Reference values for the volumes of foetal heart atrial wall by three-dimensional ultrasound using STIC and VOCAL methods between 20w0d and 33w6d weeks of gestation

Objective: To establish reference values for the volumes of foetal heart atrial wall by three-dimensional (3D) ultrasound using spatio-temporal image correlation (STIC) and virtual organ computer-aided analysis (VOCAL) methods.

Methods: We performed a retrospective cross-sectional study with 170 normal singleton pregnancies between 20 weeks?+?0 days (20w0d) and 33 weeks?+?6 days (33w6d) of gestation. Foetal heart atrial wall volume was obtained by VOCAL method with 30-degree rotation (six planes) subtracting the internal volume from the atrium volume. Polynomial regression with adjustments by determination coefficient (R²) was performed. To calculate the interobserver reproducibility, concordance correlation coefficient (CCC) was applied.

Results: The mean?±?standard deviation (SD) for the left atrium wall volume (cm³) ranged from 0.54?±?0.21 at 20w0d–20w6d to 2.17?±?0.30 at 33w0d–33w6d. The mean?±?SD for the right atrium wall volume (cm³) ranged from 0.45?±?0.16 at 20w0d–20w6d to 2.17?±?0.62 at 33w0d–33w6d. We observed a satisfactory interobserver reproducibility with CCC?=?0.69 and 0.58 for the left and right volumes of foetal heart atrial wall, respectively. The best-fit models were first-degree: volume for the left atrium wall?=??2.194?+?0.139*GA (R^2?=^?0.41) and volume for the right atrium wall?=??2.757?+?0.155*GA (R^2?=^?0.37).

Conclusion: Reference values for the volumes of foetal heart atrial wall by 3D ultrasound using STIC and VOCAL methods between 20w0d and 33w6d weeks of gestation were established.     

Fetal cardiac interventricular septum: volume assessment by 3D/4D ultrasound using spatio-temporal image correlation (STIC) and virtual organ computer-aided analysis (VOCAL)

Objective: To determine reference values for fetal interventricular septum (IVS) volume by 3D/4D ultrasound using spatio-temporal image correlation (STIC) and virtual organ computer-aided analysis (VOCAL).

Methods: A prospective cross-sectional study was conducted on 200 consecutive normal low-risk pregnant women at a gestational age ranging from 18w0d to 33w6d. The volume data sets of the fetal heart were acquired by applying STIC to a four-chamber plane. IVS volume was calculated offline using VOCAL with rotation of 30° (six planes). To assess the correlation of fetal IVS volume as a function of gestational age (GA), Pearson’s correlation coefficient (r) and polynomial regression models with adjustments through the coefficient of determination (R²) were calculated. The intra-class coefficient (ICC) was used to evaluate intra- and inter-observer reproducibility.

Results: A good correlation between GA and fetal IVS volume (r?=?0.827) was observed. The mean fetal IVS volume ranged from 0.13?±?0.03?cm³ (0.08–0.18?cm³) at 18wd0 of gestation to 1.33?±?0.37?cm³ (0.41–1.98?cm³) at 33w6d. The best correlation between fetal IVS volume and GA was exponential: fetal IVS volume?=?0.11e^0.139×GA (R^2?=?0.785). A good intra- and inter-observer reliability were observed, with ICC?=?0.999 and 0.991, respectively.

Conclusions: Reference values for fetal IVS volume using STIC and VOCAL by 3D/4D ultrasound between 18w0d and 33w6d of gestation were determined and showed to be reliable and concordant.     

Reference values for the fetal lateral ventricle atrium measurement in the second and third trimesters of pregnancy in a Brazilian population

Objective: To establish reference values for the fetal atrium lateral ventricle measurements in the second and third trimesters of pregnancy in a Brazilian population.

Methods: A retrospective cross-sectional study was performed with low-risk pregnant women who underwent ultrasound examination at 16–41 weeks of gestation. The atrium of lateral ventricle measurement was performed in the transventricular plane at the end of choroid plexus. We assessed reference curves (percentiles 5th, 50th and 95th) for the atrium of lateral ventricle measurement with gestational age (GA), using the best-fit polynomial equation, and determination coefficient (R²) and modeling the variability.

Results: The fetal atrium of lateral ventricle measurements was assessed in 519 singleton pregnancies. However, seven fetuses were excluded because of central nervous system malformations, and therefore data from 512 pregnancies were included in the analysis. The mean?±?standard deviation (range) of the fetal atrium lateral ventricle measurement (mm) was 5.1?±?1.4 (1.6–9.7). A best-fit curve was a first-degree polynomial regression: atrium lateral ventricle?=?6.455???0.049?×?GA (R²?=?0.05).

Conclusion: Reference values for the fetal atrium lateral ventricle measurements in the second and third trimesters of pregnancy in a Brazilian population were established.     

Reference range of fetal nasal bone length between 18 and 24 weeks of pregnancy in an unselected Brazilian population: experience from a single service

Abstract

Objective: To determine reference range of fetal nasal bone length (NBL) during the second trimester of pregnancy in a Brazilian population.

Methods: This was a retrospective cross-sectional study with 2681 normal singleton pregnancies between 18 and 24 weeks of gestation. The NBL was obtained in the mid-sagittal plane of the fetal face profile using the following landmarks: nasal bone, overlying skin and the tip of the nose. The NBL was measured by placing the calipers in the out-to-out position. To assess the correlation between NBL and gestational age (GA), polynomial equations were calculated, with adjustments by coefficient of determination (R²).

Results: The mean of NBL ranged from 5.72?±?0.87?mm at 18–18?+?6 weeks to 7.45?±?1.23?mm at 24–24+6 weeks of pregnancy. We observed a good correlation between NBL and GA, best represented by a linear equation: NBL?=?0.080+0.276*GA (R^2?=?0.16).

Conclusion: We established a reference range of fetal NBL in the second trimester of pregnancy in a Brazilian population.     

Serial assessment of amniotic fluid index in uncomplicated term pregnancies: prognostic value of amniotic fluid reduction

Objective: Assessment of amniotic fluid volume in association with a non-stress test is a commonly used method to monitor fetal well-being in high-risk pregnancies. The aims of our study were to determine whether oligohydramnios and the trend in amniotic fluid volume have prognostic significance in low-risk pregnancies between 40.0 and 41.6 weeks' gestation.

Methods: Between January 1997 and December 2000, all uncomplicated gestations with a singleton non-anomalous fetus reaching 40.0 weeks' gestation underwent semi-weekly monitoring of amniotic fluid index (AFI) until delivery. Oligohydramnios was defined as an AFI of ??5?cm. Changes in AFI were expressed as centimeters per day, and were calculated as: [(last AFI before delivery minus first AFI at 40.0 weeks) / interval in days between the two scans]. Adverse outcome was considered the occurrence of 5-min Apgar score <?7; umbilical artery pH <?7.0; Cesarean section for fetal distress; or fetal death. Comparisons between the groups with favorable and adverse outcomes was performed with χ² or Fisher's exact test for categorical variables, and Student's t test for continuous variables. A two-tailed p value <?0.05 was considered significant.

Results: A total of 3050 women met the study criteria, and underwent a median number of two (range 1–7) sonographic assessments of AFI after 40.0 weeks, with oligohydramnios detected in 341 women. In 1466 women at least two serial AFI determinations were obtained, allowing computation of an AFI trend. Gestations resulting in adverse perinatal outcome (n?=?167, 5.5%) had a significantly higher rate of oligohydramnios (33/167, 19.8% vs. 308/2883, 10.7%, p?=?0.001), but a similar rate of reduction in AFI (???0.65?±?0.64 vs. –?0.66?±?0.66?cm/day; p?=?0.85) than those with favorable outcome. The difference in rate of reduction of AFI between the two groups was not significant, even in the subset of gestations that developed oligohydramnios (???1.08?±?0.87 vs. –?1.26?±?0.89?cm/day; p?=?0.27).

Conclusion: A sonographic diagnosis of oligohydramnios carries an increased risk of adverse perinatal outcome, even in low-risk pregnancies after 40 weeks. The trend in amniotic fluid volume reduction does not seem to have prognostic significance.     

Fetal nuchal fold thickness measurement between 18 and 24 weeks of pregnancy: reference intervals for a Brazilian population

Objective: To determine reference intervals of fetal nuchal fold (NF) thickness measurement in the second trimester of pregnancy in a Brazilian population.

Methods: This was a retrospective cross-sectional study with 2559 normal singleton pregnancies between 18 and 24 weeks of pregnancy. The fetal NF was obtained in the axial plane of fetal head at level of lateral ventricles including the cavum septum pellucidum, third ventricle, thalamus and transverse cerebellar diameter. The NF was measured posterior to the occipital bone, from the bone surface to the skin, including only soft tissue. To assess the correlation between fetal NF and gestational age (GA), polynomial equations were calculated and adjusted to determination coefficient (R²).

Results: The mean fetal NF ranged from 3.98?±?1.14?mm at 18???18?+?6 to 4.83?±?0.93?mm at 24???24?+?6 weeks of gestation. A good correlation was observed between fetal NF and GA, which is better represented by a linear equation: NF?=?1.055?+?0.158*GA (R²?=?0.06).

Conclusion: Reference intervals of fetal NF thickness measurement in the second trimester of pregnancy were determined for a Brazilian population.     

Reference ranges for the uterine arteries Doppler and cervical length measurement at 11–13(+6) weeks of gestation in a Brazilian population

Objective: To establish references ranges for the uterine arteries (UtA) Doppler and cervical length (CL) measurements at 11–13(+6) weeks of gestation in a Brazilian population.

Methods: We performed a retrospective cross-sectional study with singleton low-risk pregnant women who underwent first trimester ultrasound exams of fetuses with crown-rump length (CRL) ranging from 45 to 84?mm. The mean UtA Doppler and CL measurements were performed by transvaginal route. The mean pulsatility index (PI) of uterine arteries was obtained with color Doppler at the level of cervico-corporeal junction. The CL was obtained in a sagittal view using the cervical gland area as landmark. We determined mean?±?standard deviation (SD), ranges for mean PI of UtA and CL in each gestational age. Polynomial regression was performed to establish reference values.

Results: We have assessed 598 first-trimester pregnancies: the CL measurement was obtained from 497, while the mean PI UtA Doppler was available in 450 pregnant women. The mean CL ranged from 33.41 to 35.58?mm while the PI UtA Doppler ranged from 1.89 to 1.45. The best fit curves were: CL?=?30.790?+?0.057?×?CRL and UtA PI?=?2.411?0.011?×?CRL.

Conclusion: References ranges for the mean UtA PI Doppler and CL measurement at 11–13(+6) weeks of gestation in a Brazilian population were established.     

Predictive role of transvaginal ultrasonographic measurement of cervical length at 34 weeks for late pre-term and late-term deliveries in nulliparous women

Objective: To investigate the predictive role of transvaginal ultrasonographic measurement of cervical length (CL) at 34 weeks of gestation in determining late-preterm and late-term deliveries in nulliparous women.

Methods: CL was measured by transvaginal ultrasonography at 34 weeks in 318 women (singleton, nulliparous, low-risk and vertex presentation). All women were followed-up till birth and delivered at hospital. Deliveries were classifed according to gestational week as late-preterm (34^0/7 to 36^6/7 weeks), term (37^0/7 to 40^6/7 weeks) and late-term (41^0/7 to 41^6/7 weeks).

Results: There was a significant correlation between CL at 34 weeks and gestational week at delivery (r?=?0.614, p?<?0.001). Receiver-operating characteristic curve analysis showed that CL measurement below 25.5?mm predicted late-preterm delivery with a sensitivity of 80.0%, specificity of 93.9%, positive predictive value (PPV) of 52.6% and negative predictive value (NPV) of 98.2%; while CL above 42.5?mm had 70.4% sensitivity, 93.5% specificity, 50.0% PPV and 97.1% NPV in prediction of late-term delivery.

Conclusion: Measurement of CL with transvaginal ultrasonography at 34 weeks of gestation can be of beneficial in predicting the risk of late-preterm and late-term deliveries in nulliparous women.     

The effect of gestational age on neonatal outcome in low-risk singleton term deliveries

Objective: To assess the association between gestational age at delivery and adverse neonatal outcome among term low-risk singleton neonates.

Methods: A retrospective cohort study design was used. The study group included all low-risk singleton term (37?+?0 to 41?+?6 weeks) newborns delivered in a single tertiary university-affiliated medical center over a 5-year period. Outcome of neonates delivered at 37?+?0 to 37?+?6 weeks of gestation (early term) and 41?+?0 to 41?+?6 weeks of gestation (late term) was compared to that of neonates delivered at 39?+?0–39?+?6 weeks of gestation (control).

Results: Overall, the outcome of 30?229 neonates was analyzed. The incidence of neonatal mortality was 1.0 per 1000 live-born neonates, with no significant difference between the various gestational age groups. Early term newborns were at higher risk for respiratory morbidity, hypoglycemia, hypocalcemia, thrombocytopenia and unexplained jaundice, and had higher rates of prolonged hospital stay, NICU admission, sepsis workup and antibiotic treatment. On multivariate analysis, early term delivery was an independent predictor for composite respiratory morbidity (OR=2.4, 95% CI 1.6–3.8, p?p?p?p?Conclusion: Even in low-risk singleton deliveries, early term is associated with an increased risk of neonatal morbidity.     

Reference ranges of fetal adrenal gland and fetal zone volumes between 24 and 37 + 6 weeks of gestation by three-dimensional ultrasound

Objective: To establish reference ranges of the fetal adrenal gland (AG) and fetal zone (FZ) volumes using three-dimensional ultrasound (3DUS).

Methods: We performed a prospective cross-sectional study with 204 normal singleton pregnancies between 24 and 37?+?6 weeks of gestation. The fetal AG and FZ volumes were obtained using the virtual organ computer-aided analysis method with a 30° rotation. To establish reference ranges as the function of gestational age (GA), quantile regression was performed with the adjusted coefficient of determination (R²). Intra- and inter-observer repeatability was performed using the intraclass correlation coefficient (ICC).

Results: The mean results of fetal AG and FZ values were 0.42?cm³ (0.04–1.22) and 0.10?cm³ (0.02–0.47), respectively. The best-fit quantile regression models for fetal AG and FZ volumes as the function of GA were in first-degree models: AG = ?0.937?+?0.041 × GA (R^2?=^?0.124) and FZ = ?0.201?+?0.009 × GA (R^2?=^?0.127), respectively. We observed good intra-observer repeatability of fetal AG and FZ volumes, with an ICC of 0.996 and 0.989, respectively. We also observed good inter-observer repeatability, with an ICC of 0.972 and 0.966 for AG and FZ, respectively.

Conclusion: The reference ranges of AG and FZ volumes using 3DUS between 24 and 37?+?6 weeks of gestation were established and exhibited good repeatability.     

Differences in amniotic fluid patterns and fetal biometric parameters in third trimester pregnancies with and without diabetes

Objective.?The amniotic fluid index (AFI) has been increasingly used in the assessment of fetal well-being. We conducted the study to evaluate and compare the amniotic fluid index in third trimester normal and diabetic human pregnancy and to assess the correlation between the AFI and the fetal biometric parameters.

Methods.?Real-time ultrasound was performed to evaluate the AFI (four-quadrant technique), and to measure the biparietal diameter, head circumference, abdominal circumference, and femur length in 225 normal and 120 diabetic pregnant women from 27 to 42 weeks of gestation. Each patient was studied only once.

Results.?AFI in normal pregnancies was less than that in diabetic pregnancies throughout the gestational ages studied (27–42 weeks). In normal pregnancy, the mean AFI was 14.0 cm at 27 weeks and decreased to 11.4 cm at 42 weeks (r = 0.25, p = 0.0005), whereas in diabetic pregnancies, the values remained stable throughout the gestational ages studied. There exist significant differences in AFI, estimated fetal weight, estimated fetal weight %, abdominal circumference, abdominal circumference %, and head circumference to abdominal circumference ratio between the two groups. In both normal and diabetic pregnancies, there is a positive correlation between the AFI and the percentile of abdominal circumference (p < 0.0001), and between the AFI and the percentile of estimated fetal weight (p < 0.0001).

Conclusion.?This study provides gestational age-specific values of the AFI in normal and diabetic pregnancies. Diabetic pregnancy has greater AFI values than normal pregnancy between 27 and 42 weeks. The AFI correlates to the percentile of the estimated fetal weight and the abdominal circumference in both groups, suggesting that there may be a relationship between increased AFI and large for gestational age fetus independent of diabetes.     

A scoring system for detection of macrosomia and prediction of shoulder dystocia: A disappointment

Objective. To develop a scoring system for the detection of a macrosomic fetus (birth weight (BW) ≥ 4000 g) and predict shoulder dystocia among large for gestational age fetuses.

Study design. We retrospectively identified all singletons with accurate gestational age (GA) that were large for GA (abdominal circumference (AC) or estimated fetal weight (EFW) ≥ 90% for GA) at ≥37 weeks with delivery within three weeks. The scoring system was: 2 points for biparietal diameter, head circumference, AC, or femur length ≥90% for GA, or if the amniotic fluid index (AFI) was ≥24 cm; for biometric parameters <90% or with AFI <24 cm, 0 points. The predictive values for detection of shoulder dystocia were calculated.

Results. Of the 225 cohorts that met the inclusion criteria the rate of macrosomia was 39% and among vaginal deliveries (n = 120) shoulder dystocia occurred in 12% (15/120; 95% confidence interval (CI) 7–20%). The sensitivity of EFW ≥4500 g to identify a newborn with shoulder dystocia was 0% (95% CI 0–21%), positive predictive values 0% (95% CI 0–46%), and likelihood ratio of 0. For a macrosomia score >6, the corresponding values were 20% (4–48%), 25% (5–57%) and 2.3.

Conclusion. Though the scoring system can identify macrosomia, it offers no advantage over EFW. The scoring system and EFW are poor predictors of shoulder dystocia.     

Does the level of amniotic fluid have an effect on the accuracy of sonographic estimated fetal weight at term?

Objective: Controversy exists concerning the impact of amniotic fluid index (AFI) on the accuracy of sonographic estimation of fetal weight (EFW). Thus, we aimed to evaluate whether differences in AFI has an influence on the accuracy of sonographic EFW.

Methods: All term, singleton pregnancies which underwent a sonographic EFW and measurement of AFI within a week from delivery were included. Cases were stratified into three categories according to AFI: (1) Normal AFI (51–249?mm), (2) Oligohydramnios (AFI?≤?50?mm) and (3) Polyhydramnios (AFI?≥?250?mm). Inaccurate EFW was defined if there was more than 15% difference between sonographic EFW and actual birthweight.

Results: Overall, 1746 pregnancies were identified (1096 with normal AFI, 455 with oligohydramnios and 195 with polyhydramnios). Mean AFI was 115.8?±?60?mm, 28.1?±?13?mm and 293?±?35?mm, p?<?0.001, and mean sonographic EFW was 3182.5?±?573?g, 3118.8?±?517?g and 3713.2?±?461?g, p?<?0.001, respectively. Demographic data and gestational age at delivery were similar. Mean birthweight was 3221.7?±?535?g, 3132.5?±?505?g and 3654.1?±?480?g, p?<?0.001, respectively. The rate of inaccurate EFW was similar between the groups (8.4%, 8.7% and 9.7%, p?=?0.19, respectively). On multivariate analysis, AFI was not associated with EFW inaccuracy (OR 1.01, 95% C.I 0.67–1.54, p?=?0.93).

Conclusion: AFI has limited impact on the percentage of errors in sonographic fetal weight estimation a week prior delivery.     

Reference range for the pulsatility index ductus venosus Doppler measurement between 11 and 13 + 6 weeks of gestation in a Brazilian population

Objective: To establish reference range for the pulsatility index (PI) ductus venosus (DV) Doppler measurement between 11 and 13?+?6 weeks of gestation in a Brazilian population.

Methods: A retrospective cross-sectional study was performed with 430 singleton pregnancies. The PI DV Doppler measurement was performed as routine during the first trimester screening. DV was identified by color Doppler and the pulsed Doppler gate was placed in the distal portion of the umbilical sinus. When at least three typical DV waveforms were obtained, PI DV was measured manually in one waveform. Polynomial regression was used to obtain the best fit using PI DV Doppler measurement and crown-rump length (CRL) with adjustments by the determination coefficient (R²). 5th, 50th and 95th percentiles for the PI DV Doppler measurements at each gestational were determined.

Results: The mean of PI DV Doppler measurement was 1.1?±?0.2 (range 0.8–3.7). The linear regression was the best fit: PI DV measurement?=?1.288–0.0034*CRL (R^2?=?0.03).

Conclusions: Reference range for the PI DV Doppler measurement between 11 and 13?+?6 weeks of gestation in a Brazilian population was established.     

Reference range for the fetal intracranial translucency measurement between 11 and 14 + 2 weeks of gestation in a Brazilian population

Objective: To establish a reference range for the fetal intracranial translucency (IT) measurement between 11 and 14?+?2 weeks in a Brazilian population.

Methods: A retrospective cross-sectional study was performed with 199 low-risk singleton pregnancies during the first trimester ultrasound exam. The IT (fourth ventricle width) measurement was performed in a mid-sagittal view of fetal profile defined by two echogenic borders – the dorsal part of the brain stem anteriorly and the choroid plexus of the fourth ventricle posteriorly. Polynomial regression was used to obtain the best fit using fetal IT measurements and crown-rump length (CRL). Percentiles 5th, 50th and 95th were determined for each gestational age.

Results: The mean of fetal IT ranged from 1.6 mm at CRL 45 to 2.0 mm at CRL 84 mm. A best fit curve was a first-degree polynomial regression: IT measurement?=?1.001?+?0.0124?×?CRL (R²=0.09).

Conclusion: Reference range for the fetal IT measurement between 11 and 14?+?2 weeks of gestation in a Brazilian population was established.     

Fetal thymus: visualization rate and volume by integrating 2D- and 3D-ultrasound during 2nd trimester echocardiography

Objective: To assess the visualization rate and transverse diameter of fetal thymus by two-dimensional ultrasound (2DUS) as well as the fetal thymus volume by three-dimensional ultrasound (3DUS) during the 2nd trimester echocardiography.

Methods: A prospective cross-sectional study involving 100 normal fetuses between 18w0d and 23w6d was performed. The identification of fetal thymus and peri-thymic vessels was realized at level of three vessels and trachea (3VT). The transverse diameter was obtained placing a line cursor perpendicular to the line connecting the sternum and the spine. The fetal thymus volume was obtained by virtual organ computer-aided analysis (VOCAL) with 30° of rotation. We used the percentage of visualization rate of 2D structures and means and 95% confidence intervals (CI) for fetal thymus transverse diameter and volume.

Results: The visualization rate of fetal thymus by 2DUS was of 100% in all gestational ages using the 3VT view. Addition of color Doppler ultrasound facilitates identification of the thy-box and enhanced the calculation of both fetal thymus transverse diameter and volume. The mean fetal thymus transverse diameter by 2DUS ranged from 11?mm at 18 weeks to 19?mm at 23 weeks of gestation. The mean fetal thymus volume by 3DUS ranged from 1.25?cm³ at 18 weeks to 2.61?cm³ at 23 weeks of gestation.

Conclusion: We demonstrated a high visualization rate of fetal thymus and peri-thymic vessels by 2DUS during the 2nd trimester echocardiography. The measurements of transverse diameter by 2DUS and the volume by 3DUS also showed a high success rate.     

Decreased placental thickness and impaired Doppler indices in idiopathic polyhydramnios: a prospective case–control study

Objective: To evaluate placental thickness, Doppler velocimetry, biophysical profile and perinatal outcomes in pregnancies complicated by idiopathic polyhydramnios.

Materials and methods: This prospective case–control study was conducted on 139 pregnant women, of these 70 patients with idiopathic polyhydramnios comprised the study group and 60 pregnant women comprised the control group. Risk factors recorded were; age, parity, body mass index (BMI), gestational weeks, amniotic fluid index (AFI), biophysical profiles (BPP), placental thickness, middle cerebral artery pulsatility index (MCA PI), umbilical artery Doppler velocimetry (Umb A S/D) values and perinatal outcomes.

Results: Sixty-nine of the cases had mild-moderate (AFI: 250–450?mm) polyhydramnios (%98.5) and one of the cases had severe polyhydramnios (>450?mm) in study group. There was no statistically significant difference between the groups in terms of age, parity, BMI, gestational weeks, fetal birth weights and BPP (p?>?0.05). Placental thickness, MCA PI and UA S/D values showed statistically significant difference between the groups (p?<?0.05). The fetuses with lower placental thickness had lower scores of biophysical profile. There were negative correlations between placental thickness and AFI (r?=??0.265), umbilical artery S/D and placental thickness (r?=??0.212), MCA PI and AFI (r?=??171, p?=?0.44). However there was a positive correlation between AFI and umbilical artery Doppler values (r?=?0.450).

Conclusion: Idiopathic polyhydramnios is associated with decreased placental thickness, impaired uterine, umbilical and middle cerebral artery flow.     

Postdates induction with an unfavorable cervix and risk of cesarean*

Objective: To determine the risk of cesarean delivery associated with postdates induction (≥41 weeks) compared to term induction (37–40w6d) among women with an unfavorable cervix, and to examine the risk factors associated with cesarean among women undergoing postdates induction.

Methods: A planned secondary analysis of a large prospective cohort study on induction (n?=?854) was performed. Women with a singleton gestation, intact membranes, and an unfavorable cervix (Bishop score of ≤6 and dilation ≤2?cm) who were undergoing a term (≥37 weeks) induction for any indication were included. Women with a prior cesarean were excluded. The primary outcome was cesarean delivery. Relative risk of cesarean was estimated using a modified Poisson’s regression model.

Results: There was a significantly increased risk of cesarean for women undergoing postdates induction (n?=?154) compared to women 37–40w6d (n?=?700), (46.8 versus 26.0%, p?p?Conclusions: Women ≥41 weeks undergoing an induction with an unfavorable cervix are at a significantly increased risk of cesarean compared to women 37–40w6d, with nulliparity, obesity, and cervical dilation <1?cm being independent risk factors. These data can be used to augment patient counseling and support the ongoing discussion regarding the risk of post dates induction.     

Evaluation of antenatal corticosteroid prescribing patterns among 984 women at risk for preterm delivery

Abstract

Objective: To evaluate the prescribing patterns of the first antenatal corticosteroids (ACS) course in our tertiary referral centre from 2005 until 2010.

Study design: We conducted a retrospective cohort study including all women who received ACS between 24⁺⁰ and 34⁺⁰ weeks of gestation. Main outcome measure was the number of women who delivered within 7?d after ACS administration. The time interval from administration to delivery was compared between women with different indications. Furthermore, all women delivering between 24⁺⁰ and 34⁺⁰ weeks of gestation who did not receive ACS were identified.

Results: 1008 women received ACS, 15 (1.5%) women were lost to follow up. Main indications were suspected preterm labour, preterm prelabour rupture of membranes, maternal indication, foetal indication and vaginal blood loss (VBL). Overall, 447 (45.4%) women delivered ≤7?d after ACS administration. This percentage was 13.6% in women with VBL and 61.5% in women with maternal indication. During the study period, 1267 women delivered before 34 weeks of gestation, 126 (9.9%) women did not receive ACS.

Conclusions: The time interval from ACS administration to delivery differs per indication. Women with VBL are most often over treated. The timing of the first ACS course should be improved.     

Facial shape; height and width in the second and third trimester of pregnancy

Objectives: The objective of this study is to calculate on 3D volumes obtained from 16 weeks’ gestation normative data of facial height (FH), facial width (FW) and their ratio and to test these parameters in pathological cases.

Methods: In total, 228 volumes were analyzed: 207 from normal and 21 from pathological cases. After multiplanar correction to the exact midsagittal plane FH was measured from the nasion to the gnathion and FW between the most lateral points on the zygomatic arch.

Results: For both FH and FW the intra- and inter-observer intraclass correlation coefficient variability was 0.99 and the difference between paired measurements was less than 0.3?cm in 95% of the cases. FH increased from 1.48 to 5.08?cm (FH?=??16.10?+?3.78?×?log(GA), R²: 0.93) and FW from 2.20 to 6.42?cm (FW: 4.19–17.18?×?log(GA), R²: 0.85). The ratio increased steadily until about 25 weeks and less thereafter (ratio: (1/GA)?×?26.44?+?0.92, R²: 0.23). In pathological cases 16.6% of measurements were outside the normal range.

Conclusions: This study provides normative data for FH and FW measurements and insight in normal facial growth after 16 weeks’ gestation. FH exceeds FW growth especially before 25 weeks.