Uncertain Gestational Age Research Articles

Role of Foetal Trans-cerebellar Diameter in the Prediction of Gestational Age in Correlation with other Foetal Biometric Parameter: A Cross-sectional Study in a Secondary Hospital of Bangladesh

Introduction: Uncertain gestational age is associated with higher perinatal mortality rates. Accurate assessment of gestational age is an important parameter in obstetrics for the management of pregnancy and evaluation of foetal development. Objective: To evaluate whether trans-cerebellar diameter (TCD) in singleton uncomplicated gestations can serve as a reliable predictor of gestational age (GA) in fetuses between 18-38 weeks of pregnancy. Methods: This cross-sectional study was carried out in the department of Radiology and Imaging of CMH, Ghatail, from January 2019 to December 2019 among purposively selected 89 outpatient and admitted pregnant women without any complication having regular menstrual cycle and confirmed about last menstrual period (LMP). The transabdominal USG was performed in each patient and trans-cerebellar diameter was taken which was later correlated with other foetal biometric parameters like biparietaldiameter (BPD), femoral length (FL) etc. Results: Most of the patients belonged to 21-25 years age group (32.6%). Mean age of the study subjects was 26.94±5.70 years ranging from 19 to 38 years and were predominantly (51.7%) primipara. Mean gestational age was 220.69±37.30 days by LMP, 216.20±36.06 days by BPD, 219.00±38.43 days by FL and 218.81±39.36 days by TCD. Mean of biparietal diameter, femoral length and transverse cerebellar diameter were 7.59±1.40cm, 5.91± 1.33cm and 3.93±1.00cm respectively. A significant positive linear correlation between GA by LMP with GA by BPD, FL and TCD was observed (p<0.001). Conclusion: Foetal trans-cerebellar diameter is a reliable sonological parameter for the estimation of foetal gestational age and dating of pregnancy can be made depending on TCD in the pregnant women with unsure of their LMP. JAFMC Bangladesh. Vol 18, No 2 (December) 2022: 40-45

Comparison between Transcerebellar Diameter, Biparietal Diameter and Femur length for Gestational Age Measurement Accuracy in Third Trimester of Pregnancy

Background: The provision of obstetric and neonatal care, as well as the public health monitoring of pregnancy outcomes, relies upon the accurate determination of gestational age. Uncertain gestational age has been associated with adverse pregnancy outcomes including low birth weight, preterm delivery and perinatal mortality, independent of maternal characteristics. The use of ultrasonography has significantly improved the evaluation of fetal growth and development and has permitted prenatal diagnosis of a variety of congenital malformations. Objective: The aim of this study was to detect an accurate method for assessment of gestational age in the third trimester of pregnancy comparing the transcerebellar diameter (TCD), biparietal diameter (BPD) and femur length (FL). Patients and Methods: A total of 200 pregnant women in third trimester pregnancy were assessed in this randomized controlled study in Department of Obstetrics and Gynecology at Sohag General Hospital by two-dimensional ultrasound from January to June 2o18 to assess an accurate method for assessment of gestational age in third trimester of pregnancy. Results: We found that out of 200 pregnant women, the TCD gave a correct assessment of gestational age within 3 days in 129 (64.5%) and within 1 week in 178 (89%). While the FL gave a correct assessment of gestational age within 3 days in 97 (48.5%) and within 1 week in 163 (81.5%). The least accurate was the BPD that gave a correct assessment of gestational age within 3 days in 65 (32.5%) and within 1 week in 123 (61.5%) pregnant women. Conclusion: It could be concluded that TCD is the most accurate method for assessment of gestational age in the third trimester followed by FL, and the least accurate is the BPD.

Comparison between Transcerebellar Diameter, Biparietal Diameter and Femur length for Gestational Age Measurement Accuracy in Third Trimester of Pregnancy

Background: The provision of obstetric and neonatal care, as well as the public health monitoring of pregnancy outcomes, relies upon the accurate determination of gestational age. Uncertain gestational age has been associated with adverse pregnancy outcomes including low birth weight, preterm delivery and perinatal mortality, independent of maternal characteristics. The use of ultrasonography has significantly improved the evaluation of fetal growth and development and has permitted prenatal diagnosis of a variety of congenital malformations. Objective: The aim of this study was to detect an accurate method for assessment of gestational age in the third trimester of pregnancy comparing the transcerebellar diameter (TCD), biparietal diameter (BPD) and femur length (FL). Patients and Methods: A total of 200 pregnant women in third trimester pregnancy were assessed in this randomized controlled study in Department of Obstetrics and Gynecology at Sohag General Hospital by two-dimensional ultrasound from January to June 2o18 to assess an accurate method for assessment of gestational age in third trimester of pregnancy. Results: We found that out of 200 pregnant women, the TCD gave a correct assessment of gestational age within 3 days in 129 (64.5%) and within 1 week in 178 (89%). While the FL gave a correct assessment of gestational age within 3 days in 97 (48.5%) and within 1 week in 163 (81.5%). The least accurate was the BPD that gave a correct assessment of gestational age within 3 days in 65 (32.5%) and within 1 week in 123 (61.5%) pregnant women. Conclusion: It could be concluded that TCD is the most accurate method for assessment of gestational age in the third trimester followed by FL, and the least accurate is the BPD.

Comparison between Taans Cerebellar Diameter, Biparietal Diameter and Femur Length for Gestational Age Measurement Accuracy in The 3rd Trimester

Background: the provision of obstetric and neonatal care, as well as the public health monitoring of pregnancy outcomes, relies upon the accurate determination of gestational age. Uncertain gestational age has been associated with adverse pregnancy outcomes including low birth weight, preterm delivery and perinatal mortality and independent of maternal characteristics. Many patients in Egypt due to socio-economic reasons come for their first antenatal visit in the third trimester. Most of them are uneducated and come from remote areas. Also, many being lactating mothers are unsure of their LMP or have irregular cycles. Because of non-availability of any dating scans or earlier ultrasound and uncertainty in LMP, it becomes very difficult to calculate their due dates, so many pregnancies considered to be preterm or posterm were wrongly classified. The use of ultrasonography has significantly improved evaluation of fetal growth and development and had permitted prenatal diagnosis of a variety of congenital malformations. Ultrasonographic fetal biometry is highly reliable in the first and second trimester of pregnancy, but reliability of any ultrasound method greatly diminishes as gestational age advances, in the third trimester, reliability of any single ultrasound parameter alone is poor without correlation with other parameters. Objective: in our study, TCD was compared to FL and BPD in accuracy of assessment of gestational age in the third trimester of pregnancy. We correlated between the three parameters, Transcerebellar (TCD) and Biparietal diameter (BPD) and Femur length (FL), for accurate determination of gestational age in third trimester of pregnancy. Methods: a total of 200 pregnant women in the third trimester pregnancy were assessed in this observational study in Department of Obstetrics and Gynecology, Damietta Hospital, Al-Azhar University (Outpatient) by two-dimensional ultrasound to assess the accurate method for assessment of gestational age in the third trimester of pregnancy. Examinations were performed after a verbal consent from the patient with the patient lying in the dorsal supine position. Two dimensional ultrasounds were carried out. Fetal biometry and amniotic fluid volume were assessed. All women included in this study were subjected to history taking and clinical examination. Results: we found that out of 200 patients, TCD gave correct assessment of gestational age within 3 days in 118 patients (59%) and within 1 week in 180 patients (90%). While, FL gave correct assessment of gestational age within 3 days in 92 patients (46%) and within 1 week in 160 patients (80%). The least accurate was BPD that gave correct assessment of gestational age within 3 days in 59 patients (29.5%) and within 1 week in 120 patients (60%). Conclusion: from this study, we concluded that TCD was the most accurate method for assessment of gestational age in the third trimester followed by FL and the least accurate was the BPD. Also, by combining accuracy of TCD (90%) and that of FL (80%) we can be near certain of gestational age in most of our patients even if they are unsure of their dates. Recommendations: measuring TCD as routine in the third trimester as it has the same accuracy as the current fetal biometry (BPD and FL).

Comparison between taans cerebellar diameter, biparietal diameter and femur length for gestational age measurement accuracy in the 3rd trimester

Background: the provision of obstetric and neonatal care, as well as the public health monitoring of pregnancy outcomes, relies upon the accurate determination of gestational age. Uncertain gestational age has been associated with adverse pregnancy outcomes including low birth weight, preterm delivery and perinatal mortality and independent of maternal characteristics. Many patients in Egypt due to socio-economic reasons come for their first antenatal visit in the third trimester. Most of them are uneducated and come from remote areas. Also, many being lactating mothers are unsure of their LMP or have irregular cycles. Because of non-availability of any dating scans or earlier ultrasound and uncertainty in LMP, it becomes very difficult to calculate their due dates, so many pregnancies considered to be preterm or posterm were wrongly classified. The use of ultrasonography has significantly improved evaluation of fetal growth and development and had permitted prenatal diagnosis of a variety of congenital malformations. Ultrasonographic fetal biometry is highly reliable in the first and second trimester of pregnancy, but reliability of any ultrasound method greatly diminishes as gestational age advances, in the third trimester, reliability of any single ultrasound parameter alone is poor without correlation with other parameters. Objective: in our study, TCD was compared to FL and BPD in accuracy of assessment of gestational age in the third trimester of pregnancy. We correlated between the three parameters, Transcerebellar (TCD) and Biparietal diameter (BPD) and Femur length (FL), for accurate determination of gestational age in third trimester of pregnancy. Methods: a total of 200 pregnant women in the third trimester pregnancy were assessed in this observational study in Department of Obstetrics and Gynecology, Damietta Hospital, Al-Azhar University (Outpatient) by two-dimensional ultrasound to assess the accurate method for assessment of gestational age in the third trimester of pregnancy. Examinations were performed after a verbal consent from the patient with the patient lying in the dorsal supine position. Two dimensional ultrasounds were carried out. Fetal biometry and amniotic fluid volume were assessed. All women included in this study were subjected to history taking and clinical examination. Results: we found that out of 200 patients, TCD gave correct assessment of gestational age within 3 days in 118 patients (59%) and within 1 week in 180 patients (90%). While, FL gave correct assessment of gestational age within 3 days in 92 patients (46%) and within 1 week in 160 patients (80%). The least accurate was BPD that gave correct assessment of gestational age within 3 days in 59 patients (29.5%) and within 1 week in 120 patients (60%). Conclusion: from this study, we concluded that TCD was the most accurate method for assessment of gestational age in the third trimester followed by FL and the least accurate was the BPD. Also, by combining accuracy of TCD (90%) and that of FL (80%) we can be near certain of gestational age in most of our patients even if they are unsure of their dates. Recommendations: measuring TCD as routine in the third trimester as it has the same accuracy as the current fetal biometry (BPD and FL).

Comparison between Trans-cerebellar Diameter, Bi-parietal Diameter and Femur Length for Gestational Age Measurement Accuracy in Third Trimester of Pregnancy

Background: the provision of obstetric and neonatal care, as well as the public health monitoring of pregnancy outcomes, relies upon the accurate determination of gestational age. Uncertain gestational age has been associated with adverse pregnancy outcomes including low birth weight, preterm delivery and perinatal mortality, independent of maternal characteristics. Aim of the Work: was fine out an accurate method for assessment of gestational age in third trimester of pregnancy comparing the Transcerebellar diameter, Biparietal diameter and femur length. Patients and Methods: a total of 200 pregnant women in third trimester pregnancy were assessed in this prospective observational study held at Al-Hussein University Hospital and New Cairo Police Hospital using two-dimensional ultrasound technique during the period from January to June 2018 in order to assess an accurate method for assessment of gestational age in third trimester of pregnancy. Examinations were performed after a written consent received from the patients lying in the dorsal supine position. Two-dimensional ultrasound examination was carried out. Fetal biometry and amniotic fluid volume were assessed. These ultrasound parameters were done under the supervision of a certified gynecologist to exclude bias. Results: the majority of the patients in our study belong to the age group 20 to 30 years (65%) with minimum of 15 years and maximum of 35 years. In our study, also 55 patients out of 200 were primigravida and 145 patients were multigravida. Our patients showed that the percentages of accurate assessment of gestational age within 3 days were as follow: Out of 200 patients, TCD gave accurate assessment within 3 days in 118 patients (59%), FL gave accurate assessment within 3 days in 92 patients (46%), while the BPD gave accurate assessment within 3 days in 59 patients (29.5%). Conclusion: we concluded that TCD is the most accurate method for the assessment of gestational age in third trimester followed by FL, and the least accurate is the BPD. Also by combining accuracy of TCD (90%) and that of FL (80%).

Comparison between Trans-cerebellar Diameter, Bi-parietal Diameter and Femur Length for Gestational Age Measurement Accuracy in Third Trimester of Pregnancy

Background: the provision of obstetric and neonatal care, as well as the public health monitoring of pregnancy outcomes, relies upon the accurate determination of gestational age. Uncertain gestational age has been associated with adverse pregnancy outcomes including low birth weight, preterm delivery and perinatal mortality, independent of maternal characteristics. Aim of the Work: was fine out an accurate method for assessment of gestational age in third trimester of pregnancy comparing the Transcerebellar diameter, Biparietal diameter and femur length. Patients and Methods: a total of 200 pregnant women in third trimester pregnancy were assessed in this prospective observational study held at Al-Hussein University Hospital and New Cairo Police Hospital using two-dimensional ultrasound technique during the period from January to June 2018 in order to assess an accurate method for assessment of gestational age in third trimester of pregnancy. Examinations were performed after a written consent received from the patients lying in the dorsal supine position. Two-dimensional ultrasound examination was carried out. Fetal biometry and amniotic fluid volume were assessed. These ultrasound parameters were done under the supervision of a certified gynecologist to exclude bias. Results: the majority of the patients in our study belong to the age group 20 to 30 years (65%) with minimum of 15 years and maximum of 35 years. In our study, also 55 patients out of 200 were primigravida and 145 patients were multigravida. Our patients showed that the percentages of accurate assessment of gestational age within 3 days were as follow: Out of 200 patients, TCD gave accurate assessment within 3 days in 118 patients (59%), FL gave accurate assessment within 3 days in 92 patients (46%), while the BPD gave accurate assessment within 3 days in 59 patients (29.5%). Conclusion: we concluded that TCD is the most accurate method for the assessment of gestational age in third trimester followed by FL, and the least accurate is the BPD. Also by combining accuracy of TCD (90%) and that of FL (80%).

The influence of seasonality and weather changes on premature birth incidence

BackgroundAlthough the effects of meteorological factors on the general population health are widely documented, little is known about their influence on human pregnancy and birth. The present study aims at analyzing the influence of the atmospheric conditions on premature births.MethodOne hundred and eight nine cases of premature births were included in the study, with a gestational age between 24 to 37 weeks of amenorrhea. Cases with antepartum fetal death and those with uncertain gestational age have been excluded. Daily weather data were obtained using http://www.wunderground.com site.A Pearson’s product-moment correlation was run to assess the relationship between weekly preterm birth incidence and the total number of premature births and the mean maximum and minimum temperature (Tmax, Tmin), maximum and minimum average humidity (Umax, Umin), maximum and minimum atmospheric pressure mean (P max, P min), average wind speed and average quantity precipitations, calculated for one calendar week.ResultsApproximately 7.7% of all births during the study period occurred before 37 weeks of gestation, the main reason for hospitalization being premature rupture of membranes (45%). The analysis revealed a moderate positive correlation between weekly preterm birth incidence and the average temperature (r=0.306, n=52, p=0.027) and a moderate positive correlation between weekly preterm birth incidence and temperature variation (r=0.307, n=52, p=0.007). Our study found no significant statistic correlation between the humidity variation, pressure variation, and wind speed.ConclusionsThe incidence of premature births can be influenced by variations of specific weather factors, especially during the weeks characterized by large fluctuations in temperature. The results obtained might inspire the construction of multicenter studies to investigate more thoroughly the adverse effects of some meteorological factors that can influence the outcomes of human pregnancy.

How safely can post-term pregnancies with uncertain gestational age be followed up using amniotic fluid index measurements?

Objective. To review whether 2 weeks’ follow-up is safe for women at 42 weeks with an uncertain gestational age (GA) and amniotic fluid index (AFI) of ≥10 cm, as well as reassuring cardiotocography (CTG). Methods. A retrospective descriptive study of women with an uncertain GA of 42 weeks was done at Tygerberg Hospital. The women had weekly CTG and AFI determinations. Induction of labour followed non-reassuring CTG or an AFI of <5. Results. A total of 135 women were studied. The time interval between first evaluation at uncertain 42 weeks and delivery ranged between 0 and 46 days (median 10 days). Of the women, 104 had normal vaginal deliveries and 31 (23.0%) caesarean sections. Eleven women (8.1%) with an AFI ≥10 had CS for fetal distress within 2 weeks of the visit at 42 weeks. No neonatal morbidity or mortality was noted. Conclusion. Weekly monitoring with CTG and AFI at 42 weeks with unsure GA is safe. A follow-up visit after 2 weeks cannot be recommended, as 8% of women required CS within less than 2 weeks because of fetal distress.

Mass spectrometric profiling of cord blood serum proteomes to distinguish infants with intrauterine growth restriction from those who are small for gestational age and from control individuals

Intrauterine growth restriction (IUGR) is a multifactorial condition in that the fetus does not reach its genetically given growth potential. Besides its contribution to perinatal mortality, it is a risk factor for cardiovascular and metabolic diseases later in life. The diagnosis is based on antenatal sonography, which allows differentiating between IUGR and fetuses that are small by constitution (small for gestational age [SGA]). Yet, neither a clinical nor a biochemical tool is available to confirm reliably the diagnosis of IUGR postnatally. Recently, we identified umbilical cord blood proteins of the apolipoprotein family by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry with differential signal intensities between the IUGR group and a control group. We hypothesized that identified molecules have the potential to generate a proteome profile specific for IUGR. A total of 114 serum samples (42 from the IUGR group, 12 from the SGA group, and 60 from the control group) of the umbilical vein (99 samples) and umbilical artery (15 samples) were analyzed. Sample quality was estimated by determining the abundance of hemoglobin (hemolysis) and CXC-motif chemokines CXCL4 and CXCL7 (platelet activation). Samples passing the quality criteria were forwarded to multiplex apolipoprotein profiling. Assay performance was tested with the sample sets, resulting in a sensitivity of 0.91 and a specificity of 0.85 in the test set with venous blood samples. Arterial cord blood samples followed the trend (sensitivity, 0.67; specificity, 0.85). SGA samples grouped together with the control samples. We conclude that the proteome profiling signature is confirmatory to clinical surveillance with the potential to identify neonates with IUGR postnatally in low-birth weight babies born at uncertain gestational age when antenatal sonography data have not been recorded.

Amyotrophic lateral sclerosis and riluzole use during pregnancy: A case report

arteri osus without clinical symptoms or haemody-namic repercussion. Association between ALS and pregnancy has rarely been described. Since 1977, 19 pregnancies in 16 women have been reported, including the present case (2 6). As foetal growth can be affected by mul-tiple factors, it is diffi cult to attribute this fi nding to the drug use. This is the fi rst report of association between riluzole use and cardiac malformation, although prevalence of cardiac malformations in the general population is considerable. Riluzole use during pregnancy is thought to be harmless, but foetal effects are unknown. It is catego-rized as a Class C drug by the Food and Drug Administration (FDA) (7). The only case of riluzole use throughout pregnancy reported a low birth weight of the newborn, but IURG was not consid-ered because of an uncertain gestational age (2). There has been another case in which riluzole was used until pregnancy diagnosis, at nine weeks GA, when the drug was discontinued (3). ALS seems not to cause obstetric complications. In advanced cases, respiratory complications have been described (4). This was not seen in our patient, whose neurological evaluation deteriorated as a normal progression. Also, uterine contractions seem not to be adversely affected by ALS (5). No clear evidence exists as to the better method of delivery. Besides incipient respiratory failure, caesarean delivery indication should follow obstetrics routine (6).

Full Length Article

On January 14, 2006, at approximately 10 am, our service—Neonatal Emergency Transport Service of Liguria Region, Gaslini Children's Hospital, Genoa University, Italy—received a request for neonatal transport from Pontremoli, Tuscan Region, back to our neonatal intensive care unit (NICU). Unfortunately, our NICU had no available beds, so we decided to fly from Pontremoli to the NICU at Santa Chiara Hospital in Pisa. Pontremoli is a little village close to mountains on the way to the largest Italian plain, Padana plain, and to the city of Parma. The patients were micropreemie twins of uncertain gestational age (approximately 23–24 weeks).

Ponderal index for discrimination between symmetric and asymmetric growth restriction: Percentiles for neonates from 30 weeks to 43 weeks of gestation

Aims. The ponderal index describes body proportionality at birth thus distinguishing symmetric from asymmetric growth restriction. We aimed to develop ponderal index percentiles for preterm and term neonates born in a European population.Methods. Auxologic data were obtained from neonates born from January 1990 to December 1998 from the datasets reported to the perinatal quality assurance system of the Federal State of Hesse, Germany. We excluded data from neonates with lethal malformations, with chromosomal aberrations, from multiple births, from neonates with uncertain gestational age, and from neonates of a gestational age of less than 30 completed weeks. We calculated the weekly 5th, 10th, 25th, 50th, 75th, 90th, and 95th ponderal index percentile values.Results. A total of 480 841 neonates (233 662 females and 247 179 males) were included. Charts and tables of ponderal index values show percentiles for males, females, and for the total group. There were no significant differences between boys and girls.Conclusion. Our data offer the ability to refer a neonate's body proportionality to updated percentiles. The percentiles allow the discrimination between symmetric and asymmetric growth restriction in preterm and term infants.

Sonographic diagnosis of intrauterine growth restriction (IUGR) by fetal transverse cerebellar diameter (TCD)/abdominal circumference (AC) ratio

Objective: To evaluate the validity of TCD/AC ratio in predicting IUGR. Study design: Prospective descriptive analysis. Setting: Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University. Subjects: Women meeting the inclusion criteria consisting of: (1) singleton pregnancies after 28 weeks of gestation; (2) known accurate gestational age; and (3) clinically suspected IUGR. Methods: The patients were sonographically examined for TCD/AC ratio. The best cut-off value of TCD/AC ratio in predicting IUGR was determined by a receiver operating characteristic (ROC) curve. The fetus with a TCD/AC ratio greater than the cut-off value would be antenatally diagnosed as IUGR for every gestational week. Standard definition of IUGR was a low birthweight, less than the l0 th percentile. Results: One hundred and sixty-seven pregnancies with suspected IUGR were analyzed. The prevalence of IUGR among the study group was 51.5%. The best cut-off value of the TCD/AC ratio for predicting IUGR was 15.4%, giving the sensitivity, specificity, positive predictive value and negative predictive value of 73.26%, 80.25%, 79.75%, and 73.86%, respectively. Conclusion: The sonographic fetal TCD/AC ratio as a gestational age-independent method can be helpful in antenatal diagnosis of IUGR, especially in pregnancy with uncertain gestational age.

Prenatal determination of lung maturity from amniotic fluid--indications and new methods

Although fetal lung maturity determination is carried out more and more rarely in the German-speaking area, a reliable information about the degree of lung maturity is still very important in the care of high-risk pregnancies. The side effects and costs of a postpartal surfactant administration can be avoided if lung maturity is proved. Indications for determination of fetal lung maturity are the threatening preterm delivery and the premature rupture of membranes before the 34th week of gestation and uncertain gestational age. Furthermore, in preeclampsia resp. in diabetes mellitus, which is difficult to control, premature delivery may be necessary. To improve lung maturity testing we introduce a new "sequence scheme" containing three lung maturity tests which are easy to carry out (in the following sequence: Amniostat-FLM ultrasensitive, counting of the lamellar bodies in amniotic fluid, surfactant/albumin ratio with TDx-FLM). The principle of this scheme is, that if any of these three tests indicates lung maturity, the sequence is terminated and no further test is performed. Only if all three tests indicated immaturity, the child was at risk for RDS. In 87 amniotic fluid samples with 7 RDS-cases, we achieved high predictive values for lung maturity (specificity 90%, sensitivity 100%, predictive value of positive test 47%, predictive value of negative test 100%). In 62% only one test was needed for lung maturity determination. It is possible to use other combinations in such a scheme (e.g. the L/S ratio). This might lead to equal or perhaps better results. An advantage of this suggested "sequence scheme" is that it can be performed in any clinic.

Evaluation of pulsatility index nomograms based on fetal biometry in small for gestational age fetuses.

Reference limits for the PI from the umbilical, middle cerebral, and renal arteries were constructed using BPD, AC, FL, and transverse cerebellar diameter as independent variables and their efficacy tested in a population of SGA fetuses. Therefore, 153 normal fetuses and 90 SGA fetuses with established dates between 20 and 40 weeks of gestation were considered. Normal fetuses showed a linear negative relationship between the PI from all the vessels investigated and all the biometric parameters considered. Although the BPD related better with the PI from the umbilical artery (r = 0.646) and the renal artery (r = 0.765) and the transverse cerebellar diameter related better with middle cerebral artery PI values (r = 0.510), no evident differences in fitting were found among the variables tested. In SGA fetuses the nomograms on BPD, AC, and FL significantly underestimated PI values in all the vessels studied when compared to the nomograms based on gestational age, while a similar ability in identifying abnormal PI values was found for nomograms based on gestational age and transverse cerebellar diameter. These newly developed nomograms based on transverse cerebellar diameter may prove useful in the evaluation of Doppler indices of fetuses with uncertain gestational age.

Audit of compliance with antenatal protocols.

To assess the implementation of action protocols dictated by antenatal risk factors noted at the initial (booking) antenatal visit. Retrospective study of 2000 women delivered between 1 March 1990 and 29 March 1991. Maternity department of a district general hospital supporting a multiethnic population in inner London. Comparison of clinical actions performed against those dictated by the department's protocols. Analysis according to clinical importance, gestation at booking, maternal age, parity, birth order, ethnic origin, and certainty of gestational age. Interobserver agreement between the two auditors was good (kappa statistic for risk factors detected, 0.78; for actions generated, 0.80). Of the 15,658 actions dictated by department protocols, 3673 (23.5%) were actually performed by the clinicians. The 63 combinations of risk factors and actions believed by consultants to be of particular clinical importance had an action rate of 28.3% compared with 18.6% for those considered less important (p < 0.001). Mothers who first visited the hospital antenatal clinic at or before 24 weeks' gestation had 25.2% of relevant protocols fulfilled (p < 0.001). Compliance was significantly improved in women aged 36 or over (32.4%), black women (24.9%), and cases of uncertain gestation (24.5%). Parity and birth order were not associated with an altered action rate. Ethnic origin deemed as "other" (than white, black, Asian, or oriental) or "unknown" was associated with poor compliance (19.3%). Compliance to a set of agreed protocols was poor even though a computer system was available and a protocol manual had been distributed. Protocols were more likely to be implemented in women who booked early and in some groups of women deemed at high risk including older mothers, black women, and those denoted as having uncertain gestational age.

Doppler flow studies (duplex sonography). Differential diagnostic assessment of intrauterine growth retardation and uncertain gestational age

In 116 patients referred to Heidelberg University Gynecological Clinic because of a discrepancy between calculated and biologically determined gestational age, the suitability of the Doppler Flow examination method (duplex method) for resolving this question was studied. The signals from the fetal descending aorta, the umbilical artery, and from maternal placental vessels were used. An A/B ratio of over 7 in the fetal aorta, an A/B ratio of over 4 in the umbilical artery, and detection of an early diastolic incisure in the so-called arcuate arteries were considered pathologic. The relatively high accuracy of this examination method is expressed by its sensitivity (91%) and likewise high specificity (86%) for this diagnostic question. In view of the predictive value of 88% thus determined, reliable differential diagnostic distinction between intrauterine growth retardation and uncertainty regarding term appears possible. Doppler sonographic examination can be performed without causing any serious discomfort to the patient and within a short period of time. While the number of false-positive results in this study was in any case relatively low (11%), an in-depth analysis showed that an "acute placental insufficiency" had occurred in the peripartum in more than one-half of the cases.

CONCENTRATIONS OF TRIGLYCERIDES, FREE FATTY ACIDS AND GLYCEROL IN CORD BLOOD OF NEWBORN INFANTS WITH A BIRTH WEIGHT OF ≤2700 GRAMS

Concentrations of triglycerides, free fatty acids (FFA) and glycerol were measured in umbilical venous blood from 99 infants with a birth weight of between 1100-2700 g and a gestational age of 27-41 weeks. Thirty infants were small for gestational age (SGA), 58 were appropriate (AGA) and 11 were of uncertain gestational age. In AGA infants with a gestational age of less than or equal to 35 weeks. FFA values were lower than in those with a gestational age of less than 35 weeks; otherwise concentrations of triglycerides, FFA and glycerol were independent of birth weight and gestational age in AGA infants. In SGA infants, higher FFA values were found compared with both AGA and term infants of normal birth weight. Triglyceride values were higher in SGA than in AGA infants. In SGA infants, a significant positive correlation was found between gestational age and concentrations of both FFA and triglycerides. No differences in FFA, glycerol and triglyceride concentrations were seen between asphyxiated and non-asphyxiated AGA infants.