Appropriate fetal growth and development inutero is essential for newborn health and lifelong well-being. Both fetalgrowth restriction (in which the fetus does not achieve its growth potential,usually because of placental insufficiency) and macrosomia (excessive in uterogrowth, frequently associated with maternal obesity and/or diabetes), areassociated with stillbirth, neonatal morbidity and mortality, and long-termrisks to health ( Stock & Myers, 2017).
Fetal growth abnormalities are commonlydiagnosed using criteria such as low birth weight, macrosomia, small-for-gestationalage (SGA) and large-for-gestational age (LGA). One important feature of thismethod of identifying abnormal growth is the use of normal children in thecreation of the standard. This issue is of particular relevance because manyfetal growth references are based on fetuses from normal and abnormalpregnancies, without sufficient acknowledgment of the implications fornormative interpretation using percentiles ( Mayer & Joseph, 2013).Fetal growth restriction (FGR) also knownas intrauterine growth retardation (IUGR) is defined as a failure to achievethe endorsed growth potential (Figueras & Gratacós, 2014). IUGR is acommon condition affecting about 10–15% of the general maternity population (Gardosi,2011). There are predominately three types ofIUGR: asymmetrical IUGR (malnourished babies), symmetrical IUGR (hypoplasticsmall for date), and mixed IUGR (Sharma et al., 2016).Many variables affect fetal growthincluding physiological and pathological changes, such as maternal height andweight, drug or tobacco exposure, fetal sex (Giorlandino et al.
,2009), ethnicity(Jacquemyn etal., 2000), genetic syndromes, congenital anomalies and placentalfailure. Therefore, each particular population or ethnic group should havetheir own reference charts for the different fetal anthropometrical variablesin order to provide the most accurate fetal assessment. Furthermore, fetalnomograms need to be revised regularly as fetus is growing up in the lastdecades (Giorlandino et al., 2009).Ultrasound scanning in pregnancy has becomethe standard for care in the high income countries (HIC) (Khan et al.
,2017). It is currently offered at week 12 or around week 18, or both. Thegeneral purpose of the ultrasound examination is to determine the location of thefetus and the placenta, the number of fetuses, the gestational age (GA) andestimated day of delivery (EDD) and to detect anomalies as a basis for furtherfetal medical management (Salomon et al., 2013).Biparietal diameter (BPD) maintains theclosest correlation with gestational age in the second trimester. In cases ofvariation in the shape of the skull, Head circumference(HC) is an effectivealternative. Abdominal circumference(AC) is the most useful dimension toevaluate fetal growth, and Femur length(FL) is the best parameter in theevaluation of skeletal dysplasia. Use of multiple predictors improves theaccuracy of estimates( Degani, 2001).
Many charts or curves showing the normalvalues of measurement in fetal biometry have been published, these charts forbiometry are based mainly on studies from Western or American populations (Jung et al., 2007). Such standards may be inappropriate for other populations;in fact, several studies have demonstrated significant ethnic variations infetal size and growth (Bernstein et al., 1996; Chung et al.,2003; Jacquemyn et al., 2000). The ethnic factor shows to interferein the fetal growth pattern, impossible that reference ranges of fetal biometricparameters from homogeneous population could be applied in other populations,mainly heterogeneous populations ( Peixoto et al., 2017).
In anAmerican study with singleton pregnancies between 17 and 22.9 weeks,Afro-American fetuses have smaller abdominal circumference (AC) than Caucasianfetuses. As AC contributes heavily to the estimated fetal weight, theAfro-American fetuses could be mistakenly underestimated (Parikh et al.,2014).The objective of this study is to establishfetal biometric charts and regression equations for pregnant women living inPort Said & Ismailia Governorates in Egypt.