FETAL ADRENAL GLAND SIZE AND PREDICTION OF PRETERM BIRTH
Keywords:
Preterm birth, adrenal gland, ultrasound
Abstract
Abstract
Objective: To assess whether ultrasound-measured fetal adrenal gland size in symptomatic women is effective in predicting spontaneous preterm delivery within 7 days and to compare these predictions with the cervical length measurement.
Methods: We performed a prospective study with 49 pregnant women who showed symptoms of spontaneous preterm birth between 24-36 weeks of gestation and 60 women with normal pregnancies. Fetal adrenal glands were ultrasonographically measured and compared between the two groups. Also, an ultrasound exam was performed to obtain the cervical length measurement on day 1 of hospital admission. The main outcome measure was the time between the ultrasound exam and delivery, which was classified into two groups: delivery ≤7 days and delivery >7 days.
Results: The fetal adrenal gland biometry predicted delivery within 7 days in pregnant women with symptoms of spontaneous preterm birth and had a predictive accuracy better than cervical length measurement. (ROC curve 0.701 versus 0.640)
Conclusion: This study concludes that fetal adrenal gland measurements can be used as a noninvasive and cost effective anew marker in prediction of preterm birth.
Keywords: Preterm birth, adrenal gland, ultrasound
References
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[2] J. McManemy, E. Cooke, E. Amon, and T. Leet, “Recurrence risk for preterm delivery.,” Am. J. Obstet. Gynecol., vol. 196, no. 6, p. 576.e1–6; discussion 576.e6-7, Jun. 2007, doi: 10.1016/j.ajog.2007.01.039.
[3] E. R. Norwitz, J. N. Robinson, and J. R. Challis, “The control of labor.,” N. Engl. J. Med., vol. 341, no. 9, pp. 660–666, Aug. 1999, doi: 10.1056/NEJM199908263410906.
[4] J. D. Iams et al., “The length of the cervix and the risk of spontaneous premature delivery. National Institute of Child Health and Human Development Maternal Fetal Medicine Unit Network.,” N. Engl. J. Med., vol. 334, no. 9, pp. 567–572, Feb. 1996, doi: 10.1056/NEJM199602293340904.
[5] “ACOG Practice Bulletin. Assessment of risk factors for preterm birth. Clinical management guidelines for obstetrician-gynecologists. Number 31, October 2001. (Replaces Technical Bulletin number 206, June 1995; Committee Opinion number 172, May 1996; Committee Opinion number 187, September 1997; Committee Opinion number 198, February 1998; and Committee Opinion number 251, January 2001).,” Obstet. Gynecol., vol. 98, no. 4, pp. 709–716, Oct. 2001.
[6] “ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologist. Number 43, May 2003. Management of preterm labor.,” Obstet. Gynecol., vol. 101, no. 5 Pt 1, pp. 1039–1047, May 2003, doi: 10.1016/s0029-7844(03)00395-8.
[7] J. R. Challis et al., “The fetal placental hypothalamic-pituitary-adrenal (HPA) axis, parturition and post natal health.,” Mol. Cell. Endocrinol., vol. 185, no. 1–2, pp. 135–144, Dec. 2001, doi: 10.1016/s0303-7207(01)00624-4.
[8] A. B. Anderson, K. M. Laurence, K. Davies, H. Campbell, and A. C. Turnbull, “Fetal adrenal weight and the cause of premature delivery in human pregnancy.,” J. Obstet. Gynaecol. Br. Commonw., vol. 78, no. 6, pp. 481–488, Jun. 1971, doi: 10.1111/j.1471-0528.1971.tb00305.x.
[9] F. G. Cunningham et al., “Overview of Obstetrics,” in Williams Obstetrics, 25e, Book, Section vols., New York, NY: McGraw-Hill Education, 2018. Accessed: Jun. 10, 2024. [Online]. Available: accessmedicine.mhmedical.com/content.aspx?aid=1160771467
[10] J. A. McGregor et al., “Salivary estriol as risk assessment for preterm labor: a prospective trial.,” Am. J. Obstet. Gynecol., vol. 173, no. 4, pp. 1337–1342, Oct. 1995, doi: 10.1016/0002-9378(95)91383-1.
[11] P. D. Wadhwa, M. Porto, T. J. Garite, A. Chicz-DeMet, and C. A. Sandman, “Maternal corticotropin-releasing hormone levels in the early third trimester predict length of gestation in human pregnancy.,” Am. J. Obstet. Gynecol., vol. 179, no. 4, pp. 1079–1085, Oct. 1998, doi: 10.1016/s0002-9378(98)70219-4.
[12] P. D. Wadhwa et al., “Placental corticotropin-releasing hormone (CRH), spontaneous preterm birth, and fetal growth restriction: a prospective investigation.,” Am. J. Obstet. Gynecol., vol. 191, no. 4, pp. 1063–1069, Oct. 2004, doi: 10.1016/j.ajog.2004.06.070.
[13] D. K. Grammatopoulos and E. W. Hillhouse, “Role of corticotropin-releasing hormone in onset of labour.,” Lancet Lond. Engl., vol. 354, no. 9189, pp. 1546–1549, Oct. 1999, doi: 10.1016/S0140-6736(99)03418-2.
[14] O. M. Turan, S. Turan, E. F. Funai, I. A. Buhimschi, J. A. Copel, and C. S. Buhimschi, “Fetal adrenal gland volume: a novel method to identify women at risk for impending preterm birth.,” Obstet. Gynecol., vol. 109, no. 4, pp. 855–862, Apr. 2007, doi: 10.1097/01.AOG.0000258282.47919.41.
[15] O. M. Turan et al., “Ultrasound measurement of fetal adrenal gland enlargement: an accurate predictor of preterm birth.,” Am. J. Obstet. Gynecol., vol. 204, no. 4, p. 311.e1–10, Apr. 2011, doi: 10.1016/j.ajog.2010.11.034.
[16] M. S. To, E. B. Fonseca, F. S. Molina, A. M. Cacho, and K. H. Nicolaides, “Maternal characteristics and cervical length in the prediction of spontaneous early preterm delivery in twins.,” Am. J. Obstet. Gynecol., vol. 194, no. 5, pp. 1360–1365, May 2006, doi: 10.1016/j.ajog.2005.11.001.
[17] A. Guler, H. Pehlivan, B. Cakmak, and I. Baser, “Assessment of fetal adrenal gland enlargement in term and preterm labor cases,” Int. J. Res. Med. Sci., vol. 3, p. 1035, Jan. 2015, doi: 10.5455/2320-6012.ijrms20150501.
[18] J. R. Lindsay and L. K. Nieman, “The hypothalamic-pituitary-adrenal axis in pregnancy: challenges in disease detection and treatment.,” Endocr. Rev., vol. 26, no. 6, pp. 775–799, Oct. 2005, doi: 10.1210/er.2004-0025.
[19] Y. Hoffman Sage, L. Lee, A. M. Thomas, C. B. Benson, and T. D. Shipp, “Fetal adrenal gland volume and preterm birth: a prospective third-trimester screening evaluation.,” J. Matern.-Fetal Neonatal Med. Off. J. Eur. Assoc. Perinat. Med. Fed. Asia Ocean. Perinat. Soc. Int. Soc. Perinat. Obstet., vol. 29, no. 10, pp. 1552–1555, 2016, doi: 10.3109/14767058.2015.1059811.
[20] S. H. van Vuuren et al., “Size and volume charts of fetal kidney, renal pelvis and adrenal gland.,” Ultrasound Obstet. Gynecol. Off. J. Int. Soc. Ultrasound Obstet. Gynecol., vol. 40, no. 6, pp. 659–664, Dec. 2012, doi: 10.1002/uog.11169.
[21] M. K. Hoffman et al., “Ultrasound Measurement of the Fetal Adrenal Gland as a Predictor of Spontaneous Preterm Birth.,” Obstet. Gynecol., vol. 127, no. 4, pp. 726–734, Apr. 2016, doi: 10.1097/AOG.0000000000001342.
[22] R. Romero, J. Espinoza, L. F. Gonçalves, J. P. Kusanovic, L. Friel, and S. Hassan, “The role of inflammation and infection in preterm birth.,” Semin. Reprod. Med., vol. 25, no. 1, pp. 21–39, Jan. 2007, doi: 10.1055/s-2006-956773.
[23] V. E. Beshay, B. R. Carr, and W. E. Rainey, “The human fetal adrenal gland, corticotropin-releasing hormone, and parturition.,” Semin. Reprod. Med., vol. 25, no. 1, pp. 14–20, Jan. 2007, doi: 10.1055/s-2006-956772.
[24] S. Trivedi et al., “Fetal-placental inflammation, but not adrenal activation, is associated with extreme preterm delivery.,” Am. J. Obstet. Gynecol., vol. 206, no. 3, p. 236.e1–8, Mar. 2012, doi: 10.1016/j.ajog.2011.12.004.
[25] O. M. Turan et al., “Comparative analysis of 2-D versus 3-D ultrasound estimation of the fetal adrenal gland volume and prediction of preterm birth.,” Am. J. Perinatol., vol. 29, no. 9, pp. 673–680, Oct. 2012, doi: 10.1055/s-0032-1314887.
[26] M. I. Ibrahim et al., “Can three-dimensional ultrasound measurement of fetal adrenal gland enlargement predict preterm birth?,” Arch. Gynecol. Obstet., vol. 292, no. 3, pp. 569–578, Sep. 2015, doi: 10.1007/s00404-015-3668-3.
Published
2024-06-18
How to Cite
Rîcu, A., Sima, R., Roșu, G., Zygouropoulos, N., & Ionescu, C. (2024). FETAL ADRENAL GLAND SIZE AND PREDICTION OF PRETERM BIRTH. Romanian Journal of Clinical Research, 7(1). https://doi.org/10.33695/rjcr.v7i1.240
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Articles
