Trimester Ultrasound Examination Research Articles

Does decreased fetal growth estimation in the appropriate for gestational age range affect delivery outcomes?

To study the effect of decreased estimated fetal weight (EFW) percentiles in appropriate for gestational age fetuses. This retrospective cohort study included women who had second and third trimester ultrasound examinations. Delivery and neonatal outcomes of pregnancies with decreased EFW of ≥ 30 percentiles in EFW between ultrasound examinations (decreased growth group) and those without such a decrease (control group) were compared. Deliveries with EFW or birthweight below the 10th percentile were excluded. Among 1610 deliveries, 57 were in the decreased growth group and 1553 in the control group. Maternal characteristics did not differ between the groups except for higher rate of nulliparity in the decreased growth group. We found similar rates of Category II/III monitoring, cesarean deliveries due to non-reassuring fetal heart rate and adverse neonatal outcomes. Neonatal birthweight was lower in the decreased growth group as compared to controls. This study did not find association between the group of appropriate for gestational age fetuses with decreased growth, with adverse outcomes.

644 Indicated versus universal third trimester ultrasound examination in low-risk pregnancies: a pre- and post-intervention trial

644 Indicated versus universal third trimester ultrasound examination in low-risk pregnancies: a pre- and post-intervention trial

Validity of foetal Doppler indices in predicting postnatal respiratory distress syndrome: a prospective study

BackgroundRespiratory distress syndrome (RDS) is a potentially fatal condition of neonate occurring due to alveolar surfactant deficiency causing inefficient gaseous exchange and leading to hampered respiratory function. Purpose of our study is to investigate the role of Doppler indices in antenatal prediction of clinical Respiratory Distress Syndrome (RDS) in late preterm and early term foetuses using Main pulmonary artery (MPA) Doppler indices. The current study was conducted on 342 pregnant women between 34 and 39 weeks of gestational age, who came for routine third trimester ultrasound examination. The standard foetal biometric parameters, gestational age and estimated foetal weight were first obtained. The MPA Doppler indices like pulsatility index (PI), resistivity index (RI), peak systolic velocity (PSV), systolic/diastolic ratio and acceleration time/ejection time (At/Et) were recorded and correlated with the postnatal development of RDS.ResultsOf the 342 foetuses, neonatal RDS was diagnosed in 47 foetuses. Foetuses diagnosed with RDS had statistically higher PI and RI values, whereas At/Et ratio and PSV were lower. At/Et ratio, PI and RI, PSV showed significant correlation with gestational age and the most statistically significant correlation was found with At/Et ratio. A cut-off value of 0.2865 (sensitivity 89.45%, specificity 94.79%) and 0.3155 (sensitivity 93.22%, specificity 96.78%) correlated strongly with development of RDS in late preterm foetuses and early term infants.ConclusionFoetal MPA indices like PSV, RI, PI and especially Foetal At/Et ratio is a promising non-invasive tool which helps in identifying foetuses at risk and may be very useful to plan delivery in complicated pregnancies and also for better post-natal care of the neonate.

Importance of Aberrant Right Subclavian Artery Detection During Second Trimester Ultrasound Examination in Low-Risk Population

OBJECTIVE: Aberrant right subclavian artery, which is detected in 1-1.5% of the population, is considered an anatomical variant. Aberrant right subclavian artery is usually not symptomatic, but can sometimes lead to dysphagia due to esophageal compression. On the other hand, it has been found that it has accompanied some fetal anomalies in the last two decades. Although aberrant right subclavian artery is seen at a rate of 1-1.5% in normal chromosomal fetuses, it is seen at a rate of 19-36%, especially in fetuses with Down syndrome. STUDY DESIGN: Our study was carried out in the Department of Obstetrics and Gynaecology at Ankara University Faculty of Medicine between the dates of January 2017-January 2020. Pregnant women have had their detailed ultrasonography at our clinic and who were between 18th-24th gestational weeks were included. Amniocentesis was performed on the patients who have accepted, and genetic results were followed up. The patients who did not accept were followed up until after birth, and genetic testing was requested for babies suggestive of anomaly. RESULTS: Our study included 6205 patients who underwent detailed ultrasonography in our clinic between January 2017 and June 2020. Our detailed ultrasonography application week was between 16-24 weeks. During this period, aberrant right subclavian artery was detected in 47 of our patients. The detection rate of ARSA in the normal population in our study was 0.7% (46/6205). While aberrant right subclavian artery was the only ultrasonographic finding in 28 patients, extra anomalies were observed in 18 patients. Down syndrome was detected in four fetuses, CONCLUSION: We did not find any chromosomal anomalies in any of the patients with isolated aberrant right subclavian artery. Therefore, we do not recommend invasive intervention in patients with isolated aberrant right subclavian artery. On the other hand, our study confirmed that aberrant right subclavian artery screening should be a part of a detailed fetal ultrasonographic examination. Further studies with larger patient groups are needed.

Ultrasound markers of chromosome aberrations on routine second trimester screening

Second trimester ultrasound examination for risk assessment of chromosomal abnormalities remains an important component of prenatal evaluation. We have conducted a retrospective study to evaluate the efficiency of ultrasonographic screening for the markers of chromosomal aberrations and to classify ultrasonographic markers according to the aberration they were found with. Over a 10 year period we performed 620 karyotype analyses of fetal blood taken by cordocentesis after detection of fetal anomalies in a second trimester scan in unselected population and 216 samples of peripheral blood of neonates having phenotypic features suspected for chromosomopathies. Ultrasound examination and cytogenetic data were obtained from the laboratory database. Chromosomal abnormalities were found in 36 (5,8%) fetuses with anomalies. Most frequently chromosomal aberrations were detected in fetuses with multiple anomalies (13,3%), heart anomalies (11,5%), short femurs (12,5%) and polyhydramnios (7,7%). The success rate of sonographic examination in detection of Down syndrome was 85%, and in detection of sex chromosome trisomies 80%. Trisomy 18, trisomy 13 and polyploidy were found prenatally in 100% each. Nearly 42% of trisomy 21 fetuses had heart anomaly, 35,3% polyhydramnios and 17,7% short femurs. Trisomy 18 fetuses had polyhydramnios in 87,5%, CNS anomalies in 62,5% and symmetrical IUGR in 50% of cases. All of the fetuses with monosomy X had short femurs. Ultrasonographic evaluation is the most sensitive screening method for the identification of fetuses having a high risk rate for chromosomal abnormalities in a low risk population.

306EMF Defining the Learning Curve for First Trimester Ultrasound Image Interpretation Skills for Emergency Physicians

First trimester pregnancy ultrasound is an oft-used, high-stakes skill for emergency physicians (EPs). Performing bedside ultrasound for symptomatic first trimester pregnant patients requires the skill of image acquisition, image interpretation and integration of interpretation in clinical decision-making. Learning curves for EPs' skills in ultrasound applications have been shown to vary considerably. Some have advocated for a “mastery-based” competency evaluation in which trainees practice until they reach a pre-defined level of performance. However, clinical practice alone may not be sufficient in achieving this standard since opportunities for immediate feedback at the bedside may be limited by the number of patient encounters and the frequency of pathology. Little is known about the development of the skill of image interpretation over time among EPs engaged in deliberate practice of image review. The objective of this study is develop an educational innovation to teach first trimester pregnancy ultrasound image assessment using an online learning platform and assess learners’ skill acquisition for this critical emergency medicine skill. This is a multicenter prospective cohort study. First trimester ultrasound examinations from two academic medical centers’ ultrasound image archival systems were reviewed to identify 400 high-quality studies with complete imaging and a specified case mix. An online experience was developed for each case and integrated into an online learning platform. Images, case-specific information and education for each case were developed and reviewed by emergency ultrasound specialists. EPs will be recruited to complete an education experience using the online learning platform which presents cases and images to physicians whose interpretations are then evaluated. 400 cases of early first trimester ultrasound examinations have been reviewed and cataloged, including 200 transvaginal and 200 transabdominal ultrasound examinations. Of these, 195 include an intrauterine pregnancy (IUP), 205 do not include an IUP, 132 are viable, and 43 are confirmed ectopic pregnancies. Classification of findings of each case has been reviewed by one expert reviewer. Development of an online learning intervention is underway. Data acquisition of 135 EPs’ performance with this intervention, rate of skill acquisition and learning curves is forthcoming. We will determine changes in accuracy, sensitivity and specificity, and the effect size of the learning intervention. We will determine the item reliability and interpretation difficulty for each case. We will determine the time it took to complete the course and evaluate the participant experience. We will examine the rate of learning for first trimester TVUS and TAUS measured by deriving learning curves and determining the median number of cases required to reach the following performance benchmarks: 80%, 85%, 90%, and 95% accuracy. EPs frequently evaluate symptomatic first trimester pregnant patients. Patients experience high morbidity and mortality if an ectopic pregnancy is missed and ultrasound is the imaging modality of choice to evaluate for the presence or absence of an IUP. We have developed an online learning platform with an image bank of 400 cases and plan to evaluate 135 physician’ learning with the platform.

Risk Factors for Low Birth Weight among Term Newborns in Babil Maternity and Children Teaching Hospital

Background: Great importance has been attributed to birthweight all over the world because it is considered one of the best predictors of perinatal survival and a good indicator of life quality. Aims and Objectives: The aim of this study was to determine the risk factors for low birth weight among term babies in Babil maternity and children teaching hospital. Materials and Methods: This was a cross-sectional study conducted in Babil maternity and children teaching hospital. The study was carried out in the neonatal care unit from March 1, 2020 to August 31, 2020. Seven hundred and fifty-four term singleton live births were included in the study. All the neonates were checked for birth weight, and their gestational age was determined from maternal last menstrual period and early (first trimester) ultrasound examination and New Ballard score. Neonates with normal birth weight were considered as gestationally full term (≥37 weeks) with birth weight 2500–4000 g. Results: Babies with normal birth weight represent 87.9% of the study sample (663 babies). The number of term neonates with low birth weight was 69/754, with 9.2% and large for gestational age represent 2.9% of the study sample (22 babies). Low birth weight of 2100–2400 g represents 6.3% of the study sample (47 babies). Low birth weight of 1500–2000 g represents 2.9% of the study sample (22) babies. Age of mother, residency, family income, maternal education, antenatal care, bad obstetrical history, illnesses during pregnancy, and parental consanguinity were considered to be risk factors for low birth weight at P values of 0.05, <0.001, <0.001, <0.001, <0.001, <0.001, 0.001, 0.002, and <0.001, respectively. However, gender of the baby, parity, and paternal age were not considered to be risk factors. Conclusion: The problem of low birth weight among term babies is still common in our country. There was a higher incidence of low birth weight among term neonates in the rural areas and in mothers with low education level and those who live in families with low income. The most common associated risk factors associated with low birth weight were young age mothers, positive parental consanguinity, bad obstetrical history, and illnesses during pregnancy (e.g., hypertension, diabetes mellitus, and urinary tract infection).

Development of the utero-placental circulation in cesarean scar pregnancies: a case-control study

Cesarean scar pregnancies carry a high risk of pregnancy complications including placenta previa with antepartum hemorrhage, placenta accreta spectrum, and uterine rupture. To evaluate the development of utero-placental circulation in the first half of pregnancy in ongoing cesarean scar pregnancies and compare it with pregnancies implanted in the lower uterine segment above a previous cesarean delivery scar with no evidence of placenta accreta spectrum at delivery STUDY DESIGN: This was a retrospective case-control study conducted in 2 tertiary referral centers. The study group included 27 women who were diagnosed with a live cesarean scar pregnancy in the first trimester of pregnancy and who elected to conservative management. The control group included 27 women diagnosed with an anterior low-lying placenta or placenta previa at 19 to 22 weeks of gestation who had first and early second trimester ultrasound examinations. In both groups, the first ultrasound examination was carried out at 6 to 10 weeks to establish the pregnancy location, viability, and to confirm the gestational age. The utero-placental and intraplacental vasculatures were examined using color Doppler imaging and were described semiquantitatively using a score of 1 to 4. The remaining myometrial thickness was recorded in the study group, whereas the ultrasound features of a previous cesarean delivery scar including the presence of a niche were noted in the controls. Both the cesarean scar pregnancies and the controls had ultrasound examinations at 11 to 14 and 19 to 22 weeks of gestation. The mean color Doppler imaging vascularity score in the ultrasound examination at 6 to 10 weeks was significantly (P<.001) higher in the cesarean scar pregnancy group than in the controls. High vascularity scores of 3 and 4 were recorded in 20 of 27 (74%) cases of the cesarean scar pregnancy group. There was no vascularity score of 4, and only 3 of 27 (11%) controls had a vascularity score of 3. In 15 of the 27 (55.6%) cesarean scar pregnancies, the residual myometrial thickness was <2 mm. In the ultrasound examination at 11 to 14 weeks, there was no significant difference between the groups in the number of cases with an increased subplacental vascularity. However, 12 cesarean scar pregnancies (44%) presented with 1 or more placental lacunae whereas there was no case with lacunae in the controls. Of the 18 cesarean scar pregnancies that progressed into the third trimester, 10 of them were diagnosed with placenta previa accreta at birth, including 4 creta and 6 increta. In the 19 to 22 weeks ultrasound examination, 8 of the 10 placenta accreta spectrum patients presented with subplacental hypervascularity, out of which 6 showed placental lacunae. The vascular changes in the utero-placental and intervillous circulations in cesarean scar pregnancies are due to the loss of the normal uterine structure in the scar area and the development of placental tissue in proximity of large diameter arteries of the outer uterine wall. The intensity of these vascular changes, the development of placenta accreta spectrum, and the risk of uterine rupture are probably related to the residual myometrial thickness of the scar defect at the start of pregnancy. A better understanding of the pathophysiology of the utero-placental vascular changes associated with cesarean scar pregnancies should help in identifying those cases that may develop major complications. It will contribute to providing counseling for women about the risks associated with different management strategies.

Maternal serum biochemical markers combined with ultrasound diagnosis at the end of the first trimester

Objectives. Evaluating the benefits of an early screening of combined maternal markers and ultrasound of the fetuses. Methods. Prospective study (1 January and 31 December 2018) enrolled 187 patients, evaluated at the end of the first trimester of pregnancy (nuchal scan). Biochemical markers: detection of free β human chorionic gonadotropin and serum pregnancy associated plasma protein A. The first trimester ultrasound examination included the assessment of the nuchal translucency, fetal crown rump length and fetal heart. Results. 9 cases with abnormal biomarkers, increased nuchal translucency and cardiac anomalies, including abnormal 4-chamber view (6 cases) and great vessel anomalies (3 cases). 1 case considered initially negative in the first trimester was diagnosed by morphological scan with tetralogy of Fallot in the second trimester. Conclusions. A first trimester combined ultrasound protocol and maternal serum biochemical markers is important in the early prenatal care screening.

Prenatal diagnosis of amyoplasia

Objectives. To describe ultrasound and pathomorphological signs of amyoplasia in the fetus. Materials. Sporadic case of prenatal diagnosis on second trimester ultrasound examination is presented. Prenatal diagnosis is confirmed on pathomorphological and histological examinations. Results. The ultrasound signs were contractures of the upper and lower extremities, bilateral clubfoot, akinesia, extreme cervical spinal hyperextension. The diagnosis was established by pathomorphological and histological expertise. Histological examination of the muscle tissue of the rectus femoris muscle determined the residual muscle tissue infiltrated with fat and connective tissue. Conclusions. Amyoplasia, especially its severe subtypes, can be diagnosed prenatally. The ultrasound signs were contractures of the upper and lower extremities, bilateral clubfoot, akinesia, extreme cervical spinal hyperextension. Histological examination of muscle tissue in fetuses with signs of arthrogryposis will increase the frequency of diagnosis of amioplasia

Early prenatal presentation of the cartilage-hair hypoplasia / anauxetic dysplasia spectrum of disorders mimicking recurrent thanatophoric dysplasia

Three sibling fetuses identified with limb shortening and thoracic narrowing at twelve weeks’ gestation on first trimester ultrasound examination are presented. The parents were non-consanguineous, Caucasian, healthy, of normal stature and had a healthy normal daughter. The radiographic abnormalities were highly suggestive of thanatophoric dysplasia, but molecular analysis failed to identify a pathogenic variant in FGFR3. The three fetuses were found to have identical compound heterozygous mutations in RMRP in trans, one inherited from the mother and one from the father. This represents the early prenatal presentation and fetal findings of metaphyseal dysplasia type McKusick (Cartilage-hair hypoplasia; CHH)/anauxetic dysplasia spectrum of disorders.

VP04.05: Associated anomalies and outcome in cases of absent ductus venosus diagnosed at 11–13+6 weeks' scan

To determine the incidence of associated anomalies and outcomes in absent ductus venosus in pregnant women undergoing the nuchal translucency scan (NT) at 11-13+6. A retrospective case record-based study of prospectively collected data from pregnant women attending NT scan at a single centre in western India. The assessment included measurement of NT, evaluation of nasal bone (NB), ductus venosus (DV), tricuspid regurgitation (TR), according to the Fetal Medicine Foundation protocols. The detailed anatomical evaluation was done in all patients. When the DV was not seen, the umbilical vein was traced to evaluate it's joining with systemic veins. The incidence of absent ductus venosus and the association with anomalies were determined. The cases where the pregnancy was continued, were followed up in postnatal life. The records of 2884 first trimester ultrasound examination from December 2016 to December 2019 were analysed. Absent ductus venosus was detected in 10 (0.35 %, 95 % CI: 0.19, 0.64) pregnant women . Eight (80.00 %) women were primigravida. Seven (70 %) had a normal NT thickness. Five (50.00 %) of these 10 fetuses had associated cardiac anomalies and one had radial ray defect. One fetus had bilateral jugular sacs, absent NB and increased NT which was confirmed as trisomy 21 after amniocentesis. In 9 cases the umbilical vein was opening in inferior vena cava, while in 1 case it was opening in iliac vein. All seven abnormal pregnancies were terminated. The remaining three fetuses with isolated absent DV were followed, one fetus had intrauterine demise at 29 weeks. The other two were born normal. One of these babies died at 6 months of age because of pneumonia. The other baby is normal till date. No postnatal sonography was done in these two live-born children. Assessment of DV during NT scan is very important. Absent DV is associated with cardiac, extracardiac and chromosomal abnormalities. Absent DV is associated with adverse outcome. Absent DV may be present even with a normal NT.

Peer review of third trimester abdominal circumference measurements.

Third trimester growth scans represent a significant proportion of the workload in obstetric ultrasound departments. The objective of these serial growth scans is to improve the antenatal detection of babies with fetal growth restriction. The aim of this paper is to describe a method of peer review for third trimester abdominal circumference measurements which is realistic within busy obstetric ultrasound departments in the UK. Twenty-two, third trimester, measured abdominal circumference images were randomly selected. Images were assessed subjectively by 12 sonographers using the image Criteria Achieved Score. For quantitative assessment, termed the Inter-operator Variability Score, three of the abdominal circumference (AC) images were blindly remeasured. Following this, a questionnaire was used to ascertain which image criteria sonographers considered most important and to reach an agreement on correct caliper placement. The least frequently met image criteria with the lowest Criteria Achieved Score related to an oblique abdominal circumference section. These included fetal kidney present (Criteria Achieved Score 24.6%), multiple oblique ribs (Criteria Achieved Score 39.4%) and oblique spine (Criteria Achieved Score 37.5%). Caliper placement was also identified as inconsistent. This study demonstrates that the perfect AC section is not always possible and sonographers use their professional judgement to determine whether an image is acceptable. Seventy-three percent of the images reviewed were of an acceptable standard. There can be inconsistencies in sonographer opinion regarding what is an acceptable third trimester abdominal circumference image. These differences need to be addressed to maximise the effectiveness of the third trimester ultrasound examination. Peer review can be used to monitor scan quality and identify areas of inconsistency.

First trimester anomaly scan using virtual reality (VR FETUS study): study protocol for a randomized clinical trial

BackgroundIn recent years it has become clear that fetal anomalies can already be detected at the end of the first trimester of pregnancy by two-dimensional (2D) ultrasound. This is why increasingly in developed countries the first trimester anomaly scan is being offered as part of standard care. We have developed a Virtual Reality (VR) approach to improve the diagnostic abilities of 2D ultrasound. Three-dimensional (3D) ultrasound datasets are used in VR assessment, enabling real depth perception and unique interaction. The aim of this study is to investigate whether first trimester 3D VR ultrasound is of additional value in terms of diagnostic accuracy for the detection of fetal anomalies. Health-related quality of life, cost-effectiveness and also the perspective of both patient and ultrasonographer on the 3D VR modality will be studied.MethodsWomen in the first trimester of a high risk pregnancy for a fetus with a congenital anomaly are eligible for inclusion. This is a randomized controlled trial with two intervention arms. The control group receives ‘care as usual’: a second trimester 2D advanced ultrasound examination. The intervention group will undergo an additional first trimester 2D and 3D VR ultrasound examination. Following each examination participants will fill in validated questionnaires evaluating their quality of life and healthcare related expenses. Participants’ and ultrasonographers’ perspectives on the 3D VR ultrasound will be surveyed. The primary outcome will be the detection of fetal anomalies. The additional first trimester 3D VR ultrasound examination will be compared to ‘care as usual’. Neonatal or histopathological examinations are considered the gold standard for the detection of congenital anomalies. To reach statistical significance and 80% power with a detection rate of 65% for second trimester ultrasound examination and 70% for the combined detection of first trimester 3D VR and second trimester ultrasound examination, a sample size of 2800 participants is needed.DiscussionFirst trimester 3D VR detection of fetal anomalies may improve patients’ quality of life through reassurance or earlier identification of malformations. Results of this study will provide policymakers and healthcare professionals with the highest level of evidence for cost-effectiveness of first trimester ultrasound using a 3D VR approach.Trial registrationDutch Trial Registration number NTR6309, date of registration 26 January 2017.

Sonographic Diagnosis of Velamentous and Marginal Placental Cord Insertion.

Routine second trimester ultrasound (US) examinations include an assessment of the umbilical cord given its vital role as a vascular conduit between the maternal placenta and fetus during fetal development. Placental cord insertion abnormalities can be identified during prenatal US screening and are increasingly recognized as independent risk factors for various complications during pregnancy and delivery. The purpose of this pictorial review is to illustrate examples of velamentous and marginal placental cord insertion with an emphasis on how to differentiate their morphology using color Doppler US.

Prenatal Diagnosis of a De Novo Partial Trisomy 6q and Partial Monosomy 18p Associated with Cephalocele: A Case Report.

A 28-year-old woman underwent amniocentesis at 18 weeks’ gestation upon detection of increased fetal nuchal fold and parietal cephalocele on the second trimester ultrasound examination. Prenatal microarray showed a de novo unbalanced translocation resulting in a gain in 6q and loss in 18p. A female infant was delivered at 38 weeks’ gestation. At birth, cephalocele and webbed neck were noted as major dysmorphic features. The case presented here shows how a combination of different genetic studies is used to accurately elucidate a chromosomal anomaly in a prenatal setting.

Preterm and term birth in twin pregnancies during a seven-year period: a call for obstetricians to declare about amnionicity and chorionicity.

Aim To compare maternal, foetal and neonatal characteristics, and perinatal outcome of preterm and term deliveries in twins pregnancies in order to improve perinatal care in Bosnia and Herzegovina. Methods This retrospective cohort study included pregnant women with twin pregnancy who delivered during the period between 1 January 2012 and 31 December 2018 at the Clinic for Gynaecology and Obstetrics, University Clinical Centre Tuzla. Results During the seven-year period 26 734 deliveries were recorded, out of which 362 (1.35 %) were twin pregnancies, 226 (62.4%) preterm and 136 (37.5%) term ones. In the preterm group 38 (16.8%) pregnancies were assisted medical reproduction, and 16 (11.7%) of those were in the term group. The average birth weight was significantly higher for the first twin in both groups (p<0.00001). Incipient intrauterine foetal asphyxia was more frequent in the preterm group (p<0.05). The most common indication for Caesarean section was abnormalities of foetal presentation and lie, 176 (68.2%) for the overall sample. Conclusion Cornerstone of twin pregnancy antenatal care is to get correct data about amnionicity and chorionicity. Since majority of prenatal data did not have this information we call all obstetricians to declare about amnionicity and chorionicity in twin pregnancies during the first trimester ultrasound examination.

Prospective Comparative Evaluation of Performance of Fetal Growth Charts in the Diagnosis of Suboptimal Fetal Growth During Third Trimester Ultrasound Examination in an Unselected South Indian Antenatal Population

AbstractGrowth standards are key tools in assigning fetal smallness. Growth charts are central to this. The availability of growth charts with varying conceptual methodology and design makes their comparison imperative to ensure wise clinical decision making. This was a prospective, descriptive and correlational study performed at two fetal medicine centers, on 1019 unselected third trimester South Indian women with singleton pregnancies. The estimated fetal weight (EFW) was calculated from one dataset per woman using the Hadlock III formula. The EFW centiles were obtained from eight prenatal growth charts: Hadlock, FMF, Spanish, INTERGROWTH, WHO, NICHD, Mikolajczyk and GROW (fully customized), and categorized to ≤ 5th, 5.1 to ≤ 10th, 10.1–89.9th and ≥ 90 centiles. Comparison was done with similar categories of neonatal birthweight centiles obtained from Fenton, INTERGROWTH and GROW customized neonatal standards. At EFW cut-off of ≤ 10th centile, the sensitivity range of the fetal growth charts were between 9.5 and 60% and the false positive rates (FPR) between 1.9 and 18.38%. Similar figures for EFW ≤ 5th centile, were 9.5–64.2% and 1.0–12.8%, respectively. The INTERGROWTH chart had the highest positive predictive value of 54.6–63.6%. The FMF chart had the highest sensitivity and the highest FPR. The sensitivity, at a cut-off of ≤ 5th centile, of Mikolajczyk (9.5–12.6%), and the GROW (14.4–18.9%) prenatal charts were closest to the incidence of uteroplacental insufficiency (7.9%) in our study. Wide variations noted in the performance of prenatal and neonatal growth charts in detecting fetal-neonatal smallness indicates the need for critical selection of growth charts and possibly additional supportive information in clinical decision making.

Quality of consumer-oriented websites containing information about the second trimester ultrasound examination during pregnancy

BackgroundProviding information about prenatal tests is a clinical challenge and the public frequently accesses the Web to read pregnancy-related information. The overarching aim of this study was to investigate the quality of consumer-oriented websites addressing obstetric ultrasound examination in the second trimester of pregnancy.MethodsSwedish websites were identified with Google, using 20 search strings and screening 400 hits (n = 71 included websites). Reliability and information about the examination were assessed with the DISCERN instrument, completeness was assessed according to national guidelines, and readability analyzed with the Readability Index. Popularity was determined with the ALEXA tool and search rank was determined according to Google hit lists.ResultsThe mean total DISCERN score was 29.7/80 (SD 11.4), with > 50% having low quality for 15 of the 16 questions. The mean completeness score was 6.8/24 (SD 4.5). The Readability Index ranged between 22 and 63, with a mean of 42.7 (SD 6.8), indicating difficult readability. Weak and non-significant correlations were observed between ALEXA/search rank and the investigated quality variables, except for search rank and reliability.ConclusionsThe quality of consumer-oriented websites addressing the second trimester ultrasound examination is low. Health professionals need to discuss this with expectant parents considering undergoing the examination. There is a need for efforts that aim to improve the poor quality of online sources in the field of prenatal examinations.

Risk factor assessment for fetal growth restriction, are we providing best care?

Serial third trimester ultrasound examinations for fetal biometry are recommended for women with risk factors of fetal growth restriction (FGR). We conducted a retrospective cohort study on all singleton births in Victoria from 2009 to 2017 to assess how many women with major risk factors for FGR had serial third trimester biometry. Only 19.5% of women with at least one major risk factor for FGR had evidence of serial third trimester ultrasound assessments. The development and implementation of a state-wide or nationwide guideline for early pregnancy risk factor assessment in FGR may be beneficial.