Role of fetal length in the prediction of fetal weight

Fetal thoracic circumference in mid-pregnancy and infant lung function

BACKGROUND AND AIM

Impaired lung function in early infancy is associated with later wheeze and asthma, while fetal thoracic circumference (TC) predicts severity of neonatal lung hypoplasia. Exploring fetal origins of lung function in infancy, we aimed to determine if fetal TC in mid-pregnancy was associated with infant lung function.

METHODS

From the prospective Scandinavian general population-based PreventADALL mother-child birth cohort, all 851 3-month-old infants with tidal flow-volume measurements in the awake state and ultrasound fetal size measures at 18 (min-max 16-22) weeks gestational age were included. Associations between fetal TC and time to peak tidal expiratory flow to expiratory time (t_PTEF /t_E ) were analyzed in linear regression models. To account for gestational age variation, we adjusted TC for simultaneously measured general fetal size, by head circumference (TC/HC), abdominal circumference (TC/AC), and femur length (TC/FL). Multivariable models were adjusted for maternal age, maternal asthma, pre-pregnancy body mass index, parity, nicotine exposure in utero, and infant sex.

RESULTS

The infants (47.8% girls) were born at mean (SD) gestational age of 40.2 (1.30) weeks. The mean (SD) t_PTEF /t_E  was 0.39 (0.08). The mean (SD) TC/HC was 0.75 (0.04), TC/AC 0.87 (0.04), and TC/FL 4.17 (0.26), respectively. Neither TC/HC nor TC/AC were associated with infant t_PTEF /t_E while a week inverse association was observed between TC/FL and t_PTEF /t_E  ( β ^ $\hat{\beta }$  = -0.03, 95% confidence interval [-0.05, -0.007], p = 0.01).

CONCLUSION

Mid-pregnancy fetal TC adjusted for fetal head or abdominal size was not associated with t_PTEF /t_E in healthy, awake 3-month-old infants, while a weak association was observed adjusting for fetal femur length.

FIGO (international Federation of Gynecology and obstetrics) initiative on fetal growth: best practice advice for screening, diagnosis, and management of fetal growth restriction

Fetal growth restriction (FGR) is defined as the failure of the fetus to meet its growth potential due to a pathological factor, most commonly placental dysfunction. Worldwide, FGR is a leading cause of stillbirth, neonatal mortality, and short- and long-term morbidity. Ongoing advances in clinical care, especially in definitions, diagnosis, and management of FGR, require efforts to effectively translate these changes to the wide range of obstetric care providers. This article highlights agreements based on current research in the diagnosis and management of FGR, and the areas that need more research to provide further clarification of recommendations. The purpose of this article is to provide a comprehensive summary of available evidence along with practical recommendations concerning the care of pregnancies at risk of or complicated by FGR, with the overall goal to decrease the risk of stillbirth and neonatal mortality and morbidity associated with this condition. To achieve these goals, FIGO (the International Federation of Gynecology and Obstetrics) brought together international experts to review and summarize current knowledge of FGR. This summary is directed at multiple stakeholders, including healthcare providers, healthcare delivery organizations and providers, FIGO member societies, and professional organizations. Recognizing the variation in the resources and expertise available for the management of FGR in different countries or regions, this article attempts to take into consideration the unique aspects of antenatal care in low-resource settings (labelled “LRS” in the recommendations). This was achieved by collaboration with authors and FIGO member societies from low-resource settings such as India, Sub-Saharan Africa, the Middle East, and Latin America.

Fetal left ventricular mass determination on 2-dimensional echocardiography using area-length calculation methods

OBJECTIVES

Fetal cardiac examination is an important part of fetal malformation screening. The purposes of this study were to describe the left ventricular (LV) mass in the second and third trimesters by 2-dimensional echocardiography using area-length calculation methods and to examine the clinical usefulness of this procedure in evaluation of gestational age (GA)- and fetal weight-related LV mass changes.

METHODS

Five hundred healthy fetuses were divided into 2 groups (250 participants per group): second- and third-trimester groups. The estimated fetal weight (EFW) was computed according to the Hadlock formula (Radiology 1984; 150:535-540). The LV mass at end diastole (LVd mass) and LV mass at end systole (LVs mass) were measured, and the difference between the LVd mass and LVs mass [LV(d-s) mass], LVd mass/EFW ratio, and LVs mass/EFW ratio were calculated.

RESULTS

The EFW, LVd mass, LVs mass, and LV(d-s) mass were all significantly greater in the third-trimester group than the second-trimester group (P < .05), whereas the LVd mass/EFW and LVs mass/EFW ratios did not differ between the groups (P > .05). The LVd mass, LVs mass, and LV(d-s) mass all significantly correlated with GA and weight (P< .001), but the LVd mass/EFW and LVs mass/EFW ratios did not (P > .05).

CONCLUSIONS

Two-dimensional echocardiography using area-length calculation methods can effectively provide measurements for LV mass and can sensitively indicate fetal weight- and GA -related changes in LV mass. Fetal cardiac mass measurement is a useful parameter for evaluation of fetal heart development.