Investigation of Bone Ratios for Prenatal Fetal Assessment in Taiwanese Population

Feng-Yi Yang, Yi -Li Lin

Department of Biomedical Imaging and Radiological Sciences , School of Biomedical Science and Engineering, National Yang-Ming University.

DOI: 10.4236/eng.2012.410B038                

Abstract

The purpose of this study is to calculate the ratios of fetal limb bone to nasal bone length (NBL) obtained by transabdominal ultrasound between 19 and 28 weeks of gestation. Cross-sectional data were obtained from 1408 women with singleton pregnancies who underwent an advanced prenatal ultrasound examination from August 2006 to September 2008. The single measurement plane of fetal limb bones was on the longest section of each structure with appropriate image magnification. To assess repeatability of the intraobserver, two repeated measurements were obtained in 44 fetuses. The ratio of fetuses with biparietal diameter (BPD)/NBL was compared with those of fetal limb bones/NBL. The mean ratio was found between fetal NBL measurements and BPD (7.240), humerus length (HL) (4.807), radius length (RL) (4.157), ulna length (UL) (4.502), femur length (FL) (5.131), tibia length (TL) (4.528), and fibula length (FiL) (4.507). The reference ranges of fetal long bone length/NBL ratios for the second trimester was established by transabdominal sonography. There were no significant increases in these ratios with gestational age, especially the HL/NBL ratio.

Keywords

Nasal Bone Length; Limb Bone; Ratio; Second Trimester; Ultrasound

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Bell, R., J. Rankin, and L.J. Donaldson, Down's syndrome: occurrence and outcome in the north of England, 1985-99. Paediatr Perinat Epidemiol, 2003. 17(1): p. 33-9.
[2]	Van den Hof, M.C. and R.D. Wilson, Fetal soft markers in obstetric ultrasound. J Obstet Gynaecol Can, 2005. 27(6): p. 592-636.
[3]	Stempfle, N., et al., Skeletal abnormalities in fetuses with Down's syndrome: a radiographic post-mortem study. Pediatr Radiol, 1999. 29(9): p. 682-8.
[4]	Nicolaides, K.H., Nuchal translucency and other first-trimester sonographic markers of chromosomal abnormalities. Am J Obstet Gynecol, 2004. 191(1): p. 45-67.
[5]	Cicero, S., et al., Absence of nasal bone in fetuses with trisomy 21 at 11-14 weeks of gestation: an observational study. Lancet, 2001. 358(9294): p. 1665-7.
[6]	Viora, E., et al., Ultrasound evaluation of fetal nasal bone at 11 to 14 weeks in a consecutive series of 1906 fetuses. Prenat Diagn, 2003. 23(10): p. 784-7.
[7]	Ramos-Corpas, D., J.C. Santiago, and F. Montoya, Ultrasonographic evaluation of fetal nasal bone in a low-risk population at 11-13 + 6 gestational weeks. Prenat Diagn, 2006. 26(2): p. 112-7.
[8]	Monni, G., et al., Nuchal translucency and nasal bone for trisomy 21 screening: single center experience. Croat Med J, 2005. 46(5): p. 786-91.
[9]	Bunduki, V., et al., Fetal nasal bone length: reference range and clinical application in ultrasound screening for trisomy 21. Ultrasound Obstet Gynecol, 2003. 21(2): p. 156-60.
[10]	Otano, L., et al., Association between first trimester absence of fetal nasal bone on ultrasound and Down syndrome. Prenat Diagn, 2002. 22(10): p. 930-2.
[11]	Cicero, S., et al., Integrated ultrasound and biochemical screening for trisomy 21 using fetal nuchal translucency, absent fetal nasal bone, free beta-hCG and PAPP-A at 11 to 14 weeks. Prenat Diagn, 2003. 23(4): p. 306-10.
[12]	Cusick, W., et al., Fetal nasal bone length in euploid and aneuploid fetuses between 11 and 20 weeks' gestation: a prospective study. J Ultrasound Med, 2004. 23(10): p. 1327-33.
[13]	Viora, E., et al., Fetal nasal bone and trisomy 21 in the second trimester. Prenat Diagn, 2005. 25(6): p. 511-5.
[14]	Vintzileos, A., C. Walters, and L. Yeo, Absent nasal bone in the prenatal detection of fetuses with trisomy 21 in a high-risk population. Obstet Gynecol, 2003. 101(5 Pt 1): p. 905-8.
[15]	Odibo, A.O., et al., The association between fetal nasal bone hypoplasia and aneuploidy. Obstet Gynecol, 2004. 104(6): p. 1229-33.
[16]	Kanagawa, T., et al., Mid-second trimester measurement of fetal nasal bone length in the Japanese population. J Obstet Gynaecol Res, 2006. 32(4): p. 403-7.
[17]	Bromley, B., et al., Fetal nose bone length: a marker for Down syndrome in the second trimester. J Ultrasound Med, 2002. 21(12): p. 1387-94.
[18]	Naraphut, B., et al., Nasal bone hypoplasia in trisomy 21 at 15 to 24 weeks' gestation in A high risk Thai population. J Med Assoc Thai, 2006. 89(7): p. 911-7.
[19]	Tran, L.T., et al., Second-trimester biparietal diameter/nasal bone length ratio is an independent predictor of trisomy 21. J Ultrasound Med, 2005. 24(6): p. 805-10.
[20]	Shohat, T. and O. Romano-Zelekha, Ultrasonographic measurements of fetal femur length and biparietal diameter in an Israeli population. Isr Med Assoc J, 2001. 3(3): p. 166-8.
[21]	Cicero, S., et al., Fetal nasal bone length in chromosomally normal and abnormal fetuses at 11-14 weeks of gestation. J Matern Fetal Neonatal Med, 2002. 11(6): p. 400-2.
[22]	Sonek, J.D. and K.H. Nicolaides, Prenatal ultrasonographic diagnosis of nasal bone abnormalities in three fetuses with Down syndrome. Am J Obstet Gynecol, 2002. 186(1): p. 139-41.
[23]	Goldstein, R.B., R.A. Filly, and G. Simpson, Pitfalls in femur length measurements. J Ultrasound Med, 1987. 6(4): p. 203-7.
[24]	De Biasio, P., et al., Reference values for fetal limb biometry at 10-14 weeks of gestation. Ultrasound Obstet Gynecol, 2002. 19(6): p. 588-91.
[25]	Merz, E. and S. Wellek, [Normal fetal growth profile--a uniform model for calculating normal curves for current head and abdomen parameters and long limb bones]. Ultraschall Med, 1996. 17(4): p. 153-62.
[26]	Salomon, L.J., J.P. Bernard, and Y. Ville, Estimation of fetal weight: reference range at 20-36 weeks' gestation and comparison with actual birth-weight reference range. Ultrasound Obstet Gynecol, 2007. 29(5): p. 550-5.
[27]	Odibo, A.O., et al., Evaluating the efficiency of using second-trimester nasal bone hypoplasia as a single or a combined marker for fetal aneuploidy. J Ultrasound Med, 2006. 25(4): p. 437-41; quiz 443.