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Fetal proximal humeral epiphysis as an indicator of term gestation in different ethnic groups
Deepika Garg1, Peter Homel2, Tinu Hirachan1
1a Department of Obstetrics and Gynecology , Maimonides Medical Center , Brooklyn, New York , USA.
Insights
The proximal humeral epiphysis (PHE) appears as early as 36 weeks gestation and is not consistently present before 40 weeks. Its appearance is independent of ethnic background, aiding in accurate pregnancy dating.
Area of Science:
- Prenatal imaging and fetal development.
- Obstetrics and Gynecology.
- Radiology and medical imaging.
Background:
- Accurate pregnancy dating is crucial for optimal clinical management and fetal well-being.
- The proximal humeral epiphysis (PHE) is a potential ossification center used in fetal assessment.
- Variations in PHE appearance across ethnic groups require investigation.
Purpose of the Study:
- To determine the gestational age of proximal humeral epiphysis (PHE) appearance.
- To assess the consistency of PHE visualization across diverse ethnic populations.
- To evaluate the utility of 3D imaging in visualizing the PHE.
Main Methods:
- A cross-sectional study involving 360 patients and 563 scans of singleton pregnancies.
- Inclusion criteria: well-dated pregnancies between 34 and 40+ weeks gestation.
- Data collected on PHE presence and visualization across different ethnic groups.
Main Results:
- Proximal humeral epiphysis (PHE) was not observed at 34 or 35 weeks gestation.
- PHE was visualized in 2% at 36 weeks, 12% at 37 weeks, 51% at 38 weeks, 75% at 39 weeks, and 100% at 40 weeks.
- PHE visualization rates varied slightly among ethnic groups but showed a consistent increase with gestational age.
Conclusions:
- The appearance of proximal humeral epiphysis (PHE) increases with gestational age.
- PHE is not uniformly present before 40 weeks gestation.
- PHE emergence is observed as early as 36 weeks, irrespective of the patient's ethnic background.
Objectives:
Accurate pregnancy dating is critical for appropriate clinical management. Our aim was to determine the time of appearance of proximal humeral epiphysis (PHE), consistency of its appearance among ethnic groups and whether 3D imaging helps with its visualization.
Methods:
A cross-sectional study was done on 360 patients with 563 scans in different ethnic groups between August 2013 and July 2015. Inclusion criteria were singleton pregnancies (34-40+ weeks of gestation), well dated by <20 weeks sonogram.
Results:
PHE was not seen at 34 (n = 44) or 35 weeks (n = 36) and was present at gestational ages 36 (n = 3), 37 (n = 126), 38 (n = 96), 39 (n = 100) and 40 weeks (n = 28) in 2%, 12%, 51%, 75% and 100%, respectively. PHE was seen in 20 of 50 (60%) African-Americans, 22 of 61 (64%) south Asians, 41 of 72 (57%) Caucasians, 45 of 86 (48%) Hispanics and 41 of 80 (49%) Asians.
Conclusion:
Appearance of PHE did increase with gestational age, prior to 40 weeks, it was not uniformly present and was seen as early as 36 weeks independent of ethnic group.
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