open access
The crown-rump length measurement — ISUOG criteria and clinical practice
, 2, 2
Affiliations- Pomeranian Medical University, Szczecin, Poland
- Clinical Department of Obstetrics and Gynecology, Pomeranian Medical University in Szczecin, Poland
open access
Abstract
Objectives: Significance of the crown-rump length (CRL) measurement criteria in the assessments of gestational age and
actual precision in daily clinical practice.
Material and methods: We recruited 806 pregnant women with singleton pregnancy and history of regular menstrual
periods.We analysed retrospectively CRL measurements obtained during routine first trimester scan performed between
11 + 0 and 13 + 6 weeks gestation. Gestational age was calculated using both the last menstrual period (LMP) and the CRL.
The images of the CRL measurements were assessed by the expert. The visual analysis of the images in terms of meeting the
five criteria recommended by the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) was performed.
Statistical analysis were used to assess how the above-mentioned criteria influenced calculation of the gestational age.
Results: The study showed 323 out of 806 of the CRL measurements (40.1%) were qualified by a specialist as accurate,
279 (34.6%) as inaccurate, and 204 (25.3%) as inaccurate, but not changing the duration of a pregnancy. With the application
in the assessment of the five criteria of the ISOUG 217 (26.9%), the following results of qualification were obtained: accurate
— fulfilled ≥ 4, inaccurate 341 (42.3%) — fulfilled ≤ 2, whereas inaccurate, but not changing the duration of a pregnancy
248 (30.8%) — 3 criteria fulfilled. We found that only the neutralof the fetus demonstrated a significant corellation with
the assessment of the duration of a gestation.
Conclusions: a) the accurate audit of the CRL measurements is recommended; b) neutral position of the fetus is the most
important criterion out of 5.
Abstract
Objectives: Significance of the crown-rump length (CRL) measurement criteria in the assessments of gestational age and
actual precision in daily clinical practice.
Material and methods: We recruited 806 pregnant women with singleton pregnancy and history of regular menstrual
periods.We analysed retrospectively CRL measurements obtained during routine first trimester scan performed between
11 + 0 and 13 + 6 weeks gestation. Gestational age was calculated using both the last menstrual period (LMP) and the CRL.
The images of the CRL measurements were assessed by the expert. The visual analysis of the images in terms of meeting the
five criteria recommended by the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) was performed.
Statistical analysis were used to assess how the above-mentioned criteria influenced calculation of the gestational age.
Results: The study showed 323 out of 806 of the CRL measurements (40.1%) were qualified by a specialist as accurate,
279 (34.6%) as inaccurate, and 204 (25.3%) as inaccurate, but not changing the duration of a pregnancy. With the application
in the assessment of the five criteria of the ISOUG 217 (26.9%), the following results of qualification were obtained: accurate
— fulfilled ≥ 4, inaccurate 341 (42.3%) — fulfilled ≤ 2, whereas inaccurate, but not changing the duration of a pregnancy
248 (30.8%) — 3 criteria fulfilled. We found that only the neutralof the fetus demonstrated a significant corellation with
the assessment of the duration of a gestation.
Conclusions: a) the accurate audit of the CRL measurements is recommended; b) neutral position of the fetus is the most
important criterion out of 5.
Keywords
CRL, gestation, early pregnancy
About this articleTitle
The crown-rump length measurement — ISUOG criteria and clinical practice
Journal
Issue
Article type
Research paper
Pages
674-678
Published online
2020-10-01
Page views
1805
Article views/downloads
3148
DOI
Pubmed
Bibliographic record
Ginekol Pol 2020;91(11):674-678.
Keywords
CRL
gestation
early pregnancy
Authors
Dominik Jakubowski
Daria Salloum
Andrzej Torbe
Sebastian Kwiatkowski
Magdalena Bednarek-Jedrzejek
References (14)- Wennerholm UB, Bergh C, Hagberg H, et al. Gestational age in pregnancies after in vitro fertilization: comparison between ultrasound measurement and actual age. Ultrasound Obstet Gynecol. 1998; 12(3): 170–174.
- Drumm JE. The prediction of delivery date by ultrasonic measurement of fetal crown-rump length. Br J Obstet Gynaecol. 1977; 84(1): 1–5.
- Salomon LJ, Alfirevic Z, Bilardo CM, et al. ISUOG practice guidelines: performance of first-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol. 2013; 41(1): 102–113.
- Butt K, Lim KI, Butt K, et al. Determination of gestational age by ultrasound. J Obstet Gynaecol Can. 2014; 36(2): 171–181.
- Cadkin A. Crown-rump length dating of pregnancy at less than nine weeks' gestation. American Journal of Obstetrics and Gynecology. 1992; 166(1): 269.
- Mongelli M, Wilcox M, Gardosi J. Estimating the date of confinement: ultrasonographic biometry versus certain menstrual dates. Am J Obstet Gynecol. 1996; 174(1 Pt 1): 278–281.
- van Heesch PN, Struijk PC, Laudy JAM, et al. Estimating the effect of gestational age on test performance of combined first-trimester screening for Down syndrome: a preliminary study. J Perinat Med. 2010; 38(3): 305–309.
- Blondel B, Morin I, Platt RW, et al. Algorithms for combining menstrual and ultrasound estimates of gestational age: consequences for rates of preterm and postterm birth. BJOG. 2002; 109(6): 718–720.
- Roux N, Dhombres F, Friszer S, et al. Comment évaluer la flexion de l’embryon lors de la mesure de la longueur cranio-caudale. Gynécologie Obstétrique & Fertilité. 2016; 44(3): 146–150.
- Kagan KO, Hoopmann M, Baker A, et al. Impact of bias in crown-rump length measurement at first-trimester screening for trisomy 21. Ultrasound Obstet Gynecol. 2012; 40(2): 135–139.
- Sagi-Dain L, Peleg A, Sagi S. First-Trimester crown-rump length and risk of chromosomal aberrations-a systematic review and meta-analysis. Obstet Gynecol Surv. 2017; 72(10): 603–609.
- Dhombres F, Roux N, Friszer S, et al. Quality of first-trimester measurement of crown-rump length. Am J Obstet Gynecol. 2014; 211(6): 672.e1–672.e5.
- Sarris I, Ioannou C, Dighe M, et al. Standardization of fetal ultrasound biometry measurements: improving the quality and consistency of measurements. Ultrasound Obstet Gynecol. 2011; 38(6): 681–687.
- Wanyonyi SZ, Napolitano R, Ohuma EO, et al. Image-scoring system for crown-rump length measurement. Ultrasound Obstet Gynecol. 2014; 44(6): 649–654.
