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ABSTRACT: Objectives- To analyze the effect of fetal sex on intrauterine growth patterns during the second and third trimesters. Methods- We conducted a cross-sectional study of women with uncomplicated singleton pregnancies who underwent sonographic fetal weight estimation during the second and third trimesters in a single tertiary center. The effect of fetal sex on intrauterine growth patterns was analyzed for each of the routine fetal biometric indices (biparietal diameter, head circumference, occipitofrontal diameter, abdominal circumference, and femur length) and their ratios. Sex-specific regression models were generated for these indices and their ratios as a function of gestational age. Sex-specific growth curves were generated from these models for each of the biometric indices and their ratios for gestational weeks 15 to 42. Results- Overall, 12,132 sonographic fetal weight estimations were included in the study. Fetal sex had an independent effect on the relationship between each of the biometric indices and their ratios and gestational age. These effects were most pronounced for biparietal diameter (male/female ratio, 1.021) and the head circumference/femur length and biparietal diameter/femur length ratios (male/female ratios, 1.014 and 1.016, respectively). For the head measurements, these sex-related differences were observed as soon as the early second trimester, whereas for abdominal circumference, the differences were most notable during the late second and late third trimesters. Conclusions- Female fetuses grow considerably slower than male fetuses, and these differences are observed from early gestation. However, the female fetus is not merely a smaller version of the male fetus, but, rather, there is a sex-specific growth pattern for each of the individual fetal biometric indices. These findings provide support for the use of sex-specific sonographic models for fetal weight estimation as well as the use of sex-specific reference growth charts.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 01/2013; 32(1):35-43. · 1.25 Impact Factor
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ABSTRACT: Objective: To investigate the emotional response in cases of multifetal reduction and pregnancy termination and to compare the psychological response between these two groups. Methods: A prospective study in a tertiary-care, university-affiliated medical center. The study group included 65 women who had been advised to terminate pregnancy because of a finding of a severe fetal abnormality on ultrasound screening (pregnancy termination group) and 41 women advised to undergo reduction because of the presence of multiple fetuses (multifetal reduction group). All women underwent psychological testing using validated questionnaires addressing perinatal grief and anxiety levels. Results: Women in both the multifetal reduction and the pregnancy termination groups reported significant degree of grief and anxiety before and after the procedure, although the levels of anxiety on the day of procedure and anxiety and grief at follow up were higher in the pregnancy termination group (t = 2.438, p = 0.016; t = 2.441, p = 0.017; and t = 3.111, p = 0.03, respectively). In both groups there was a gradual decrease in the state anxiety with time (48.01 ± 8.26 to 37.59 ± 9.23; t = -9.931; p < 0.001). Several factors affected the emotional response in the cases, including marital status, level of education, employment status, and gestational age. There was no association between a history of prior perinatal loss and emotional response. Conclusion: There is need for a continuing psychosocial support of women undergoing multifetal reduction and pregnancy termination for fetal abnormalities.
The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 09/2012; · 1.36 Impact Factor
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ABSTRACT: The aim of the study was to establish a nomogram for renal parenchymal thickness throughout pregnancy.
One-hundred and twenty-eight healthy women with singleton, well-dated, uncomplicated second- or third-trimester pregnancies were prospectively evaluated for renal parenchymal thickness on routine ultrasound scans. The renal parenchyma was measured in transverse and sagittal sections using predefined criteria.
There were no differences in anterior or posterior parenchymal measurements in either plane by fetal sex. On sagittal-section analysis, no differences were noted between the right and left kidneys. A nomogram was established on the basis of the findings. The results showed constant linear growth of the fetal parenchyma during pregnancy.
The normal fetal parenchyma grows at a constant, linear rate throughout pregnancy. The nomogram formulated may serve as a basis of future studies of the correlation of parenchymal thickness with postnatal kidney function in fetuses with urinary tract anomalies.
Archives of Gynecology 05/2012; 286(4):867-72. · 0.91 Impact Factor
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ABSTRACT: The purpose of this study was to determine the accuracy of sonographic diagnosis of ovarian torsion and the predictive value of typical sonographic signs.
The study included 63 women attending an ultrasound unit of a tertiary obstetrics and gynecology department in 2002 through 2008 who had suspected ovarian torsion on sonography and subsequently underwent laparoscopy.
Sonography had diagnostic accuracy of 74.6% for ovarian torsion. Abnormal ovarian blood flow and the presence of free fluid were the most diagnostically accurate isolated sonographic signs (positive predictive values, 80.0% and 89.2%, respectively; negative predictive values, 46.2% and 46.2%). Using combinations of sonographic signs yielded higher specificity and positive predictive values and lower sensitivity and negative predictive values for ovarian torsion. The diagnostic accuracy was largely affected by the ultrasound operator (mean ± SD, 78.8% ± 16.0%; range, 60.0%-100%).
In the setting of a specialized ultrasound unit, sonographic diagnosis of ovarian torsion had high (74.6%) accuracy compared with previous reports. The absence of typical sonographic signs does not rule out ovarian torsion, especially when the clinical presentation is suggestive. Basing assessments on multiple sonographic signs, including Doppler evaluation, increases the diagnostic specificity.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 09/2011; 30(9):1205-10. · 1.25 Impact Factor
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ABSTRACT: To determine whether the use of a sex-specific sonographic model improves the accuracy of fetal weight estimation.
New regression models (sex-independent and sex-specific) were developed, based on 1708 sonographic weight estimations performed within 3 days prior to delivery. The accuracy of these models was compared to that of several published models including two of the original Hadlock models (which incorporate the biometric indices abdominal circumference (AC), biparietal diameter (BPD), femur diaphysis length (FL) and head circumference (HC) as follows: AC-FL-BPD and AC-FL-HC, designated here as Hadlock I and Hadlock II, respectively), modified versions of the Hadlock I and II models for which coefficients were adjusted to our local cohort, sex-specific versions of the Hadlock I and II models and Schild's model (a previously published sex-specific model).
The unadjusted models of Hadlock and Schild were associated with the highest systematic error (1.6-4.9%; P < 0.001) which was significantly higher for females (2.3-4.9%) compared to males (1.6-2.0%; P < 0.001). Adjustment of model coefficients to the local population decreased the systematic error (-1.4% to 1.5%) and resulted in a systematic error that was of similar magnitude (P = 0.3) but opposite in direction for male and female fetuses. The sex-specific models (adjusted or newly developed) were associated with the lowest systematic error (-0.4 to 0.5%) and were the only models for which the systematic error was similar for male and female fetuses. There were no differences in the systematic error between adjusted sex-specific versions of the Hadlock I and II models and the newly developed sex-specific models (0.0% to 0.4% vs. - 0.4% to 0.5%; P = 0.4). The random error was similar for all models and, for most of the models, was unrelated to fetal sex.
The use of sex-specific models appears to improve the accuracy of fetal weight estimation, principally because the optimal set of model coefficients differs for male and female fetuses. The improved accuracy is mainly the result of a decrease in systematic error, as the random error was not affected by the use of such sex-specific models.
Ultrasound in Obstetrics and Gynecology 08/2011; 39(5):549-57. · 3.01 Impact Factor
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ABSTRACT: To assess the accuracy of sonographic weight estimation for fetuses in breech presentation, and to determine whether certain sonographic models perform better than others in cases of breech presentation.
This was a retrospective cohort study of all sonographic weight estimations of fetuses in breech presentation performed within 3 days prior to delivery (n = 165). The accuracy of weight estimation was evaluated using eight sonographic models and was compared with a control group of fetuses in vertex presentation matched to the study group by birth weight and fetal gender (n = 165).
After exclusion of a model based on femur diaphysis length alone, which was found to be highly inaccurate, the systematic error for fetuses in breech presentation was smaller than that observed for fetuses in vertex presentation (mean of all models - 0.14% vs. 2.0%, P = 0.01). The random error was higher in cases of breech presentation (9.4-13.2% vs. 7.5-8.9%, P < 0.05), and was lower for models that are based on three to four biometric indices (9.4-9.5%) compared with models that incorporate one to two biometric indices (10.8-13.6%, P < 0.05). Overall, the higher random error outweighed the decrease in the systematic error, as reflected by the lower fraction of weight estimations within 10% of birth weight among fetuses in breech presentation. Models based on three to four biometric indices were more accurate in detecting the weight thresholds beyond which a trial of vaginal delivery is usually not recommended.
Sonographic weight estimation appears to be less accurate for fetuses in breech presentation, principally because of a larger random error. The use of sonographic models that are based on three to four biometric indices, training aimed at improving measurement in breech fetuses and the development of sonographic models derived from fetuses in breech presentation, may improve the accuracy of weight estimation in these cases.
Ultrasound in Obstetrics and Gynecology 01/2011; 38(4):418-24. · 3.01 Impact Factor
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ABSTRACT: To determine whether the accuracy of sonographic fetal weight estimation is related to fetal sex.
The accuracy of sonographic fetal weight estimation was compared between male and female fetuses using 3672 sonographic weight estimations performed within 3 days prior to delivery. Fetal weight was estimated using eight regression models that are based on different combinations of the following biometric parameters: abdominal circumference (AC), femur diaphysis length (FL), biparietal diameter (BPD) and head circumference (HC).
In seven out of the eight models tested, the presence of a male fetus was associated with a significantly lower systematic error compared with a female fetus (-0.2 to 2.1% vs. 1.3 to 6%, P<0.001). On multivariate analysis, fetal sex was independently associated with sonographic accuracy so that the likelihood of a weight estimation within 10% of birth weight was 30% higher for male fetuses compared with female fetuses. The biometric parameters that contributed most to these sex-related differences were FL and AC, while models that included HC were associated with the lowest differences in the systematic error between male fetuses and female fetuses. For most models, the random error and correlation between estimated weight and birth weight were not affected by fetal sex (8.1-12.8% vs. 8.2-13.6%, and 0.856-0.944 vs. 0.842-0.944, respectively).
Sonographic estimation of fetal weight is more accurate for male fetuses than for female fetuses. The use of sex-specific models may improve the accuracy of fetal weight estimation for female fetuses.
Ultrasound in Obstetrics and Gynecology 01/2011; 38(1):67-73. · 3.01 Impact Factor
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ABSTRACT: To compare the accuracy of 21 sonographic fetal weight-estimation models and abdominal circumference (AC) as a single measure for the prediction of fetal macrosomia (> 4000 g) using either fixed or optimal model-specific thresholds.
A total of 4765 sonographic weight estimations performed within 3 days prior to delivery were analyzed. The predictive accuracy of 21 published sonographic fetal weight-estimation models was calculated using three different thresholds: a fixed threshold of 4000 g; a model-specific threshold obtained from the inflexion point of the receiver-operating characteristics (ROC) curve; and a model-specific threshold associated with the highest overall accuracy. Cluster analysis was used to determine whether a certain combination of fetal biometric indices is associated with a higher predictive accuracy than others.
For a fixed threshold of > 4000 g, there was considerable variation among the models in sensitivity (range, 13.6-98.5%) and specificity (range, 63.6-99.8%) for fetal macrosomia. Use of the threshold derived from the inflexion point of the ROC curve decreased the intermodel variation to a minimum (sensitivity, 84.4-91.4%; and specificity, 79.5-86.3%). Even when this optimal model-specific threshold was applied, models based on three to four biometric indices were more accurate than were models based on only two biometric indices or on AC as a single measure (P=0.03).
Sonographic fetal weight-estimation models based on three to four biometric indices appear to be more accurate than are models based on two indices or on AC as a single measure, for the diagnosis of macrosomia. In these cases, the use of an optimal, model-specific threshold is associated with a higher degree of accuracy than is the uniform use of a fixed threshold of an estimated weight of > 4000 g.
Ultrasound in Obstetrics and Gynecology 01/2011; 38(1):74-81. · 3.01 Impact Factor
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ABSTRACT: The purpose of this study was to determine the effect of false diagnosis of macrosomia (<4500 g) on maternal/perinatal outcomes.
We conducted a case-control study of women (n = 1938) in whom sonographically estimated fetal weight (EFW) was determined up to 3 days before delivery and actual birth weight (BW) was 3500 to 4499 g. Women with false-positive and -negative findings for macrosomia were compared, respectively, with women with true-negative and -positive findings for outcome variables.
The cesarean delivery (CD) rate was 2 to 2.5 times higher when EFW was 4000 to 4499 g, regardless of actual BW. Failure to detect macrosomia was associated with higher rates of perineal trauma, 5-minute Apgar scores less than 7, and neonatal trauma, mostly related to the higher rate of surgical vaginal deliveries. The use of another sonographic model with a lower false-positive rate could theoretically reduce the CD rate by approximately 5%.
False diagnosis of macrosomia substantially increases the CD rate and leads to maternal/neonatal complications.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 02/2010; 29(2):225-30. · 1.25 Impact Factor
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ABSTRACT: The purpose of this study was to compare the accuracy of different sonographic models for fetal weight estimation.
We evaluated 26 different models using 3705 sonographic weight estimations performed less than 3 days before delivery. Models were ranked on the basis of systematic and random errors and were grouped according to the combination of biometric indices in each model. Cluster analysis was used to compare the accuracy of the different model groups.
A considerable variation in the accuracy of the different models was found. For birth weights (BWs) in the range of 1000 to 4500 g, models based on 3 or 4 fetal biometric indices were significantly more accurate than models that incorporated only 1 or 2 indices. The accuracy of weight estimation decreased at the extremes of BWs, leading to overestimation in low-BW categories as opposed to underestimation when the BW exceeded 4000 g. The precision of most models was lowest in the low-BW groups.
To improve the accuracy of fetal weight estimation, sonographic models that are based on 3 or 4 fetal biometric indices should be preferred. Recognizing the accuracy and the tendency for underestimation or overestimation of each of the available models is important for the judicious interpretation of fetal weight estimations, especially at the extremes of fetal weight.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 06/2009; 28(5):617-29. · 1.25 Impact Factor
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ABSTRACT: Nonvisualization of the fetal gallbladder by ultrasound poses a diagnostic dilemma. The aim of the study was to establish reference values for the hepatobiliary enzyme gamma-glutamyl-transferase (GGT) in amniotic fluid in normal pregnancies, and to determine the maximal week of gestation in which reference values can be determined.
A cross-sectional design was used. The study group consisted of pregnant women at 16 gestational weeks or more referred to our ultrasound unit for amniocentesis. Amniotic fluid was assayed for levels of GGT and other hepatobiliary enzymes using the Integra 800 device. The 5th and 95th percentiles for each gestational week were calculated.
A total of 263 samples were analyzed. After conversion to log units, enzyme levels showed a good correlation with gestational week (Pearson). The mean values and the 5th and 95th percentiles were calculated for gestational weeks 16 to 22. Beyond 22 weeks, the number of examinations was insufficient for analysis. On multiple regression analysis, log values of alkaline phosphatase, maternal age, and gestational age independently affected log GGT values. Levels of alkaline phosphatase, aspartate aminotransferase, and alanine aminotransferase were too low, and their correlation with gestational week too poor for calculation of reference values.
GGT reference values in amniotic fluid in normal pregnancies were defined for gestational weeks 16 to 22. These data may be useful for differentiating isolated absence of fetal gallbladder from extrahepatic biliary atresia.
Prenatal Diagnosis 05/2009; 29(7):703-6. · 2.11 Impact Factor
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ABSTRACT: The purpose of this study was to develop new regression formulas based on large numbers of sonographic examinations performed within 10, 7, and 3 days of delivery.
Sonographic fetal biometric measurements and delivery ward data for an unselected population were analyzed. Multivariate linear regression models were fitted to the sonographic data to predict the actual birth weight (BW) within 10, 7, and 3 days.
The analyses included 6289, 5449, and 4007 patients who underwent sonographic examinations within 10, 7, and 3 days of delivery, respectively. All models yielded very high correlation coefficients (r = 0.927-0.958; R(2) = 0.859-0.918), low mean deviations between the calculated and actual BWs (6.4%-6.6% +/- 1 SD of 5.5%-5.9%), and high percentages of the calculated BW within 10% of the actual BW (78.5%-80.4%). Estimated fetal weight analyses made within 3 days of delivery yielded slightly better results than within 7 and 10 days.
The new regression formulas yielded overall similar results, with a small advantage for estimates calculated within 3 days of delivery. Further prospective studies are needed to compare the accuracy of these formulas with those used to date.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 12/2008; 27(11):1553-8. · 1.25 Impact Factor
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ABSTRACT: The purpose of this study was to assess the value of combining the sonographically estimated fetal weight (EFW) and amniotic fluid index (AFI) measured within 10 days of term delivery for prediction of macrosomia at birth.
Prospective sonographic fetal biometric measurements and delivery ward data of a single center, uploaded separately over a 4-year period, were retrospectively linked to yield an unselected sample of nondiabetic pregnancies with live-born term neonates.
Of the 1925 pregnancies evaluated, 140 (7.2%) were macrosomic (birth weight > or =4000 g). The AFI was significantly higher in the macrosomic group (P < .001). On receiver operating characteristic curve analysis, the area under the curve was larger for predictions based on the EFW alone than on the AFI. An EFW of 4000 g or higher had a positive predictive value of 46.6% for macrosomia at birth. Use of the previously suggested combined EFW and AFI cutoffs of 3689 g and 119 mm, respectively, yielded a positive predictive value of 30.3%.
Combined use of the EFW and AFI rather than the EFW alone does not improve prediction of macrosomia at birth.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 07/2008; 27(7):1029-32. · 1.25 Impact Factor
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ABSTRACT: Correct prenatal determination of the fetal right/left axis is essential for the diagnosis of fetal malformations, in particular congenital heart anomalies. A reliable method of transabdominal echocardiographic assessment of the fetal situs in the late second trimester was established. We aimed to determine the validity of the transvaginal approach to assess fetal axis.
The study group consisted of 108 consecutive women in the second trimester of a singleton pregnancy, undergoing elective transvaginal anatomy scans. All had undergone previous transabdominal echocardiography to establish fetal axis. The same technique was used to assess the fetal axis during the transvaginal study, and the findings were compared.
There was total agreement in fetal axis determination between transabdominal and transvaginal scans in all cases. The accuracy of the transvaginal study was not affected by maternal obesity, fetal position or the presence of cardiac malformation (in one case).
Transvaginal ultrasonography is the reliable and accurate means of determining the fetal axis.
Archives of Gynecology 02/2008; 278(3):237-9. · 0.91 Impact Factor
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ABSTRACT: A congenital limitation of finger movements is associated with many syndromes that interfere with child well-being. The normal range of fetal finger movements during the second and third trimester is unknown. The aim of this study was to measure the normal range. In this study, fetal finger flexion and extension were examined during routine ultrasound screening in 260 consecutive normal fetuses at gestational age 16-41 weeks. Full extension and flexion of the fingers were noted in 110 fetuses examined at 16-26 weeks. Of the 150 fetuses examined at 27-41 weeks, full flexion and extension were noted in 118 (78.7%), full flexion and partial extension in 30 (20%), and full flexion without extension in two (1.3%). Knowledge of the normal range of fetal finger movements will assist clinicians in the prenatal diagnosis of other anomalies and syndromes.
Journal of Pediatric Orthopaedics B 08/2007; 16(4):252-5. · 0.47 Impact Factor
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ABSTRACT: Bleeding in the first trimester of pregnancy is a common phenomenon, associated with early pregnancy loss. In many instances a subchorionic hematoma is found sonographically.
To evaluate the possible benefit of bed-rest in women with threatened abortion and sonographically proven subchorionic hematoma, and to examine the possible relationship of duration of vaginal bleeding, hematoma size, and gestational age at diagnosis to pregnancy outcome.
The study group consisted of 230 women of 2,556 (9%) referred for ultrasound examination because of vaginal bleeding in the first half of pregnancy, who were found to have a subchorionic hematoma in the presence of a singleton live embryo or fetus. All patients were advised bed-rest at home; 200 adhered to this recommendation for the duration of vaginal bleeding (group 1) and 30 continued their usual lifestyle (group 2). All were followed with repeated sonograms at 7 day intervals until bleeding ceased, the subchorionic hematoma disappeared, or abortion occurred. The groups were compared for size of hematoma, duration of bleeding, and gestational age at diagnosis in relation to pregnancy outcome (spontaneous abortion, term or preterm delivery).
The first bleeding episode occurred at 12.6 +/- 3.4 weeks of gestation (range 7-20 weeks) and lasted for 28.8 +/- 19.1 days (range 4-72 days). The women who adhered to bed-rest had fewer spontaneous abortions (9.9% vs. 23.3%, P = 0.006) and a higher rate of term pregnancy (89 vs. 70%, P = 0.004) than those who did not. There was no association between duration of vaginal bleeding, hematoma size, or gestational age at diagnosis of subchorionic hematoma and pregnancy outcome.
Fewer spontaneous abortions and a higher rate of term pregnancy were noted in the bed-rest group. However, the lack of randomization and retrospective design of the outcome data collection preclude a definite conclusion. A large prospective randomized study is required to confirm whether bed-rest has a real therapeutic effect.
The Israel Medical Association journal: IMAJ 07/2003; 5(6):422-4. · 1.02 Impact Factor
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ABSTRACT: To evaluate the accuracy of sonographic estimation of fetal weight (EFW) in diabetic pregnancies and pregnancies with suspected fetal macrosomia.
63 women with diabetic pregnancies, 74 nondiabetic women with suspected large-for-gestational-age (LGA) infants, and 161 controls underwent ultrasound assessment prior to induction of labor. EFW was compared to the weight at birth, 1-3 days later.
EFW was highly correlated to birth weight. Absolute or actual weight differences between the birth weight and the EFW, and the rate of EFW within 10% of birth weight were not different between the groups. A linear regression model controlling for maternal and gestational age, diagnosis of gestational or pregestational diabetes, birth weight, gravidity, parity, nulliparity, placental location and AFI was not significantly correlated to the absolute or actual weight differences. In pregnancies with suspected LGA, higher birth weight was an independent and significant predictor of high weight difference inaccuracy.
The ultrasonographic EFW 1-3 days before delivery is highly correlated with birth weight, reaffirming the clinical use of abdominal circumference and femur length in estimating fetal weight near labor at term. In pregnancies with suspected LGA fetuses and higher prevalence of macrosomia, ultrasound has higher sensitivity but lower specificity than the controls.
Journal of Perinatal Medicine 02/2003; 31(3):225-30. · 1.70 Impact Factor
