Prediction Of Intrauterine Growth Retardation Research Articles

HC/AC Ratio as a Predictor of Intrauterine Growth Retardation during Pregnancy: Diagnostic Tool

Fetal wellbeing is predicted by his growth assessment during pregnancy. Aim: To evaluate HC/AC ratio as a predictor of intrauterine growth retardation during pregnancy. Study design: Cross sectional study. Methodology: Total of 80 singleton pregnant females with an age ranging from 18-40 years having 20 weeks gestation were enrolled at Combined Military Hospital Kharian. Ultrasound abdomen was done for all enrolled subjects while HC/AC ratio was calculated. All data was noted on Performa. Consent was taken before enrollment. SPSS v.26 analyzed the data. Frequency and percentages were used for quantitative parameters. Results: The mean HC/AC on ultrasound was 1.46±0.14. There were 35 (43.75%) positive for IUGR while 45 (56.25%) were negative for IUGR. Conclusion: It was concluded that HC/AC ratio can serve as a predictor of IUGR during pregnancy with high diagnostic accuracy. Keywords: Abdominal Circumference, Head Circumference and Birth Weight.

Role of Color Doppler Flowmetry in Prediction of Intrauterine Growth Retardation in High-Risk Pregnancy

Objective: To evaluate the usefulness of Color Doppler flowmetry in the prediction of intrauterine growth restriction (IUGR) in high-risk pregnancies.Materials and method: A total of 62 high-risk pregnant women underwent Color Doppler flowmetric umbilical artery pulsatility index (PI), resistive index (RI) and systolic/diastolic (S/D) ratio, middle cerebral artery PI, RI and S/D ratio, Ductus venosus S-wave/isovolumetric A-wave index (SIA) and vertebral artery RI at 23-27 weeks, 28-32 weeks and 32-36 weeks of their pregnancy. Cerebral-umbilical C/U PI, RI and S/D were evaluated at the third visit. All the pregnancies were followed up till delivery. Ponderal index <10 was considered to be indicative of IUGR. Data were analyzed using IBM Statistical Package for Social Sciences (SPSS) 21.0.Results: Thirty-nine (62.9%) deliveries were IUGR. On all the three visits, umbilical artery, mean PI, RI and SD values were significantly higher while MCA PI, RI and SD values were significantly lower in IUGR as compared to non-IUGR cases. Third visit C/U PI, RI and SD ratio values were also significantly lower in IUGR as compared to non-IUGR cases. Ductus venosus SIA values did not show a significant difference between IUGR and non-IUGR groups. The vertebral artery resistive index was significantly higher in non-IUGR as compared to IUGR on all the visits. Umbilical artery PI was the most sensitive and specific for the prediction of IUGR at all the three visits, with the maximum sensitivity and specificity at the third visit (82.1% and 87%). Third visit C/U PI was most sensitive (82.1%) and specific (96.7%) for the prediction of IUGR.Conclusion: This showed that Doppler flowmetry is a useful method for the prediction of IUGR in high-risk pregnancies.

Value of placental volume and vascular flow indices as predictors of intrauterine growth retardation

ObjectiveTo evaluate the utility of first-trimester placental volume and vascular flow indices to predict intrauterine growth retardation (IUGR). Study designIn 1004 singleton pregnancies attending routine care we recorded maternal characteristics, biophysical and biochemical factors included in the first trimester screening for aneuploidy (FTSA) and uterine artery pulsatility index (PI). Placental volume, Vascularization Index, Flow Index and Vascularization Flow Index were obtained. Customized curves were used to define IUGR. We compared pregnancies with and without IUGR. The performance of different predictive models was described by the areas under the receiver operator characteristic (AUROC) curve. Predictive models of IUGR were compared using a two by two approach and subset analysis was performed. ResultsPlacental volume and all vascular indices were significantly lower (p<0.001, p≤0.01), and uterine artery PI higher (p<0.001), in pregnancies with IUGR, with and without associated pre-eclampsia. Resultsobtained in the analysis of homogeneous subsets showed that the effectiveness of combined predictive models for IUGR improved significantly after adding vascular indices or placental volume to maternal characteristics, FTSA variables and uterine artery PI (AUROC curve value 0.703 (95% CI 0.663–0.744) versus 0.720 (95% CI 0.681–0.759) and 0.735 (95% CI 0.696–0.733), respectively). The most effective model at first trimester was that which included only maternal characteristics, uterine a-PI and placental volume, similar to that of the most complex model built with all the factors analyzed in this study AUROC curve value 0.735 (95% CI 0.696–0.773). ConclusionsPlacental volume and vascular indices were predictors factors of IUGR at first trimester. The effectiveness of combined predictive models for IUGR increased significantly after adding these factors, but the sensitivity of these models was too low for them to be considered useful in clinical practice.

Параметры центрального артериального давления и сосудистой ригидности у беременных c синдромом обструктивного апноэ-гипопноэ сна

The objective of this research is to study the characteristics of parameters of central arterial pressure and indices of blood vessels rigidity in pregnant women with obstructive sleep apnоa-hypopnea. 24-hours monitoring of blood pressure and somnography tests were conducted on 43 pregnant, the average age was 28,87±5,72 years, the pregnancy – 32,43±4.25 weeks. ABPM was performed using BPLabVasotens system («PetrTelegin», Russia). The device allows to determine the propagation time of the reflected wave, augmentation index in the brachial artery (AIx) and aortic (AIxao), the parameters of the central blood pressure. Somnography was performed using portable unit Sleeptrek3 (USA). Sonographic studies of obstructive sleep apnea-hypopnoe were determined arterial hypertension in 55.8% of pregnant women, of whom 66.7% In women with obstructive sleep apnea-hypopnoe more frequent profile type &amp;#34;non-dipper&amp;#34;, &amp;#34;night-piker&amp;#34;, the indices of central BP and vascular stiffness were significantly higher than in pregnant women without obstructive sleep apnea-hypopnoe. The correlation between peripheral augmentation index (Alx) and indicators SBPao and DBPao was found. Pregnant women with obstructive sleep apnea-hypopnoe had the syndrome of intrauterine growth retardation in 33.3% in the comparison group at 15.8%.Conclusions. 24-hour monitoring of сentral blood pressure and indicators of blood vessels rigidity allows to detect differences of parameters in pregnant women with and without obstructive sleep apnea-hypopnoe. Pregnant with obstructive sleep apnea-hypopnoe have more risk factors for adverse pregnancy outcomes. obstructive sleep apnea-hypopnoe remains a significant predictor of intrauterine growth retardation.

Метод прогнозирования задержки роста плода в сроки недоношенной беременности

Метод прогнозирования задержки роста плода в сроки недоношенной беременности

Early pregnancy B vitamin status, one carbon metabolism, pregnancy outcome and child development.

Periconception supplementation with folic acid is recommended until 12 gestational weeks to prevent neural tube defects. Doses of folic acid contained in supplements and timing and length of use during pregnancy vary. The effects of status in periconception and pregnancy folate, cobalamin, betaine and their interactions on one carbon metabolism (1C), as well as the global effect of 1C on foetal growth and pregnancy outcome, are reviewed. Results from prospective studies are reviewed. Cessation of folic acid supplement use after the first trimester is associated with a sharp drop in plasma folate status and enhanced conversion of betaine to dimethylglycine. Dimethylglycine production is also higher in mothers with low folate status than in those with normal-high folate status. The effects of high doses of folic acid on one carbon metabolism in mothers with low early pregnancy cobalamin status and on foetal growth are also reviewed. Several studies report that moderately elevated early pregnancy fasting plasma total homocysteine (tHcy) is inversely associated with birth weight and a predictor of intrauterine growth retardation. There is also evidence for increased risk of preterm birth when maternal folate status is low.

Histomorphometry of Umbilical Cord and its Vessels in Pre- Eclampsia as Compared to Normal Pregnancies

Aims: To study and compare the morphometric alteration in the umbilical cord obtained from thirty normal pregnancies (Group-I) and thirty pre-eclamptic pregnancies (Group-II). Methods: Morphological changes in umbilical cords were examined on formalin fixed paraffin embedded section. Various parameters were measured by planimeter. Results: In pre-eclamptic group total vessel area, total vein area, total luminal area of vein, and wall thickness of arteries were increased, whereas jelly area and wall thickness of vein were decreased as compared to normal group. Conclusion: Increased umbilical arterial thickness, decreased umbilical vein wall thickness and increased luminal area of vein which could be a predictor of intrauterine growth retardation in term pre-eclamptic patients. Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 1 / Issue 13 / Jan- June, 2012 / 28-32 DOI: http://dx.doi.org/10.3126/njog.v7i1.8832

Significance of serum ferritin level in the prediction of delivery of low birth weight newborns for gestational age

Intrauterine growth restriction is one of the leading causes of prenatal morbidity and mortality. As there is no causal therapy, prediction of intrauterine growth retardation is one of the priorities of prenatal healthcare. The purpose of this study was to analyze blood ferritin level, and erythrocyte, hemoglobin and hematocrit count in pregnant women between 30-32 weeks of gestation and to set apart those with a possible development of intrauterine growth restriction. A prospective study was conducted that included 220 healthy pregnant women between 30-32 gestational weeks. The study was done at the Clinical Center of Vojvodina, Department of Obstetrics and Gynecology Novi Sad and Clinical laboratory from March 1, 2008 to November 30, 2009. Serum ferritin level, hemoglobin, hematocrit and erythrocyte count were determined from blood samples of all pregnant women. After term delivery, 8.1% of pregnant women gave birth to low birth weight babies for gestational age but without anemia.The value of ferritin, hemoglobin, hematocritanderythrocyte was significantly higher in women with low birth weight babies. In mothers with low birth weight newborns serum ferritin level was on the average for 6.4 g/l higher than in mothers with normal weight newborns (p<0.005). Statistically, ROC curve analysis showed that the pregnant women with the ferritin level above 13.6 microg/L, and with erythrocyte count >3.76x10(12)/L, hemoglobin >117 g/L and hematocrit >32.9%, in the period of 30-32 weeks of gestation, also had a significantly higher probability of having a low birth weight newborn for gestational age (p<0.05). Based on the level of ferritin and other parameters in the period of 30-32 weeks of gestation, we can predict pregnant women in whom we can expect development of intrauterine growth restriction.

The sensitivity of Doppler studies vs. biochemical indices in predicting fetal outcome in cases of pregnancy induced hypertension

Location: The Outpatient Clinic of Obstetrics and Gynecology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt and the High Risk Pregnancy Unit of King's College University Hospital, London, UK.Aim of the work: To compare the sensitivity and specificity of the Doppler studies vs. the biochemical indices in predicting fetal outcome in cases of pregnancy induced hypertension.Material and methods: A total of 252 cases were the subject of this study 192 cases from King's College Hospital and 60 from Suez Canal University Hospital. All cases were selected as having pregnancy‐induced hypertension, 226 cases with proteinuric hypertension and 26 cases with non‐proteinuric pregnancy induced hypertension. All cases were monitored weekly from 28th gestational week till delivery whereby all Doppler studies were carried out on a free loop of umbilical artery. Serum uric acid, liver enzyme aspartate‐aminotransferase, and platelet count were estimated weekly.Results: Out of 252 patients with PIH, 136 patients (54%) had abnormal Doppler flow velocimetry associated with abnormal higher mean AST proteinuria, serum urate &gt;350 mm/L, lower platelet count and higher perinatal mortality. The sensitivity and specificity of abnormal Doppler velocimetry in the prediction of intrauterine growth retardation (IUGR) were 80 and 52.6%. These were raised to 94 and 88%, respectively, with higher mean serum urate and lower platelet counts. However, the specificity of the abnormal Doppler with abnormal all biochemical indices for the prediction of adverse neonatal outcome and IUGR was 100%, but this was a late event in cases of PIH as the sensitivity dropped down. It is not advisable to wait for both to happen before taking a decision for induction of labor.

Fetal growth velocity in the prediction of intrauterine growth retardation in a low risk population.

To determine whether fetal growth velocity derived from two antenatal ultrasound measurements in the third trimester, 28 days apart, can identify infants born with anthropometric features of intrauterine growth retardation. Prospective observational study. Department of obstetric ultrasound, Ninewells Hospital, Dundee. Two hundred and seventy four low risk women participating in a longitudinal study of serial fortnightly ultrasound in pregnancy. Growth velocities of the fetal abdominal area and bi-parietal diameter were calculated from the third from last and last measurements prior to delivery. Receiver Operator Characteristics curves were employed to determine an optimal cutoff point for velocity to predict intrauterine malnourishment. Likelihood ratios for fetal abdominal area and bi-parietal diameter growth velocity in the prediction of growth retarded infants with skinfold thickness < 10th centile; ponderal index < 25th centile, or mid-arm circumference to occipito-frontal circumference ratio (MAC:OFC ratio) of less than -1 SD. A likelihood ratio of > 10 generates significant changes in the pre-test probability of growth retardation, whereas a likelihood ratio of 5 to 10 generates only moderate changes. Fetal abdominal area velocity predicted growth retardation with likelihood ratio 10.4 (95% CI 3.9 to 26) for skinfold thickness; likelihood ratio 9.5 (95% CI 4.6 to 19) for ponderal index; a likelihood ratio 4.7 (2.3 to 8.4) for MAC:OFC. Bi-parietal diameter velocity predicted growth retardation with likelihood ratio 6.5 (95% CI 1.9 to 20) for skinfold thickness but did not predict low ponderal index or MAC:OFC ratio. Fetal abdominal area velocity is useful in identifying infants with reduced skinfold thickness or low ponderal index. Prospective evaluation of serial ultrasound and velocity calculation in a selected population at increased risk of growth failure and a clearer understanding of the relative significance of the different neonatal anthropometric measures of impaired growth achievement is necessary before the estimation of growth velocity can be recommended in clinical practice.

Maternal Hematocrit and Albumin as Predictors of Intrauterine Growth Retardation and Preterm Delivery

Objective: To determine if maternal hematocrit and serum albumin can predict intrauterine growth retardation and/or preterm delivery. Methods: Analyses were performed during each trimester of pregnancy to evaluate the predictive value of these two common laboratory parameters as predictors of intrauterine growth retardation and/or prematurity. Results: 1468 women participated in the study. Intrauterine growth retardation occurred in 9.9% and preterm delivery in 6.1%. A significant inverse correlation between hematocrit and albumin and birth weight was found ( r= -0.005, p = 0.04, and r= -0.07, p = 0.007, respectively), albumin being a stronger predictor as demonstrated by multiple regression. Low hematocrit at the third visit was associated with a longer pregnancy duration ( r= -0.06, p = 0.02). Women with higher serum albumin levels at the second visit, had a longer pregnancy duration, possibly reflecting a better nutritional status ( r= 0.057, p= 0.03). To determine the predictive value of hematocrit and serum albumin, the prevalence of intrauterine growth retardation and premature delivery in the highest quartiles were compared with the lowest, and no significant differences were observed ( p > 0.1). Conclusion: Maternal hematocrit and serum albumin concentation cannot be used as useful predictors of intrauterine growth retardation or preterm delivery.

Differentiation of growth retarded from normally grown fetuses and prediction of intrauterine growth retardation using Doppler ultrasound.

To assess the hypothesis that infants exhibiting catch-up growth as an indicator of intrauterine growth retardation (IUGR) have a higher incidence of predelivery abnormal Doppler results. SETTING. Obstetric unit, St James's University Hospital, Leeds. One hundred and ninety-six women with singleton pregnancies at high risk of IUGR, delivered between October 1992 and August 1993. Postnatal catch-up growth during the first seven months. Forty-six of the 196 infants demonstrated catch-up growth and were therefore classified as growth retarded; 85% of this group had had abnormal Doppler results prior to delivery, compared with 14% of the normally grown group. However, there is considerable overlap in birthweight ratio distribution between the two groups. This study confirms the existence of a population of IUGR infants of average birthweight ratio. Doppler appears to distinguish IUGR (as defined by catch-up growth) from normal growth more successfully in infants with an average birthweight ratio than in infants with a low birthweight ratio and is a better predictor of IUGR than SGA.

Validity of umbilical artery blood velocimetry in the prediction of intrauterine growth retardation and fetal compromise

In a prospective longitudinal investigation, the validity of umbilical artery velocimetry in the detection of IUGR and fetal compromise was calculated in a group of 105 patients. With the help of pulsed Doppler ultrasound, measurements were performed from a menstrual age of 15 weeks onwards till term. The pulsatility index was calculated. The sensitivity, specificity, likelihood ratio and post test probability were determined with regard to the ability to predict IUGR and fetal compromise. The sensitivity in the detection of IUGR was 44.4%, the post test probability was 32.4%. For the prediction of fetal distress a sensitivity of 77.8% and a post test probability of 40.1% was calculated. In a selected group of high-risk patients (IUGR or PIH) the post-test probability was 77.6%. It seems clear that umbilical artery velocimetry is not useful as a screening tool for IUGR, but it has some potential to predict fetal distress.

Uterine and Umbilical Artery Flow Velocity Waveform Analysis in Pregnancies Complicated by Chronic Hypertension or Preeclampsia

Using continuous wave Doppler ultrasound, we studied the umbilical and uterine flow velocity waveforms in 68 pregnant women who had chronic hypertension and/or preeclampsia. The systolic-diastolic (S/D) ratio was considered an expression of vascular resistance peripheral to the point of insonation. Abnormal umbilical artery S/D ratio (greater than 95th percentile) alone or with abnormal uterine artery S/D ratio was associated with poor pregnancy outcome as judged by incidence of intrauterine growth retardation (IUGR), cesarean section rate, birth weight, perinatal morbidity and mortality, and prematurity. In patients with preeclampsia and abnormal Doppler values, pregnancy outcome was poor, whereas in those with normal Doppler values, pregnancy outcome approached normal. The same relationship was also found in patients with chronic hypertension. The sensitivity and specificity for the prediction of IUGR by the umbilical artery S/D ratio alone was 71% and 93%, respectively. The uterine artery S/D ratio alone yielded a 66% sensitivity and 64% specificity, and when both tests were taken into account, the sensitivity increased to 75% and the specificity to 100%. Abnormal umbilical and uterine artery S/D ratios were associated with 100% IUGR and 25% perinatal mortality. We conclude that in pregnant women with hypertensive disorders there is a significant difference in pregnancy outcome between those with normal and those with abnormal Doppler values. Umbilical artery S/D ratio alone is a better predictor of IUGR and poor pregnancy outcome than the uterine artery S/D ratio.

A combined historic and sonographic score for the detection of intrauterine growth retardation

Sonographic analysis of fetal biometry has been useful in the antepartum detection of intrauterine growth retardation (IUGR). Little attention, however, has been focused upon elements of the maternal and fetal history that may significantly affect the likelihood of IUGR. To define more precisely both the clinical and sonographic parameters associated with IUGR, we studied the following variables: routine fetal biometry (biparietal diameter, head circumference, abdominal circumference, and femur length), fetal weight percentile, amniotic fluid volume, and an antenatal scoring system for IUGR. One hundred one consecutive fetuses with an estimated fetal weight at or below the tenth percentile for gestational age formed the study population. The results of multiple logistic regression analysis indicated that weight percentile was the single most important sonographic parameter in the detection of IUGR. Maternal history and femur length were also found to be important independent predictors of IUGR.

The prediction of intrauterine growth retardation in remote area aboriginal women using serial fundal-symphysial height measurements.

A well recognised, simple and effective method of charting uterine growth by measuring the fundal-symphysial height serially was used in 3 tribal Aboriginal communities in East Arnhemland. A total of 34 women were followed with serial measurements using a nomogram derived from Quaranta et al. There were 7 births with recorded birth-weights of 2,500g or less (range 2,130g-2,500g). Six of these had serial fundal height measurements consistently at or below the 10th percentile. These 6 babies were also found to be small for gestational age. There were 13 births with recorded birth-weights between 2,500g-3,000g. Four of these babies had serial fundal height measurements at or below the 10th percentile and 3 of the 4 were small for gestational age. It is suggested that fundal-symphysial height measurements may be useful in the detection of intrauterine growth retardation, particularly in remote areas where there is a shortage of experienced medical personnel. It can be used by trained Health Workers and provides an objective record of antenatal progress.

Improved prediction of intrauterine growth retardation with use of multiple parameters.

Several sonographic parameters have been proposed for predicting intrauterine growth retardation (IUGR), but each has been shown to have a low positive predictive value. To predict IUGR more reliably, the authors developed a multiparameter approach based on sonographic and clinical data from 62 fetuses with IUGR and 91 normal fetuses. Logistic regression analysis revealed that the combination of sonographically estimated fetal weight, amniotic fluid volume, and maternal blood pressure status best correlates with the presence or absence of IUGR and produced an IUGR scoring system based on these three parameters. The scoring system, which has a range of 0-100, was tested on a second set of fetuses (47 with IUGR, 81 normal) to determine its performance characteristics. An IUGR score below 50 virtually excludes the diagnosis of IUGR (0.9% likelihood of IUGR, or negative predictive value of 99.1%). A score above 75 allows confident diagnosis of IUGR (positive predictive value, 82%). A score of 50-75 is equivocal, in that it is associated with an intermediate (24%) likelihood of IUGR. The IUGR score is a practical tool that can be easily used in any ultrasound facility.

The impact of diagnostic ultrasound on the prediction of intrauterine growth retardation in developing countries

The purpose of this report is to throw light on the problem of intrauterine growth retardation in our society, and to show how this situation could be affected by the introduction of diagnostic ultrasound in our antenatal service. A series of 828 pregnant women were serially examined by ultrasound during the course of pregnancy. Among the whole series (no. 828) there were 98 growth retarded neonates (11.8%). Antenatal ultrasonic evaluation could predict 89.7% of these cases, while only 34.7% of cases could have been predicted by fundal palpation. Among the different etiological factors, maternal anemia was the most common (25%).

Sonographic estimation of fetal weight and Doppler analysis of umbilical artery velocimetry in the prediction of intrauterine growth retardation: A prospective study

A prospective study was undertaken to examine whether Doppler velocimetry studies of the umbilical artery give a better or an earlier prediction of intrauterine growth retardation (IUGR) than do sonographic estimation of fetal weight. A total of 385 examinations were performed between 30 and 42 weeks of gestation on 168 patients who were at risk for IUGR. Forty-two (25%) of the patients delivered an infant with a birth weight below the tenth percentile. Although sensitivity was lower for the systolic to diastolic ratio (55%) of the umbilical artery than for the sonographic estimation of fetal weight (76%), the umbilical artery studies had a higher specificity (92% versus 80%) and predictive value of a positive test (73% versus 58%) when the last study to delivery interval was within 2 weeks. Furthermore, among 21 IUGR pregnancies with serial studies, the umbilical systolic to diastolic ratio was abnormal at a significantly earlier gestational age than when the sonographic estimate of fetal weight identified growth retardation. These findings indicate that sonographic biometry is a more sensitive technique for identifying IUGR but that the umbilical artery waveforms are a valuable adjunct for improving the diagnostic accuracy for the prenatal detection of IUGR. These data also provide suggestive evidence that umbilical artery velocimetry may be predictive of IUGR at an earlier gestational age than sonographic estimation of fetal weight.

A link between relative hypoglycemia-hypoinsulinemia during oral glucose tolerance tests and intrauterine growth retardation

Early identification of the intrauterine growth-retarded fetus is a key factor in improving associated perinatal morbidity and mortality. We investigated, in a prospective study of 43 patients at high risk of intrauterine growth retardation, the predictive value of a derived glucose index and whether hypoglycemia accompanied by hypoinsulinemia in normotensive patients is associated with intrauterine growth retardation. Our findings suggest that the glucose index and 2-hour plasma glucose concentration appear to be useful antepartum predictors of intrauterine growth retardation in normotensive high-risk pregnancies. There is an apparent link between selective maternal hypoglycemia, hypoinsulinemia, and being small for gestational age. A "flat" glucose tolerance test should be regarded as an abnormal pattern in normotensive pregnancies as it was associated with a twentyfold increased risk of intrauterine growth retardation in this study.