Utility of third trimester sonographic measurements for predicting SGA in cases of fetal gastroschisis (original) (raw)
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Gastroschisis: Antenatal Sonographic Predictors of Adverse Neonatal Outcome
Journal of Pregnancy, 2014
Objectives. The aim of this review was to identify clinically significant ultrasound predictors of adverse neonatal outcome in fetal gastroschisis.Methods. A quasi-systematic review was conducted in PubMed and Ovid using the key terms “gastroschisis,” “predictors,” “outcome,” and “ultrasound.”Results. A total of 18 papers were included. The most common sonographic predictors were intra-abdominal bowel dilatation (IABD), intrauterine growth restriction (IUGR), and bowel dilatation not otherwise specified (NOS). Three ultrasound markers were consistently found to be statistically insignificant with respect to predicting adverse outcome including abdominal circumference, stomach herniation and dilatation, and extra-abdominal bowel dilatation (EABD).Conclusions. Gastroschisis is associated with several comorbidities, yet there is much discrepancy in the literature regarding which specific ultrasound markers best predict adverse neonatal outcomes. Future research should include prospecti...
Fetal growth standards in gastroschisis: Reference values for ultrasound measurements
Prenatal Diagnosis, 2017
Bulleted statements: Growth pattern of fetuses with gastroschisis is not fully elucidated and causes controversy in time to delivery, increasing prematurity and neonatal morbidity. This study created specific curves for gastroschisis and Umbilical Artery Doppler velocimetry patterns were obtained. We concluded that these fetuses show symmetrical growth deficits for all biometric parameters, being constitutionally smaller and would be better followed-up using specific growth charts.
Gastroschisis: can prenatal sonography predict neonatal outcome?
Ultrasound in Obstetrics and Gynecology, 2003
Objective Gastroschisis is associated with significant neonatal morbidity, and occasionally mortality. Previous studies looking at ways to prognosticate this condition by antenatal ultrasound have shown conflicting results. The aim of this study was to evaluate the usefulness of prenatal sonographic parameters to predict neonatal outcome of gastroschisis. Methods The charts, photographs, and videotapes of all fetuses with gastroschisis who were assessed during pregnancy at the Mater Mothers' Hospital, Brisbane over an 8.5-year period (Jan 1993 -May 2001) were reviewed. Adverse neonatal outcome was defined as death, severe bowel complications (atresia, perforation, necrotic segments), need for multiple bowel operations, or a combination of these. Various sonographic parameters assessed included: gestation at first diagnosis, maximum bowel diameter, maximum bowel wall thickness, presence of other anomalies, evidence of growth restriction, and polyhydramnios.
The Journal of Maternal-Fetal & Neonatal Medicine, 2020
Background: An accurate estimated fetal weight (EFW) calculated with traditional formulae in cases of abdominal wall defects (AWDs) can be challenging. As a result of reduced abdominal circumference, fetal weight may be underestimated, which could affect prenatal management. Siemer et al. proposed a formula without the use of abdominal circumference, but it is not used in our protocols yet. Objectives: Our aim was to evaluate the correlation of EFW and birth weight in fetuses with AWD by using Hadlock 1, Hadlock 2, and Siemer et al.'s formulae. Our secondary goal was to evaluate how often fetuses classified as small for gestational age (SGA) were in fact SGA at birth. Study design: This was a retrospective cohort study of gestations complicated by gastroschisis and omphalocele at two tertiary-care centers in Brazil and Italy during an 8-year period. Of a total of 114 cases, 85 (44 cases of gastroschisis and 41 cases of omphalocele) met our criteria. Results: The last prenatal scan was performed 5.2 (±4.1) days before birth. The mean gestational age at birth was 37.2 (±1.8) weeks. Correlation of EFW with birth weight was calculated with the three formulae with and without adjustment for weight gain between scan and birth, with the use of the Spearman coefficient. The correlation between EFW and weight at birth was positive according to all three formulae for the infants with gastroschisis. This finding was not confirmed in the infants with omphalocele. All formulae overestimated the number of SGA cases: although only 17.6% of fetuses were actually SGA at birth, the Hadlock formulae had classified nearly 35% of them as SGA, and Siemer et al.'s formula, 15.3%. Conclusion: All three formulae yielded a good correlation between EFW in the last scan and birth weight in the infants with gastroschisis but not for those with omphalocele. Cases of SGA were overestimated.
OP18.10: Fetal gastric size measurements in diagnosing GI abnormalities
Ultrasound in Obstetrics & Gynecology, 2018
Short oral presentation abstracts Results: 65 pregnancies with CDH were evaluated, with 7 loss of follow-up, 1 miscarriage and 2 with ongoing pregnancies. From 55 that were subject of analysis, there were 46 left and 9 right CDH. All evaluations were done between 24 and 32 weeks of GA. Five pregnancies with left CDH and <25% O/E had 0% survival. Three of these were treated by FETO, without neonatal survival. All these cases were plugged and unplugged at 27 and 34 weeks respectively. Delivery occurred in 6 hospitals. There was a significant correlation between O/E LHR and survival in Left and Right CDH (pearson p<0.05). The figure shows survival in Chile, compared to Leuven, by sides. Some groups of O/E LHR had very few cases which could explain differences to survival in Leuven. Conclusions: Survival is related to lung size at evaluation, as well as other reference charts. Until now, despite FETO, severe cases have not survived.
Umbilical artery pulsatility index and fetal abdominal circumference in isolated gastroschisis
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 2011
ObjectivesTo investigate changes in abdominal circumference (AC) and umbilical artery pulsatility index (UA-PI) with gestation in fetuses with isolated gastroschisis, and to determine whether a relationship exists between UA-PI and fetal AC.To investigate changes in abdominal circumference (AC) and umbilical artery pulsatility index (UA-PI) with gestation in fetuses with isolated gastroschisis, and to determine whether a relationship exists between UA-PI and fetal AC.MethodsData from 58 pregnancies with isolated gastroschisis diagnosed at between 24 and 36 weeks' gestation were included in the study. Z-scores were calculated with respect to expected UA-PI values in normal pregnancies after log-transformation. AC-Z-scores were calculated with respect to expected size in normal pregnancies according to a standard chart. Functional linear discriminant analysis (FLDA) was applied to generate 50th, 5th and 95th percentile curves for changes in both AC and UA-PI with gestational age in fetuses with gastroschisis. These curves were compared with the standard curves, as were the means. UA-PI was also plotted against AC. For this relationship, a robust Spearman correlation coefficient was obtained with FLDA.Data from 58 pregnancies with isolated gastroschisis diagnosed at between 24 and 36 weeks' gestation were included in the study. Z-scores were calculated with respect to expected UA-PI values in normal pregnancies after log-transformation. AC-Z-scores were calculated with respect to expected size in normal pregnancies according to a standard chart. Functional linear discriminant analysis (FLDA) was applied to generate 50th, 5th and 95th percentile curves for changes in both AC and UA-PI with gestational age in fetuses with gastroschisis. These curves were compared with the standard curves, as were the means. UA-PI was also plotted against AC. For this relationship, a robust Spearman correlation coefficient was obtained with FLDA.ResultsIn fetuses with gastroschisis, there was a highly significant negative correlation between UA-PI and AC, normalized for gestation using Z-scores (median correlation coefficient, − 0.289; median P = 0.000023). Moreover, compared with standard curves AC was lower and UA-PI higher in the gestational-age range studied. Both the AC and UA-PI curves showed a significantly different rate of change with gestation compared with the normal ranges. The mean values for fetuses with gastroschisis compared with the standard AC and UA-PI range curves were significantly different for AC throughout gestation, and for UA-PI from 32 weeks' gestation.In fetuses with gastroschisis, there was a highly significant negative correlation between UA-PI and AC, normalized for gestation using Z-scores (median correlation coefficient, − 0.289; median P = 0.000023). Moreover, compared with standard curves AC was lower and UA-PI higher in the gestational-age range studied. Both the AC and UA-PI curves showed a significantly different rate of change with gestation compared with the normal ranges. The mean values for fetuses with gastroschisis compared with the standard AC and UA-PI range curves were significantly different for AC throughout gestation, and for UA-PI from 32 weeks' gestation.ConclusionsIn fetal gastroschisis, it is well known that AC tends to be smaller, though UA-PI has not been reported to be abnormal in any consistent way. There is a clear relationship between the fetus's AC for gestation and UA-PI, which is not the case for normally grown fetuses. The data suggest that the growth restriction seen in gastroschisis may be explained by hypoxia, and not simply by the classical explanation of extra-abdominal displacement of the abdominal viscera. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.In fetal gastroschisis, it is well known that AC tends to be smaller, though UA-PI has not been reported to be abnormal in any consistent way. There is a clear relationship between the fetus's AC for gestation and UA-PI, which is not the case for normally grown fetuses. The data suggest that the growth restriction seen in gastroschisis may be explained by hypoxia, and not simply by the classical explanation of extra-abdominal displacement of the abdominal viscera. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.
Journal of Perinatal Medicine, 2008
Objective: To analyze the value of a single ultrasound biometry examination at the onset of the third trimester of pregnancy for the detection of small-for-gestationalage (SGA) and large-for-gestational-age (LGA) at birth in a low risk population. The aim of this study was to develop a simple and useful method for the detection of growth deviations during pregnancy in primary care (midwife or general practitioner) practices. Setting: A Dutch primary care midwifery practice. Study design: In an earlier study, we developed parity and sex specific fetal growth charts of abdominal circumference (AC) and head circumference (HC) on the basis of ultrasound data of a low-risk midwifery population in the Netherlands. In the present study, we calculated sensitivity, specificity and predictive values at different cutoff points of AC and HC for the prediction of growth deviations at birth. Patients booked for perinatal care between 1 January 1993 and 31 December 2003 (ns3449) were used for the identification of cutoff points (derivation cohort) and those admitted between 1 January 2004 and 31 December 2005 (ns725) were used to evaluate the performance of these cutoffs in an independent population (validation cohort). For the determination of SGA and macrosomia at birth, we used the recently published Dutch birth weight percentiles.
Journal of Evolution of Medical and Dental Sciences, 2015
BACKGROUND: Fetal weight measurement by ultrasonographic methods can be considered as an important modality for antenatal prediction of fetal weight (preferable single USG should be done at 34-36.9wks) to rule out various complications of pregnancy such as macrosomia, IUGR etc which enable us to be prepared for the delivery of the baby and prevent any further dreaded complications resulting out of these conditions including shoulder dystocia, severely compromised baby AIM: To compare the accuracy of predicted birth weight by ultrasonographic measurements obtained just before and at term. METHOD: The study was performed in a tertiary care Hospital in West Bengal between 1st July 2012 to 30th June 2013 on 100 Pregnant women attending Antenatal Clinic (34-36.9 wks) with a live singleton pregnancy, all women underwent ultrasound examination twice(< 37 weeks/ > 37 weeks). The estimated fetal weight calculated using Hadlock's formula. Data were then compared for each pair of sonograms from the same patient using a paired t test. P value of <0.05 was considered statistically significant. RESULTS: The study included 100 patients undergoing 200 sonograms. The mean absolute error of the predicted birth weight was smaller for period 1 (34-36.9 wks) than for period 2 (≥ 37 wks) (152 ± 125g compared with 193.5 ± 121g, P=0.0001). The overall mean absolute percent errors in predicting birth weight were 5.6 ± 4.7 (Period 1) & 7.6 ± 4.3 (Period 2) for IUGR and 5.4 ± 3.9 (Period 1) & 6 ± 3 (Period 2) for Macrosomia. Averaging data from both gestational periods did not improve the prediction of birth weight. Our study did not show any correlation between latency and the accuracy of birth weight predictions. CONCLUSION: This study indicates that serial sonograms in the late third trimester do not improve the ability to predict birth weight, even in abnormally grown fetuses. So, a single sonogram between 34 and 37 weeks' gestation is recommended for prediction of birth weight.
Journal of Holistic Nursing and Midwifery, 2021
This study compares the accuracy of clinical methods and ultrasonography in Estimating Fetal Weight (EFW) with Actual Birth Weight (ABW) in term pregnant women. Materials and Methods: This diagnostic test evaluation study was performed on 247 single-term pregnant women admitted to an educational, therapeutic hospital in Rasht City, Iran. In this study, abdominal palpation, Johnson's formula, Insler's formula, and ultrasonography were used to estimate fetal weight. One-sample t-test, the Chi-square, and the Bland-Altman plot were used to compare the diagnostic value of fetal weight estimation methods. The accuracy of tests was estimated based on sensitivity and specificity in fetal weight groups (below 2500 g, 2500-4000 g, and above 4000 g) by the Bland-Altman plot. Results: The participating pregnant women had a Mean±SD age of 28.86±4.24 years, body mass index of 32.98±6.0 kg/m 2 , and gestational age of 39±1.04 wk. Their Mean±SD actual birth weight was 3343.352±432.799 gr, Also, the Mean±SD birth weight found by abdominal palpation was 3371.053±345.561 gr, Mean±SD birth weight by Johnson's formula 3041.206 ±411 gr, by Insler's formula 3556.316±531.567 gr, and by ultrasonography 3294.28±380.09 gr, Based on the one-sample t-test, the abdominal palpation had the lowest (P=0.261), and the Insler's formula (P=0.001) had the highest difference with the actual birth weight. Regarding the fetal weight groups, Insler's formula (96.33%) was highly accurate in Low Birth Weight (LBW), but abdominal palpation (91.09%) was more accurate in normal weight and macrosomia (94.72%) groups. There was a significant difference between clinical methods with ABW (P=0.026). Conclusion: Clinical methods are accessible, affordable, and available and can estimate fetal weight in developing countries, especially in our country.