10 Dec when is third trimester ultrasound done
There were also significant differences in growth of EFW between countries. Driven by the same motivation, we prioritized ultrasound measurements in common clinical use worldwide, the most prominent being EFW (Fig 1; Table 11). The nuchal translucency screening is a normal ultrasound. Fetal growth charts may thus need to be adjusted to fit the diversity of individuals and populations if they are to be of the greatest clinical utility. To have a single fetal growth chart that fits all pregnancies across the world would require that all fetuses had the same genetic background for growth, that this genetic background was reliably expressed in the mother, and that influences such as nutrition, physical activity, stress, toxicants, and other environmental conditions had similar effects on the genotype in all embryos and fetuses. The clinical relevance of the differences between the country quantiles and the global quantiles can be assessed in quantile–quantile plots (Fig 4). Yes The ten population samples, including two in South-East Asia and two in Africa, were included to increase generalizability, but they are still a very limited sample of the global human population. At each examination, all measurements were obtained three times from three separately generated ultrasound images and uploaded electronically (with the associated images) to the data management system. Centers in ten countries (Argentina, Brazil, Democratic Republic of the Congo, Denmark, Egypt, France, Germany, India, Norway, and Thailand) recruited participants who had reliable information on last menstrual period and gestational age confirmed by crown–rump length measured at 8–13 wk of gestation. Otherwise, no further procedures were added to the routine antenatal care provided at the study centers. Pooling data is not ideal in the presence of variation among populations, and a single overall growth chart will only partially reflect the individual populations included. Apart from random error, systematic error due to differences in ultrasound measurement techniques could influence the differences between the studies. While ethnic differences may play a role in this variation, as for the US-based study [19], variation could also be due to differences in diet and cultural and socioeconomic factors commonly associated with particular ethnic groups. Even influences on fetal growth classically thought to be primarily genetic, such as maternal and paternal height, are complicated by environmental factors. As seen from Table 17, it is as if rigorous selection and exclusions have limited effect, and other uncontrolled factors are responsible for the variation between studies and countries. Ultrasounds donât just reveal the babyâs gender; the procedure is done mainly to take an early look at the fetus to make sure itâs developing properly. Output from quantile multivariate regression showing Wald chi-square tests for gestational age; country; the interaction of gestational age and country; sex of the fetus; and maternal characteristics. No, it does not mean there is a problem. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Influence of country on fetal growth expressed as the ultrasound measure biparietal diameter. Another large recent study, the NICHD Fetal Growth Studies, showed significant differences in fetal growth with ethnicity, and established ethnic-specific growth charts [19]. Abbreviations: Perinatal mortality and morbidity continue to be major global health challenges strongly associated with prematurity and reduced fetal growth, an issue of further interest given the mounting evidence that fetal growth in general is linked to degrees of risk of common noncommunicable diseases in adulthood. Graphs of the 10th, 50th, and 90th percentiles for the ultrasound measure AC in millimeters for the ten participating countries. PLOS Medicine 18(1): e1003526. If the reading fell between two values, the lower was recorded. Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, Affiliation In spite of the multinational nature of the study, sample size is a limiting factor for generalization of the charts. Importantly, more than 60% of such deaths are associated with low birthweight due to intrauterine growth restriction or preterm birth or both [4,5]. Statistics for participating women’s characteristics, their daily caloric intake, and ethnicity are presented in Table 2. Growth chart for estimated fetal weight for female fetuses. Fetuses diagnosed with any anomaly were managed according to local clinical guidelines. Second Trimester Screening. 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