Published: 2016-12-15

Role of trans-cerebellar diameter in estimating gestational age in second and third trimester of pregnancy

Prashant Arun Uikey, Kshama Vivek Kedar, Surekha Narayan Khandale


Background: Uncertain gestational age is associated with higher perinatal mortality rates and an increased incidence of low birth weight and spontaneous preterm delivery. Errors in gestational age estimation can lead to iatrogenic neonatal morbidity from prematurity. Precise determination of gestational age antenatally is a boon to modern obstetrics in context with improved neonatal survival. The most effective way to date pregnancy is by sonography. Several parameters can be considered for estimation of gestational age trans-cerebellar diameter is one such parameter. The objective of this study was to study the role of fetal trans-cerebellar diameter in estimating the gestational age in second and third trimester of pregnancy and its correlation with gestational age, BPD, HC, AC and FL. The design of this study was to hospital based prospective cohort study conducted at department of obstetrics of Government medical College Nagpur, over a period of 1 year.

Methods: 500 women with sure dates between 7 and 11 weeks of gestation were booked. First trimester USG using crown rump length for confirmation of gestational age was done. These patients were advised to come for follow up till 40 weeks of gestation and repeat USG was done in second and third trimester. Trans-cerebellar diameter was correlated with expected gestational age with CRL, BPD, HC, AC and FL in weeks.

Results: 98.56% of variability in gestational age could be explained by variation in trans-cerebellar diameter (TCD) only. Addition of other variables did not make any significant difference indicating that TCD alone is the strong predictor of gestational age.

Conclusions: Normative cerebellar measurements throughout pregnancy permit estimation of gestational age independent of the shape of fetal head and also offer potential for evaluating abnormal fetal growth and anomalous development of central nervous system.


Gestational, TCD, Pregnancy

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.

Butt K, Lim K. Determination of gestational age by ultrasound; SOGC clinical practice guide lines. J Obstet Gynaecol Can. 2014;36(2):171-81.

Goldstein I, Albert R, Pilu G, Hobbins JC. Cerebellar measurements with ultrasonography in the evaluation of fetal growth and development. Am J Obstet Gynecol. 1987;156:1065.

Micovic Z, Markovic A. growth of fetal cerebellum in normal pregnancy; Jugosol. Ginecol. Perinatol. (Yugoslavia). 1989;29:157.

Montenegro NA, Leite LP. Fetal cerebellar measyrementsin second trimester ultrasonography, clinical value; J Pernat Med. 1989;17:365.

Hata K, Hata T, Senoh D, Makinara K. Ultrasonographic measurement of fetal TCD in utero. Gynecol Obstet Invest. 1989;28:111.

Nikolov V, Khandzhier A, Brankova M. The echographic measurement of fetal transverse cerebellar diameter in the second pregnancy trimester: a nonstandard method for determining gestational age. Akuush Ginecol. 1991;30:16.

Guan B. Surveillance of fetal growth and fetal cerebellar transverse diameter by ultrasonographic measurement. Chung Hsueh Tsa Chih (Taipei) China. 1992;72:65.

Khemani M, Gupta A, Mittal KP, Sachdeo G. Ultrasonic evaluation of fetal cerebellar measurements as an independent marker for estimating gestational age in second and third trimester of pregnancy. J Obstet Gynecol Ind. 1993;43:497.

Mayer WJ, Gawthier DW, Goldberg B. Fetal TCD/AC ratio: a gestational age independent method of assessing fetal size. J Ultrasound Med. 1993;12:379.

Malik R, Pandya VK, Shrivastav P. gestational age estimation using trans-cerebellar diameter with grading of fetal cerebellum and evaluation of TCD/AC ratio as a gestational age independent parameter. Indian J Radiol Imaging. 2003;13:95-7.

Altman DG, Chitty LS. Charts of fetal size methodology. Br J Obstetgynecol. 1994;101:29-34.

Goel P, Singla M, Ghai R. Trans-cerebellar diameter- a marker for estimation of gestational age. J Anat Soc India. 2010;59(2)158-61.

Naseem F, Fatima N. Comparision between trans-cerebellar diameter with biparietal diameter of ultrasound for gestational age measurement in third trimester of pregnancy. J Col Phys Surg Pakistan. 2013;23(5):322-5.

Bansal M, Bansal A. A study of correlation of transverse cerebellar diameter with gestational age in the normal and growth restricted foetuses in western Uttar Pradesh. Peop J Sci Res. 2014;7(2).

Adeyekun AA, Orji MO. Predictive accuracy of trans-cerebellar diameter in comparision with other fetal biometric parameters for gestational age estimation among pregnant Nigerian women. East Afr Med J. 2014;91(4):138-44.