The use of fetal foot length to determine stillborn gestational age in Vietnam

Investigation into abandoned neonates admitted to Salt River Forensic Pathology Mortuary, Cape Town

The high rates of abandoned neonatal remains admitted to Salt River Mortuary (SRM), Cape Town, and the dearth of literature published in South Africa prompted a retrospective assessment of these cases to describe the profile and assess the scope of the post-mortem investigation of abandoned neonates, as well as determine the prosecution rate of abandoned live births. Demographic details, scene information and post-mortem findings were obtained from medico-legal case files concerning non-viable fetuses, stillbirths and concealment of birth cases admitted to SRM between 1 January 2012 and 31 December 2016 (n=249). Despite the majority of the cases being natural deaths, the cause of death frequently remained 'undetermined' in these cases, often due to the presence of decomposition. Histological analyses were only performed in a small fraction of undetermined cases. Furthermore, the hypothesis that the prosecution rate of abandoned live births is extremely low was supported by this study, with only one case prosecuted in the 5-year period. For the remainder of the cases, the court status was given as either 'under investigation' (47.8%) or 'case closed' (47.8%). In the majority of the instances, the case was closed due to the unknown identity of the biological mother; however, DNA analyses were not performed in all of these cases. Overall, the data highlighted the need for the development and implementation of standard protocols, and recommendations were made for conducting the medico-legal investigation of abandoned neonates in a South African setting.

Fetal foot length at delivery as a tool for determining gestation length in non-macerated stillbirths

OBJECTIVE

To assess whether fetal foot length at autopsy could reliably indicate gestation duration at stillbirth and the effects of maceration on this method.

METHODS

The present cross-sectional secondary analysis was part of the Safe Passage Study; all Safe Passage Study participants who experienced a stillbirth at Tygerberg Academic Hospital, Cape Town, South Africa, between August 1, 2007, and January 31, 2015, were eligible to participate. After providing written informed consent for autopsy, the duration of gestation calculated using early ultrasonography and fetal foot length were compared.

RESULTS

There were 69 fetal autopsies included in the present study; placental histology was available for 65. Generally, the gestation length calculated from the first ultrasonography scan correlated well with that calculated from the fetal foot length (Spearman correlation=0.85). However, significant differences were found in the gestation lengths calculated when the fetus was macerated (P<0.001), or when umbilical cord pathology (P<0.001) or maternal vascular malperfusion (P<0.001) was the cause of fetal death.

CONCLUSION

Foot length at stillbirth was a good indicator of gestation length; however, it was a weaker indicator if fetal maceration had occurred.

A revisit of the fetal foot length and fetal measurements in early pregnancy sonography

Objectives

To present the fetal measurements in relation to the foot length at 10–16 weeks gestation on antenatal ultrasound.

Materials and methods

We reviewed the fetal measurements in 47 scans performed at 10–16 weeks gestation in women attending routine antenatal care. The fetal measurements and measurement ratios were examined in relation to the foot length.

Results

The fetal biparietal diameter, head circumference, abdominal circumference, femur length and foot length increase linearly with the gestational age at 10–16 weeks gestation. The correlation between fetal foot length and fetal biparietal diameter, head circumference, abdominal circumference and femur length are better than with the crown rump length. The femur length to foot length ratio and the femur length to abdominal circumference ratios increase with the gestational age in an inverse relationship throughout the same period.

Conclusion

Fetal foot length is an accurate estimate of the gestational age in early pregnancy. Compared with crown rump length, the correlation between foot length and other fetal measurements is better. The fetal measurements ratios are gestational age dependent between 10–16 weeks. Gestational age specific ratio should be used in this period.

Foot length measurements of newborns of high and low risk pregnancies

OBJECTIVE

Comparing foot length measurements of newborns in high and low risk pregnancies at a public hospital in Goiânia, GO, Brazil.

METHOD

A cross-sectional study carried out between April, 2013 and May, 2015, with a sample consisting of 180 newborns; 106 infants of women from high-risk pregnancies and 74 of women from low-risk pregnancies. Data were descriptively analyzed. Foot length measurement was performed using a stiff transparent plastic ruler, graduated in millimeters. The length of both feet was measured from the tip of the hallux (big toe) to the end of the heel.

RESULTS

A statistically significant relationship was found between the foot length and newborn's weight, between the cephalic and thoracic perimeters in the high-risk group and between the cephalic perimeter in the control group.

CONCLUSION

There is a need for creating cut-off points to identify newborns with intrauterine growth disorders using foot length.

OBJETIVO

Comparar as medidas do comprimento hálux-calcâneo de recém-nascidos em gestações de alto e baixo risco em um hospital público de Goiânia, GO.

MÉTODO

Estudo transversal, realizado no período de abril de 2013 a maio de 2015, cuja amostra constituiu-se de 180 recém-nascidos, 106 filhos de mulheres com gestação de alto risco e 74 de mulheres com gestação de baixo risco. Os dados foram analisados descritivamente. A medida do comprimento hálux-calcâneo foi realizada utilizando-se de régua plástica transparente rígida, graduada em milímetros. Foram medidos ambos os pés, aferindo-se o comprimento da ponta do hálux até a extremidade do calcâneo.

RESULTADOS

Foi encontrada relação estatisticamente significante entre o comprimento hálux-calcâneo e o peso do recém-nascido, entre os perímetros cefálico e torácico no grupo de alto risco e entre o perímetro cefálico no grupo controle.

CONCLUSÃO

Existe necessidade da criação de pontos de corte para identificar recém-nascidos com desvios de crescimento intrauterino utilizando-se do comprimento hálux-calcâneo.

OBJETIVO

Comparar las mediciones de la longitud hallux-calcáneo de los recién nacidos en embarazos de alto y bajo riesgo en un hospital público de Goiânia, GO.MÉTODOSEstudio transversal realizado de abril 2013 a mayo 2015, cuya muestra estuvo constituida por 180 recién nacidos, 106 de mujeres con embarazos de alto riesgo y 74 de mujeres con embarazos de bajo riesgo. Los datos se analizaron de manera descriptiva. La medida de la longitud hallux-calcáneo se realizó mediante regla de plástico rígido transparente, graduada en milímetros. Se midieron en ambos pies, las longitudes de la punta del hallux hasta el final del calcáneo.

RESULTADOS

Se encontró una relación estadísticamente significativa entre la longitud hallux-calcáneo y el peso del recién nacido, entre las circunferencias cefálica y torácica en el grupo de alto riesgo y entre la circunferencia cefálica en el grupo control.

CONCLUSIÓN

Existe la necesidad de crear puntos de corte para identificar los recién nacidos con desviaciones de crecimiento intrauterino utilizando la longitud desde el hallux hasta el calcáneo.

The influence of body mass on foot dimensions during pregnancy

In this study, a time-series approach was used to measure women's feet to accurately analyze changes in foot size and body mass during pregnancy. One-hundred women who were pregnant for the first time were asked to respond to questions on subjective complaints of foot discomfort listed in a questionnaire. Among these 100 women, a sample of 30 was obtained and used to measure the women's feet from the twentieth week of the gestation period until labor. The data (from 5 of the 30 women) were used to establish a prediction model for the influence of body mass on changes in foot size during pregnancy. The results indicate that the women subjectively complained that their shoes were too tight, resulting in foot discomfort. From the twentieth to the thirty-eighth week of pregnancy, the average increase in foot length, width, and back foot surface was 0.86 cm (3.6%), 0.25 cm (2.6%), and 18.36 cm(2) (11.9%), respectively. The height of the arch decreased by an average of 0.52 cm (-24.2%). Body mass accounted for more than 90% of the variation (R(2)) in foot dimensions during pregnancy and, thus indicated satisfactory predictive ability. The prediction model developed in this study can serve as a reference for clinical applications and shoe design to prevent women from experiencing extreme discomfort in their feet during pregnancy.