Prediction of preterm birth by evaluating the fetal adrenal gland volume and blood flow: a pilot study


  • Ali Saber Ali Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Egypt
  • Mostafa Hussein Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Egypt
  • Ahmed N. Fetih
  • Abdelghafar M. Ahmed Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Egypt
  • Ahmed M. Abbas Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Egypt



Adrenal gland, Doppler, Preterm birth, Vocal


Background: The aim of the current study was to estimate the risk of preterm birth (delivery < 37 weeks of gestation) by evaluating the fetal adrenal gland volume and blood flow at Women’s Health Hospital, Assiut University, Egypt.

Methods: A pilot prospective cohort study included pregnant women presented to our hospital with threatened preterm labor between December 2016 and May 2018. All women were recruited consecutively at the emergency unit of Women’s Health Hospital at Assiut University. The fetal adrenal gland volume was assessed using 3-dimensional images of the fetal adrenal with the aid of Virtual Organ Computer-Aided Analysis (VOCAL) software. Doppler evaluation of the fetal adrenal blood vessels was carried out. The RI, PI and S/D ratio was calculated for every case. The neonatal outcomes at delivery were assessed and compared with respect to the duration of actual delivery from the time of evaluation. The obtained data were analyzed by SPSS software (version 22.0) and p<0.05 was taken as the significant level.

Results: The study included 30 pregnant women at the final analysis. Women were classified according to the time of actual delivery into two groups. Group (I, n=13) those who delivered within 7 days and group (II, n=17) those who delivered 7 days or more. No difference between both groups regarding the baseline characteristics. No difference regarding the mode of delivery (p=0.708). All Doppler indices were statistically in-different between both groups. The fetal adrenal gland volume was significantly lower in group II than group I (p=0.001). On ROC analysis, the area under the curve (AUC) for prediction of preterm birth based on the fetal adrenal gland volume was (AUC= 0.873). The ROC curve shows that the best cut off value using the volume was ≥0.461 with 76.92% sensitivity and 88.24% specificity for prediction of preterm birth with an overall accuracy of 83.3%.

Conclusions: Fetal adrenal gland volume was identified as a significant predictor of delivery in pregnant women who had spontaneous preterm births with intact membranes.


Marlow N, Wolke D, Bracewell MA, Samara M. Neurologic and developmental disability at six years of age after extremely preterm birth. New Eng J Med. 2005;352(1):9-19.

Hamilton BE, Martin JA, Ventura SJ, Sutton PD, Menacker F. Births: preliminary data for 2004. Natl Vital Stat Rep. 2005;54(8):1-17.

Lockwood CJ, Kuczynski E. Markers of risk for preterm delivery. J Perinat Med. 1999;27(1):5-20.

Norwitz ER, Robinson JN, Challis JR. The control of labor. New Eng J Med. 1999;341(9):660-6.

Challis JR. CRH. A placental clock and preterm labour. Nature Med.1999;1;1(5):416.

Langlois D, Li JY, Saez JM. Development and function of the human fetal adrenal cortex. J Pediat Endocrinol Metabol: JPEM. 2002;15:1311-22.

Anderson AM, Laurence KM, Davies K, Campbell H, Turnbull AC. Fetal adrenal weight and the cause of premature delivery in human pregnancy. BJOG. 1971;78(6):481-8.

Goldenberg RL, Goepfert AR, Ramsey PS. Biochemical markers for the prediction of preterm birth. Am J Obstet Gynecol. 2005;192(5):S36-46.

ACOG. Practice bulletins No. 139: premature rupture of membranes. Obstet Gynecol. 2013;122(4):918-30.

Guler AE, Pehlivan H, Cakmak B, Baser I. Assessment of fetal adrenal gland enlargement in term and preterm labor cases. Int J Res Med Sci.2017;3(5):1035-40.

Turan OM, Turan S, Funai EF, Buhimschi IA, Campbell CH, Bahtiyar OM et al. Ultrasound measurement of fetal adrenal gland enlargement: an accurate predictor of preterm birth. Am J Obstet Gynecol .2011;204(4):311-e1.

Hoffman Sage Y, Lee L, Thomas AM, Benson CB, Shipp TD. Fetal adrenal gland volume and preterm birth: a prospective third-trimester screening evaluation. J Maternal-Fetal Neonatal Med. 2016;29(10):1552-5.

Lim K, Butt K, Crane JM, Morin L, Bly S, Cargill Y, et al. Ultrasonographic cervical length assessment in predicting preterm birth in singleton pregnancies. J Obstetrics Gynaecol Canada. 2011;33(5):486-99.

Renzo GC, Rosati A, Mattei A, Gojnic M, Gerli S. The changing role of progesterone in preterm labour. BJOG. 2011;112(s1):57-60.

Carvalho FH, Lemos AP, Feitosa FE, Feitosa HN, Augusto LC, Mota RM, et al. Can fetal adrenal artery Doppler velocimetry predict delivery date in pregnant women with spontaneous preterm birth? Medical ultrasonography. 2017;19(3):295-301.






Original Research Articles