A cross-sectional study to evaluate sonographic foetal humerus length for estimation of gestational age in normal singleton pregnancies at a tertiary care centre

Premlata Mital, Richa Ainani, Nupur Hooja, Priya Sonkhya, Vishwas Pradodh, Kavita Chaudhary, Urmila Kharbas, Saloni Sethi, Jeetendra Singh, Ankita Chaudhary


Background: Accurate knowledge of gestational age of the foetus is essential for planning a timely and uneventful outcome. Biparietal diameter, head circumference, abdominal circumference and femur length reliably predict gestational age. The humerus length is not widely used as biometric parameter for determining the GA so the present study was done to estimate foetal gestational age by measuring humerus length between 18 to 36 weeks of normal singleton pregnancies and to compare humerus length with routine parameters.

Methods: This was a hospital based descriptive cross-sectional study, 200 women with viable singleton pregnancy, with known LMP, between 18 weeks to 36 weeks of gestation were included. Various foetal measurements such as biparietal diameter, head circumference, abdominal circumference, femur length and humerus length were measured using electronic calipers on ultrasound. Data were statistically analyzed.

Results: The mean humerus length at 18 weeks was 25.27±1.16 mm and at 36 weeks of gestation was 57.11±1.58 mm. Simple linear regression analysis shows a strongly significant linear relationship between humerus length and gestational age. Where, gestational age (weeks) Y= 0.5213 x humerus length (X) + 4.905; with high degree of correlation coefficient (R2 =0.9785 and P≤0.0001). When Compared with BPD, HC, AC and FL, humerus length also shows a linear correlation.

Conclusions: The measurement of the humerus length can be an important additional parameter for estimating gestational age along with other parameters and can be used to predict the gestational age of fetuses in special circumstances.


Femur length, Gestational age, Normal pregnancy, Ultrasonography

Full Text:



Reddy UM, Abuhamad AZ, Levine D, Saade GR. Fetal imaging: executive summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal Imaging workshop. Fetal imaging workshop invited participants. Obstet Gynecol. 2014;123:1070-82.

Rowitz L. Health management information systems: methods and practical. N Engl J Med.2001;21:225-344.

Rihab MA, Bushra HA, Salah MA, Mohamed TI. The accuracy of gestational age predicted from femur and humerus length in Saanen goats using ultrasonography. Acta Vet Brno. 2012;81:295-9.

Patre V, Aryan AK, Sahu P, Patre V. Ultrasonographic evaluation of fetal humerus length for assessment of gestational age and its comparison with other conventional parameters. Int J Sci Stud. 2015;3(7):58-64.

Nagesh R, Pramila SVV, Shukla AK. Ultrasonographic estimation of foetal gestational age by humerus length and its comparison with femur length. J. Evid. Based Med. Healthc. 2016;3(74);4040-4.

Gaharwar A, Tiwari V. Correlation between Crown Rump Length of Fetus and Gestational Age in First Trimester of Pregnancy in North Indian Population. Int J Med Res Prof. 2019 May;5(3):102-4.

Robinson HP, Fleming JE. A critical evaluation of sonar “crown–rump length” measurements. Br J Obstet Gynaecol. 1975;82:702-10.

Pexsters A, Daemen A, Bottomley C, Schoubroeck VD, Catte L, Moor B, et al. New crown–rump length curve based on over 3500 pregnancies. Ultrasound Obstet Gynecol. 2010;35:650-5.

Verburg BO, Steegers EA, Ridder M, Snijders RJ, Smith E, Hofman A. New charts for ultrasound dating of pregnancy and assessment of fetal growth: longitudinal data from a population-based cohort study. Ultrasound Obstet Gynecol. 2008;31:388-96.

Methods for estimating the due date. Committee Opinion No. 700. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2017;129:e150-4.

Shehzad K, Ali M, Zaid S. Fetal Biometry. Pak J Med Sci. 2006;22(4):503-8.

Rao CBR, Sreepadma S. The study of the humerus and femur length as combined predictors of the gestational age of human fetuses using ultrasonography. Int J Res Med Sci. 2017;5:2701-5.

Rao CBR, Sreepadma S, Kalghatgi RN. The study of relation between the gestational age of human fetuses and the diaphyseal length of femur using ultrasonography. Int J Anat Res. 2017;5(1):3342-9.

Tahmasebpour AR, Pirjani R, Rahimi-Foroushani A, et al Normal ranges for fetal femur and humerus diaphysis length during the second trimester in an Iranian population. J Ultrasound Medicine. 2012;31(7):991-5.

Gameraddin M, Abdelmaboud S, Alshoabi S. The role of fetal humeral length in determination of gestational age compared with femoral length using ultrasonography. IOSR-JDMS. 2015;14(5):65-8.