Fetal Parameters Research Articles

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

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

Evaluating the Impact of Maternal Lipid Profiles on Fetal Cardiac Function at Mid-Gestation: An Observational Study

Background: Maternal dyslipidemia during pregnancy may influence fetal cardiac development and function, potentially predisposing offspring to cardiovascular diseases later in life. This study aims to evaluate the relationship between maternal lipid profiles and fetal cardiac function at mid-gestation, utilizing detailed echocardiographic assessments. Methods: In this prospective cohort study conducted at the Obstetrics and Gynecology Clinic of the Timișoara Municipal Emergency Hospital, 19 pregnant women aged 27–40 years were recruited and divided into two groups based on their triglyceride levels: Group A (triglycerides ≤ 150 mg/dL, n = 48) and Group B (triglycerides > 150 mg/dL, n = 28). Maternal demographic data and lipid profiles were recorded. Fetal echocardiographic measurements, including global longitudinal strain and ventricular function parameters, were obtained between 20 and 24 weeks of gestation. Statistical analyses, including subgroup comparisons, correlations, and regression analyses, were performed. Results: Maternal BMI was significantly higher in Group B compared to Group A (31.94 ± 2.80 vs. 27.01 ± 2.40 kg/m2, p < 0.001). Group B showed higher mean triglyceride levels (163.43 ± 11.34 mg/dL) compared to Group A (131.42 ± 10.57 mg/dL, p < 0.001). Fetal echocardiographic measurements indicated reduced global longitudinal strain in fetuses of Group B mothers (LV strain: −19.86% ± 6.83% vs. −26.14% ± 5.92%, p = 0.017). Significant correlations were found between maternal triglyceride levels and fetal LV strain (r = 0.536, p = 0.019). Regression analysis identified maternal triglyceride levels and BMI as significant predictors of reduced fetal LV strain (β = 0.45, p = 0.021 and β = 0.39, p = 0.038, respectively). Conclusions: Elevated maternal triglyceride levels, LDL cholesterol, and BMI are associated with altered fetal cardiac function parameters at mid-gestation, suggesting that maternal lipid profiles may impact fetal cardiac development. These findings underscore the importance of monitoring lipid levels during pregnancy and suggest potential benefits of managing dyslipidemia to improve fetal cardiac outcomes. However, the study included only a small sample; therefore, the study needs to be continued with a larger group.

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

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

Transcerebellar diameter / abdominal circumference (TCD/AC) versus (HC/AC) head circumference / abdominal circumference --- USG prediction of fetal growth restriction? What do we observe in north Kerala, India

: Fetal growth restriction (FGR) refers to a condition in which a fetus is unable to achieve its genetically determined potential. A ratio of TCD /AC which is gestational age independent is very useful in predicting FGR. This prospective comparative study compared trans-cerebellar diameter / abdominal circumference versus head circumference / abdominal circumference in predicting fetal growth restriction. : A cross- sectional study done in 200 pregnant women attending Malabar Institute of Medical Sciences hospital during March 2018- May 2019. 40 pregnant women in third trimester with clinically suspected FGR over one year were the cases and 160 with normal growth pattern were the controls. Evaluation was done with 3.5 MHz frequency ultrasound. Fetal parameters such as BPD, HC, AC and FL were measured. Data were collected in Excel. Two morphometric ratios- TCD/AC and HC/AC will be calculated. Both TCD/ AC ratio and HC/AC of study group were compared with that of control group. The values above 2 standard deviations (SD) above mean were taken as FGR and was confirmed by postnatal newborn assessment by modified Ballard score. New born weight was compared with Fenton’s chart. If it was less than 10 percentile for the gestational age, it was diagnosed as a real case of FGR. Maximum number of cases (46.5%) belonged to the group 26-30 years. Around 23.5% in the group 31-35 years, 23% <= 25 years and 7% of the cases were >35 years. Clinical examination accounts for a sensitivity of 89.74%, Specificity of 96.9%, positive predictive value of 87.5% and negative predictive value of 97.5%. The sensitivity for TCD/ AC ratio is 94.87%. Specificity is 99.37%, positive predictive value is 97.36% and negative predictive value is 98.76%. TCD/AC and HC/AC were gestational age independent parameters and can be used in detecting IUGR with good diagnostic accuracy. However, TCD/AC ratio had a better diagnostic validity and accuracy compared to HC/AC ratio in predicting asymmetric FGR

Enrichment of trimethyl histone 3 lysine 4 in the Dlk1 and Grb10 genes affects pregnancy outcomes due to dietary manipulation of excess folic acid and low vitamin B12

The aberrant expression of placental imprinted genes due to epigenetic alterations during pregnancy can impact fetal development. We investigated the impact of dietary modification of low vitamin B12 with varying doses of folic acid on the epigenetic control of imprinted genes and fetal development using a transgenerational model of C57BL/6J mice. The animals were kept on four distinct dietary combinations based on low vitamin B12 levels and modulated folic acid, mated in the F0 generation within each group. In the F1 generation, each group of mice is split into two subgroups; the sustained group was kept on the same diet, while the transient group was fed a regular control diet. After mating, maternal placenta (F1) and fetal tissues (F2) were isolated on day 20 of gestation. We observed a generation-wise opposite promoter CpG methylation and gene expression trend of the two developmental genes Dlk1 and Grb10, with enhanced gene expression in both the sustained and transient experimental groups in F1 placentae. When fetal development characteristics and gene expression were correlated, there was a substantial negative association between placental weight and Dlk1 expression (r = − 0.49, p < 0.05) and between crown-rump length and Grb10 expression (r = − 0.501, p < 0.05) in fetuses of the F2 generation. Consistent with these results, we also found that H3K4me3 at the promoter level of these genes is negatively associated with all fetal growth parameters. Overall, our findings suggest that balancing vitamin B12 and folic acid levels is important for maintaining the transcriptional status of imprinted genes and fetal development.

Nomograms of fetal thoracic dimensions from 17 to 37 weeks of gestation

Abstract Introduction: We aimed to construct the nomograms for fetal thoracic parameters among Thai fetuses that were between 17 and 37 gestational weeks, as assessed by three distinct two‐dimensional (2D) measurement techniques (thoracic diameter, circumference and area) and compare our findings with those of previous publications. Methods: A cross-sectional study involving 511 low-risk singleton pregnancies with normal fetuses at Siriraj Hospital, Bangkok, Thailand, was conducted. Using the four-chamber view, fetal thoracic measurements were obtained through three 2D sonographic measurement methods. Reference intervals at 95% and Z-scores were established for all techniques based on gestational age (GA) and biparietal diameter (BPD). Intraclass correlation coefficients (ICCs) were computed to assess reproducibility of the measurement methods. Results: Measurements of fetal thorax size exhibited consistent, proportional increases with advancing GA and BPD across all techniques. Intraobserver and interobserver reliability coefficients for all methods indicated excellent agreement, with all ICCs being at least 0.991. Nomograms of fetal thoracic diameter, circumference and area across GA and BPD were constructed from the obtained values. Discrepancies in Z-score reference ranges for fetal thoracic circumference were noted between the present study and previous research in other populations, particularly among Caucasians. Conclusion: Our study established normal reference ranges for evaluating fetal chest size through three different methods from 17 to 37 weeks of gestation in the Thai population. Nomograms may vary due to population differences, emphasising the importance of using reference values from similar demographic groups. The findings could potentially be used to identify fetuses that are at risk of abnormal thoracic dimensions or thoracic dysplasia.

Maternal iron nutrition during pregnancy and fetal intrauterine growth

BackgroundIron is critical for maternal and fetal health; however, the effect of iron nutrition on fetal intrauterine growth remains unclear. This study aimed to investigate the associations of maternal iron nutrition during pregnancy with fetal intrauterine growth parameters among the Chinese population.MethodsThis retrospective birth cohort study included 482 pregnant women. Maternal information was collected by standard questionnaires. Maternal concentrations of serum ferritin and hemoglobin were detected. Fetal ultrasound examinations in the second and third trimesters were conducted. Quantile regression or linear regression models were applied to assess the associations.ResultsParticipants took iron supplementation in early, mid, and late pregnancy accounted for 19.1%, 40.3%, and 37.8%, respectively. Iron supplementation in the first and second trimesters and total iron intake in pregnancy were positively associated with fetal intrauterine growth parameters at some percentiles. Compared with those without iron supplementation in the second trimester, women with iron supplementation in the second trimester had 0.37 (95%CI = 0.24–0.49), 0.37 (95%CI = 0.26–0.48), 0.15 (95%CI = 0.04–0.26), and 0.52 (95%CI = 0.42–0.61) higher z-scores in fetal biparietal diameter, femur length, abdominal circumference, and estimated fetal weight at the 50th percentile in the second trimester, respectively. Maternal serum ferritin and hemoglobin concentrations in the first and second trimesters were positively correlated with several fetal growth parameters.ConclusionsFetal intrauterine growth may benefit from maternal iron nutrition in the first and second trimesters.

Factors Predicting Fetal Growth Restriction and Fetal Cardiac Remodeling.

This study aimed to investigate factors influencing fetal growth restriction (FGR) occurrence and assess the clinical significance of fetal cardiac parameters in FGR prediction. Pregnant women with clinically suspected FGR (n=179) and uncomplicated pregnancies (n=53) were included. All had undergone routine obstetric ultrasonography and fetal echocardiography. Umbilical artery flow (UAF) and fetal cardiac parameters (left atrial transverse diameter (LAd), right atrial transverse diameter (RAd), left ventricular transverse diameter (LVd), right ventricular transverse diameter (RVd), foramen ovale width, atrial septum diameter, interventricular septal thickness, left ventricular posterior wall thickness, right ventricular free wall thickness, aortic diameter, pulmonary artery diameter, mitral E velocity, mitral A velocity, tricuspid E velocity, tricuspid A velocity, aortic valve peak flow velocity, and pulmonary valve peak flow velocity) were detected. Follow up was conducted until birth, various fetal clinical parameters were collected: maternal body mass index (BMI), hypertensive disorders complicating pregnancy (HDCP), abnormal umbilical artery flow, placental or umbilical cord anomalies, low amniotic fluid volume, preterm birth, emergency cesarean delivery, maternal height, maternal age, gestational diabetes mellitus (GDM), hypothyroidism, assisted reproductive technology (ART), parity, and neonatal gender. Participants were categorized into confirmed FGR (n=119) and control (n=113) groups based on neonatal birth weight. Significant differences were observed between groups in maternal BMI, HDCP, abnormal UAF, placental or umbilical cord anomalies, low amniotic fluid volume, preterm birth, and emergency cesarean delivery. FGR was positively related to abnormal UAF, placental or umbilical cord anomalies, preterm birth and emergency cesarean delivery and negatively to maternal BMI (r=-0.276). Compared to the control group, the FGR group exhibited significantly larger RAd, RVd, RA/LA, and RV/LV. Fetal growth-restricted fetuses have enlarged right heart structures. Fetal cardiac examinations are valuable for early FGR diagnosis, potentially improving neonatal body weight and reducing adverse pregnancy outcomes.

Ebstein's anomaly with coarctation of the aorta and a bicuspid aortic valve: a case report of a rare association with unique prenatal findings.

Ebstein's anomaly is rarely accompanied by coarctation of the aorta, although patients with Ebstein's anomaly have a relatively small left ventricle. Here, we report a rare case of Ebstein's anomaly with coarctation of the aorta and a bicuspid aortic valve. We compared the foetal echocardiographic parameters of five previous cases with Ebstein's anomaly without left heart obstruction to explore the association between left ventricular volume, Ebstein's anomaly severity, and left heart obstruction.

Reference values of normal fetal ductus venosus Doppler flow measurements at 11-14 weeks of gestation.

To establish the reference range of normal fetal ductus venosus pulsatility index (DV PI) and ductus venosus (DV) blood flow velocity at 11-14 weeks of gestation. Fetal ductus venosus Doppler flow was measured in singleton pregnancies attending our hospital for early pregnancy nuchal translucency (NT) screening between June 2021 and May 2022. All fetuses were followed up for pregnancy outcome using the following inclusion criteria: Singleton pregnancy; no maternal underlying diseases such as diabetes, hypertension, rheumatism, or other pregnancy complications; fetal crown-rump length (CRL) of 45 to 84 mm; normal NT screening ultrasound; no absent or reversed ductus venosus a-wave; no fetal structural abnormalities; no chromosomal abnormalities during follow-up; and good pregnancy outcome. DV PI, peak ventricular systolic velocity (S-wave), atrial systolic flow velocity (a-wave) and time-averaged maximum velocity (TAMXV) were recorded. The ductus venosus Doppler parameters of 224 fetuses which met the inclusion criteria were analysed. DV PI P5 and P95 ranged from 1.0007 and 1.3415 for a CRL of 45 mm to 0.9734 and 1.2115 for a CRL of 84 mm, indicating a statistically significant correlation with CRL. DV S-wave, a-wave, and TAMXV all increased as CRL increased, demonstrating a statistically significant correlation with CRL values. A reference range of normal fetal ductus venosus Doppler spectral parameters at 11-14 weeks was established to provide a basis for further research into the clinical value of normal and abnormal DV PI values in relation to adverse pregnancy outcomes.

Fertility and teratogenic study of the aqueous extract of Hibiscus sabdariffa L. in female Sprague Dawley rats

Hibiscus sabdariffa (roselle) has long been gaining attention in phytotherapy research due to its medicinal properties. Despite its benefits, there is very scarce information available on the reproductive toxicity of this plant. The aqueous extract of H. sabdariffa (AEHS) was tested in the present study to investigate its potential effects on fertility and teratogenicity in 40 female Sprague Dawley rats. AESH treatment was administered orally by gavage at four different dosages: 250, 500 and 1000 mg/kg/day or distilled water (control). Treatment began from pre-mating and continued through mating up to the 19th day of pregnancy periods. Throughout this study, the reproductive parameters were evaluated until the day of sacrifice (day 20th of pregnancy). Results obtained revealed no significant differences in general physical health, behaviours and maternal body weights throughout the treatment period. Furthermore, the mean length of the oestrous cycle was not statistically affected, even though a few rats displayed irregular cycles. In addition, there was no statistical significance in the mating and pregnancy indices, number of corpora lutea and implantation sites, percentages of pre-implantation loss and postimplantation death and reproductive organ weights. Foetal parameters such as the number of live foetuses, sex ratio and body weight were also not statistically affected by AESH. Ultimately, there were no signs of teratogenicity observed since none of the foetuses exhibited congenital malformations. In conclusion, these findings imply that the oral administration of AEHS up to 1000 mg/kg/day did not pose any significant toxicity on the fertility and teratogenicity but slightly affected the oestrous cycle in rats.

Gross movement counting of fetuses conceived with assisted reproductive technology using a fetal movement acceleration measurement recorder

To investigate whether assisted reproductive technology (ART) affects gross fetal movement. A prospective cohort study. 65 women who conceived with ART (ART group) and 211 women (control group) without ART recorded fetal movement with the fetal movement acceleration measurement recorder at night weekly after 28 weeks. The number ratio of 10 s epochs with fetal movement to all epochs was calculated as the fetal movement parameter. When no fetal movement was observed for more than 5 min, it was defined as a no fetal movement period, and the average number per hour, the average duration, and the longest duration of the no fetal movement periods were calculated as the no fetal movement parameters. Gestational weeks were classified into 28–33 and 34–39 weeks, and the fetal movement parameter and the no fetal movement parameters were compared using the Student’s t-test. The fetal movement parameters at 28–33 weeks were 17.43% (ART) and 16.58% (control) (p = 0.219), and those at 34–39 weeks were 11.72% (ART) and 11.96% (control) (p = 0.590). In the same way, for the no fetal movement parameters, the average numbers were 1.58 and 1.63 per hour (p = 0.357), and 2.36 and 2.30 per hour (p = 0.503). The average durations were 8.30 and 8.46 min (p = 0.712), and 9.20 and 9.51 min (p = 0.188). The longest durations were 16.26 and 17.02 min (p = 0.295), and 22.34 and 22.87 min (p = 0.534). ART does not affect gross fetal movement count.

New measurement indicator of ultrasound assessment of the fetal pancreas based on anatomical landmarks and its application to fetuses with gestational diabetes mellitus.

To assess the best method for measuring the fetal pancreas, provide nomograms and evaluate the effect of GDM on it. A total of 271 singleton fetuses (17-36weeks) were included in this study. Measurements of pancreatic parameters established reference ranges. Repeatability and consistency analyzed. GDM impact on fetal pancreatic growth assessed. Measurements of fetal pancreatic parameters fell within the 95 % confidence interval when performed by the same or different physicians. Pancreatic midline longitudinal axis demonstrated the best intraclass correlation coefficients (ICC) and follow by the pancreatic circumference. The successful display rate and measured parameters of the integral fetal pancreas achieved 90.3 %. Pancreatic midline longitudinal axis and circumference increased with gestational age, with significant differences observed among fetuses at different gestational ages (F=2060 and F=2264, p<0.05). Pancreatic midline longitudinal axis and circumference in normal fetuses from 17 to 36weeks of gestation were positively correlated with gestational age and abdominal circumference. Poorly controlled GDM fetuses exhibited significantly larger pancreatic midline longitudinal axis and circumference compared to the normal group fetuses (Z-values were-3.82 and-3.77, both p<0.01), while no significant differences were found between well-controlled GDM group fetuses and normal group fetuses (Z-values were-0.59 and-0.042, both p>0.05). Ultrasound method using anatomical landmarks to measure the fetal pancreatic midline longitudinal axis and circumference is reliable. Pancreatic measurements increase with gestational age. Poorly controlled gestational diabetes can lead to enlargement of the fetal pancreas.

Effects of abdominal touch, music, and virtual reality video during the non-stress test on maternal anxiety and fetal parameters: A randomized controlled clinical trial

This randomized control trial compared the effects of abdominal touch, music, and virtual reality video on maternal anxiety and fetal parameters. 120 pregnant women were randomly assigned to one of three experimental arms (abdominal touch, music, virtual reality video) or the control group (30 pregnant women in each group). Data were collected through the Participant Information Form, and outcomes were assesssed using the Non-stress test (NST) Findings Registry Form, and the State Anxiety Scale. This trial showed that abdominal touch and virtual reality videos were superior to music in increasing fetal heart rate (p=0.001), and music and virtual reality videos were superior to abdominal touch in decreasing maternal anxiety (p=0.001). Abdominal touch and virtual reality video were effective in increasing fetal heart rate, and music and virtual reality video were effective in decreasing maternal anxiety. It is recommended to provide pregnant women access to abdominal touch, music, and virtual reality videos to reduce maternal stress and anxiety and to increase fetal heart rate.

Trans-Vaginal Cervical Length and Amniotic Fluid Index in Prediction of Delivery Latency Following Preterm Pre-Labor Rupture of Membranes

Abstract Background After premature pre-labor rupture of membranes (PPROM), it is challenging to forecast with precision the time to delivery (latency). Predicting delivery delay may be useful in determining when to recommend hospitalization, close observation, prenatal steroid use, and magnesium sulfate for neuroprotection. In women who report with preterm pre-labor rupture of membranes (PPROM), our goal is to ascertain if transvaginal cervical length (TVCL), amniotic fluid index (AFI), or a combination of both can predict delivery latency. Methods 70 pregnant women presented with PPROM between the gestational age of 28 weeks and 36 weeks +6 days were enrolled. Transvaginal ultrasound measurement of cervical length and amniotic fluid index was performed within 24 hours of admission, to assess number of women reached latency period of 7 days or more and assess other maternal and fetal parameters as number of women reached 36 +6 weeks, mode of delivery, development of chorioamnionitis, gestational age at PPROM and delivery, birthweight at delivery, presence of neonatal sepsis, Apgar score at 1 and 5 minutes and need for NICU admission and indication. Results The best sensitivity of TVCL in prediction of delivery latency was 100 % at TVCL&amp;gt;3 cm in women with AFI &amp;gt;5 cm. On the other hand, the best specificity was 80.5% at TVCL&amp;gt;3 cm in women with AFI ≤5 cm. Conclusion When a woman presents with preterm pre-labor rupture of the membranes, it is recommended to employ either transvaginal cervical length, amniotic fluid index, or both to forecast delivery delay.

Does placental VEGF-A protein expression predict early neurological outcome of neonates from FGR complicated pregnancies?

Fetal hypoxia due to placental dysfunction is thehallmark of fetal growth restriction (FGR). Preferential perfusion of the brain (brain-sparing effect), as a part of physiological placental cardiovascular compensatory mechanisms to hypoxia, in FGR was reported. Therefore, the correlation between vascular endothelial growth factor A (VEGF-A) protein expression in the FGR placentas and newborns' early neurological outcome was examined. This study included 50 women with FGR complicated pregnancies and 30 uneventful pregnancies. Fetal hemodynamic parameters, neonatal acid-base status after delivery, placental pathohistology and VEGF-A expression were followed. Early neonatal morphological brain evaluation by ultrasound and functional evaluation of neurological status by Amiel- Tison Neurological Assessment at Term (ATNAT) were performed. VEGF-A protein expression level was significantly higher in the FGR placentas than normal term placentas (Fisher-Freeman-Halton's test, p≤0.001). No statistically significant correlation between placental VEGF-A expression and different prenatal and postnatal parameters was noticed. Whereas the alteration of an early neurological status assessed by ATNAT was found in 58 % of FGR newborns, morphological brain changes evaluated by UZV was noticed in 48 % of cases. No association between the level of placental VEGF-A expression and the early neurological deficits was found. As far as we know this is the first study of a possible connection between VEGF-A protein expression in the FGR placentas and neonates' early neurological outcomes. The lack of correlation between the FGR placental VEGF-A expression and neonates' neurological outcome could indicate that optimal early neurodevelopment may take place due to compensatory mechanism not related to placental VEGF-A expression.

Using Doppler ultrasound to assess fetal cardiac function and pregnancy outcomes in obstetric antiphospholipid syndrome pregnancies: a case-control study.

This study aimed to evaluate fetal left ventricular function (LVF) in pregnant women with obstetric antiphospholipid syndrome (OAPS) by Doppler ultrasound and developed a clinical nomogram to predict adverse perinatal outcomes. In this prospective observational study, 105 pregnant women were enrolled and divided into the OAPS cohort (n = 60) and the control cohort (n = 45). Fetal cardiac function parameters were collected and compared between two cohorts. Univariate and multivariate analysis was conducted to select the risk factors associated with adverse perinatal outcomes, and a clinical nomogram was developed based on these selected risk factors. The predictive performance of corresponding indicators for adverse perinatal outcomes was evaluated using receiver operating characteristic (ROC) curve analysis. The OAPS cohort revealed an increase in the isovolumic relaxation time (IVRT) and myocardial performance index (MPI), a decrease in the ejection time (ET), middle cerebral artery pulsatility index (MCA-PI) and cerebroplacental ratio (CPR) compared to the control cohort. Through univariate and multivariate analysis, gravidity, CPR, and MPI were the risk factors associated with adverse perinatal outcomes. A model predicting adverse perinatal outcomes in OAPS pregnant women was constructed based on these three factors and visualized as a nomogram. The nomogram could accurately predict adverse perinatal outcomes with an area under the curve of 0.923 (95% CI: 0.858-0.982). This performance was better than evaluating individual factors such as MPI (0.825, 95% CI: 0.739-0.911) and CPR (0.816, 95% CI: 0.705-0.927) for efficacy. MPI can be used to assess fetal LVF and predict adverse perinatal outcomes. We developed a nomogram to predict adverse perinatal outcomes in OAPS women. This imaging-based evidence can provide timely clinical intervention, enabling personalized clinical decision-making.

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

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

Evaluation of Polyphenol Intake in Pregnant Women from South-Eastern Spain and the Effect on Anthropometric Measures at Birth and Gestational Age.

During pregnancy, controlling nutrition is crucial for the health of both mother and foetus. While polyphenols have positive health effects, some studies show harmful outcomes during pregnancy. This study evaluated polyphenol intake in a cohort of mother-child pairs and examined its effects on foetal anthropometric parameters. Polyphenol intake was assessed using food frequency questionnaires (FFQs) and 24-h dietary recalls, and analysed with the Phenol-Explorer database. Gestational age and birth measurements were retrieved from medical records. Statistical analyses validated dietary records and assessed polyphenol impact using multivariate generalised linear models. The study found that mean gestational age was 39.6 weeks, with a mean birth weight of 3.33 kg. Mean total polyphenol intake by FFQ was 2231 mg/day, slightly higher than 24-h recall data. Flavonoids and phenolic acids constituted 52% and 37% of intake, respectively, with fruits and legumes as primary sources. This study highlights the use of FFQs to estimate polyphenol intake. Furthermore, the study found associations between polyphenol consumption and anthropometric parameters at birth, with the effects varying depending on the type of polyphenol. However, a more precise evaluation of individual polyphenol intake is necessary to determine whether the effects they produce during pregnancy may be harmful or beneficial for foetal growth.

Assessing Fetal Circulatory Changes in Gestational Diabetes via Aortic Isthmus Doppler

Background: Gestational diabetes mellitus (GDM) is a common complication during pregnancy that can negatively impact fetal heart function and structure. This study aimed to investigate the hemodynamic characteristics of the fetal aortic isthmus in patients with GDM using Doppler ultrasound parameters. Methods:This was a cross-sectional observational study including 47 pregnant patients with GDM and 47 healthy pregnant patients as controls. Fetal biometric measurements and umbilical artery Doppler values were obtained. Aortic isthmus Doppler was used to measure systolic and diastolic flow velocity time integrals (S and D), peak systolic velocity (PSV), and systolic nadir (Ns) to calculate the isthmus flow index (IFI) = (S + D)/S and isthmus systolic index (ISI) = Ns/PSV. A generalized additive model was used to analyze the relationship between IFI, ISI and gestational age. Results: Compared to controls, the GDM group had significantly lower D (2.39 cm vs. 2.76 cm), Ns (11.48 cm/s vs. 14.06 cm/s), IFI (1.24 vs. 1.27) and ISI (0.14 vs. 0.16). Curve fitting showed IFI was lower in the GDM group for most gestational weeks and decreased with advancing weeks, while ISI remained constantly lower and decreased linearly. Conclusions: Fetal aortic isthmus Doppler parameters IFI and ISI were altered in GDM pregnancies, suggesting earlier changes in aortic arch hemodynamics compared to the umbilical artery. Combining IFI and ISI may provide more comprehensive assessment of fetal circulatory changes in GDM. These findings could enhance our understanding of the pathophysiologic impacts of maternal diabetes.