A Novel Approach to Prenatal Measurement of the Fetal Frontal Lobe Using Three-Dimensional Sonography.

Objective: To assess the feasibility of a standardized approach to biometric measurement of the fetal frontal lobe and to construct frontal lobe growth trajectories throughout gestation. Study Design: A sonographic 3-dimensional (3D) volume set was obtained and measured in 101 patients between 16.1 and 33.7 gestational weeks. Measurements were obtained by 2 independent raters. To model the relationship between gestational age and each frontal lobe measurement, flexible linear regression models were fit using penalized regression splines. Results: The sample contained an ethnically diverse population (7.9% Native Americans, 45.5% Hispanics/Latinas). There was high interrater reliability (correlation coefficients 0.95, 1.0, and 0.87 for frontal lobe length, width, and height; p values <0.001). Graphs of the growth trajectories and corresponding percentiles were estimated as a function of gestational age. The estimated rates of frontal lobe growth were 0.096 cm/week, 0.247 cm/week, and 0.111 cm/week for length, width, and height, respectively. Conclusion: To our knowledge, this is the first study to examine fetal frontal lobe growth trajectories through 3D prenatal ultrasound examination. Such normative data will allow for future prenatal evaluation of a particular disease state by 3D ultrasound imaging.

A Novel Approach to Prenatal Measurement of the Fetal Frontal Lobe Using Three-Dimensional Sonography.

OBJECTIVE: While prenatal 3D ultrasonography results in improved diagnostic accuracy, no data are available on biometric assessment of the fetal frontal lobe. This study was designed to assess feasibility of a standardized approach to biometric measurement of the fetal frontal lobe and to construct frontal lobe growth trajectories throughout gestation. STUDY DESIGN: A sonographic 3D volume set was obtained and measured in 101 patients between 16.1 and 33.7 gestational weeks. Measurements were obtained by two independent raters. To model the relationship between gestational age and each frontal lobe measurement, flexible linear regression models were fit using penalized regression splines. RESULTS: The sample contained an ethnically diverse population (7.9% Native Americans, 45.5% Hispanic/Latina). There was high inter-rater reliability (correlation coefficients: 0.95, 1.0, and 0.87 for frontal lobe length, width, and height; p-values < 0.001). Graphs of the growth trajectories and corresponding percentiles were estimated as a function of gestational age. The estimated rates of frontal lobe growth were 0.096 cm/week, 0.247 cm/week, and 0.111 cm/week for length, width, and height. CONCLUSION: To our knowledge, this is the first study to examine fetal frontal lobe growth trajectories through 3D prenatal ultrasound examination. Such normative data will allow for future prenatal evaluation of a particular disease state by 3D ultrasound imaging.

Geographical information systems for mapping maternal ground transport to level III care neonatal centers.

OBJECTIVE: The objective of this investigation was to determine maternal ground transport times from community hospitals to the nearest hospital offering comprehensive (level III) neonatal care within the contiguous United States. STUDY DESIGN: This observational study combined data from the 2010 U.S. Census tract and 2010 American Hospital Association Annual Survey. Level III (full complement of care) neonatal centers were plotted using 2010 geographical information systems (GIS) mapping software (ESRI, Redland, California, United States). Locations of level I (uncomplicated care) and level II (limited complicated care) centers and residences of reproductive-aged women (18 to 39 years old) were mapped to identify maternal ground transport times to level III centers. RESULTS: Most of the 584 level III neonatal centers were located in metropolitan areas (83.5%). The proportions of level I and level II hospitals within a 30-minute drive of a level III neonatal center were 19.8 and 47.3%, and 52.2 and 69.8% were within a 60-minute drive time. Ground transport times were shortest in the Northeast and metropolitan areas, and longest in the rural Great Plains and noncoastal West. CONCLUSION: GIS mapping enables health providers and health policy makers to better understand maternal ground transport times to current and future regional hospitals offering level III neonatal services.

Maternal obesity and nonstress testing.

We evaluated the impact of maternal obesity on the characteristics and results of nonstress tests (NST). This prospective 1-year cohort study included 2026 NSTs performed on 575 consecutively chosen women with singleton gestations ≥ 32 weeks and no known fetal anomalies. Body mass index (BMI) class was determined at the first prenatal visit. The primary outcome was the duration of fetal heart rate monitoring before a reactive result. Obese women were not more likely to have nonreactive NST results. The mean duration before obtaining a reactive result was unaffected by obesity after controlling for diabetes and gestational age. The overall number of NSTs per patient was higher in obese than in nonobese women (3.9 versus 3.1, P < 0.01). More tests per patient are performed among obese subjects, yet the ability to perform an NST and the duration before obtaining a final result were unaffected by obesity.

Trauma during pregnancy.

Traumatic injuries in pregnancy are both common and burdensome. Optimal management includes proper triage, maternal resuscitation, fetal monitoring, and diagnostic imaging.

Association between intrapartum fetal heart rate patterns and neonatal abstinence syndrome in methadone exposed neonates.

OBJECTIVE: Determine whether infants exposed to chronic maternal methadone with abnormal intrapartum fetal heart rate (FHR) patterns are more likely to require treatment for neonatal abstinence syndrome (NAS). STUDY DESIGN: Intrapartum FHR tracings analyzed in 104 pregnancies at ≥ 34 weeks gestation for FHR variability, accelerations, and decelerations. FHR patterns compared between neonates based on treatment with methadone for NAS. Secondary analysis included relation between maternal methadone dose and intrapartum FHR patterns, initiation of methadone, age at methadone initiation, and total neonatal methadone dose. Study powered to detect 30% increase in NAS incidence in neonates with abnormal FHR tracings. RESULTS: Seventy-six (73%) of 104 neonates required methadone treatment for NAS. Neonates who required methadone had higher average baseline FHR (131 vs. 126 bpm; p < 0.04) in active labor and less likely to have FHR tracings without accelerations (1.7% vs. 20.3%; p = 0.007) in latent labor. No significant associations between neonate's need for methadone and intrapartum FHR variability or FHR decelerations. No association between maternal methadone dose (range 30-280 mg) and treatment for NAS. CONCLUSION: The need for an infant to require methadone treatment for NAS was not reliably predicted by the intrapartum FHR patterns or the maternal methadone dose.