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Objective: The current study aims to compare the ultrasonographic evaluation of fetal lung Gray-level histogram width (GLHW) ratio with an amniotic fluid lamellar body count (LBC) in the prediction of fetal lung maturity.

Methods: A prospective cohort study was conducted at a tertiary University Hospital in the period between May 1, 2017 and March 31, 2018. The study included pregnant women with a single fetus at ≥37 weeks of gestation scheduled for delivery by elective cesarean section (CS). Ultrasound evaluation was performed for assessment of the fetal lung to liver GLHW ratio to predict lung maturity. Lamellar body count was determined from an amniotic fluid sample obtained via amniotomy during CS. The lamellar body count for this sample was measured using a hematology analyzer. These data were further compared to Apgar scores at 1 and 5 minutes after delivery to assess the condition of the newborn immediately after birth, the degree of respiratory distress syndrome (RDS) and the need for resuscitation.

Results: One hundred twenty women and their neonates were included in the study. There was a statistically significant decrease in the levels of both GLHW and LBC among those neonates that showed distressed respiration after Apgar testing as compared with those who did not show similar distress, with p-value <0.001. The Receiver Operating Characteristic Curve (ROC) for LBC levels in the prediction of respiratory distress shows the best cutoff point for LBC was found at ≤20214/μL with a sensitivity of 100.0%, specificity of 75.47% and area under the curve (AUC) of 88.4%. The ROC curve for GLWH levels in the prediction of respiratory distress shows the best cutoff point for GLWH was found at ≤0.93 with sensitivity of 100.0%, specificity of 84.91% and AUC of 97.1%.

Conclusions: Ultrasonographic evaluation of GLHW of the fetal lung and liver is a non-invasive, inexpensive and time-efficient test for prediction of fetal lung maturity that has higher sensitivity and specificity.


Lung maturity, ultrasonography, lung histogram, lamellar body count

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Financial Disclosure

The authors report no conflict of interest.

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Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.