Kidney length, a visceral parameter predicts foetal age between 24 to 40 weeks of gestation
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20190273Keywords:
Foetal kidney length, Gestational age, UltrasoundAbstract
Background: Accurate estimation of gestational age is important in providing appropriate antenatal care. Recent evidence suggests that weightage should also be given to kidney length in addition to standard biometric parameters in determining the duration of pregnancy by ultrasound.
Methods: In a single centre, prospective cross-sectional study was done in 120 pregnant women. In addition to standard biometric parameters, kidney length was also measured between 24 to 40 weeks at two-week intervals. A total of 240 renal vertical measurements were done and average of right and left renal lengths was taken as a final kidney length. Descriptive analysis was carried out to find the mean and standard deviations for each variable. Regression analysis was carried for each variable either singly or in combinations and Pearson regression coefficients was used to find the association between gestational age and various foetal parameters and to determine which of the regression model gives the best fit for prediction of gestational age.
Results: Foetal kidney length progressively increased throughout the gestation (from 23.2 mm at 24 weeks to 40.1 mm at 40 weeks). The regression formula using only kidney length as an independent variable (gestational age=2.195±0.942 X kidney length) had high degree of correlation (R2 0.97, p<0.001, SE of prediction 4.7±3.9), which was superior to other prediction models using standard biometric parameters. In multiple regression models using several conventional parameters, when femur length was added in a stepwise manner, there was significant improvement in forecasting gestational age.
Conclusions: Present study showed that foetal kidney length is a reliable indicator of gestational age between 24 to 40 weeks of pregnancy and may be of utility in pregnancies with wrong dates, non-availability of dating scan and women who have conceived during lactational period.
References
Jehan I, Zaidi S, Rizvi S, et al. Dating gestational age by last menstrual period, symphysis-fundal height, and ultrasound in urban Pakistan. Int J Gynaecol Obstet. 2010;110(3):231-4.
Zador IE, Hertz RH, Sokol RJ, Hirsch VJ. Sources of error in the estimation of fetal gestational age. Am J Obstet Gynecol. 1980;138(3):344-5.
Butt K, Lim K. Determination of gestational age by ultrasound. J Obstet Gynaecol Can. 2014;36(2):171-81.
Murphy KE, Willan AR, Hannah ME, et al. Effect of antenatal corticosteroids on fetal growth and gestational age at birth. Obstet Gynecol. 2012;119(5):917-23.
Filkins K, Koos BJ. Ultrasound and fetal diagnosis. Curr Opin Obstet Gynecol. 2005;17(2):185-95.
March MI, Warsof SL, Chauhan SP. Fetal biometry: relevance in obstetrical practice. Clin Obstet Gynecol. 2012;55(1):281-7.
Buscicchio G, Milite V, D’Emidio L, Giorlandino M, Cavaliere A, Padula F, et al. Analysis of fetal biometric measurements in the last 30 years. J Prenat Med. 2008;2(1):11-3.
Orji MO, Adeyekun AA. Ultrasound estimation of foetal gestational age by transcerebellar diameter in healthy pregnant nigerian women. West Afr J Med. 2014;33(1):61-7.
Rosati P, Bartolozzi F, Guariglia L. Reference values of fetal orbital measurements by transvaginal scan in early pregnancy. Prenat Diagn. 2002;22(10):851-5.
Sherer DM, Sokolovski M, Santoso PG, Dalloul M, Abulafia O. Nomograms of sonographic measurements throughout gestation of the fetal hard palate width, length and area. Ultrasound Obstet Gynecol. 2004;24(1):35-41.
Yarkoni S, Schmidt W, Jeanty P, Reece EA, Hobbins JC. Clavicular measurement: a new biometric parameter for fetal evaluation. J Ultrasound Med. 1985;4(9):467-70.
Shripad Hebbar, Kopal S, Prashant Adiga, Lavanya Rai. Fetal foot length throughout gestation: a nomogram. Sri Lanka Journal of Obstetrics and Gynaecology. 2013;35(2):58-6
Tarca AL, Hernandez-Andrade E, Ahn H, Garcia M, Xu Z, Korzeniewski SJ, et al. Single and Serial Fetal Biometry to Detect Preterm and Term Small- and Large-for-Gestational-Age Neonates: A Longitudinal Cohort Study. PLoS ONE. 2016;11(11):e0164161.
Papageorghiou AT, Kemp B, Stones W, Ohuma EO, Kennedy SH, Purwar M, et al. Ultrasound-based gestational-age estimation in late pregnancy. Ultrasound Obstet Gynecol. 2016;48(6):719-26.
Ugur MG, Mustafa A, Ozcan HC, Tepe NB, Kurt H, Akcil E, et al. Fetal kidney length as a useful adjunct parameter for better determination of gestational age. Saudi Med J. 2016;37(5):533-7.
Brennan S, Watson D, Rudd D, Schneider M, Kandasamy Y. Evaluation of fetal kidney growth using ultrasound: A systematic review. Eur J Radiol. 2017;96:55-64.
Sato A, Yamaguchi Y, Liou SM, Sato M, Suzuki M. Growth of fetal kidney assessed by real time ultrasound. Eur Urol. 1990;17(1):62-5.
Konje JC, Abrams KR, Bell SC, Taylor DJ. Determination of gestational age after 24th week of gestation from fetal kidney length measurements. Ultrasound Obstet Gynecol 2002;19(6):592-7.
Latini G, De mitri B, Del vecchio A, Chitano G, De felice C, Zetterström R. Foetal growth of kidneys, liver and spleen in intrauterine growth restriction: "programming" causing "metabolic syndrome" in adult age. Acta Paediatr. 2004;93(12):1635-9.
Mishra K, Datta V, Aarushi A, Kaur narula M, Iyer RS, Nangia S. The Association between Weight for Gestational Age and Kidney Volume: A Study in Newborns in India. Iran J Pediatr. 2014;24(1):93-9.
Konje JC, Abrams KR, Bell SC, Taylor DJ. Determination of gestational age after the 24th week of gestation from fetal kidney length measurements. Ultrasound Obstet Gynecol. 2002;19(6):592-7.
Kansaria JJ, Parulekar SV. Nomogram for fetal kidney length. Bombay Hosp J. 2009;51(2):155-62.
Kumar M, Lalwani R, Babu R, Aneja S, Malik A. Ultrasonographic estimation of fetal gestational age by fetal kidney length. J Anat Soc India. 2013;62:33-6.
Peter M, Nayak AK, Giri PP, Jain MK. Fetal kidney length as a parameter for determination of gestational age from 20th week to term in healthy women with uncomplicated pregnancy. Int J Res Med Sci 2017;5(5):1869-73.