Update Reference Charts: Fetal Biometry between the 15th and 42nd Week of Gestation

Abstract

Objectives This study was designed to establish new reference charts for BPD (biparietal diameter), OFD (occipitofrontal diameter), HC (head circumference), CM (cisterna magna), TCD (transverse cerebellar diameter), PCV (posterior cerebral ventricle), AC (abdominal circumference), FL (femur length), and HL (humerus length) and extend known charts to 42 weeks of gestation. These new charts were compared to studies carried out by Snijders and Nicolaides, the INTERGROWTH 21st Project, and the WHO Fetal Growth Charts.

Methods In this retrospective cross-sectional single-center study of 12,972 low-risk pregnancies, biometric data between the 15th and 42nd weeks of gestation were evaluated. Only one examination per pregnancy was selected for statistical analysis. Descriptive analysis for the 5th, 50th, and 95th quantile was performed for each parameter as listed above. Regression models were used to fit the mean and the SD at each gestational age.

Results Initially the reference curves for BPD, OFD, HC, AC, FL, and HL show a linear increase, which changes into a cubic increase towards the end of pregnancy. The results of this study show statistically noticeable differences from the percentile curves of the studies listed above.

Conclusions The percentile curves in this study differ from the commonly used ones. The presented standard curves can be used as a reference in prenatal diagnostics.

Zusammenfassung

Ziel Ziel dieser Studie ist es, neue Wachstumskurven für BPD (Biparietaler Durchmesser), OFD (Okzipitofrontaler Durchmesser), KU (Kopfumfang), CM (Cisterna magna), TZD (Transzerebellärer Durchmesser), hHSV (hinterer Hirnseitenventrikel), AU (Abdomenumfang), FL (Femurlänge) und HL (Humeruslänge) zu erstellen und diese bis zur abgeschlossenen 42. Schwangerschaftswoche zu erweitern. Unsere Ergebnisse verglichen wir mit Studien von Snijders und Nicolaides, dem INTERGROWTH 21st Project und den WHO Fetal Growth Charts.

Material und Methoden In dieser retrospektiven, single center Querschnittsstudie wurden 12.972 Niedrigrisikoschwangerschaften zwischen der 15. und 42. Schwangerschaftswoche untersucht. In jeder Schwangerschaft wurde nur eine Ultraschalluntersuchung für die statistische Auswertung einbezogen. Bei jedem der oben genannten Parameter wurde eine deskriptive Analyse für das 5., 50. und 95. Quantil angewendet. Für jedes Gestationsalter wurde ein Regressionsmodel genutzt, um den Median und die Standardabweichung (SD) zu berechnen.

Ergebnisse Im Verlauf der Schwangerschaft zeigten die Perzentilenkurven größtenteils einen linearen Anstieg, der zum Ende der Schwangerschaft in einen kubischen Anstieg über#ging. Die Perzentilenkurven der obengenannten Studien unterscheiden sich statistisch signifikant gegenüber den Werten unserer Studie.

Schlussfolgerung Die Perzentilenkurven unserer Studie unterscheiden sich von den üblicherweise verwendeten Kurven. Die vorliegenden Normkurven können für die pränatale Diagnostik genutzt werden.

Key words

fetal biometry - second to third trimester - fetal ultrasound - growth chart

Schlüsselwörter

fetale Biometrie - Perzentilenkurven - fetaler Ultraschall - zweites bis drittes Trimester

• References

• 1 Merz E, Eichhorn KH, von Kaisenberg C. et al. Updated quality requirements regarding secondary differentiated ultrasound examination in prenatal diagnostics (=DEGUM Level II) in the period from 18+0 to 21+6 weeks of gestation. Ultraschall in Med 2012; 33: 593-596
• 2 Vitner D, Bleicher I, Kadour-Peero E. et al. Induction of labor versus expectant management among women with macrosomic neonates: a retrospective study. J Matern Fetal Neonatal Med 2020; 33: 1831-1839 0.1080/14767058.2018.1531121
• 3 Ryo Yamamoto R, Ishii K, Nakajima E. et al. Ultrasonographic prediction of antepartum deterioration of growth-restricted fetuses after late preterm. J Obstet Gynecol Res 2018; 44: 1057-1062
• 4 Boers KE, Vijgen SMC, Bijlenga D. et al. Induction versus expectant monitoring for intrauterine growth restriction at term: randomised equivalence trial (DIGITAT). BMJ 2010; 341: c7087
• 5 Linder N, Hiersch L, Fridman E. et al. Post-term pregnancy is an independent risk factor for neonatal morbidity even in low-risk singleton pregnancies. Arch Dis Child Fetal Neonatal Ed 2017; 102: F286-F290
• 6 Middleton P, Shepherd E, Crowther CA. Induction of labour for improving birth outcomes for women at or beyond term (Review). Cochrane Database Syst Rev 2018; 5: CD004945
• 7 Kubiak K, Koch R, Klockenbusch W. et al. Update reference charts: fetal biometry between the 15th and 20th week of gestation. Fetal Diagn Ther 2016; 40: 195-204
• 8 Snijders RJM, Nicolaides KH. Fetal biometry at 14–40 weeks´ gestation. Ultrasound Obstet Gynecol 1994; 4: 34-48
• 9 Kiserud T, Piaggio G, Carroli G. et al. The World Health Organization Fetal Growth Charts: a multinational longitudinal study of ultrasound biometric measurements and estimated fetal weight. PLoS Med 2017; 14: 1-36
• 10 Papageorghiou AT, Ohuma EO, Altman DG. et al. International standards for fetal growth based on serial ultrasound measurements: the Fetal Growth Longitudinal Study of the INTERGROWTH-21^st Project. Lancet 2014; 384: 869-879
• 11 Voigt M, Fusch C, Olbertz D. et al. Analysis of the neonatal collective in the Federal Republic of Germany 12th report: presentation of detailed percentiles for the body measurement of newborns. Geburtsh Frauenheilkd 2006; 66: 956-970
• 12 Salomon LJ, Duyme M, Crequat J. et al. French fetal biometry: reference equations and comparison with other charts. Ultrasound Obstet Gynecol 2006; 28: 193-198
• 13 Smith R, Mohapatra L, Hunter M. et al. A case for not adjusting birthweight customized standards for ethnicity: observations from a unique Australian cohort. Am J Obstet Gynecol 2019; 220: 277.e1-e10
• 14 Sletner L, Kiserud T, Vangen S. et al. Effects of applying universal fetal growth standards in a Scandinavian multi-ethnic population. Acta Obstet Gynecol Scand 2018; 97: 168-179
• 15 Papaioannou GI, Syngelaki A, Poon LCY. et al. Normal ranges of embryonic length, embryonic heart rate, gestational sac diameter and yolk sac diameter at 6 – 10 weeks. Fetal Diagn Ther 2010; 28: 207-219
• 16 Araujo Júnior E, Martins WP, Nardozza LMM. et al. Reference range of fetal transverse cerebellar diameter between 18 and 24 weeks of pregnancy in a Brazilian population. J Child Neurol 2015; 30: 250-253
• 17 Vulturar D, Farcasanu A, Turcu F. et al. The volume of the cerebellum in the second semester of gestation. Clujul Medical 2018; 91: 176-180
• 18 Bhimarao, Nagaraju RM, Bhat V et al. Efficacy of transcerebellar diameter/abdominal circumference versus head circumference/abdominal circumference in predicting asymmetric intrauterine growth retardation. J Clin Diagn Res 2015; 9: 1–5. 10.7860/JCDR/2015/14079.6554
• 19 Wong L, Paul E, Murday HKM. et al. Biparietal diameter measurements using the outer-to-outer versus outer-to-inner measurement: A question of pedantry?. AJUM 2018; 21: 161-168
• 20 Pretscher J, Schwenke E, Baier F. et al. Can sonographic fetal biometry predict adverse perinatal outcome?. Ultraschall in Med 2019; 40: 230-236
• 21 Grantz KL, Kim S, Grobman WA. et al. Fetal growth velocity: the NICHD fetal growth studies. Am J Obstet Gynecol 2018; 219: 285.e1-36
• 22 Mailath-Pokorny M, Worda K, Schmid M. et al. Isolated single umbilical artery: evaluating the risk of adverse pregnancy outcome. Eur J Obstet Gynecol Reprod Biol 2015; 184: 80-83
• 23 Voskamp BJ, Fleurke-Rozema H, Oude-Rengerink K. et al. Relationship of isolated single umbilical artery to fetal growth, aneuploidy and perinatal mortality: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2013; 42: 622-628