Does emigration by itself improve birth weight? Study in European newborns of Indo-Pakistan origin.

Objective: Our aim was to evaluate the effect of emigration on fetal birth weight (BW) in a group of pregnant women coming from the Indian subcontinent. Methods: This was a retrospective study in a mixed population of pregnant women from the Indian subcontinent that either moved to Europe or stayed in their original countries. The influence of emigration along with several pregnancy characteristics: GA at delivery, fetal gender, maternal age, height, weight, body mass index (BMI) and parity on BW was evaluated by means of multivariable linear regression analysis. Results: According to European standards, babies born to Indo-Pakistan emigrants and babies born to women staying in the Indian subcontinent were similarly small (BW centile 30± 29 and 30.1 ± 28, p<0.68). Multivariable regression demonstrated that emigration by itself did not exert a direct influence on BW (p  = 0.27), being BMI and gestational age at delivery the true determinants of BW (p<0.0001). Conclusions: Maternal BMI is the most relevant parameter affecting fetal growth regardless of the place of residence.

Identifying unanswered questions and setting the agenda for future systematic research in Multiple Sclerosis. A worldwide, multi-stakeholder Priority Setting project.

BACKGROUND: Eliciting the research priorities of people affected by a condition, carers and health care professionals can increase research value and reduce research waste. The Cochrane Multiple Sclerosis and Rare Disease of CNS Group, in collaboration with the Cochrane Neurological Sciences Field, launched a priority setting exercise with the aim of prioritizing pressing questions to ensure that future systematic reviews are as useful as possible to the people who need them, in all countries, regardless of their economic status. METHOD: Sixteen high priority questions on different aspects of MS were developed by members of a multi-stakeholder priority setting Steering Group (SG). In an anonymous online survey translated into 12 languages researchers, clinicians, people with MS (PwMS) and carers were asked to identify and rank, 5 out of 16 questions as high priority and to provide an explanation for their choice. An additional free-text priority research topic suggestion was allowed. RESULTS: The survey was accessible through MS advocacy associations' social media and Cochrane web pages from October 20, 2020 to February 6, 2021. 1.190 responses (86.73% of all web contacts) were evaluable and included in the analysis. Responses came from 55 countries worldwide, 7 of which provided >75% of respondents and 95% of which were high and upper-middle income countries. 58.8% of respondents live in the EU, 23% in the Americas, 8.9% in the Western Pacific, 2.8% in the Eastern Mediterranean and 0.3% in South Eastern Asia. About 75% of the respondents were PwMS. The five research questions to be answered with the highest priority were: Question (Q)1 "Does MRI help predict disability worsening of PwMS?" (19.9%), Q5 "What are the benefits and harms of treating PwMS with one disease-modifying drug compared to another?" (19.3%), Q3 "Does multidisciplinary care by teams of different social and health professionals improve health outcomes and experiences for PwMS?" (11.9%), Q16 "Does psychological health affect disease progression in PwMS?" (9.2%) and Q10 "What are the benefits and harms of exercise for PwMS?" (7.2%). The multivariable logistic regression analysis indicated a significant influence of geographic area and income level on the ranking of Q1 and a marginal for Q16 as top a priority after accounting for the effect of all other predictors. Approximately 50% of the respondents indicated that they had an important additional suggestion to be considered. CONCLUSION: This international collaborative initiative in the field of MS offers a worldwide perspective on the research questions perceived as pivotal by a geographically representative sample of multiple stakeholders in the field of MS. The results of the survey could guide the prioritization of research on pharmacological and non-pharmacological interventions which could be meaningful and useful for PwMS and carers, avoiding the duplication of efforts and research waste. High quality systematic reviews elicited by priority setting exercises may offer the best available evidence and inform decisions by healthcare providers and policy-makers which can be adapted to the different realities around the world.

Predictors of adverse perinatal outcome up to 34 weeks, a multivariable analysis study.

The objective was to evaluate the best predictors of adverse perinatal outcome (APO) in foetuses examined up to 34 weeks and delivered by spontaneous or induced labour. This was a retrospective study of 129 pregnancies that underwent an ultrasound Doppler examination at 23-34 weeks and entered into labour within 30 days. Cerebroplacental ratio (CPR) and mean uterine artery pulsatility index (mUtA PI) were converted into multiples of the median (MoM) and estimated foetal weight (EFW) into centiles to adjust for gestational age (GA). Sonographic and clinical parameters were evaluated using logistic regression analysis.The multivariable model for the prediction of APO presented a notable accuracy: Detection rate (DR) was 39.5% for a false positive rate (FPR) of 5% and 56.8% for a FPR of 10%, AUC 0.82, p < .0001. Significant predictors were GA, EFW centile, and CPR MoM, but not mUtA PI MoM. Moreover, the type of labour onset did not exert any influence on APO. In conclusion, up to 34 weeks, prediction of APO after spontaneous or induced labour may be done measuring CPR and EFW.IMPACT STATEMENTWhat is already known on this subject? Earlier in pregnancy, foetal growth restriction is caused by placental disease causing progressive hemodynamic changes. These changes have been exhaustively described. Conversely, information about the best predictors of adverse outcome is scarce.What do the results of this study add? The findings of this study show that prior to 34 weeks and up to 1 month before labour, labour outcome might be predicted by gestational age, foetal cerebroplacental ratio (CPR) and estimated foetal weight (EFW).What are the implications of these findings for clinical practice and/or further research? If CPR behaves as a good marker of outcome not only at the end of pregnancy but also earlier in gestation, it might be interrogated along with EFW in foetuses attempting vaginal delivery to determine the risk of adverse outcome.

Birth-weight differences at term are explained by placental dysfunction and not by maternal ethnicity. Study in newborns of first generation immigrants.

OBJECTIVE: The aim of the study was to investigate the influence of ethnicity and cerebroplacental ratio (CPR) on the birth weight (BW) of first generation Indo-Pakistan immigrants' newborns. METHODS: This was a retrospective study in a mixed population of 620 term Caucasian and Indo-Pakistan pregnancies, evaluated in two reference hospitals of Spain and Italy. All fetuses underwent a scan and Doppler examination within two weeks of delivery. The influence of fetal gender, ethnicity, GA at delivery, CPR, maternal age, height, weight and parity on BW was evaluated by multivariable regression analysis. RESULTS: Newborns of first generation Indo-Pakistan immigrants were smaller than local Caucasian newborns (mean BW mean= 3048 ± 435 g versus 3269 ± 437 g, p < .001). Multivariable regression analysis demonstrated that all studied parameters, but maternal age and ethnicity, were significantly associated with BW. The most important were GA at delivery (partial R2 = 0.175, p < .001), CPR (partial R2 = 0.032, p < .001), and fetal gender (partial R2 = 0,029, p < .001). CONCLUSIONS: The propensity to a lower BW, explained by placental dysfunction but not by maternal ethnicity is transmitted to newborns of first generation immigrants. Whatever are the factors implied they persist in the new residential setting.

Reference values for pulsatility index of fetal anterior and posterior cerebral arteries in prolonged pregnancy.

OBJECTIVE: To establish consistent normal reference values for fetal anterior cerebral artery (ACA) and posterior cerebral artery (PCA) pulsatility index (PI) in prolonged pregnancy. METHODS: This prospective cross-sectional observational study included singleton normal prolonged pregnancies into two study groups according to the gestational age: from 40 + 0 to 40 + 6 and from 41 + 0 to 41 + 6 weeks. The PI was assessed in both anatomical segments of ACA (ACA-S1 and ACA-S2) and of PCA (PCA-S1 and PCA-S2) with color Doppler imaging and pulsed Doppler examination, and reference centiles charts were generated. PI values from the two investigated segments of each vessel were also compared. RESULTS: Data were obtained in 771 patients: n = 448 in the 40 + 0 and 40 + 6 weeks group, and n = 323 in the 41 + 0 and 41 + 6 weeks group. A moderate decrease in PI was observed as pregnancy progressed. No differences in PI values were found between the two anatomical segments of ACA and PCA. CONCLUSION: This study provides Doppler reference values for the fetal ACA and PCA PI. It also shows that Doppler examination could be performed indifferently in one of the two anatomical segments of these arteries.

Fetal brain hemodynamics in pregnancies at term: correlation with gestational age, birthweight and clinical outcome.

INTRODUCTION: The primary aim of this study was to ascertain the strength of association between cerebral blood flow assessed in anterior (ACA), middle (MCA), and posterior (PCA) cerebral arteries and the following clinical outcomes: small for gestational age (SGA), induction of labor (IOL) for oligohydramnios and caesarean section (CS) for nonreassuring fetal status (NRFS) during labor. MATERIAL AND METHODS: Retrospective analysis of prospectively collected data on consecutive singleton pregnancies from 40 0/7 to 41 6/7 week of gestation. UA, ACA, MCA, PCA pulsatility index (PI) were measured from 40 weeks of gestations. Furthermore, the ratios between cerebral blood flow and UA (CPR, ACA/UA and PCA/UA) were calculated and correlated with the observed outcomes. RESULTS: Two hundred twenty-four singleton pregnancies were included in the study. Mean PI of either ACA (p = .04), MCA (p = .008), and PCA (p = .003) were lower in the SGA compared to non-SGA group; furthermore, mean PCA PI was significantly lower than MCA PI (p = .04). Furthermore, CPR (p = .016), ACA/UA (p = .02), and PCA/UA (p = .003) were significantly lower in the SGA group compared to controls. UA, ACA, MCA, and PCA PI were higher in women undergoing IOL for oligohydramnios compared to controls. Logistic regression analysis showed that CPR and PCA/UA ratio were independently associated with SGA. SGA, ACA PI, and ACA/UA were independently associated with CS for NRFS. Finally, birthweight centile, were independently associated with IOL oligohydramnios. Despite this, the predictive accuracy of Doppler in detecting any of the explored outcome was only poor to moderate. CONCLUSION: Redistribution of cerebral blood flow at term is significantly associated with SGA, IOL for oligohydramnios and CS for NRFS in labor. However, the predictive accuracy of Doppler at term is only poor to moderate, thus advising against its use in clinical practice as a standalone screening test for adverse perinatal outcome in pregnancies at term. Key Message Redistribution of cerebral blood flow at term is significantly associated with SGA, IOL for oligohydramnios and CS for NRFS in labor.

Fetal Doppler velocimetry and bronchopulmonary dysplasia risk among growth-restricted preterm infants: an observational study.

OBJECTIVE: To investigate whether fetal growth restriction (FGR) diagnosis, based on pathological prenatal fetal Doppler velocimetry, is associated with bronchopulmonary dysplasia (BPD) independently of being small for gestational age (SGA) per se at birth among very preterm infants. DESIGN: Prospective, observational study. FGR was defined as failing fetal growth in utero and fetal Doppler velocimetry abnormalities. SETTING: Policlinico Universitario Agostino Gemelli, Roma, Italy. PATIENTS: Preterm newborns with gestational age ≤30 weeks and birth weight (BW) ≤1250 g. MAIN OUTCOME MEASURES: Bronchopulmonary dysplasia. RESULTS: In the study period, 178 newborns were eligible for the study. Thirty-nine infants (22%) were considered fetal growth-restricted infants. Among the 154 survived babies at 36 weeks postmenstrual age, 12 out of 36 (33%) of the FGR group developed BPD versus 8 out of 118 (7%) of the NO-FGR group (p<0.001). BPD rate was sixfold higher among the SGA-FGR infants compared with the SGA-NO-FGR infants. In a multivariable model, FGR was significantly associated with BPD risk (OR 5.1, CI 1.4 to 18.8, p=0.01), independently from BW z-score that still remains a strong risk factor (OR 0.5, CI 0.3 to 0.9, p=0.01). CONCLUSION: Among SGA preterm infants, BPD risk dramatically increases when placenta dysfunction is the surrounding cause of low BW. Antenatal fetal Doppler surveillance could be a useful tool for studying placenta wellness and predicting BPD risk among preterm babies. Further research is needed to better understand how FGR affects lung development.

A comparison between amniotic fluid index and the single deepest vertical pocket technique in predicting adverse outcome in prolonged pregnancy.

OBJECTIVE: to compare perinatal outcome in induced postterm pregnancies with normal amniotic volume and in patients with prolonged pregnancy undergone induction for oligohydramnios, evaluated by two different ultrasonographic methods. METHODS: amniotic fluid volume was measured, using Single Deepest Vertical Pocket (SDVP) and Amniotic Fluid Index (AFI), in 961 singleton uncomplicated prolonged pregnancies. In 109 of these patients, hospitalization was planned for induction of labor, during or after 42 weeks of gestation, for oligohydramnios, postterm pregnancy and other indications in 47, 51 and 11 cases, respectively. Perinatal outcome included: rate of caesarean section, fetal distress, non reassuring fetal heart tracing, presence of meconium, umbilical artery pH < 7.1, Apgar score at 5 minutes < 7, admission to neonatal intensive care unit (NICU). RESULTS: oligohydramnios was diagnosed in 4.89% of cases, when at least one of the two methods was used. A reduced AFI and SDVP value identified 4.47% and 3.75% of cases, respectively, even if without statistical difference. No statistical differences were reported in perinatal outcomes in postterm versus prolonged pregnancies with oligohydramnios, also in relation to the two different ultrasonographic methods. CONCLUSIONS: oligohydramnios is more frequently diagnosed using AFI than SDVP, consequently determining a higher rate of induction of labor. Moreover, perinatal outcome in prolonged induced pregnancies is not affected by oligohydramnios.

Succenturiate lobe of placenta with vessel anomaly: a case report of prenatal diagnosis and literature review.

We report the case of a 33-year-old woman with antenatal ultrasound diagnosis of succenturiate placental lobe at 33 weeks confirmed by B-flow rendering, describing the advantages of the application of color Doppler to diagnosis and management of placental anomalies. We searched studies about antenatal diagnosis of succenturiate placental lobe, including only cases in which color Doppler was used. This case underlines the importance of color Doppler in increasing the accuracy of diagnosis and achieving an improved differential diagnosis.

Fetal cholelithiasis: a diagnostic update and a literature review.

Fetal gallstones and cholelithiasis, detected by routine third trimester ultrasound, have been described in the literature with controversial clinical significance. We report a case of fetal cholelithiasis detected at 35 weeks gestation during a routine scan. The diagnosis was performed using an integrated 2-dimensional (2-D) and 3-dimensional (3-D) ultrasound approach in order to obtain a better definition of the fetal gallbladder and its content. A neonatal follow-up was achieved. The present study has a twofold purpose: firstly, to update the diagnostic approach using the innovative 3-D modalities and secondly, to review the management of this condition during fetal and postnatal life.

Child nutritional status: a representative survey in a metropolitan school.

OBJECTIVE: To assess the prevalence of obesity, overweight, and thinness among children in an Italian school. METHODS: Five hundred ninety-five children (289 males and 306 females) were enrolled, aged between 6 and 19 years old, in Italian school in Rome. Body mass index (BMI) was calculated according to International Obesity Task Force (IOFT) cut-off points. By age criterion all participants have been classified in age classes. RESULTS: A normal BMI was recorded in 73.6% of all cases. Obesity, overweight, and thinness prevalence was 5.9%, 9.6%, and 10.9%, respectively, without statistical differences in both genders, except the prevalence of overweight that resulted statistically significant (13.1% males versus 6.2% females, P < 0.05). Differences in the age groups have been found. About 23.4% of children between 7 to 11 years were defined obese and about 42.3% between 6 to 8 years thin grade 2, respectively. CONCLUSION: The study reports the low prevalence of overweight and obesity, in contrast to the unexpected thinness prevalence. The identification of specific age groups with abnormal nutritional status could be the first step to address future epidemiological investigations in order to plan strategic approach in selected age periods.

Cerebral blood flow autoregulation and congenital heart disease: possible causes of abnormal prenatal neurologic development.

OBJECTIVE: To determine whether the major congenital heart diseases (CHDs) can modify the cerebrovascular flow dynamics and the biometrical parameters in fetuses at third trimester of pregnancy. METHODS: We studied 60 fetuses with CHD. Data included prenatal versus postnatal cardiac diagnosis, cerebral and umbilical artery doppler, fetal biometrical parameters, fetal weight, and gestational age. The pulsatility index (PI) was used to determine blood flow velocities in the umbilical artery (UA) and middle cerebral artery (MCA), while the cerebro/placental ratio (CPR) was assessed as a measure of cerebral autoregulation. Fetuses with CHD were compared to normal controls and then analyzed after being divided into groups based on specific defects. RESULTS: Compared with control fetuses, those with CHD showed a decrease of resistance blood flow in the middle cerebral artery (1.76 vs 1.92 PI) especially considering the CPR (1.66 vs 2.03 PI) (p < 0.01). Furthermore, fetuses with CHD also had smaller head circumferences (30.6 cm vs 31.5 cm p < 0.01) and head/abdominal (HC/AC) ratio (1 vs 1.05 p < 0.01). When stratified for single cardiac diseases, fetuses with hypoplasic left heart syndrome showed a lower CPR and HC/AC ratio. CONCLUSIONS: Cerebrovascular resistance is significantly lower in fetuses with CHD, especially in cases of left side obstruction. The cerebro/placental hemodynamic changes are similar to that described in fetuses with placental insufficiency and may contribute to their abnormal neurologic development.

Laparoscopic myomectomy at 25 weeks of pregnancy: case report.

We performed laparoscopic myomectomy for treatment of a large, twisted, subserous myoma at 25 weeks of pregnancy in a woman with acute abdominal pain that did not respond to analgesic therapy. There are few reports in literature about laparoscopic management of uterine leiomyoma during the first half of pregnancy that demonstrate its feasibility in selected cases. Laparoscopic myomectomy can be considered a minimally invasive alternative to the traditional laparotomy when myomectomy is necessary during the second half of pregnancy, resulting in less postoperative pain and shorter recovery time.

Ultrasonographic weight estimation in large for gestational age fetuses: a comparison of 17 sonographic formulas and four models algorithms.

OBJECTIVE: To evaluate the accuracy of different formulas and role of fetal parameters (cephalic, abdominal, femur) used for estimation fetal weight (EFW) in large for gestational age (LGA) fetus in diabetic and non-diabetic mothers. METHODS: Seventeen formulas were assessed individually and clustered in four algorithms (X, Y, Z, W) on the basis of fetal biometric parameters using the mean absolute % error, standard deviation (SD), prediction within +/-5%, +/-10%, +/-15% of error and introducing new variable hypotenuse test (HPT) that can sum up precision and accuracy of formulas employed. For predicting fetal macrosomia (BW > or = 4200 g) a receiver-operating characteristic curve was constructed. RESULTS: Warsof2 formula showed the lowest mean % error, SD and HPT (p < 0.01) with overall prediction +/-5, +/-10%, +/-15% of birth weight in 68, 94 and 98%. The formulas that were only based on abdominal measurement (Warsof2, Hadlock1, Campbell) showed the best ability to identify fetal macrosomia. The X algorithm confirming primary role of abdominal circumference for EFW in diabetic mothers. CONCLUSIONS: Accuracy of EFW in LGA fetuses is attributable to the biometric parameters used. Our findings show that the best formulas for EFW are those which only consider the abdominal measurements, especially in diabetic mothers. The new variable that we propose (HPT) confirms this result.

Cardiac circumference measurement: possible screening tool in early pregnancy for anomalous cardiac development.

OBJECTIVE: In this study, cardiac circumference (CC), measured by transvaginal sonography, was analyzed to determine the growth during the early stage of pregnancy and its relationship to abdominal circumference and femur length (FL). METHODS: Biometric measurements, including CC, were obtained in 1,182 euploid fetuses at 9-16 weeks' gestation. The CC measurements were related to gestational age (GA), abdominal circumference, and FL. The corresponding 95% confidence intervals were calculated. RESULTS: A linear growth function was observed between CC (mm) and GA (days) (r2 = 0.601; p < 0.0001; y = 0.573 GA - 24.185). Similarly, a good correlation is described with a linear function between CC (mm) and abdominal circumference (mm) (r2 = 0.70; p < 0.0001; y = 0.343 AC + 3.696) and between CC (mm) and FL (mm) (r2 = 0.626; p < 0.0001; y = 1.335 FL + 14.444). The regression analysis that best correlates the dependent variable CC (mm) with the independent variables, GA (days), abdominal circumference (mm), and FL (mm), is: y = 0.137 GA + 0.235 AC + 0.199 FL - 3.303 (r2 = 0.708; p < 0.0001). CONCLUSION: Our results provide normative data of the growth of the CC in early pregnancy. The good correlation described between CC and abdominal circumference and FL suggests that cardiac measurements in early pregnancy alone, or related to other fetal biometric parameters, could be used as a screening tool to identify fetuses at risk for abnormal heart development.

Feasibilty of in utero DNA vaccination following naked gene transfer into pig fetal muscle: transgene expression, immunity and safety.

The high toll of death among first-week infants is due to infections occurring at the end of pregnancy, during birth or by breastfeeding. This problem significantly concerns industrialized countries also. To prevent the typical "first-week infections", a vaccine would be protective as early as at the birth. In utero DNA immunization has demonstrated the effectiveness in inducing specific immunity in newborns. We have already published results of a 2-year follow-up showing long-term safety, protective antibody titers at birth and long-term immune memory, following intramuscular in utero anti-HBV DNA immunization in 90-days pig fetuses. We have now analyzed further parameters of short-term safety. Two different reporter genes were injected in the thigh muscles of 90-days fetuses. At 8 days following DNA injection, we found high-level of transgenes expression in all injected fetuses. A step gradient of expression from the area of injection was observed with both reporter genes. CMV promoter/enhancer produced higher levels of expression compared to SV40 promoter/enhancer. Moreover, no evidence of local or systemic flogistic alterations or fetal malformations, mortality or haemorrhage following intramuscular injection were observed. A single anti-HBV s-antigen DNA immunization in 90-days fetuses supported protective antibody levels in all immunized newborns, lasting at least up to 4 months after birth. Our report further sustains safety and efficacy of intramuscular in utero naked gene transfer and immunization. This approach may support therapeutic or prophylactic procedure in many early life-threatening pathologic conditions.

Evaluation of femur/foot and humerus/foot ratios by transvaginal sonography between 62 and 116 days of gestation.

OBJECTIVE: The objective was to construct nomograms of femur/foot length and humerus/foot length ratios in early pregnancy by transvaginal sonography. METHODS: In the period 1994-2000, 1,008 singleton pregnant patients were examined from 62 to 116 days of gestation using transvaginal high-resolution ultrasound technique. As a part of biometric survey femur, humerus and foot length were recorded and evaluated as ratio at each gestational age. The distribution of the residuals for the different ratios is also described. RESULTS: A significant correlation was demonstrated between femur and foot length (R2=0.984; p<0.0001) and between humerus and foot length (R2=0.983; p<0.0001). The femur/foot length and humerus foot/length ratios were approximately 1 throughout this period of gestation with a narrow range. CONCLUSION: The presented data obtained in early pregnancy by transvaginal scan offer normative measurements of femur/foot length and humerus foot/length ratios which may be useful in the prenatal diagnosis of congenital syndromes that include skeletal maldevelopment.

Early transvaginal fetal orbital measurements: a screening tool for aneuploidy?

OBJECTIVE: To assess whether simple biometric parameters such as orbital diameters measured in early pregnancy by transvaginal sonography can be used as screening tools for aneuploid fetuses. METHODS: The study group consisted of 2771 fetuses of pregnant women referred to our center for genetic amniocentesis and examined by transvaginal sonography between 11 and 16 weeks' gestation. Karyotypes were normal in 2717 fetuses, and 54 fetuses were aneuploid. Individual values for the aneuploid fetuses were compared with normative data obtained previously for single orbital measurements (interocular and binocular distance) versus gestational age and head measurements. RESULTS: The orbital diameters were within the normal range in the cases with trisomy 21, gonosomal aberrations, trisomy 18, and unbalanced anomalies. Three of the 4 fetuses with trisomy 13 had hypotelorism, confirmed later at autopsy in 2 cases and after delivery in 1 case. CONCLUSIONS: With regard to the small number of cases, our data suggest that ocular biometric parameters may be useful sonographic markers for trisomy 13, even if further evaluation is needed.

Mathematical models to predict long bone lengths by transvaginal scan at 11-16 weeks' gestation.

OBJECTIVE: To propose a new mathematical model to estimate the length of fetal long bones in early pregnancy that can be used in the routine clinical setting. METHODS: In a group of 400 singleton normal fetuses, referred for transvaginal ultrasound examination between 11 and 16 weeks' gestation prior to genetic amniocentesis, a regression analysis was performed to evaluate the relationship between femur length (FLl) (mm) and biparietal diameter (BPD) (mm) and gestational age (GA) (days), as well as between humerus length (HL) (mm) and BPD (mm) and GA (days). The confidence intervals (CIs) of the predicted values for different values of BPD and for different gestational periods and CIs for the regression coefficients are stated as the mean +/- SD of standardized residuals. The accuracy of our best models obtained were evaluated at each gestational week between 11 and 16 with a 10% error cut-off limit. RESULTS: The best relationships between FL and HL versus BPD and GA are: expected FL = -16.92108 + 0.4569402 BPD +0.171617 GA (R(2) = 0.86) and expected HL = -16.28531 + 0.4283019 BPD + 0.1696017 GA (R(2) = 0.88), respectively. When a cut-off limit of 10% in estimating fetal long bones was utilized, the mathematical models revealed a good accuracy particularly at 13-14 weeks' gestation, a period when transvaginal biometric and morphologic examination is advisable and the highest percentage of scans are performed. DISCUSSION: Our proposed two linear models had a very good ability to estimate FL and HL and, due to the simplicity of the calculations, would be particularly useful in the routine clinical setting.

Reference values of fetal orbital measurements by transvaginal scan in early pregnancy.

OBJECTIVE: To construct reference ranges of orbital diameters, measured in early pregnancy by transvaginal sonography. METHODS: The study group consisted of 2717 fetuses of pregnant women referred to our center and examined by transvaginal ultrasound between 11-16 week's gestation. Nomograms with confidence intervals (5th and 95th percentile) for each orbital measurement (orbital diameter, interocular and binocular distance) versus gestational age were produced. RESULTS: The orbital measurements increased in a linear fashion throughout early pregnancy with a good correlation with gestational age. CONCLUSION: Transvaginal sonography is able to visualize and measure orbital diameters with accuracy in early pregnancy; reference ranges were developed that can be used to evaluate normal orbital development and can be helpful in the detection of syndromes with orbital growth defects and other associated fetal anomalies.