Determination of gestational age: correlation between foetal biometry and transverse cerebellar diameter in women with uncomplicated pregnancy
Keywords:Gestational age, Transverse cerebellar diameter, Ultrasonogram
Background: Transverse Cerebellar Diameter (TCD) serves as a reliable predictor of gestational age in foetus and is a standard against which aberrations in other foetal parameters can be compared, especially when the GA cannot be determined by the date of last menstrual period or early pregnancy scan, TCD is one foetal parameter that has remained consistently superior in predicting gestational age in both singleton and twin gestation. Aim of the study was to assess and evaluate the effectiveness of transverse cerebellar diameter by using ultrasonography for determining the gestational age of the foetus.
Methods: A cross-sectional study was done in 100 uncomplicated pregnant patients between the 15th week of gestation to term referred from routine antenatal clinic in outpatient and in-patient department of Obstetrics and Gynecology department of Vinayaka Mission Krupananda Variyar medical college and hospital, Salem during study period April 2015-March 2016. TCD is obtained in the axial plane in the cerebellar view i.e. with a slight rotation of the transducer approximately 30° from the conventional thalamic plane where the biparietal diameter is measured using the cavum septi pellucidi, third ventricle and thalami as landmarks.
Results: The correlation of transcerebellar diameter (TCD) with that of BPD (bi-parietal diameter) had shown a perfect positive correlation (r = 0.978) and a similar type of correlation was also seen with HC (head circumference) (r = 0.979), AC (abdominal circumference) (r = 0.966), FL (femur length) (r = 0.976) and USG GA (ultrasonogram gestational age) (r = 0.983).
Conclusions: In the normally developing foetus, the TCD increases in a linear fashion with advancing gestational age. The data of this study suggest foetal TCD on ultrasound is a reliable predictive biometric parameter of gestational age.
Callen PW. Ultrasonography in obstetrics and gynecology, 3rd ed. WB Saunders company, Philadelphia;1994.
Nyborg WL. Safety of Medical Diagnostic Ultrasound. InSeminars Ultrasound, CT and MRI. 2002;23(5):377-86.
Mahony BS, Callen PW, Filly RA. The distal femoral epiphyseal ossification center in the assessment of third-trimester menstrual age: sonographic identification and measurement. Radiology. 1985;155(1):201-4.
Kieler H, Haglund B, Waldenström U, Axelsson O. Routine ultrasound screening in pregnancy and the children's subsequent growth, vision and hearing. BJOG. 1997;104(11):1267-72.
Salvesen KA, Vatten LJ, Eik-Nes SH, Hugdahl K, Bakketeig LS. Routine ultrasonography in utero and the subsequent handedness and neurological development. BMJ. 1993;307:159-164.
Campbell S. An improved method of foetal cephalometery by ultrasound. J Obstet Gynaecol Brit Cwelth. 1968;75:568-76.
Kurtz AB, Wapner RJ, Kurtz RJ, Dershaw DD, Rubin CS. Analysis of biparietal diameter as an accurate indicator of gestational age, JCU. 1980;8:319-326.
Sabbagha RE, Hughey M. Standardization of sonar cephalometry and gestational age. Obstet Gynecol. 1978;52:402-6.
Hadlock FP, Deter RL, Harrist RB, Park SK. Foetal biparietal diameter: a critical re-evaluation of the relation to menstrual age using realtime ultrasound, JUM. 1982;1:97-104.
Richard D. Mcleary, Lawerence R. Kuhns and Mason Barr Jr. Ultrasonography of the foetal cerebellum. Radiology. 1984;151:439-42.
Goldstein I, Reece EA. Cerebellar growth in normal and growth restricted foetuses of multiple gestation. Am J Obstet gynecol. 1995;173(4):1343-8.
Co E, Raju TN, O Aldana. Cerebellar dimensions in assesement of gestational age in neonates. Radiology.1991;181:581-5.
Reece EA, Goldstein I, Pilu G, Hobbins JC. Foetal cerebellar growth unaffected by intrauterine growth retardation: A new parameter for prenatal diagnosis. Am J Obstet Gynecol. 1987;157:632-8.
Sharma G, Ghode R. Foetal transcerebellar diameter and transcerebellar diameter – abdominal circumference ratio as a menstrual age independent parameter for gestational age estimation with grading of cerebellar maturity. Int J Reprod Contracept Obstet Gynecol. 2015;4(6):2036-40.
Julia AS, Hamzeiou KS, Rajagopalan V, Kim K, Barkovich AJ, Habas PA et al. 3D morphometric analysis of human foetal cerebellar development. In: Julia AS, Hamzeiou KS, Rajagopalan V, editors. The cerebellum. Philadelphia: Mosby;2012:761-70.
Kuklisova M, Aljabar P, Srinivasan L, Counsell SJ, Doria V, Serag A et al. A dynamic 4D probabilistic atlas of the developing brain. Neuroimage. 2011;54:2750-63.
Baschat AA. Foetal growth disorders. In: Baschat AA, editor. High risk pregnancy. St. Louis: Saunder;2011:173-9.
Sinnatamby CS. Last’s Anatomy Regional and Applied. Central Nervous System. 10th ed. New York: Churchill Livingstone;2000:479-81.
McLeary RD, Kunhs LR, Barr M, Ultrasonography of the foetal cerebellum. Radiology. 1984;151:439-42.
Monotenegro NA, Leite LP. Foetal cerebellar measurements in second trimester ultrasonography-clinical value. J Perinat Med. 1989;17:365-9.
Strizhova NV, Elamin HY, Bokin IS. The ultrasound diagnosis of intrauterine foetal growth retardation. Akush Ginekol (Mosk). 1992;30-1.
Hata K, Hata T, Senoh D. Ultrasonographic measurement of the foetal cerebellum in utero Gynecol Obstet Invest. 1989;28:111-2.
Mikovic Z, Markovic A, Dukic M, Pazin V. Growth of the foetal cerebellum in normal pregnancy. Jugost Ginekol Perinatol. 1989;29:157-60.
Campbell WA, Nardi D, Vintzileos AM, Rodis JF, Turner GW, Egan JF. Transverse cerebellar diameter/abdominal circumference ratio throughout pregnancy: a gestational age-independent method to assess fetal growth. Obstet Gynecol. 1991;77(6):893-6.
Guan B. Surveillance of foetal growth and foetal cerebellar transverse diameter by ultrasonographic measurement. Zhonghua Yi Xue Zhi. 1992;72:65-7.
Chavez MR, Ananth CV, Smulian JC, Lashely S, Konotopouls EV, Vintzileos AM. Foetal transcerebellar diameter nomogram in singleton gestations with special emphasis in the third trimester: A comparison with previously published nomograms. J Obstet Gynecol. 2003;189:1021-5.