Update Reference Charts: Fetal Biometry between the 15th and 20th Week of Gestation

To construct new reference charts and equations for fetal biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur diaphysis length (FDL) from Korean fetuses at 12-40 weeks. Prospective cross-sectional data obtained in one center for 5 years from a population of pregnant women undergoing ultrasound examination between the 12th and 40th week of gestation. Exclusion criteria comprised all maternal and fetal conditions possibly affecting fetal biometry. No fetuses were excluded on the basis of abnormal biometry. For each measurement, regression models were fitted to estimate both the mean and the standard deviation at each menstrual age. Biometric measurements were obtained for 10 455 fetuses. New charts and reference equations are reported for BPD, HC, AC and FDL. Reference equations are cubic models. We present new Korean reference charts and equations for fetal biometry. They can be easily used in obstetric ultrasound studies for the Korean population.

Annals for Educators - 21 August 2018.

Background:trans unsaturated fatty acids are thought to interfere with essential fatty acid metabolism. To extend our knowledge of this phenomenon, we investigated the relationship between trans isomeric and long-chain polyunsaturated fatty acids (LCPUFA) in mothers during pregnancy and in their infants at birth. Methods: Fatty acid composition of erythrocyte phosphatidylcholine (PC) and phosphatidylethanolamine (PE) was determined in Spanish (n = 120), German (n = 78) and Hungarian (n = 43) women at the 20th and 30th week of gestation, at delivery and in their newborns. Results: At the 20th week of gestation, the sum of trans fatty acids in PE was significantly (p < 0.01) lower in Hungarian [0.73 (0.51), % wt/wt, median (IQR)] than in Spanish [1.42 (1.36)] and German [1.30 (1.21)] women. Docosahexaenoic acid (DHA) values in PE were significantly (p < 0.01) higher in Hungarian [5.65 (2.09)] than in Spanish [4.37 (2.60)] or German [4.39 (3.3.2)] women. The sum of trans fatty acids significantly inversely correlated to DHA in PCs in Spanish (r = –0.37, p < 0.001), German (n = –0.77, p < 0.001) and Hungarian (r = –0.35, p < 0.05) women, and in PEs in Spanish (r = –0.67, p < 0.001) and German (r = –0.71, p < 0.001), but not in Hungarian (r = –0.02) women. Significant inverse correlations were seen between trans fatty acids and DHA in PEs at the 30th week of gestation (n = 241, r = –0.52, p < 0.001), at delivery (n = 241, r = –0.40, p < 0.001) and in cord lipids (n = 218, r = –0.28, p < 0.001). Conclusion: Because humans cannot synthesize trans isomeric fatty acids, the data obtained in the present study support the concept that high maternal trans isomeric fatty acid intake may interfere with the availability of LCPUFA both for the mother and the fetus.

For the first time, the rate of spontaneous abortion is reported in a multicenter study of three different gynecological centers. In 1987 und 1988, the average spontaneous abortion rate in 315 pregnancies was 3.3%, after foetal heart actions had been verified by ultrasonic examination between the 7th and 12th week of gestation. A statistical significance has been calculated between the spontaneous abortion rate of 6.3%, if foetal heart beats were seen between the 7th and 9th week, and the spontaneous abortion rate of 1.0% with an evidence of foetal life (p less than 0.01) between the 10th to 12th week of gestation. The rate of spontaneous abortion of women above 34 years of age (8.9%) is statistically different (p less than 0.01) to that of women under 35 (1.9%). In women older than 34, the spontaneous abortion rate before the 10th week of gestation is 22.2% in contrast to 3.2% of women younger than 35 (p less than 0.01). Considering the evidence of foetal heart actions between the 10th and 12th week, the spontaneous abortion rate of women above the age of 34 is 1.9%, compared to 0.8% of women younger than 35. The statistical higher spontaneous abortion rate of women above the age of 34 before the 10th week of gestation and the lack of statistical difference of the abortion rate in this defined age group for foetal life to be proven from the 10th week on, should be an argument in favour of the 10th week of gestation as the earliest date of prenatal diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)

The aim of the study was to assess the value of the today's appropriate approach, preterm delivery in the 34th week of gestation by Caesarean section and subsequent surgical intervention at the perinatal center, in daily practice of pediatric surgery with regard to early postoperative and mid-term outcome. Over the time period of 9 years, all consecutive cases diagnosed with gastroschisis at the perinatal center, University Hospital of Magdeburg, were born by Caesarean section within the 34th week of gestation followed by surgical intervention. The registered data were compared with those published by other groups. Overall, there were 19 cases through the investigation period from 01/01/2006 to 12/31/2014. The mean duration of gestation was 237.9 days. The mean birth weight was 2,276 g. In all individuals, a primary closure with no artificial material was achieved. The duration of postoperative artificial respiration was 2.3 days. Oral uptake could be initiated on the 10th postoperative day on average. The mean hospital stay was 37 days. There was no lethality. As complications, postoperative (iv catheter-associated) sepsis occurred in one case and relaparotomy became necessary in a further case because of no possible completion of enteral nutrition by 20 days after primary closure (complication and relaparotomy rate, 10.5% and 5.26%, respectively). The data indicate that in case of gastroschisis, primary closure can be more frequently achieved by section within the 34th week of gestation. Under the prediction of an optimal neonatological care, the risks of a preterm delivery by a planned section appear to be manageable.

Taste buds are assemblies of slender epithelial cells that receive chemical stimuli from the outer (oral) environment. In contrast to the large and well documented information on the morphology of taste buds in adult humans and animals, there are only a few reports on fetal ones, and ultrastructural studies of prenatal human taste buds are lacking completely. Therefore, the present investigation has been carried out to study the taste bud primordium, its morphological changes including synaptogenesis, cell differentiation, and taste pore formation from the time of the onset of taste bud formation around the 8th week until the 15th postovulatory week. Taste bud primordia of 42 human embryonic/fetal tongues have been examined by means of transmission electron microscopy. Nerve fibers approach the lingual epithelium between the 6th and 7th postovulatory week. They penetrate the basal lamina during the 8th week and form synapses with poorly differentiated, elongated, epithelial cells. By the 12th week, more differentiated cell types are seen: 1) electron-dense cells resembling type III cells of the adult taste bud containing large numbers of dense-cored vesicles (80-150 nm in diameter); 2) electron-dark cells with well developed endoplasmic reticulum and many apical mitochondria, being candidates for type II cells. Basally, these cells have foot-like processes containing dense-cored vesicles (120-200 nm in diameter), but they do not synapse to nerve fibers. Type I cells, characterized by apically located dense secretory granules, are not observed. First shallow grooves above the taste bud primordium are found around the 10th week. Untypically differentiated apical cellular processes extend onto the surface. Most of the taste pores develop around the 14th to 15th week. In the taste pit, mucous material is not present during the first 15 weeks of gestation. Synapses between cells and afferent nerve fibers were found by the 8th week, reaching a maximum around the 12th to 13th week. The early presence of taste bud cells containing dense-cored vesicles suggests an at least dual function of embryonic/ fetal taste buds: First, from the 8th until the 14th week, non-gustatory, paracrine functions should be considered. After the 14th week of gestation, when typical taste pores are present, the taste buds possibly start their gustatory function. Differentiated marginal cells are possibly involved in the formation of the taste pore. The lack of type I cells producing the mucous material in the taste pit indicates that the taste bud has not achieved a fully developed function until the 15th week of gestation.

The aim of the study was to assess the utility of mid-trimester ultrasound parameters in predicting birth weight in low-risk pregnancy and high-risk pregnancy complicated with pregestational diabetes mellitus. A study group comprised 97 healthy women and 160 women with pregestational diabetes (PGDM, type 1), all in singleton pregnancy. Ultrasound examination was performed between weeks 11 and 14, and in weeks 20 and 30 of gestation, based on recommendations of the Polish Society of Gynecologists and Obstetricians, Ultrasonography Division. We also checked uterine artery blood flow parameters. There is a correlation between the birth weight and ultrasound-ascertained parameters, including those characterising uterine artery blood flow and foetal biometry [abdominal circumference (AC), femoral length (FL), biparietal dimension (BPD)].The biparietal dimension (BPD), head circumference (HC) abdominal circumference (AC) and pre-existing diabetes are the ultrasound predictors of LGA. The presence of an early-diastolic uterine artery blood flow waveform notching, as well as the uterine artery pulsatility index (UAPI), femoral length (FL) and hypertension in pregnancy are the ultrasound predictors of SGA. In the subset of women with pre-gestational diabetes (PGDM), there is a negative correlation between the birth weight and the uterine artery pulsatility index and early-diastolic uterine artery blood flow waveform notching. In women with pre-gestational diabetes mellitus (PGDM), femoral length (FL) is a significant predictor of LGA and in case of SGA significant predictors are uterine artery pulsatility index, artery blood flow waveform notching and femoral length (FL). Midtrimester ultrasound parameters with confirmed usefulness in the prediction of birth weight in low-risk pregnancy and high-risk pregnancy complicated with pregestational diabetes mellitus include: uterine artery PI, early-diastolic uterine artery blood flow waveform notching and foetal biometry.

Female fetuses, on average, weigh less than male fetuses at all gestational ages. The purpose of this study was to compare female and male fetuses in terms of intrauterine ultrasound growth measurements and to develop gestational-age-related charts based on a computerized perinatal database. This was a retrospective study of unselected women in the second and third trimesters of pregnancy, who had a normal scan at 10-14 weeks. Data analysis was performed using measurements obtained from a mixed-race population of 4234 women, who underwent 5198 ultrasound examinations. The scans were performed by four trained sonographers, according to a standardized protocol. Routine measurements included biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL). The main end-points were sex- and race-specific differences in fetal biometry, which were also used to estimate fetal weight. The base-line demographic characteristics and risk factors were comparable in female and male fetuses. Significant differences in fetal BPD, HC, AC and estimated fetal weight, but not FL, were seen between male and female fetuses. Centile charts for each of these variables were constructed for both male and female fetuses. This study suggests that small but consistent sex-related differences in prenatal BPD, HC and AC measurements are established by as early as 15 weeks of gestation. The use of sex-specific nomograms may improve the prenatal assessment of fetal growth as well as the diagnosis of structural abnormalities.

The assessment of normal fetal liver volume by three-dimensional ultrasound.

Purpose: To correlate fetal outcome and placental histology of fetuses with umbilical cord Doppler S/D-ratios below the 5th percentile. Design and Methods: Among a total of 4000 fetuses 180 showed an umbilical Doppler resistance index below the 5th percentile, 250 above the 95th percentile and 3,650 within the normal range. We obtained 1-4 individual measurements per case. Results: Among 180 fetuses with low fetoplacental impedance we found in 68 (38%) growth retardation, in 36 (20%) premature delivery and in 30 (17%) the need for Caesarean section for fetal asphyxia. In cases with elevated S/D-ratio these figures were 125 (50%), 98 (39%) and 50 (20%), respectively. These amounts differed significantly from the reference group. If low impedance was detected before the 28th week of gestation (66 cases), we observed growth retardation in 40 cases (60%), in 22 (30%) premature delivery and in 16 (25%) cesarean section for fetal asphyxia. In cases with elevated S/D-ratio before 28th week of gestation (n=40) these figures were 33 (80%), 22 (55%) and 20 (50%), respectively. If low impedance occurred later (114 cases), the figures were 28 (25%), 14 (12%) and 14 (12%), respectively. In cases with high impedance after the 28th week (210 cases) these figures were 93 (44%), 75 (36%) and 30 (14%), respectively. This was also statistically significant. From the placentamorphological point of view low fetoplacental impedance reflects accelerated villus maturation whereas high impedance represents retarded maturation of the villus tree. Conclusion: There is some evidence that strikingly low umbilical resistance indices, assumed to demonstrate a particularly good fetal blood supply, may also indicate a placental compensatory phenomenon due to imminent placental insufficiency with the need for more intensive fetal surveillance, especially if this flow pattern is observed before the 28th week of gestation.

Background: In routine ultrasonography, the ultrasonologist measures the bi-parietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL) in estimating the gestational age (GA) and estimated date of delivery. However, as the pregnancy advances these parameters become increasingly unreliable in prediction of GA. Estimation of GA in late second and third trimester accurately still a problem till now. Fetal kidney has been shown a steady growth of 1.7 mm fortnightly (every 2 weeks) along pregnancy and is unaffected by growth abnormalities. Many studies have reported that fetal kidney length (FKL) correlates with the gestational age in late trimester very strong. The study aimed to assess the accuracy of the gestational age estimated by mean fetal kidney length compared to multiple growth parameters like BPD, HC, AC & FL in addition to the actual gestational age derived from the reliable last menstrual period. Methods: Cross sectional hospital based study, was conducted at ultrasound unit; department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University from the period of July 2018 to December 2018. A total number of 115 Pregnant women at their third trimester by reliable LMP attended antenatal care clinic at Ain-Shams University Hospital and consented to participate in this study. Every woman was subjected to: Expected date of delivery was calculated according to Naegle’s formula: Ultrasonography: Fetal biometry and estimated date of delivery (EDD) by assessment of BPD, HC, FL & AC. Expected fetal weight measured by Hadlock formula. Fetal lie and presentation. Exclusion of fetal anomalies. Measurement of both right & left fetal kidney length. Results: In this study, 255 participants were recruited and assessed for eligibility, 125 women were allocated to perform obstetric ultrasound just 115 completed and were included in the final analysis. The current study found that there was a highly significant positive correlation between gestational age (according to ultrasound parameters) and KL, BDP, HC, AC and FL but Kidney length was the most correlated parameter. Also this study found that there was significant positive correlation between gestational age (according to LMP) and gestational age estimated by BPD, HC, AC, FL and KL with the most significant positive correlation being with KL. Also this study found that there was no significant difference (matched) in KL and Gestational age compared to other parameters. This means that KL is the most accurate parameter for Estimating Gestational age, correlation between MKL and GA by LMP (r = 0.951, p = 0.000) the most significant correlation. In this study, no significant difference was found between gestational age estimated by KL and gestational age in all stages of pregnancy. This means that KL remains accurate as a predictor for gestational age regardless stage of pregnancy. Conclusion: Kidney length can be used as an individual parameter in estimating gestational age.

Observational and intervention studies have reported inconsistent results of the relationship between polyunsaturated fatty acids (PUFAs) and hypertension during pregnancy. Here, we examined maternal plasma concentrations of n-3 and n-6 PUFAs between the 26th and the 28th week of gestation in relation to blood pressures and pregnancy-associated hypertension.We used data from a birth cohort study of 751 Chinese, Malay, and Indian women. Maternal peripheral systolic blood pressure (SBP) and diastolic blood pressure (DBP) were taken from the brachial arm, and central SBP and pulse pressures (PPs) were derived from radial artery pressure waveforms between the 26th and the 28th week of gestation. Pregnancy-associated hypertension (including gestational hypertension and preeclampsia) was ascertained from medical records. Plasma phosphatidylcholine n-3 and n-6 PUFAs were measured by gas chromatography and expressed as percentage of total fatty acids.Peripheral SBP was inversely associated with total n-3 PUFAs [-0.51 (95% confidence interval, CI, -0.89 to -0.13) mm Hg] and long-chain n-3 PUFAs [-0.52 (CI -0.92 to -0.13) mmHg]. Similar but weaker associations were observed for central SBP and PP. Dihomo-γ-linolenic acid was marginally positively associated with peripheral SBP, central SBP, and PP, whereas linoleic acid and total n-6 PUFAs showed no significant associations with blood pressures. We identified 28 pregnancy-associated hypertension cases, and 1% increase in total n-3 PUFAs was associated with a 24% lower odds of pregnancy-associated hypertension (odds ratio 0.76; 95% CI 0.60 to 0.97). Maternal ethnicity modified the PUFAs-blood pressure relations, with stronger inverse associations with n-3 PUFAs in Chinese women, and stronger positive associations with n-6 PUFAs in Indian women (P values for interaction ranged from 0.02 to 0.07).Higher n-3 PUFAs at midgestation are related to lower maternal blood pressures and pregnancy-associated hypertension in Asian women, and the ethnicity-related variation between PUFAs and blood pressures deserves further investigation.

Background/Objectives: To construct and compare multivariable prediction models for the early prediction of large-for-gestational-age (LGA) neonates, using ultrasound biometry and maternal characteristics. Methods: This retrospective cohort study analyzed data from singleton pregnancies that underwent routine ultrasound examinations at 30+0–34+0 weeks of gestation. Ultrasound parameters included fetal abdominal circumference (AC), head circumference (HC), femur length (FL), HC-to-AC ratio, mean uterine artery pulsatility index (mUtA-PI), and presence of polyhydramnios. LGA neonates were defined as those having a birthweight > 90th percentile. Logistic regression was used to evaluate associations between ultrasound markers and LGA after adjusting for the following maternal and pregnancy-related covariates: maternal age, body mass index, parity, gestational diabetes mellitus (GDM), pre-existing diabetes, previous cesarean section (PCS), assisted reproductive technology (ART) use, smoking, hypothyroidism, and chronic hypertension. Associations were expressed as adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Three prognostic models were developed utilizing the following predictors: (i) biometric ultrasound measurements including AC, HC-to-AC ratio, FL, UtA-PI, and polyhydramnios (Model 1), (ii) a combination of biometric ultrasound measurements and clinical–maternal data (Model 2), and (iii) only the estimated fetal weight (EFW) (Model 3). Results: In total, 3808 singleton pregnancies were included in the analyses. The multivariable analysis revealed that AC (aOR 1.07, 95% CI [1.06, 1.08]), HC to AC (aOR 1.01, 95% CI [1.006, 1.01]), FL (aOR 1.01, 95% CI [1.009, 1.01]), and the presence of polyhydramnios (aOR 4.97, 95% CI [0.7, 58.8]) were associated with an increased risk of LGA, while a higher mUtA-PI was associated with a reduced risk (aOR 0.98, 95% CI [0.98, 0.99]). Maternal parameters, such as GDM, pre-existing diabetes, elevated pre-pregnancy BMI, absence of uterine artery notching, mUtA-PI, and multiparity, were significantly higher in the LGA group. Both models 1 and 2 showed similar performance (AUCs: 84.7% and 85.3%, respectively) and outperformed model 3 (AUC: 77.5%). Bootstrap and temporal validation indicated minimal overfitting and stable model performance, while decision curve analysis supported potential clinical utility. Conclusions: Models using biometric and Doppler ultrasound at 30–34 weeks demonstrated good discriminative ability for predicting LGA neonates, with an AUC up to 84.7%. Adding maternal characteristics did not significantly improve performance, while the biometric model performed better than EFW alone. Sensitivity at conventional thresholds was low but increased substantially when lower probability cut-offs were applied, illustrating the model’s threshold-dependent flexibility for early risk stratification in different clinical screening needs. Although decision curve analysis was performed to explore potential clinical utility, external validation and prospective assessment in clinical settings are still needed to confirm generalizability and to determine optimal decision thresholds for clinical application.

Ultrasound biometry of Arabian fetuses

The application of Intuitionistic fuzzy total edge magic labelling to a graphical image at the 20th week of gestation provides insights into facilitates gender prediction as well as assessment of fetal blood flow on a second-trimester Doppler ultrasound screen. Ultrasounds screen the fetal heart rate during the 20th week of gestation using Doppler ultrasound for blood flow. A fetal heart rate above 2.5 beats per second suggests a female baby, while a rate less than 2.5 beats per second indicates a male baby. We convert the fetal heart blood flow into a graphical image and label it using intuitionistic fuzzy total edge magic labelling.