FETALBIOMETRY

VINO BHARATH KUPPUSAMI

 Obstetricsonography accuratedeterminationof
gestationalage
Byconvention,gestationalageusedinterchangeably
withmenstrualage
Conceptional age
Establised menstrualageshouldneverbechanged
laterinpregnancy
Subsequentfetalmeasurements indexoffetal
growthratherthanmenstrualage
 Fetal
biometry???
Earlypregnancy

Schedulingofinvasiveprocedures
Interpretationofbiochemicaltests

Latepregnancy

Evaluatingfetalgrowth
Spontaneousorplannedelectivedelivery
 AccuracyofbiometryinpredictingGA

Firsttrimester 35days
12to18wks 1week
Thirdtrimester unreliable
 Gestationalsac

earliestsonographic signofpregnancy
precisetermchorionicsac
Chorionicvilli echogenic ring
Fluidwithinthesacchorionicfluidinearly
pregnancies
TVSprobes seenby5menstrualweek
Gestationalsac
 Gestationalsac

Intradecidualsign
Chorionicsacdisplacestheendometrialstripe
Actuallyresidesindeciduanotinendometrial
cavity
TVS 4.55wksofGA
Intradecidual sign-an echogenic area embedded in the thickened
decidua that is eccentrically located on one side of the uterine cavity,
which appears as a well-defined endometrial stripe.
Intradecidualsign
 Gestationalsac

Doubledecidual sacsign
sonographic visualisation ofthreelayersofdecidua
2echogenic layers
Innerringgestationalsac&itsechogenic outerlayerof
chorion
Outerringechogenic endometrium withdecidual reation
Markerofintrauterinepregnancy
Doubledecidualsac
sign
The double decidual sac sign is useful in
distinguishing between an early intrauterine
pregnancy (IUP) and a pseudogestational sac.
 Meansacdiameter

MSD
Meaninternaldiameterofsac
Obtainedfromtheinterfaceofchorionicvilli
andchorionicfluid
Wallofthesacnotincluded
 MSD

MeanofAP,transverse,
longitudinaldiameter
length&depth
measuredinlong.
Image,widthin
transverseimage
 MSD

23mm whenfirstobserved
Increases1mm/dayinearlygestation

2mmat44.5wks
5mmat5weeks

UntilMSDof25
GAindayscalculatedbyadding30toMSD
Eg;MSDof5mm=35days/5wks
 MSD

5.5wksyolksacappears
6wksembryoappears

MSDof214mmhighlyreliable
Accuracydeterioratesafter14mm
MSDlessreliableinlate1st trimester

Watchcarefullyif
MSD>8mmwithoutyolksac
MSD>16mmwithoutembryo
 Yolksac

Firststructureseeningestationalsac

Diagnosticofintrautrine gestation

Connectedtomidgutbyvitelline duct

Growsatrateof0.1mm/mmgrowthofMSDuntilMSD<15
mm

Upperlimit 5.6mmbn 5&10wks

YS
 CRL

Iftheembryoisvisualised,measurementofchoiceis
CRL

MSDequals14mmwhenCRLmeasures5mm

Embryoinasaggitalsection
Measurefromthetipofthecephalicpole crown
tothetipofthecaudalpole rump
CRL
 CRL

Maximalstraightlinelengthofthefetus
AverageCRLmeasurementfrom3satisfactory
images
OptimaltimeforpredictionofGAfromCRL 69
WKS
predictablity+/ 35days
Decreasesasthepregnancyprogresses
BPDissuperiorthanCRLat1214wks
 CRL

Pitfalls:
Faultymeasurementsdueto:
FetalPosition
Excessiveflexionorhyperextension=
underestimation
Poormeasurementplane
InclusionofYSinCRLmeasurementinearly
pregnancy
 Transitionbn1st &2nd trimester(1314
weeks)appropriatetimetomaketransition
fromCRLtoBPD,HC,AC,&FL
 BPD

Accuratepredictorofmenstrualagebefore20
weeks

Bn14&20wks,variablity:+/ 1wk

After20wksvariablity:+/ 3.5wks
 BPD

Twodimentionalmeasurement

Anyplaneofsectionthattraverses3rd ventricleandthalamus

Transducer
Perpendiculartoparietalbones
Incorrectcephalocaudalpositiontointersect3v&
thalami

Consistantandaccuratemeasurement
BPD
 BPD

Threerules
Correctplaneofsectionthrothirdventricle&thalami
Calvaria smooth&symmetricalbilatrally
Positioningofcursors properendpointsofmeasurement
outeredgeofnearcalvarialwalltoinneredgeoffar
calvarialwall
Inneredgeofnearcalvariumtoouteredgeoffar
calvarium
Middleofnearcalvariumtomiddleofoutercalvarium
 Cephalicindex

Toassessheadshape
CI=BPD OFDx100
CI 75%=dolicocephalic
CI 85%=brachicephalic
OFDmeasuredfromouterto
outeredgeofcalvaria
 HC

Threedimentionalmeasurement

Independentofheadshape

PredictGAtowithin1wkbefore20wks

Variablityof3.8wksinlatethirdtrimester
 HC

Obtainedthrosingleplaneofsection parallelsthebaseof
skull

Transducer

Perpendiculartoparietalbones
Incorrectcephalocaudalpositiontointersect3v&thalami
Properlyorientedtoskullbase
 HC

RulesformeasuringHC

Correctplanethro3v&thalamiincentre
Cavumseptumpellucidianteriorportion
Tentorialhiatusposteriorportion
Smooth&bilaterallysymmetricalcalvaria
 HC

Arrowsign
Featherscavum
septumpellucidi&
frontalhorns
3v&sylvianaqueduct
shaft
Ambient&
quadrigerminalcisterns
&tentorialhiatus
arrowhead
 HC

Cursors atouteredgeofnearcalvarialwall
&outeredgeoffarcalvarialwall
Computergeneratedelipsefittedtocalvaria
Entireperimeterofcalvarianeednotbe
demonstrated
Elipsemeasuresadequatelyevenwhenthe
entirecalvariaisnotentirelyimaged
HC
 HC

ProperBPDcanbeobtainedfromsameimage
forHCMEASUREMENT
Reverseisnottrue
ProperlypositionedcursorsforHC
inappropriateforBPD
ForHCelipsefittedtocalvarianottheskinof
thescalp
HC
 FL

Technicallytheeasiestofcommonbiometric
measurements
Accuratepredictorofageinearly2nd trimester( 1
wk)
Transduceralignedtolongaxisofdiaphysis
EntirefemurLnotmeasured
Onlyossifiedportionsofdiaphysis&metaphysis
measured
Cartilaginousendsexcluded
 FL

Properalignment
cartilaginousfemoralheadorgreatertrochander
femoralcondylesinsamesection
Positioningcursors
Atthejunctionofbonewithcartilage
Avoiddistalfemoralpoint
FL
FL
 FL

Distalfemoralepiphysis appearat34wksin
94%offetuses
Proximaltibialepiphysis appearat37wksin
80%offetuses
Forconfirmingbiometricdatainlate
pregnancy
 AC

Threedimentionalmeasurement

Acutelyaffectedbygrowthdisturbances

Mostdifficultofthefourmeasurements
AC

Measuredatgreatest
trasversediameterof
liver
Rt&Ltportalveins
continuouswitheach
other hockeystick
appearance
 AC

RulesformeasurementofAC
Perpendiculartomidline
Correctcephalocaudalplane
Symmetriclowerribs
ShortestLofumblicalsegmentofLtportal
vein
Elipsefittoskinedge
AC
 AC

Whenanatomiclandmarksdifficultto
demonstrate
Followtherule:roundCoversamultitude
ofsins
Circumferenceestimatemoreaccurate
Avoidexcessivepressuretotransducer
AC
 FL/ACRATIO

FL/ACratio=22

Constantfrom22wksonwards

HelpfulindiagnosingasymmetricIUGR
 Transcerebellardiameter

Notaffectedbygrowth
disturbances
Fetusindirectoccipito
anteriorposition
Diameterinmm
correspondstoGAin1st 26
wksofpregnancy
Cisternamagnanot>than
9mm
 Datingwithothermeasurements

Longbonesofarms&legs
Fetalchest
Orbital&interorbitaldistance
FootLength
Claviclelength
 conclusion

Establisedmenstrualageshouldneverbechangedlaterin
pregnancy
Subsequentfetalmeasurementsindexoffetalgrowthrather
thanmenstrualage
Examinershouldavoidthetemptationtomassagethe
endpointsofmeasurementsionbcoztheagecomputationis
smallerorlarger
Insteaditiscrucialtolearntherulesforeachmeasurement
Thank u