Two-Dimensional Ultrasound Fetal Adrenal Gland Enlargement to Predict Spontaneous Preterm Birth in Singleton Pregnancy at GA 240/7-296/7 Weeks

Objectives: To predict spontaneous Preterm Birth (PTB) in asymptomatic singleton pregnant women by two-dimensional (2D) ultrasound measurement of Fetal Zone Enlargement (FZE).

Methods: A prospective cohort study was conducted at Srinagarind Hospital, Khon Kaen University. Asymptomatic singleton pregnancies between 24^0/7 and 29^6/7 weeks were included. Fetal adrenal gland size was assessed using Trans abdominal 2D ultrasound. Ratios between fetal zone and total adrenal gland in transverse, coronal and sagittal planes as length/Length (l/L), width/Width (w/W) and depth/ Depth (d/D), respectively were used to measure FZE. The ratio of each dimension was used to predict spontaneous preterm birth, with the receiver operating characteristic (ROC) curve used to assess diagnostic accuracy.

Results: A total of 148 pregnancies were included in the study. Sixteen pregnant women (10.81%) had spontaneous preterm birth. The fetal Zone Enlargement in coronal (w/W) and sagittal planes (d/D) were statistically significantly higher in the preterm group (P<0.05). Cut-off values of w/W and d/D ratio greater than 61.80% and 60.15%, respectively were satisfactory predictors of spontaneous preterm birth (d/D ratio, area under curve (AUC)=0.65, 95% CI 0.53-0.78; w/W ratio, 0.68, 95% CI 0.55-0.81) compared to l/L ratio (AUC=0.51, 95% CI 0.38-0.65).

Conclusion: Fetal adrenal gland enlargement measurement by 2D ultrasound between 24^0/7 and 29^6/7 weeks successfully predicted spontaneous preterm birth in asymptomatic singleton pregnant women.

Author(s): Porntip Tassananutriyakul, Sukanya Chaiyarach* and Piyamas Saksiriwutth

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