Prediction of fetal macrosomia using two-dimensional and three-dimensional ultrasound.

OBJECTIVE: The estimation of the fetal weight by three-dimensional (3D) ultrasound (US) with fractional thigh volume (TVol) has been suggested to be more accurate than two-dimensional (2D) US particularly within the context of fetuses at risk of macrosomia. The objective of this study was to compare the accuracy of 2D US and 3D US with two different methods of projection for the identification of fetal macrosomia at term. STUDY DESIGN: Prospective study which included women at risk for fetal macrosomia referred for fetal biometry between 34+0-36+6 weeks. The estimated fetal weight (EFW) was computed using 2D US and the Hadlock Model IV or through 3D US and the Model VI by Lee et al. The projection of the EFW at the time of delivery was performed by using Yudkin's chart percentiles and the gestation-adjusted projection (GAP) method. RESULTS: Overall, 230 patients were included. Paired comparison between 2D-US-EFW and 3D-US-EFW with either method of projection of the EFW at birth suggested different properties of the techniques, being 2D-US-EFW associated with higher sensitivity and 3D-US-EFW with higher specificity, PPV and LR + . At ROC curve no difference was found in the prediction of birthweight ≥90th centile using 2D-US-EFW or 3D-US-EFW (AUC 0.831, 95%CI 0.768-0.894 versus AUC 0.860, 95%CI 0.799-0.920, respectively, p 0.37) nor in the prediction of birthweight >95th centile with 2D-US-EFW compared to 3D-US-EFW (0.803, 95%CI 0.731-0.874 versus 0.866, 95%CI 0.805-0.926, respectively, p 0.07). Similarly, a non-significant difference in the accuracy of the prediction of birthweight >4000 g (AUC 0.788, 95%CI 0.716-0.859 for 2D-US-EFW vs AUC 0.802, 95%CI 0.723-0.880 for 3D-US-EFW, p 0.72) and >4500 g (0.828, 95%CI 0.720-0.936 for 2D-US-EFW vs 0.858, 95%CI 0.759-0.956 for 3D-US-EFW, p 0.71) with the GAP method could be demonstrated. CONCLUSIONS: Within a population at risk of fetal macrosomia the performance of 3D-US-EFW is similar to that of 2D-US-EFW in the prediction of macrosomia at term regardless of the method used for the projection of the EFW, however different properties were noted between the two techniques. Such finding suggests a potential complementary role of the techniques which warrants evaluation in future research.

The Effect of Chorionicity on Maternal Cardiac Adaptation to Uncomplicated Twin Pregnancy: A Prospective Longitudinal Study.

OBJECTIVE: The objective of this study was to longitudinally evaluate maternal echocardiographic findings in uncomplicated twin gestations according to chorionicity. METHODS: Healthy women with twin pregnancy were assessed with transthoracic echocardiography across the first, second, and third trimesters. Cardiac findings were compared within each group and between monochorionic (MC) and dicho-rionic (DC) pregnancies. RESULTS: Overall, 19 MC and 48 DC uncomplicated twin pregnancies were included. In the MC group, no significant maternal haemodynamic changes were documented across gestation, with the exception of a decrease in ejection fraction. Compared to DC pregnancies, in the MC set lower cardiac output (second and third trimester, p = 0.001 and p = 0.006, respectively) and higher total vascular resistance (first trimester, p = 0.032) were observed. Regarding the diastolic function in MC twins, significantly higher values were observed for mitral E/A ratio (third trimester, p = 0.014), septal mitral E1/A1 ratio (third trimester, p = 0.030), lateral mitral E1 (second and third trimester, p = 0.014 and p = 0.029, respectively), and E1/A1 ratio (third trimester, p = 0.006). CONCLUSIONS: Maternal cardiac adaptation in twin pregnancy seems to differ significantly according to chorionicity. In particular, in MC pregnancies the impairment of diastolic function is less pronounced, presumably due to the lower circulating volume.

Maternal hydration therapy improves the quantity of amniotic fluid and the pregnancy outcome in third-trimester isolated oligohydramnios: a controlled randomized institutional trial.

OBJECTIVES: Amniotic fluid is important for the maintenance of fetal well-being; therefore, an amniotic fluid deficiency, ie, oligohydramnios, can have multiple impacts on the prognosis of the pregnancy. In some cases, there are no evident fetal or maternal causes, and the condition is called isolated oligohydramnios. The aim of our study was to validate maternal intravenous and oral hydration therapy as a means for improvement of isolated oligohydramnios in the third trimester of pregnancy. METHODS: We conducted a prospective randomized controlled study on pregnancies complicated by idiopathic oligohydramnios (group A, 66 women) with a control group of women with normal pregnancies without oligohydramnios (group B, 71 women). Oligohydramnios was diagnosed using the amniotic fluid index (AFI; <5 cm). Sonographic examinations were performed with a convex 3.5-MHz probe. Group A underwent 6 days of intravenous infusion of 1500 mL of an isotonic solution per day. An AFI measurement, a nonstress test, and a fetal biophysical profile were performed at 0 and 7 days. Group A was randomized into subgroups A1 and A2. Subgroup A1 was prescribed home oral hydration therapy of 1500 mL/d and subgroup A2 2500 mL/d. We considered the AFI to compare the effectiveness of the therapy. RESULTS: General features did not reveal any significant differences between the two groups. In group A, the mean AFI ± SD at recruitment was 39.68 ± 11.11 mm; in group B, it was 126.92 ± 10.59 mm (P < .001). In group A, the mean AFI at 7 days was 77.70 ± 15.03 mm; in group B, it was unchanged. In subgroup A1, the mean AFI at birth was 86.21 ± 16.89 mm; in subgroup A2, it was 112.45 ± 14.92 mm (P < .001). CONCLUSIONS: Our data show that in pregnancies complicated by isolated oligohydramnios, hydration therapy significantly improves the quantity of amniotic fluid.