3D Ultrasonography Fetal Lung Volume Measurement and Neonatal Respiratory Function
Condition: Neonatal Respiratory Function
Study type: Observational

Summary: 
      One hundred healthy women with singleton pregnancies in the 1st stage of labor will be
      included in the study, divided into two groups; Group A (n: 50 - women pregnant ± 34-37
      weeks) & Group B (n: 50 - women pregnant ± 37+1-40 weeks). A 3D volume model of the right
      fetal lung is generated & lung volume is calculated using VOCAL software. After child birth,
      neonatal respiratory functions will be assessed using APGAR score at (1, 5 and 10 min)
      together with occurrence of RDS and the further need for NICU admission and respiratory
      support measurements.
    

Detailed description: 
      One hundred healthy women with singleton pregnancies presented in the 1st stage of labour
      will beincluded in the study. Participants will be divided into two groups; Group A (n: 50 -
      women pregnant ± 34-37 weeks gestation) & Group B (n: 50 - women pregnant ± 37+1-40 weeks
      gestation). Gestational age (GA) is established by menstrual dates then confirmed by
      obstetric ultrasound.

      For both groups, full history will be taken including the receiving of antenatal steroids
      followed by general, abdominal & pelvic examination to confirm the stage of labour & to
      exclude the presence of rupture of membranes. Obstetric ultrasound will be done to confirm
      GA, assess amniotic fluid index (AFI) & to exclude fetal anomalies. Fetal lung volume (FLV)
      measured using Voluson 730 Expert ultrasonography machine (GE Healthcare Austria GmbH, Seoul,
      Korea) equipped with a 4- to 8- MHz transabdominal transducer for 3-dimensional (3D) volume
      scanning. A single examiner will perform all ultrasound examinations with the following
      technique; a transverse section of the fetal thorax at the level of the 4-chamber view, with
      the fetal heart proximal to the transducer, was identified by 2-dimensional ultrasonography,
      and the volume box will be adjusted to scan the entire fetal thorax. The maximum resolution
      will be adjusted. The angle of volume sampling varied throughout gestational age with a
      maximum limit of 75° in the third trimester. After scanning the volume, multiplanar imaging
      in the 3 orthogonal ultrasonographic sections will be analyzed to reconstruct the 3D
      ultrasound image. Before its volume was analyzed, each lung was carefully identified on the 3
      orthogonal multiplanar imaging sections. The investigators will use the rotational technique
      that entails the VOCAL imaging program to measure lung volume. A transverse section of the
      multiplanar imaging will be chosen as the reference image for volume analyses (Figure 1).
      Right lung volume will be measured by a series of area tracing of the studied lung after
      serial rotations of 30° (6 times; Figures 2 and 3). Reviewing parallel slices executed
      through the whole lung in the 3 perpendicular planes allowed us to check the adequacy of our
      rotational area tracing approach. Right lung volume was automatically measured and plotted
      against gestational age, taking about 2 minutes to estimate the lung volume. After child
      birth, neonatal respiratory functions will be assessed using APGAR score at (1, 5 and 10 min)
      together with occurrence of RDS and the further need for neonatal ICU admission and
      respiratory support measurements.
    

Intervention name(s): 3D ultrasonography
Intervention type(s): Radiation
Intervention description(s): The angle of volume sampling varied throughout gestational age with a maximum limit of 75° in the third trimester. After scanning the volume, multiplanar imaging in the 3 orthogonal ultrasonographic sections was analyzed to reconstruct the 3D ultrasound image. Before its volume was analyzed, each lung was carefully identified on the 3 orthogonal multiplanar imaging sections. We used the rotational technique that entails the VOCAL imaging program to measure lung volume. A transverse section of the multiplanar imaging was chosen as the reference image for volume analyses
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        One hundred healthy women with singleton pregnancies presented in the 1st stage of labour
      
Keywords: 3D ultrasonography; fetal Lung Volume; neonatal respiratory function