Abstract
Introduction: Gestational age estimation is of prime importance in anticipating the day of delivery and preventing obstetric complications. Several ultrasonogram measured foetal parameters arc used to determine gestational age which include crown -rump length (CRL), biparietal diameter (BPD), head circumference (HC), femur length (FL), abdominal circumference (AC) and trans-cerebellar diameter (TCD). TCD and FL have been proposed as variables which are not subjected to much variation due to intra-uterine forces other than growth of the foetus.
Materials and Methods: A hospital-based, prospective study was conducted in the Department of Radiology, Andhra Medical College, Visakhapatnam between October 2018 and February 2020 on 100 normal singleton pregnant women with normal foetal growth pattern.
Results: The study showed that the study participants were mostly young women (mean age= 25.6±4.53) with majority in the 21-25 years age group (74%) and primigravida (61%). The gestational age as determined by CRL in first trimester correlated significantly [p<0.001] with the TCD (mm) values (r2 = 0.9545) and FL (mm) values (r2 = 0.975) measured in the third trimester. TCD and FL showed significant [p<0.001] positive correlation (r2 = 0.870) in determining GA. The reliability of the two parameters in assessing gestational age was 87% and a percentage error of 0.082%.
Conclusion: The study established the TCD and FL values in third trimester of pregnancy among normal singleton pregnant women. It also showed there was significant correlation of the TCD and FL values measured in third trimester with gestational age determined by CRL in the first trimester. Hence TCD and FL can both be used as reliable and individually used intra-uterine foetal biometric parameters in estimating the gestational age during the third trimester of a normal pregnancy.
References
- Hadlock FP, Deter RL, Harrist RB, Park SK., Foetal abdominal circumference as a predictor of menstrual age. AJR Am J Roentgenol. 1982 Aug; 139(2):367-70.
- Hadlock FP, Deter RL, Harrist RB, Park SK. Foetal biparietal diameter: a critical re-evaluation of the relation to menstrual age by means of real-time ultrasound. J Ultrasound Med. 1982 Apr;1(3):97-104.
- Hadlock FP, Deter RL, Harrist RB, Park SK. Foetal head circumference: relation to menstrual age. AJR Am J Roentgenol. 1982 Apr;138(4):649-53.
- Hadlock FP, Harrist RB, Deter RL., Park SK. Foetal femur length as a predictor of menstrual age: sonographically measured. AJR Am J Roentgenol. 1982 May; 138(5):875-8.
- Deter RL, Harrist RB, Hadlock FP, Carpenter RJ. Foetal head and abdominal circumferences: II. A critical re-evaluation of the relationship to menstrual age. Clin Ultrasound. 1982 Oct;10(8):365-72.
- McLeary RD, Kuhns LR, Barr M, Jr. Ultrasonography of the foetal cerebellum. Radiology 1984; 151:439-42.
- Prabhat Goel, Mukesh Singla et al. J Anat. Soc. India.2010; 59(2):158-161.
- Fatima K, Shahid R, Virk A. Determination of mean foetal trans cerebellar diameter as a predictive biometric parameter in third trimester of pregnancy in correlation with foetal gestational age. Pakistan Armed Forces Medical Journal [Internet]. 2017 [cited 2017 Aug 5];67(1). Available from: http://pafmj.org/artpdf/32.pdf
- Mustafa Z.Mahamoud, Omer A. Mohamoudet al. International Journal of Life Science and Medical Research. 2013;3(3):89-93.
- Kazumasa Hashimoto, Takashi Shimizu, Koichiro Shimoya, Toru Kanzaki, James F. Clapp, Yuji Murata. Foetal Cerebellum: US Appearance with advancing Gestational Age Radiology 2001; 221:70-74.
- Gupta AD, Banerjee A, Rammurthy N, Revati P, Jose J. Gestational age estimation using trans cerebellar diameter with grading of foetal cerebellar growth. National Journal of Clinical Anatomy. 2012;1(3):115-20.
- Naseem F, All S, Basit U, Fatima N. Assessment of gestational age; comparison between trans cerebellar diameter versus femur length on ultrasound in third trimester of pregnancy. Professional Med J. 2014;21(2):412-17.
- Rotmensch S, Goldstein J, Liberati M, Shalev J, Ben-Rafael Z, Copel JA. Foetaltranscerebellar diameter in down's syndrome. Obstet Gynecol. 1997;89(4): 53437.
- Goldstein I, Albert R, Pilu G, Hobbins JC. Cerebellar measurements with ultrasonography in the evaluation of foetal growth and development. Am J Obstet Gynecol. 1987; 156:1065.
- Hata K, Hata T, Senoh D, Makinara K. Ultrasonographic measurement of foetal TCD in utero. GynecolObstet Invest. 1989; 28:1 11.
- Vinkcsteijn ASM, Mulder PGH. Foetal transcerebellar diameter and chromosomal abnormalities. Ultrasound Obstet Gynecol 2001; 17: 502 - 505.
- Malik G, Waqar F. Determination of gestational age by transverse cerebellar diameter in third trimester of pregnancy. J Coll Physicians Surg Pak. 2006;16(4):249-52.
- Uikey PA, Kedar KV, Khandale SN. Role of trans-cerebellar diameter in estimating gestational age in second and third trimester of pregnancy. Int J Reprod Contracept Obstet Gynecol 2016; 5:3411-5.
Corresponding Author
Dr S. Vandana Sasi Kiran MD (RD)
Assistant Professor, Department of Radio-Diagnosis, Andhra Medical College, Visakhapatnam, India
DOI: https://dx.doi.org/10.18535/jmscr/v8i5.73
