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Avcı F, Serin S, Bakacak M, Ercan O, Kostu B, Arıkan DC, Kulhan M, Bilgi A, Celik C, Duymus AC, Kulhan NG. An analytical cross-sectional study: determining gestational age using fetal clavicle length during the second trimester. Arch Gynecol Obstet 2024; 309:2663-2668. [PMID: 37653252 DOI: 10.1007/s00404-023-07196-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/15/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE To investigate the correlation between fetal clavicle length and gestational age in pregnant patients from 14 and 27 weeks of gestation. METHODS This was a retrospective cross-sectional study of patients from 14 and 27 weeks of gestation. Ultrasonographic measurements such as abdominal circumference (AC), femur length (FL), humerus length (HL), clavicle length (CL), head circumference (HC), biparietal diameter (BPD), estimated fetal weight (EFW), and transverse cerebellum diameter (TCD) were made and compared. RESULTS A total of 552 patients were evaluated in our clinic and CL was measured properly and successfully in all fetuses. Fetal AC, FL, HL, CL, BPD, HC, EFW and TCD measurements were significantly and strongly correlated with gestational week, and Pearson's correlation values were 0.964, 0.965, 0.959, 0.965, 0.951, 0.917, 0.925, and 0.954, respectively (p < 0.001). In the regression analysis equation, gestational week = 0.894 + CL × 0.961. CONCLUSION There was a significant positive correlation between fetal CL (mm) and gestational week. We suggest that the 1 mm = 1 week rule can be used for patients with anomalies of the cerebellum and vermis, as well as for patients with unknown last menstrual period.
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Affiliation(s)
- Fazıl Avcı
- Selcuk University Faculty of Medicine, Deparment of Obstetrics and Gynecology, Konya, Turkey.
| | - Salih Serin
- Selcuk University Faculty of Medicine, Deparment of Obstetrics and Gynecology, Konya, Turkey
- Clinic of Obstetrics and Gynecology, Private, Bitlis, Turkey
| | - Murat Bakacak
- Department of Obstetrics and Gynecology, Kahramanmaras Sutcu Imam University Faculty of Medicine, Kahramanmaras, Turkey
| | - Onder Ercan
- Department of Obstetrics and Gynecology, Kahramanmaras Sutcu Imam University Faculty of Medicine, Kahramanmaras, Turkey
| | - Bulent Kostu
- Department of Obstetrics and Gynecology, Kahramanmaras Sutcu Imam University Faculty of Medicine, Kahramanmaras, Turkey
| | - Deniz Cemgil Arıkan
- Selcuk University Faculty of Medicine, Deparment of Obstetrics and Gynecology, Konya, Turkey
- Department of Obstetrics and Gynecology, Kahramanmaras Sutcu Imam University Faculty of Medicine, Kahramanmaras, Turkey
| | - Mehmet Kulhan
- Selcuk University Faculty of Medicine, Deparment of Obstetrics and Gynecology, Konya, Turkey
| | - Ahmet Bilgi
- Selcuk University Faculty of Medicine, Deparment of Obstetrics and Gynecology, Konya, Turkey
| | - Cetin Celik
- Selcuk University Faculty of Medicine, Deparment of Obstetrics and Gynecology, Konya, Turkey
| | - Ayse Ceren Duymus
- Selcuk University Faculty of Medicine, Deparment of Obstetrics and Gynecology, Konya, Turkey
| | - Nur Gozde Kulhan
- Department of Obstetrics and Gynecology, University of Health Sciences, Konya City Hospital, Konya, Turkey
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Gadekar VP, Damaraju N, Xavier A, Thakur SB, Vijayram R, Desiraju BK, Misra S, Wadhwa N, Khurana A, Rathore S, Abraham A, Rengaswamy R, Benjamin S, Cherian AG, Bhatnagar S, Thiruvengadam R, Sinha H. Development and external validation of Indian population-specific Garbhini-GA2 model for estimating gestational age in second and third trimesters. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 25:100362. [PMID: 39021476 PMCID: PMC467080 DOI: 10.1016/j.lansea.2024.100362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 01/02/2024] [Accepted: 01/23/2024] [Indexed: 07/20/2024]
Abstract
Background A large proportion of pregnant women in lower and middle-income countries (LMIC) seek their first antenatal care after 14 weeks of gestation. While the last menstrual period (LMP) is still the most prevalent method of determining gestational age (GA), ultrasound-based foetal biometry is considered more accurate in the second and third trimesters. In LMIC settings, the Hadlock formula, originally developed using data from a small Caucasian population, is widely used for estimating GA and foetal weight worldwide as the pre-programmed formula in ultrasound machines. This approach can lead to inaccuracies when estimating GA in a diverse population. Therefore, this study aimed to develop a population-specific model for estimating GA in the late trimesters that was as accurate as the GA estimation in the first trimester, using data from GARBH-Ini, a pregnancy cohort in a North Indian district hospital, and subsequently validate the model in an independent cohort in South India. Methods Data obtained by longitudinal ultrasonography across all trimesters of pregnancy was used to develop and validate GA models for the second and third trimesters. The gold standard for GA estimation in the first trimester was determined using ultrasonography. The Garbhini-GA2, a polynomial regression model, was developed using the genetic algorithm-based method, showcasing the best performance among the models considered. This model incorporated three of the five routinely measured ultrasonographic parameters during the second and third trimesters. To assess its performance, the Garbhini-GA2 model was compared against the Hadlock and INTERGROWTH-21st models using both the TEST set (N = 1493) from the GARBH-Ini cohort and an independent VALIDATION dataset (N = 948) from the Christian Medical College (CMC), Vellore cohort. Evaluation metrics, including root-mean-squared error, bias, and preterm birth (PTB) rates, were utilised to comprehensively assess the model's accuracy and reliability. Findings With first trimester GA dating as the baseline, Garbhini-GA2 reduced the GA estimation median error by more than three times compared to the Hadlock formula. Further, the PTB rate estimated using Garbhini-GA2 was more accurate when compared to the INTERGROWTH-21st and Hadlock formulae, which overestimated the rate by 22.47% and 58.91%, respectively. Interpretation The Garbhini-GA2 is the first late-trimester GA estimation model to be developed and validated using Indian population data. Its higher accuracy in GA estimation, comparable to GA estimation in the first trimester and PTB classification, underscores the significance of deploying population-specific GA formulae to enhance antenatal care. Funding The GARBH-Ini cohort study was funded by the Department of Biotechnology, Government of India (BT/PR9983/MED/97/194/2013). The ultrasound repository was partly supported by the Grand Challenges India-All Children Thriving Program, Biotechnology Industry Research Assistance Council, Department of Biotechnology, Government of India (BIRAC/GCI/0115/03/14-ACT). The research reported in this publication was made possible by a grant (BT/kiData0394/06/18) from the Grand Challenges India at Biotechnology Industry Research Assistance Council (BIRAC), an operating division jointly supported by DBT-BMGF-BIRAC. The external validation study at CMC Vellore was partly supported by a grant (BT/kiData0394/06/18) from the Grand Challenges India at Biotechnology Industry Research Assistance Council (BIRAC), an operating division jointly supported by DBT-BMGF-BIRAC and by Exploratory Research Grant (SB/20-21/0602/BT/RBCX/008481) from Robert Bosch Centre for Data Science and Artificial Intelligence (RBCDSAI), IIT Madras. An alum endowment from Prakash Arunachalam (BIO/18-19/304/ALUM/KARH) partly funded this study at the Centre for Integrative Biology and Systems Medicine, IIT Madras.
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Affiliation(s)
- Veerendra P. Gadekar
- Department of Biotechnology, Bhupat and Jyoti Mehta School of Biosciences, Indian Institute of Technology Madras, Chennai, India
- Centre for Integrative Biology and Systems medicinE, Indian Institute of Technology Madras, Chennai, India
- Robert Bosch Centre for Data Science and Artificial Intelligence, Indian Institute of Technology Madras, Chennai, India
| | - Nikhita Damaraju
- Department of Biotechnology, Bhupat and Jyoti Mehta School of Biosciences, Indian Institute of Technology Madras, Chennai, India
- Centre for Integrative Biology and Systems medicinE, Indian Institute of Technology Madras, Chennai, India
| | - Ashley Xavier
- Department of Biotechnology, Bhupat and Jyoti Mehta School of Biosciences, Indian Institute of Technology Madras, Chennai, India
- Centre for Integrative Biology and Systems medicinE, Indian Institute of Technology Madras, Chennai, India
| | - Shambo Basu Thakur
- Department of Biotechnology, Bhupat and Jyoti Mehta School of Biosciences, Indian Institute of Technology Madras, Chennai, India
- Centre for Integrative Biology and Systems medicinE, Indian Institute of Technology Madras, Chennai, India
| | - Ramya Vijayram
- Department of Biotechnology, Bhupat and Jyoti Mehta School of Biosciences, Indian Institute of Technology Madras, Chennai, India
- Centre for Integrative Biology and Systems medicinE, Indian Institute of Technology Madras, Chennai, India
| | - Bapu Koundinya Desiraju
- Maternal and Child Health Program, Translational Health Science and Technology Institute, Faridabad, India
| | - Sumit Misra
- Maternal and Child Health Program, Translational Health Science and Technology Institute, Faridabad, India
| | - Nitya Wadhwa
- Maternal and Child Health Program, Translational Health Science and Technology Institute, Faridabad, India
| | - Ashok Khurana
- The Ultrasound Lab, Defence Colony, New Delhi, India
| | - Swati Rathore
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India
| | - Anuja Abraham
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India
| | - Raghunathan Rengaswamy
- Centre for Integrative Biology and Systems medicinE, Indian Institute of Technology Madras, Chennai, India
- Department of Chemical Engineering, Indian Institute of Technology Madras, Chennai, India
- Robert Bosch Centre for Data Science and Artificial Intelligence, Indian Institute of Technology Madras, Chennai, India
| | - Santosh Benjamin
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India
- Department of Community Health, Christian Medical College, Vellore, India
| | | | - Shinjini Bhatnagar
- Maternal and Child Health Program, Translational Health Science and Technology Institute, Faridabad, India
| | - Ramachandran Thiruvengadam
- Maternal and Child Health Program, Translational Health Science and Technology Institute, Faridabad, India
- Department of Biochemistry, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Himanshu Sinha
- Department of Biotechnology, Bhupat and Jyoti Mehta School of Biosciences, Indian Institute of Technology Madras, Chennai, India
- Centre for Integrative Biology and Systems medicinE, Indian Institute of Technology Madras, Chennai, India
- Robert Bosch Centre for Data Science and Artificial Intelligence, Indian Institute of Technology Madras, Chennai, India
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Vitral GLN, Romanelli RMDC, Leonel TA, Souza Gaspar JD, Aguiar RALPD, Reis ZSN. Influence of different methods for calculating gestational age at birth on prematurity and small for gestational age proportions: a systematic review with meta-analysis. BMC Pregnancy Childbirth 2023; 23:106. [PMID: 36774458 PMCID: PMC9921121 DOI: 10.1186/s12884-023-05411-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 01/27/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Recognizing premature newborns and small-for-gestational-age (SGA) is essential for providing care and supporting public policies. This systematic review aims to identify the influence of the last menstrual period (LMP) compared to ultrasonography (USG) before 24 weeks of gestation references on prematurity and SGA proportions at birth. METHODS Systematic review with meta-analysis followed the recommendations of the PRISMA Statement. PubMed, BVS, LILACS, Scopus-Elsevier, Embase-Elsevier, and Web-of-Science were searched (10-30-2022). The research question was: (P) newborns, (E) USG for estimating GA, (C) LMP for estimating GA, and (O) prematurity and SGA rates for both methods. Independent reviewers screened the articles and extracted the absolute number of preterm and SGA infants, reference standards, design, countries, and bias. Prematurity was birth before 37 weeks of gestation, and SGA was the birth weight below the p10 on the growth curve. The quality of the studies was assessed using the New-Castle-Ottawa Scale. The difference between proportions estimated the size effect in a meta-analysis of prevalence. RESULTS Among the 642 articles, 20 were included for data extraction and synthesis. The prematurity proportions ranged from 1.8 to 33.6% by USG and varied from 3.4 to 16.5% by the LMP. The pooled risk difference of prematurity proportions revealed an overestimation of the preterm birth of 2% in favor of LMP, with low certainty: 0.02 (95%CI: 0.01 to 0.03); I2 97%). Subgroup analysis of USG biometry (eight articles) showed homogeneity for a null risk difference between prematurity proportions when crown-rump length was the reference: 0.00 (95%CI: -0.001 to 0.000; I2: 0%); for biparietal diameter, risk difference was 0.00 (95%CI: -0.001 to 0.000; I2: 41%). Only one report showed the SGA proportions of 32% by the USG and 38% by the LMP. CONCLUSIONS LMP-based GA, compared to a USG reference, has little or no effect on prematurity proportions considering the high heterogeneity among studies. Few data (one study) remained unclear the influence of such references on SGA proportions. Results reinforced the importance of qualified GA to mitigate the impact on perinatal statistics. TRIAL REGISTRATION Registration number PROSPERO: CRD42020184646.
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Affiliation(s)
- Gabriela Luiza Nogueira Vitral
- Faculdade de Medicina, Universidade Federal de Minas Gerais, 30.130.100, Belo Horizonte, Avenida Professor Alfredo Balena, 190, Sala 601, Brazil. .,Faculdade de Ciências Médicas de Minas Gerais, Alameda Ezequiel Dias, 275, Belo Horizonte, 30130-110, Brazil.
| | - Roberta Maia de Castro Romanelli
- grid.8430.f0000 0001 2181 4888Faculdade de Medicina, Universidade Federal de Minas Gerais, 30.130.100, Belo Horizonte, Avenida Professor Alfredo Balena, 190, Sala 601 Brazil
| | - Tiago Alves Leonel
- grid.8430.f0000 0001 2181 4888Faculdade de Medicina, Universidade Federal de Minas Gerais, 30.130.100, Belo Horizonte, Avenida Professor Alfredo Balena, 190, Sala 601 Brazil
| | - Juliano de Souza Gaspar
- grid.8430.f0000 0001 2181 4888Faculdade de Medicina, Universidade Federal de Minas Gerais, 30.130.100, Belo Horizonte, Avenida Professor Alfredo Balena, 190, Sala 601 Brazil
| | - Regina Amélia Lopes Pessoa de Aguiar
- grid.8430.f0000 0001 2181 4888Faculdade de Medicina, Universidade Federal de Minas Gerais, 30.130.100, Belo Horizonte, Avenida Professor Alfredo Balena, 190, Sala 601 Brazil
| | - Zilma Silveira Nogueira Reis
- grid.8430.f0000 0001 2181 4888Faculdade de Medicina, Universidade Federal de Minas Gerais, 30.130.100, Belo Horizonte, Avenida Professor Alfredo Balena, 190, Sala 601 Brazil
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Bilardo CM, Chaoui R, Hyett JA, Kagan KO, Karim JN, Papageorghiou AT, Poon LC, Salomon LJ, Syngelaki A, Nicolaides KH. ISUOG Practice Guidelines (updated): performance of 11-14-week ultrasound scan. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:127-143. [PMID: 36594739 DOI: 10.1002/uog.26106] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 05/27/2023]
Affiliation(s)
- C M Bilardo
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam UMC, University of Amsterdam, and Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - R Chaoui
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - J A Hyett
- Western Sydney University, Sydney, Australia
| | - K O Kagan
- Department of Obstetrics and Gynecology, University of Tuebingen, Tuebingen, Germany
| | - J N Karim
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | | | - L C Poon
- Department of Obstetrics and Gynaecology, Chinese University of Hong Kong, Hong Kong SAR, China
| | - L J Salomon
- Department of Obstetrics and Fetal Medicine, Paris Cité University, Assistance Publique-Hopitaux de Paris, Hopital Necker-Enfants Malades, Paris, France
| | - A Syngelaki
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - K H Nicolaides
- Fetal Medicine Research Institute, King's College Hospital, London, UK
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Sharma LK, Bindal J, Shrivastava VA, Sharma M, Choorakuttil RM, Nirmalan PK. Discordant dating of pregnancy by LMP and ultrasound and its implications in perinatal statistics. Indian J Radiol Imaging 2020; 30:27-31. [PMID: 32476747 PMCID: PMC7240897 DOI: 10.4103/ijri.ijri_383_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/18/2019] [Accepted: 01/16/2020] [Indexed: 11/04/2022] Open
Abstract
Context High perinatal mortality in India may be caused by inaccurate dating of pregnancy resulting from suboptimal uptake of antenatal care and ultrasound services during pregnancy. Aim To determine the discrepancy in the last menstrual period (LMP) assigned expected date of delivery (EDD) and ultrasound assigned EDD in pregnant women in a rural district of central India. Methods Data from an ongoing cross-sectional screening program providing fetal radiology imaging in Guna district of Madhya Pradesh from 2012-2019 was analyzed for recall of LMP and discordance between LMP and ultrasound assigned EDD. The discrepancy was present when EDD assigned by ultrasound differed by 3 or more days at gestational ages less than 8+6 weeks, 5-7 days at gestational ages 8+6 weeks till 14 weeks, and 7-10 days at gestational ages 14-20 weeks. Results The program screened 14,701 pregnant women of which 4,683 (31.86%, 95% CI: 31.11, 32.61) could not recall LMP. EDD assigned by LMP and ultrasound matched in 7,035 (70.22%, 95% CI: 69.32, 71.12) of the remaining 10,018 pregnant women. EDD was overestimated by LMP for 26.06% (95% CI: 25.21, 26.93) women; these foetuses were at risk of being misclassified as a term fetus. In 2018, the project had no maternal deaths, infant mortality rate of 24.7, low birth weight rate of 9.69%, and 100% antenatal coverage. Conclusion Accurate dating of pregnancy and systematic follow-up integrating radiology imaging and obstetrics care for appropriate risk-based management of pregnant women can significantly improve perinatal statistics of India.
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Affiliation(s)
- Lalit K Sharma
- Raj Sonography and X-Ray Clinic, Baiju Choraha, Nayapura, Madhya Pradesh, India
| | - Jyoti Bindal
- Department of Woman and Child Development, Guna, Madhya Pradesh, India
| | | | - Mansi Sharma
- Department of Obstetrics and Gynaecology, Columbia Asia and Sahyadri Hospital, Pune, Maharashtra, India
| | - Rijo M Choorakuttil
- National Coordinator for Samrakshan IRIA, AMMA Center for Diagnosis and Preventive Medicine, Kochi, Kerala, India
| | - Praveen K Nirmalan
- Chief Research Mentor, AMMA Education Research Foundation, Kochi, Kerala, India
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Lund N, Sandager P, Leonhard AK, Vogel I, Petersen OB. Second-trimester fetal head circumference in more than 350 000 pregnancies: Outcome and suggestion for sex-dependent cutoffs for small heads. Prenat Diagn 2019; 39:910-920. [PMID: 31218719 DOI: 10.1002/pd.5504] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/28/2019] [Accepted: 06/08/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To explore the relationship between small fetal second-trimester head circumference (HC) and pregnancy outcome and identify a cutoff point for offering genetic testing. METHOD Data from second-trimester scans in Denmark were linked to national registers. Fetuses with anomalies diagnosed before this scan were excluded. Fetuses were grouped according to HC z-score. RESULTS We included 352 515 singleton fetuses. The mean HC was significantly larger among males than among females with z-scores averaging 0.52 more in males. Small HC was associated with chromosomal anomaly, malformations of the CNS and heart, miscarriage/perinatal death, termination, preterm delivery, and intrauterine growth restriction (test for trend: P < .001 for all outcomes). Fetuses in the group with z-score less than -3 had the highest incidence of adverse outcome, irrespective of fetal sex. In the groups with z-scores between -3 and -2.5, and between -2.5 and -2, risk of adverse outcome was lower for females than males for all outcome categories. CONCLUSION Small HC in second trimester is a prognostic marker for adverse outcome. The smaller the HC, the higher the risk of adverse outcome. We suggest an HC cutoff point of -2 SD for males and -2.5 SD for females for offering genetic testing.
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Affiliation(s)
- Najaaraq Lund
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Puk Sandager
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Ida Vogel
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
| | - Olav Bjørn Petersen
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Kullinger M, Granfors M, Kieler H, Skalkidou A. Adherence to Swedish national pregnancy dating guidelines and management of discrepancies between pregnancy dating methods: a survey study. Reprod Health 2019; 16:95. [PMID: 31272510 PMCID: PMC6610777 DOI: 10.1186/s12978-019-0760-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 06/25/2019] [Indexed: 11/24/2022] Open
Abstract
Background Swedish national guidelines for pregnancy dating were published in 2010. Follow-up is needed to assess adherence and to identify whether any clinical topics are not covered in the guidelines. Methods All units in Sweden that performed ultrasound-based pregnancy dating were asked to complete a web-based questionnaire comprising multiple-response questions and commentary fields. Information was collected regarding baseline information, current and previous clinical practice, and management of discrepancies between last-menstrual-period- and ultrasound-based methods for pregnancy dating. Results The response rate was 79%. Half of the units offered first-trimester ultrasound to all pregnant women. However, contrary to the guidelines, the crown–rump length was not used for ultrasound-based pregnancy dating in most units. Instead, ultrasound-based pregnancy dating was performed only if the biparietal diameter was between 21 and 55 mm. Management of discrepancies between methods for pregnancy dating varied widely. Conclusions The units reported high adherence to national guidelines, except for early pregnancy dating, for which many units followed unwritten or informal guidelines. The management of discrepancies between last-menstrual-period-based and ultrasound-based estimated day of delivery varied widely. These findings emphasize the need for regular updating of national written guidelines and efforts to improve their implementation in all units.
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Affiliation(s)
- Merit Kullinger
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. .,Region Vastmanland - Uppsala University, Center for Clinical Research, Hospital of Vastmanland Västerås, Kvinnokliniken, Västmanlands sjukhus, 721 89, Västerås, Sweden.
| | - Michaela Granfors
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Science, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Helle Kieler
- Department of Medicine, Solna, Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Alkistis Skalkidou
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Singleton fetal growth kinetics depend on the mode of conception. Fertil Steril 2019; 110:1109-1117.e2. [PMID: 30396555 DOI: 10.1016/j.fertnstert.2018.06.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/25/2018] [Accepted: 06/20/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To study the impact of in vitro fertilization, with or without intracytoplasmic sperm injection (IVF/ICSI), frozen-embryo transfer (FET), and intrauterine insemination (IUI) on fetal growth kinetics throughout pregnancy and to compare the different modes of conception. DESIGN Retrospective cohort study. SETTING University. PATIENT(S) A total of 560 singleton pregnancies were included (96 IVF, 210 ICSI, 121 FET, and 133 IUI). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) We compared crown-rump length (CRL) at the first trimester (T1: 11-13 weeks of gestation [WG] + 6 days), estimated fetal weight (EFW) at the second (T2: 21-23 WG + 6 days) and third (T3: 31-33 WG + 6 days) trimesters, and birth weight (BW) z-scores with those in the reference curves (Papageorghiou for T1, and Ego M2 for T2, T3, and birth). Multivariate analyses were performed. RESULT(S) For T1, the CRL was longer than the reference curve whatever the assisted reproductive technique (ART). For T2, EFW was significantly greater for all groups compared with the reference curve, and for T3 only FET singletons had a greater EFW. ICSI, IVF, and IUI singletons had a significantly lower BW compared with reference curves. For all ART fetuses, growth kinetics differed from T2. Only FET fetuses maintained their significantly above-reference growth values. The proportion of fetuses for which at least one period of growth loss was observed from T2 to birth was higher after IVF, ICSI, and IUI than after FET. CONCLUSION(S) For the first time, we have highlighted that fetal growth kinetics differed from T2 depending on the ART protocols used. They could have an impact on trophoblastic invasiveness and might lead to long-term health effects.
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Discrepancy between pregnancy dating methods affects obstetric and neonatal outcomes: a population-based register cohort study. Sci Rep 2018; 8:6936. [PMID: 29720591 PMCID: PMC5932022 DOI: 10.1038/s41598-018-24894-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 03/29/2018] [Indexed: 02/07/2023] Open
Abstract
To assess associations between discrepancy of pregnancy dating methods and adverse pregnancy, delivery, and neonatal outcomes, odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for discrepancy categories among all singleton births from the Medical Birth Register (1995-2010) with estimated date of delivery (EDD) by last menstrual period (LMP) minus EDD by ultrasound (US) -20 to +20 days. Negative/positive discrepancy was a fetus smaller/larger than expected when dated by US (EDD postponed/changed to an earlier date). Large discrepancy was <10th or >90th percentile. Reference was median discrepancy ±2 days. Odds for diabetes and preeclampsia were higher in pregnancies with negative discrepancy, and for most delivery outcomes in case of large positive discrepancy (+9 to +20 days): shoulder dystocia [OR 1.16 (95% CI 1.01-1.33)] and sphincter injuries [OR 1.13 (95% CI 1.09-1.17)]. Odds for adverse neonatal outcomes were higher in large negative discrepancy (-4 to -20 days): low Apgar score [OR 1.18 (95% CI 1.09-1.27)], asphyxia [OR 1.18 (95% CI 1.11-1.25)], fetal death [OR 1.47 (95% CI 1.32-1.64)], and neonatal death [OR 2.19 (95% CI 1.91-2.50)]. In conclusion, especially, large negative discrepancy was associated with increased risks of adverse perinatal outcomes.
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Skalkidou A, Kullinger M, Georgakis MK, Kieler H, Kesmodel US. Systematic misclassification of gestational age by ultrasound biometry: implications for clinical practice and research methodology in the Nordic countries. Acta Obstet Gynecol Scand 2018; 97:440-444. [DOI: 10.1111/aogs.13300] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 01/12/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Alkistis Skalkidou
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | - Merit Kullinger
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
- Center for Clinical Research; Hospital of Västmanland Västerås; Region Västmanland - Uppsala University; Västerås Sweden
| | - Marios K. Georgakis
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | - Helle Kieler
- Center for Pharmacoepidemiology; Department of Medicine; Karolinska Institute; Solna Sweden
| | - Ulrik S. Kesmodel
- Department of Obstetrics and Gynecology; Herlev University Hospital; University of Copenhagen; Herlev Denmark
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11
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Simic M, Stephansson O, Petersson G, Cnattingius S, Wikström AK. Slow fetal growth between first and early second trimester ultrasound scans and risk of small for gestational age (SGA) birth. PLoS One 2017; 12:e0184853. [PMID: 28934257 PMCID: PMC5608242 DOI: 10.1371/journal.pone.0184853] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 09/02/2017] [Indexed: 12/04/2022] Open
Abstract
Objectives To investigate the association between fetal growth between first and early second trimester ultrasound scan and the risk of severe small for gestational age (SGA) birth. Methods This cohort study included 69 550 singleton pregnancies with first trimester dating and an early second trimester growth scan in Stockholm and Gotland Counties, Sweden between 2008 and 2014. Exposure was difference in biparietal diameter growth between observed and expected at the second trimester scan, calculated by z-scores. Risk of birth of a severe SGA infant (birth weight for gestational age by fetal sex less than the 3rd centile) was calculated using multivariable logistic regression analysis and presented as adjusted odds ratio (aOR). Results Parietal growth less than 2.5 percentile between first and second trimester ultrasound examination was associated with elevated risk of being born severe SGA. (aOR 1.67; 95% Confidence Interval 1.28–2.18). The risks of preterm severe SGA (birth before 37 weeks) and term severe SGA (birth 37 weeks or later) were at similar levels, and risk of severe SGA were also elevated in the absence of preeclampsia, hypertensive diseases or gestational diabetes. Conclusions Fetuses with slow growth of biparietal diameter at ultrasound examination in early second trimester exhibit increased risk of being born SGA independent of gestational age at birth and presence of maternal hypertensive diseases or diabetes mellitus.
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Affiliation(s)
- Marija Simic
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska University Hospital and Institutet, Stockholm, Sweden
- * E-mail:
| | - Olof Stephansson
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska University Hospital and Institutet, Stockholm, Sweden
- School of Public Health, University of California, Berkeley, California, United States of America
| | - Gunnar Petersson
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska University Hospital and Institutet, Stockholm, Sweden
| | - Sven Cnattingius
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska University Hospital and Institutet, Stockholm, Sweden
| | - Anna-Karin Wikström
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska University Hospital and Institutet, Stockholm, Sweden
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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12
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Papageorghiou AT, Kemp B, Stones W, Ohuma EO, Kennedy SH, Purwar M, Salomon LJ, Altman DG, Noble JA, Bertino E, Gravett MG, Pang R, Cheikh Ismail L, Barros FC, Lambert A, Jaffer YA, Victora CG, Bhutta ZA, Villar J. Ultrasound-based gestational-age estimation in late pregnancy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:719-726. [PMID: 26924421 PMCID: PMC6680349 DOI: 10.1002/uog.15894] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 02/12/2016] [Accepted: 02/18/2016] [Indexed: 05/04/2023]
Abstract
OBJECTIVE Accurate gestational-age (GA) estimation, preferably by ultrasound measurement of fetal crown-rump length before 14 weeks' gestation, is an important component of high-quality antenatal care. The objective of this study was to determine how GA can best be estimated by fetal ultrasound for women who present for the first time late in pregnancy with uncertain or unknown menstrual dates. METHODS INTERGROWTH-21st was a large, prospective, multicenter, population-based project performed in eight geographically defined urban populations. One of its principal components, the Fetal Growth Longitudinal Study, aimed to develop international fetal growth standards. Each participant had their certain menstrual dates confirmed by first-trimester ultrasound examination. Fetal head circumference (HC), biparietal diameter (BPD), occipitofrontal diameter (OFD), abdominal circumference (AC) and femur length (FL) were measured every 5 weeks from 14 weeks' gestation until delivery. For each participant, a single, randomly selected ultrasound examination was used to explore all candidate biometric variables and permutations to build models to predict GA. Regression equations were ranked based upon minimization of the mean prediction error, goodness of fit and model complexity. An automated machine learning algorithm, the Genetic Algorithm, was adapted to evaluate > 64 000 potential polynomial equations as predictors. RESULTS Of the 4607 eligible women, 4321 (94%) had a pregnancy without major complications and delivered a live singleton without congenital malformations. After other exclusions (missing measurements in GA window and outliers), the final sample comprised 4229 women. Two skeletal measures, HC and FL, produced the best GA prediction, given by the equation loge (GA) = 0.03243 × (loge (HC))2 + 0.001644 × FL × loge (HC) + 3.813. When FL was not available, the best equation based on HC alone was loge (GA) = 0.05970 × (loge (HC))2 + 0.000000006409 × (HC)3 + 3.3258. The estimated uncertainty of GA prediction (half width 95% interval) was 6-7 days at 14 weeks' gestation, 12-14 days at 26 weeks' gestation and > 14 days in the third trimester. The addition of FL to the HC model led to improved prediction intervals compared with using HC alone, but no further improvement in prediction was afforded by adding AC, BPD or OFD. Equations that included other measurements (BPD, OFD and AC) did not perform better. CONCLUSIONS Among women initiating antenatal care late in pregnancy, a single set of ultrasound measurements combining HC and FL in the second trimester can be used to estimate GA with reasonable accuracy. We recommend this tool for underserved populations but considerable efforts should be implemented to improve early initiation of antenatal care worldwide. © 2016 Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A. T. Papageorghiou
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton CollegeUniversity of OxfordOxfordUK
| | - B. Kemp
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton CollegeUniversity of OxfordOxfordUK
| | - W. Stones
- Faculty of Health SciencesAga Khan UniversityNairobiKenya
- School of MedicineUniversity of St AndrewsSt AndrewsScotland
| | - E. O. Ohuma
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton CollegeUniversity of OxfordOxfordUK
- Centre for Statistics in Medicine, Botnar Research CentreUniversity of OxfordOxfordUK
| | - S. H. Kennedy
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton CollegeUniversity of OxfordOxfordUK
| | - M. Purwar
- Nagpur INTERGROWTH‐21 Research CentreKetkar HospitalNagpurIndia
| | - L. J. Salomon
- Maternité Necker‐Enfants Malades, AP‐HPUniversité Paris DescartesParisFrance
| | - D. G. Altman
- Center for Statistics in Medicine, Nuffield Department of OrthopaedicsRheumatology and Musculoskeletal Sciences, University of OxfordOxfordUK
| | - J. A. Noble
- Department of Engineering ScienceUniversity of OxfordOxfordUK
| | - E. Bertino
- Dipartimento di Scienze Pediatriche e dell'Adolescenza, Cattedra di NeonatologiaUniversità degli Studi di TorinoTurinItaly
| | - M. G. Gravett
- Global Alliance to Prevent Prematurity and Stillbirth (GAPPS)SeattleWAUSA
| | - R. Pang
- School of Public HealthPeking UniversityBeijingChina
| | - L. Cheikh Ismail
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton CollegeUniversity of OxfordOxfordUK
| | - F. C. Barros
- Programa de Pós‐Graduação em Saúde e ComportamentoUniversidade Católica de PelotasPelotasRSBrazil
- Programa de Pós‐Graduação em EpidemiologiaUniversidade Federal de PelotasPelotasRSBrazil
| | - A. Lambert
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton CollegeUniversity of OxfordOxfordUK
| | - Y. A. Jaffer
- Department of Family & Community HealthMinistry of HealthMuscatSultanate of Oman
| | - C. G. Victora
- Programa de Pós‐Graduação em EpidemiologiaUniversidade Federal de PelotasPelotasRSBrazil
| | - Z. A. Bhutta
- Division of Women & Child HealthThe Aga Khan UniversityKarachiPakistan
- Center for Global HealthHospital for Sick ChildrenTorontoONCanada
| | - J. Villar
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton CollegeUniversity of OxfordOxfordUK
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13
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Morken NH, Skjærven R, Richards JL, Kramer MR, Cnattingius S, Johansson S, Gissler M, Dolan SM, Zeitlin J, Kramer MS. Adverse Infant Outcomes Associated with Discordant Gestational Age Estimates. Paediatr Perinat Epidemiol 2016; 30:541-549. [PMID: 27555359 PMCID: PMC5576505 DOI: 10.1111/ppe.12311] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Gestational age estimation by last menstrual period (LMP) vs. ultrasound (or best obstetric estimate in the US) may result in discrepant classification of preterm vs. term birth. We investigated whether such discrepancies are associated with adverse infant outcomes. METHODS We studied singleton livebirths in the Medical Birth Registries of Norway, Sweden and Finland and US live birth certificates from 1999 to the most recent year available. Risk ratios (RR) with 95% confidence intervals (CI) by discordant and concordant gestational age estimation for infant, neonatal and post-neonatal mortality, Apgar score <4 and <7 at 5 min, and neonatal intensive care unit (NICU) admission were estimated using generalised linear models, adjusting for maternal age, education, parity, year of birth, and infant sex. Results were presented stratified by country. RESULTS Compared to infants born at term by both methods, infants born preterm by ultrasound/best obstetric estimate but term by LMP had higher infant mortality risks (range of adjusted RRs 3.9 to 7.2) and modestly higher risks were obtained among infants born preterm by LMP but term by ultrasound/best obstetric estimate (range of adjusted RRs 1.6 to 1.9). Risk estimates for the other outcomes showed the same pattern. These findings were consistent across all four countries. CONCLUSIONS Infants classified as preterm by ultrasound/best estimate, but term by LMP have consistently higher risks of adverse outcomes than those classified as preterm by LMP but term by ultrasound/best estimate. Compared with ultrasound/best estimate, use of LMP overestimates the proportion of births that are preterm.
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Affiliation(s)
- Nils-Halvdan Morken
- Departments of Global Public Health and Primary Care, University of Bergen, Bergen, Norway,Clinical Science, University of Bergen, Bergen, Norway
| | - Rolv Skjærven
- Departments of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Jennifer L. Richards
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Michael R. Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Sven Cnattingius
- Clinical Epidemiology Unit, T2, Department of Medicine Solna, Karolinska University Hospital
| | - Stefan Johansson
- Clinical Epidemiology Unit, T2, Department of Medicine Solna, Karolinska University Hospital,Department of Clinical Science and Education, Söodersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Mika Gissler
- Information Services Department, National Institute for Health and Welfare, Helsinki, Finland
| | - Siobhan M. Dolan
- Department of Obstetrics and Gynecology and Women’s Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
| | - Jennifer Zeitlin
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France
| | - Michael S. Kramer
- Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, QC, Canada
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Kullinger M, Haglund B, Kieler H, Skalkidou A. Effects of ultrasound pregnancy dating on neonatal morbidity in late preterm and early term male infants: a register-based cohort study. BMC Pregnancy Childbirth 2016; 16:335. [PMID: 27799069 PMCID: PMC5088647 DOI: 10.1186/s12884-016-1129-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 10/25/2016] [Indexed: 12/02/2022] Open
Abstract
Background Assessing gestational age by ultrasound can introduce a systematic bias due to sex differences in early growth. Methods This cohort study included data on 1,314,602 births recorded in the Swedish Medical Birth Register. We compared rates of prematurity-related adverse outcomes in male infants born early term (gestational week 37–38) or late preterm (gestational week 35–36), in relation to female infants, between a time period when pregnancy dating was based on the last menstrual period (1973–1978), and a time period when ultrasound was used for pregnancy dating (1995–2010), in order to assess the method’s influence on outcome by fetal sex. Results As expected, adverse outcomes were lower in the later time period, but the reduction in prematurity-related morbidity was less marked for male than for female infants. After changing the pregnancy dating method, male infants born early term had, in relation to female infants, higher odds for pneumothorax (Cohort ratio [CR] 2.05; 95 % confidence interval [CI] 1.33–3.16), respiratory distress syndrome of the newborn (CR 1.99; 95 % CI 1.33–2.98), low Apgar score (CR 1.26; 5 % CI 1.08–1.47), and hyperbilirubinemia (CR 1.12; 95 % CI 1.06–1.19), when outcome was compared between the two time periods. A similar trend was seen for late preterm male infants. Conclusion Misclassification of gestational age by ultrasound, due to size differences, can partially explain currently reported sex differences in early term and late preterm infants’ adverse neonatal outcomes, and should be taken into account in clinical decisions and when interpreting study results related to fetal sex. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1129-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Merit Kullinger
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. .,Centre for Clinical Research, Västmanland County Hospital, Västerås, Sweden. .,Department of Obstetrics and Gynecology, Västmanland County Hospital, Västerås, Sweden.
| | - Bengt Haglund
- Department of Medicine, Solna, Centre for Pharmacoepidemiology (CPE), Karolinska Institute, Stockholm, Sweden
| | - Helle Kieler
- Department of Medicine, Solna, Centre for Pharmacoepidemiology (CPE), Karolinska Institute, Stockholm, Sweden
| | - Alkistis Skalkidou
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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15
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Iacobaeus C, Kahan T, Jörneskog G, Bremme K, Thorsell M, Andolf E. Fetal growth is associated with first-trimester maternal vascular function. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:483-490. [PMID: 26776383 DOI: 10.1002/uog.15863] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 12/25/2015] [Accepted: 01/08/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To investigate the relationship between maternal endothelial function in the first trimester, assessed in both the brachial artery and the forearm skin microcirculation, and fetal growth. METHODS Vascular function was assessed in 56 pregnant women during gestational weeks 11-14. Vascular reactivity in the brachial artery was evaluated by postischemic hyperemia-induced flow-mediated vasodilatation (FMD) and by vasodilatation following administration of sublingual glyceryl trinitrate (GTN). Forearm skin microcirculation was investigated by laser Doppler perfusion imaging during iontophoresis of acetylcholine (ACh) and sodium nitroprusside (SNP) to assess endothelium-dependent and -independent microvascular vasodilatation, respectively. Fetal growth was measured at study inclusion and birth-weight centile was calculated after delivery. RESULTS FMD and GTN-induced vasodilatation were both associated with birth-weight centile. On multivariate analysis (adjusted for brachial artery diameter at rest, blood pressure, maternal age and heart rate), for FMD β = 1.7 (95% CI, 0.06-3.34), r2 = 0.26 and P = 0.042, and for GTN-induced vasodilatation β = 2.6 (95% CI, 0.44-4.68), r2 = 0.15 and P = 0.02. Endothelium-dependent and -independent microvascular reactivity were also associated with birth-weight centile: for ACh β = 7.82 (95% CI, 1.81-13.83), r2 = 0.12 and P = 0.029, and for SNP β = 6.27 (95% CI, 1.20-11.34), r2 = 0.11 and P = 0.016. CONCLUSION First-trimester maternal vascular dilatation capacity (rather than endothelial function alone) is associated with fetal growth. These findings were consistent in both the brachial artery and the forearm skin microcirculation. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- C Iacobaeus
- Division of Gynecology and Obstetrics, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
| | - T Kahan
- Division of Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - G Jörneskog
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - K Bremme
- Department of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - M Thorsell
- Division of Gynecology and Obstetrics, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - E Andolf
- Division of Gynecology and Obstetrics, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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16
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Early fetal growth in progesterone-treated IVF pregnancies. Arch Gynecol Obstet 2015; 294:63-9. [DOI: 10.1007/s00404-015-3951-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 10/28/2015] [Indexed: 12/21/2022]
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Björkman K, Wesström J. Risk for girls can be adversely affected post-term due to underestimation of gestational age by ultrasound in the second trimester. Acta Obstet Gynecol Scand 2015; 94:1373-9. [PMID: 26381500 DOI: 10.1111/aogs.12774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 09/05/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Post-term pregnancies are associated with greater risks for mother and child. Accurate determination of gestational age is necessary for safe care. Female fetuses have been shown to be smaller than males at the time of second-trimester ultrasound (US) examination, leading to underestimation of their age and, potentially, greater impacts of perinatal complications in post-term girls than in post-term boys. The purpose of this study was to investigate the sex ratio of post-term births and differences in perinatal complications (stillbirth, low Apgar score, low birthweight, meconium aspiration and low umbilical artery pH) between post-term boys and girls according to dating method [second-trimester US and last menstrual period (LMP)]. MATERIAL AND METHODS Data from gestational week ≥39 to delivery of 13 338 singleton pregnancies between 13 February 2006 and 15 January 2014, were collected from the Obstetrix(®) (Siemens Healthcare) medical records system in Dalarna County, Sweden. RESULTS The neonatal male:female ratio increased with gestational age after week 40, as dated by US, reaching 1.69 in gestational week 42. This ratio remained 1 throughout gestation according to dating by the LMP. Post-term pregnancy increased the risks of meconium aspiration and low Apgar score, with no sex difference observed. CONCLUSIONS US gestational dating indicated that more boys than girls were born post-term, whereas dating according to LMP revealed no sex difference. These results support the hypothesis that female fetuses are smaller than males, leading to underestimation of their gestational age, at the time of second-trimester US examination.
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Affiliation(s)
- Katarina Björkman
- Department of Obstetrics and Gynecology, Falu Hospital, Falun, Sweden
| | - Jan Wesström
- Department of Obstetrics and Gynecology, Falu Hospital, Falun, Sweden.,Center for Clinical Research Dalarna, Falun, Sweden.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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18
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Karl S, Li Wai Suen CSN, Unger HW, Ome-Kaius M, Mola G, White L, Wangnapi RA, Rogerson SJ, Mueller I. Preterm or not--an evaluation of estimates of gestational age in a cohort of women from Rural Papua New Guinea. PLoS One 2015; 10:e0124286. [PMID: 25945927 PMCID: PMC4422681 DOI: 10.1371/journal.pone.0124286] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 03/12/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Knowledge of accurate gestational age is required for comprehensive pregnancy care and is an essential component of research evaluating causes of preterm birth. In industrialised countries gestational age is determined with the help of fetal biometry in early pregnancy. Lack of ultrasound and late presentation to antenatal clinic limits this practice in low-resource settings. Instead, clinical estimators of gestational age are used, but their accuracy remains a matter of debate. METHODS In a cohort of 688 singleton pregnancies from rural Papua New Guinea, delivery gestational age was calculated from Ballard score, last menstrual period, symphysis-pubis fundal height at first visit and quickening as well as mid- and late pregnancy fetal biometry. Published models using sequential fundal height measurements and corrected last menstrual period to estimate gestational age were also tested. Novel linear models that combined clinical measurements for gestational age estimation were developed. Predictions were compared with the reference early pregnancy ultrasound (<25 gestational weeks) using correlation, regression and Bland-Altman analyses and ranked for their capability to predict preterm birth using the harmonic mean of recall and precision (F-measure). RESULTS Average bias between reference ultrasound and clinical methods ranged from 0-11 days (95% confidence levels: 14-42 days). Preterm birth was best predicted by mid-pregnancy ultrasound (F-measure: 0.72), and neuromuscular Ballard score provided the least reliable preterm birth prediction (F-measure: 0.17). The best clinical methods to predict gestational age and preterm birth were last menstrual period and fundal height (F-measures 0.35). A linear model combining both measures improved prediction of preterm birth (F-measure: 0.58). CONCLUSIONS Estimation of gestational age without ultrasound is prone to significant error. In the absence of ultrasound facilities, last menstrual period and fundal height are among the more reliable clinical measures. This study underlines the importance of strengthening ultrasound facilities and developing novel ways to estimate gestational age.
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Affiliation(s)
- Stephan Karl
- Walter and Eliza Hall Institute of Medical Research (WEHI), Melbourne, Australia
- Department of Medical Biology, The University of Melbourne, Melbourne, Australia
| | - Connie S. N. Li Wai Suen
- Walter and Eliza Hall Institute of Medical Research (WEHI), Melbourne, Australia
- Department of Medical Biology, The University of Melbourne, Melbourne, Australia
| | - Holger W. Unger
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Melbourne, Australia
- Papua New Guinea Institute of Medical Research (PNG IMR), Goroka, Papua New Guinea
| | - Maria Ome-Kaius
- Papua New Guinea Institute of Medical Research (PNG IMR), Goroka, Papua New Guinea
| | - Glen Mola
- Department of Obstetrics and Gynaecology, University of Papua New Guinea, Port Moresby, Papua New Guinea
| | - Lisa White
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Regina A. Wangnapi
- Papua New Guinea Institute of Medical Research (PNG IMR), Goroka, Papua New Guinea
| | - Stephen J. Rogerson
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Melbourne, Australia
| | - Ivo Mueller
- Walter and Eliza Hall Institute of Medical Research (WEHI), Melbourne, Australia
- Department of Medical Biology, The University of Melbourne, Melbourne, Australia
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- * E-mail:
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19
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Rytter D, Bech BH, Frydenberg M, Henriksen TB, Olsen SF. Fetal growth and cardio-metabolic risk factors in the 20-year-old offspring. Acta Obstet Gynecol Scand 2014; 93:1150-9. [PMID: 25053259 DOI: 10.1111/aogs.12463] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 07/18/2014] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To investigate the association between prenatal growth patterns as estimated by biparietal diameter and cardio-metabolic risk at 20 years. DESIGN Follow-up study. SETTING Denmark 1988-2009. POPULATION Two cohorts of children born between 1988 and 1990 (n=707) and followed up in 2008-2009 (n=333-509). METHODS We have access to biparietal diameter from early ultrasound scan and birthweight. For each gender, biparietal diameter and birthweight, gestational age-specific growth-z-scores were calculated. A change in growth trajectory was depicted as a shift in z-score for the two growth measures. Multiple linear regression modeling was used to estimate associations between biparietal diameter and birthweight z-scores and later cardio-metabolic risk factors as well as estimating whether changing growth trajectory was associated with later cardio-metabolic risk. MAIN OUTCOME MEASURES Self-reported anthropometrics and clinically measured blood pressure, heart rate and biochemical measures associated with cardio-metabolic health. RESULTS After adjustments, biparietal diameter was not associated with any of the outcomes. Birthweight was positively associated with both adult height and weight and inversely associated with insulin, triglyceride and insulin resistance. Also, the data indicated a U-shaped association between growth in the second half of pregnancy and adult body mass index among individuals with a low biparietal diameter in mid-pregnancy. CONCLUSION Different patterns of intrauterine growth may be associated with later risk of cardio-metabolic disease.
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Affiliation(s)
- Dorte Rytter
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
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20
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Morken NH, Skjaerven R, Wilcox AJ. Ultrasound prediction of perinatal outcome: the unrecognised value of sibling data. BJOG 2014; 122:1674-81. [DOI: 10.1111/1471-0528.13022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2014] [Indexed: 10/24/2022]
Affiliation(s)
- N-H Morken
- Department of Global Public Health and Primary Care; University of Bergen; Bergen Norway
- Department of Clinical Sciences; University of Bergen; Bergen Norway
| | - R Skjaerven
- Department of Global Public Health and Primary Care; University of Bergen; Bergen Norway
- Norwegian Institute of Public Health; Bergen Norway
| | - AJ Wilcox
- Epidemiology Branch; NIEHS/NIH; Durham NC USA
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van Oppenraaij RHF, Eilers PHC, Willemsen SP, van Dunné FM, Exalto N, Steegers EAP. Determinants of number-specific recall error of last menstrual period: a retrospective cohort study. BJOG 2014; 122:835-841. [PMID: 25040796 DOI: 10.1111/1471-0528.12991] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the digit preference for last menstrual period (LMP) dates, associated determinants and impact on obstetric outcome. DESIGN Retrospective cohort study. SETTING University medical centre (the Netherlands). POPULATION Cohort of 24 665 LMP records and a subgroup of 4630 cases with known crown-rump length (CRL) measurement, and obstetric outcome. METHODS Digit preference was determined by comparing the observed to expected counts of each day. Associated determinants were identified by multivariate regression analysis. Differences in obstetric outcome between LMP and CRL dating were analysed. MAIN OUTCOME MEASURES (Non)deprived neighbourhood, cycle irregularity, certainty of LMP date, maternal age, smoking, body mass index, parity and ultrasound investigator. Preterm and post-term delivery. RESULTS LMP digit preference for the first [odds ratio (OR), 1.28; 95% confidence interval (95% CI), 1.20-1.36], fifth (OR, 1.10; 95% CI, 1.03-1.17), 10th (OR, 1.17; 95% CI, 1.09-1.25), 15th (OR, 1.31; 95% CI, 1.23-1.40), 20th (OR, 1.22; 95% CI, 1.15-1.30) and 25th (OR, 1.08; 95% CI, 1.01-1.15) days of the month occurred more often than expected. Digit preference occurred more frequently in women living in a deprived neighbourhood (OR, 1.21; 95% CI, 1.06-1.39), with uncertain LMP (OR, 2.03; 95% CI, 1.63-2.52) or irregular cycle (OR, 1.24; 95% CI, 1.06-1.44). More post-term (≥42 weeks) deliveries (OR, 1.27; 95% CI, 1.05-1.54) were observed in LMP dating. This effect was larger in women with a digit preference (OR, 1.56; 95% CI, 1.03-2.37). CONCLUSIONS LMP digit preference occurs more often in women living in deprived neighbourhoods, with uncertain LMP or an irregular cycle. LMP-dated pregnancies are associated with more post-term pregnancies.
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Affiliation(s)
- R H F van Oppenraaij
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
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Barra DA, Lima JC, Mauad Filho F, Araujo Júnior E, Martins WP. Measuring fetal volume during late first trimester by three-dimensional ultrasonography using virtual organ computer-aided analysis. ULTRASOUND IN MEDICINE & BIOLOGY 2013; 39:1552-1559. [PMID: 23791355 DOI: 10.1016/j.ultrasmedbio.2013.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 02/02/2013] [Accepted: 02/07/2013] [Indexed: 06/02/2023]
Abstract
Our aim was to determine whether rotating the fetus over its largest axis and reducing the rotational step angle can improve reliability/agreement of fetal volume measurements obtained with three-dimensional ultrasonography (3-DUS). Two observers acquired three 3-DUS data sets for a fetus with a crown-rump length between 45 and 84 mm. These observers determined the fetal volume using virtual organ computer-aided analysis (VOCAL), by three different methods, with a rotational step angle of 30°: (1) minimal manipulation of the 3-DUS data set, fetus rotated over any axis; (2) manipulation of the 3-DUS data set until the fetus could be seen in a standardized manner, fetus rotated over its anteroposterior axis; (3) same 3-DUS data set manipulation, fetus rotated over its longitudinal axis. Intra- and inter-observer reliability/agreement was determined with intra-class correlation coefficients and limits of agreement. In addition, we tested the method that provided the best reliability/agreement results using 15° and 9° of rotational step angles. The time taken to manipulate 3-DUS and determine fetal volume was recorded. The best intra- and inter-observer reliability/agreement results were observed when the fetus was rotated over its longitudinal axis. Reducing rotational step angle to 15° or 9° did not further improve reliability/agreement. The observer took approximately 1 min to determine fetal volume using this method. Our findings indicate that fetal volume should be determined by rotating the fetus over its longitudinal axis, at a rotational step angle of 30°, which is relatively fast and allows analysis of fetal volume with good reliability and agreement.
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Affiliation(s)
- Daniela A Barra
- Department of Obstetrics and Gynecology, Medical School of Ribeirao Preto, University of Sao Paulo (DGO-FMRP-USP), Ribeirao Preto, Brazil
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23
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Ghrelins, obestatin, nesfatin-1 and leptin levels in pregnant women with and without hyperemesis gravidarum. Clin Biochem 2013; 46:828-30. [DOI: 10.1016/j.clinbiochem.2013.01.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 01/16/2013] [Accepted: 01/19/2013] [Indexed: 11/19/2022]
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Villar J, Altman DG, Purwar M, Noble JA, Knight HE, Ruyan P, Cheikh Ismail L, Barros FC, Lambert A, Papageorghiou AT, Carvalho M, Jaffer YA, Bertino E, Gravett MG, Bhutta ZA, Kennedy SH. The objectives, design and implementation of the INTERGROWTH-21stProject. BJOG 2013; 120 Suppl 2:9-26, v. [PMID: 23678873 DOI: 10.1111/1471-0528.12047] [Citation(s) in RCA: 195] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- J Villar
- Nuffield Department of Obstetrics & Gynaecology, and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK Centre for Statistics in Medicine, University of Oxford, Oxford, UK Ketkar Nursing Home, Nagpur, India Department of Engineering Science, University of Oxford, Oxford, UK School of Public Health, Peking University, Beijing, China Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Pelotas, RS, Brazil Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brazil Faculty of Health Sciences, Aga Khan University, Nairobi, Kenya Department of Family & Community Health, Ministry of Health, Muscat, Sultanate of Oman Dipartimento di Scienze Pediatriche e dell'Adolescenza, Cattedra di Neonatologia, Università degli Studi di Torino, Torino, Italy University of Washington School of Medicine, Seattle, WA, USA Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan
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Tedner SG, Örtqvist AK, Almqvist C. Fetal growth and risk of childhood asthma and allergic disease. Clin Exp Allergy 2013; 42:1430-47. [PMID: 22994341 PMCID: PMC3564398 DOI: 10.1111/j.1365-2222.2012.03997.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction Early genetic and environmental factors have been discussed as potential causes for the high prevalence of asthma and allergic disease in the western world, and knowledge on fetal growth and its consequence on future health and disease development is emerging. Objective This review article is an attempt to summarize research on fetal growth and risk of asthma and allergic disease. Current knowledge and novel findings will be reviewed and open research questions identified, to give basic scientists, immunologists and clinicians an overview of an emerging research field. Methods PubMed-search on pre-defined terms and cross-references. Results Several studies have shown a correlation between low birth weight and/or gestational age and asthma and high birth weight and/or gestational age and atopy. The exact mechanism is not yet clear but both environmental and genetic factors seem to contribute to fetal growth. Some of these factors are confounders that can be adjusted for, and twin studies have been very helpful in this context. Suggested mechanisms behind fetal growth are often linked to the feto-maternal circulation, including the development of placenta and umbilical cord. However, the causal link between fetal growth restriction and subsequent asthma and allergic disease remains unexplained. New research regarding the catch-up growth following growth restriction has posited an alternative theory that diseases later on in life result from rapid catch-up growth rather than intrauterine growth restriction per se. Several studies have found a correlation between a rapid weight gain after birth and development of asthma or wheezing in childhood. Conclusion and clinical relevance Asthma and allergic disease are multifactorial. Several mechanisms seem to influence their development. Additional studies are needed before we fully understand the causal links between fetal growth and development of asthma and allergic diseases.
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Affiliation(s)
- S G Tedner
- Department of Medical Epidemiology and Biostatistics, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
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Myklestad K, Vatten LJ, Magnussen EB, Salvesen KÅ, Romundstad PR. Do parental heights influence pregnancy length?: A population-based prospective study, HUNT 2. BMC Pregnancy Childbirth 2013; 13:33. [PMID: 23383756 PMCID: PMC3608172 DOI: 10.1186/1471-2393-13-33] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 01/30/2013] [Indexed: 11/15/2022] Open
Abstract
Background The objective of this study was to examine the association of maternal and paternal height with pregnancy length, and with the risk of pre- and post-term birth. In addition we aimed to study whether cardiovascular risk factors could explain possible associations. Methods Parents who participated in the Nord-Trøndelag Health Study (HUNT 2; 1995–1997) were linked to offspring data from the Medical Birth Registry of Norway (1997–2005). The main analyses included 3497 women who had delivered 5010 children, and 2005 men who had fathered 2798 pregnancies. All births took place after parental participation in HUNT 2. Linear regression was used to estimate crude and adjusted differences in pregnancy length according to parental heights. Logistic regression was used to estimate crude and adjusted associations of parental heights with the risk of pre- and post-term births. Results We found a gradual increase in pregnancy length by increasing maternal height, and the association was essentially unchanged after adjustment for maternal cardiovascular risk factors, parental age, offspring sex, parity, and socioeconomic measures. When estimated date of delivery was based on ultrasound, the difference between mothers in the lower height quintile (<163 cm cm) and mothers in the upper height quintile (≥ 173 cm) was 4.3 days, and when estimated date of delivery was based on last menstrual period (LMP), the difference was 2.8 days. Shorter women (< 163 cm) had lower risk of post-term births, and when estimated date of delivery was based on ultrasound they also had higher risk of pre-term births. Paternal height was not associated with pregnancy length, or with the risks of pre- and post-term births. Conclusions Women with shorter stature had shorter pregnancy length and lower risk of post-term births than taller women, and when EDD was based on ultrasound, they also had higher risk of preterm births. The effect of maternal height was generally stronger when pregnancy length was based on second trimester ultrasound compared to last menstrual period. The association of maternal height with pregnancy length could not be explained by cardiovascular risk factors. Paternal height was neither associated with pregnancy length nor with the risk of pre- and post-term birth.
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Affiliation(s)
- Kirsti Myklestad
- Department of Public Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim N-7489, Norway.
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Salomon LJ, Alfirevic Z, Bilardo CM, Chalouhi GE, Ghi T, Kagan KO, Lau TK, Papageorghiou AT, Raine-Fenning NJ, Stirnemann J, Suresh S, Tabor A, Timor-Tritsch IE, Toi A, Yeo G. ISUOG practice guidelines: performance of first-trimester fetal ultrasound scan. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 41:102-13. [PMID: 23280739 DOI: 10.1002/uog.12342] [Citation(s) in RCA: 350] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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Harland KK, Saftlas AF, Wallis AB, Yankowitz J, Triche EW, Zimmerman MB. Correction of systematic bias in ultrasound dating in studies of small-for-gestational-age birth: an example from the Iowa Health in Pregnancy Study. Am J Epidemiol 2012; 176:443-55. [PMID: 22886591 DOI: 10.1093/aje/kws120] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The authors examined whether early ultrasound dating (≤20 weeks) of gestational age (GA) in small-for-gestational-age (SGA) fetuses may underestimate gestational duration and therefore the incidence of SGA birth. Within a population-based case-control study (May 2002-June 2005) of Iowa SGA births and preterm deliveries identified from birth records (n = 2,709), the authors illustrate a novel methodological approach with which to assess and correct for systematic underestimation of GA by early ultrasound in women with suspected SGA fetuses. After restricting the analysis to subjects with first-trimester prenatal care, a nonmissing date of the last menstrual period (LMP), and early ultrasound (n = 1,135), SGA subjects' ultrasound GA was 5.5 days less than their LMP GA, on average. Multivariable linear regression was conducted to determine the extent to which ultrasound GA predicted LMP dating and to correct for systematic misclassification that results after applying standard guidelines to adjudicate differences in these measures. In the unadjusted model, SGA subjects required a correction of +1.5 weeks to the ultrasound estimate. With adjustment for maternal age, smoking, and first-trimester vaginal bleeding, standard guidelines for adjudicating differences in ultrasound and LMP dating underestimated SGA birth by 12.9% and overestimated preterm delivery by 8.7%. This methodological approach can be applied by researchers using different study populations in similar research contexts.
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Affiliation(s)
- Karisa K Harland
- Injury Prevention Research Center and Department of Epidemiology, University of Iowa, Iowa City, IA 52242-5000, USA.
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Simic M, Amer-Wåhlin I, Maršál K, Källén K. Effect of various dating formulae on sonographic estimation of gestational age in extremely preterm infants. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 40:179-185. [PMID: 21953817 DOI: 10.1002/uog.10101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Gestational age (GA) is one of the most important obstetric factors and prediction of date of delivery is usually based on ultrasonographic fetal measurements. Our aim was to determine whether applying three different dating formulae to a cohort of extremely preterm infants influenced the estimation of their GA. METHODS This was a study of 513 infants delivered before 27 gestational weeks, included in a Swedish national population study (EXPRESS), with information available on mid-trimester ultrasonographically measured biparietal diameter and femur length. We applied using these parameters three dating formulae, the Persson & Weldner formula, commonly used in Sweden, the Hadlock formula and the Mul formula, and compared their GA estimates to the clinically reported GA (recorded at delivery) and the last menstrual period (LMP)-based GA. RESULTS The mean reported GA was 173.2 days, corresponding well to the GA according to the Persson & Weldner dating formula (173.3). The mean GA according to LMP, the Hadlock formula and the Mul formula were 176.8, 175.3 and 175.6 days, respectively. The Hadlock and Mul GA estimates differed significantly from that based on the Persson & Weldner formula (both P-values < 10(-6)). Among 68 pregnancies with a reported duration of 22 weeks, 33 (49%) had a duration of 23 weeks or more when GA was calculated according to LMP and 22 (32%) when GA was calculated according to the Hadlock formula. CONCLUSION Estimated GA among infants delivered before 27 gestational weeks varied significantly depending on the dating formula used to calculate the estimated date of delivery; this might influence the clinical management of extremely preterm fetuses and infants.
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Affiliation(s)
- M Simic
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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Rijken MJ, Mulder EJH, Papageorghiou AT, Thiptharakun S, Wah N, Paw TK, Dwell SLM, Visser GHA, Nosten FH, McGready R. Quality of ultrasound biometry obtained by local health workers in a refugee camp on the Thai-Burmese border. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 40:151-157. [PMID: 22262286 PMCID: PMC3443371 DOI: 10.1002/uog.11091] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/30/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE In a refugee camp on the Thai-Burmese border, accurate dating of pregnancy relies on ultrasound measurements obtained by locally trained health workers. The aim of this study was to substantiate the accuracy of fetal biometry measurements performed by locally trained health workers by comparing derived reference equations with those published for Asian and European hospitals. METHODS This prospective observational study included 1090 women who had a dating crown-rump length (CRL) scan and one study-appointed ultrasound biometry scan between 16 and 40 weeks of gestation. The average of two measurements of each of biparietal diameter, head circumference, abdominal circumference and femur length was used in a polynomial regression model for the mean and SD against gestational age (GA). The biometry equations obtained were compared with published equations of professional sonographers from Asian and European hospitals by evaluation of the SD and Z-scores of differences between models. RESULTS Reference equations of biometric parameters were found to fit cubic polynomial models. The observed SD values, for any given GA, of fetal biometric measurements obtained by locally trained health workers were lower than those previously reported by centers with professional sonographers. For nearly the entire GA range considered, the mean values of the Asian and European equations for all four biometric measurements were within the 90% expected range (mean ± 1.645 SD) of our equations. CONCLUSION Locally trained health workers in a refugee camp on the Thai-Burmese border can obtain measurements that are associated with low SD values and within the normal limits of published Asian and European equations. The fact that the SD values were lower than in other studies may be explained by the use of the average of two measurements, CRL dating or motivation of the locally trained sonographers.
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Affiliation(s)
- M J Rijken
- Shoklo Malaria Research Unit, Mae Sot, Tak, Thailand.
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Pexsters A, Luts J, Van Schoubroeck D, Bottomley C, Van Calster B, Van Huffel S, Abdallah Y, D'Hooghe T, Lees C, Timmerman D, Bourne T. Clinical implications of intra- and interobserver reproducibility of transvaginal sonographic measurement of gestational sac and crown-rump length at 6-9 weeks' gestation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 38:510-515. [PMID: 21077156 DOI: 10.1002/uog.8884] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/27/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To assess intra- and interobserver agreement of routinely performed measurements-crown-rump length (CRL) and mean gestational sac diameter (MSD)-for assessing the likelihood of miscarriage in the first trimester of pregnancy using transvaginal sonography. METHODS A cross-sectional study of CRL and gestational sac measurements in first-trimester pregnancies was conducted in a fetal medicine referral center with a predominantly Caucasian population. Gestational age ranged from 6 to 9 weeks. All patients underwent a transvaginal ultrasound examination using a high-resolution ultrasound machine. Two measurements of CRL and measurements of three diameters of the gestational sac were obtained by two observers. Agreement within and between observers for CRL and between observers for MSD was analyzed using 95% prediction intervals, Bland-Altman plots with 95% limits of agreement and the intraclass correlation coefficient (ICC). RESULTS In total 54 patients were included in the study, with measurements obtained by both observers in 44 of these. Intra- and interobserver ICCs were high for CRL measurements, with values of 0.992 and 0.993 for intraobserver agreement and 0.993 for interobserver agreement. For the MSD, the interobserver ICC was 0.952. Limits of agreement were ± 8.91 and ± 11.37% for intraobserver agreement of CRL and ± 14.64% for interobserver agreement of CRL. For MSD, the interobserver limits of agreement were ± 18.78%. For an MSD measurement of 20 mm by the first observer, the prediction interval for the second observer was 16.8-24.5 mm. For a CRL measurement of 6 mm, the prediction interval for the second observer was 5.4-6.7 mm. CONCLUSION For dating purposes, there is reasonable reproducibility of CRL measurements using transvaginal ultrasonography at 6-9 weeks' gestation. When diagnosing miscarriage based on measurements of CRL care must be taken for values close to any decision boundary. The higher interobserver variability that we observed for MSD has implications for the diagnosis of miscarriage based on this measurement in the absence of a visible embryo or yolk sac.
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Affiliation(s)
- A Pexsters
- Department of Obstetrics and Gynaecology, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium.
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White LJ, Lee SJ, Stepniewska K, Simpson JA, Dwell SLM, Arunjerdja R, Singhasivanon P, White NJ, Nosten F, McGready R. Estimation of gestational age from fundal height: a solution for resource-poor settings. J R Soc Interface 2011; 9:503-10. [PMID: 21849388 PMCID: PMC3262426 DOI: 10.1098/rsif.2011.0376] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Many women in resource-poor settings lack access to reliable gestational age assessment because they do not know their last menstrual period; there is no ultrasound (US) and methods of newborn gestational age dating are not practised by birth attendants. A bespoke multiple-measures model was developed to predict the expected date of delivery determined by US. The results are compared with both a linear and a nonlinear model. Prospectively collected early US and serial symphysis-pubis fundal height (SFH) data were used in the models. The data were collected from Karen and Burmese women attending antenatal care on the Thai–Burmese border. The multiple-measures model performed best, resulting in a range of accuracy depending on the number of SFH measures recorded per mother (for example six SFH measurements resulted in a prediction accuracy of ±2 weeks). SFH remains the proxy for gestational age in much of the resource-poor world. While more accurate measures should be encouraged, we demonstrate that a formula that incorporates at least three SFH measures from an individual mother and the slopes between them provide a significant increase in the accuracy of prediction compared with the linear and nonlinear formulae also using multiple SFH measures.
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Affiliation(s)
- Lisa J White
- Centre for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 7LJ, UK.
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Salomon LJ, Hourrier S, Fanchin R, Ville Y, Rozenberg P. Is first-trimester crown-rump length associated with birthweight? BJOG 2011; 118:1223-8. [DOI: 10.1111/j.1471-0528.2011.03009.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tsuchiya M, Kikuchi A, Takakuwa K, Tanaka K. Increased pulsatility of the ductus venosus blood velocity in the first trimester is associated with the delivery of small for gestational age or low birth weight infants. J Obstet Gynaecol Res 2010; 36:1151-60. [DOI: 10.1111/j.1447-0756.2010.01299.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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36
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Ultrasound Pregnancy Dating Leads to Biased Perinatal Morbidity and Neonatal Mortality Among Post-term-born Girls. Epidemiology 2010; 21:791-6. [DOI: 10.1097/ede.0b013e3181f3a660] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Thorsell M, Kaijser M, Almström H, Andolf E. Large fetal size in early pregnancy associated with macrosomia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 35:390-394. [PMID: 20069673 DOI: 10.1002/uog.7529] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To assess if fetal size at the time of ultrasound dating examination is associated with the risk of macrosomia and complications associated with macrosomia. METHODS This was a retrospective cohort study of 19 377 singleton pregnancies dated in gestational weeks 16-20 during the period 1998-2004 at Danderyd Hospital, Stockholm, Sweden. Obstetric outcome was assessed through linkage to the Swedish Medical Birth Register. RESULTS When fetuses were > or = 7 days larger than expected at dating, compared with the expected size according to last menstrual period, there was a 59% increase in the risk of birth weight > or = 4500 g and a 145% increase in the risk of birth weight > or = 5000 g (odds ratio (OR), 1.59; 95% CI, 1.12-2.24 and OR, 2.45; 95% CI, 1.22-4.90, respectively). For a birth weight of > or = 4000 g the risk estimate was 1.19 (95% CI, 0.96-1.47). CONCLUSION Fetuses that are larger than expected in the second trimester have an increased risk of macrosomia. This emphasizes that fetal size in early pregnancy is not only a function of gestational duration, but also of fetal growth. However, only a limited proportion of all infants born macrosomic can be identified as such at the time of ultrasound dating.
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Affiliation(s)
- M Thorsell
- Division of Obstetrics and Gynaecology, Danderyd Hospital, Stockholm, Sweden.
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Salomon LJ. Early fetal growth: concepts and pitfalls. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 35:385-389. [PMID: 20373482 DOI: 10.1002/uog.7623] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- L J Salomon
- Université Paris Descartes, Service de Gynécologie Obstétrique, Centre Hospitalo-Universitaire Necker-Enfants Malades, AP-HP, 75015 Paris, France.
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Abstract
The major issues in obstetric practice in developing countries are the high rates of maternal and perinatal mortality. In most low-income countries health financing systems are not well established so most people pay for health services at the service delivery points. This causes cost-related issues to be of major concern. The main questions that therefore need to be addressed about obstetric ultrasonography in low-income countries is whether the practice improves maternal and neonatal outcomes and whether the service is within the means of most people in these countries. The indications for obstetric ultrasound, guidelines for the use of obstetric ultrasound and the benefits of obstetric ultrasound in low-income countries are discussed and the future of obstetric ultrasound in developing countries is also briefly considered.
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Bottomley C, Bourne T. Dating and growth in the first trimester. Best Pract Res Clin Obstet Gynaecol 2009; 23:439-52. [PMID: 19282247 DOI: 10.1016/j.bpobgyn.2009.01.011] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Accepted: 01/20/2009] [Indexed: 11/16/2022]
Abstract
Measurement of embryonic or foetal size using the greatest length of the embryo or foetal crown rump length can be used to accurately determine the gestational age of a normal first trimester pregnancy to within three to five days. Transvaginal ultrasound scan can be used to measure the size of an embryo and gestation sac earlier than transabdominal ultrasound. The original Robinson curve used for dating pregnancies is still valid in most cases. Ultrasound dating in the first trimester is now recommended for all women with spontaneous pregnancies, even those with certain menstrual dates. First trimester growth in normal pregnancy is not uniform and is influenced by both maternal and foetal factors. Early foetal growth restriction is demonstrated in many pregnancies that subsequently end in first trimester miscarriage and is also demonstrated in fetuses with triploidy, trisomy 18 and possibly trisomy 13. Pregnancies which are small at the 11-14 week ultrasound scan appear to be at risk of later intrauterine growth restriction, preeclampsia and preterm delivery. Cross-sectional and serial measurement of foetal growth in the first trimester may be helpful in predicting both miscarriage and adverse late pregnancy outcomes.
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Bottomley C, Daemen A, Mukri F, Papageorghiou AT, Kirk E, Pexsters A, De Moor B, Timmerman D, Bourne T. Assessing first trimester growth: the influence of ethnic background and maternal age. Hum Reprod 2009; 24:284-90. [DOI: 10.1093/humrep/den389] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
OBJECTIVE To evaluate the association between fetal size and growth between the first and second trimesters and subsequent adverse pregnancy outcome. METHODS A cohort was created of 7,642 singleton pregnancies cared for in three obstetric units associated with Copenhagen University. Data were obtained from ultrasound measurements at 11-14 weeks (crown-rump length, biparietal diameter) and 17-21 weeks (biparietal diameter). Fetal size was assessed by gestation-specific z scores, and fetal growth between the first and second trimester was calculated individually using conditional centiles. The main outcome measures were preterm delivery, smallness for gestational age, and perinatal death. RESULTS Slow growth of the biparietal diameter less than the 10th and less than the 2.5th conditional centiles between first and second trimesters occurred in 10.4% and 3.6% of the population, respectively. Biparietal diameter growth less than the 10th centile was associated with perinatal death before 34 weeks (risk 0.5% compared with 0.04%, odds ratio [OR] 16.0, confidence interval [CI] 2.9-88.7). Biparietal diameter growth less than the 2.5th centile was the best predictor of perinatal death at any gestation, with a positive likelihood ratio of 4.7 and an OR of 7.3 (CI 2.4-22.2). In contrast, the biparietal diameter, dated by crown-rump length, did not have an increased risk of perinatal death; however, there was a mildly increased risk of small for gestational age birth weight (less than the 10th customized centile) if the biparietal diameter was below the 10th centile in the first trimester (risk 17% compared with 12%, OR 1.5, CI 1.2-1.8) or in the second trimester (risk 15.8% compared with 12.4%, OR 1.3, CI 1.1-1.5). CONCLUSION Slow growth of the fetal biparietal diameter between the first and second trimesters of pregnancy is a strong predictor of perinatal death before 34 weeks.
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