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Mazzone E, Kadji C, Cannie MM, Badr DA, Jani JC. Prediction of large-for-gestational age at 36 weeks' gestation: two-dimensional ultrasound vs three-dimensional ultrasound vs magnetic resonance imaging. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 63:489-496. [PMID: 37725758 DOI: 10.1002/uog.27485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/05/2023] [Accepted: 09/08/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE To compare the performance of two-dimensional ultrasound (2D-US), three-dimensional ultrasound (3D-US) and magnetic resonance imaging (MRI) at 36 weeks' gestation in predicting the delivery of a large-for-gestational-age (LGA) neonate, defined as birth weight ≥ 95th percentile, in patients at high and low risk for macrosomia. METHODS This was a secondary analysis of a prospective observational study conducted between January 2017 and February 2019. Women with a singleton pregnancy at 36 weeks' gestation underwent 2D-US, 3D-US and MRI within 15 min for estimation of fetal weight. Weight estimations and birth weight were plotted on a growth curve to obtain percentiles for comparison. Participants were considered high risk if they had at least one of the following risk factors: diabetes mellitus, estimated fetal weight ≥ 90th percentile at the routine third-trimester ultrasound examination, obesity (prepregnancy body mass index ≥ 30 kg/m2) or excessive weight gain during pregnancy. The outcome was the diagnostic performance of each modality in the prediction of birth weight ≥ 95th percentile, expressed as the area under the receiver-operating-characteristics curve (AUC), sensitivity, specificity and positive and negative predictive values. RESULTS A total of 965 women were included, of whom 533 (55.23%) were high risk and 432 (44.77%) were low risk. In the low-risk group, the AUCs for birth weight ≥ 95th percentile were 0.982 for MRI, 0.964 for 2D-US and 0.962 for 3D-US; pairwise comparisons were non-significant. In the high-risk group, the AUCs were 0.959 for MRI, 0.909 for 2D-US and 0.894 for 3D-US. A statistically significant difference was noted between MRI and both 2D-US (P = 0.002) and 3D-US (P = 0.002), but not between 2D-US and 3D-US (P = 0.503). In the high-risk group, MRI had the highest sensitivity (65.79%) compared with 2D-US (36.84%, P = 0.002) and 3D-US (21.05%, P < 0.001), whereas 3D-US had the highest specificity (98.99%) compared with 2D-US (96.77%, P = 0.005) and MRI (96.97%, P = 0.004). CONCLUSIONS At 36 weeks' gestation, MRI has better performance compared with 2D-US and 3D-US in predicting birth weight ≥ 95th percentile in patients at high risk for macrosomia, whereas the performance of 2D-US and 3D-US is comparable. For low-risk patients, the three modalities perform similarly. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E Mazzone
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - C Kadji
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M M Cannie
- Department of Radiology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
- Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - D A Badr
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - J C Jani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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Ikenoue S, Akiba Y, Ishii R, Otani T, Kasuga Y, Tanaka M. Association of maternal obesity with growth of fetal fractional limb volume. Early Hum Dev 2024; 191:105990. [PMID: 38518425 DOI: 10.1016/j.earlhumdev.2024.105990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/29/2024] [Accepted: 03/15/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Maternal obesity influences birth weight and newborn adiposity. Fetal fractional limb volume has recently been introduced as a useful parameter for the proxy of fetal adiposity. However, the association between maternal adiposity and the growth of fetal fractional limb volume has not been examined. AIMS To investigate the association of maternal pre-pregnancy BMI with the growth of fetal fractional limb volume. STUDY DESIGN Prospective cohort study. SUBJECTS Women with singleton uncomplicated pregnancies enrolled between July 2017 and June 2020. OUTCOME MEASURES Fetal fractional limb volume was assessed between 20 and 40 weeks' gestation, measured as cylindrical limb volume based on 50 % of the total diaphysis length. The measured fractional limb volume at each gestational week were converted to z-scores based on a previous report. The association between pre-pregnancy BMI and fetal fractional limb volume was examined. Maternal age, parity, gestational weight gain and fetal sex were considered as potential confounding variables. RESULTS Ultrasound scans of 455 fractional arm volume and thigh volume were obtained. Fractional limb volume increased linearly until the second trimester of gestation, then increased exponentially in the third trimester. Maternal pre-pregnancy BMI was significantly correlated with z-scores of fractional arm volume and thigh volume across gestation. The post-hoc analysis showed the association between pre-pregnancy BMI and fractional arm volume was significant especially between 34 and 40 weeks. CONCLUSIONS Maternal obesity influences the growth pattern of fetal fractional limb volume. Fractional arm volume may potentially provide a useful surrogate marker of fetal nutritional status in late gestation.
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Affiliation(s)
- Satoru Ikenoue
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan; Department of Obstetrics and Gynecology, Saitama Municipal Hospital, Saitama, Japan.
| | - Yohei Akiba
- Department of Obstetrics and Gynecology, Saitama Municipal Hospital, Saitama, Japan
| | - Ryota Ishii
- Department of Biostatistics, Institute of Medicine, University of Tsukuba, Japan
| | - Toshimitsu Otani
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Yoshifumi Kasuga
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Mamoru Tanaka
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
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Gembicki M, Offerman DR, Weichert J. Semiautomatic Assessment of Fetal Fractional Limb Volume for Weight Prediction in Clinical Praxis: How Does It Perform in Routine Use? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:355-364. [PMID: 33830545 DOI: 10.1002/jum.15712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Semiautomatic fractional limb volume (FLV) models have recently produced promising results for fetal birth weight (BW) estimation. We tested those models in a more unselected population hypothesizing that the FLV models would improve accuracy and precision of fetal BW estimation compared to the Hadlock model. METHODS We compared the performance of different BW prediction models: Hadlock (biparietal diameter [BPD], abdominal circumference (AC), femur diaphysis length) and modified Lee thigh volume (TVol) and arm volume (AVol) (BPD, AC, automated fractional TVol, and AVol). Accuracy (systematic errors, mean percent differences) and precision (random errors, ± 1 SD of percent differences) were calculated. RESULTS A total of 75 fetuses were included for final analysis. The Hadlock model showed the most consistent results with accurate BW estimation not significantly different from zero (-0.37 ± 8.53%). The modified fractional thigh and arm volume models were less accurate but trended toward more precise results (-2.63 ± 7.69% and -3.85 ± 7.47%, respectively). In addition, the modified TVol model showed the trend to predict more BWs within ±10% of the actual BW compared to the Hadlock model (81.3 versus 74.67%, ns). CONCLUSIONS Based on our results, fetal weight estimation using the modified semiautomatic FLV models generates less accurate results in third-trimester fetuses compared to the Hadlock model. Those models recently published might improve the results of BW prediction by showing a higher precision than conventional models, especially in small and large fetuses. Further studies are needed to investigate the clinical usefulness of the new models.
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Affiliation(s)
- Michael Gembicki
- Department of Gynecology and Obstetrics, Division of Prenatal Medicine, University Hospital of Schleswig-Holstein, Luebeck, Germany
| | - David R Offerman
- Department of Gynecology and Obstetrics, Division of Prenatal Medicine, University Hospital of Schleswig-Holstein, Luebeck, Germany
| | - Jan Weichert
- Department of Gynecology and Obstetrics, Division of Prenatal Medicine, University Hospital of Schleswig-Holstein, Luebeck, Germany
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Lee W. Soft tissue assessment for fetal growth restriction. Minerva Obstet Gynecol 2021; 73:442-452. [PMID: 33978351 DOI: 10.23736/s2724-606x.21.04829-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Contemporary clinical practice heavily relies on interpretation of population-based birth weight standards to evaluate neonatal nutrition status. Obstetricians have adopted the use of estimated fetal weight in a similar manner to estimate fetal nutritional status. However, most fetal weight prediction models overemphasize skeletal parameters such as biparietal diameter, head circumference, and femur diaphysis length. Although most EFW calculations also include abdominal circumference, this 2D growth parameter is largely defined by liver size and a small rim of subcutaneous fat. Advances in 3D ultrasound imaging and the development of more robust image analysis tools have now made it possible to reliably add a soft tissue component for fetal nutritional assessment. This chapter explains why fetal soft tissue evaluation is clinically relevant, describes different techniques for evaluating these sonographic parameters, and outlines future directions for their practical utility in the care of malnourished fetuses.
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Affiliation(s)
- Wesley Lee
- Division of Women's and Fetal Imaging, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA -
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Wu X, Niu Z, Xu Z, Jiang Y, Zhang Y, Meng H, Ouyang Y. Fetal weight estimation by automated three-dimensional limb volume model in late third trimester compared to two-dimensional model: a cross-sectional prospective observational study. BMC Pregnancy Childbirth 2021; 21:365. [PMID: 33964891 PMCID: PMC8106859 DOI: 10.1186/s12884-021-03830-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/19/2021] [Indexed: 11/25/2022] Open
Abstract
Background Accurate estimation of fetal weight is important for prenatal care and for detection of fetal growth abnormalities. Prediction of fetal weight entails the indirect measurement of fetal biometry by ultrasound that is then introduced into formulae to calculate the estimated fetal weight. The aim of our study was to evaluate the accuracy of fetal weight estimation of Chinese fetuses in the third trimester using an automated three-dimensional (3D) fractional limb volume model, and to compare this model with the traditional two-dimensional (2D) model. Methods Prospective 2D and 3D ultrasonography were performed among women with singleton pregnancies 7 days before delivery to obtain 2D data, including fetal biparietal diameter, abdominal circumference and femur length, as well as 3D data, including the fractional arm volume (AVol) and fractional thigh volume (TVol). The fetal weight was estimated using the 2D model and the 3D fractional limb volume model respectively. Percentage error was defined as (estimated fetal weight - actual birth weight) divided by actual birth weight and multiplied by 100. Systematic errors (accuracy) were evaluated as the mean percentage error (MPE). Random errors (precision) were calculated as ±1 SD of percentage error. The intraclass correlation coefficient (ICC) was used to analyze the inter-observer reliability of the 3D ultrasound measurements of fractional limb volume. Results Ultrasound examination was performed on 56 fetuses at 39.6 ± 1.4 weeks’ gestation. The average birth weight of the newborns was 3393 ± 530 g. The average fetal weight estimated by the 2D model was 3478 ± 467 g, and the MPE was 3.2 ± 8.9. The average fetal weights estimated by AVol and TVol of the 3D model were 3268 ± 467 g and 3250 ± 485 g, respectively, and the MPEs were − 3.3 ± 6.6 and − 3.9 ± 6.1, respectively. For the 3D TVol model, the proportion of fetuses with estimated error ≤ 5% was significantly higher than that of the 2D model (55.4% vs. 33.9%, p < 0.05). For fetuses with a birth weight < 3500 g, the accuracy of the AVol and TVol models were better than the 2D model (− 0.8 vs. 7.0 and − 2.8 vs. 7.0, both p < 0.05). Moreover, for these fetuses, the proportions of estimated error ≤ 5% of the AVol and TVol models were 58.1 and 64.5%, respectively, significantly higher than that of the 2D model (19.4%) (both p < 0.05). The inter-observer reliability of measuring fetal AVol and TVol were high, with the ICCs of 0.921 and 0.963, respectively. Conclusion In this cohort, the automated 3D fractional limb volume model improves the accuracy of weight estimation in most third-trimester fetuses. Prediction accuracy of the 3D model for neonatal BW, particularly < 3500 g was higher than that of the traditional 2D model.
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Affiliation(s)
- Xining Wu
- Department of ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Zihan Niu
- Department of ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Zhonghui Xu
- Department of ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Yuxin Jiang
- Department of ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Yixiu Zhang
- Department of ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Hua Meng
- Department of ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
| | - Yunshu Ouyang
- Department of ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
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Predicting fetal weight by three-dimensional limb volume ultrasound (AVol/TVol) and abdominal circumference. Chin Med J (Engl) 2021; 134:1070-1078. [PMID: 33883411 PMCID: PMC8116021 DOI: 10.1097/cm9.0000000000001413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Fetal weight is an important parameter to ensure maternal and child safety. The purpose of this study was to use three-dimensional (3D) limb volume ultrasound combined with fetal abdominal circumference (AC) measurement to establish a model to predict fetal weight and evaluate its efficiency. METHODS A total of 211 participants with single pregnancy (28-42 weeks) were selected between September 2017 and December 2018 in the Beijing Obstetrics and Gynecology Hospital of Capital Medical University. The upper arm (AVol)/thigh volume (TVol) of fetuses was measured by the 3D limb volume technique. Fetal AC was measured by two-dimensional ultrasound. Nine cases were excluded due to incomplete information or the interval between examination and delivery >7 days. The enrolled 202 participants were divided into a model group (134 cases, 70%) and a verification group (68 cases, 30%) by mechanical sampling method. The linear relationship between limb volume and fetal weight was evaluated using Pearson Chi-squared test. The prediction model formula was established by multivariate regression with data from the model group. Accuracy of the model formula was evaluated with verification group data and compared with traditional formulas (Hadlock, Lee2009, and INTERGROWTH-21st) by paired t-test and residual analysis. Receiver operating characteristic curves were generated to predict macrosomia. RESULTS AC, AVol, and TVol were linearly related to fetal weight. Pearson correlation coefficient was 0.866, 0.862, and 0.910, respectively. The prediction model based on AVol/TVol and AC was established as follows: Y = -481.965 + 12.194TVol + 15.358AVol + 67.998AC, R2adj = 0.868. The scatter plot showed that when birth weight fluctuated by 5% (i.e., 95% to 105%), the difference between the predicted fetal weight by the model and the actual weight was small. A paired t-test showed that there was no significant difference between the predicted fetal weight and the actual birth weight (t = -1.015, P = 0.314). Moreover, the residual analysis showed that the model formula's prediction efficiency was better than the traditional formulas with a mean residual of 35,360.170. The combined model of AVol/TVol and AC was superior to the Lee2009 and INTERGROWTH-21st formulas in the diagnosis of macrosomia. Its predictive sensitivity and specificity were 87.5% and 91.7%, respectively. CONCLUSION Fetal weight prediction model established by semi-automatic 3D limb volume combined with AC is of high accuracy, sensitivity, and specificity. The prediction model formula shows higher predictive efficiency, especially for the diagnosis of macrosomia. TRIAL REGISTRATION ClinicalTrials.gov, NCT03002246; https://clinicaltrials.gov/ct2/show/NCT03002246?recrs=e&cond=fetal&draw=8&rank=67.
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Lee W, Mack LM, Sangi-Haghpeykar H, Gandhi R, Wu Q, Kang L, Canavan TP, Gatina R, Schild RL. Fetal Weight Estimation Using Automated Fractional Limb Volume With 2-Dimensional Size Parameters: A Multicenter Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1317-1324. [PMID: 32022946 DOI: 10.1002/jum.15224] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 12/08/2019] [Accepted: 12/28/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To develop new fetal weight prediction models using automated fractional limb volume (FLV). METHODS A prospective multicenter study measured fetal biometry within 4 to 7 days of delivery. Three-dimensional data acquisition included the automated FLV that was based on 50% of the humerus diaphysis (fractional arm volume [AVol]) or 50% of the femur diaphysis (fractional thigh volume [TVol]) length. A regression analysis provided population sample-specific coefficients to develop 4 weight estimation models. Estimated and actual birth weights (BWs) were compared for the mean percent difference ± standard deviation of the percent differences. Systematic errors were analyzed by the Student t test, and random errors were compared by the Pitman test. RESULTS A total of 328 pregnancies were scanned before delivery (BW range, 825-5470 g). Only 71.3% to 72.6% of weight estimations were within 10% of actual BW using original published models by Hadlock et al (Am J Obstet Gynecol 1985; 151:333-337) and INTERGROWTH-21st (Ultrasound Obstet Gynecol 2017; 49:478-486). All predictions were accurate by using sample-specific model coefficients to minimize bias in making these comparisons (Hadlock, 0.4% ± 8.7%; INTERGROWTH-21st, 0.5% ± 10.0%; AVol, 0.3% ± 7.4%; and TVol, 0.3% ± 8.0%). Both AVol- and TVol-based models improved the percentage of correctly classified BW ±10% in 83.2% and 83.9% of cases, respectively, compared to the INTERGROWTH-21st model (73.8%; P < .01). For BW of less than 2500 g, all models slightly overestimated BW (+2.0% to +3.1%). For BW of greater than 4000 g, AVol (-2.4% ± 6.5%) and TVol (-2.3% ± 6.9%) models) had weight predictions with small systematic errors that were not different from zero (P > .05). For these larger fetuses, both AVol and TVol models correctly classified BW (±10%) in 83.3% and 87.5% of cases compared to the others (Hadlock, 79.2%; INTERGROWTH-21st, 70.8%) although these differences did not reach statistical significance. CONCLUSIONS In this cohort, the inclusion of automated FLV measurements with conventional 2-dimensional biometry was generally associated with improved weight predictions.
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Affiliation(s)
- Wesley Lee
- Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Lauren M Mack
- Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | | | - Rajshi Gandhi
- Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Qingqing Wu
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Li Kang
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Timothy P Canavan
- Magee-Women's Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Akiba Y, Ikenoue S, Endo T, Kasuga Y, Ochiai D, Miyakoshi K, Ishii R, Yakubo K, Tanaka M. Differences in fetal fractional limb volume changes in normal and gestational diabetic pregnancies: an exploratory observational study. BJOG 2020; 128:329-335. [PMID: 32298518 DOI: 10.1111/1471-0528.16265] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Fetal fractional limb volume has been proposed as a useful measure for quantifying fetal soft tissue development. The aim of this study was to investigate the growth of fractional arm volume (AVol) and fractional thigh volume (TVol) of fetuses with maternal gestational diabetes (GDM) compared with those of fetuses with normal glucose tolerance (NGT). We hypothesised fetal fractional limb volume would be larger in the GDM group than in the NGT group in late gestation. DESIGN Exploratory observational study. SETTING Saitama Municipal Hospital. SAMPLE A total of 165 (125 NGT and 40 GDM) singleton Japanese pregnant women. METHODS AVol and TVol were assessed between 20 and 37 weeks' gestation as cylindrical limb volumes based on 50% of the fetal humeral or femoral diaphysis length. Women were diagnosed as GDM based on the criteria of the Japan Society of Obstetrics and Gynecology. MAIN OUTCOME MEASURES AVol and TVol were compared between women with NGT and those with GDM at each gestational age period (2-week intervals from 20 to 37 weeks' gestation). RESULTS Overall, 287 ultrasound scans were performed (NGT group, 205 scans; GDM group, 82 scans). There was no significant difference of AVol between the groups before 32 weeks' gestation. AVol was significantly larger in the GDM group than in the NGT group after 32 weeks' gestation (P < 0.05). TVol was not statistically different between the groups across gestation. CONCLUSIONS Detection of variations in fetal AVol may provide greater insight into understanding the origins of altered fetal body proportion in GDM. TWEETABLE ABSTRACT AVol, but not TVol, is significantly larger in fetuses with GDM than in those with NGT after 32 weeks' gestation.
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Affiliation(s)
- Y Akiba
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan.,Department of Obstetrics and Gynecology, Saitama Municipal Hospital, Saitama, Japan
| | - S Ikenoue
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - T Endo
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan.,Department of Obstetrics and Gynecology, Saitama Municipal Hospital, Saitama, Japan
| | - Y Kasuga
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - D Ochiai
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - K Miyakoshi
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - R Ishii
- Biostatistics Unit, Clinical and Translational Research Center, Keio University School of Medicine, Tokyo, Japan
| | - K Yakubo
- Department of Obstetrics and Gynecology, Saitama Municipal Hospital, Saitama, Japan
| | - M Tanaka
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
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Does the Porter formula hold its promise? A weight estimation formula for macrosomic fetuses put to the test. Arch Gynecol Obstet 2019; 301:129-135. [PMID: 31883045 PMCID: PMC7028832 DOI: 10.1007/s00404-019-05410-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 12/07/2019] [Indexed: 11/06/2022]
Abstract
Purpose Estimating fetal weight using ultrasound measurements is an essential task in obstetrics departments. Most of the commonly used weight estimation formulas underestimate fetal weight when the actual birthweight exceeds 4000 g. Porter et al. published a specially designed formula in an attempt to improve detection rates for such macrosomic infants. In this study, we question the usefulness of the Porter formula in clinical practice and draw attention to some critical issues concerning the derivation of specialized formulas of this type. Methods A retrospective cohort study was carried out, including 4654 singleton pregnancies with a birthweight ≥ 3500 g, with ultrasound examinations performed within 14 days before delivery. Fetal weight estimations derived using the Porter and Hadlock formulas were compared. Results Of the macrosomic infants, 27.08% were identified by the Hadlock formula, with a false-positive rate of 4.60%. All macrosomic fetuses were detected using the Porter formula, with a false-positive rate of 100%; 99.96% of all weight estimations using the Porter formula fell within a range of 4300 g ± 10%. The Porter formula only provides macrosomic estimates. Conclusions The Porter formula does not succeed in distinguishing macrosomic from normal-weight fetuses. High-risk fetuses with a birthweight ≥ 4500 g in particular are not detected more precisely than with the Hadlock formula. For these reasons, we believe that the Porter formula should not be used in clinical practice. Newly derived weight estimation formulas for macrosomic fetuses must not be based solely on a macrosomic data set. Electronic supplementary material The online version of this article (10.1007/s00404-019-05410-7) contains supplementary material, which is available to authorized users.
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Hehir MP, Burke N, Burke G, Turner MJ, Breathnach FM, Mcauliffe FM, Morrison JJ, Dornan S, Higgins J, Cotter A, Geary MP, Mcparland P, Daly S, Cody F, Dicker P, Tully E, Malone FD. Sonographic markers of fetal adiposity and risk of Cesarean delivery. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 54:338-343. [PMID: 30887629 DOI: 10.1002/uog.20263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 03/10/2019] [Accepted: 03/12/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Increased fetal size is associated with shoulder dystocia during labor and subsequent need for assisted delivery. We sought to investigate if increased fetal adiposity diagnosed sonographically in late pregnancy is associated with increased risk of operative delivery. METHODS This secondary analysis of the Genesis Study recruited 2392 nulliparous women with singleton pregnancy in cephalic presentation, in a prospective, multicenter study, to examine prenatal and intrapartum predictors of Cesarean delivery. Participants underwent ultrasound and clinical evaluation between 39 + 0 and 40 + 6 weeks' gestation. Data on fetal biometry were not revealed to patients or to their managing clinicians. A fetal adiposity composite of fetal thigh adiposity and fetal abdominal wall thickness was compiled for each infant in order to determine whether fetal adiposity > 90th centile was associated with an increased risk of Cesarean or operative vaginal delivery. RESULTS After exclusions, data were available for 2330 patients. Patients with a fetal adiposity composite > 90th centile had a higher maternal body mass index (BMI) (25 ± 5 kg/m2 vs 24 ± 4 kg/m2 ; P = 0.005), birth weight (3872 ± 417 g vs 3585 ± 401 g; P < 0.0001) and rate of induction of labor (47% (108/232) vs 40% (834/2098); P = 0.048) than did those with an adiposity composite ≤ 90th centile. Fetuses with adiposity composite > 90th centile were more likely to require Cesarean delivery than were those with adiposity composite ≤ 90th centile (P < 0.0001). After adjusting for birth weight, maternal BMI and need for induction of labor, fetal adiposity > 90th centile remained a risk factor for Cesarean delivery (P < 0.0001). A fetal adiposity composite > 90th centile was more predictive of the need for unplanned Cesarean delivery than was an estimated fetal weight > 90th centile (odds ratio, 2.20 (95% CI, 1.65-2.94; P < 0.001) vs 1.74 (95% CI, 1.29-2.35; P < 0.001). Having an adiposity composite > 90th centile was not associated with an increased likelihood of operative vaginal delivery when compared with having an adiposity composite ≤ 90th centile (P = 0.37). CONCLUSIONS Fetuses with increased adipose deposition are more likely to require Cesarean delivery than are those without increased adiposity. Consideration should, therefore, be given to adding fetal thigh adiposity and abdominal wall thickness to fetal sonographic assessment in late pregnancy. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M P Hehir
- Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland
| | - N Burke
- Rotunda Hospital, Dublin, Ireland
| | - G Burke
- Department of Obstetrics and Gynaecology, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - M J Turner
- University College Dublin Centre for Human Reproduction, School of Medicine and Medical Science, Coombe Women and Infants Maternity Hospital, Dublin, Ireland
| | - F M Breathnach
- Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland
| | - F M Mcauliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - J J Morrison
- Department of Obstetrics and Gynaecology, National University of Ireland, Galway, Ireland
| | - S Dornan
- Royal Jubilee Maternity Hospital, Belfast, Ireland
| | - J Higgins
- University College Cork, Cork University Maternity Hospital, Cork, Ireland
| | - A Cotter
- Department of Obstetrics and Gynaecology, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | | | - P Mcparland
- National Maternity Hospital, Dublin, Ireland
| | - S Daly
- Coombe Women and Infants Maternity Hospital, Dublin, Ireland
| | - F Cody
- Rotunda Hospital, Dublin, Ireland
| | - P Dicker
- Epidemiology & Public Health, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - E Tully
- Rotunda Hospital, Dublin, Ireland
| | - F D Malone
- Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland
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11
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Birth weight prediction models for the different gestational age stages in a Chinese population. Sci Rep 2019; 9:10834. [PMID: 31346206 PMCID: PMC6658529 DOI: 10.1038/s41598-019-47056-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 07/05/2019] [Indexed: 11/17/2022] Open
Abstract
The study aims to develop new birth weight prediction models for different gestational age stages using 2-dimensional (2D) ultrasound measurements in a Chinese population. 2D ultrasound was examined in pregnant women with normal singleton within 3 days prior to delivery (28–42 weeks’ gestation). A total of 19,310 fetuses were included in the study and randomly split into the training group and the validation group. Gestational age was divided into five stages: 28–30, 31–33, 34–36, 37–39 and 40–42 weeks. Multiple linear regression (MLR), fractional polynomial regression (FPR) and volume-based model (VM) were used to develop birth weight prediction model. New staged prediction models (VM for 28–36 weeks, MLR for 37–39 weeks, and FPR for 40–42 weeks) provided lower systematic errors and random errors than previously published models for each gestational age stage in the training group. The similar results were observed in the validation group. Compared to the previously published models, new staged models had the lowest aggregate systematic error (0.31%) and at least a 19.35% decrease; at least a 4.67% decrease for the root-mean-square error (RMSE). The prediction rates within 5% and 10% of birth weight for new staged models were higher than those for previously published models, which were 54.47% and 85.10%, respectively. New staged birth weight prediction models could improve the accuracy of birth weight estimation for different gestational age stages in a Chinese population.
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12
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Corrêa VM, Araujo Júnior E, Braga A, Elito Júnior J. Prediction of birth weight in twin pregnancies using fractional limb volumes by three-dimensional ultrasonography. J Matern Fetal Neonatal Med 2019; 33:3652-3657. [PMID: 30760073 DOI: 10.1080/14767058.2019.1582632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective: To predict birth weight using fetal fractional limb volumes (FLVs) by three-dimensional (3D) ultrasonography in twin pregnancies.Method: This prospective observational cohort study evaluated 51 twin pregnancies, including 28 dichorionic and 23 monochorionic pregnancies. Ultrasound examinations were performed up to 5 d before delivery. Birth weight prediction models were developed using the fractional arm volume (FAV), fractional thigh volume (FTV), and Hadlock's formula and were compared with the actual birth weight.Results: The mean gestational age at the time of ultrasound examination was 35.3 weeks. The mean birth weight was slightly higher in dichorionic than in monochorionic pregnancies 2391.2 versus 2352.4 g. The measurements using FTV were the closest to actual birth weights. For the total group, the Hadlock formula had mean percentage change of 7.18% while the FTV model presented mean percentage change of 6.62% in relation to birth weight. However, no significant difference was noted between Hadlock's formula and FTV p = .363 and .678 for dichorionic and monochorionic pregnancies, respectively.Conclusions: FTV accurately predicted birth weight in twin monochorionic and dichorionic pregnancies. However, Hadlock's formula should still be used.
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Affiliation(s)
- Vivian Melo Corrêa
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Antonio Braga
- Department of Obstetrics and Gynecology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.,Department of Maternal and Child, Fluminense Federal University (UFF), Niteroi, Brazil
| | - Julio Elito Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
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13
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Sharma KA, Das D, Dadhwal V, Deka D, Singhal S, Vanamail P. Two-dimensional fetal biometry versus three-dimensional fractional thigh volume for ultrasonographic prediction of birthweight. Int J Gynaecol Obstet 2019; 145:47-53. [PMID: 30702147 DOI: 10.1002/ijgo.12770] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 09/01/2018] [Accepted: 01/29/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To develop and validate birthweight prediction models using fetal fractional thigh volume (TVol) in an Indian population, comparing them with existing prediction models developed for other ethnicities. METHODS A prospective observational study was conducted among 131 pregnant women (>36 weeks) attending a tertiary hospital in New Delhi, India, for prenatal care between December 1, 2014, and November 1, 2016. Participants were randomly divided into formulating (n=100) and validation (n=31) groups. Multiple regression analysis was performed to generate four models to predict birthweight using various combinations of two-dimensional (2D) ultrasonographic parameters and a three-dimensional (3D) ultrasonographic parameter (TVol). The best fit model was compared with previously published 2D and 3D models. RESULTS The best fit model comprised biparietal diameter, head circumference, abdominal circumference, and TVol. This model had the lowest mean percentage error (0.624 ± 8.075) and the highest coefficient of determination (R2 =0.660). It correctly predicted 70.2% and 91.6% of birthweights within 5% and 10% of actual weight, respectively. Compared with previous models, attributability for the 2D and 3D models was 0.65 and 0.55, respectively. Accuracy was -0.05 ± 1.007 and -2.54 ± 1.11, respectively. CONCLUSION Models that included TVol provided good prediction of birthweight in the target population.
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Affiliation(s)
- K Aparna Sharma
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Dipti Das
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Vatsla Dadhwal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Dipika Deka
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Singhal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Perumal Vanamail
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
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Liao S, Wang Y, Xiao S, Deng X, Fang B, Yang F. A New Model for Birth Weight Prediction Using 2- and 3-Dimensional Ultrasonography by Principal Component Analysis: A Chinese Population Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2553-2563. [PMID: 29603318 DOI: 10.1002/jum.14613] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 01/28/2018] [Accepted: 01/31/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To establish a new model for birth weight prediction using 2- and 3-dimensional ultrasonography (US) by principal component analysis (PCA). METHODS Two- and 3-dimensional US was prospectively performed in women with normal singleton pregnancies within 7 days before delivery (37-41 weeks' gestation). The participants were divided into a development group (n = 600) and a validation group (n = 597). Principal component analysis and stepwise linear regression analysis were used to develop a new prediction model. The new model's accuracy in predicting fetal birth weight was confirmed by the validation group through comparisons with previously published formulas. RESULTS A total of 1197 cases were recruited in this study. All interclass and intraclass correlation coefficients of US measurements were greater than 0.75. Two principal components (PCs) were considered primary in determining estimated fetal birth weight, which were derived from 9 US measurements. Stepwise linear regression analysis showed a positive association between birth weight and PC1 and PC2. In the development group, our model had a small mean percentage error (mean ± SD, 3.661% ± 3.161%). At least a 47.558% decrease in the mean percentage error and a 57.421% decrease in the standard deviation of the new model compared with previously published formulas were noted. The results were similar to those in the validation group, and the new model covered 100% of birth weights within 10% of actual birth weights. CONCLUSIONS The birth weight prediction model based on 2- and 3-dimensional US by PCA could help improve the precision of estimated fetal birth weight.
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Affiliation(s)
- Shuxin Liao
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yunfang Wang
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shufang Xiao
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xujie Deng
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Bimei Fang
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fang Yang
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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15
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Simcox LE, Myers JE, Cole TJ, Johnstone ED. Fractional fetal thigh volume in the prediction of normal and abnormal fetal growth during the third trimester of pregnancy. Am J Obstet Gynecol 2017; 217:453.e1-453.e12. [PMID: 28651860 PMCID: PMC5628948 DOI: 10.1016/j.ajog.2017.06.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/09/2017] [Accepted: 06/16/2017] [Indexed: 11/23/2022]
Abstract
Background Currently, 2-dimensional ultrasound estimation of fetal size rather than fetal growth is used to define fetal growth restriction, but single estimates in late pregnancy lack sensitivity and may identify small for gestational age rather than growth restriction. Single or longitudinal measures of 3-dimensional fractional thigh volume may address this problem. Objective We sought to derive normal values for 3-dimensional fractional thigh volume in the third trimester, determine if fractional thigh volume is superior to 2-dimensional ultrasound biometry alone for detecting fetal growth restriction, and determine whether individualized growth assessment parameters have the potential to identify fetal growth restriction remote from term delivery. Study Design This was a longitudinal prospective cohort study of 115 unselected pregnancies in a tertiary referral unit (St Mary’s Hospital, Manchester, United Kingdom). Standard 2-dimensional ultrasound biometry measurements were obtained, along with fractional thigh volume measurements (based on 50% of the femoral diaphysis length). Measurements were used to calculate estimated fetal weight (Hadlock). Individualized growth assessment parameters and percentage deviations in longitudinally measured biometrics were determined using a Web-based system (iGAP; http://iGAP.research.bcm.edu). Small for gestational age was defined <10th and fetal growth restriction <3rd customized birthweight centile. Logistic regression was used to compare estimated fetal weight (Hadlock), estimated fetal weight (biparietal diameter–abdominal circumference–fractional thigh volume), fractional thigh volume, and abdominal circumference for the prediction of small for gestational age or fetal growth restriction at birth. Screening performance was assessed using area under the receiver operating characteristic curve. Results There was a better correlation between fractional thigh volume and estimated fetal weight ((biparietal diameter–abdominal circumference–fractional thigh volume) obtained at 34-36 weeks with birthweight than between 2-dimensional biometry measures such as abdominal circumference and estimated fetal weight (Hadlock). There was also a modest improvement in the detection of both small for gestational age and fetal growth restriction using fractional thigh volume–derived measures compared to standard 2-dimensional measurements (area under receiver operating characteristic curve, 0.86; 95% confidence interval, 0.79–0.94, and area under receiver operating characteristic curve, 0.92; 95% confidence interval, 0.85–0.99, respectively). Conclusion Fractional thigh volume measurements offer some improvement over 2-dimensional biometry for the detection of late-onset fetal growth restriction at 34-36 weeks.
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Affiliation(s)
- Louise E Simcox
- Maternal and Fetal Health Research Center, Institute of Human Development, University of Manchester, Manchester, United Kingdom; St Mary's Hospital, Central Manchester University Hospitals National Health Service Foundation Trust, Manchester Academic Health Science Center, Manchester, United Kingdom.
| | - Jenny E Myers
- Maternal and Fetal Health Research Center, Institute of Human Development, University of Manchester, Manchester, United Kingdom; St Mary's Hospital, Central Manchester University Hospitals National Health Service Foundation Trust, Manchester Academic Health Science Center, Manchester, United Kingdom
| | - Tim J Cole
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Edward D Johnstone
- Maternal and Fetal Health Research Center, Institute of Human Development, University of Manchester, Manchester, United Kingdom; St Mary's Hospital, Central Manchester University Hospitals National Health Service Foundation Trust, Manchester Academic Health Science Center, Manchester, United Kingdom
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16
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Mack LM, Kim SY, Lee S, Sangi-Haghpeykar H, Lee W. Automated Fractional Limb Volume Measurements Improve the Precision of Birth Weight Predictions in Late Third-Trimester Fetuses. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1649-1655. [PMID: 28439966 DOI: 10.7863/ultra.16.08087] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 10/24/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Fetal soft tissue can be assessed by using fractional limb volume as a proxy for in utero nutritional status. We investigated automated fractional limb volume for rapid estimate fetal weight assessment. METHODS Pregnant women were prospectively scanned for 2- and 3-dimensional fetal biometric measurements within 4 days of delivery. Performance of birth weight prediction models was compared: (1) Hadlock (Am J Obstet Gynecol 1985; 151:333-337; biparietal diameter, abdominal circumference, and femur diaphysis length); and (2) Lee (Ultrasound Obstet Gynecol 2009; 34:556-565; biparietal diameter, abdominal circumference, and automated fractional limb volume). Percent differences were calculated: [(estimated birth weight - actual birth weight) ÷ (actual birth weight] × 100. Systematic errors (accuracy) were summarized as signed mean percent differences. Random errors (precision) were calculated as ± 1 SD of percent differences. RESULTS Fifty neonates were delivered at 39.4 weeks' gestation. The Hadlock model generated the most accurate birth weight (0.31%) with a mean random error of ±7.9%. Despite systematic underestimations, the most precise results occurred with fractional arm volume (-9.1% ± 5.1%) and fractional thigh (-5.2% ± 5.2%) models. The size and distribution of these prediction errors were improved after correction for systematic errors. CONCLUSIONS Automated fractional limb volume measurements can improve the precision of weight predictions in third-trimester fetuses. Correction factors may be necessary to adjust underestimated systematic errors when using automated fractional limb volume with prediction models that are based on manual tracing of fetal limb soft tissue borders.
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Affiliation(s)
- Lauren M Mack
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Sung Yoon Kim
- Samsung Medison Research and Development Center, Seoul, Korea
| | - Sungmin Lee
- Samsung Medison Clinical Research Team, Seoul, Korea
| | - Haleh Sangi-Haghpeykar
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Wesley Lee
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
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17
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Simcox LE, Higgins LE, Myers JE, Johnstone ED. Intraexaminer and Interexaminer Variability in 3D Fetal Volume Measurements During the Second and Third Trimesters of Pregnancy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1415-1429. [PMID: 28339117 DOI: 10.7863/ultra.16.03045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 09/22/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To assess intraexaminer and interexaminer reliability of 3-dimensional fetal sonographic measurements. METHODS Three-dimensional fetal organ volumes (head, kidney, total thigh volume, and fractional thigh volume) were acquired during the second and third trimesters, with the addition of placental volume in the second trimester, by 2 different experienced, blinded sonographers. Fifty-eight fetuses were examined from 21 to 39 weeks' gestation. Intraexaminer and Interexaminer reliability was assessed with Bland-Altman plots, and their 95% limits of agreement and intraclass correlation coefficients. RESULTS The most significant interexaminer error was observed in the second-trimester kidney volume (95% limits of agreement, ± 110%), and the best agreement was for the third-trimester fractional thigh volume (95% limits of agreement, ± 25%) and second-trimester head volume (95% limits of agreement, -7%-25%). Second- and third-trimester intraclass correlation coefficient results were all greater than 0.75, apart from second-trimester kidney volume intraexaminer (0.374) and interexaminer (0.061) measurements, second-trimester placenta interexaminer measurements (0.390), and third-trimester kidney interexaminer measurements (0.647). CONCLUSIONS Three-dimensional fetal sonographic volumes of the head, kidney, total thigh, and placenta have limited reproducibility, and improvements in measurement techniques are needed before they can be used routinely to assess fetal growth. The 3-dimensional fractional thigh volume can be reliably obtained in the late third trimester.
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Affiliation(s)
- Louise E Simcox
- Maternal and Fetal Health Research Center, Institute of Human Development, University of Manchester, Manchester, England
- St Mary's Hospital, Central Manchester University Hospitals National Health Service Foundation Trust, Manchester Academic Health Science Center, Manchester, England
| | - Lucy E Higgins
- Maternal and Fetal Health Research Center, Institute of Human Development, University of Manchester, Manchester, England
- St Mary's Hospital, Central Manchester University Hospitals National Health Service Foundation Trust, Manchester Academic Health Science Center, Manchester, England
| | - Jenny E Myers
- Maternal and Fetal Health Research Center, Institute of Human Development, University of Manchester, Manchester, England
- St Mary's Hospital, Central Manchester University Hospitals National Health Service Foundation Trust, Manchester Academic Health Science Center, Manchester, England
| | - Edward D Johnstone
- Maternal and Fetal Health Research Center, Institute of Human Development, University of Manchester, Manchester, England
- St Mary's Hospital, Central Manchester University Hospitals National Health Service Foundation Trust, Manchester Academic Health Science Center, Manchester, England
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18
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Shmueli A, Aviram A, Bardin R, Wiznitzer A, Chen R, Gabbay-Benziv R. Effect of fetal presentation on sonographic estimation of fetal weight according to different formulas. Int J Gynaecol Obstet 2017; 137:234-240. [PMID: 28295324 DOI: 10.1002/ijgo.12152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 01/25/2017] [Accepted: 03/09/2017] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To compare the accuracy of various sonographic estimation of fetal weight (sEFW) formulas for breech-presenting fetuses. METHODS A retrospective analysis of sEFW performed within 3 days of delivery in a tertiary medical center in Israel between July 2007 and December 2014 was conducted. Breech-presenting singleton fetuses were matched by sex and birth weight to vertex-presenting fetuses. sEFW was calculated using 21 formulas. Systematic and random errors, proportion of estimates (POE) within 10% of actual birth weight, and reliability analysis were used to compare sonographic accuracy. The best performing formula was determined by Euclidean distance. RESULTS Both groups contained 274 fetuses. Systematic error was lower for breech fetuses when compared with control fetuses in 17 of 21 formulas; there was no significant difference in random error between the breech and vertex groups. For vertex fetuses, Euclidean distance was smaller in 17 of 21 formulas, and POE within 10% of birth weight was higher in most formulas. Cronbach α value was higher for vertex fetuses than for breech fetuses in all formulas. The formulas of Combs et al. and Hadlock et al. were highest ranking for breech-presenting fetuses. CONCLUSION sEFW might be more accurate for vertex than for breech fetuses.
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Affiliation(s)
- Anat Shmueli
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Aviram
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Lis Maternity and Women's Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Ron Bardin
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon Wiznitzer
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rony Chen
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rinat Gabbay-Benziv
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Mack LM, Kim SY, Lee S, Sangi-Haghpeykar H, Lee W. A Novel Semiautomated Fractional Limb Volume Tool for Rapid and Reproducible Fetal Soft Tissue Assessment. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1573-1578. [PMID: 27269002 DOI: 10.7863/ultra.15.09086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 10/26/2015] [Indexed: 06/06/2023]
Abstract
The purpose of this study was to document the reproducibility and efficiency of a semiautomated image analysis tool that rapidly provides fetal fractional limb volume measurements. Fifty pregnant women underwent 3-dimensional sonographic examinations for fractional arm and thigh volumes at a mean menstrual age of 31.3 weeks. Manual and semiautomated fractional limb volume measurements were calculated, with the semiautomated measurements calculated by novel software (5D Limb Vol; Samsung Medison, Seoul, Korea). The software applies an image transformation method based on the major axis length, minor axis length, and limb center coordinates. A transformed image is used to perform a global optimization technique for determination of an optimal limb soft tissue boundary. Bland-Altman analysis defined bias with 95% limits of agreement (LOA) between methods, and timing differences between manual versus automated methods were compared by a paired t test. Bland-Altman analysis indicated an acceptable bias with 95% LOA between the manual and semiautomated methods: mean arm volume ± SD, 1.7% ± 4.6% (95% LOA, -7.3% to 10.7%); and mean thigh volume, 0.0% ± 3.8% (95% LOA, -7.5% to 7.5%). The computer-assisted software completed measurements about 5 times faster compared to manual tracings. In conclusion, semiautomated fractional limb volume measurements are significantly faster to calculate when compared to a manual procedure. These results are reproducible and are likely to reduce operator dependency. The addition of computer-assisted fractional limb volume to standard biometry may improve the precision of estimated fetal weight by adding a soft tissue component to the weight estimation process.
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Affiliation(s)
- Lauren M Mack
- Division of Women's and Fetal Imaging, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas USA
| | - Sung Yoon Kim
- Samsung Medison Research and Development Center, Seoul, Korea
| | - Sungmin Lee
- Samsung Medison Clinical Research Team, Seoul, Korea
| | - Haleh Sangi-Haghpeykar
- Division of Women's and Fetal Imaging, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas USA
| | - Wesley Lee
- Division of Women's and Fetal Imaging, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas USA
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20
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Mohsen LA, Amin MF. 3D and 2D ultrasound-based fetal weight estimation: a single center experience. J Matern Fetal Neonatal Med 2016; 30:818-825. [PMID: 27160422 DOI: 10.1080/14767058.2016.1187125] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Evaluate two new 3D and two new 2D ultrasound formulae for fetal weight estimation against the modified Hadlock formula and compare their estimation to the actual fetal weight. METHODS Fifty pregnant females were included. INCLUSION CRITERIA singleton pregnancy, within five days of delivery and normal or IUGR pregnancy. 3D evaluation of the fetal thigh and arm was done to calculate mid-thigh and mid-arm volumes. The actual fetal weight was recorded at delivery and compared to the estimated weights. RESULTS Modified Hadlock formula had higher accuracy, whereas fractional limb volume method had higher precision. Systematic errors for the modified Hadlock formula, Model 6 of fractional limb volume and the original mid-thigh soft tissue thickness methods were 2.3%, -4.8% and 11%, respectively, whereas the random errors were 7.7%, 6.2% and 13.8%, respectively. The percentage of cases estimated within 5%, 10% and 15% of actual fetal weight were 48%, 86% and 92%, respectively, for the modified Hadlock method, whereas for the fractional limb volume method, these were 40%, 78% and 98%, respectively. CONCLUSION Fractional limb volume method is a very promising method for fetal weight estimation. Its performance is not significantly different from the modified Hadlock method.
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Affiliation(s)
- Laila A Mohsen
- a Radiology Department, Minia University , Minia , Egypt
| | - Mohamed F Amin
- a Radiology Department, Minia University , Minia , Egypt
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Abdel Fattah Abdel Moety G, Abdel Monem El Kattan E. Three-dimensional ultrasound using the VOCAL technique for estimation of reference values of fetal thigh volume in normally grown Egyptian fetuses from 20 to 41 weeks. J Matern Fetal Neonatal Med 2015; 29:2083-7. [DOI: 10.3109/14767058.2015.1075201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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22
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Malin GL, Bugg GJ, Takwoingi Y, Thornton JG, Jones NW. Antenatal magnetic resonance imaging versus ultrasound for predicting neonatal macrosomia: a systematic review and meta-analysis. BJOG 2015. [DOI: 10.1111/1471-0528.13517] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- GL Malin
- School of Medicine; the University of Nottingham; Nottingham UK
| | - GJ Bugg
- School of Medicine; the University of Nottingham; Nottingham UK
- Department of Obstetrics; Queen's Medical Centre; Nottingham University Hospitals NHS Trust; Nottingham UK
| | - Y Takwoingi
- School of Health and Population Sciences; University of Birmingham; Birmingham UK
| | - JG Thornton
- School of Medicine; the University of Nottingham; Nottingham UK
| | - NW Jones
- School of Medicine; the University of Nottingham; Nottingham UK
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Tonni G, Martins WP, Guimarães Filho H, Araujo Júnior E. Role of 3-D ultrasound in clinical obstetric practice: evolution over 20 years. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:1180-1211. [PMID: 25748522 DOI: 10.1016/j.ultrasmedbio.2014.12.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 12/10/2014] [Accepted: 12/11/2014] [Indexed: 06/04/2023]
Abstract
The use of 3-D ultrasound in obstetrics has undergone dramatic development over the past 20 years. Since the first publications on this application in clinical practice, several 3-D ultrasound techniques and rendering modes have been proposed and applied to the study of fetal brain, face and cardiac anatomy. In addition, 3-D ultrasound has improved calculations of the volume of fetal organs and limbs and estimations of fetal birth weight. And furthermore, angiographic patterns of fetal organs and the placenta have been assessed using 3-D power Doppler ultrasound quantification. In this review, we aim to summarize current evidence on the clinical relevance of these methodologies and their application in obstetric practice.
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Affiliation(s)
- Gabriele Tonni
- Department of Obstetrics and Gynecology, Guastalla Civil Hospital, ASL Reggio Emilia, Italy; Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - Wellington P Martins
- Department of Obstetrics and Gynecology, Ribeirão Preto School of Medicine, University of São Paulo (DGO-FMRP-USP), Ribeirão Preto-SP, Brazil
| | | | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil.
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Fetal mid-thigh soft-tissue thickness: a novel method for fetal weight estimation. Arch Gynecol Obstet 2014; 290:1101-8. [DOI: 10.1007/s00404-014-3348-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 06/27/2014] [Indexed: 11/24/2022]
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Lee W, Deter R, Sangi-Haghpeykar H, Yeo L, Romero R. Prospective validation of fetal weight estimation using fractional limb volume. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 41:198-203. [PMID: 22605519 PMCID: PMC3601845 DOI: 10.1002/uog.11185] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/24/2012] [Indexed: 05/24/2023]
Abstract
OBJECTIVES To prospectively validate the use of fractional limb volume measurements for estimated fetal weight (EFW) during the second and third trimesters of pregnancy and to summarize the medical literature regarding application of fractional limb volume for fetal weight estimation. METHODS One hundred and sixty-four women prospectively underwent three-dimensional ultrasonography within 4 days of delivery. Birth weights (BWs) ranged from 390 to 5426 g. Fetal measurements were extracted using volume datasets for biparietal diameter, abdominal circumference, femur diaphysis length, fractional arm volume and fractional thigh volume. Fractional limb volumes were manually traced from a central portion of the humerus or femur diaphysis. Mean percentage differences and SDs of the percentage differences were calculated for EFW. The proportion of newborns with EFW within 5 or 10% of BW were compared with an estimate obtained using a Hadlock formula that was modified using model coefficients from the same local population sample. RESULTS Ultrasound scans were performed between 21.7 and 42 weeks' menstrual age. Optimal model performance (1.9 ± 6.6%) resulted from using a combination of biparietal diameter, abdominal circumference and fractional thigh volume. The precision of this model was superior to results obtained using a modified Hadlock model (1.1 ± 8.4%), although accuracy of these predictions was slightly decreased for female infants. For all fetuses, the prediction model that incorporated fractional thigh volume correctly classified a greater proportion of EFW within 5% (55.1 vs 43.7%; P = 0.03) or 10% (86.5 vs 75.9%; P < 0.05) of BW when compared with the modified Hadlock model. CONCLUSIONS Fractional thigh volume can be added to two-dimensional sonographic measurements of the head and trunk to improve the precision of fetal weight estimation. This approach permits the inclusion of soft tissue development as part of a weight estimation procedure for the assessment of generalized fetal nutritional status.
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Affiliation(s)
- W Lee
- Department of Obstetrics and Gynecology, Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
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Lee W, Riggs T, Koo W, Deter RL, Yeo L, Romero R. The relationship of newborn adiposity to fetal growth outcome based on birth weight or the modified neonatal growth assessment score. J Matern Fetal Neonatal Med 2012; 25:1933-40. [PMID: 22494346 PMCID: PMC3930167 DOI: 10.3109/14767058.2012.683084] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES (1) Develop reference ranges of neonatal adiposity using air displacement plethysmography. (2) Use new reference ranges for neonatal adiposity to compare two different methods of evaluating neonatal nutritional status. METHODS Three hundred and twenty-four normal neonates (35-41 weeks post-menstrual age) had body fat (%BF) and total fat mass (FM, g) measured using air displacement plethysmography shortly after delivery. Results were stratified for 92 of these neonates with corresponding fetal biometry using two methods for classifying nutritional status: (1) population-based weight percentiles; and (2) a modified neonatal growth assessment score (m(3)NGAS(51)). RESULTS At the 50th percentile, %BF varied from 7.7% (35 weeks) to 11.8% (41 weeks), while the corresponding 50th percentiles for total FM were 186-436 g. Among the subset of 92 neonates, no significant differences in adiposity were found between small for gestational age (SGA), appropriate for gestational age (AGA), and large for gestational age (LGA) groups using population-based weight standards. Classification of the same neonates using m(3)NGAS(51) showed significant differences in mean %BF between corresponding groups. CONCLUSIONS Population-based weight criteria for neonatal nutritional status can lead to misclassifications on the basis of adiposity. A neonatal growth assessment score, that considers the growth potential of several anatomic parameters, appears to more effectively classify under- and over-nourished newborns.
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Affiliation(s)
- Wesley Lee
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, 6651 Main Street, Suite 1020, Houston, TX 77030, USA.
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Lee IW, Chang CH, Cheng YC, Ko HC, Chang FM. A Review of Three-dimensional Ultrasound Applications in Fetal Growth Restriction. J Med Ultrasound 2012. [DOI: 10.1016/j.jmu.2012.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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