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The development of hand movements in utero
SPO A b s t r a c t s
V o l u m e 172, N u m b e r 1, Part 2 A m J O b s t e t Gynecol
327
ASCERTAINMENT BIAS IN ULTRASOUND MEASUREMENT MW Tomlinsonf x MC Treadwell, and SF Bottoms. Department of Obstetrics and Gynecology, Wayne State University, Hutzel Hospital, Detroit, MI. OBJECTIVE: To evaluate the influence of interpretation on routine ultrasound measurements.
329
AGE-INDEPENDENT ASSESSMENT OF ABNORMAL FETAL GROWI'I! IN TIlE TIIIRD TRIMESTER. F. Baron~ D. Graham, x W.L. Graves? Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta GA. OBJECI1VE: This study was undertaken to assess use of the sonographic growth rate of a fetus in the third trimester, independent of gestational age, as a tool to evaluate adequacy of fetal growth. STUDY DESIGN: The ultrasound database at Grady Memorial Hospital was reviewed for patients having a first trimester scan showing a singleton pregnancy and confirming their last menstrual period, and also a third trimester scan. A table of estimated fetal weights for patients with confirmed gestational ages was created, and weight percentiles were calculated. Average fetal growth in grams per week between 28 and 38 weeks' gestation was then calculated for each weight percentile. We then investigated adequacy of fetal growth for patients with two ultrasound exams, at least two weeks apart, after 28 weeks. The interval fetal growth rate between these two timed examinations was then calculated, and compared to the expected growth rate table we had previously calculated. RESULTS: 890 patients met the criteria for calculating the table of estimated fetal weights. Weekly incremental growth (grams per week, _+ standard deviation) was then determined: 10th percentile: 153g + 32, 50th percentile: 191g + 38, 90th percentile: 228g + 90. A further 134 patients were then studied for adequacy of fetal growth. Eleven patients were identified as having fetal growth rates of less than the 10th percentile of interval fetal growth; only one of these patients was clinically suspected for IUGR. O f four patients being followed for IUGR, three had growth rates greater than the 10th percentile by our t,qble. CONCLUSIONS: By comparing the individual fetal growth rate to the expected rate for our population, we have identified a subgroup of fetuses with abnormal growth not detected by standard ultrasound measurements. Our method would be particularly useful for evaluating fetuses with ambiguous gestational ages, as measuring interval growth can detect growth disorders independent of gestational age in the third trimester.
330
THE DEVELOPMENT OF HAND MOVEMENTS IN UTERO. J.J. van ToI-Geerdink ix, J.W. Sparling 1, N.C. Chescheir 2. 1Dept. Med. Allied Health Prof., 2Dept. Obs. & Gyn., Univ. of North Carolina, Chapel Hill, NC. OBJECTIVE: This study focuses on the prenatal development of hand movements with emphasis on hand-mouth contact, which is an important behavior for state control in the newborn. Special attention is given to functional asymmetries between the right and left hand, based on previous research suggesting a right sided preference. STUDY DESIGN: The hand movements of fetuses in low risk singleton pregnancies are recorded on videotape for 15 minutes at the gestational ages of 14, 20, 26, 32, and 38 wks. Contact of either hand to mouth, face or other body parts is coded from tape using an interactive computer program. The amount of time contact occurred is expressed relative to the total time the hand could be observed. RESULTS: Percentage of time contact occurred: Age Hand-Mouth Hand-Face Hand-Body Right Left Right Left Right Left 14 wk (n=11) 4.4 4.0 14.8 17.8 11.6 12.3 20 wk (n=10) 3.6 5.1 20.5 26.1 19.5 17.3 26 wk (n=7) 0.3 0.1 16.5 5.1 25.9, 23.5 32 wk (n=7) 0.0 0.0 8.2 2.9 40.7 69.3 36 wk (n=7) 0.3 0.0 8.8 3.6 25.6 9.9 Hand-mouth and hand-face contacts reached their highest values at 14 and 20 wks, followed by a decline for both right and left hand. In contrast, the hands increase their contact with other body parts until later in pregnancy. Despite minor differences over age, the overall means for right and left hand were strikingly similar for contact with mouth, (2.3 vs. 2.6%, respectively), face (14.7 vs. 14.4%), and other body pads (22.0 vs. 21.6 %). CONCLUSIONS: Hand-mouth contact appears to be established early in pregnancy, followed by a remarkable shift to contact with other body pads. In addition, the present findings do not support the concept of prenatal existence of right hand dominance.
interactive
STUDY DESIGN: We recorded biometrics in 163 pregnancies at 14-28 weeks before and after providing computerized interpretation of menstrual dates and initial ultrasound measurements. Differences in biparietal diameter (BPD), occipital-frontal diameter (OFD), humerus, femur, average abdominal diameter (AAD), and estimated fetal weight (EFW) were analyzed with the paired t test and McNemar's test. RESULTS: A difference in at least one of the measurements occurred in 41% of scans. Humerus changed in 5% of cases, BPD in 10%, OFD in 12%, femur in 14%, and h A D in 23%. Measurement changes exceeded 10% with 1 BPD, no OFD, 1 femur, 2 humerus, and 7 h A D measurements. EFW determinations changed in 39% of cases, exceeding 10% in 23% of cases and 20% in 12% of cases. Assigned gestational age was changed in 21% of cases, but did not exceed 7 days in any case. Changes in ultrasound measurements were related to internal consistency of gestational age and growth percentiles, but not significantly influenced by menstrual dates or technician experience. CONCLUSION: Ascertainment bias from interpretation of ultrasound measurements influences results toward internal consistency. The effect of using systems and equipment that provide interactive interpretation should be scrutinized more closely.
328
SONOGRAPHIC ASSESSMENT OF BIRTH WEIGHT AMONG BREECH PRESENTATIONS. S.P. Chsuhsr!., E.F. Magsnn, J.N. Martin, Jr., W.E. Roberts, K.G. Perry, Jr., J.C. Morrison. Dept. Ob/Gyn, Univ. of Mississippi Medical Center, Jackson, MS. OBJECTIVE: To compare the accuracy of a sono~¥sphic estimate of birth weight among singleton gestations with breech vs vertex presentation. STUDY DESIGN: Over two years, 104 consecutive singleton gestations with e breech presentation were prospectively identified who also had sonographic measurements of biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL), with a computated estimate of birth weight. The control group (n ffi 104) consisted of the next parturient with similar maternal demographics end a fetus in vertex position with a sonographic estimate of birth weight within 100 gm of the study patient. The estimate of the birth weight was derived for both groups using seven published models that utilize a combination of two to four fetal measurements. RESULTS: Distribution of the actual newborn weight and the mean (4SD) birth weight of those with breech (2191 __+ 1177 gm) and vertex presentation (2199 + 1107 gm) were similar (p = 0.96). Among the study group, the mean standardized absolute error was similar for the seven models (range 12.0 + 10.4 to 13.8 4- 11.8 gm/kg; p = 0.08}. For six of the models, the mean standardized absolute error was significantly higher for fetuses with malpresentation than for gm/kg; (p = 0.02 to < 0.0001). Estimate of birth weight based on HC end AC had similar accuracy for both groups (p = 0.07). Prediction limit calculations indicate that the actual birth weight is between 1500 and 3999 gm with 99% accuracy if the estimate of birth weight (based on HC and AC) is from 2400 to 2900 gm. CONCLUSION: For fetuses in a breech presentation, the accuracy of the sonographic estimated birth weight does not improve as more fetal parameters are utilized. The error with most models is significantly higher than for e fetus in the vertex position.
351
V o l u m e 172, N u m b e r 1, Part 2 A m J O b s t e t Gynecol
327
ASCERTAINMENT BIAS IN ULTRASOUND MEASUREMENT MW Tomlinsonf x MC Treadwell, and SF Bottoms. Department of Obstetrics and Gynecology, Wayne State University, Hutzel Hospital, Detroit, MI. OBJECTIVE: To evaluate the influence of interpretation on routine ultrasound measurements.
329
AGE-INDEPENDENT ASSESSMENT OF ABNORMAL FETAL GROWI'I! IN TIlE TIIIRD TRIMESTER. F. Baron~ D. Graham, x W.L. Graves? Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta GA. OBJECI1VE: This study was undertaken to assess use of the sonographic growth rate of a fetus in the third trimester, independent of gestational age, as a tool to evaluate adequacy of fetal growth. STUDY DESIGN: The ultrasound database at Grady Memorial Hospital was reviewed for patients having a first trimester scan showing a singleton pregnancy and confirming their last menstrual period, and also a third trimester scan. A table of estimated fetal weights for patients with confirmed gestational ages was created, and weight percentiles were calculated. Average fetal growth in grams per week between 28 and 38 weeks' gestation was then calculated for each weight percentile. We then investigated adequacy of fetal growth for patients with two ultrasound exams, at least two weeks apart, after 28 weeks. The interval fetal growth rate between these two timed examinations was then calculated, and compared to the expected growth rate table we had previously calculated. RESULTS: 890 patients met the criteria for calculating the table of estimated fetal weights. Weekly incremental growth (grams per week, _+ standard deviation) was then determined: 10th percentile: 153g + 32, 50th percentile: 191g + 38, 90th percentile: 228g + 90. A further 134 patients were then studied for adequacy of fetal growth. Eleven patients were identified as having fetal growth rates of less than the 10th percentile of interval fetal growth; only one of these patients was clinically suspected for IUGR. O f four patients being followed for IUGR, three had growth rates greater than the 10th percentile by our t,qble. CONCLUSIONS: By comparing the individual fetal growth rate to the expected rate for our population, we have identified a subgroup of fetuses with abnormal growth not detected by standard ultrasound measurements. Our method would be particularly useful for evaluating fetuses with ambiguous gestational ages, as measuring interval growth can detect growth disorders independent of gestational age in the third trimester.
330
THE DEVELOPMENT OF HAND MOVEMENTS IN UTERO. J.J. van ToI-Geerdink ix, J.W. Sparling 1, N.C. Chescheir 2. 1Dept. Med. Allied Health Prof., 2Dept. Obs. & Gyn., Univ. of North Carolina, Chapel Hill, NC. OBJECTIVE: This study focuses on the prenatal development of hand movements with emphasis on hand-mouth contact, which is an important behavior for state control in the newborn. Special attention is given to functional asymmetries between the right and left hand, based on previous research suggesting a right sided preference. STUDY DESIGN: The hand movements of fetuses in low risk singleton pregnancies are recorded on videotape for 15 minutes at the gestational ages of 14, 20, 26, 32, and 38 wks. Contact of either hand to mouth, face or other body parts is coded from tape using an interactive computer program. The amount of time contact occurred is expressed relative to the total time the hand could be observed. RESULTS: Percentage of time contact occurred: Age Hand-Mouth Hand-Face Hand-Body Right Left Right Left Right Left 14 wk (n=11) 4.4 4.0 14.8 17.8 11.6 12.3 20 wk (n=10) 3.6 5.1 20.5 26.1 19.5 17.3 26 wk (n=7) 0.3 0.1 16.5 5.1 25.9, 23.5 32 wk (n=7) 0.0 0.0 8.2 2.9 40.7 69.3 36 wk (n=7) 0.3 0.0 8.8 3.6 25.6 9.9 Hand-mouth and hand-face contacts reached their highest values at 14 and 20 wks, followed by a decline for both right and left hand. In contrast, the hands increase their contact with other body parts until later in pregnancy. Despite minor differences over age, the overall means for right and left hand were strikingly similar for contact with mouth, (2.3 vs. 2.6%, respectively), face (14.7 vs. 14.4%), and other body pads (22.0 vs. 21.6 %). CONCLUSIONS: Hand-mouth contact appears to be established early in pregnancy, followed by a remarkable shift to contact with other body pads. In addition, the present findings do not support the concept of prenatal existence of right hand dominance.
interactive
STUDY DESIGN: We recorded biometrics in 163 pregnancies at 14-28 weeks before and after providing computerized interpretation of menstrual dates and initial ultrasound measurements. Differences in biparietal diameter (BPD), occipital-frontal diameter (OFD), humerus, femur, average abdominal diameter (AAD), and estimated fetal weight (EFW) were analyzed with the paired t test and McNemar's test. RESULTS: A difference in at least one of the measurements occurred in 41% of scans. Humerus changed in 5% of cases, BPD in 10%, OFD in 12%, femur in 14%, and h A D in 23%. Measurement changes exceeded 10% with 1 BPD, no OFD, 1 femur, 2 humerus, and 7 h A D measurements. EFW determinations changed in 39% of cases, exceeding 10% in 23% of cases and 20% in 12% of cases. Assigned gestational age was changed in 21% of cases, but did not exceed 7 days in any case. Changes in ultrasound measurements were related to internal consistency of gestational age and growth percentiles, but not significantly influenced by menstrual dates or technician experience. CONCLUSION: Ascertainment bias from interpretation of ultrasound measurements influences results toward internal consistency. The effect of using systems and equipment that provide interactive interpretation should be scrutinized more closely.
328
SONOGRAPHIC ASSESSMENT OF BIRTH WEIGHT AMONG BREECH PRESENTATIONS. S.P. Chsuhsr!., E.F. Magsnn, J.N. Martin, Jr., W.E. Roberts, K.G. Perry, Jr., J.C. Morrison. Dept. Ob/Gyn, Univ. of Mississippi Medical Center, Jackson, MS. OBJECTIVE: To compare the accuracy of a sono~¥sphic estimate of birth weight among singleton gestations with breech vs vertex presentation. STUDY DESIGN: Over two years, 104 consecutive singleton gestations with e breech presentation were prospectively identified who also had sonographic measurements of biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL), with a computated estimate of birth weight. The control group (n ffi 104) consisted of the next parturient with similar maternal demographics end a fetus in vertex position with a sonographic estimate of birth weight within 100 gm of the study patient. The estimate of the birth weight was derived for both groups using seven published models that utilize a combination of two to four fetal measurements. RESULTS: Distribution of the actual newborn weight and the mean (4SD) birth weight of those with breech (2191 __+ 1177 gm) and vertex presentation (2199 + 1107 gm) were similar (p = 0.96). Among the study group, the mean standardized absolute error was similar for the seven models (range 12.0 + 10.4 to 13.8 4- 11.8 gm/kg; p = 0.08}. For six of the models, the mean standardized absolute error was significantly higher for fetuses with malpresentation than for gm/kg; (p = 0.02 to < 0.0001). Estimate of birth weight based on HC end AC had similar accuracy for both groups (p = 0.07). Prediction limit calculations indicate that the actual birth weight is between 1500 and 3999 gm with 99% accuracy if the estimate of birth weight (based on HC and AC) is from 2400 to 2900 gm. CONCLUSION: For fetuses in a breech presentation, the accuracy of the sonographic estimated birth weight does not improve as more fetal parameters are utilized. The error with most models is significantly higher than for e fetus in the vertex position.
351