RSS-Feed abonnieren
DOI: 10.1055/s-0028-1103513
Nuchal Translucency Thickness in Euploid Fetuses: Is Two Millimeters Too Risky?
Publikationsverlauf
Publikationsdatum:
21. November 2008 (online)
![](https://www.thieme-connect.de/media/ajp/200904/lookinside/thumbnails/10.1055-s-0028-1103513-1.jpg)
ABSTRACT
We sought to determine whether nuchal translucency (NT) thickness of ≥ 2 mm poses a risk for adverse perinatal outcome. A prospective observational study was conducted including all singleton pregnancies undergoing NT screening between 11 and 13.6 weeks' gestation, from January 1999 to October 2006, in a University Medical Center. Aneuploid and malformed fetuses were excluded from the analysis, as well as fetuses from pregnancies that ended before 22 gestational weeks. A comparison was performed between fetuses with NT of ≥ 2 mm and those with NT < 2 mm. Stratified analyses using the Mantel-Haenszel technique and multivariable analyses were performed to control for confounders. A total of 2205 singleton fetuses with normal karyotype were evaluated during the study period. Of these, 2.0% (n = 45) had NT of 2 mm and above. Pregnancies with NT of ≥ 2 mm were significantly associated with diabetes mellitus (either gestational or pregestational; odds ratio [OR] = 2.3, 95% confidence interval [CI] 1.02 to 5.1; p = 0.023). Higher rates of perinatal mortality (OR = 17.5, 95% CI 4.5 to 61.8; p < 0.001) and stillbirth in particular (OR = 25.6, 95% CI 4.9 to 120.7; p < 0.001) were noted among pregnancies with NT ≥ 2 mm. Using a multivariable analysis and controlling for confounders such as diabetes mellitus and the crown-rump length, NT ≥ 2 mm was found to be an independent risk factor for perinatal mortality (adjusted OR 14.3; 95% CI 1.8 to 3.5; p < 0.001). Nuchal translucency thickness of ≥ 2 mm in euploid, anatomically normal fetuses poses a significant risk for adverse perinatal outcome.
KEYWORDS
Nuchal translucency - ultrasound - perinatal mortality - diabetes mellitus - obstetric outcomes
REFERENCES
- 1 Nicolaides K H, Azar G, Byrne D, Mansur C, Marks K. Fetal nuchal translucency: ultrasound screening for chromosomal defects in first trimester of pregnancy. BMJ. 1992; 304 867-869
- 2 Snijders R J, Noble P, Sebire N, Souka A, Nicolaides K H. UK multicentre project on assessment of risk of trisomy 21 by maternal age and fetal nuchal-translucency thickness at 10–14 weeks of gestation. Fetal Medicine Foundation First Trimester Screening Group. Lancet. 1998; 352 343-346
- 3 Snijders R J, Sundberg K, Holzgreve W, Henry G, Nicolaides K H. Maternal age- and gestation-specific risk for trisomy 21. Ultrasound Obstet Gynecol. 1999; 13 167-170
- 4 Nicolaides K H. Nuchal translucency and other first-trimester sonographic markers of chromosomal abnormalities. Am J Obstet Gynecol. 2004; 191 45-67
- 5 Souka A P, Snijders R J, Novakov A, Soares W, Nicolaides K H. Defects and syndromes in chromosomally normal fetuses with increased nuchal translucency thickness at 10–14 weeks of gestation. Ultrasound Obstet Gynecol. 1998; 11 391-400
- 6 Souka A P, Von Kaisenberg C S, Hyett J A, Sonek J D, Nicolaides K H. Increased nuchal translucency with normal karyotype. Am J Obstet Gynecol. 2005; 192 1005-1021
- 7 Hyett J, Perdu M, Sharland G, Snijders R, Nicolaides K H. Using fetal nuchal translucency to screen for major congenital cardiac defects at 10–14 weeks of gestation: population based cohort study. BMJ. 1999; 318 81-85
- 8 Sherod C, Sebire N J, Soares W, Snijders R J, Nicolaides K H. Prenatal diagnosis of trisomy 18 at the 10–14-week ultrasound scan. Ultrasound Obstet Gynecol. 1997; 10 387-390
- 9 Pandya P P, Snijders R J, Johnson S P, De Lourdes Brizot M, Nicolaides K H. Screening for fetal trisomies by maternal age and fetal nuchal translucency thickness at 10 to 14 weeks of gestation. Br J Obstet Gynaecol. 1995; 102 957-962
- 10 Maymon R, Jauniaux E, Cohen O, Dreazen E, Weinraub Z, Herman A. Pregnancy outcome and infant follow-up of fetuses with abnormally increased first trimester nuchal translucency. Hum Reprod. 2000; 15 2023-2027
- 11 Kagan K O, Avgidou K, Molina F S, Gajewska K, Nicolaides K H. Relation between increased fetal nuchal translucency thickness and chromosomal defects. Obstet Gynecol. 2006; 107 6-10
- 12 Comstock C H, Malone F D, Ball R H et al.. Is there a nuchal translucency millimeter measurement above which there is no added benefit from first trimester serum screening?. Am J Obstet Gynecol. 2006; 195 843-847
- 13 Westin M, Saltvedt S, Almstrom H, Grunewald C, Valentin L. By how much does increased nuchal translucency increase the risk of adverse pregnancy outcome in chromosomally normal fetuses? A study of 16,260 fetuses derived from an unselected pregnant population. Ultrasound Obstet Gynecol. 2007; 29 150-158
- 14 Zoppi M A, Ibba R M, Floris M, Manca F, Axiana C, Monni G. Changes in nuchal translucency thickness in normal and abnormal karyotype fetuses. BJOG. 2003; 110 584-588
- 15 Michailidis G D, Economides D L. Nuchal translucency measurement and pregnancy outcome in karyotypically normal fetuses. Ultrasound Obstet Gynecol. 2001; 17 102-105
- 16 Hiippala A, Eronen M, Taipale P, Salonen R, Hiilesmaa V. Fetal nuchal translucency and normal chromosomes: a long-term follow-up study. Ultrasound Obstet Gynecol. 2001; 18 18-22
- 17 Senat M V, De Keersmaecker B, Audibert F, Montcharmont G, Frydman R, Ville Y. Pregnancy outcome in fetuses with increased nuchal translucency and normal karyotype. Prenat Diagn. 2002; 22 345-349
- 18 Leipold H, Worda C, Ozbal A, Husslein P, Krampl E. First-trimester nuchal translucency screening in pregnant women who subsequently developed gestational diabetes. J Soc Gynecol Investig. 2005; 12 529-532
- 19 Kelekci S, Yilmaz B, Savan K, Sonmez S. Can increased nuchal translucency in the first trimester of pregnancy predict gestational diabetes mellitus. J Obstet Gynaecol. 2005; 25 579-582
- 20 Nicolaides K H, Snijders R J, Cuckle H S. Correct estimation of parameters for ultrasound nuchal translucency screening. Prenat Diagn. 1998; 18 519-523
- 21 Spencer K, Cicero S, Atzei A, Otigbah C, Nicolaides K H. The influence of maternal insulin-dependent diabetes on fetal nuchal translucency thickness and first-trimester maternal serum biochemical markers of aneuploidy. Prenat Diagn. 2005; 25 927-929
- 22 Nicolaides K H, Heath V, Cicero S. Increased fetal nuchal translucency at 11–14 weeks. Prenat Diagn. 2002; 22 308-315
- 23 Haak M C, van Vugt J M. Pathophysiology of increased nuchal translucency: a review of the literature. Hum Reprod Update. 2003; 9 175-184
- 24 Plante G E, Chakir M, Ettaouil K, Lehoux S, Sirois P. Consequences of alteration in capillary permeability. Can J Physiol Pharmacol. 1996; 74 824-833
- 25 Brausewetter F, Jehle P M, Jung M F et al.. Microvascular permeability is increased in both types of diabetes and correlates differentially with serum levels of insulin-like growth factor I (IGF-I) and vascular endothelial growth factor (VEGF). Horm Metab Res. 2001; 33 713-720
- 26 Bartha J L, Wood J, Kyle P M, Soothill P W. The effect of metabolic control on fetal nuchal translucency in women with insulin-dependent diabetes: a preliminary study. Ultrasound Obstet Gynecol. 2003; 21 451-454
Eyal SheinerM.D.
Departments of Obstetrics and Gynecology, Soroka University Medical Center
Beer-Sheva 84103, Israel
eMail: sheiner@bgu.ac.il