AN ALGORITHM FOR THE ESTIMATION OF GESTATIONAL AGE AT THE TIME OF FETAL DEATH

Learn what it might mean if your baby is smaller or larger than average. Quantitative standards for fetal and neonatal autopsy. Am J Clin Pathol. Reference values for second trimester fetal and neonatal organ weights and measurement. University of New South Wales Embryology. Fetal Anomaly Screening Programme: Antenatal care for uncomplicated pregnancies.

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Accuracy of the EFW is reported to be best when examinations are performed within 7 days before delivery [38]. ACOG advises “An accurate diagnosis of macrosomia can be made only by weighing the newborn after delivery. J Matern Fetal Neonatal Med. Epub Sep

The gestational sac is the first identifiable structure routinely imaged in the first trimester. It is identified by transabdominal ultrasound as early as 5 weeks’ gestation and may be seen as early as 4 weeks’ gestation by transvaginal ultrasound. 15, 16, 47 The gestational sac is an echo-free space containing the fluid, embryo, and extraembryonic structures.

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Growth, Doppler, and Fetal Assessment

Abstract Background Stillbirth is strongly related to impaired fetal growth. However, the relationship between fetal growth and stillbirth is difficult to determine because of uncertainty in the timing of death and confounding characteristics affecting normal fetal growth. Methods and Findings We conducted a population-based case—control study of all stillbirths and a representative sample of live births in 59 hospitals in five geographic areas in the US.

Gestational age at death was determined using an algorithm that considered the time-of-death interval, postmortem examination, and reliability of the gestational age estimate. Data were weighted to account for the sampling design and differential participation rates in various subgroups.

The role of ultrasonography in obstetric practice has continuously evolved since its introduction more than 40 years ago. Indeed, it is difficult to imagine a modern obstetric practice without access to the information provided by real-time ultrasound.

Underestimation of gestational age by conventional crown-rump length growth curves. Reprinted with permission of American College of Obstetricians and Gynecologists Variations in the measurement of CRL can be attributed to differences in fetal growth patterns. Such differences are related to factors similar to those that influence birth weight curves, including maternal age and parity, prepregnancy maternal weight, geographic location, and population characteristics.

These include incorporation of the yolk sac or lower limbs in the CRL measurement, excessive curling or extension of the fetus, and tangential section of the trunk. The biparietal diameter BPD is one of the most commonly measured parameters in the fetus. Campbell was the first investigator to link fetal BPD to gestational age 20 ; however, since this original report, numerous publications on this subject have appeared in the literature.

The BPD is imaged in the transaxial plane of the fetal head at a level depicting thalami in the midline, equidistant from the temporoparietal bones and usually the cavum septum pellucidum anteriorly Fig. Transaxial image of the fetal head for biparietal diameter and head circumference measurements.

DATING BY LMP AND BIOMETRIES

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The ranges reported reflect the differences among studies in the patient populations under investigation and differences in the criteria used for the diagnosis of each complication. Several studies subdivide such results into those that apply to women of different race, male versus female fetuses, and primiparous versus multiparous gravidas. Standard fetal growth curves are useful for estimating the range of expected fetal weight at any particular gestational age.

However, in order for the growth curves to be useful, all such tables presuppose that the gestational age of the fetus is established properly. Without adequate gestational dating, the standard fetal growth curves cannot be interpreted successfully. The principle limitations of standard fetal growth curves that are derived from population-based studies are as follows: They apply only to fetuses that are of normal size for gestational age and not to those with significant and potentially pathologic growth abnormalities.

The standard deviation SD associated with the mean birth weight estimate at any particular gestational age is wide, typically exceeding grams. The fetus’s gestational age must be known with a high degree of certainty to use the growth curves with any degree of reliability. In general, these growth curves can expect to apply to large populations of pregnant women who have well-dated pregnancies, but the limits of their predictive accuracy make them less than ideal tools for estimating fetal weight for individual patients.

In addition, the fetal growth curves are the most inaccurate at the extremes of fetal weight deviation ie, women carrying fetuses that are either growth restricted or macrosomic.

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Calculating the results of various prenatal tests , for example, in the triple test. Birth classification into for example preterm, term or postterm. Classification of infant deaths and stillbirths Postnatally after birth to estimate various risk factors Timeline of pregnancy by gestational age. Estimation of due date[ edit ] Distribution of gestational age at childbirth among singleton live births, given both when gestational age is estimated by first trimester ultrasound and directly by last menstrual period.

Accurate gestational assessment is essential for adequate growth assessment, appropriate aneuploidy screening and correct management of term. Based on expert opinion and beside ART pregnancies, it is recommended to use crown-rump length (CRL) to determine date of conception whenever there is an appropriate measurement taken at 11–14 weeks.

The gestational sac is measured in three planes with the calipers placed at the interface between the wall of the sac and the embryonic fluid. Notice that the sac wall is not incorporated in the measurement. The MSD is the average of the three measurements. The gestational sac can often be confused with a pseudo-sac seen in ectopic pregnancy. To distinguish a true gestational sac, one must identify a double sac sign. This is a finding that is created by visualization of the two layers of the decidua parietalis.

The deep layer of the decidua parietalis and early villi is more echogenic, and this can be seen as separated from the less echogenic layer of the superficial layer. Also, the intradecidual sign can be seen, where the sac is imbedded in the decidua rather than between two layers of the endometrium Fig. Characteristics of a gestational sac. In this image, the gestational sac is seen eccentrically located in the endometrial cavity.

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DATING BY LMP AND BIOMETRIES

This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Clear guidance on fetal growth assessment is important because of the strong links between growth restriction or macrosomia and adverse perinatal outcome in order to reduce associated morbidity and mortality. Fetal growth curves are extensively adopted to track fetal sizes from the early phases of pregnancy up to delivery.

In the literature, a large variety of reference charts are reported but they are mostly up to five decades old. Furthermore, they do not address several variables and factors e.

If the dating is off with ART, think about asking if the embryo was put in the uterus at 5 days, and not zero days, as that is how it is often calculated. This can be important if the embryo is larger than expected, as ART pregnancies have an increased incidence of Beckwith Weidman Syndrome, which is an overgrowth syndrome.

If the embryo is smaller than expected, then the embryo should be followed more closely for possible congenital or chromosomal anomalies. Committee Opinion No, American College of Obstetricians and Gynecologists. Obstet Gynecol ; Measurement of the embryo or fetus in the first trimester is the most accurate method to determine gestational age. In the first trimester, the Recommendations state that if the pregnancy is less than 8 weeks 6 days, the embryo should be within 5 days of LMP last menstrual period and otherwise should be re-dated using ultrasound dates of the crown rump length.

One mistake often made at this time is to include the gestational sac size in dating; the crown rump length is more accurate than the sac size and thus it should not be averaged into the estimated gestational age. Crown rump length growth curves have been updated by Pexsters et al Ultrasound Obstet Gynecol ; These have some significant discrepancies in the 5—7 weeks gestational age range so we recommend using the Pexsters curves.

We should not re-date a pregnancy in the second or third trimester if there are good ultrasound dates in the first trimester.

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The publisher’s final edited version of this article is available at Paediatr Perinat Epidemiol See other articles in PMC that cite the published article. Abstract Background Accurate assignment of gestational age at time of fetal death is important for research and clinical practice. An algorithm to estimate gestational age GA at fetal death was developed and evaluated. The SCRN conducted a population-based case-control study of women with stillbirths and live births from to in five geographic catchment areas.

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Fetal and Obstetric Ultrasound Measurements in Pregnancy

Accurately assess the gestational age To carry out specific prenatal tests To gauge fetal growth To take critical decision for specific obstetric complications Lengths of pregnancy: Lengths of pregnancy Elephant- days Dogs- 63 days Cat- 65 days Camel- days Monkey- days Mouse- 21 days Sheep- days Cow- days Human- days do we mature early? Does gestation vary by ethnic group? The median gestational age at delivery was 39 weeks in Blacks and Asians and 40 weeks in white Europeans. Meconium stained amniotic fluid, which is a sign of fetal maturity, was statistically significantly more frequent in preterm Black and Asian infants and term Black infants compared with white European infants.

Embryological age 2 1 3 2 Basic methods:

Neither gestational age nor birth weight is a sufficient or complete indicator of the level of immaturity of a newborn. Biophysical Profile Obstetricians need accurate estimates of fetal maturity to make decisions about the optimal time for delivery of the preterm fetus in an adverse intrauterine environment. Fetal heart rate, movement, and responses to stimuli can be monitored to determine fetal well-being. A single measure that combines many of these measures, the biophysical profile, is often used to monitor high-risk pregnancies Manning, The likelihood of mortality and morbidity with an immediate preterm birth is weighed against the risks of worsening intrauterine conditions which at some point could lead to fetal demise and, on occasion, worsening maternal status.

Accurate estimates of fetal maturity would thus facilitate planning for delivery and postnatal management. Measures of Fetal Lung Maturity In the s, obstetricians began to analyze chemically the amniotic fluid surrounding the fetus to measure fetal lung maturity Gluck and Kulovich, a; Gluck, ; Gluck et al. The respiratory distress syndrome associated with immature lungs is due in part to the deficient production of surfactant, which stabilizes the alveoli air sacs Chapter With fetal breathing, surfactant is dispersed into the amniotic fluid.

Gluck and Gluck and Kulovich a measured increasing concentrations of lecithin in comparison with the concentrations of sphingomyelin i. Other amniotic fluid tests for fetal lung maturity include the shake test; lamellar body count; and measurement of the phosphatidylglycerol, saturated phosphatidylcholine, fluorescent polarization, or lung phospholipid profile Torday and Rehan, ; Wijnberger et al. Physiological Severity Measures The number, type, and severity of complications of prematurity are directly proportional to neonatal immaturity and physiological instability.

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