure operculization degree. Conclusions: The proposed pipeline shows the potential of deep learning methods to delineate fetal head and brain structures and obtain automatic measures of each anatomical standard plane acquired during routine fetal US examination.

Normal Fetal Growth Profile at 10-41 Weeks of Gestation - An Update Based on 10225 Normal Singleton Pregnancies and Measurement of the Fetal Parameters Using 3D Ultrasound.

To construct new growth charts and tables for the following fetal growth parameters: biparietal diameter (BPD), occipitofrontal diameter (OFD), head circumference (HC), abdominal transverse diameter (ATD), abdominal sagittal diameter (ASD), abdominal circumference (AC), femur length (Fe), tibia length (Ti), fibula length (Fi), humerus length (Hu), radius length (Ra), and ulna length (Ul). This prospective study was conducted at a level III ultrasound center as a population-based cross-sectional study on 10 225 normal singleton pregnancies with a gestational age between 10 and 41 completed weeks. Gestational age was confirmed in all cases by an ultrasound examination with crown-rump measurement before 10 weeks of gestation. All examinations were performed with 3 D probes. BPD, OFD, ATD, and ASD were measured as outer-to-outer measurements (skin-to-skin) after identifying the exact biometric planes by 3 D multiplanar display. HC was computed using the formula . For AC the approximate elliptical formula AC = (ATD+ASD)/2 × 3.142 was used. Measurements of the limb bones included the entire ossified shaft. Based on a nonlinear regression model for the age-specific mean values, distribution-free reference ranges were calculated for the parameters BPD, OFD, HC, ATD, ASD, AC, Fe, Ti, Fi, Hu, Ra and Ul. The new reference ranges were compared with our reference ranges published in 1996 as well as with different reference charts published by other authors. 3 D ultrasound allows a controlled demonstration of all fetal planes required for exact biometric measurements. The fetal growth profile including the 12 biometric parameters gives a precise overview of normal or abnormal fetal growth.

A Cross Sectional Study of Cephalic Index using Various Measurement Techniques in Varanasi Region of North Indian Population

Background: Cephalic Index is defined as the ratio calculated by the occipitofrontal diameter (OFD) to thebiparietal diameter (BPD).It has been reported that factors like race, ethnicity, genetic interactions, traditions, nutrition, environment, andclimate influences head types.The multifariousness of our nation fascinates and raises the need for anthropometric studies in various regionsand compare the outcomes.The cross-sectional study was carried on three different groups/subjects of either sex.Group 1 comprised of living subjects (Undergraduate students) belonging to this particular region.Group 2 comprised of those that presented to the radio- diagnosis department of Sir Sunderlal Hospital, IMS,BHU, UP, India.Group 3 comprised of dry skulls available in the departmental museum of department of Forensic medicine, IMS,BHU, UP, India.The measurement of maximum cranial breadth and maximum cranial length, are taken manually/on DICOM CTrecords depending on the group and recorded for analysis.The average CI in both the sexes and prevalence of the type is classified according to Martin and Saller classification.(1957)Objectives: The objectives were to find out the prevalence of the type of skull in the study population. It wouldalso show the sensitivity of radiology and its efficaciousness in anthropometric measurements. To ascertain themean CI,range of maximum cranial breadth and maximum cranial length.Result: A total of 70% amongst the study population shows dolichocephalisation.The mean cephalic index in this particular study population was 73.92 ± 5.05.&#x0D; Maximum cranial breadth ranged from 10.4cms to 16.2cms with a mean breadth of 13.21±0.93.Maximum cranial length ranged from 15.6 cms to 20.67cms with a mean length of 17.89 ± 0.86.Conclusion: The observations and findings of the present study based on CT can be replicated in variouscommunities, castes, and regions of India. The data can also be helpful in establishment of identity particularlyrace using skeletal remains.

Computed Tomography Assessment of Cephalic Index and Sella Turcica Dimensions and Morphology in a Nigerian Population

Cephalic index (CI) is the percentage of biparietal diameter to the occipitofrontal diameter of the skull and can be used in forensic investigations in cases of disputed identity where only fragments of the head/skull are available. The sella turcica houses the pituitary gland whose hormones regulate the functions of many other glands and systems of the body. Abnormal sizes of sella turcica could indicate sella/pituitary pathology with health implications. This study aimed to assess CI, head shapes and sella turcica dimensions and morphology of the Yoruba tribe of Nigeria. The objectives are: to relate CI and head shapes with sella turcica dimensions and morphology, to use CI and head shape to identify and distinguish the Yoruba tribe from other tribes, to use CI and head shape to distinguish between genders. Skull/head and sella turcica dimensions were measured on 321 retrospectively enlisted normal cranial Computed Tomography (CT) images of Yoruba subjects, mean age 55 (SD ± 17) years, in a Tertiary Hospital in South-West Nigeria between January 2020 and April 2021, and then CI calculated. Data was analyzed using IBM SPSS 27(IBM Corp. Armonk, NY, USA, 2019). Predominant head shape of the studied group was dolichocephalic. Mean CI was 70.0 ± 3.7 and showed no statistically significant difference between gender (P = 0.097). Mean sella length, depth; and anteroposterior diameter was 1.22 ± 0.24 cm, 0.80 ± 0.15 cm, 1.34 ± 0.25 cm respectively. Mean sella length and depth showed significant difference between gender (P = 0.0001; P = 0.032) respectively. Head shape has no association with sella dimensions and morphology. Head shape and CI may stratify populations in forensic practice and surgical planning.

Frontal lobe development in fetuses with growth restriction by using ultrasound: a case–control study

BackgroundFetal growth restriction (FGR) occurs in up to 10% of pregnancies and is a leading cause of perinatal mortality and neonatal morbidity. Three-dimensional ultrasonography of intracranial structure volume revealed significant differences between fetuses with FGR and appropriate for gestational age (AGA) fetuses. We aimed to compare the frontal lobe development between fetuses with FGR and appropriately grown fetuses and evaluate the impact of fetal circulatory redistribution (FCR) on frontal lobe development in fetuses with FGR.MethodsWe performed a case–control study at our institution from August 2020 to April 2021. The frontal antero-posterior diameter (FAPD) and occipito-frontal diameter (OFD) were measured on the trans-ventricle view and we calculated the Z-scores for FAPD and OFD standardized for gestational age (GA) and transverse cerebellar diameter (TCD) by performing a standard regression analysis followed by weighted regression of absolute residual values in appropriately grown fetuses. We calculated the FAPD/OFD ratio as 100 × FAPD/OFD and FAPD/HC (head circumference) as 100 × FAPD/HC. To compare intracranial parameters, we randomly selected a control group of appropriately grown fetuses matched with the FGR group at the time of ultrasonography. We performed between-group comparisons of the FAPD Z-score, OFD Z-score, FAPD/OFD ratio and FAPD/HC. Similarly, we compared intracranial parameters between fetuses with FGR with and without FCR.ResultsFAPD/OFD ratio was curvilinear related to all the independent variables (GA, BPD, FL, and TCD). Compared with appropriately grown fetuses, fetuses with FGR showed a significantly lower FAPD/OFD ratio, FAPD Z-score, and FAPD/HC. There was no significant difference in the FAPD Z-score, FAPD/OFD ratio, and FAPD/HC between FGR fetuses with and without FCR.ConclusionsThe FAPD/OFD ratio varied during pregnancy, with a mild reduction before and a mild increase after about 33 gestational weeks. Fetuses with FGR showed reduced frontal lobe growth; moreover, fetal frontal lobe development disorders were not significantly different in fetuses with FCR.Trial registrationDate: 09–27-2017; Number: [2017]239.

Update Reference Charts: Fetal Biometry between the 15th and 42nd Week of Gestation.

This study was designed to establish new reference charts for BPD (biparietal diameter), OFD (occipitofrontal diameter), HC (head circumference), CM (cisterna magna), TCD (transverse cerebellar diameter), PCV (posterior cerebral ventricle), AC (abdominal circumference), FL (femur length), and HL (humerus length) and extend known charts to 42 weeks of gestation. These new charts were compared to studies carried out by Snijders and Nicolaides, the INTERGROWTH 21st Project, and the WHO Fetal Growth Charts. In this retrospective cross-sectional single-center study of 12,972 low-risk pregnancies, biometric data between the 15th and 42nd weeks of gestation were evaluated. Only one examination per pregnancy was selected for statistical analysis. Descriptive analysis for the 5th, 50th, and 95th quantile was performed for each parameter as listed above. Regression models were used to fit the mean and the SD at each gestational age. Initially the reference curves for BPD, OFD, HC, AC, FL, and HL show a linear increase, which changes into a cubic increase towards the end of pregnancy. The results of this study show statistically noticeable differences from the percentile curves of the studies listed above. The percentile curves in this study differ from the commonly used ones. The presented standard curves can be used as a reference in prenatal diagnostics.

Sexual dimorphism of the fetal brain biometry: an MRI-based study.

Fetal growth assessment is a key component of prenatal care. Sex-specific fetal brain nomograms on ultrasound are available and are clinically used. In recent years, the use of fetal MRI has been increasing; however, there are no sex-specific fetal CNS nomograms on MRI. The study aimed to assess the differences in fetal brain biometry and growth trajectories and to create population-based standards of the fetal brain on MRI. In this cross-sectional study, brain structures of singleton fetuses with normal brain MRI scans were analyzed: biparietal diameter, occipitofrontal diameter, trans-cerebellar diameter, and the corpus callosum were measured and converted into centiles. Sex-specific nomograms were created. A total of 3848 MRI scans were performed in one tertiary medical center between 2011 and 2019; of them, 598 fetuses met the inclusion criteria, 300 males and 298 females between 28- and 37-weeks' gestation. Males had significantly larger occipitofrontal diameter than females (median 75%, IQR 54-88%; median 61%, IQR 40-77%) and biparietal diameter (median 63%, IQR 42-82%; median 50%, IQR 25-73%), respectively (p < 0.001). The cerebellum had the greatest growth rate, with a 1.5-fold increase in diameter between 28 and 37weeks' gestation, with no measurement difference between the sexes (p = 0.239). No significant difference was found in the corpus callosum (p = 0.074). Measuring both sexes on the same nomograms may result in over-estimation of male fetuses and under-estimation of females. We provide fetal sex-specific nomograms on two-dimensional MRI.

Prenatal Diagnosis and Management of Thrombocytopenia-Absent Radius Syndrome.

Prenatal Diagnosis and Management of Thrombocytopenia-Absent Radius Syndrome.

Variation of Prenatal Ultrasound-Estimated Cephalic Index; A Comparative Study of Igbo, Hausa and Yoruba Ethnic Groups in Nigeria

&#x0D; &#x0D; &#x0D; &#x0D; Background: Fetal ultrasound-estimated cephalic index refers to the ratio of the fetal biparietal diameter (BPD) to the occipito-frontal diameter (OFD) by means of ultrasound estimation. The cephalic index is regarded as a useful anthropometric variable in medicine, forensic science and anthropology. There is limited data on the cephalic indices of Nigerian fetuses&#x0D; Objective: To check for variations of prenatal ultrasound-estimated cephalic indices between fetuses of Igbo, Yoruba and Hausa ancestry.&#x0D; Methodology: In a cross sectional study carried out in ultrasound diagnostic centres in Lagos, Enugu and Kano, all in Nigeria, fetal biparietal and occipitofrontal diameters were obtained from 200 fetuses each of Igbo, Yoruba and Hausa ethnic groups. The cephalic index was calculated for each group. The values were statistically analysed after deriving the relevant indices.&#x0D; Result: The fetal cephalic indices for Igbo, Yoruba and Hausa ethnic groups were observed to be 80 ± 3.4, 79.1 ± 5.1 and 78.4 ± 2.6 %, respectively.&#x0D; Conclusion: The results showed that fetuses of Igbo ancestry had a different cephalic index categorization from other ethnic groups. This knowledge will be useful to sonographers and researchers.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

Variation of Prenatal Ultrasound-Estimated Cephalic Index; A Comparative Study of Igbo, Hausa and Yoruba Ethnic Groups in Nigeria

&#x0D; &#x0D; &#x0D; &#x0D; Background: Fetal ultrasound-estimated cephalic index refers to the ratio of the fetal biparietal diameter (BPD) to the occipito-frontal diameter (OFD) by means of ultrasound estimation. The cephalic index is regarded as a useful anthropometric variable in medicine, forensic science and anthropology. There is limited data on the cephalic indices of Nigerian fetuses&#x0D; Objective: To check for variations of prenatal ultrasound-estimated cephalic indices between fetuses of Igbo, Yoruba and Hausa ancestry.&#x0D; Methodology: In a cross sectional study carried out in ultrasound diagnostic centres in Lagos, Enugu and Kano, all in Nigeria, fetal biparietal and occipitofrontal diameters were obtained from 200 fetuses each of Igbo, Yoruba and Hausa ethnic groups. The cephalic index was calculated for each group. The values were statistically analysed after deriving the relevant indices.&#x0D; Result: The fetal cephalic indices for Igbo, Yoruba and Hausa ethnic groups were observed to be 80 ± 3.4, 79.1 ± 5.1 and 78.4 ± 2.6 %, respectively.&#x0D; Conclusion: The results showed that fetuses of Igbo ancestry had a different cephalic index categorization from other ethnic groups. This knowledge will be useful to sonographers and researchers.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

Reference values of fetal ultrasound biometry: results of a prospective cohort study in Lithuania.

The aim of the study was to construct a reference range for the Lithuanian population for fetal biparietal diameter (BPD), occipitofrontal diameter (OFD), head circumference (HC), abdominal circumference (AC) and femur length (FL) and to compare them with the old local and current international reference values. A prospective cross-sectional study was carried out in secondary referral centres Vilnius University Hospital Santariškių Klinikos Centro Affiliate in 2008-2009 and Vilnius Maternity Hospital in 2009-2014. The fetal biometry of 556 fetuses between 12 and 42weeks gestation was performed. BPD, OFD, HC, AC and FL were measured. The data were collected and the analysis was performed using statistical programs MS Excel, SPSS and Matlab. Different regression models were fitted to calculate the mean and standard deviation at each gestational age for each parameter. The biometric measurements of HC, BPD, OFD as well as AC and FL were performed for 556 fetuses. The centile charts, tables and regression formulae of the biometric parameters were constructed. The comparison of the current charts with those of other two studies revealed no significant differences of HC centiles. AC values were similar to those presented in the international study INTERGROWTH-21 and significantly higher in comparison to the study for the Lithuanian population conducted by Ališauskas (1980). FL values, especially in late pregnancy, were significantly smaller in the INTERGROWTH-21 study compared to our charts; however, there were no significant differences of the 50th centile compared to the results from Ališauskas. We have constructed and presented centile charts, tables and regression formulae for fetal biometry for the Lithuanian population and compared them with the results of two other studies. The significant differences between our centile charts and those from INTERGROWTH-21 imply the necessity to have local standards of fetal biometry, while the differences of our results from the older study in the same population show the importance of updating fetal biometry reference charts for every generation.