Fetal Parameters Research Articles

Pravastatin Prevents Increases in Activity of Metalloproteinase-2 and Oxidative Stress, and Enhances Endothelium-Derived Nitric Oxide-Dependent Vasodilation in Gestational Hypertension.

Pre-eclampsia (PE) is a hypertensive disorder of pregnancy and has been associated with placental growth restriction. The pre-eclamptic placenta releases free radicals to maternal circulation, thus increasing oxidative stress. An impaired redox state leads to reduction in circulating nitric oxide (NO) levels and activation of extracellular matrix metalloproteinases (MMPs). However, activation of MMPs induced by oxidative stress is still unclear in PE. Antioxidant effects have been demonstrated with the use of pravastatin. Therefore, we hypothesized that pravastatin protects against oxidative stress-induced activation of MMPs in a rat model of PE. The animals were divided into four groups: normotensive pregnant rats (Norm-Preg); pregnant rats treated with pravastatin (Norm-Preg + Prava); hypertensive pregnant rats (HTN-Preg); and hypertensive pregnant rats treated with pravastatin (HTN-Preg + Prava). The deoxycorticosterone acetate (DOCA) and sodium chloride (DOCA-salt) model was used to induce hypertension in pregnancy. Blood pressure, and fetal and placental parameters were recorded. The gelatinolytic activity of MMPs, NO metabolites and lipid peroxide levels were also determined. Endothelium function was also examined. Pravastatin attenuated maternal hypertension, prevented placental weight loss, increased NO metabolites, inhibited increases in lipid peroxide levels, and reduced the activity of MMP-2, and these effects were observed along with enhanced endothelium-derived NO-dependent vasodilation. The present results provide evidence that pravastatin protects against activation of MMP-2 induced by oxidative stress in pre-eclamptic rats. These findings may also involve improvement in endothelial function related to NO and antihypertensive effects of pravastatin, thus suggesting pravastatin as a therapeutic intervention for PE.

Appropriate Delivery Timing in Fetuses with Fetal Growth Restriction to Reduce Neonatal Complications: A Case-Control Study in Romania.

(1) Background: The main challenge in cases of early onset fetal growth restriction is management (i.e., timing of delivery), trying to determine the optimal balance between the opposing risks of stillbirth and prematurity. The aim of this study is to determine the likelihood of neonatal complications depending on the time of birth based on Doppler parameters in fetuses with early onset fetal growth restriction; (2) Methods: A case-control study of 205 consecutive pregnant women diagnosed with early onset FGR was conducted at the Obstetrics Clinic of the Municipal Emergency Hospital in Timisoara, Romania; The case group included newborns who were delivered at the onset of umbilical arteries absent/reversed end-diastolic flow, and the control included infants delivered at the onset of reversed/absent ductus venosus A-wave. (3) Results: The overall neonatal mortality rate was 2.0%, and there was no significant statistical difference between the two study groups. In infants delivered up to 30 gestational weeks, grades III/IV intraventricular hemorrhage and bronchopulmonary dysplasia were statistically significantly more frequent in the control group. Moreover, univariate binomial logistic regression analysis on fetuses born under 30 gestational weeks shows that those included in the control group are 30 times more likely to develop bronchopulmonary dysplasia and 14 times more likely to develop intraventricular hemorrhage grades III/IV; (4) Conclusions: Infants delivered according to the occurrence of umbilical arteries absent/reversed end-diastolic flow are less likely to develop intraventricular hemorrhage grades III/IV and bronchopulmonary dysplasia.

DOPPLER INDICES OF FETAL MIDDLE-CEREBRAL AND UMBILICAL ARTERIES IN NORMAL 28–40 WEEKS PREGNANCIES

Objectives: The aim of the study was to establish normative data for the pulsatility index (PI), resistive index, and cerebro placental ratio of umbilical artery (UA), and fetal middle cerebral artery (MCA) of Indian pregnant women in the third trimester of pregnancy using multiples of the median and percentile reference range. Methods: It was a cross-sectional study; the study was carried out at the Department of Obstetrics and Gynaecology and Radiology in MGM Medical College and LSK Hospital, the tertiary care and teaching hospital. A total of 200 cases were enrolled for this study. Patients with Singleton low-risk pregnancies with confirmed gestational age, normal anatomy, normal estimated fetal weight, and born at term with birth weight between 10th and 90th percentile and gestational age was based on LMP date, corrected if required by trimester first/second (Before 20 weeks) fetal sonographic parameters were included in the study. Results: We found from 28 weeks to 39 weeks of gestational age, MCA PI showed a significantly positive correlation with the cerebro-placental ratio (CPR) 40th week of gestational age. We found no significant correlation. While from 28 weeks to 40 weeks of gestational age, UA PI showed a significantly negative correlation with the CPR. Conclusion: Doppler ultrasound is used as a part of the clinical protocol in the surveillance of pregnancies. The UA and MCA Doppler indices and CPR are currently used to modify the scheduling of antepartum surveillance and, in some cases, to timely delivery of the compromised fetus. Researchers measured the pulsatility, resistivity, and cardiac indices of the UA and the fetal MCA between 28 and 40 weeks of gestation to establish a normal range.

Changing Some Parameters of The Fetus Head

The characteristic of the growth rates of various indicators at the stages of screening examination allows us to judge the adaptation processes occurring in the process of fetal growth. And in fetuses of pregnant women in a state of hypothyroidism, the intensity of growth of head parameters was less compared with the parameters of fetuses of healthy pregnant women. In fetuses of pregnant women in a state of hypothyroidism, the biparietal head size is significantly smaller at the stage of the second screening examination than in fetuses of healthy pregnant women

Using computer expert system to solve complications primarily due to low and excessive birth weights at delivery: Strategies to reviving the ageing and diminishing population

The world now lives in an ageing society. Significant empirical evidence from the literature revealed that the world’s total fertility rate (TFR) estimate has experienced a declining trend from 5.30 in 1963 to 2.3 in 2020. The TFR for 2023 for the United States was 1.84, Canada 1.57, United Kingdom 1.63, Germany 1.58, Japan 1.39, China 1.45, Nigeria 4.57, India 2.07, Ghana 3.61, with Taiwan 1.09 and Niger 6.73 having the least and highest respectively. Non-adherence to God's childbearing principles, a female's age when she has her first child, educational opportunities, access to family planning, and government acts and policies affecting childbearing are all factors that may influence TFR. Despite the danger posed by the declining TFR trend, childbearing challenges and complications primarily due to low and excessive birth weights at delivery have heightened this danger. This study highlights strategies to leverage the provision of a computerized expert system (ES) solution to the problems of complications primarily due to low and excessive birth weights at delivery. A Knowledge-Based System (KBS) framework to simulate the problem-solving behavior of an expert in a narrow domain or discipline to unite the accumulated expertise of individual disciplines such as gynecology, ultrasonography, computer software design, and engineering was adopted. Fetal weight has been found to be a function of fetal head circumference (HC), femur length (FL), abdominal circumference (AC), and biparietal diameter (BPD) and predictable with a polynomial equation. Also, fetal age has been found to be a function of fetal weight and predictable by an equation. The equations for the determination of conception date and delivery dates were derived. The Expert System (ES) primarily estimates fetal parameters (fetal weight, fetal age or gestational age, conception date, and delivery date) in the first trimester using ultrasonographic fetal biometric data. The result of this study may eliminate or reduce the occurrence of potential complications associated with the birth of both small and excessively large fetuses, thereby contributing to reviving the world declining population.

Maternal and fetal predictors of anthropometry in the first year of life in offspring of women with GDM.

Gestational Diabetes Mellitus (GDM) carries an increased risk for adverse perinatal and longer-term cardiometabolic consequences in offspring. This study evaluated the utility of maternal anthropometric, metabolic and fetal (cord blood) parameters to predict offspring anthropometry up to 1 year in pregnancies with GDM. In this prospective analysis of the MySweetheart study, we included 193/211 women with GDM that were followed up to 1 year postpartum. Maternal predictors included anthropometric (pre-pregnancy BMI, gestational weight gain (GWG), weight and fat mass at the 1st GDM visit), and metabolic parameters (fasting insulin and glucose, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), Quantitative insulin-sensitivity check index (QUICKI), HbA1c, triglycerides, and high-density lipoprotein (HDL) at the 1st visit and HbA1c at the end of pregnancy). Fetal predictors (N=46) comprised cord blood glucose and insulin, C-Peptide, HOMA-IR, triglycerides and HDL. Offspring outcomes were anthropometry at birth (weight/weight z-score, BMI, small and large for gestational age (SGA,LGA)), 6-8 weeks and 1 year (weight z-score, BMI/BMI z-score, and the sum of 4 skinfolds). In multivariate analyses, birth anthropometry (weight, weight z-score, BMI and/or LGA), was positively associated with cord blood HDL and HbA1c at the 1st GDM visit, and negatively with maternal QUICKI and HDL at the 1st GDM visit (all p ≤ 0.045). At 6-8 weeks, offspring BMI was positively associated with GWG and cord blood insulin, whereas the sum of skinfolds was negatively associated with HDL at the 1st GDM visit (all p ≤0.023). At 1 year, weight z-score, BMI, BMI z-score, and/or the sum of skinfolds were positively associated with pre-pregnancy BMI, maternal weight, and fat mass at the 1st GDM visit and 3rd trimester HbA1c (all p ≤ 0.043). BMI z-score and/or the sum of skinfolds were negatively associated with cord blood C-peptide, insulin and HOMA-IR (all p ≤0.041). Maternal anthropometric, metabolic, and fetal metabolic parameters independently affected offspring anthropometry during the 1st year of life in an age-dependent manner. These results show the complexity of pathophysiological mechanism for the developing offspring and could represent a base for future personalized follow-up of women with GDM and their offspring.

The role of the PLGF in the management of pregnancies complicated with fetal microsomia.

To explore the contribution of maternal and fetal parameters in predicting the time interval between diagnosis and development of adverse events leading to delivery in singleton pregnancies complicated with fetal microsomia. Prospective study on singleton pregnancies referred to a tertiary center because of suspicion of fetal smallness in the third trimester. The study cohort included cases with fetal abdominal circumference (AC) ≤ 10th centile or estimated fetal weight ≤ 10th centile or umbilical artery pulsatitlity index ≥ 90th centile. Development of pre-eclampsia, fetal demise, and fetal deterioration diagnosed by fetal Doppler studies or fetal heart rate monitoring and leading to delivery were considered as adverse events. Maternal demographics, obstetric history, blood pressure, serum PLGF, and fetal Doppler studies were explored as predictors of the time interval between the first visit to the clinic and the diagnosis of complications. In 59 women, the median incubation period from presentation to the clinic to an adverse event was 6, 2weeks, whereas half of the pregnancies (52.5%) did not develop any adverse event. PLGF was the strongest predictor of adverse events. Both PLGF in raw values and PLGF MOM had equally good predictive ability (AUC 0.82 and 0.78 respectively). Optimal cut-off points were 177.7pg/ml for PLGF raw values (sensitivity 83% and specificity 66.7%) and 0.277 MoM (sensitivity 76% and specificity 86.7%). On multiple Cox regression analysis, maternal systolic blood pressure, PLGF, fetal increased umbilical artery PI, and reduced CP ratio were independently associated with adverse events. Half of the pregnancies with low PLGF and only one in ten with high PLGF were delivered within two weeks after the initial visit. Half of the pregnancies carrying a small fetus in the third trimester will not develop maternal or fetal complications. PLGF is a strong predictor of adverse events that can be used to customize antenatal care.

Sonographic examination at the beginning of the second stage of labor predicts birth outcome in vaginally intended breech deliveries: a blinded prospective study

PurposeIn order to spread competence in vaginal breech deliveries, it is necessary to develop new and easily applicable tools for birth progression and safety evaluation. Ultrasound is a useful and ubiquitously available tool with already documented value for birth progression observation. In deliveries out of breech presentation, an established ultrasound examination is missing. We determined the descent of the fetal buttocks in relation to the maternal pelvic inlet using intrapartum ultrasound. We evaluated these results in comparison to the clinical vaginal examination with the aim to establish an easily applicable method for birth outcome prediction. Therefore, we analyzed the predictive value of our examinations on birth outcome parameters, such as cesarean section rate, as well as fetal and maternal outcome parameters.MethodsWe performed a prospective blinded study on 106 mothers with vaginally intended breech delivery. At beginning of stage two in labor, the descent of the fetal buttocks into the mother’s pelvic inlet was detected with transabdominal ultrasound and vaginal examination by different observers. Primary outcome variable: Cesarean section rate. Secondary outcome variables: rate of manual assistance in vaginal deliveries, birth duration, 5′ APGAR score, umbilical arterial pH, maternal blood loss, and perineal injury. For non-parametric values, Wilcoxon’s χ2 test was performed. In order to analyze the predictive value of our examination, lack-of-fit analysis was conducted. Reliability evaluation of the sonographic examination was done with a matched-pair analysis.ResultsWomen with positive intrapartum ultrasound breech engagement sign (+ IPUBES) had a significantly lower rate of cesarean section in comparison with those with negative IPUBES (5/67; 7.5% vs. 18/39; 46.2%; p < 0.0001). The area under the ROC curve for the prediction of CS for negative IPUBES was 0.765 with a sensitivity of 78.3% and a specificity of 74.7%. Sonographic examination showed an excellent reliability in a matched-pair analysis comparing vaginal and sonographic examinations with a mean difference of 0.012 (SD ± 0.027, 95% CI − 0.014 to 0.065). Mean birth duration was significantly longer in deliveries with negative IPUBES (533 min vs. 440 min; p = 0.0011). Fetal and maternal outcome parameters were not significantly different between deliveries with positive and negative IPUBES.ConclusionsSonographic evaluation of the fetal descent in relation to the mother’s pelvic inlet screens reliably for emergency cesarean section. This newly presented method for birth progression observation might be a powerful tool for distribution of expertise in vaginal breech delivery and is able to give reference for clinical vaginal examination by obstetricians in training.Trail registryClinical trial. Date of registration: 13.03.2019; Date of initial participant enrollment: 20.03.2019; DRKS00016885; https://www.drks.de; German clinical trials register.

Placental and Doppler ultrasound findings in pregnant women with SARS-CoV-2 infection

Several viral infections cause changes in the placenta. Cytomegalovirus, herpes viruses, and HIV cause increased placental thickness; Zika virus induces focal regions of necrosis; parvovirus B19 causes a structural injury. Umbilical flow can be considered a direct measurement of vascular placental function. This study aimed to compare placental ultrasound and umbilical Doppler findings in pregnant women who tested positive or negative for SARS-CoV-2. Our work aimed to confirm the suspicion of placental infection and the consequence in fetal physiopathology. Fifty-seven pregnant women who tested positive for SARS-CoV-2 at the time of or 1 month before the ultrasound scan were evaluated. Cases included 9 first trimester, 16 second trimester, and 32 third trimester ultrasound scans. For comparison, 110 pregnant women (controls) were evaluated. They included 19 women in their first trimester, 43 in their second trimester, and 48 in the third trimester. Controls were asymptomatic and tested negative for SARS-CoV-2 infection in the last 72 hours before the ultrasound scan. Fetal biometry, placental thickness, placental lakes and Doppler umbilical vein parameters, including venous cross-sectional area (mean transverse diameter and radius of umbilical vein, mean velocity of umbilical vein), and umbilical vein blood flow were evaluated. Placental thickness (in millimeter) was significantly higher in the group of pregnant women with SARS-CoV-2 infection (53.82 [10-115]) than in the control group (33.82 [12-66]; P<.001) in their second and third trimesters. The frequency of >4 placental lakes was significantly higher in the group of pregnant women with SARS-CoV-2 infection (28/57 [50.91%]) than in the control (7/110 [6.36]; P<.001) in all 3 trimesters. The mean velocity of umbilical vein was significantly higher in the group of pregnant women with SARS-CoV-2 infection (12.45 [5.73-21]) than in the control group (10.81 [6.31-18.80]; P=.001) in all 3 trimesters. Umbilical vein blood flow (in milliliter per minute) was significantly higher in the group of pregnant women with SARS-CoV-2 infection (389.9 [6.52-1496.1]) than in the control group (305.05 [3.11-1441]; P=.05) in all 3 trimesters. Significant differences in placental and venous Doppler ultrasound were documented. Placental thickness, placental venous lakes, mean velocity of umbilical vein, and umbilical vein flow were significantly higher in the group of pregnant women with SARS-CoV-2 infection in all 3 trimesters.

Continuous monitoring of fetal gross movement and maternal glucose level using newly developed methods

There is no consensus on the relationship between maternal glucose levels and fetal movements. This study aimed to investigate the correlation between gross fetal movements and maternal glucose levels in the hours around food intake. This was an observational study with 2 newly developed technologies, which were a glucose monitoring system and a fetal movement acceleration measurement recorder. A total of 15 women with singleton pregnancies were provided with the glucose monitoring system that automatically recorded their glucose levels every 15 minutes. In addition, fetal movements were recorded using the fetal movement acceleration measurement recorder, for 4 hours starting from 1 hour before lunch, once a week beginning at 28 weeks of gestation. For the four 1-hour periods, the ratios of the number of 10-second epochs with fetal movement divided by the total number of epochs (defined as the fetal movement parameter) were compared at the earlier (28-33 weeks of gestation), later (34-39 weeks of gestation), and overall (28-39 weeks of gestation) gestational weeks using analysis of variance analyses. A linear regression analysis was developed between the glucose level and the movement parameter for the earlier, later, and overall gestational weeks. All data were divided into 4 categories: (1) both the glucose level and the fetal movement parameter increased from the previous 15 minutes; (2) the glucose level increased, but the fetal movement parameter did not increase; (3) the glucose level did not increase, but the fetal movement parameter increased; and (4) both glucose level and fetal movement parameter did not increase. The numbers for each category were compared for the earlier, later, and overall gestational weeks using χ2 analyses. There was no significant change in the fetal movement parameter among the four 1-hour periods at the earlier (P=.509), later (P=.884), and overall (P=.816) gestational weeks. There was a positive correlation between the glucose level and the movement parameter at 28 to 33 weeks of gestation (P=.001), but not at 33 to 39 (P=.129) and 28 to 39 (P=.115) weeks of gestation. Compared with fetuses whose mothers did not have increased glucose levels, fetuses whose mothers had increased glucose levels moved more at 28 to 33 weeks of gestation (P=.031), but not at 34 to 39 (P=.398) and 28 to 39 (P=.238) weeks of gestation. Having a meal did not change gross fetal movement counting; however, there are positive correlations between maternal glucose level and gross fetal movement at 28 to 33 weeks of gestation, but not at 34 to 39 weeks of gestation, for both glucose values and value changes under natural conditions of the mother and fetus.

Fetal Diaphragmatic Excursion Is Decreased in Hospitalized Pregnant Women Infected with COVID-19 during the Second and Third Trimesters.

In the present study, we aimed to evaluate coronavirus disease 2019 (COVID-19) infection effects on fetal diaphragm thickness and diaphragmatic excursion, which together show the quality of diaphragmatic contractions. One hundred and ninety-two pregnant women were included in this prospective case-control study. Patients were divided into four groups according to their COVID-19 infection history in their second or third trimester: hospitalized COVID-19-infected pregnant women group (n = 48), outpatient COVID-19-infected pregnant women group (n = 48), common cold (COVID-19 polymerase chain reaction negative) pregnant women group (n = 48), and noninfected healthy controls (n = 48). The number of patients was determined by power analysis following the pilot study. All participants underwent an ultrasound examination to determine fetal diaphragm parameters at 32 to 37 weeks of gestation. Demographic characteristics were similar among the four groups. The gestational age at ultrasound examination and gestational age at delivery were similar among the groups. Neonatal intensive care unit (NICU) admission rate was significantly higher in the hospitalized COVID-19-infected pregnant women group than the other groups. The fetal diaphragm thickness during inspiration and expiration, and fetal costophrenic angles at inspiration and expiration were similar among the groups. Fetal diaphragmatic excursion was significantly decreased in the hospitalized COVID-19-infected pregnant women group compared with the other groups. Our results indicated that moderate maternal COVID-19 infection decreased fetal diaphragmatic excursion, and ultrasonographic evaluation of fetal diaphragmatic excursion before delivery can provide critical information to predict whether infants will require NICU admission. · Diaphragm ultrasound as a new technique for characterizing the diaphragm's structure and function.. · Fetal diaphragmatic excursion is decreased in the presence of moderate COVID-19 infection.. · Ultrasonographic evaluation of fetal diaphragmatic excursion provides critical information to predict NICU admission..

Evaluation of fetal cardiac function in fetal growth restriction via fetal HQ analysis based on two-dimensional STI.

Abnormalities of the fetal cardiovascular system caused by fetal growth restriction (FGR) may lead to adverse outcomes. The fetal cardiac function assessment is of great significance for treatment selection and prognostic evaluation of fetuses with FGR. This study aimed to explore the value of fetal HQ analysis based on speckle tracking imaging (STI) to evaluate the global and regional cardiac function of fetuses with early-onset or late-onset FGR. From June 2020 to November 2022, 30 pregnant women with early-onset FGR (21-38 gestational weeks) and 30 pregnant women with late-onset FGR (21-38 gestational weeks) in the Department of Ultrasound, Shandong Maternal and Child Health Hospital were enrolled. Also, 60 healthy volunteer pregnant women were enrolled as two control groups according to the principle of matching gestational weeks (21-38 gestational weeks). The fetal cardiac functions, including fetal cardiac global spherical index (GSI), left ventricular ejection fraction (LVEF), fractional area change (FAC) of both ventricles, global longitudinal strain (GLS) of both ventricles, 24-segmental fractional shortening (FS), 24-segmental end-diastolic ventricular diameter (EDD), and 24-segmental spherical index (SI), were assessed using fetal HQ. The standard biological values of fetuses and Doppler blood flow parameters of fetuses and mothers were measured. The estimated fetal weight (EFW) measured by the last prenatal ultrasound was calculated, and the weights of newborns were followed up. Among early FGR, late FGR and total control group, significant differences were found in global cardiac indexes of right ventricle (RV), left ventricle (LV) and GSI. For the segmental cardiac indexes, there are significant differences in three groups except parameter of LVSI. Compared with the control group at the same gestational week, the Doppler indexes including MCAPI and CPR in both the early-onset FGR group and the late-onset FGR group were significantly different. The intra- and inter-observer correlation coefficients of RV FAC, LV FAC, RV GLS, and LV GLS were good. Further, the intra- and inter-observer variability in FAC and GLS was small, as analyzed using the Bland-Altman scatter plot. Fetal HQ software based on STI showed that FGR affected the global and segmental cardiac function of both ventricles. FGR no matter early-onset or late-onset altered Doppler indexes significantly. The FAC and the GLS had satisfactory repeatability in evaluating fetal cardiac function.

Fetal and maternal Doppler adaptation to maternal exercise during pregnancy: a randomized controlled trial

Background Regular and supervised exercise during pregnancy is worldwide recommended due to its proven benefits, but, during exercise, maternal blood flow is redirected from the viscera to the muscles and how fetal wellbeing may be affected by this redistribution is still not well known. Objective To analyze the longitudinal effect of a supervised moderate physical exercise program during pregnancy on uteroplacental and fetal Doppler parameters. Methods This is a planned secondary analysis of an randomized controlled trial (RCT), performed at Hospital Universitario de Torrejón, Madrid, Spain, including 124 women randomized from 12+0 to 15+6 weeks of gestation to exercise vs. control group. Fetal umbilical artery (UA), middle cerebral artery, and uterine artery pulsatility index (PI), were longitudinally collected by Doppler ultrasound assessment throughout gestation, and derived cerebroplacental ratio (normalized by z-score), and maternal mean PI in the uterine arteries (normalized by multiplies of the median). Obstetric appointments were scheduled at 12 (baseline, 12+0 to 13+5), 20 (19+0 to 24+2), 28 (26+3 to 31+3) and 35 weeks (32+6 to 38+6) of gestation. Generalized estimating equations were adjusted to assess longitudinal changes in the Doppler measurements according to the randomization group. Results No significant differences in the fetal or maternal Doppler measurements were found at any of the different checkup time points studied. The only variable that consistently affected the Doppler standardized values was gestational age at the time of assessment. The evolution of the UA PI z-score during the pregnancy was different in the two study groups, with a higher z-score in the exercise group at 20 weeks and a subsequent decrease until delivery while in the control group it remained stable at around zero. Conclusions A regular supervised moderate exercise program during pregnancy does not deteriorate fetal or maternal ultrasound Doppler parameters along the pregnancy, suggesting that the fetal well-being is not compromised by the exercise intervention. Fetal UA PI z-score decreases during pregnancy to lower levels in the exercise group compared with the control group.

Comparative Study of Gestational Age Using Mean Fetal Kidney Length and Other Sonographic Fetal Parameters in Singleton Pregnancy After 24 Weeks

Introduction: To accurately estimate the fetus age and follow up on the growth of different fetal organs, it is vital to know the accurate date of birth. It also helps to prevent prenatal and postnatal complications for the newborn. It is common for antenatal mothers to be unaware of last menstrual period (LMP). In such situations, it would be difficult to calculate the delivery date. According to various studies, up to 30% of women were not sure of their LMP. The treating obstetricians would have to be very careful when the exact LMP is unknown in order to prevent post maturity and prematurity deliveries. Material And Methods: The present study is prospective comparative study of Department of Obstetrics and Gynaecology in Guntur Medical College and Hospital, Andhra Pradesh, India. After 24 weeks of gestational age are included who are at age between 20-35 yrs which is of 200 sample size in the year 2020-21. Clinical assessment of gestational age was done by palpating the fundal height of the patient. Following this using ultrasound, meam fetal kidney length (FKL) along with other fetal parameters were calculated. Result: In the present study, BPD ranged from 28-40 wks, whereas the mean BPD was 35.25+2.67 HC ranged between 27-40 and the mean BPD was 35.35+2.88 MKL ranged between 27-41 and the mean MKL was 35.93+3.49. Upon the composite of multiple parameters GA ranged between 27.8-39.6 and the mean was 3.5.36+2.7. Conclusion: The FKL is very much useful in assessing the gestational age. From our study we state that there is a significant correlation between fatal kidney length and the gestational age. Hence fetal kidney is appropriate in estimation of gestational age.

Predictive value of fetal echocardiographic parameters in surgical strategy for Tetralogy of Fallot.

This study aimed to evaluate whether fetal echocardiographic parameters were predictive of the postnatal surgical treatment required for fetuses with Tetralogy of Fallot (TOF). The fetal echocardiographic and postnatal clinical data of all cases of prenatal TOF at Xinhua Hospital from 2016 to 2020 were reviewed. Patients were categorized based on the operation type, and cardiac parameters were compared between groups. Of the 37 fetuses assessed, the development of the pulmonary valve annulus (PVA) was significantly poorer in the transannular patch group. Patients with a prenatal PVA z-score (Schneider's method) ≥ -2.645, a PVA z-score (Lee's method) ≥ -2.805, a PVA/aortic valve annulus diameter ratio ≥.697, and a pulmonary annulus index ≥ .823 were more likely to undergo pulmonary valve-sparing surgery. There was a strong correlation between prenatal and postnatal PVA z-scores. The PVA growth potential was greater in the pulmonary valve-sparing surgery group. PVA-related parameters evaluated by fetal echocardiography can predict the type of surgical intervention required and are valuable in improving prenatal counseling in fetal cases of TOF.

Ultrasonography of Pregnancy in Murciano-Granadina Goat Breed: Fetal Growth Indices and Umbilical Artery Doppler Parameters

The evolution of some fetal growth indices and arterial blood flow parameters in the umbilical cord of the embryos and fetuses of primiparous pregnant goats of Murciano-Granadina breed were analyzed by ultrasonography. Weekly ultrasonographic sessions took place from 18- to 125-days post-breeding. Fetal measures were carried out by ultrasound B-mode. This mode was used to take a series of measurements in the embryo/fetus throughout pregnancy: crown-rump length (CRL, from 24-days post-mating -dpm- to 61 dpm), trunk diameter (TD, 24-34 dpm), biparietal diameter (BPD, 28-125 dpm) and eye orbit diameter (EOD, 75-125 dpm). Spectral Doppler was used to study blood flow from umbilical artery. Different blood flow parameters were obtained as follows: Arterial Pulse, Peak Systolic Velocity (PSV), End Diastolic Velocity (EDV), Mean Velocity (MV), Systolic velocity/Diastolic velocity Ratio (S/D), Pulsatility Index (PI) and Resistance Index (RI). In this study, the umbilical cord was first noticed between 32- and 35-days post-breeding. However, these umbilical arterial blood flow parameters were not conclusive (positive S/D ratios and RI < 1) until 65-80 days of pregnancy. The explanation to these results could be that vascular development related to umbilical arteries elasticity and diameter is not good enough in early pregnancy. Therefore, these vessels have already acquired their appropriate characteristics in order to allow blood flow parameters and Doppler index measures from only 2.5 months of pregnancy. This is the first time that a detailed study of fetal growth indices and umbilical artery flow rates in fetuses from Murciano-Granadina goats has been performed throughout virtually the entire duration of gestation. In conclusion, the evolution of the fetal growth indices in this breed has determined that the umbilical artery velocimetric parameters (PSV, EDV, MV) increase significantly and the AP, S/D, PI and RI indices decrease significantly throughout the analyzed pregnancy period.

FETOMETRY OF THE FETUS

The characteristic of the growth rates of various indicators at the stages of screening examination allows us to judge the adaptation processes occurring in the process of fetal growth. And in fetuses of pregnant women in a state of hypothyroidism, the intensity of growth of head parameters was less compared with the parameters of fetuses of healthy pregnant women. In fetuses of pregnant women in a state of hypothyroidism, the biparietal head size is significantly smaller at the stage of the second screening examination than in fetuses of healthy pregnant women.

Indicators of Fetometry of the Fetus in Pregnant Women in a State of Hypothyroidism

The characteristic of the growth rates of various indicators at the stages of screening examination allows us to judge the adaptation processes occurring in the process of fetal growth. And in fetuses of pregnant women in a state of hypothyroidism, the intensity of growth of head parameters was less compared with the parameters of fetuses of healthy pregnant women. In fetuses of pregnant women in a state of hypothyroidism, the biparietal head size is significantly smaller at the stage of the second screening examination than in fetuses of healthy pregnant women.

Transfer of bovine embryos into a uterus primed with high progesterone concentrations positively impacts fetal development at 42 days of gestation

Elevated circulating progesterone (P4) concentrations in the first week after conception have been associated with accelerated post-hatching conceptus elongation. However, the consequences, if any, on the development of the fetus are unknown. The objective of this study was to determine the relationship between early circulating P4 and fetal and placental morphometric characteristics at 42 days of gestation. A previously validated model of asynchronous embryo transfer (ET), known to alter uterine exposure to P4, was used in 107 heifers divided in two replicates (replicate 1: n = 51, replicate 2: n = 56). Heifers were randomly assigned to one of the two following groups: those receiving a Day 7 embryo on Day 7 of the cycle (synchronous; ET_D7, n = 49) and those transferred a Day 7 embryo on Day 9 of the cycle (asynchronous; ET_D9, n = 58). The synchronization protocol was started two days earlier for heifers in the ET_D9 group such that ET was done on the same day for both groups. P4 concentrations were determined from Day 3 after estrus to the day of ET. Pregnant heifers were slaughtered at Day 42 of gestation for fetal and placental morphometric measurements. The effects of the group, replicate, fetal sex, and interactions between these variables on fetal and placental characteristics were determined by ANOVA, while Pearson correlation was employed to assess the linear relationship between P4 concentrations two days before and on the day of ET on the fetal parameters. The uteri of heifers in the ET_D9 group were exposed to higher concentrations (P < 0.0001) of P4 from four days before ET, than heifers in the ET_D7 group. Both group and fetal sex variables impacted on fetal crown-rump length (CRL) (group: P < 0.0001, sex: P = 0.001) and fetal weight (group: P = 0.006, sex: P = 0.003). Fetal sex influenced the amniotic sac area (P = 0.003) and amniotic sac weight (P = 0.004); while the group affected the number of cotyledons (P = 0.0009), and the fetal heart weight (P = 0.018). All these parameters were larger in the ET_D9 group compared with ET_D7, and in males compared with females. There was a positive correlation between P4 concentrations two days before ET and fetal weight and CRL, for each sex or considering all fetuses (R2 ∼0.4, p < 0.05). In conclusion, bovine embryos transferred into a uterus primed with higher P4 concentrations underwent enhanced development reflected in higher weight and size at the beginning of the fetal period.

A comparative study on third trimester fetal biometric parameters with maternal age.

Advanced maternal age is an important parameter associated with increased risk of feto-maternal complications and it is an evolving trend in society for women planning for pregnancy in late ages. However there are no studies done whether advanced maternal age has its effects on expression of growth pattern in the fetus. So this study was done to compare the maternal age with the third trimester fetal biometric parameters. This study was done in 100 antenatal women and divided into two groups: Group 1: optimal maternal age group between 21-29 years of age and Group 2: advanced maternal age 30 and above. The pre-pregnant maternal weight, gestational age and third trimester fetal biometrics using ultrasound are noted and compared between the groups. The maternal weight gain between the groups was optimal but the third trimester fetal parameters were significantly less in advanced maternal age. The abdominal circumference in optimal age group and head circumference in advanced maternal age group was closer to calculated estimated date of delivery (EDD) and would be specific in calculating the gestational age. Though there is no significant difference in maternal weight gain, there are fetal growth restrictions in advanced maternal age group due to which the third trimester fetal parameters are lesser than the optimal age group. Head circumference would be specific in calculating the estimated date of delivery in advanced maternal age group.