Objectives

Objectives The main goals were to provide normal reference ranges for fractional limb volume as a new index of generalized fetal nutritional status, to evaluate the reproducibility of fractional fetal limb volume measurements during the second and third trimesters of pregnancy, and to demonstrate technical considerations for this technique. Methods This was a prospective, cross-sectional study of gravid women during mid to late pregnancy. Fractional limb volumes were based on either 50% of humeral or femoral diaphysis length. Each partial volume was subdivided into five equidistant slices that were centered along the mid-arm or mid-thigh. Slices were traced manually to obtain fractional arm (AVol) or fractional thigh (TVol) volume. Reproducibility studies were performed, using Bland-Altman plots, to assess blinded interobserver and intraobserver measurement bias and agreement. Selected images were chosen to demonstrate technical factors for the acquisition and analysis of these parameters. Reference charts were established to describe normal ranges for AVol and TVol. Results Three hundred and eighty-seven subjects were scanned to include 380 AVol (range, 1.1-68.3 mL) and 378 TVol (Range, 2.0-163.2 mL) measurements between 18.0 and 42.1 weeks’ menstrual age. No gender differences were found in these soft tissue measurements (AVol, P = 0.90; TVol, P = 0.91; Mann-Whitney test). Intraobserver mean bias ± SD and 95% limits of agreement (LOA) for fractional limb volumes were: 2.2 ± 4.2% (95% LOA, −6.0 to 10.5%) for AVol and 2.0 ± 4.2% (95% LOA, −6.3 to 10.3%) for TVol. Interobserver bias and agreement were −1.9 ± 4.9% (95% LOA, −11.6 to 7.8%) for AVol and −2.0 ± 5.4% (95% LOA, −12.5 to 8.6%) for TVol. Technical factors were related to image optimization, transducer pressure, fetal movement, soft tissue compression and amniotic fluid volume. Conclusions Fractional limb volume assessment may improve the detection and monitoring of malnourished fetuses because this soft tissue parameter can be obtained quickly and reproducibly during mid to late pregnancy. Careful attention should be placed on technical factors that can potentially affect optimal acquisition and analysis of these volume measurements.

ObjectivesThe main goal was to develop new z-score reference ranges for common fetal echocardiographic measurements from a large referral population. Methods

K E Y W O R D S:amniotic fluid 'sludge'; chorioamnionitis; intrauterine inflammation; microbial invasion of the amniotic cavity; preterm delivery; preterm labor; ultrasound ' [AF 'sludge' median, 1 (IQR,[1][2][3][4][5] 33 (IQR, ABSTRACT

Objectives The main goal was to investigate the relationship between prenatal sonographic parameters and birth weight in predicting neonatal body composition. Methods Standard fetal biometry and soft tissue parameters were assessed prospectively in third-trimester pregnancies using three-dimensional ultrasonography. Growth parameters included biparietal diameter (BIPARIETAL DIAMETER (BPD), head circumference (HC), abdominal circumference (AC), mid-thigh circumference and femoral diaphysis length (FDL). Soft tissue parameters included fractional arm volume (AVol) and fractional thigh volume (TVol) that were derived from 50% of the humeral or femoral diaphysis lengths, respectively. Percentage of neonatal body fat (%BF) was determined within 48 h of delivery using a pediatric air displacement plethysmography system based on principles of whole-body densitometry. Correlation and stepwise multiple linear regression analyses were performed with potential prenatal predictors and %BF as the outcome variable. Results Eighty-seven neonates were studies with a mean ± SD %BF of 10.6 ± 4.6%. TVol had the greatest correlation with newborn %BF of all single-parameter models. This parameter alone explained 46.1% of the variability in %BF and the best stepwise multiple linear regression model was: %BF = 0.129 (TVol) – 1.03933 (P<0.001). Birth weight similarly explained 44.7% of the variation in %BF. AC and estimated fetal weight (EFW) accounted for only 24.8% and 30.4% of the variance in %BF, respectively. Skeletal growth parameters, such as FDL (14.2%), HC (7.9%) and BPD (4.0%), contributed the least towards explaining the variance in %BF. Conclusions During the late third trimester of pregnancy %BF is most highly correlated with TVol. Similar to actual birth weight, this soft tissue parameter accounts for a significant improvement in explaining the variation in neonatal %BF compared with fetal AC or EFW alone.

Our objective was to determine the incidence and rate of persistence of placenta previa diagnosed at 15-20 weeks' gestation by using transvaginal sonography (TVS), and to describe the characteristics of TVS that predict placenta previa at delivery. Patients having placental tissue within 20 mm of the cervical os were prospectively identified by transabdominal ultrasound and underwent TVS. The distance of the placental edge from the cervical os was measured in millimeters. Characteristics of TVS predicting placenta previa at delivery were analyzed by logistic regression. The incidence of placenta previa diagnosed by TVS at 15-20 weeks was 1.1%; 14% persisted until delivery. Gestational age at the time of TVS and the distance of the placental edge to the cervical os helped predict placenta previa at delivery. Between 15 and 24 weeks' gestation, placenta overlapping the internal os by > or = 10 mm identified patients at risk of placenta previa at delivery with 100% sensitivity and 85% specificity. The use of TVS in the second trimester to diagnose placenta previa resulted in a lower incidence than was historically reported with the use of transabdominal ultrasound. The distance of the placental edge from the cervical os helps identify patients at risk of previa at delivery.

ObjectivesThe main goals of this study were to introduce fractional thigh volume (TVol)

Objectives