Intra-and inter-observer reproducibility study of gestational age estimation using three common foetal biometric parameters: Experienced versus inexperienced sonographer (original) (raw)
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Background: Assessment of fetal gestational age with ultrasound provides high accuracy and reliability, as ultrasound is safe, easy operating and cheap. Objectives: to predict the GA with BPD and FL, to derive equations from linear regression analysis of GA with BPD and FL this could be applied to determine the fetal GA, to compare between BPD and FL. Methods: there were 100 normal pregnancies (singleton) had been selected for the study during the second and third trimesters. They were scanned with ultrasound using 3.5 MHz probe applying the obstetrics protocol to measure the fetal biometrics. The length of femoral diaphysis was measured from upper end to lower end excluding epiphysis. The biparietal diameter was measured from the fetal skull when being in oval shape; two thalami should be equal in size. The diameter was drawn from inner to outer margins of the skull perpendicular to the thalami. Results: statistical tests such as correlation and linear regression had been used to get the correlation coefficients and linear equations. There was a strong positive correlation between gestational age and femoral length and biparietal diameter (r = 0.97, r = 0.98). The estimation of gestational age from biparietal diameter could be calculated from the equation GA= 3.385+0.359BPD, and the estimation of gestational age could be calculated from the equation GA= 7.890 + 0.388FL. The most accurate most accurate equation to estimate the fetal gestational age was derived from the equation GA= 4.970 +0.157FL+0.218BPD. Conclusion: The estimation of gestational age with fetal biparietal diameter and femoral length still remain the most common measurements to assess the fetal growth. Evaluation of gestational age with biparietal diameter and femoral length joined together is more accurate than biparietal diameter and femoral length when used separately.
Accuracy of emergency physicians using ultrasound to determine gestational age in pregnant women
The American Journal of Emergency Medicine, 2010
Introduction: Rapid and accurate determination of gestational age may be vital to the appropriate care of the critically ill pregnant patient. Before the use of emergency ultrasound, physical examination of fundal height (FH) in the nonverbal patient was considered the quickest method to estimate gestational age. We conducted a prospective, observational study of the performance of bedside sonography to determine gestational age. Methods: We enrolled a convenience sample of women in their second or third trimester of pregnancy. Emergency physicians (EPs) made ultrasound measurements of fetal biparietal diameter (BPD) and femur length, followed by a measurement of FH. These measurements were compared with true gestational age (TGA), sonography by an ultrasound technician, and measurement of FH performed by an obstetrician. Main outcome measures were the average time needed to complete measurements; correlation coefficients between EP measurements and those made by an ultrasound technician, an obstetrician, and TGA, and overall accuracy to determine fetal age greater than 24 weeks. Results: The average time to complete ultrasound measurements was less than 1 minute. When physician-performed measurements were compared with TGA, the correlation coefficients were 0.947 (0.926-0.968) for BPD, 0.957 (0.941-0.973) for femur length, and 0.712 (0.615-0.809) for FH. When determining fetal viability, EP's overall accuracy was 96% using ultrasound and 80% using FH. Conclusions: With brief training, EPs can quickly and accurately determine gestational age using ultrasound, and these estimates may be more accurate than those obtained through physical examination. Emergency physicians should consider using ultrasound in emergent evaluation of pregnant patients who are unable to provide history.
Medico-Legal Aspect of Fetal Age Determination from Ultrasound Parameters
Background: Fetal Biometry can be used to estimate gestational age. An exact method to find out gestational age is measurement of Crown rump length (CRL) in the first trimester of pregnancy and Bi-parietal diameter (BPD) in second trimester , so gestational age in present study was calculated with respect to Bi-parietal diameter, Femur length and Crown rump length using Hadlock's formulae. Material and Methods: The study was undertaken on 200 human foetuses amongst the women attending antenatal clinic, who came for routine obstetric ultrasonography in MMIMSR, Mullana Distt. Ambala , Haryana and the collected data was analysed at GMC, Amritsar, afterwards. Results: The mean of total age of the sample studied was 26.21 years with standard deviation of ±4.27.. The total mean of parity of the sample studied was 0.64 with standard deviation of ±0.76. Mean gestational age of cases studied was 20.68 weeks with standard deviation±10.84 weeks and range of 5.86 with standard deviation of ± 40.71 weeks. Mean of BPD was 6.03 cm with standard deviation is ±2.58, with range 1.72 cm to 9.79cm. Mean femur length of the cases studied was 4.3cm, with standard deviation ±2.44cm, were within range of 1.10cm to 7.77cm. Conclusion: The advantage of measuring multiple parameters is that the same single ultrasound examination employed for measuring of BPD is sufficient to measure all the multiple parameters without any potential hazards to both mother and foetus, easier to measure, is reliable parameters for estimation of gestational age and can be used easily by anyone. The variability associated with this prediction was found to be comparable to Hadlock's formulae in the gestational period of >5 weeks.
International journal of scientific research, 2020
INTRODUCTION: Gestational age (GA) estimation, is a critical factor, in decision making in Pre-term care, Prognostication and Follow-up of the newborn. Unfortunately, in developing & resource restricted countries like, INDIA, in the absence of routine abdominal ultrasound, gestational age estimation is done by Ballard's score and Last menstrual period (LMP) dating, both of which are well predictive, but not accurate. In sick babies scoring becomes hazardous and difcult to estimate gestational age. AIM: The aim of this Co-relational, Observational study, was to determine whether postnatal foot length measurement, compared with Ultrasound, Ballard's score, could accurately determine Gestational age in neonates studied at, Durgapur steel plant hospital, West-Bengal, India. MATERIALS &METHODS: A VERNIER CALLIPER is used to accurately measure the foot-length (mid-point of heel to longest toe) INCLUSION CRITERION-babies born <24 hours of life; AGA (Appropriate for gestational age);USG done <12 weeks. EXCLUSION CRITERION-SGA(Small for gestational age);LGA(Large for gestational age); congenital anomalies,obvious disproportionate foot. RESULTS: A foot length GA model (FL-model) has been constructed by Regression, and plotted on a graph, to independently predict Gestational age from Post-natal Foot length. The curve obtained, on regression was denoted by, Gestational age in weeks = [(0.365 * Foot length in mm) +9.6] A sample test value of size 20, who has been randomly selected from the master sheet, has been tested on this regression model (FL-model). The Differential error between Foot-length predicted gestational age (Fl-model) and GA USG is 1.5%; The Differential error between Foot-length predicted gestational age (Fl-model) and GALMP is 2.1%; The Differential error between Foot-length predicted gestational age (Fl-model) and GA Ballard is 2.3%. DISCUSSION AND CONCLUSION: This study was done at a hospital in Eastern India. The male: female ratio of the study population was 49:51. This study was done in 200 newborns. If this study is done in a bigger sample size, it could lead to a Foot length model, that can be used with high accuracy to determine the Gestational age in a population, where there is poor utilization of antenatal ultrasound.
stuDy oF accuracy oF commonly useDFetal Parameters For estimation oF gestational age
Journal of Nepal Medical Association, 2006
Estimation of the gestational age by sonographic measurements of fetal parameters is usually done by measuring mean sac diameter (MSD), Crown-rump length (CRL), biparietal diameter (BPD), head circumference (HC), femoral length (FL) and abdominal circumference (AC) depending on the trimester of pregnancy. This is a prospective study to see the correlation of different fetal param-eters in estimating the gestational age. A total of 71 normal women were taken and ultrasonogram was done to take MSD and CRL in 1st trimester and BPD, HC, FL and AC in 2 nd and 3 rd trimester. Gestational age was calculated by MSD using Rempen normogram and Hadlock normograms were used for the rest of fetal parameters. Gestational age by LMP was also calculated at the same time. Correlation of different fetal parameters in estimating gestational age in different trimesters was done by Pearson correlation. Pearson correlation showed that the CRL was the best fetal param-eter (correlation coefficient of 0.90...
Use of Foot Measurements as Sonographic Parameter for Estimation of Fetal Age
Open Journal of Medical Imaging
Objectives: this research was conducted to describe the ultrasonic measurements of the foot full measurements (FFM) and their importance in the antenatal care (ANC). Material and methods: the Descriptive quantitative cross-sectional study conducted in the ultrasound department at Alshaekh Mohammed Ali Fadol hospital in Omdurman locality. The study included 400 healthy Sudanese pregnant women whom in the 1st (late), 2nd and 3rd trimesters (i.e., after 10 weeks gestational age) of different parity and ages (15 years old and above); they have regular menstrual cycle and well certain of their last menstrual period and calculated date of delivery. Ultrasonographic measurement of Full Foot Length1 (FFL1), Foot Full Length2 (FFL2), and Foot Full Width (FFW) of all pregnant women were done. Sonographically we measured fetal foot from 14 to 40 weeks of gestation. Results: the study revealed that the mean FFL1 was 58.7 ± 12.9 mm. The minimum measurement was 18.8 mm, and the maximum was 89.1 mm, while the mean value of FFL2 was 53.4 ± 11.4 mm, with minimum value 17.5 mm and maximum 81.7 mm, and the mean FFW was 23.7 ± 5.1 mm, with minimum value 7.0 mm and maximum 38.0 mm. Conclusion: a strongly significant relationships were observed between (FFL1, FFL2, FFW) and gestational age (p = 0.00). However there is no significant difference between the FFL1, FFL2, and correlations with sex of embryo, residence, occupation, parity, maternal height, socioeconomic status, bleeding during this pregnancy, chronic illness, and caesarian section, moreover there are significant correlations between the FFL1, FFL2 and the
Accuracy of Ultrasound to Determine Gestational Age in Third Trimester
Rapid and accurate determination of gestational age (GA) may be vital to the appropriate care of the critically ill pregnant patient and improve obstetric care through allowing the optimal timing of necessary INTERVENTIONS and the avoidance of unnecessary ones. Ultrasound scans are considered to be the most cost-effective, accurate and safe methods for measurement of various fetal parts in pregnant women. The aim of this research is to explore the accuracy of ultrasound in determining gestational age of fetus in third trimesters. Data collected for all pregnant women referred to the Maternity & Children’s Hospital in Jeddah. Only women with single live fetus were included in this study. Women who participated in the study were selected on following criteria: Regular menstrual cycles, known date of last menstrual period and previous live normal neonates in multipara. All scans were performed by a single ultrasonologist on one ultrasound machine. From collected data, it was found that out of 53 (100%) patients, 44 (84.62%) pregnant woman have different gestational age from US and last menstrual period (LMP). From this study we can conclude that the main method to follow fetus growth in third trimester not biparietal diameter (BPD) measurement only. The BPD in third trimester is not reliable and be useless when the patient pass 30 weeks and the BPD has to be side with other measurements when we take it in later trimesters to emphasize the normal growth of fetus and avoid wrong measurement of ultrasound.
Estimation of Fetal Age Sonographically Using Umbilical Cord Diameter in Second and Third Trimester
American Journal of Health Research, 2014
Assessment of gestational age is paramount in obstetric care. This study was to evaluate the gestational age (GA) by measuring the Umbilical Cord Diameter (UCD) in the second and third trimester of pregnancy, and to compare the findings with the Femur Length (FL), Bi-parietal Diameter (BPD) and Last Menstrual Period (LMP). Fifty Sudanese Pregnant women underwent routine sonographic examination using 3.5MHz curve liner transducer; the sonographic cross-sectional area of the umbilical cord was measured in a plane adjacent to the insertion of the cord into the fetal abdomen. Maternal age and number of parity have been evaluated. The relation was statistically significant between UCD depth, width and GA. Gestational age can be predicted and can be depicted by the following equations: GA= (1.380 × UCD length +8.160) and GA= (1.545× UCD width+5.943). There was unsubstantial relation between UCD and maternal age. A linear relationship was found between parity and the UCD depth and width. Using paired T-test indicates that the GAs calculated from FL was accurate, there was no significant difference detected between the LMP age and the estimated one and UCD depth, width, but BPD showed significant difference at p = 0.005 .Measuring UCD is useful for the assessment of gestational age. It has a role in obstetric care in the second and third trimester of pregnancy, and these equations can be used to estimate the gestational age instead of BPD and FL.
Gestational Age Estimation Based on Fetal Pelvimetry on Fetal Ultrasound in Iraqi Women
Journal of Global Radiology, 2016
Ultrasound is an integral part of obstetric practice, and assessment of gestational age (GA) is a central element of obstetric ultrasonography. Sonographic estimation of GA is derived from calculations based on fetal measurements. Numerous equations for GA calculation from fetal biometry have been adopted in routine practice. This study reports a new method of estimating GA in the second and third trimester using interischial distance (IID), the distance between the two ischial primary ossification centers, on fetal ultrasound. Four hundred women with uncomplicated normal singleton pregnancies from 16 weeks to term were examined. Standard fetal obstetric ultrasound was done measuring biparietal diameter (BPD) and femur length (FL) for each fetus. The IID, in millimeters, was correlated with the GA in weeks based upon the BPD and FL individually, and the BPD and FL together. Statistical analysis showed strong correlation between the IID and GA calculated from the FL with correlation coefficient (r =0.989, P<0.001). Strong linear correlation was also found between the IID and GA based upon BPD and BPD+FL. Further statistical analysis using regression equations also showed that the IID was slightly wider in female fetuses, but this difference was not statistically significant. Resulting from this analysis, we have arrived at an easy-to-use equation: GA Weeks = (IID mm + 8) ±1 week. We feel this method can be especially applicable in the developing world, where midwives may not have access to software for fetal biometry in their basic handheld ultrasound machines. Even more sophisticated machines may not come with loaded software for obstetrics analysis. There are several limitations to this study, discussed below. We recommend further studies correlating the IID with other biometric parameters.
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
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 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. INTERGROWTH-21(st) was a large, prospective, multicentre, population-based project performed in eight geographically defined urban populations. One of its principal components, the Fetal Growth Longitudinal Study (FGLS), aimed to develop international fetal growth standards. Each participant had certain menstrual dates confirmed by first trimester ultrasound. 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 birth. For each participant, a single, randomly selec...