DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20222312
Published: 2022-08-29

Efficacy of trans-cerebellar diameter/abdominal circumference ratio versus head circumference/abdominal circumference ratio in prediction of asymmetrical intrauterine growth retardation

Silvin Sofia Maryi, Indirani D., Vinothkumar P. S.

Abstract


Background: Determination of gestational age is an important step of pregnancy management and foetal development evaluation in obstetrics. Any error in this gestational age estimation results in prematurity or post maturity and in case if the expected date of delivery is not known, there is high chance of perinatal mortality in the near outcome. Hence it is important in achieving an uneventful gestation to have a sensitive, specific and age independent obstetric biometric parameter that stays constant throughout the gestation. Trans-cerebellar diameters (TCD)/ abdominal circumference (AC) ratio are reliable, constant predictors to assess the gestational age and to evaluate fetal growth. Aim was to compare the accuracy of TCD/ AC ratio with head circumference (HC)/ AC ratio in predicting asymmetrical IUGR.

Methods: A prospective study was conducted over a period of one year on 100 clinically suspected IUGR pregnancies who were evaluated with BPD, HC, AC and FL along with TCD were measured for assessing the sonological gestational age. Two morphometric ratios-TCD/AC and HC/AC were calculated. Estimated fetal weight was calculated for all these pregnancies and its percentile was determined. Then those clinically suspected IUGR cases were followed up to delivery and post-delivery new Ballord score and CAN score (clinical assessment of nutritional status at birth) were calculated.

Results: In the present study, the sensitivity, specificity, PPV, NPV and DA were 83.93%, 65.91%, 75.81%, 76.32% and 76% respectively for TCD/AC ratio versus respectively for HC/AC ratio in predicting IUGR.  

Conclusions: Both ratios were gestational age independent and can be used in detecting IUGR with good diagnostic accuracy. However, TCD/AC ratio had a better diagnostic validity and accuracy compared to HC/AC ratio in predicting asymmetric IUGR.


Keywords


Fetal cerebellum, Geatationl age, TCD/AC, Ultrasonography

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References


Chew LC, Verma RP. Fetal Growth Restriction. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022. Available from: http://www.ncbi.nlm.nih.gov/books/NBK562268/. Accessed on 2022, May 23.

Butt K, Lim K, diagnostic imaging committee. Determination of gestational age by ultrasound. J Obstet Gynaecol Can. 2014;36(2):171-81.

Lee W, Balasubramaniam M, Deter R, Hassan S, Gotsch F, Kusanovic J et al. Fetal growth parameters and birth weight: their relationship to neonatal body composition. Ultrasound Obstet Gynecol. 2009;33(4):441-6.

Hashimoto K, Shimizu T, Shimoya K, Kanzaki T, Clapp JF, Murata Y. Fetal cerebellum: US appearance with advancing gestational age. Radiology. 2001;221(1):70-4.

Liu F, Zhang Z, Lin X, Teng G, Meng H, Yu T et al. Development of the human fetal cerebellum in the second trimester: a post mortem magnetic resonance imaging evaluation. J Anat. 2011;219(5):582-8.

Goel P, Singla M, Ghal R, Jain S, Budhiraja V, Babu CSR. Transverse Cerebellar Diameter-A Marker for Estimation of Gestational Age. J Anatomical Society of India. 2010;59(2):158-61.

Vinkesteijn AS, Mulder PG, Wladimiroff JW. Fetal transverse cerebellar diameter measurements in normal and reduced fetal growth. Ultrasound Obstet Gynecol. 2000;15(1):47-51.

Themes UFO. Ultrasound evaluation of fetal biometry and normal and abnormal fetal growth. Radiology Key. 2016. Available at: https://radiologykey.com/ultrasound-evaluation-of-fetal-biometry-and-normal-and-abnormal-fetal-growth/. Accessed 2022 May 23.

Campbell AG, Dawes GS, Fishman AP, Hyman AI. Regional redistribution of blood flow in the mature fetal lamb. Circ Res. 1967;21(2):229-35.

Behrman RE, Lees MH, de Peterson EN, Lannoy CW, Seeds AE. Distribution of the circulation in the normal and asphyxiated primate. Am J Obstet Gynecol. 1970;108:956-96.

Chavez MR, Ananth CV, Smulian JC, Vintzileos AM. Fetal transcerebellar diameter measurement for prediction of gestational age at the extremes of fetal growth. J Ultrasound Med. 2007;26(9):1167-71.

Hadlock F, Deter R, Harrist R, Roecker E, Park S. A date-independent predictor of intrauterine growth retardation: femur length/abdominal circumference ratio. Am J Roentgenol. 1983;141(5):979-84.

Tongsong T, Wanapirak C, Thongpadungroj T. Sonographic diagnosis of intrauterine growth restriction (IUGR) by fetal transverse cerebellar diameter (TCD)/abdominal circumference (AC) ratio. Int J Gynaecol Obstet. 1999;66(1):1-5.

Woo JS, Wan CW, Cho KM. Computer-assisted evaluation of ultrasonic fetal weight prediction using multiple regression equations with and without the fetal femur length. J Ultrasound Med. 1985;4(2):65-7.

Fetal Transcerebellar Diameter to Abdominal Circumference Ratio (TCD/AC) in the Assessment of Normal Fetal Growth, Semantic Scholar. Available at: https://www.semanticscholar.org/paper/Fetal-Transcerebellar-Diameter-to-Abdominal-Ratio-Dhumale-Pujar/9d7327ba4cd4f99e7055085b3d7acf0049563df0. Accessed on 2022 May 23.

Malik R, Pandya VK, Shrivastava P. Gestational age estimation using transcerebellar diameter with grading of fetal cerebellum and evaluation of TCD/AC (Transcerebellar diameter/abdominal circumference) ratio as a gestational age independent parameter. Ind J Radiol Imaging. 2003;13:95-7.

Bansal M, Bansal A, Jain S, Khare S, Ghai R. A study of Correlation of Transverse Cerebellar Diameter with Gestational Age in the Normal and Growth Restricted Fetuses in Western Uttar Pradesh. People’s J Scientific Res. 2014;7(2):16-21.

Sharma N. Predictors of overweight and Obesity among Medical Students. Int J Scientific Res Public. 2017;4(12):1-5.

Lee W, Barton S, Comstock CH, Bajorek S, Batton D, Kirk JS. Transverse cerebellar diameter: A useful predictor of gestational age for fetuses with asymmetric growth retardation. Am J Obstetr Gynecol. 1991;165(4-1):1044-50.

Benson CB, Belville JS, Lentini JF, Saltzman DH, Doubilet PM. Intrauterine growth retardation: diagnosis based on multiple parameters--a prospective study. Radiology. 1990;177(2):499-502.

Divon MY, Boldes R, Gahan JPM. Assessment of intrauterine growth retardation. In Gahan J P M, Porto M, Diagnostic obstetrical ultrasound. 2nd ed., Montana, Lippincott Williams and Wilkins. 1994;278-91.

Hill LM, Guzick D, DiNofrio D, Maloney J, Merolillo C, Nedzesky P. Ratios between the abdominal circumference, head circumference, or femur length and the transverse cerebellar diameter of the growth-retarded and macrosomic fetus. Am J Perinato.l 1994;11(2):144-8.

Campbell WA, Vintzileos AM, Rodis JF, Turner GW, Egan JF, Nardi DA. Use of the transverse cerebellar diameter/abdominal circumference ratio in pregnancies at risk for intrauterine growth retardation. J Clin Ultrasound. 1994;22(8):497-502.

Bellad MB, Dhumale H, Pujar YV, Shravage JC, Sherigar BY, Durdi GS et al. Fetal Transcerebellar Diameter to Abdominal Circumference Ratio (TCD/AC) in the Assessment of Normal Fetal Growth. Donald School J Ultrasound Obstetr Gynecol. 2010;4(4):455-7.

Meyer WJ, Gauthier D, Ramakrishnan V, Sipos J. Ultrasonographic detection of abnormal fetal growth with the gestational age-independent, transverse cerebellar diameter/abdominal circumference ratio. Am J Obstet Gynecol. 1994;171(4):1057-63.

Belizán JM, Villar J, Nardin JC, Malamud J, De Vicurna LS. Diagnosis of intrauterine growth retardation by a simple clinical method: measurement of uterine height. Am J Obstet Gyneco. 1978;131(6):643-6.

Divon MY, Chamberlain PF, Sipos L, Manning FA, Platt LD. Identification of the small for gestational age fetus with the use of gestational age-independent indices of fetal growth. Am J Obstet Gynecol. 1986;155(6):1197-201.

Kurjak A, Kirkinen P, Latin V. Biometric and dynamic ultrasound assessment of small-for-dates infants: report of 260 cases. Obstet Gynecol. 1980;56(3):281-4.