Book Reading

Fetal Biometry and Growth

SECOND AND THIRD TRIMESTER DATING

Presentant :
Dr. Radinal Yusivanandra Prayitno

DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

FACULTY OF MEDICINE SRIWIJAYA UNIVERSITY
Dr. MOH. HOESIN GENERAL HOSPITAL PALEMBANG
 ASSIGNMENT OF GESTATIONAL AGE

• The gestational age of a pregnancy can be assigned based on either clinical

factors or sonographic findings.
• Dating by ultrasound, particularly before the third trimester, is generally more
accurate than clinical dating by LMP or physical examination.
• Once gestational age has been assigned by sonography or by clinical
information in an ART patient, the pregnancy should not be redated nor
should the EDD be changed
• Selecting the appropriate sonographic method for dating pregnancy depends
on how far along the pregnancy is

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FIRST TRIMESTER DATING
• Early in the first trimester, before the embryo is visible, gestational age can
be assigned based on transvaginal sonographic findings.
• The earliest sonographic finding of pregnancy is a small rounded intrauterine
fluid collection in the central portion of the uterus.
• An alternate method for dating early pregnancy is to measure the mean sac
diameter of the gestational sac.
• From the time the embryo is visible until the end of the first trimester,
dating is based on the CRL.
• Gestational age is assigned based on CRL by using published formulas or
tables

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Early first trimester dating with sonographic milestones.
A, Sagittal image showing a small rounded ntrauterine fluid collection
(arrow) in the central portion of the uterus, consistent with 5.0 weeks’
gestation. B, Intrauterine gestational sac containing a yolk sac
(arrow), consistent with 5.5 weeks’ gestation. C, Intrauterine
gestational sac containing a small embryo with heartbeat (arrow)
adjacent to the yolk sac. M-mode tracing through the embryo
documents a heart rate of 100 beats per minute. These findings are
consistent with gestational age of 6.0 weeks.
Mean sac diameter in early pregnancy. A, Coronal image of intrauterine gestational sac measuring
approximately 15 mm in transverse diameter and 9 mm in anteroposterior diameter (calipers). B,
Longitudinal view of gestational sac with sagittal measurement of approximately 11 mm. The mean
sac diameter of this pregnancy is 12 mm.
Crown-rump length measurement.
Sonogram of fetus in gestation sac with
crown-rump length measured (calipers).
The yolk sac (arrow) is visible adjacent to
the fetus, not included in the crown-rump
length measurement
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SECOND AND THIRD TRIMESTER DATING
Measurements

The most commonly used measurements for

gestational age assignment are : HC = 1.62 × (BPD+OFD)
• biparietal diameter (BPD)
• occipitofrontal diameter (OFD)
Corrected BPD = square root of [(BPD×OFD) 1.265]
• head circumference (HC)
• abdominal diameter (AD) AC = 1.57 × (anteroposterior AD+ transverse AD)
• abdominal circumference (AC)
• femur length (FL)

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Head measurements.
A, Axial image of fetal head at the level of the
paired thalami (arrows), third ventricle, and
cavum septum pellucidum (arrowhead), with
biparietal diameter (calipers 1) and
occipitofrontal diameter (calipers 2) measured. B,
Head circumference measured with elliptical
caliper tracing (dotted line) on the same image
used to measure the biparietal and
occipitofrontal diameters.
Diagram demonstrating anatomy at the level of appropriate measurement of the fetal
biparietal diameter (A) and head circumference (B). CP, choroid plexus; CSP, cavum
septum pellucidum; F, falx; T, thalami.
Abdominal diameter and circumference measurements. A, Axial image of the fetal abdomen at the level
of the stomach (S) and intrahepatic portion of the umbilical vein (arrow) where it joins the left portal vein
with the anteroposterior diameter (calipers 1) and transverse diameter (calipers 2) measured. B, Axial
image of another fetal abdomen with the abdominal circumference measured with elliptical caliper tracing
(dotted line). S, stomach.
Diagram demonstrating anatomy at the level of appropriate
measurement of the fetal abdominal circumference.
PV, right portal vein; Sp, spine; St, stomach; UV, umbilical vein.
Femur length measurement. Sonogram
of femur with ossified diaphysis
measured (calipers).
The linear projection from the diaphysis
of the femoral epiphysis (arrow) is not
included in the measurement.
Radiograph
(A) from a term neonatal autopsy
specimen and illustration (B) of the femur.
Sonographic measurements of the
“femur” include only the ossified portion
of the diaphysis (D) and metaphysis (M).
The cartilaginous femoral head (FH),
greater trochanter (GT), and distal
epiphysis (DE) are not included in the
measurement. When it ossifies, the distal
femoral epiphyseal (DFE) secondary
ossification center is also not included in
the measurement.
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Assigning Gestational Age in the Second

and Third Trimesters

In the second and third trimesters, gestational age can be assigned based on a single
measurement, such as the BPD, corrected BPD, HC, or FL or on a combination of
measurements, such as with composite age formulas

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FETAL WEIGHT ESTIMATION AND WEIGHT PERCENTILES

• Fetal weight is estimated using a formula based on fetal measurements.
• Each formula was developed using a population of fetuses scanned close
to the time of delivery by assessing the sonographic measurements in
relation to birth weight
• Determining the weight percentile, once the gestational age has been
established and the fetal weight estimated, is accomplished using
published formulas or tables
• Estimating fetal size for gestational age via weight percentile is best
performed in the latter part of the second trimester and during the third
trimester.

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