Individualized growth assessment of fetal soft tissue using fractional thigh volume

Authors

  • W. Lee,

    Corresponding author
    1. Division of Fetal Imaging, Department of Obstetrics and Gynecology, William Beaumont Hospital, Royal Oak, MI, USA
    2. Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD, USA
    3. Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
    • Division of Fetal Imaging, Department of Obstetrics and Gynecology, William Beaumont Hospital, 3601 West Thirteen Mile Road, Royal Oak, MI 48073-6769, USA
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  • R. L. Deter,

    1. Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
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  • B. McNie,

    1. Division of Fetal Imaging, Department of Obstetrics and Gynecology, William Beaumont Hospital, Royal Oak, MI, USA
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  • L. F. Gonçalves,

    1. Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD, USA
    2. Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
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  • J. Espinoza,

    1. Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD, USA
    2. Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
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  • T. Chaiworapongsa,

    1. Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
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  • R. Romero

    1. Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD, USA
    2. Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
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Abstract

Objectives

The main goals of this study were to introduce fractional thigh volume (TVol) as a new soft tissue parameter for fetal growth evaluation, define its relationship to menstrual age, and develop individualized fetal growth standards based on Rossavik growth models.

Methods

A prospective, longitudinal study of 22 fetuses was conducted with conventional biometry and TVol measurements by three-dimensional ultrasonography. Infant growth outcomes were determined from modified neonatal growth assessment scores. Rossavik functions (P = c(t)k+s(t)) were used to fit complete datasets to examine relationships between TVol and model coefficients. Second-trimester models were subsequently specified from the linear slopes of growth curves before 28.0 menstrual weeks with each fetus acting as its own control. Third-trimester trajectories and birth measurements were predicted for standard growth parameters and TVol. Observed and predicted measurements were compared using percent deviations and growth potential realization index values. Four additional infants, with serial prenatal scans and postnatal evidence of intrauterine growth restriction (IUGR), were also evaluated.

Results

All 22 fetuses had no evidence of growth abnormalities after delivery. Accelerated soft tissue deposition occurred in the fetal thigh by 28 menstrual weeks. A mean TVol start point of 9.0 ± 1.4 menstrual weeks was consistent with embryological studies of thigh development. Rossavik functions fitted all TVol trajectories well (mean R2 = 0.998 ± 0.002). By fixing the coefficient k at its mean value (2.976), the fit did not change and the variabilities of coefficients c and s were reduced. The mean percent deviation between observed and predicted third-trimester TVol measurements was −0.048 ± 7.5%. Relatively early pathological deviations were observed for TVol in all four fetuses with IUGR; in these cases the abdominal circumference was abnormal in only one fetus and thigh circumference in none.

Conclusions

Individualized growth assessment can be used to accurately predict TVol during the third trimester of pregnancy and at birth. Expected growth trajectories, from second-trimester data, do not rely on population-based standards because each fetus serves as its own control. This new parameter may allow earlier detection and improved monitoring of fetal soft tissue abnormalities such as IUGR. Copyright © 2004 ISUOG. Published by John Wiley & Sons, Ltd.

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