Assessment of fetal adrenal gland enlargement in term and preterm labor cases

Askin E. Guler, Huseyin Pehlivan, Bulent Cakmak, Iskender Baser


Background: The objective of this study was to compare the Fetal Zone Depth (FZD) of fetal adrenal gland in term and preterm labor cases.  

Methods: Twenty nine preterm pregnant women at 29-36 weeks of gestation with single pregnancy admitted with the clinical diagnosis of preterm labor and the comparison group of 33 pregnant women at 37-40 weeks with term pregnancy were included in this study. FZD and Total Gland Depth (TGD) of fetal adrenal gland of the entire fetuses in sagittal plane were ultrasonographically measured and FZD/TGD ratios were calculated. Demographic and clinical features, laboratory findings and fetal adrenal gland FZD/TGD ratios were compared between the two groups.

Results: No difference was found between the two groups in respect of age, number of pregnancies and delivery method (P >0.05); yet preterm birth history and duration of hospital stay were higher in preterm group (P <0.05). Fetal adrenal gland FZD/TGD ratio was statistically significantly higher in preterm group compared to the term group (55.4% ± 4.9 vs. 47.7% ± 5.6; P <0.001).

Conclusion: The growth in FZ as a fetal adaptation mechanism in increased fetal stress in preterm labor cases was at a significant level. Once supported by more comprehensive studies, we think that this result would be beneficial in the prediction of preterm labor in clinical practice.



Preterm labor, Adrenal gland, Fetal zone, Ultrasonography

Full Text:



Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller AB, Narwal R, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet. 2012;379:2162-72.

Matthews T, MacDorman M. Infant mortality statistics from the 2009 period linked birth/infant death data set. Natl Vital Stat Rep. 2013;61:1-27.

Copper RL, Goldenberg RL, Creasy RK. A multicenter study of preterm birth weight and gestational age specific mortality. Am J Obstet Gynecol. 1993;168:78-84.

McDonald HM, O’loghlin JA, Jolley P, Vigneswaran R, McDonald PJ. Prenatal microbiological risk factors associated preterm birth. Br J Obstet Gynaecol. 1992:99:190-6.

Meis PJ, Goldenberg RL, Mercer BM, Iams JD, Moawad AH, Miodovnik M, et al. The preterm prediction study: risk factors for indicated preterm births. Maternal-Fetal Medicine Units Network of the National Institute of Child Health and Human Development. Am J Obstet Gynecol. 1998;178:562-7.

Hasegawa I, Tanaka K, Takahashi K, Tanaka T, Aoki K, Torii Y, et al. Transvaginal ultrasonographic cervical assessment for the prediction of preterm delivery. J Matern Fetal Med. 1996;5:305-9.

Iams JD, Goldenberg RL, Meis PJ, Mercer BM, Moawad A, Das A, et al. The length of the cervix and the risk of spontaneous premature delivery. National Institute of Child Health and Human Development Maternal Fetal Medicine Unit Network. N Engl J Med. 1996;334:567-72.

Crane JM, Van den Hof M, Armson BA, Liston R. Transvaginal ultrasound in the prediction of preterm delivery: singleton and twin gestations. Obstet Gynecol. 1997;90:357-63.

Iams JD, Paraskos J, Landon MB, Teteris JN, Johnson FF. Cervical sonography in preterm labor. Obstet Gynecol. 1994;84:40-6.

Goto M, Piper Hanley K, Marcos J, Wood PJ, Wright S, Postle AD, et al. In humans, early cortisol biosynthesis provides a mechanism to safeguard female sexual development. J Clin Invest. 2006;116:953-60.

Neville AM, O’Hare MJ. The human adrenal cortex. In: Neville AM, O’Hare MJ, eds. Pathology and Biology: an Integrated Approach. 1st ed. New York: Springer-Verlag; 1982: 11-33.

Norwitz ER, Robinson JN, Challis JR. The control of labor. N Engl J Med. 1999;341:660-6.

Langlois D, Li JY, Saez JM. Development and function of the human fetal adrenal cortex. J Pediatr Endocrinol. 2002;15(Suppl 5):1311-22.

Anderson AB, Laurence KM, Davies K, Campbell H, Turnbull AC. Fetal adrenal weight and the cause of premature delivery in human pregnancy. J Obstet Gynaecol Br Commonw. 1971;78:481-8.

Turan OM, Turan S, Fuani EF, Buhimschi IA, Copel JA, Buhimschi CS. Fetal adrenal gland volume. A novel method for identify women at risk for impending preterm birth. Obstet Gynecol. 2007;109:855-62.

Turan OM, Turan S, Funai EF, Buhimschi IA, Campbell CH, Bahtiyar OM, et al. Ultrasound measurement of fetal adrenal gland enlargement: an accurate predictor of preterm birth. Am J Obstet Gynecol. 2011;204:311.e1-10.

Wright L, Vohr BR, Fanaroff AA. Perinatal-neonatal epidemiology. In: Taeusch HW, Ballard RA, Gleason CA, eds. Avery’s Diseases of the New-born. 8th ed. Philadelphia: Elsevier Saunders; 2005: 1-8.

Vendittelli F, Volumenie J. Transvaginal ultrasonography examination of the uterine cervix in hospitalised women undergoing preterm labour. Eur J Obstet Gynecol Reprod Biol. 2000;90:3-11.

Warren WB, Patrick SL, Goland RS. Elevated maternal plasma corticotropin-realising hormone levels in pregnancies complicated by preterm labor. Am J Obstet Gynecol. 1992;166:1198-207.

Lockwood CJ. Recent advances in elucidating the pathogenesis of preterm delivery, the detection of patients at risk and preventative therapies. J Matern Fetal Med. 1994;6:7-18.

Buhimschi CS, Turan OM, Funai EF, Azpurua H, Bahtiyar MO, Turan S, et al. Fetal adrenal gland volume and cortisol/dehydroepiandrosterone sulfate ratio in inflammation-associated preterm birth. Obstet Gynecol. 2008;111:715-22.

Ljubitsh V, Petkovitsh S, Radunovitsh N. The fetal adrenal gland in risk pregnancy. Srp Arh Celok Lek. 2002;130:198-200.