Академический Документы
Профессиональный Документы
Культура Документы
Abstract
Making appropriate management decisions requires accurate appraisal of gestational age. Accurate
pregnancy dating may assist obstetricians in appropriately counselling women who are at risk of a
preterm delivery about likely neonatal outcomes and is also essential
essential in the evaluation of fetal
growth and the detection of intrauterine growth restriction. The purpose of this study was
wa to find
out the other parameters such as tibial length which can be used to determine the gestational age
either more accurately or can be used in other conditions where the previous parameters are
unreliable. We found that in normally developing fetus the fetal tibial length increases with
advancing gestational age and regression analysis showed a strongly significant relationship between
fetal tibial length and gestational age. Fetal tibial length is a good marker for gestational age and can
also be used in cases, which are not sure about their last menstrual period (LMP)).
Key words
Fetal tibial length, Gestational
al age, Ultrasonography, Fetal age determination.
d
Page 39
Introduction
Appropriate assessment of gestational age is
paramount in obstetric care. Making
appropriate management decisions requires
accurate appraisal of gestational age. Accurate
pregnancy dating may assist obstetricians in
appropriately counseling women who are at risk
of a preterm delivery about likely neonatal
outcomes and is also essential in the evaluation
of fetal growth and the detection of intrauterine
growth restriction. Accurate gestational age is
also important in the interpretation of
biochemical
ochemical serum screening test or for
counselling patients regarding the option of
pregnancy termination early in the pregnancy.
Since clinical data such as the menstrual cycle or
uterine size often are not reliable, the most
precise parameter for pregnancy
pregnanc dating should
be determined by the obstetrician by
ultrasound. Ultrasound is an accurate and useful
modality for the assessment of gestational age
in the first and second trimester of pregnancy
and, as a routine part of prenatal care, can
greatly impact obstetric management and
improve antepartum care. When choosing the
optimal parameter for estimating gestational
age, it is essential that the structure has little
biologic variation, and can be measured with a
high degree of reproducibility. In the past, the
biparietal diameter (BPD) had been described as
a reliable method of determining gestational
age. While the BPD was the first fetal parameter
to be clinically utilized in the determination of
fetal age in the second trimester, more recent
studies have evaluated the use several other
biometric
parameters
including
head
circumference (HC), abdominal circumference
(AC), femur length (FL), foot length, ear size,
orbital diameters, cerebellum diameter and
others [1]. The measurement of the long bones
of the extremities is being increasingly
incorporated into the ultrasonic evaluation for
fetal development and diagnosis of fetal
anomalies [2]. All of the limb bone lengths
Page 40
Results
The present study was conducted in 100
pregnant women, between the age range of 18
to 40 years, during 2nd and 3rd trimester.
Gestational age was calculated individually on
BPD (Bi Parietal Diameter), AC (Abdominal
(Abdom
Circumference) and FL (Femur Length),
Length) and then
mean gestational age was determined by the
above mentioned parameters. Sonographically
we measured fetal tibial length from 15th week
of gestation to 38th week of gestation. Other
parameters measured were BPD, AC, and FL as
per Table-1.
Y = 9.117 + 0.371X
Where
y=gestational age in weeks,
weeks X=tibial
length in mm.
Discussion
Ultrasound assessment of gestational age has
become an integral part of obstetric practice in
recent times. In the past, the biparietal diameter
(BPD) had been described as a reliable method
of determining gestational age. While the BPD
was the first fetal parameter to be clinically
utilized in the determination of fetal age in the
second trimester, more recent studies have
evaluated the use several other biometric
parameters including head circumference (HC),
abdominal circumference (AC), femur length
Page 41
2.
3.
5.
4.
6.
7.
Conclusion
In normally developing fetus the fetal tibial
length increases with advancing gestational age.
Fetal tibial length is a good marker for
gestational age and can be used in cases, which
are not sure about their LMP.
References
8.
Note: This study is a part of PhD work of first author under guidance of the second author.
Page 42
Mean
tibial
Mean BPD
length
(mmSD)
(mmSD)
Mean AC
(mmSD)
Mean FL
(mmSD)
15
10.250.50
15.501.41
95.003.82
15.751.70
16
15.250.50
32.751.89
104.02.82
20.500.57
17
19.750.50
37.250.95
111.26.99
23.250.95
18
24.400.55
40.600.89
116.44.09
27.800.44
19
28.000.82
45.250.95
124.52.51
30.501.00
20
31.000.90
47.660.81
144.04.19
33.331.21
21
35.750.50
55.000.81
155.02.58
34.000.81
22
37.400.90
56.800.83
173.22.77
37.201.30
23
41.500.58
58.000.81
181.02.58
40.661.00
10
24
42.400.55
61.001.41
196.23.63
42.600.89
11
25
44.500.58
62.001.41
200.84.85
45.501.00
12
26
46.400.55
65.201.64
216.45.77
49.201.30
13
27
48.250.50
65.001.15
225.55.00
51.501.00
14
28
50.600.82
71.663.07
231.211.5
54.002.52
15
29
52.800.55
74.800.83
255.45.45
54.401.14
16
30
55.400.55
75.001.00
272.83.34
57.400.89
17
31
57.500.58
78.750.95
271.55.97
58.750.95
18
32
60.500.52
79.200.83
288.29.70
62.402.07
19
33
62.500.58
83.502.51
294.03.74
63.002.58
20
34
65.500.58
85.000.81
304.04.32
66.2050.5
21
35
68.500.58
87.251.50
312.73.40
69.251.70
22
36
70.800.84
89.801.48
325.66.22
72.601.34
Page 43
Gestational age
(weeks)
C. Exacoustos
Lyn S. Chitty
15
10.25
16.00
14.10
16
15.25
20.00
16.90
17
19.75
22.00
22.00
19,90
18
24.40
23.00
23.00
22.80
19
28.00
26.00
26.00
25.70
20
31.00
29.00
29.00
28.50
21
35.75
32.00
32.00
31.20
22
37.40
33.00
33.00
33.80
23
41.50
37.00
37.00
36.40
24
42.40
39.00
39.00
38.80
25
44.50
41.00
40.50
41.00
26
46.40
43.00
43.00
43.20
27
48.25
45.00
45.00
45.30
28
50.60
46.00
46.00
47.30
29
52.80
49.00
48.00
49.20
30
55.40
50.00
49.50
51.00
31
57.50
52.00
52.00
52.70
32
60.50
55.00
55.00
54.40
33
62.50
56.00
55.00
55.90
34
65.50
57.00
57.oo
57.50
35
68.50
59.00
59.oo
58.90
36
70.80
61.00
60.00
60.30
Page 44
Graph - 2: Comparative plot between mean TL, FL, BPD, AC - Linear increase of BPD, AC, FL as
compared to tibial length as pregnancy progresses from 15 weeks to 36 weeks.
Page 45