FETAL BIOMETRY AND GROWTH

CALLEN’S ULTRASONOGRAPHY IN OBSTETRICS AND GYNECOLOGY (SIXTH EDITION)

P R E S ENTER
D R . A S E P N U R UL H U D A

MOD E RAT OR
D R . H J . P U T R I MI R ANI , S P OG(K)

W E D N ESDAY, A U GUS T 1 S T 2 0 1 8
 ASSIGNMENT OF GESTATIONAL AGE

• Sonographic measurements of fetal structures provide an

accurate means of determining the age of a pregnancy

• Gestational age is the term most commonly used for

specifying the age of a pregnancy.

• Dating based on LMP is fraught with inaccuracies.

 FIRST TRIMESTER DATING

• Early in the first trimester, before the embryo is visible,

gestational age can be assigned based on transvaginal
sonographic findings.

• Finding of pregnancy is a small rounded intrauterine fluid

collection in the central portion of the uterus.
FIRST TRIMESTER DATING

Sagittal image showing a small

rounded intrauterine fluid
collection (arrow) in the
central portion of the uterus,
consistent with 5.0 weeks’
gestation
FIRST TRIMESTER DATING

Intrauterine gestational
sac containing a yolk sac
(arrow), consistent with 5.5
weeks’ gestation
FIRST TRIMESTER DATING
Intrauterine gestational sac
containing a small embryo with
heartbeat (arrow) adjacent to
the yolk sac.

M-mode tracing through the

embryo documents a heart
rate of 100 beats per minute.

These findings are consistent

with gestational age of 6.0
weeks.
FIRST TRIMESTER DATING
Mean sac diameter in early pregnancy.

A, Coronal image of intrauterine

gestational sac measuring
approximately 15 mm in transverse
diameter and 9 mm in anteroposterior
diameter (calipers).

B, Longitudinal view of gestational sac

with sagittal measurement of
approximately 11 mm.

The mean sac diameter of this

pregnancy is 12 mm.
 TABLE 1 Gestational Dating by Mean
Sac Diameter in the Early First Trimester
Mean Sac Diameter (mm) Gestational Age (Weeks)*
2 5.0
3 5.1
4 5.2
5 5.4
6 5.5
7 5.6
8 5.7
9 5.9
10 6.0
95% confidence interval = ±0.5 week.

*Values from Daya S, Woods S, Ward S, et al: Early pregnancy assessment of transvaginal ultrasound scanning. Can Med Assoc J144(4):441-446, 1991.
 FIRST TRIMESTER DATING
• However, once the embryo is large enough to measure, dating based on
the size of the embryo is more accurate than using the mean sac
diameter.

• Gestational age is assigned based on CRL.

• Dating is based on the length of the embryo or fetus, measured from the
top of the head to the bottom of the rump, the CRL.

• Dating by CRL is more accurate in the early first trimester, when accuracy
is ±0.5 week, than toward the end of the first trimester, when accuracy
approaches ±1.0 week.
FIRST TRIMESTER DATING

Crown-rump length measurement.

Sonogram of fetus in gestation sac

with crown-rump length measured
(calipers).

The yolk sac (arrow) is visible

adjacent to the fetus, not included
in the crown-rump length
measurement
 TABLE 2 Gestational Age Estimation by Crown-
Rump Length (CRL)
CRL Gestatio CRL Gestatio CRL Gestatio CRL Gestatio CRL Gestatio CRL Gestatio CRL Gestatio
nal Age nal Age nal Age nal Age nal Age nal Age nal Age
(mm) (Weeks) (mm) (Weeks) (mm) (Weeks) (mm) (Weeks) (mm) (Weeks) (mm) (Weeks) (mm) (Weeks)
* * * * * * *
5 6.0 17 8.1 29 9.6 41 10.8 53 11.8 65 12.7 77 13.5

6 6.2 18 8.3 30 9.7 42 10.8 54 11.8 66 12.7 78 13.5

7 6.4 19 8.4 31 9.8 43 10.9 55 11.9 67 12.8 79 13.6

8 6.6 20 8.5 32 9.9 44 11.0 56 12.0 68 12.9 80 13.7

9 6.8 21 8.7 33 10.0 45 11.1 57 12.1 69 12.9

10 7.0 22 8.8 34 10.1 46 11.2 58 12.2 70 13.0

11 7.2 23 8.9 35 10.2 47 11.3 59 12.2 71 13.1

12 7.4 24 9.0 36 10.3 48 11.4 60 12.3 72 13.2

13 7.5 25 9.1 37 10.4 49 11.4 61 12.4 73 13.2

14 7.7 26 9.3 38 10.5 50 11.5 62 12.4 74 13.3

15 7.8 27 9.4 39 10.6 51 11.6 63 12.5 75 13.4

16 8.0 28 9.5 40 10.7 52 11.7 64 12.6 76 13.4

*Values derived from Robinson HP, Fleming JEE: A critical evaluation of sonar “crown-rump length” measurements. Br J Obstet Gynecol 82:702-710, 1975.
 SECOND AND THIRD TRIMESTER DATING

• Gestational age assignment are

• The biparietal diameter (BPD),
• Occipitofrontal diameter (OFD),
• Head circumference (HC),
• Abdominal diameter (AD),
• Abdominal circumference (AC),
• Femur length (FL).
HEAD MEASUREMENTS

Axial image of fetal head at the

level of the paired thalami (arrows),
third ventricle, and cavum septum
pellucidum (arrowhead), with
biparietal diameter (BPD) (calipers 1)
and occipitofrontal diameter (OFD)
(calipers 2) measured.
HEAD MEASUREMENTS

Head circumference measured with

elliptical caliper tracing (dotted line)
on the same image used to measure
the biparietal and occipitofrontal
diameters.
HEAD MEASUREMENTS

Diagram demonstrating anatomy at

the level of appropriate measurement
of the
A. Fetal Biparietal Diameter
B. Head Circumference

CP, choroid plexus;

CSP, cavum septum pellucidum;
F, falx;
T, thalami.
 TABLE 3 Gestational Age Estimation
by Biparietal Diameter
BPD or Gestatio BPD or Gestatio BPD or Gestatio BPD or Gestatio BPD or Gestatio BPD or Gestatio BPD or Gestatio
nal Age nal Age nal Age nal Age nal Age nal Age nal Age
BPDc (Weeks) BPDc (Weeks) BPDc (Weeks) BPDc (Weeks) BPDc (Weeks) BPDc (Weeks) BPDc (Weeks)
(mm) * (mm) * (mm) * (mm) * (mm) * (mm) * (mm) *
20 13.2 32 15.8 44 19.0 56 22.8 68 27.3 80 32.7 92 39.2

21 13.4 33 16.1 45 19.3 57 23.1 69 27.7 81 33.2 93 39.8

22 13.6 34 16.3 46 19.6 58 23.5 70 28.1 82 33.7 94 40.4

23 13.8 35 16.6 47 19.9 59 23.8 71 28.5 83 34.2 95 41.0

24 14.0 36 16.8 48 20.2 60 24.2 72 29.0 84 34.7 96 41.6

25 14.3 37 17.1 49 20.5 61 24.5 73 29.4 85 35.2 ≥97 42

26 14.5 38 17.3 50 20.8 62 24.9 74 29.9 86 35.8

27 14.7 39 17.6 51 21.1 63 25.3 75 30.3 87 36.3

28 14.9 40 17.9 52 21.4 64 25.7 76 30.8 88 36.9

29 15.1 41 18.1 53 21.7 65 26.1 77 31.2 89 37.4

30 15.4 42 18.4 54 22.1 66 26.5 78 31.7 90 38.0

31 15.6 43 18.7 55 22.4 67 26.9 79 32.2 91 38.6

From Doubilet PM, Benson CB: Improved prediction of gestational age in the late third trimester. J Ultrasound Med 12:647-653, 1993.
 TABLE 4 Gestational Age Estimation by
Head Circumference (HC)
HC Gestational
Age
HC (mm) Gestational
Age
HC (mm) Gestational
Age
HC (mm) Gestational
Age
HC (mm) Gestational
Age
(mm) (Weeks)* (Weeks)* (Weeks)* (Weeks)* (Weeks)*
80 13.4 140 17.3 200 22.2 260 28.3 320 36.1

85 13.7 145 17.7 205 22.6 265 28.9 325 36.8

90 14.0 150 18.1 210 23.1 270 29.4 330 37.6

95 14.3 155 18.4 215 23.6 275 30.0 335 38.3

100 14.7 160 18.8 220 24.0 280 30.7 340 39.1

105 15.0 165 19.2 225 24.5 285 31.3 345 39.9

110 15.3 170 19.6 230 25.0 290 31.9 350 40.7

115 15.6 175 20.0 235 25.5 295 32.6 355 41.6

120 16.0 180 20.4 240 26.1 300 33.3 360 42.4

125 16.3 185 20.8 245 26.6 305 33.9

130 16.6 190 21.3 250 27.1 310 34.6

135 17.0 195 21.7 255 27.7 315 35.3

Values derived from Law RG, MacRae KD: Head circumference as an index of fetal age. J Ultrasound Med 1:281-288, 1982.
Abdominal Diameter Measurements

Axial image of the fetal abdomen at

the level of the stomach (S) and
intrahepatic portion of the umbilical
vein (arrow) where it joins the left
portal vein with the anteroposterior
diameter (calipers 1) and transverse
diameter (calipers 2) measured.
Abdominal circumference measurements

Axial image of another fetal

abdomen with the abdominal
circumference measured with
elliptical caliper tracing (dotted
line). S, stomach.
Abdominal circumference measurements

Diagram demonstrating
anatomy at the level of
appropriate measurement of
the fetal abdominal
circumference.

PV, right portal vein;

Sp, spine;
St, stomach;
UV, umbilical vein.
Femur Length Measurements

Sonogram of femur with

ossified diaphysis measured
(calipers).

The linear projection from the

diaphysis of the femoral
epiphysis (arrow) is not
included in the measurement.
Femur Length Measurements
A. Radiograph from a term neonatal autopsy
specimen
B. illustration of the femur.

Sonographic measurements of the “femur”

include only the ossified portion of the diaphysis
(D) and metaphysis (M).

The cartilaginous femoral head (FH), greater

trochanter (GT), and distal epiphysis (DE) are not
included in the measurement.

When it ossifies, the distal femoral epiphyseal

(DFE) secondary ossification center is also not
included in the measurement.
 TABLE 5 Gestational Age Estimation by
Femur Length (FL)
FL Gestation
al Age
FL (mm) Gestation
al Age
FL (mm) Gestation
al Age
FL (mm) Gestation
al Age
FL (mm) Gestation
al Age
FL (mm) Gestation
al Age
(mm) (Weeks)* (Weeks)* (Weeks)* (Weeks)* (Weeks)* (Weeks)*
10 13.7 22 16.7 34 20.4 46 24.9 58 30.3 71 37.7

11 13.9 23 17.0 35 20.7 47 25.3 59 30.9 72 38.3

12 14.2 24 17.3 36 21.1 48 25.7 60 31.4 73 39.0

13 14.4 25 17.6 37 21.4 49 26.2 61 31.9 74 39.6

14 14.6 26 17.9 38 21.8 50 26.6 62 32.5 75 40.3

15 14.9 27 18.2 39 22.2 51 27.0 63 33.0 76 40.9

16 15.1 28 18.5 40 22.5 52 27.5 64 33.6 77 41.6

17 15.4 29 18.8 41 22.9 53 28.0 65 34.1 ≥78 42

18 15.6 30 19.1 42 23.3 54 28.4 67 34.7

19 15.9 31 19.4 43 23.7 55 28.9 68 35.3

20 16.2 32 19.7 44 24.1 56 29.4 69 35.9

21 16.4 33 20.1 45 24.5 57 29.9 70 37.1

From Doubilet PM, Benson CB: Improved prediction of gestational age in the late third trimester. J Ultrasound Med 12:647-653, 1993.
Gestational Age Assignment
by Initial Ultrasound Scan

*Two standard deviations, or 95% confidence interval.

BPD, biparietal diameter;

BPDc, corrected BPD;
CRL, crown-rump length;
FL, femur length;
GA, gestational age;
HC, head circumference;
MSD, mean sac diameter;
OFD, occipitofrontal diameter.
 TABLE Approach to Fetal Weight Estimation

• Formula 1
• Log10(EFW) = 1.4787 – 0.003343 AC x FL + 0.001837 BPD2 + 0.0458 AC + 0.158 FL

• Formula 2
• Log10(EFW) = 1.1134 + 0.05845 AC – 0.000604 AC2 – 0.007365 BPD2 + 0.00595 BPD x AC + 0.1694 BPD

• Formula 3
• Log10(EFW) = 1.3598 + 0.051 AC + 0.1844 FL – 0.0037 AC x FL
Data from Hadlock FP, Harrist RB, Carpenter RJ, et al: Sonographic estimation of fetal weight: the value of femur length in addition to head and abdomen measurements.
Radiology 150:535-540, 1984.
TABLE Fetal Weight Percentiles in the Third Trimester

*From Doubilet PM, Benson CB, Nadel AS, Ringer SA: Improved birth weight table for neonate developed from gestations dated by early ultrasonography.
J Ultrasound Med 16:241-249, 1997.
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