Capacidad del diámetro biparietal para predecir los recién nacidos grandes para edad gestacional. Estudio de cohorte retrospectivo / Ability of biparietal diameter to predict large for gestational age newborns. A retrospective cohort study

Fundamento: Predecir el recién nacido grande para la edad gestacional es una acción de salud que necesita de herramientas tecnológicas de probada eficiencia. Objetivo: Determinar la capacidad predictiva del diámetro biparietal en los recién nacidos grandes para la edad gestacional. Metodología: Estudio de cohorte retrospectivo que incluyó 1959 gestantes cubanas con embarazo simple con captación y término del embarazo entre enero del 2009 y diciembre de 2017. En cada trimestre de gestación se compararon las condiciones tróficas adecuado para la edad gestacional (AEG) y grandes para la edad gestacional (GEG) mediante estadígrafos de tendencia central (media) y de dispersión (rango, desviación estándar) correspondientes al diámetro biparietal. Se calculó además el intervalo de confianza (IC) de 95 % para la diferencia de medias del diámetro biparietal. Asimismo, se realizó un análisis de curvas ROC para determinar si el diámetro biparietal y el peso fetal predicen la condición trófica grande para la edad gestacional en el segundo y tercer trimestre de gestación. Los datos fueron recogidos del libro registro de genética del área de salud. Resultados: El diámetro biparietal en el segundo y tercer trimestre de gestación tuvo un área bajo curva de 0.60 (IC 95 %: 0.54-0.65) y 0.59 (IC 95 %: 0.54-0.64) respectivamente. Los puntos de corte establecidos (T2: 56.55 mm, T3: 81.55 mm) tienen una especificidad y exactitud superior al 78 %. Conclusiones: El diámetro biparietal y los modelos de regresión de Shepard y de Hadlock V mostraron capacidad para discriminar el nacimiento grande para la edad gestacional del adecuado para la edad gestacional, a partir del segundo trimestre de gestación siendo más eficaces en el tercero.

Background: Predicting large for gestational age newborns is a medical action that requires technological tools with proven efficiency. Objective: To determine the predictive ability of biparietal diameter in large newborns for gestational age. Methodology: Retrospective cohort study that included 1959 Cuban pregnant women with a singleton pregnancy, with recruitment and pregnancy term between January 2009 and December 2017. In each gestational trimester, trophic conditions appropriate for gestational age (GAW) were compared and large for gestational age (GA) using central tendency (mean) and dispersion (range, standard deviation) statistics corresponding to the biparietal diameter. The 95% confidence interval (CI) for mean biparietal diameter difference was also calculated. In addition, an analysis of ROC curves was performed to determine if biparietal diameter and fetal weight predict large trophic condition for gestational age in the second and third gestational trimester. Data were gathered from the health area genetics registry book. Results: Biparietal diameter in the second and third trimester of gestation had an area under curve of 0.60 (95% CI: 0.54-0.65) and 0.59 (95% CI: 0.54-0.64) respectively. The established cut-off points (T2: 56.55 mm, T3: 81.55 mm) have a specificity and accuracy greater than 78%. Conclusions: Biparietal diameter and the Shepard and Hadlock V regression models showed ability to discriminate large for gestational age birth from adequate for gestational age birth from the second trimester of gestation onward, being more effective in the third trimester.

Relación entre biometría fetal, producto de acumulación de los lípidos y condición trófica al nacer / Relationship between fetal biometry, lipid accumulation product and the trophic condition at birth

Fundamento: Las alteraciones del estado nutricional materno generalmente se relacionan con desviaciones del crecimiento fetal, que pueden detectarse por los parámetros biofísicos fetales e identifican la posible condición trófica al nacer. Objetivo: Determinar la posible relación entre los parámetros biométricos fetales, la condición trófica al nacer y el producto de acumulación de los lípidos. Metodología: Se realizó un estudio transversal en el Policlínico Chiqui Gómez Lubian del municipio Santa Clara, durante el año 2019, en una población de 253 gestantes normopeso supuestamente sanas al inicio de la gestación. La muestra no probabilística fue de 144 gestantes. Las variables de estudio fueron: producto de acumulación de los lípidos, biometría fetal y condición trófica al nacer. Se utilizaron métodos teóricos, empíricos y estadísticos. Resultados: En el segundo trimestre ningún parámetro biométrico coincidió con la condición al nacer de pequeño, mientras que para el grande coincidieron las circunferencias cefálica y abdominal. En el tercer trimestre la longitud del fémur y la circunferencia abdominal coinciden en la identificación del pequeño y del grande. El PAL se correlacionó con la circunferencia abdominal del tercer trimestre y con el peso al nacer; presentando mayor frecuencia de valores en el tercer tertil para los nacimientos grandes. Conclusiones: La circunferencia abdominal fue el parámetro biométrico con mayor coincidencia con la condición trófica al nacer, la que se asoció con valores en el tercer tertil del PAL para la detección de nacimientos grandes, relacionándose el fenotipo normopeso metabólicamente obeso con el crecimiento fetal por exceso.

Background: Maternal nutritional status disorders are usually related to fetal growth deviations, which can be detected by fetal biophysical parameters and identify the possible trophic condition at birth. Objective: To determine the possible relationship between fetal biometric parameters, the birth trophic state and lipid accumulation product. Methodology: A cross-sectional study was conducted at the Chiqui Gómez Lubian Polyclinic in Santa Clara municipality, during 2019, in a population of 253 normal-weight pregnant women who were apparently healthy at the beginning of their gestation. The non-probability sample was made up of 144 pregnant women. Study variables were: lipid accumulation product, fetal biometry and trophic condition at birth. Theoretical, empirical and statistical methods were used. Results: In the second trimester, none of the biometric parameters matched the condition at birth as a small child, while in the large one the head and abdominal circumferences matched. In the third trimester, femoral length and abdominal circumference coincide in identifying the small one and the large one. LAP correlated with third trimester abdominal circumference and birth weight, presenting higher frequency of values in the third tertile for large births. Conclusions: Abdominal circumference was the biometric parameter with the highest coincidence with trophic condition at birth, associated with values in the third tertile of the LAP for detecting large births, relating the metabolically obese normal weight phenotype with excessive fetal growth.

Normative references of fetal chest circumference in a Nigerian population

A linear relationship between gestational age and fetal thoracic size has been observed, with growth occurring at a regular rate from 16 to 40 weeks.Objective: To determine the fetal chest circumference in normal late second and third-trimester pregnancies in a Nigerian population.Materials and Methods: This was a descriptive cross-sectional study carried out on gravid women with normal singleton pregnancies at 22 ­ 38 weeks gestational age. We recruited 440 eligible gravid women. The fetal gestational age was estimated from the last menstrual period and an early first trimester ultrasound report (< 10 weeks). The fetal chest circumference was measured on an axial view of the fetal chest after ensuring adequate visualisation of the four cardiac chambers, both fetal lungs and ribs. The other fetal biometric parameters were determined using the previously established guidelines. Descriptive statistics, Pearson's correlation, and regression analysis were used as appropriate. Statistical tests were considered significant at P ≤ 0.05.Results: The mean age of the subjects was 29.8 ± 4.6 years (range = 18-45 years). The chest circumference of the fetuses ranged from 16.56 ± 0.29 cm to 30.87 ± 6.88 cm. The fetal chest circumferences increased with advancing gestational age (16.56 ± 0.29 cm at 22 weeks to 30.87 ± 6.88 cm at 37 weeks gestational age). There was strong positive correlation between chest circumference and menstrual gestational age (r=0.85, p=<0.0001), biparietal diameter (r=0.88, p<0.0001), abdominal circumference (r=0.90, p<0.0001) and fetal length (r=0.88, p<0.0001).Conclusion: The fetal chest circumference grew as the pregnancy progressed. There was a positive linear correlation between fetal chest circumference and menstrual gestational age as well as the other fetal biometric parameters.

Assessment of the customized birth weight formula in a low risk Indian population

Background: Birth weight is probably the single most important factor that affects neonatal mortality, infant and childhood morbidity in both developed and developing countries. Objective of the study was to formulate a model for prediction of fetal weight at term based on individualized fetal growth parameters.Methods: 131 participant low risk gravidas were enrolled into the study. The participants underwent an ultrasound 7 days prior to delivery. All fetal variables of growth of a random 100 participants were incorporated in an equation derived using multiple regressions to predict birth weight at term. The new equation was then prospectively applied to another 31 pregnant women for validation. The diagnostic performance of the new regression formula was then compared to the Hadlock formula.Results: The customised birth weight formula predicted a higher accuracy with MPE±SD of 0.790±9. compared to the Hadlock formula with MPE±SD - 4.42±8.73. The new formula also explained a greater variance in birth weight of 56% compared to the Hadlock formula of 49%.Conclusions: The new model based on individualized fetal growth parameters recognizes the capacity to modulate an accurate final birth weight, thus emphasizing the need for customized population specific birth weight formulas.

Efectividad de los indicadores antropométricos para el diagnóstico de restricción del crecimiento intrauterino / Effectiveness of Anthropometric Indicators for the Diagnosis of Intrauterine Growth Restriction

Introducción: La restricción del crecimiento intrauterino se refiere a la incapacidad del feto para alcanzar su potencial genético de crecimiento biológicamente determinado. Las herramientas proporcionadas por el ultrasonido colocadas en manos en manos diestras, constituyen la piedra angular para el diagnóstico de restricción del crecimiento en la que la biometría fetal es clave. Objetivo: Determinar la efectividad de los indicadores antropométricos para el diagnóstico de la restricción del crecimiento intrauterino. Métodos: Se realizó un estudio prospectivo en el período comprendido desde octubre de 2012 hasta octubre de 2014 en gestantes con embarazos simples y de peso adecuado, en el área de salud Chiqui Gómez Lubián de Santa Clara. Se construyeron curvas de Receiver Operating Characteristic de indicadores antropométricos para la predicción de la restricción de crecimiento intrauterino. Resultados: El indicador circunferencia cefálica/circunferencia abdominal mostró mayor área bajo la curva ROC en ambos trimestres, con valores más elevados en el tercer trimestre. Conclusiones: La efectividad de los indicadores estudiados para la predicción de la restricción del crecimiento intrauterino solo fue comprobada en el tercer trimestre(AU)

Introduction: Intrauterine growth restriction refers to the inability of the fetus to reach the biologically determined growth potential. The ultrasound tool is the cornerstone for the diagnosis of growth restriction in which fetal biometry is crucial. Objective: To determine the effectiveness of anthropometric indicators for the diagnosis of intrauterine growth restriction. Methods: A prospective study was conducted from October 2012 to October 2014 in pregnant women with simple pregnancies and adequate weight, at Chiqui Gómez Lubián health area in Santa Clara. Receiver Operating Characteristic (ROC) curves of anthropometric indicators were constructed for the prediction of intrauterine growth restriction. Results: The cephalic circumference / abdominal circumference indicator showed greater area under ROC curve in both quarters, with higher values in the third quarter. Conclusions: The effectiveness of the indicators studied for the prediction of intrauterine growth restriction was only verified in the third quarter(AU)

Biometría del cráneo y sistema ventricular cerebral fetal: tablas de normalidad a través de pruebas no paramétricas

Objetivos: Realizar tablas de referencia a través de estadística no paramétrica para definir en percentiles los rangos de normalidad del diámetro biparietal, la circunferencia cefálica, el atrio ventricular cerebral, la cisterna magna, el cavum septum pellucidum y los ventrículos laterales, según recomendaciones de la International Society of Ultrasound in Obstetrics and Gynecology de evaluación y medida. Métodos: Estudio transversal realizado desde enero 2014 a enero 2016. Se evaluaron 1004 embarazadas normales, en diferentes edades gestacionales, y de manera previamente estandarizada se midieron las estructuras mencionadas. El análisis estadístico se realizó con el software libre PAST 3.04 para la organización de los datos de cada edad gestacional en percentiles. Se presentaron en gráficos tipo nomogramas y en modelo de regresión polinómica de primer orden. Cada gráfico fue evaluado con significancia estadística con P<0,05. Resultados: Las estructuras intracraneales pudieron medirse en su totalidad en 864 casos (86 % de los exámenes). Los diámetros biparietal y las circunferencias cefálica pudieron obtenerse en todos los casos, se observó un crecimiento directamente proporcional a la edad gestacional (P< 0,05). La medida del atrio ventricular resultó estable lo largo del embarazo. Se presentan las medidas de la cisterna magna, del cavum septum pellucidum y de los ventrículos laterales. Conclusiones: Los rangos de normalidad se representaron en tablas para correcto uso clínico y de investigación, no difieren de investigaciones previas realizadas en otros países. Se presentan valores de referencia utilizables en la consulta prenatal, a través de estadística no gaussiana.

Objectives: To carry out reference tables through non-parametric statistics to define in percentile ranges of normality of the biparietal diameter, head circumference, the cerebral ventricular atrium, the cisterna magna, cavum septum pellucidum, and the lateral ventricles, according to the recommendations of the International Society of Ultrasound in Obstetrics and Gynecology of evaluation and measurement. Methods: A cross-sectional study was carried out from January 2014 to January 2016; 1004 normal pregnant women, in different gestational ages, were evaluated, and the mentioned structures, previously standardized, were measured. The statistical analysis was performed with the FOSS PAST 3.04 for the organization of the data at each gestational age, in percentiles. They arose in graphic type nomograms and first-order polynomial regression model. Each graphic was evaluated with statistics significance with P < 0.05. Results: The intracranial structures could be measured entirely in 864 cases (86% of the tests). Biparietal diameter and head circumferences were obtained in all cases; it was observed a directly proportional growth to gestational age (P < 0.05). The measurement of the ventricular Atrium was stable throughout the pregnancy. Measures of the cisterna magna, cavum septum pellucidum and of the lateral ventricles are represented. Conclusions: Normal ranges are represented in tables for correct clinical use and research, the results are not different from previous research conducted in other countries. Usable reference values, in the prenatal consultation, through non-Gaussian statistics are presented.

Correlación de la biometría fetal estándar y la biometría secundaria con la edad gestacional en gestantes del segundo y tercer trimestre

Objetivo: Determinar la correlación de la biometría fetal estándar y la biometría secundaria con la edad gestacional en gestantes del segundo y tercer trimestre. Diseño: Estudio transversal analítico. Institución: Hospital III Honorio Delgado de Arequipa, Perú. Participantes: Gestantes del segundo y tercer trimestre de gestación que acudieron para evaluación ecográfica de rutina sin evidencia de patología, desde enero hasta mayo de 2014. Métodos: Se consideró como biometría fetal estándar a la medición del diámetro biparietal (DBP), circunferencia cefálica (CC), longitud del fémur (LF) y circunferencia abdominal (CA); y biometría fetal secundaria a la medición del diámetro cerebeloso transverso (DCT), longitud renal (LR) y longitud del pie (LP). Principales medidas de resultados: Cálculo de regresión y correlación de la biometría fetal estándar y secundaria con la edad gestacional. Resultados: Se evaluó 140 gestantes del segundo y tercer trimestre de gestación con una edad materna promedio de 26,14 años y se encontró que todos los parámetros biométricos tuvieron buena correlación con la EG. Sin embargo, la mejor correlación con la EG fue la de la LF (r2 = 0,943) seguido por la LP (r2 = 0,940) y la más baja correlación fue de la LR (r2 = 0,860). En el tercer trimestre, las correlaciones fueron más bajas que en el segundo trimestre, siendo la más alta correlación de la LF (r2 = 0,756), seguida de la LP (r2 = 0,713); la más baja correlación fue de la LR (r2 = 0,395). Conclusiones: En nuestra población existió buena correlación de la biometría fetal estándar y secundaria con la edad gestacional, siendo la correlación de la longitud del fémur y la longitud del pie las mejores en el segundo y tercer trimestre de gestación; la longitud renal tuvo correlación pobre en el tercer trimestre.

Objectives: To determine fetal standard and secondary biometry correlation with gestational age in the second and third trimesters. Design: Cross-sectional study. Setting: Hospital III Honorio Delgado, Arequipa, Peru. Participants: Women in second and third trimester of gestation without evidence of disease. Methods: In 140 26.14 year-old pregnant women in the second and third trimesters of pregnancy presenting for routine ultrasound evaluation, fetal standard biometry and secondary biometry were obtained and correlated with gestational age in the second and third trimesters. Standard fetal biometry included biparietal diameter (BPD), head circumference (HC), femur length (FL) and abdominal circumference (AC); secondary biometry included transverse cerebellar diameter (TCD), renal length (RL) and foot length (PL). Main outcome measures: Standard and secondary fetal biometry regression and correlation with gestational age (GA). Results: All biometric parameters correlated with GA. Best correlation existed with FL (r2 = 0.943) and PL (r2 = 0.940) and the lowest correlation with RL (r2 = 0.860). In the third trimester, correlations were lower than in the second trimester, the highest with FL (r2 = 0.756) and PL (r2 = 0.713), and the lowest with RL (r2 = 0.395). Conclusions: In our population, there was good correlation between the standard and secondary fetal biometry with gestational age; femur length and foot length showed the best correlation in the second and third trimesters of pregnancy, and renal length the poorest correlation in the third trimester.

Feasibility of three-dimensional reconstruction and automated measurement of fetal long bones using 5D Long Bone

OBJECTIVE: To evaluate the feasibility of five-dimensional Long Bone (5D LB), a new technique that automatically archives, reconstructs images, and measures lengths of fetal long bones, to assess whether the direction of volume sweep influences fetal long bone measurements in three-dimensional (3D) ultrasound and 5D LB, and to compare measurements of fetal long bone lengths obtained with 5D LB and those obtained with conventional two-dimensional (2D) and manual 3D techniques. METHODS: This prospective study included 39 singleton pregnancies at 26+0 to 32+0 weeks of gestation. Multiple pregnancies, fetuses with multiple congenital anomalies, and mothers with underlying medical diseases were excluded. Fetal long bones of the lower extremities-the femur, tibia, and fibula were measured by 2D and 3D ultrasound, and 5D LB, by an expert and non-expert examiner. First, we analyzed the 3D ultrasound and 5D LB data according to 2 different sweeping angles. We analyzed intra- and inter-observer variability and agreement between ultrasound techniques. Paired t-test, interclass correlation coefficient, and Bland-Altman plot and Passing-Bablok regression were used for statistical analysis. RESULTS: There was no statistical difference between long bone measurements analyzed according to 2 different volume-sweeping angles by 3D ultrasound and 5D LB. Intra- and inter-observer variability were not significantly different among all 3 ultrasound techniques. Comparing 2D ultrasound and 5D LB, the interclass correlation coefficient for femur, tibia, and fibula was 0.91, 0.92, and 0.89, respectively. CONCLUSION: 5D LB is reproducible and comparable with conventional 2D and 3D ultrasound techniques for fetal long bone measurement.

Medida do comprimento do osso nasal entre 11 e 15 semanas de gestação em uma população brasileira: estudo preliminar / Measurement of fetal nasal bone length in the period between 11 and 15 gestational weeks in a Brazilian population: a preliminary study

OBJETIVO: Determinar valores de referência para o comprimento do osso nasal entre 11 e 15 semanas de gestação em uma população brasileira. MATERIAIS E MÉTODOS: Realizou-se estudo de corte transversal com 171 gestantes normais entre 11 e 15 semanas completas. O osso nasal foi medido por via transabdominal em todos os casos. Foram calculados os percentis 5 a 95 para o comprimento do osso nasal pela fórmula: média ± 1,645 desvio-padrão. Para avaliar a correlação do comprimento do osso nasal com parâmetros antropométricos fetais utilizou-se o coeficiente de correlação de Spearman, com intervalo de confiança de 95 por cento. RESULTADOS: O osso nasal foi mensurado em todos os casos, sendo que o comprimento médio variou de 1,69 mm a 2,94 mm. O comprimento do osso nasal mostrou-se fortemente correlacionado com todos os parâmetros antropométricos fetais (p < 0,001) e com a idade gestacional (R² = 0,59). CONCLUSÃO: Apesar de ser um estudo preliminar, a curva de referência do comprimento do osso nasal foi estabelecida.

OBJECTIVE: To establish reference values for fetal nasal bone length measurements between 11 and 15 gestational weeks in a Brazilian population. MATERIALS AND METHODS: A cross-sectional study was developed with 171 normal pregnant women between their 11th and 15th gestational weeks. The fetal nasal bone was measured by means of transabdominal ultrasound in all of the cases. The 5th and 95th percentiles for the nasal bone length were calculated by the formula: mean ± 1.645 standard deviation. The Spearman correlation coefficient with 95 percent confidence interval was utilized to correlate the nasal bone length with fetal anthropometric parameters. RESULTS: The nasal bone could be measured in all of the cases with the mean length ranging between 1.69 mm and 2.94 mm. Nasal bone length demonstrated to be strongly correlated with all of the fetal anthropometric parameters (p < 0.001) and with the gestational age (R² = 0.59). CONCLUSION: Despite the preliminary character of the present study, a reference range of fetal nasal bone length was established.

Ultrasound Measurement of Korean Fetal Growth Parameters by Gestational Age in Midtrimester Pregnancy / 대한산부인과학회잡지

OBJECTIVE: This study was done to formulate Korean fetal biometry charts of midtrimester presenting percentile values as a function of gestational age. METHODS: The relationships between the ultrasound measurement of 5 fetal parameters (biparietal diameter, head circumference, abdominal circumference, femur length, transverse cerebellar diameter) and nuchal skinfold thickness and menstrual age were determined by a cross-sectional study. The study group consisted of 215 normal healthy pregnant Korean women with known last menstrual period and regular menstrual period who had been performed genetic amniocentesis at our hospital and for whom complete pregnancy outcome information was available. All ultrasound examination was performed by one expert examiner. For each of the 5 parameters, the 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles were determined. RESULTS: Ready-to-use fetal measurement charts in midtrimester are presented in a format giving the percentile values as a function of gestational age. CONCLUSION: These fetal biometry charts, obtained from midtrimester, Korean women can be used as a reference value.

Estimation of Mean Fetal Biometry by Using Ultrasonography in Normal Pregnancy / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to assess the mean fetal biometry and to create a formulae for estimation of gestational week using sonographic biometry measurement. METHODS: A total 271 women of singleton gestation were involved in this study of ultrasonographic fetal biometry. During the period from June 1996 to March 1998, the length of CRL (Crown Rump Length), BPD (Biparietal Diameter), HC (Head Circumference), AC (Abdominal Circumference), HL (Humerus Length) and TL (Tibia Length) of fetuses in normal pregnancy were measured by ultrasonography at Samsung Cheil Hospital and Women's Healthcare Center. The gestational age prediction equations were derived from sigletons with the use of liner regression analysis. RESULTS: We present the percentile ranks of fetal CRL, BPD, HC, AC, HL and TL measurement from 11 to 39 week's gestation and mean value of fetal size at each week. These data were analyzed and several second grade equations were derived from the data. CONCLUSION: We created these authentic equations and tables for mean value of fetal biometry in normal pregnancy at each gestation week with minimal intervariable errors.

Charts of Thai fetal biometry: Head circumference.

The purpose of this study was to develop reference centiles of head circumference (HC) for Thai fetuses, and to compare them with previously published data. Normal pregnant women who attend antenatal clinic at Siriraj Hospital provided the study population. A total of 621 cases between 12 - 41 weeks of gestation were recruited. Gestational age was determined by menstrual history which had been regular for at least 3 months without contraception prior to current pregnancy, and uterine size which was compatible with menstrual age at the first time of examination. Each fetus was measured once at a randomly assigned gestational age specifically for the purpose of this study. Due to unfavorable fetal position in some cases, HC data were only available in 609 measurements. Stepwise linear regression models were fitted separately to estimate the mean and standard deviation as functions of gestational age. A reference centile chart was constructed from both equations, assuming the data were normally distributed. A new reference centile chart for HC is presented and compared with previously published data. Our derived centile were lower than those from Western studies, which may partly be due to racial differences. This emphasizes the need to develop fetal biometric charts specific to each region.

Charts of Thai fetal biometry: Upper extremities.

A cross-sectional study was conducted in order to construct a reference chart for Thai fetal upper extremities long bone (humerus, radius, and ulna). A total of 621 normal pregnant women, who attended the antenatal clinic at Siriraj Hospital, Mahidol University, Bangkok, were recruited between 12 and 41 weeks of gestation. We identified pregnant women who had previous regular menstrual period for at least 3 months without contraception prior to current pregnancy; and uterine size at the time of examination was compatible with menstrual age. Each fetus was measured only once at a randomly assigned gestational age specifically for the purpose of this study. Due to unfavorable fetal position in some cases, data were available in only 482 measurements of the humerus, and 443 measurements of the radius and ulna respectively. Linear regression models were fitted separately to estimate the mean and standard deviation at each gestational age for each parameter. New reference centiles were constructed from both equations, assuming the data were normally distributed. This will provide more reliable reference data to be utilized in the assessment of gestational age and in the diagnosis of upper limb deformities during fetal period.

Retardo del crecimiento intrauterino / Intrauterine growth retardation

El crecimiento fetal anormal es un aspecto de gran interés en la obstetricia actual y un dilema clínico relativamente frecuente. La falla del crecimiento sigue siendo un enigma a pesar de los adelantos que ha habido en su conocimiento: el diagnóstico temprano y preciso del retardo del crecimiento puede aminorar la incidencia de complicaciones y muerte en fetos con este problema. Por ello es necesario mejorar las técnicas para identificar esta entidad y asegurar una atención apropiada durante el embarazo y el parto. En este artículo se resumen datos acerca de la definición del retardo del crecimiento fetal, su fisiopatología, clasificación, etiología, diagnóstico y manejo

Abnormal fetal growth is a very important aspect In present-day obstetrics and a frequent clinical dilemma. Fetal failure to grow continues to be puzzling, despite advances in its knowledge; early and precise diagnosis of growth retardation can diminish the incidence of complications and death of fetuses with this problem. It becomes therefore necessary, in the presence of growth retardation, to improve diagnostic techniques and assure proper attention during pregnancy and delivery. Information is summarized in this review on the definition, pathophysiology, classification, etiology, diagnosis and handling of fetal growth retardation