Hospices Civils de Lyon, Department of Obstetrics and Gynecology, Hôpital Femme Mère Enfant, Université Claude Bernard, Lyon 1, Bron-, Lyon, 69500, France.
Hospices Civils de Lyon, Department of Radiology and Fetal Imaging, Hôpital Femme Mère Enfant, Université Claude Bernard, Lyon 1, Bron-, Lyon, 69500, France.
Prenat Diagn. 2019 Jun;39(7):536-543. doi: 10.1002/pd.5465. Epub 2019 May 29.
To examine the outcome of pregnancy with fetal transverse cerebellar diameter (TCD) below the fifth percentile based on routine second- or third-trimester ultrasonography.
We retrospectively analyzed the outcomes of 12 344 women according to TCD Z scores based on systematic second- or third-trimester ultrasound examination between 2007 and 2015. Information on major malformations, chromosomal anomalies, intrauterine or neonatal demise, and other abnormal findings were collected.
In total, 408 fetuses with small prenatal TCD underwent clinical investigation; 160 major malformations were noted, consisting mainly of neurological or cardiac anomalies (39,2%%). Chromosomal anomalies were reported in 39 (9.5%) and intrauterine or neonatal demise in 41 cases (10%). Major malformations and chromosomal anomalies were found in 46.4% and 10% of fetuses with extremely small TCD (Z score < -2.5), respectively, 31.3% and 12.7% of fetuses with small TCD (Z score between -2.0 and -1.645), and 39.6 % and 7.7% of fetuses with subnormal TCD (Z score between -2.0 and -1.645). Intrauterine or neonatal demise was noted in 22%, 8.8%, and 4.8% of fetuses with extremely small, small, and subnormal TCD, respectively (P < .05). Among intrauterine growth-restricted fetuses, fetal demise or neonatal adverse outcome was reported in 75%, 81.8%, and 18.5%, respectively. Of all the fetuses, 2.2% were lost to follow-up.
A small cerebellar diameter below the fifth percentile is a relevant marker to detect associated anomalies during routine ultrasound examination in the second or third trimester. This is related to a high rate of fetal malformations, chromosomal anomalies, and genetic disorders, regardless of the severity of the cerebellar small size. Small TCD seems to be a prognostic factor for fetal growth restriction. Therefore, when facing a TCD below the fifth percentile, patients should be referred for further sonography and fetal karyotyping.
根据常规的中孕期或晚孕期超声检查，评估小脑横径（TCD）低于第 5 百分位的胎儿妊娠结局。
我们回顾性分析了 2007 年至 2015 年期间系统的中孕期或晚孕期超声检查的 12344 名孕妇的 TCDZ 评分结果。收集了胎儿畸形、染色体异常、宫内或新生儿死亡以及其他异常发现的信息。
共有 408 例产前 TCD 较小的胎儿接受了临床调查；160 例胎儿存在主要畸形，主要为神经或心脏异常（39.2%）。39 例（9.5%）胎儿存在染色体异常，41 例（10%）胎儿发生宫内或新生儿死亡。TCD 极小（Z 评分< -2.5）的胎儿中，分别有 46.4%和 10%的胎儿存在严重畸形和染色体异常，TCD 较小（Z 评分-2.0 至-1.645）的胎儿中，分别有 31.3%和 12.7%的胎儿存在严重畸形和染色体异常，TCD 低于正常（Z 评分-2.0 至-1.645）的胎儿中，分别有 39.6%和 7.7%的胎儿存在严重畸形和染色体异常。TCD 极小、较小和低于正常的胎儿中，分别有 22%、8.8%和 4.8%发生宫内或新生儿死亡（P<.05）。宫内生长受限胎儿中，分别有 75%、81.8%和 18.5%发生胎儿死亡或新生儿不良结局。所有胎儿中，有 2.2%的胎儿失访。
小脑横径低于第 5 百分位是中孕期或晚孕期超声检查时检测相关畸形的一个相关指标。这与胎儿畸形、染色体异常和遗传疾病的高发生率相关，而与小脑体积小的严重程度无关。TCD 较小似乎是胎儿生长受限的预后因素。因此，当 TCD 低于第 5 百分位时，应建议患者进一步行超声检查和胎儿染色体核型分析。
