Advertisement

Ultrasonography Diagnosis

  • Nicola Fratelli
  • Cristina Zanardini
  • Federico Prefumo
Chapter

Abstract

Fetal growth is a dynamic process determined by a combination of genetic, intrauterine, and environmental influences. However, assessment of fetal growth with a onetime measurement is standard clinical practice, despite recognition that a single measurement can only indicate size, not growth. For this purpose, the fetal biometric measurements commonly used are biparietal diameter, head circumference, abdominal circumference, and femur length. These measurements can be combined into an estimated fetal weight using various formulae to provide a more straightforward and clinically relevant estimate of fetal growth. There are many published fetal growth charts available, and the choice of chart used also requires careful consideration as several potentially confusing terms and concepts associated with fetal size and growth are reported in the literature: fetal growth “standards,” fetal growth “references,” customized charts, and growth velocity standards. The relative merits and disadvantages of each approach are discussed, although none has so far proved to be clearly superior to the others. As for the timing of third trimester ultrasound screening for term fetal growth restriction, which is not currently recommended in most countries, recent studies of high methodological quality suggest that ultrasound assessment at 35–37 weeks performs better than at 30–32 weeks.

Keywords

Fetal growth restriction Fetal growth velocity Estimated fetal weight Fetal growth potential Fetal biometry 

References

  1. 1.
    Gordijn SJ, Beune IM, Thilaganathan B, Papageorghiou A, Baschat AA, Baker PN, et al. Consensus definition of fetal growth restriction: a Delphi procedure. Ultrasound Obstet Gynecol. 2016;48:333–9.CrossRefGoogle Scholar
  2. 2.
    ACOG Committee opinion no. 700: Methods for estimating the due date. Obstet Gynecol. 2017;129:e150–4.Google Scholar
  3. 3.
    Hadlock FP, Harrist RB, Sharman RS, Deter RL, Park SK. Estimation of fetal weight with the use of head, body, and femur measurements – a prospective study. Am J Obstet Gynecol. 1985;151:333–7.CrossRefGoogle Scholar
  4. 4.
    Hammami A, Mazer Zumaeta A, Syngelaki A, Akolekar R, Nicolaides KH. Ultrasonographic estimation of fetal weight: development of new model and assessment of performance of previous models. Ultrasound Obstet Gynecol. 2018;52:35–43.CrossRefGoogle Scholar
  5. 5.
    Beune IM, Bloomfield FH, Ganzevoort W, Embleton ND, Rozance PJ, van Wassenaer-Leemhuis AG, et al. Consensus based definition of growth restriction in the newborn. J Pediatr. 2018;196:71–76.Google Scholar
  6. 6.
    Iliodromiti S, Mackay DF, Smith GC, Pell JP, Sattar N, Lawlor DA, et al. Customised and noncustomised birth weight centiles and prediction of stillbirth and infant mortality and morbidity: a cohort study of 979,912 term singleton pregnancies in Scotland. PLoS Med. 2017;14:e1002228.CrossRefGoogle Scholar
  7. 7.
    O’Gorman N, Salomon LJ. Fetal biometry to assess the size and growth of the fetus. Best Pract Res Clin Obstet Gynaecol. 2018;49:3–15.CrossRefGoogle Scholar
  8. 8.
    Salomon LJ, Bernard JP, Ville Y. Estimation of fetal weight: reference range at 20–36 weeks’ gestation and comparison with actual birth-weight reference range. Ultrasound Obstet Gynecol. 2007;29:550–5.CrossRefGoogle Scholar
  9. 9.
    Chauhan SP, Hendrix NW, Magann EF, Morrison JC, Scardo JA, Berghella V. A review of sonographic estimate of fetal weight: vagaries of accuracy. J Matern Fetal Neonatal Med. 2005;18:211–20.CrossRefGoogle Scholar
  10. 10.
    Ioannou C, Talbot K, Ohuma E, Sarris I, Villar J, Conde-Agudelo A, et al. Systematic review of methodology used in ultrasound studies aimed at creating charts of fetal size. BJOG. 2012;119:1425–39.CrossRefGoogle Scholar
  11. 11.
    Buck Louis GM, Grewal J, Albert PS, Sciscione A, Wing DA, Grobman WA, et al. Racial/ethnic standards for fetal growth: the NICHD Fetal Growth Studies. Am J Obstet Gynecol. 2015;213:449.e441.CrossRefGoogle Scholar
  12. 12.
    Kiserud T, Piaggio G, Carroli G, Widmer M, Carvalho J, Neerup Jensen L, et al. The World Health Organization fetal growth charts: a multinational longitudinal study of ultrasound biometric measurements and estimated fetal weight. PLoS Med. 2017;14:e1002220.CrossRefGoogle Scholar
  13. 13.
    Stirnemann J, Villar J, Salomon LJ, Ohuma E, Ruyan P, Altman DG, et al. International estimated fetal weight standards of the INTERGROWTH-21(st) Project. Ultrasound Obstet Gynecol. 2017;49:478–86.CrossRefGoogle Scholar
  14. 14.
    Grantz KL, Hediger ML, Liu D, Buck Louis GM. Fetal growth standards: the NICHD fetal growth study approach in context with INTERGROWTH-21st and the World Health Organization Multicentre Growth Reference Study. Am J Obstet Gynecol. 2018;218:S641–S655.e628.CrossRefGoogle Scholar
  15. 15.
    Gardosi J, Chang A, Kalyan B, Sahota D, Symonds EM. Customised antenatal growth charts. Lancet. 1992;339:283–7.CrossRefGoogle Scholar
  16. 16.
    Gardosi J, Mongelli M, Wilcox M, Chang A. An adjustable fetal weight standard. Ultrasound Obstet Gynecol. 1995;6:168–74.CrossRefGoogle Scholar
  17. 17.
    Hadlock FP, Harrist RB, Martinez-Poyer J. In utero analysis of fetal growth: a sonographic weight standard. Radiology. 1991;181:129–33.CrossRefGoogle Scholar
  18. 18.
    Gardosi J, Francis A, Turner S, Williams M. Customized growth charts: rationale, validation and clinical benefits. Am J Obstet Gynecol. 2018;218:S609–18.CrossRefGoogle Scholar
  19. 19.
    Gardosi J, Madurasinghe V, Williams M, Malik A, Francis A. Maternal and fetal risk factors for stillbirth: population based study. BMJ. 2013;346:f108.CrossRefGoogle Scholar
  20. 20.
    Chiossi G, Pedroza C, Costantine MM, Truong VT, Gargano G, Saade GR. Customized vs. population-based growth charts to identify neonates at risk of adverse outcome: systematic review and Bayesian meta-analysis of observational studies. Ultrasound Obstet Gynecol. 2017;50:156–66.CrossRefGoogle Scholar
  21. 21.
    Ghi T, Cariello L, Rizzo L, Ferrazzi E, Periti E, Prefumo F, et al. Customized fetal growth charts for parents’ characteristics, race, and parity by quantile regression analysis: a cross-sectional multicenter Italian study. J Ultrasound Med. 2016;35:83–92.CrossRefGoogle Scholar
  22. 22.
    Ghi T, Prefumo F, Fichera A, Lanna M, Periti E, Persico N, et al. Development of customized fetal growth charts in twins. Am J Obstet Gynecol. 2017;216:514.e511–7.CrossRefGoogle Scholar
  23. 23.
    Hiersch L, Melamed N. Fetal growth velocity and body proportion in the assessment of growth. Am J Obstet Gynecol. 2018;218:S700–11. e701CrossRefGoogle Scholar
  24. 24.
    Deter RL, Harrist RB. Growth standards for anatomic measurements and growth rates derived from longitudinal studies of normal fetal growth. J Clin Ultrasound. 1992;20:381–8.CrossRefGoogle Scholar
  25. 25.
    Deter RL, Rossavik IK, Harrist RB, Hadlock FP. Mathematic modeling of fetal growth: development of individual growth curve standards. Obstet Gynecol. 1986;68:156–61.Google Scholar
  26. 26.
    Tarca AL, Hernandez-Andrade E, Ahn H, Garcia M, Xu Z, Korzeniewski SJ, Set a. Single and serial fetal biometry to detect preterm and term small- and large-for-gestational-age neonates: a longitudinal cohort study. PLoS One. 2016;11:e0164161.CrossRefGoogle Scholar
  27. 27.
    Deter RL. Individualized growth assessment: evaluation of growth using each fetus as its own control. Semin Perinatol. 2004;28:23–32.CrossRefGoogle Scholar
  28. 28.
    Salomon LJ, Alfirevic Z, Berghella V, Bilardo C, Hernandez-Andrade E, Johnsen SL, et al. Practice guidelines for performance of the routine mid-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol. 2011;37:116–26.CrossRefGoogle Scholar
  29. 29.
    Stratton JF, Scanaill SN, Stuart B, Turner MJ. Are babies of normal birth weight who fail to reach their growth potential as diagnosed by ultrasound at increased risk? Ultrasound Obstet Gynecol. 1995;5:114–8.CrossRefGoogle Scholar
  30. 30.
    Breeze AC, Lees CC. Prediction and perinatal outcomes of fetal growth restriction. Semin Fetal Neonatal Med. 2007;12:383–97.CrossRefGoogle Scholar
  31. 31.
    Bricker L, Medley N, Pratt JJ. Routine ultrasound in late pregnancy (after 24 weeks’ gestation). Cochrane Database Syst Rev. 2015;6:CD001451.Google Scholar
  32. 32.
    Gardosi J, Giddings S, Clifford S, Wood L, Francis A. Association between reduced stillbirth rates in England and regional uptake of accreditation training in customised fetal growth assessment. BMJ Open. 2013;3:e003942.CrossRefGoogle Scholar
  33. 33.
    Fratelli N, Valcamonico A, Prefumo F, Pagani G, Guarneri T, Frusca T. Effects of antenatal recognition and follow-up on perinatal outcomes in small-for-gestational age infants delivered after 36 weeks. Acta Obstet Gynecol Scand. 2013;92:223–9.CrossRefGoogle Scholar
  34. 34.
    Monier I, Blondel B, Ego A, Kaminiski M, Goffinet F, Zeitlin J. Poor effectiveness of antenatal detection of fetal growth restriction and consequences for obstetric management and neonatal outcomes: a French national study. BJOG. 2015;122:518–27.CrossRefGoogle Scholar
  35. 35.
    Sovio U, White IR, Dacey A, Pasupathy D, Smith GCS. Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study. Lancet. 2015;386:2089–97.CrossRefGoogle Scholar
  36. 36.
    Roma E, Arnau A, Berdala R, Bergos C, Montesinos J, Figueras F. Ultrasound screening for fetal growth restriction at 36 vs 32 weeks’ gestation: a randomized trial (ROUTE). Ultrasound Obstet Gynecol. 2015;46:391–7.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Nicola Fratelli
    • 1
  • Cristina Zanardini
    • 1
  • Federico Prefumo
    • 1
  1. 1.Department of Obstetrics and GynaecologyASST Spedali Civili di Brescia, University of BresciaBresciaItaly

Personalised recommendations