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Fetal and perinatal outcome associated with small cerebellar diameter based on second‐ or third‐trimester ultrasonography
Author(s) -
Atallah Anthony,
Guibaud Laurent,
Gaucherand Pascal,
Massardier Jerome,
des Portes Vincent,
Massoud Mona
Publication year - 2019
Publication title -
prenatal diagnosis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.956
H-Index - 97
eISSN - 1097-0223
pISSN - 0197-3851
DOI - 10.1002/pd.5465
Subject(s) - medicine , fetus , obstetrics , pregnancy , ultrasound , intrauterine growth restriction , radiology , biology , genetics
Objective To examine the outcome of pregnancy with fetal transverse cerebellar diameter (TCD) below the fifth percentile based on routine second‐ or third‐trimester ultrasonography. Methods 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. Results 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. Conclusion 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.