A comparative analysis of second-trimester ultrasound dating formulae in pregnancies conceived with artificial reproductive techniques

A dataset of 64 pregnancies conceived by artificial reproductive techniques was studied to assess the accuracy of second-trimester dating formulae when these were applied in routine ultrasound clinics in different centers. Dating formulae for biparietal diameter (BPD) and femur length (FL) were derived for a gestational age range of 14-23 weeks. The best fit curves represented linear equations: gestational age (days) = 44.2 + 2 x BPD; and gestational age (days) = 67.4 + 2.3 x FL. Twelve published formulae for biparietal diameter and femur length were reviewed and systematic and random errors were calculated for these formulae when they were applied to second-trimester scan measurements in precisely dated pregnancies. Overall, published dating formulae performed well in predicting gestational age. The 95% confidence interval was 8.3 days for biparietal diameter and 10.2 days for femur length. The study confirms the accuracy of ultrasound dating in routine ultrasound clinics and supports the use of ultrasound measurement alone in preference to menstrual history for dating pregnancy.     

Fistula-in-Ano: perineal fistula of intra-abdominal or intrapelvic origin simulating fistula-in-ano--report of seven cases

In 219 normal pregnancies between 28 and 42 weeks the relationships of different ultrasound measurements of the fetal head and the fetal body to the gestational age were determined in order to improve the accurate diagnosis of fetal maturity during the last trimester of pregnancy. With the A and B ultrasound apparatus of Kretz, the biparietal diameter was determined by the A mode, the fronto occipital plane and the largest abdominal diamter were determined by the B scan. The following ultrasound measurements were taken: the two horizontal and transverse diameters, the circumferences and the planes. The abdominal measurements showed a higher rate of growth, compared to the cranial measurements a lesser rate of growth retardation and a higher variation of the normals. The correlation of the abdominal measurements with the gestational age was worse than that of the cranial measurements. Wth the exception of the biparietal diameter in the A mode, the mean diameters of the cranial and abdominal measurements gave better results than the single diameters. Circumference and surface measurements showed no advantages. The best results were obtained by combined fetal head and body measurements using the summation of the biparietal diameter in the A mode and the mean abdominal diameter in the B scan.     

The work of the American emergency physician

OBJECTIVE: To compare gestational age (GA) calculated from oocyte retrieval and from ultrasound measurements in pregnancies after in vitro fertilization (IVF). DESIGN: In a retrospective study of 253 women with singleton and 84 women with twin pregnancies conceived from IVF, GA calculated from the day of oocyte retrieval was compared with GA calculated in the second trimester of pregnancy from ultrasound measurements of biparietal diameter (BPD) and femur length (FL). RESULTS: For singletons, the mean GA calculated from ultrasound measurements was significantly shorter than the mean GA estimated from the day of oocyte retrieval. The mean difference was 1.9 days (SD 3.3; 95% CI 1.5-2.4) if only BPD was used and 2.1 days (SD 2.1; 95% CI 1.6-2.5) if BPD and FL were combined. For twins, the mean GA calculated from ultrasound measurements was also significantly shorter than the mean GA calculated from the day of oocyte retrieval. The mean difference was 1.4 days (SD 2.7; 95% CI 1.0-1.8) if BPD was used and 1.6 days (SD 2.5; 95% CI 1.2-2.0) if BPD and FL were combined. CONCLUSIONS: In IVF pregnancies, term prediction using ultrasound in the second trimester is reliable and may reduce the number of pregnancies subsequently classified as post-term, thus avoiding unnecessary obstetric interventions.     

Using ultrasound to assess the fetus at risk

In early pregnancy, ultrasonic scanning is valuable if the patient's menstrual history is unreliable or if uterine size is less than expected. The crown-rump length of the embryo can be measured from the sixth week of gestation, and pulsation of the heart detected from the seventh. The crown-rump length of the early embryo gives precise information about maturity. Somewhat later in pregnancy, fetal maturity and growth rate can be assessed accurately by measurement of the biparietal diameter. The head circumference and the fetal upper abdominal circumference together give the head-abdomen ratio, which can be helpful in assessing fetal nutrition. The abdominal circumference also may be used to predict fetal weight.     

Effect of Tissucol on connective tissue matrix during wound healing: an immunohistochemical study in rat skin

OBJECTIVE: Our goal was to identify prenatally available parameters that correlate with neonatal outcome and could be used for predicting such outcome in the extremely low-birth-weight pregnancy. STUDY DESIGN: From 1990 through 1995, obstetric and neonatal data of live-born nonanomalous singleton infants with birth weights between 400 and 1000 gm were reviewed. Only cases in which ultrasonographic biometry, including biparietal diameter, abdominal circumference, and femur length, was performed < or =3 days before delivery were included. Overall survival (defined as alive at discharge) and survival without specific severe neonatal morbidities (namely, retinopathy of prematurity [stage 3 or 4], intraventricular hemorrhage [grade 3 or 4], periventricular leukomalacia, chronic lung disease, and deafness) were ascertained. The best combination of prenatal parameters for the prediction of overall survival and survival without severe morbidity was determined by backward stepwise logistic regression analyses. RESULTS: The most significant prenatal predictors of overall survival were the obstetric estimate of gestational age and the abdominal circumference (chi2 = 11.8036, p = 0.0006 and chi2 = 8.1862, p < 0.005, respectively). Survival without severe morbidity was also predicted by the same combination of parameters (chi2 = 21.9079, p = 0.0001 and chi2 = 6.538, p = 0.01, respectively). The estimated fetal weight was not a significant independent predictor of either category of outcome (chi2 = 0.1249, p = 0.72 and chi2 = 0.0361, p = 0.85, respectively). On the basis of the regression formulas, curves displaying the probabilities of overall survival and survival without severe morbidity with any combination of gestational age and abdominal circumference were developed. CONCLUSION: The combination of gestational age and the abdominal circumference measurements appears to be superior to any combination that included estimated fetal weight data for predicting neonatal outcome in the neonates weighing < or =1000 gm. We developed a mechanism for predicting neonatal outcome in this weight category on the basis of prenatally available parameters. This information could prove useful for both parental counseling and obstetric decision making.     

First-trimester growth and the risk of low birth weight

BACKGROUND: Previous studies have demonstrated a correlation between first-trimester size and birth weight. It is not known, however, whether low birth weight is related to first-trimester growth. We sought to determine whether the risk of low birth weight and birth weight that was low for gestational age is related to the size of the embryo or the fetus in the first trimester. METHODS: From a data base of ultrasound records of more than 30,000 pregnancies, we identified women who had no important medical problems, a normal menstrual history, and a first-trimester ultrasound scan in which the crown-rump length of the embryo or fetus had been measured. We examined the relation between the outcome of 4229 pregnancies and the difference between the measured and the expected crown-rump length in the first trimester, expressed as equivalent days of growth. RESULTS: A first-trimester crown-rump length that was two to six days smaller than expected was associated with an increased risk (as compared with a normal or slightly larger than expected crown-rump length) of a birth weight below 2500 g (relative risk, 1.8; 95 percent confidence interval, 1.3 to 2.4), a birth weight below 2500 g at term (relative risk, 2.3; 95 percent confidence interval, 1.4 to 3.8), a birth weight below the fifth percentile for gestational age (relative risk, 3.0; 95 percent confidence interval, 2.0 to 4.4), and delivery between 24 and 32 weeks of gestation (relative risk, 2.1; 95 percent confidence interval, 1.1 to 4.0), but not with delivery between 33 and 36 weeks (relative risk, 1.0; 95 percent confidence interval, 0.7 to 1.5). CONCLUSIONS: Suboptimal first-trimester growth may be associated with low birth weight, low birth-weight percentile, and premature delivery.     

Sonographic evaluation of fetal growth: growth rate variability as a function of the interval between examinations

OBJECTIVE: Fetal growth rates determined on the basis of findings at two separate sonographic examinations can be used to detect growth abnormalities. This article determines the relationship between the length of the interval between examinations and the associated variability in measured fetal growth rates. MATERIALS AND METHODS: We analyzed 1479 fetal measurements of the biparietal diameter, average abdominal diameter, and femur length from 539 normal pregnancies. Mean growth rates were computed as functions of gestational age. The standard deviation of the growth rate was computed as a function of the interval between examinations. RESULTS: The standard deviation of fetal growth rates is relatively constant when the interval between examinations is 8-10 weeks or more, but increases substantially when the interval is fewer than 6 weeks. CONCLUSION: From a purely statistical point of view, the optimal interval for assessment of fetal growth rates is 8-10 weeks or more. Shorter intervals, however, usually are mandated by the clinical situation. Correction factors can be used to determine the standard deviations and associated confidence intervals for fetal growth measured over a period of fewer than 10 weeks.     

Analysis of testicular migration during the fetal period in humans

PURPOSE: We present an analysis concerning the testicular migration and its position correlated to body weight, crown-rump length and gestational age during the fetal period in humans without congenital abnormalities. MATERIALS AND METHODS: We studied bilaterally 142 testes taken from 71 fresh human fetuses between 10 and 35 weeks after conception. The fetuses were also evaluated in regard to crown-rump length and body weight. The position of the testes was correlated to the fetal parameters. RESULTS: In 37 fetuses (74 testes) at 10 to 23 weeks after conception only 7 testes (9.45%) had migrated from the abdomen and were situated in the inguinal canal, in 19 fetuses (38 testes) at 24 to 26 weeks after conception 22 testes (57.9%) had migrated from the abdomen and in 9 fetuses (18 testes) at 27 to 29 weeks after conception only 3 testes (16.7%) had not descended to the scrotum. The testes had not descended into the scrotum in any fetus weighing 990 gm. or less and with a crown-rump length of 24.5 cm. or less. On the other hand, in all fetuses weighing more than 1,220 gm. and with a crown-rump length of more than 27.5 cm. the testis was in the scrotum. CONCLUSIONS: Until 23 weeks after conception the majority of testes remain in the abdomen. The more intense migration of the testes through the inguinal canal occurred between 21 and 25 weeks after conception. After 30 weeks after conception all testes were descended to the scrotum in all fetuses.     

Ultrasound evaluation of the width of the fetal nose

The aim of the study was to construct a normal range for the width of the fetal nose during gestation. The study group included 229 healthy pregnant women with normal singleton pregnancies at 15-42 weeks of gestation. The ultrasound measurements were taken at the level of the lower border of the ala nasi, using the modified coronal view. Routine biometric measurements were obtained from the participants, including biparietal diameter, head and abdominal circumferences, cerebellum and femur lengths. Our results were used to construct objective measurements of the fetal nasal width across all gestational ages. We conclude that the nasal width can be easily measured from 15 weeks of gestation using the modified coronal view. A linear growth relationship was found between nasal width and gestational age, biparietal diameter, head and abdominal circumferences, and transcerebellar and femoral lengths. We feel that such measurements may prove useful in the diagnosis of cases at high risk for fetal facial abnormalities.     

A case of successful hypospadias repair without infection using recombinant human granulocyte-colony stimulating factor (rhG-CSF) for idiopathic neutropenia

OBJECTIVES: To establish normative data for the width of the fetal cavum septi pellucidi at various gestational ages. SUBJECTS AND METHODS: A total of 608 consecutive fetuses between 19 and 42 gestational weeks were included in this prospective study. The largest width of the cavum septi pellucidi was measured by two-dimensional ultrasound. Piecewise regression analysis was used to study the relationships between the width of the fetal cavum septi pellucidi, gestational age and biparietal diameter. RESULTS: The fetal cavum septi pellucidi width increased gradually between 19 and 27 weeks of gestation and then plateaued between 28 weeks and term. Regression analysis revealed significant associations between cavum septi pellucidi width and gestational age, and cavum septi pellucidi width and biparietal diameter. CONCLUSIONS: The present study provides normative data for fetal cavum septi pellucidi width and useful information about the development of the midline brain structure in the fetus.     

Sudden unexpected death in infancy: epidemiologically determined risk factors related to pathological classification

OBJECTIVE: Gestational diabetes is associated with increased risk of developing noninsulin-dependent diabetes (NIDDM) later in life. By the time that a diagnosis of NIDDM is established, functional disturbances in the vascular system may be observed. This study was planned to assess macro- and microvascular function in nonpregnant women without signs of diabetes two to four years after a pregnancy complicated with gestational diabetes. DESIGN: Cross-sectional study. SETTING: Vascular research laboratory in the obstetric unit of a university hospital. PARTICIPANTS: Seventeen nonpregnant, healthy women with a history of gestational diabetes and 20 nonpregnant control women of similar age without previous diabetes. METHODS: For quantification of the mechanical properties in large arterial vessels the wall movements of the abdominal aorta and left common carotid artery were recorded with an ultrasonic tracking system. Microvascular perfusion in the skin of the hand and foot was recorded by a laser Doppler technique to assess the vasodilatory response induced by transcutaneous acetylcholine. RESULTS: Women in the gestational diabetes group showed evidence of increased wall stiffness in the common carotid artery and a lower maximum incremental velocity of the pulsatile vessel diameter change in both aorta and carotid artery compared with controls. Acetylcholine induced vasodilatation in both hand and foot was lower in women with previous gestational diabetes compared with controls. CONCLUSION: Abnormal vascular function was found in asymptomatic women with a history of gestational diabetes. It is speculated that these abnormalities might be early evidence of vascular complications associated with subsequent NIDDM.     

Experience with the Ultrex and Ultrex Plus inflatable penile prosthesis: new implantation techniques and surgical outcome

OBJECTIVE: To construct nomograms of the size of the fetal orbit and lens during gestation. SUBJECTS: The study group included 349 normal pregnant women at 14-36 weeks' gestation. METHODS: Routine biometric measurements were obtained in all the participants; these included biparietal diameter, head and abdominal circumferences, measurements of the long bones and the diameters of the fetal orbit and lens. The orbital and lens circumference measurements were also related to gestational ages. RESULTS: A linear growth function was observed between gestational age (GA) and orbital diameter (r = 0.94; p < 0.00001; y = -0.66 + 0.5 x GA), orbital circumference (r = 0.94; p < 0.00001; y = -2.1 + 1.5 x GA) and orbital area (r = 0.94; p < 0.00001; y = -98.1 + 8.3 x GA). Significant correlation was also found between femoral length (FL) and orbital diameter (r = 0.95; p < 0.00001; y = 3.3 + 1.9 x FL), orbital circumference (r = 0.95; p < 0.00001; y = 10.3 + 5.9 x FL) and orbital area (r = 0.93; p < 0.00001; y = -28.2 + 32.2 x FL). A linear growth function was observed between orbital circumference and biparietal diameter (r = 0.94; p < 0.00001) and head circumference (r = 0.95; p < 0.00001). A linear growth function was also observed between gestational age and the diameter of the lens (r = 0.89; p < 0.00001; y = 0.88 + 1.4 x GA) the circumference of the lens (r = 0.89; p < 0.00001; y = 2.78 + 0.4 x GA) and the area of the lens (r = 0.89; p < 0.00001; y = -7.95 + 1.0 x GA). The correlation was found between the ratios of the diameters, circumferences and areas of the lens and the orbit. CONCLUSIONS: These results provide normative data of the growth of the fetal orbit and lens and may aid future studies relating to fetal eye anomalies.     

Ultrasonographic characteristics of first-trimester gestations in recurrent spontaneous aborters

OBJECTIVE: To compile, for the first time, serial ultrasonographic findings during the first trimester of pregnancy in women with a history of primary recurrent spontaneous abortion so as to define the dynamics of early normal and abnormal gestations in this category of gravidas. STUDY DESIGN: Transvaginal ultrasonograms were obtained weekly from 5 to 12 weeks' gestational age in 40 women, 10 each of four groups: recurrent spontaneous aborters and primiparas (controls), with both successful and failed gestations. RESULTS: Embryonic heart motion was detected in 40-50% of successful pregnancies during the fifth week of gestation and in the balance by the sixth week, while heart motion was detected in no more than 50% of pregnancies that later failed. Of the failed pregnancies, all were evident by the eighth week of gestation, including those with previously documented viability. The gestational sac size and crown-rump length were smaller than expected in both failed groups, with the sac size difference evident as early as week 5 and the crown-rump length difference apparent by week 7. CONCLUSION: Appropriate timing of the initial ultrasonogram in recurrent aborters (i.e., 8 weeks' gestational age) can identify, by means of heart motion and gestational sac features, all pregnancies that will ultimately fail.     

Cloning and genetic analysis of the gene encoding a new protein kinase in Saccharomyces cerevisiae

The growth of the body was studied in 30 human fetuses ranged from 10 to 22 weeks of gestation. The fetuses were fixed by immersion in 4 percent formaldehyde and the following dimensions were studied: a) lengths: arm, forearm, hand, thigh, leg, foot and crown-rump (sitting height), b) perimeters: head, thorax and abdomen. A covariance matrix was calculated from natural logarithms of all measurements. The relative growth of these measurement was computed by multivariate allometry using a principal components analysis (PCA). All characters were positively correlated with the first principal component which accounted for 94.65 per cent of the total variance. Considering the different measurements in the sequence of the increasing growth rates no one was considered to increase in isometric relationship. PCA showed that the following measurements grew with negative allometry: head perimeter, C-R length, thoracic perimeter, length of the forearm and abdominal perimeter. On the other hand, the following lengths grew with positive allometry: hand, foot, thigh, arm and leg. In conclusion, during the first two trimesters of prenatal life the growth of the body is allometrical. Limbs increase with greater growth rates than the perimeters of the body cavities.     

The Diabetes in Early Pregnancy Study: beta-hydroxybutyrate levels in type 1 diabetic pregnancy compared with normal pregnancy. NICHD-Diabetes in Early Pregnancy Study Group (DIEP). National Institute of Child Health and Development

OBJECTIVE: The objective was to assess relationships between beta-hydroxybutyrate (beta-OHB) level and pregnancy outcome in human pregnancy in light of the fact that high levels of beta-OHB cause malformations and growth retardation in in vitro studies. RESEARCH DESIGN AND METHODS: We analyzed beta-OHB in prospectively collected specimens from the National Institute of Child Health and Human Development-Diabetes in Early Pregnancy Study, in gestational weeks 6-12 in diabetic (n = 204-239) and nondiabetic (n = 316-332) pregnant women. RESULTS: Levels of beta-OHB in diabetic women were 2.5-fold higher than in nondiabetic pregnant women at 6 weeks' gestation and declined to 1.6-fold above nondiabetic women by 12 weeks' gestation (P < 0.0001 at all times). beta-OHB was positively correlated with glucose levels (P < 0.0001) in diabetic mothers, probably reflecting degree of diabetic control. beta-OHB correlated inversely with glucose (P < 0.0003) (gestational week 6 only) in nondiabetic mothers, possibly reflecting caloric intake. beta-OHB tended to be lower (not higher) in diabetic and nondiabetic mothers with malformed infants or pregnancy losses, but the difference was not statistically significant. beta-OHB in diabetic mothers at 8, 10, and 12 weeks correlated inversely with birth weight (P = 0.004-0.02), even after adjusting for maternal glucose levels. beta-OHB levels were also generally lower in diabetic mothers of macrosomic infants, and week 12 ultrasound crown-rump measurements were inversely related to beta-OHB levels. CONCLUSIONS: The lst trimester beta-OHB is significantly higher in diabetic than nondiabetic pregnant women. In both groups, beta-OHB tended to be lower, not higher, in mothers who had a malformed infant or pregnancy loss. beta-OHB was inversely related to crown-rump length and birth weight. The modest beta-OHB elevation in the 1st trimester of reasonably well-controlled diabetic pregnancy is not associated with malformations, probably because beta-OHB levels causing malformations in embryo culture models are 20- to 40-fold higher. The mechanism of the beta-OHB association with impaired fetal growth is unknown.     

Ultrasonographic examination of intrauterine growth for multiple fetal dimensions in a Chinese population. Central-South China Fetal Growth Study Group

OBJECTIVE: We sought to construct an ultrasonography-based growth curve in a Chinese population. STUDY DESIGN: Routine ultrasonographic examination was performed in 5496 normal pregnancies (>95% first births) in five obstetric ultrasonography laboratories in Central-South China from January 1, 1992, to December 31, 1993. RESULTS: All the fetal growth measures increased with gestational age, whereas the ratios either decreased or remained constant across gestation. Biparietal diameter and cerebral hemispheric width were higher at early gestational ages, whereas femur length, thoracic circumference, and abdominal circumference were lower at later gestational ages in our study than in previous studies. The ratio of lateral ventricular width/cerebral hemispheric width was lower at an early gestational age but higher in later gestational ages in our study. CONCLUSIONS: A different standard of ultrasonography-based fetal growth is needed for different populations. The ultrasonography-based growth curve constructed in this large Chinese population provides an additional tool for the evaluation of fetal growth and development.     

Cervical assessment by magnetic resonance imaging--its relationship to gestational age and interval to delivery

The aim of this cross-sectional study was to assess the uterine cervix in late pregnancy, using MRI, and to study its relationship to the gestational age and the time interval to delivery. 91 women with a singleton cephalic presenting fetus had MRI of the pelvis between 35 and 41 weeks. All had had one prior lower segment Caesarean section and no history of prior vaginal delivery. The cervical length, internal and external os diameter, cervical signal intensity and the angulation of the cervix with the cephalocaudal axis were measured on sagittal T2 weighted images and correlated with the gestational age and the interval from the MRI examination to delivery. It was found that the signal intensity of the cervical stroma increased with the gestational age. A higher signal intensity in the cervical stroma was associated with a shorter time interval to delivery. Deliveries after 40 weeks tended to occur more commonly in those with lower signal intensity in the cervical stroma and also in those with a smaller external os diameter. It is concluded that cervical softening as assessed on MRI correlated with gestational age and the time interval to delivery.     

A microscopic analysis of cut-bevel versus pencil-point spinal needles

OBJECTIVE: Our purpose was to establish new nomograms for the birth weight of twins on the basis of accurate methods to validate gestational age. STUDY DESIGN: The medical records of 1632 consecutive twin gestations delivered between 1984 and 1996 were reviewed. Only pregnancies induced by ovulation induction techniques or that were measured ultrasonographically for crown-rump length during the first trimester were included. Excluded were those whose fetuses (one or both) were stillborn, or if the mother smoked, had a significant chronic illness, or was prescribed any regular medications. The study comprised 520 twin pregnancies at 28 to 41 gestational weeks at delivery. RESULTS: The median and 10th and 90th percentile birth weight curves were calculated for the studied twins and plotted against previously reported singleton nomograms. Fetuses of twin pregnancies were found to be growth restricted in comparison with previously reported singletons throughout the third trimester. This trend became more evident after the thirty-fourth to thirty-sixth weeks. CONCLUSIONS: We recommend these novel birth weight nomograms for clinical use in the management of twin pregnancies.     

Complications of vertebral metastasis surgery

The objective of the study was to evaluate the crown-rump length (CRL) in high-order multifetal pregnancies (three or more fetuses). The records of patients who underwent multifetal pregnancy reduction were reviewed. The following parameters were defined: the mean CRL (CRLMEAN) and the difference between the largest and smallest CRL (CRLRANGE) for each pregnancy. CRLMEAN was plotted versus gestational age (GA) and the line of best fit was derived. The residual for each CRL (CRLRES) was calculated by subtracting the value predicted by the regression line from the individual CRL (CRLIND). Regression lines for single-tons with confirmed GA from four previously reported studies were used for comparison. A total of 82 patients were included (29 triplets, 38 quadruplets and 15 quintuplets; mean GA 10.7 +/- 0.78 weeks). CRLMEAN correlated with GA (CRLMEAN = 38.88 - 8.78(GA) + 0.82(GA)2; R = 0.83; R2 = 0.70). This second-degree polynomial remained within the range for singletons. No significant differences in maternal age, GA and CRLMEAN were noted between the patients with different numbers of fetuses. The median CRLRANGE was largest in quintuplets, followed by quadruplets and triplets. The CRLRANGE correlated poorly with GA. The mean CRL in multifetal pregnancies increases with GA similarly to that in singletons. The variability of individual measurements increases with the number of fetuses and CRLs are lower in quintuplets.     

Human herpesvirus-6: a new member of the herpesvirus family, a threat to AIDS, organ-transplanted and other immune deficient patients

OBJECTIVE: The purpose was to evaluate a low weight to length ratio as a correlate of perinatal morbidity and mortality. STUDY DESIGN: Data from the Collaborative Perinatal Project for infants of 34 weeks' gestation or more were evaluated. Associations between the weight to length ratio of < 10% (low weight to length) and birth weight of < 10% (small for gestational age) by gestational age and gender, perinatal depression, dysmaturity, cerebral palsy, and neonatal mortality were evaluated. RESULTS: A low weight to length ratio and small for gestational age status were associated with most markers of perinatal morbidity and mortality in term and preterm infants. In infants not small for gestational age, a low weight to length ratio was associated with increased morbidity and mortality (relative risk of 1.9 to 4.2) in term infants, and with perinatal depression (relative risk of 2.9) in preterm infants. Logistic regression found low weight to length ratio was a better independent correlate than small for gestational age status for all markers assessed and found low weight to length ratio was significantly associated with all morbidity and mortality markers in infants not small for gestational age. CONCLUSION: Low weight to length ratio, a marker for asymmetric growth restriction, is correlated with perinatal morbidity, even in infants not small for gestational age.