DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20182364

A study to evaluate a correlation between various Gray Scale parameters and period of gestation

Nancy Chakarvarty, Kumkum Srivastav, Sachin Khanduri

Abstract


Background: Accurate prediction of the gestational age (GA) is very important in the management of obstetric patients for planning a timely and uneventful outcome. Fetuses with intrauterine growth restriction (IUGR) are at high risk for poor short- and long-term outcome. The present study was conducted with the aim to evaluate a correlation between various Gray Scale parameters and period of gestation.

Methods: A total of 100 clinically suspected FGR subjects were enrolled for the present study. Women with singleton pregnancies with fundal height being less than the period of gestation by 4 weeks or more and certainty of last menstrual period with previous 3 menstrual cycles were included in the present study. Ultrasound examination both by Gray Scale USG carried out serially every three weeks starting from 30 weeks till delivery. Chi-square test was used to compare the proportions while Independent Samples "t"-test was used to compare the parametric variables in two groups. Receiver-Operator curve analysis was performed to find out appropriate cut-off points for prediction of FGR.

Results: Diagnostic accuracy of TCD/AC ratio as a marker of FGR was found to be 77%, of HC/AC ratio was found to be 93% and FL/AC ratio was 59%.

Conclusions: Among three gray scale parameters being assessed, HC/AC ratio at 36 weeks was observed to be having 98.5% sensitivity and 82.9% specificity, thus showing the highest diagnostic accuracy (93%). However, from the point of view of early detection, TCD/AC ratio was found to be most efficient with 81.5% sensitivity and 68.6% specificity and overall diagnostic accuracy of 77%. Precision of Grayscale findings at later stage (36 weeks) are higher.


Keywords


FL/AC ratio, Gray scale USG, HC/AC ratio, TCD/AC ratio

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References


Patre V, Aryan AK, Sahu P, Patre V. Ultrasonographic evaluation of fetal humerus length for assessment of gestational age and its comparison with other conventional parameters. Int J Scient Study. 2015 Oct 1;3(7):58-64.

Baschat AA. Pathophysiology of fetal growth restriction: implications for diagnosis and surveillance. Obstet Gynecol Surv. 2004 Aug 1;59(8):617-27.

Allen MC. Developmental outcome and follow up of the small for gestational age infant. Semin Perinatol. 1984;8:123-56.

Cunninghum FG, Leveno KJ, Bloom SL. Williams Obstetrics, 22nd Edition. Mc Graw Hill, Medical Publishing Division; 2005:900.

Alberry M, Soothill P. Management of fetal growth restriction. Archives of Disease in Childhood-Fetal and Neonatal Edition. 2007 Jan 1;92(1):F62-7.

Haller H, Petrovic O, Rukavina B. Fetal transverse cerebellar diameter/abdominal circumference ratio in assessing fetal size. Int J Gyncol Obstet. 1995;50(2): 159-63.

Campbell WA, Nardi D, Vintzileos AM, Rodis JF, Turner GW, Egan JF. Transverse cerebellar diameter/abdominal circumference ratio throughout pregnancy: a gestational age-independent method to assess fetal growth. Obstet Gynecol. 1991 Jun;77(6):893-6.

Ott W. An update in the ultrasonic diagnosis and evaluation of intrauterine growth restriction. The Ultrasound Rev Obstet Gynecol. 2005;5(2):111-24.

Tongsong T, Wanapirak C, Thongpadungroj T. Sonographic diagnosis of intrauterine growth restriction (IUGR) by fetal transverse cerebellar diameter (TCD)/abdominal circumference (AC) ratio. Int J Gyncol Obstet. 1999;66(1):1-5.

Blickstein I, Keith LG, editors. Multiple pregnancy: epidemiology, gestation, and perinatal outcome. CRC Press; 2005 Mar: 516.

Peleg D, Kennedy CM, Hunter SK. Intrauterine growth restriction: identification and management. American family physician. 1998 Aug;58(2):453-60.

Blackwell SC, Moldenhaeur J, Redman M, Hassan SS, Wolfe HM and Berry SM. Relationship between the sonographic pattern of intrauterine growth restriction and acid-base status at the time of cordocentesis. Arch Gynecol Obstet. 2001;264(4):191-3.

Hebbar S, Varalakshmi N. Comparison of three ultrasound ratios in term low birth weight babies – is there a role for thigh circumference? Calicut Med J. 2007;5(3)e1.

Jasovic-Siveska EI, Jasovic VI. Real-time ultrasound in detection of intrauterine growth retardation in preeclampsia. Bratisl Lek Listy. 2008;109(9):405-11.

Benson CB, Doubilet PM, Saltzman DH, Jones TB. FL/AC ratio: poor predictor of intrauterine growth retardation. Invest Radiol. 1985 Oct;20(7):727-30.

Shalev E, Blondheim O, Peleg D. Use of cordocentesis in the management of preterm or growth-restricted fetuses with abnormal monitoring. Obstet Gynecol Surv. 1995;50:839-44.