Home Medicine Evaluation of the adequacy of reference charts for the accurate identification of fetuses with bone length below the 5th percentile
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Evaluation of the adequacy of reference charts for the accurate identification of fetuses with bone length below the 5th percentile

  • Ana Alice Vidal de Carvalho , José Antônio Carvalho , Israel Figueiredo ORCID logo EMAIL logo , Luis Guillermo Velarde and Edson Marchiori
Published/Copyright: January 17, 2015
Journal of Perinatal Medicine
From the journal Journal of Perinatal Medicine Volume 44 Issue 2

Abstract

Aim: To identify reference charts for femoral and humeral lengths enabling appropriate identification of fetuses <5th percentile in one population.

Methods: Two samples of fetuses aged 14–40 weeks were selected from our institution’s ultrasonographic database. Regression analysis was used to construct reference charts of femoral and humeral lengths based on the local population (n=901). Femur and humerus length measurements from a second sample (n=1240) were transformed into Z-scores using local and previously published equations. Z-score distributions were used to assess the appropriateness of reference curves for our population. Fetuses aged 18–24 weeks with measurements <5th percentile were identified using each reference equation.

Results: For femoral length, one equation other than the local equation yielded Z-score values within the standard normal distribution (P=0.10), but the histogram was skewed to the right. All Z-score distributions for humeral length fell within the normal distribution (P>0.05), but one was skewed to the right. The numbers of fetuses with femoral and humeral lengths <5th percentile in second-trimester ultrasound examinations varied widely among reference equations used.

Conclusion: Most reference charts assessed underestimated the number of fetuses with long bone lengths <5th percentile in second-trimester ultrasound examinations and were thus unfit for interpretations of biometric data from the study population.

Keywords: Reference charts; short femur; short humerus; ultrasound
Corresponding author: Israel Figueiredo Jr, MD, PhD, Mother and Child Department, Federal Fluminense University, Hospital Universitário Antônio Pedro, 303, Centro, Niterói, Rio de Janeiro, Brazil. CEP 24033900, 55 21 982123045, E-mail: . http://orcid.org/0000-0002-2054-0739

References

[1] Aagaard-Tillery KM, Malone FD, Nyberg DA, Porter TF, Cuckle HS, Fuchs K, et al. Role of second-trimester genetic sonography after Down syndrome screening. Obstet Gynecol. 2009;114:1189–96.10.1097/AOG.0b013e3181c15064Search in Google Scholar PubMed PubMed Central

[2] Nyberg DA, Souter VL. Use of genetic sonography for adjusting the risk for fetal Down syndrome. Semin Perinatol. 2003;27:130–44.10.1053/sper.2003.50012Search in Google Scholar PubMed

[3] Chitty LS, Griffin DR, Meaney C, Barrett A, Khalil A, Pajkrt E, et al. New aids for the non-invasive prenatal diagnosis of achondroplasia: dysmorphic features, charts of fetal size and molecular confirmation using cell-free fetal DNA in maternal plasma. Ultrasound Obstet Gynecol. 2011;37:283–9.10.1002/uog.8893Search in Google Scholar PubMed

[4] Nyberg DA. May all your femurs be long! Ultrasound Obstet Gynecol. 2008;31:489–92.10.1002/uog.5358Search in Google Scholar PubMed

[5] Carvalho AA, Carvalho JA, Figueiredo I Jr, Velarde LG, Marchiori E. Association of midtrimester short femur and short humerus with fetal growth restriction. Prenat Diagn. 2013;33:130–3.10.1002/pd.4020Search in Google Scholar PubMed

[6] Papageorghiou AT, Fratelli N, Leslie K, Bhide A, Thilaganathan B. Outcome of fetuses with antenatally diagnosed short femur. Ultrasound Obstet Gynecol. 2008;31:507–11.10.1002/uog.5265Search in Google Scholar PubMed

[7] Todros T, Massarenti I, Gaglioti P, Biolcati M, Botta G, De Felice C. Fetal short femur length in the second trimester and the outcome of pregnancy. Br J Obstet Gynecol. 2004;111:83–5.10.1046/j.1471-0528.2003.00015.xSearch in Google Scholar PubMed

[8] Ventura W, Huaman J, Nazario CE, Ingar J, Huertas E, Antonio Limay O. Perinatal outcomes after sonographic detection of isolated short femur in the second trimester. J Clin Ultrasound. 2012;40:63–7.10.1002/jcu.20889Search in Google Scholar PubMed

[9] Vermeer N, Bekker MN. Association of isolated short fetal femur with intrauterine growth restriction. Prenat Diagn. 2013;33:365–70.10.1002/pd.4068Search in Google Scholar PubMed

[10] Weisz B, David AL, Chitty L, Peebles D, Pandya P, Patel P, et al. Association of isolated short femur in the mid-trimester fetus with perinatal outcome. Ultrasound Obstet Gynecol. 2008;31:512–6.10.1002/uog.5349Search in Google Scholar PubMed

[11] Salomon LJ, Bernard JP, Duyme M, Buvat I, Ville Y. The impact of choice of reference charts and equations on the assessment of fetal biometry. Ultrasound Obstet Gynecol. 2005;25:559–65.10.1002/uog.1901Search in Google Scholar PubMed

[12] Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser. 1995;854:1–452.Search in Google Scholar

[13] Royston P, Wright EM. How to construct ‘normal ranges’ for fetal variables. Ultrasound Obstet Gynecol. 1998;11:30–8.10.1046/j.1469-0705.1998.11010030.xSearch in Google Scholar PubMed

[14] Hadlock FP, Harrist RB, Deter RL, Park SK. Fetal femur length as a predictor of menstrual age: sonographically measured. AJR Am J Roentgenol. 1982;138:875–8.10.2214/ajr.138.5.875Search in Google Scholar PubMed

[15] Chitty LS, Altman DG. Charts of fetal size: limb bones. Br J Obstet Gynecol. 2002;109:919–29.10.1111/j.1471-0528.2002.01022.xSearch in Google Scholar PubMed

[16] Jeanty P, Cousaert E, Cantraine F, Hobbins JC, Tack B, Struyven J. A longitudinal study of fetal limb growth. Am J Perinatol. 1984;1:136–44.10.1055/s-2007-999989Search in Google Scholar PubMed

[17] Snijders RJ, Nicolaides KH. Fetal biometry at 14–40 weeks’ gestation. Ultrasound Obstet Gynecol. 1994;4:34–48.10.1046/j.1469-0705.1994.04010034.xSearch in Google Scholar PubMed

[18] Ioannou C, Talbot K, Ohuma E, Sarris I, Villar J, Conde-Agudelo A, et al. Systematic review of methodology used in ultrasound studies aimed at creating charts of fetal size. Br J Obstet Gynecol. 2012;119:1425–39.10.1111/j.1471-0528.2012.03451.xSearch in Google Scholar PubMed

[19] Silverwood RJ, Cole TJ. Statistical methods for constructing gestational age-related reference intervals and centile charts for fetal size. Ultrasound Obstet Gynecol. 2007;29:6–13.10.1002/uog.3911Search in Google Scholar PubMed

[20] Sananes N, Gaudineau A, Favre R. Choose a fetal biometric reference curve using Z-scores. Gynecol Obstet Fertil. 2010;38:71–2.Search in Google Scholar

The authors stated that there are no conflicts of interest regarding the publication of this article.

Received: 2014-7-21
Accepted: 2014-12-3
Published Online: 2015-1-17
Published in Print: 2016-3-1

©2016 by De Gruyter

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  2. Editorial
  3. Current topics on ultrasound in perinatology
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  17. Nonimmune fetal ascites: identification of ultrasound findings predictive of perinatal death
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  27. Congress Calendar
  28. Congress Calendar
https://doi.org/10.1515/jpm-2014-0239
Keywords for this article
Reference charts; short femur; short humerus; ultrasound

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Current topics on ultrasound in perinatology
  4. Recommendation and Guidelines for Perinatal Practice
  5. Ultrasound in Africa: what can really be done?
  6. 3D/4D sonography – any safety problem
  7. Controversial ultrasound findings in mid trimester pregnancy. Evidence based approach
  8. Academy’s Corner
  9. Sonoembryology by 3D HDlive silhouette ultrasound – what is added by the “see-through fashion”?
  10. Original articles – Obstetrics
  11. How effective is ultrasound-based screening for trisomy 18 without the addition of biochemistry at the time of late first trimester?
  12. Single center experience in selective feticide in high-order multiple pregnancy: clinical and ethical issues
  13. Diagnostic accuracy of cervical elastography in predicting labor induction success: a systematic review and meta-analysis
  14. Birth weight-related percentiles of brain ventricular system as a tool for assessment of posthemorrhagic hydrocephalus and ventricular enlargement
  15. First trimester erythropoietin (EPO) serum concentration as a potential marker for abnormal placentation disorders. Reference values for erythropoietin (EPO) concentration at 11–13+6 weeks of gestation
  16. Original articles – Fetus
  17. Nonimmune fetal ascites: identification of ultrasound findings predictive of perinatal death
  18. First trimester severe ductus venosus flow abnormalities in isolation or combination with other markers of aneuploidy and fetal anomalies
  19. Evaluation of the adequacy of reference charts for the accurate identification of fetuses with bone length below the 5th percentile
  20. Does ethnicity have an effect on fetal behavior? A comparison of Asian and Caucasian populations
  21. Accuracy of ultrasound in estimating fetal weight and growth discordancy in triplet pregnancies
  22. Fetal nasal bone length in the second trimester: comparison between population groups from different ethnic origins
  23. Pregnancy outcome and long-term follow-up of fetuses with isolated increased NT: a retrospective cohort study
  24. Effect of antenatal betamethasone administration on Doppler velocimetry of fetal and uteroplacental vessels: a prospective study
  25. Opinion paper
  26. Fetal cerebro-placental ratio and adverse perinatal outcome: systematic review and meta-analysis of the association and diagnostic performance
  27. Congress Calendar
  28. Congress Calendar
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