ULTRASONOGRAPHIC EVALUATION OF CEREBRAL CORTICAL DEVELOPMENT IN GROWTH RESTRICTED VERSUS MATCHED AVERAGE GESTATIONAL AGE FETUSES

Amany Ibrahim Azab; Tarek Abd El Zaher Karkour; Tamer Mohammed Abd El Aziz  Ibrahim Hassan; Tamer Mamdouh Abd El Dayem

Amany Ibrahim Azab Assistant Lecturer of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Faculty of Medicine, Alexandria University
Tarek Abd El Zaher Karkour Professor of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Faculty of Medicine, Alexandria University, Egypt
Tamer Mohammed Abd El Aziz Ibrahim Hassan Lecturer of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Faculty of Medicine, Alexandria University, Egypt
Tamer Mamdouh Abd El Dayem Professor of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Faculty of Medicine, Alexandria University, Egypt

Keywords: Cortical development, neurosonography, fetal growth restriction, corpus callosum, sylvian fissure, insula, cingulate fissure, calcarine fissure

Abstract

Back ground: Fetal growth restriction (FGR) contributes significantly to prenatal and long-term morbidity, including neurological impairments, which are among the sequels that are most frequently observed in this population.

Methods: Observational prospective cohort study involving 300 pregnant women (25–37 gestational weeks), 150 of whom had pre-eclampsia with FGR, and 150 of whom had normal pregnancies with average gestational age fetuses matched by gestational age at fetal neurosonography (±2weeks). Fetal Doppler and fetal biometry were done. In the axial transventricular plane, the insula and sylvian fissure depths were measured. Using two- or three-dimensional ultrasonography, the corpus callosum's length and thickness were measured in the mid-sagittal plane. Using two- or three-dimensional ultrasonography, the depths of the calcarine fissure in the coronal trans-cerebellar plane and the cingulate fissure in the transcaudal plane were measured.

Results: These 300 pregnancies were separated into 6 groups according to gestational age using a 2 week gap. Regarding age, BMI ,gravidity, parity, and abortion, the study groups were comparable. Cases complicated by PE and FGR displayed a distinct pattern of fetal cortical development on fetal neurosonography, as evidenced by significantly shallower Sylvian fissure measurements in each group of cases compared to controls. There was no statistically significant difference in insula depth between the two groups, although the FGR group's corrected insula depth (Insula depth (mm) /BPD) was deeper than the control group's. The corpus callosum length was shorter in the FGR groups than in the control groups. There was no statistically significant difference between the two groups for the anterior, middle, and posterior measurements of corpus callosum thickness. Between study groups, there were no discernible variations in calcarine and cingulate fissure depth.

Conclusion: In small fetuses, neurosonography appears to be a sensitive method for identifying subtle anatomical variations in brain development.