Evaluation of transverse cerebellar diameter to abdominal circumference ratio in prediction of intrauterine growth retardation

Background: Intrauterine growth restriction accounts for a significant increase in perinatal mortality rate as well as immediate neonatal morbidity and continuing long term disability in some of the survivors. A different clinical problem develops in infants of same weight but different gestational age therefore identification of high risk newborns based on gestational age and weight. Hence without an accurate knowledge of gestational age, the clinician is significant hampered in an attempt to differentiate truly growth restricted fetus from a patient with incorrect gestational parameters. TCD is emerging as a new sonografic parameter and least affected by fetal growth restriction while liver is most affected organ.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 birth weight, less than the 10th percentile.Results: Eighty 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 15.87%, giving the sensitivity, specificity, positive predictive value and negative predictive value of 81.25%, 62.25%, 89.65%, and 45.45%, respectively.Conclusions: The sonographic fetal TCD/AC ratio as a gestational age-independent, useful, feasible and sensitive method for antenatal diagnosis of IUGR, especially in pregnancy with uncertain gestational age. Routine TCD/AC ratio should be performed to diagnose IUGR.

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Intrauterine Growth Restriction: Antenatal and Postnatal Aspects

Clinical Medicine Insights Pediatrics ◽

10.4137/cmped.s40070 ◽

2016 ◽

Vol 10 ◽

pp. CMPed.S40070 ◽

Cited By ~ 151

Author(s):

Deepak Sharma ◽

Sweta Shastri ◽

Pradeep Sharma

Keyword(s):

Birth Weight ◽

Gestational Age ◽

Intrauterine Growth Restriction ◽

Perinatal Asphyxia ◽

Neonatal Morbidity ◽

Growth Restriction ◽

Growth Potential ◽

Intrauterine Growth ◽

Health And Disease ◽

Neonatal Problems

Intrauterine growth restriction (IUGR), a condition that occurs due to various reasons, is an important cause of fetal and neonatal morbidity and mortality. It has been defined as a rate of fetal growth that is less than normal in light of the growth potential of that specific infant. Usually, IUGR and small for gestational age (SGA) are used interchangeably in literature, even though there exist minute differences between them. SGA has been defined as having birth weight less than two standard deviations below the mean or less than the 10th percentile of a population-specific birth weight for specific gestational age. These infants have many acute neonatal problems that include perinatal asphyxia, hypothermia, hypoglycemia, and polycythemia. The likely long-term complications that are prone to develop when IUGR infants grow up includes growth retardation, major and subtle neurodevelopmental handicaps, and developmental origin of health and disease. In this review, we have covered various antenatal and postnatal aspects of IUGR.

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Early Uterine and Umbilical Artery Doppler Indices as Predictor for Preeclampsia and Intrauterine Growth Restriction

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2021/v33i2031113 ◽

2021 ◽

pp. 116-126

Author(s):

Sara E. Khalil ◽

Mohammed M. Elnamory ◽

Mona K. omar ◽

Hesham M. Eltokhy

Keyword(s):

Gestational Age ◽

Predictive Value ◽

Intrauterine Growth Restriction ◽

Umbilical Artery ◽

Growth Restriction ◽

Intrauterine Growth ◽

Doppler Study ◽

Significant Difference ◽

Umbilical Artery Doppler ◽

Doppler Indices

Background: Preeclampsia (PE) is a disorder that causes hypertension and proteinuria after week 20 of pregnancy. Several Uterine Artery (UtAs) Doppler characteristics have been investigated for their ability to predict PE. The purpose of this research is to look into the uterine and umbilical arterial Doppler indices in the early second trimester for the prediction of late preeclampsia or intrauterine growth restriction. Methods: This is a prospective cohort clinical study and was done at Obstetrics and Gynecology department, faculty of medicine Tanta university hospital from January 2020 till April 2021. 150 pregnant women aged from 18 to 30 years old with gestational age from 13 to 16 weeks of pregnancy. Study was done by the same observer by machine MINDRAY DC60 Measurement of fetal biometry (BPD, FL, AC, HC) Gestational age was confirmed with Detection of congenital malformation. Results: There is a significant difference between the groups regarding uterine and umbilical artery doppler Indices. Uterine RI only yielded significance for predicting IUGR with sensitivity of 62% and specificity of 88%, with Positive predictive value (PPV) 37% and Negative predictive value (NPV) 92%. Umbilical resistance index achieved sensitivity of 56% and specificity of 82%, with PPV 31% and NPV 30% with on statistical significance. Conclusions: Combination of uterine and umbilical artery Doppler study in early pregnancy is one of the best indicator for prediction of preeclampsia and IUGR. Therefore, Doppler study may be used for the prediction of preeclampsia and IUGR to reduce the maternal and perinatal morbidity and mortality.

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Gastroschisis: incidence and prediction of growth restriction

Journal of Perinatal Medicine ◽

10.1515/jpm-2014-0283 ◽

2015 ◽

Vol 43 (5) ◽

Cited By ~ 7

Author(s):

Fadi G. Mirza ◽

Samuel T. Bauer ◽

Anne Van der Veer ◽

Lynn L. Simpson

Keyword(s):

Gestational Age ◽

Intrauterine Growth Restriction ◽

Growth Restriction ◽

Fetal Weight ◽

Abdominal Circumference ◽

Month Of Birth ◽

Intrauterine Growth ◽

Increased Risk ◽

Tertiary Center ◽

Estimated Fetal Weight

AbstractFetuses with gastroschisis are at increased risk of intrauterine growth restriction (IUGR). However, there is a tendency for underestimation of fetal abdominal circumference and hence fetal weight, leading to overdiagnosis of IUGR. Our objective was to evaluate the accuracy of ultrasound for the prediction of being small for gestational age (SGA) at birth in these cases.A retrospective study of prenatally diagnosed cases of gastroschisis was conducted at a tertiary center. Fetal weight was estimated using the formula of Hadlock. IUGR was defined as an estimated fetal weight ≤10th percentile for gestational age. SGA at the time of birth was defined as a birth weight ≤10th percentile for gestational age. The incidence of IUGR on last ultrasound and that of SGA at birth were calculated, and the precision of ultrasound in predicting SGA was determined.IUGR was reported on the last ultrasound prior to delivery in 9/25 cases (36%). Postnatally, 13/25 newborns (52%) were SGA. All sonographically suspected cases of IUGR based on the last ultrasound were SGA at birth. The positive predictive value of the last ultrasound in identifying SGA was 100%.At least half of the infants affected by gastroschisis were SGA at birth. Sonographic estimation of fetal weight within 1 month of birth reliably predicted SGA in infants with gastroschisis.

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P205 Maternal left ventricular global longitudinal strain correlates with parameters of fetal intrauterine growth and uteroplacental hemodynamics

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.073 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

C Palermo ◽

D Muraru ◽

L Badano ◽

E Balducci ◽

S Carli ◽

...

Keyword(s):

Fetal Growth ◽

Gestational Age ◽

Longitudinal Strain ◽

Left Ventricular ◽

Growth Restriction ◽

Abdominal Circumference ◽

Intrauterine Growth ◽

Lv Mass ◽

Lv Volumes ◽

Mass Volume

Abstract Impairment of physiological mechanisms responsible for maternal cardiovascular adaptation during pregnancy may be associated to intrauterine growth restriction (IUGR). Purpose To compare maternal cardiac parameters between pregnancies with IUGR and with fetal growth appropriate for gestational age (AGA). Methods Twenty-one IUGR (median age 31 years) were compared with 18 AGA matched for age, body size and gestational age (p > 0.35 for all). LV volumes and ejection fraction (LVEF) were measured by 3D echocardiography, and LV mass (LVM) and outflow velocity time integral (VTI) by conventional echocardiography. LV longitudinal strain (GLS) was assessed by speckle-tracking. Results Compared to AGA, IUGR mothers had similar LV volumes and LVEF, but larger LV mass (76 vs 63 g/m2, p = 0.006), LV mass/volume (1.14 vs 1.0 g/ml, p = 0.036) and lower VTI (19.9 vs 21.5 cm, p = 0.046) and GLS (-20 vs -22%, p = 0.032). Maternal LV GLS correlated with fetal growth and utero-placental hemodynamics (Table). At ROC curve analysis, maternal GLS had a good ability to discriminate IUGR from AGA (Figure). Conclusions IUGR had larger LV mass/volume and lower GLS than AGA. GLS was more sensitive than LVEF to detect LV function changes in IUGR. This is the first study reporting that worse maternal LV GLS correlates with fetal growth restriction and suboptimal utero-placental hemodynamics. Rho Spearman p APGAR score 0.36 0.03 Birthweight percentile 0.38 0.02 Biparietal diameter 0.47 0.003 Cranial circumference 0.31 0.07 Abdominal circumference 0.30 0.07 Umbilical vein velocity 0.64 0.003 Uterine artery mean pulsatility index -0.36 0.028 LV length 0.36 0.034 LV mid diameter 0.32 0.05 LV end-systolic volume 0.34 0.046 MAPSE 0.45 0.006 TAPSE 0.41 0.004 Mitral E wave 0.50 0.002 Mitral A wave 0.38 0.02 Correlation of maternal GLS (considered as positive) and fetal parameters. Abstract P205 Figure. GLS ability to discriminate IUGR vs AGA

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INTRAUTERINE GROWTH RETARDATION - A REVIEW ARTICLE

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2018.6.25a ◽

2018 ◽

pp. 184-195

Author(s):

Minh Son Pham ◽

Vu Quoc Huy Nguyen ◽

Dinh Vinh Tran

Keyword(s):

Fetal Growth ◽

Gestational Age ◽

Small For Gestational Age ◽

Fetal Growth Restriction ◽

Growth Restriction ◽

Growth Potential ◽

National Guidelines ◽

Intrauterine Growth ◽

No Gold Standard

Small for gestational age (SGA) and fetal growth restriction (FGR) is difficult to define exactly. In this pregnancy condition, the fetus does not reach its biological growth potential as a consequence of impaired placental function, which may be because of a variety of factors. Fetuses with FGR are at risk for perinatal morbidity and mortality, and poor long-term health outcomes, such as impaired neurological and cognitive development, and cardiovascular and endocrine diseases in adulthood. At present no gold standard for the diagnosis of SGA/FGR exists. The first aim of this review is to: summarize areas of consensus and controversy between recently published national guidelines on small for gestational age or fetal growth restriction; highlight any recent evidence that should be incorporated into existing guidelines. Another aim to summary a number of interventions which are being developed or coming through to clinical trial in an attempt to improve fetal growth in placental insufficiency. Key words: fetal growth restriction (FGR), Small for gestational age (SGA)

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Neonatal Outcomes at Extreme Prematurity by Gestational Age Versus Birth Weight in a Contemporary Cohort

American Journal of Perinatology ◽

10.1055/s-0040-1722606 ◽

2021 ◽

Author(s):

Elizabeth B. Ausbeck ◽

Phillip Hunter Allman ◽

Jeff M. Szychowski ◽

Akila Subramaniam ◽

Anup Katheria

Keyword(s):

Birth Weight ◽

Umbilical Cord ◽

Gestational Age ◽

Predictive Value ◽

Neonatal Death ◽

Controlled Trial ◽

Neonatal Morbidity ◽

Mortality And Morbidity ◽

Severe Morbidity ◽

Multicenter Randomized Controlled Trial

Objective The aim of the study is to describe the rates of neonatal death and severe neonatal morbidity in a contemporary cohort, as well as to evaluate the predictive value of birth gestational age (GA) and birth weight, independently and combined, for neonatal mortality and morbidity in the same contemporary cohort. Study Design We performed a secondary analysis of an international, multicenter randomized controlled trial of delayed umbilical cord clamping versus umbilical cord milking in preterm infants born at 23 0/7 to 31 6/7 weeks of gestation. The current analysis was restricted to infants delivered <28 weeks. The primary outcomes of this analysis were neonatal death and a composite of severe neonatal morbidity. Incidence of outcomes was compared by weeks of GA, with planned subanalysis comparing small for gestational age (SGA) versus non-SGA neonates. Multivariable logistic regression was then used to model these outcomes based on birth GA, birth weight, or a combination of both as primary independent predictors to determine which had superior ability to predict outcomes. Results Of 474 neonates in the original trial, 180 (38%) were included in this analysis. Overall, death occurred in 27 (15%) and severe morbidity in 139 (77%) neonates. Rates of mortality and morbidity declined with increasing GA (mortality 54% at 23 vs. 9% at 27 weeks). SGA infants (n = 25) had significantly higher mortality compared with non-SGA infants across all GAs (p < 0.01). There was no difference in the predictive value for neonatal death or severe morbidity between the three prediction options (GA, birth weight, or GA and birth weight). Conclusion Death and severe neonatal morbidity declined with advancing GA, with higher rates of death in SGA infants. Birth GA and birth weight were both good predictors of outcomes; however, combining the two was not more predictive, even in SGA infants. Key Points

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Predicting Perinatal Outcome from Prenatal Ultrasound Characteristics in Pregnancies Complicated by Gastroschisis

Fetal Diagnosis and Therapy ◽

10.1159/000440699 ◽

2015 ◽

Vol 39 (4) ◽

pp. 279-286 ◽

Cited By ~ 13

Author(s):

Gabriella Martillotti ◽

Isabelle Boucoiran ◽

Amélie Damphousse ◽

Andrée Grignon ◽

Eric Dubé ◽

...

Keyword(s):

Gestational Age ◽

Predictive Value ◽

Intrauterine Growth Restriction ◽

Adverse Outcome ◽

Prenatal Ultrasound ◽

Intestinal Lumen ◽

Third Trimester ◽

Mesenteric Circulation ◽

Intrauterine Growth ◽

Bowel Dilatation

Introduction: The objective of the study was to establish the predictive value of prenatal ultrasound markers for complex gastroschisis (GS) in the first 10 days of life. Material and Methods: In this retrospective cohort study over 11 years (2000-2011) of 117 GS cases, the following prenatal ultrasound signs were analyzed at the last second- and third-trimester ultrasounds: intrauterine growth restriction, intra-abdominal bowel dilatation (IABD) adjusted for gestational age, extra-abdominal bowel dilatation (EABD) ≥25 mm, stomach dilatation, stomach herniation, perturbed mesenteric circulation, absence of bowel lumen and echogenic dilated bowel loops (EDBL). Results: Among 114 live births, 16 newborns had complex GS (14.0%). Death was seen in 16 cases (13.7%): 3 intrauterine fetal deaths, 9 complex GS and 4 simple GS. Second-trimester markers had limited predictive value. Third-trimester IABD, EABD, EDBL, absence of intestinal lumen and perturbed mesenteric circulation were statistically associated with complex GS and death. IABD was able to predict complex GS with a sensitivity of 50%, a specificity of 91%, a positive predictive value of 47% and a negative predictive value of 92%. Discussion: Third-trimester IABD adjusted for gestational age appears to be the prenatal ultrasound marker most strongly associated with adverse outcome in GS.

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Reference Values for Transverse Cerebellar Diameter Throughout Gestation

Pediatric and Developmental Pathology ◽

10.1007/s10024-001-0262-4 ◽

2002 ◽

Vol 5 (5) ◽

pp. 489-494 ◽

Cited By ~ 7

Author(s):

Halit Pinar ◽

Sarah H. Burke ◽

Carol W. Huang ◽

Don B. Singer ◽

C. James Sung

Keyword(s):

Reference Values ◽

Growth Curve ◽

Gestational Age ◽

Normal Values ◽

Growth Restriction ◽

Reliable Indicator ◽

Transverse Diameter ◽

Reliable Parameter ◽

Gestational Week ◽

Duration Of Gestation

The transverse cerebellar diameter (TCD) is well established in the ultrasound literature as a reliable parameter for estimating the duration of gestation. In cases of growth restriction the cerebellum is usually spared, making TCD a reliable indicator of gestational age even when other parameters fall off the appropriate growth curve. The purpose of this study is to establish normal values for the transverse diameter of the cerebellum in pathology specimens, and to determine if these values correlate with those obtained by ultrasound. We examined 96 specimens ranging from 14 to 42 weeks gestational age and found that our values correlate well with those published in the ultrasound literature. Mean TCD with 2 standard deviations for each gestational week were determined as reference values.

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