Normal Ranges of Embryonic Length, Embryonic Heart Rate, Gestational Sac Diameter and Yolk Sac Diameter at 6–10 WeeksPapaioannou G.I. · Syngelaki A. · Poon L.C.Y. · Ross J.A. · Nicolaides K.H.
Harris Birthright Research Centre for Fetal Medicine and Early Pregnancy Unit, King’s College Hospital, London, UK
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Article / Publication Details
Objectives: To construct normal ranges for embryonic crown-rump length (CRL), heart rate (HR), gestational sac diameter (GSD) and yolk sac diameter (YSD) at 6–10 weeks of gestation. Methods: We examined 4,698 singleton pregnancies with ultrasound measurements of CRL, HR, GSD and YSD at 6–10 weeks and CRL at 11–13 weeks resulting in the live birth after 36 weeks of phenotypically normal neonates with birth weight above the 5th centile. Gestational age was derived from CRL at the 11- to 13-week scan using the formula of Robinson and Fleming. Regression analysis was used to establish normal ranges of CRL, fetal HR, GSD and YSD with gestation, and fetal HR, GSD and YSD with CRL. Results: At 6–10 weeks there were significant quadratic associations between CRL, GSD, YSD and gestation and between HR, GSD, YSD and CRL, and a cubic association between HR and gestation. The estimated gestation from CRL was the same as that of Robinson and Fleming for a CRL of 10.2–36.5 mm, but the formula of Robinson and Fleming underestimated the gestation by 1 day for a CRL 7.4–10.2 mm and this increased to 9 days for a CRL of 1 mm. Conclusion: This study established normal ranges for early pregnancy biometry.
© 2010 S. Karger AG, Basel
- Campbell S, Warsof SL, Little D, Cooper DJ: Routine ultrasound screening for the prediction of gestational age. Obstet Gynecol 1985;65:613–620.
- Hall MH, Carr-Hill RA: The significance of uncertain gestation for obstetric outcome. Br J Obstet Gynaecol 1985;92:452–460.
- Geirsson RT, Busby-Earle RM: Certain dates may not provide a reliable estimate of gestational age. Br J Obstet Gynaecol 1991;98:108–109.
- Hoffman CS, Messer LC, Mendola P, Savitz DA, Herring AH, Hartmann KE: Comparison of gestational age at birth based on last menstrual period and ultrasound during the first trimester. Paediatr Perinat Epidemiol 2008;22:587–596.
National Institute for Clinical Excellence. Antenatal Care: Routine Care for the Healthy Pregnant Woman. Clinical Guideline CG62. London, NICE, 2008. http://guidance.nice.org.uk/CG62 (accessed May 6, 2010).
- Robinson HP: Sonar measurement of fetal crown-rump length as means of assessing maturity in first trimester of pregnancy. BMJ 1973;4:28–31.
- Robinson HP, Fleming JE: A critical evaluation of sonar crown rump length measurements. Br J Obstet Gynaecol 1975;82:702–710.
Loughna P, Chitty L, Tony Evans T, Chudleigh T: Fetal size and dating: charts recommended for clinical obstetric practice. Ultrasound 2009;13:161–167.
- Drumm JE, Clinch J, MacKenzie G: The ultrasonic measurement of fetal crown-rump length as a method of assessing gestational age. Br J Obstet Gynaecol 1976;83:417–421.
- Bovicelli L, Orsini LF, Rizzo N, Calderoni P, Pazzaglia FL, Michelacci L: Estimation of gestational age during the first trimester by real-time measurement of fetal crown-rump length and biparietal diameter. J Clin Ultrasound 1981;9:71–75.
- Nelson LH: Comparison of methods for determining crown-rump measurement by real-time ultrasound. J Clin Ultrasound 1981;9:67–70.
- Pedersen JF: Fetal crown-rump length measurement by ultrasound in normal pregnancy. Br J Obstet Gynaecol 1982;89:926–930.
- Hadlock FP, Shah YP, Kanon DJ, Lindsey JV: Fetal crown-rump length: reevaluation of relation to menstrual age (5–18 weeks) with high-resolution real-time US. Radiology 1992;182:501–505.
- Grisolia G, Milano K, Pilu G, Banzi C, David C, Gabrielli S, Rizzo N, Morandi R, Bovicelli L: Biometry of early pregnancy with transvaginal sonography. Ultrasound Obstet Gynecol 1993;3:403–411.
- Verburg BO, Steegers EA, De Ridder M, Snijders RJ, Smith E, Hofman A, Moll HA, Jaddoe VW, Witteman JC: New charts for ultrasound dating of pregnancy and assessment of fetal growth: longitudinal data from a population-based cohort study. Ultrasound Obstet Gynecol 2008;31:388–396.
- McLennan AC, Schluter PJ: Construction of modern Australian first trimester ultrasound dating and growth charts. J Med Imaging Radiat Oncol 2008;52:471–479.
- MacGregor SN, Tamura RK, Sabbagha RE, Minogue JP, Gibson ME, Hoffman DI: Underestimation of gestational age by conventional crown-rump length dating curves. Obstet Gynecol 1987;70:344–348.
- Rossavik IK, Torjusen GO, Gibbons WE: Conceptual age and ultrasound measurements of gestational sac and crown-rump length in in vitro fertilization pregnancies. Fertil Steril 1988;49:1012–1017.
- Vollebergh JHA, Jongsma HW, van Dongen PWJ: The accuracy of ultrasonic measurement of fetal crown-rump length. Eur J Obstet Gynecol Reprod Biol 1989;30:253–256.
- Silva PD, Mahairas G, Schaper AM, Schauberger CW: Early crown-rump length. A good predictor of gestational age. J Reprod Med 1990;35:641–644.
- Koornstra G, Wattel E, Exalto N: Crown-rump length measurements revisited. Eur J Obstet Gynecol Reprod Biol 1990;35:131–138.
- Evans J: Fetal crown-rump length values in the first trimester based upon ovulation timing using the luteinizing hormone surge. Br J Obstet Gynaecol 1991;98:48–51.
- Lasser DM, Peisner DB, Vollebergh J, Timor-Tritsch I: First-trimester fetal biometry using transvaginal sonography. Ultrasound Obstet Gynecol 1993;3:104–108.
- Daya S: Accuracy of gestational age estimation by means of fetal crown-rump length measurement. Am J Obstet Gynecol 1993;168:903–908.
- Guirgis RR, Alshawaf T, Dave R, Craft IL: Transvaginal crown-rump length measurements of 224 successful pregnancies which resulted from gamete intra-Fallopian transfer or in-vitro fertilization. Hum Reprod 1993;8:1933–1937.
- Wisser J, Dirschedl P, Krone S: Estimation of gestational age by transvaginal sonographic measurement of greatest embryonic length in dated human embryos. Ultrasound Obstet Gynecol 1994;4:457–462.
- Coulam CB, Britten S, Soenksen DM: Early (34–56 days from last menstrual period) ultrasonographic measurements in normal pregnancies. Hum Reprod 1996;11:1771–1774.
- Schats R, Jansen CAM, Wladimiroff WT: Embryonic heart activity: appearance and development in early human pregnancy. Br J Obstet Gynaecol 1990;97:989–994.
- Achiron R, Tadmor O, Mashiach S: Heart rate as a predictor of first-trimester spontaneous abortion after ultrasound-proven viability. Obstet Gynecol 1991;78:330–334.
- Yapar EG, Ekici E, Gökmen O: First trimester fetal heart rate measurements by transvaginal ultrasound combined with pulsed Doppler: an evaluation of 1331 cases. Eur J Obstet Gynecol Reprod Biol 1995;60:133–137.
- Falco P, Milano V, Pilu G, David C, Grisolia G, Rizzo N, Bovicelli L: Sonography of pregnancies with first-trimester bleeding and a viable embryo: a study of prognostic indicators by logistic regression analysis. Ultrasound Obstet Gynecol 1996;7:165–169.
- Britten S, Soenksen DM, Bustillo M, Coulam CB: Very early (24–56 days from last menstrual period) embryonic heart rate in normal pregnancies. Hum Reprod 1994;9:2424–2426.
- Tannirandorn Y, Manotaya S, Uerpairojkit B, Tanawattanacharoen S, Wacharaprechanont T, Charoenvidhya D: Reference intervals for first trimester embryonic/fetal heart rate in a Thai population. J Obstet Gynaecol Res 2000;26:367–372.
- Makrydimas G, Sebire NJ, Lolis D, Vlassis N, Nicolaides KH: Fetal loss following ultrasound diagnosis of a live fetus at 6–10 weeks of gestation. Ultrasound Obstet Gynecol 2003;22:368–372.
- Robinson HP, Shaw-Dunn J: Fetal heart rates as determined by sonar in early pregnancy. J Obstet Gynaecol Br Commonw 1973;80:805–809.
- Merchiers EH, Dhont M, De Sutter PA, Beghin CJ, Vandekerckhove DA: Predictive value of early embryonic cardiac activity for pregnancy outcome. Am J Obstet Gynecol 1991;165:11–14.
- Tezuka N, Sato S, Kanasugi H, Hiroi M: Embryonic heart rates: development in early first trimester and clinical evaluation. Gynecol Obstet Invest 1991;32:210–212.
- Wisser J, Dirscheld P: Embryonic heart rate in human dated embryos. Early Hum Dev 1994;37:107–115.
- Lindsay DJ, Lovett IS, Lyons EA, Levi CS, Zheng XH, Holt SC, Dashefsky SM: Yolk sac diameter and shape at endovaginal US: predictors of pregnancy outcome in the first trimester. Radiology 1992;183:115–118.
- Küçük T, Duru NK, Yenen MC, Dede M, Ergün A, Başer I: Yolk sac size and shape as predictors of poor pregnancy outcome. J Perinat Med 1999;27:316–320.
- Crooij MJ, Westhuis M, Schoemaker J, Exalto N: Ultrasonographic measurement of the yolk sac. Br J Obstet Gynaecol 1982;89:931–934.
- Reece EA, Sciosca AL, Pinter E, Hobbins JC, Green J, Mahoney MJ, Naftolin F: Prognostic significance of the human yolk sac assessed by ultrasonography. Am J Obstet Gynecol 1988;159:1191–1194.
- Jauniaux E, Jurkovic D, Henriet Y, Rodesch F, Hustin J: Development of the secondary human yolk sac: correlation of sonographic and anatomical features. Hum Reprod 1991;6:1160–1166.
- Stampone C, Nicotra M, Muttinelli C, Cosmi EV: Transvaginal sonography of the yolk sac in normal and abnormal pregnancy. J Clin Ultrasound 1996;24:3–9.
- Cepni I, Bese T, Ocal P, Budak E, Idil M, Aksu MF: Significance of yolk sac measurements with vaginal sonography in the first trimester in the prediction of pregnancy outcome. Acta Obstet Gynecol Scand 1997;76:969–972.
- Blaas HG, Eik-Nes SH, Bremnes JB: The growth of the human embryo. A longitudinal biometric assessment from 7 to 12 weeks of gestation. Ultrasound Obstet Gynecol 1998;12:346–354.
- Bromley B, Harlow BL, Laboda LA, Benacerraf BR: Small sac size in the first trimester: a predictor of poor fetal outcome. Radiology 1991;178:375–377.
Helman LM, Kobayashi M, Fillisti L, Lavenhar M: Growth and development of the human fetus prior to the twentieth week of gestation. Am J Obstet Gynecol 1969;103:789–900.
- Goldstein I, Zimmer EA, Tamir A, Peretz BA, Paldi E: Evaluation of normal gestational sac growth: appearance of embryonic heartbeat and embryo body movements using the transvaginal technique. Obstet Gynecol 1991;77:885–888.
- Robinson HP: The diagnosis of early pregnancy failure by sonar. Br J Obstet Gynaecol 1975;82:849–857.
Poon LCY, Karagiannis G, Staboulidou I, Shafiei A, Nicolaides KH: Reference range of birth weight with gestation and first-trimester prediction of small for gestation neonates. Prenat Diagn, in press.
- Choong S, Rombauts L, Ugoni A, Meagher S: Ultrasound prediction of risk of spontaneous miscarriage in live embryos from assisted conceptions. Ultrasound Obstet Gynecol 2003;22:571–577.
- Varelas FK, Prapas NM, Liang RI, Prapas IM, Makedos GA: Yolk sac size and embryonic heart rate as prognostic factors of first trimester pregnancy outcome. Eur J Obstet Gynecol Reprod Biol 2008;138:10–13.
- Ivanisević M, Djelmis J, Jalsovec D, Bljajic D: Ultrasonic morphological characteristics of yolk sac in pregnancy complicated with type-1 diabetes mellitus. Gynecol Obstet Invest 2006;61:80–86.
- Berdahl DM, Blaine J, Van Voorhis B, Dokras A: Detection of enlarged yolk sac on early ultrasound is associated with adverse pregnancy outcomes. Fertil Steril 2010;94:1535–1537.
Wladimiroff JW, Seelen JC: Fetal heart action in early pregnancy. Development of fetal vagal function. Eur J Obstet Gynecol 1972;2:55–63.
- Finley JP, Nugent ST: Heart rate variability in infants, children and young adults. J Auton Nerv Syst 1995;51:103–108.
- Oh JS, Wright G, Coulam CB: Gestational sac diameter in very early pregnancy as a predictor of fetal outcome. Ultrasound Obstet Gynecol 2002;20:267–269.
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