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Published on: June 29, 2013
Fetal growth standards in gastroschisis: Reference values for ultrasound measurements
Mariane Massaini Barbieri1, João Renato Bennini1, Marcelo Luís Nomura1
1Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medical Sciences, Campinas, São Paulo, Brazil.
Insights
Fetuses with gastroschisis exhibit symmetrical growth deficits, appearing constitutionally smaller. Umbilical artery Doppler velocimetry remains normal, suggesting no placental insufficiency in these cases.
Area of Science:
- Perinatal Medicine
- Fetal Development
- Medical Imaging
Background:
- Gastroschisis is a congenital anomaly affecting fetal growth.
- Accurate growth assessment is crucial for managing fetuses with gastroschisis.
- Umbilical artery Doppler velocimetry assesses placental function.
Purpose of the Study:
- To develop fetal growth curves for gastroschisis using ultrasonography.
- To compare these curves against established normal growth standards.
- To analyze umbilical artery (UA) Doppler velocimetry patterns in fetuses with gastroschisis.
Main Methods:
- A cohort study included 72 fetuses with gastroschisis (14-39 weeks gestation).
- Biometric parameters (biparietal diameter, head circumference, abdominal circumference, femur length, estimated fetal weight) were measured.
- Growth curves were generated, compared to normal references, and UA Doppler velocimetry was analyzed.
Main Results:
- Established centiles for key fetal biometric parameters in gastroschisis.
- Observed significantly lower measurements in fetuses with gastroschisis compared to controls, with abdominal circumference showing the largest discrepancy.
- Estimated fetal weight was reduced (mean difference of 256.3 g at 50th centile); 97.5% of UA Doppler velocimetry findings were normal.
Conclusions:
- Fetuses with gastroschisis demonstrate symmetrical growth deficits in the second and third trimesters.
- Normal UA Doppler velocimetry suggests these growth deficits are constitutional, not due to placental insufficiency.
- Findings support the hypothesis of constitutionally smaller fetuses without placental compromise.
Objectives:
The objectives of this study were to create growth curves based on ultrasonography biometric parameters of fetuses with gastroschisis, comparing them with normal growth standards, and to analyze umbilical artery (UA) Doppler velocimetry patterns.
Methods:
A cohort study of 72 fetuses with gastroschisis, at gestational ages between 14 and 39 weeks was designed. Mean and standard deviation were calculated, with the 5th, 10th, 50th, 90th, and 95th centiles being established for biometric parameters according to gestational age. Curves were obtained, comparing with normal reference via the Mann-Whitney test. UA Doppler velocimetry patterns were obtained.
Results:
A total of 434 examinations were performed, and centiles were established for biparietal diameter, head circumference, abdominal circumference, femur length, and estimated fetal weight. A significant difference was observed between the gastroschisis measurements when compared to control, with all curves shifted downwards. Abdominal circumference was the parameter presenting the largest difference. Estimated fetal weight was also lower, with mean difference of 256.3 ± 166.8 g for the 50th centile (P < .0001). UA Doppler velocimetry was normal in 97.5%.
Conclusions:
Fetuses with gastroschisis show symmetrical growth deficits in the second and third trimesters, with normal UA Doppler velocimetry. These results reinforce the hypothesis that they are constitutionally smaller, yet not restricted because of placental insufficiency.
