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Spina bifida screening in the first trimester using ultrasound biparietal diameter measurement adjusted for

Seshadri Suresh1, Suresh Sudarshan1, Arthi Rangaraj1

  • 1Department of Fetal Medicine, Mediscan Systems and Fetal Care Research Foundation, Chennai, India.

Prenatal Diagnosis
|February 6, 2019
PubMed

Insights

Adjusting biparietal diameter (BPD) for abdominal circumference (AC) significantly improves first-trimester screening for open spina bifida (OSB) compared to using crown-rump length (CRL). This method detects up to two-thirds of cases.

Area of Science:

  • Prenatal diagnosis
  • Fetal medicine
  • Obstetric ultrasound

Background:

  • Open spina bifida (OSB) is a serious neural tube defect.
  • First-trimester ultrasound screening aims to detect fetal anomalies early.
  • Biparietal diameter (BPD) is a common fetal biometric parameter used in screening.

Purpose of the Study:

  • To compare the effectiveness of first-trimester biparietal diameter (BPD) screening for open spina bifida (OSB).
  • To evaluate BPD adjusted for crown-rump length (CRL) versus abdominal circumference (AC).

Main Methods:

  • BPD was expressed as multiples of the normal median (MoM) adjusted for either CRL or AC.
  • Screening performance was evaluated using Mahalanobis distance, detection rates at 5th and 10th percentile cut-offs, and area under the receiver-operator characteristic curve (AUC).
  • A cohort of 63 OSB cases and 24,265 unaffected pregnancies was analyzed.

Main Results:

  • BPD adjusted for AC showed a higher Mahalanobis distance (1.69 vs. 1.14) compared to adjustment for CRL.
  • Detection rates for OSB were higher when using AC adjustment (59-63%) versus CRL adjustment (41-51%) at standard cut-offs.
  • The area under the receiver-operator characteristic curve (AUC) was significantly higher for AC-adjusted BPD (0.872) than for CRL-adjusted BPD (0.735).

Conclusions:

  • Adjusting biparietal diameter (BPD) for abdominal circumference (AC) is superior to using crown-rump length (CRL) for first-trimester open spina bifida (OSB) screening.
  • This optimized method can detect a substantial proportion (half to two-thirds) of OSB cases in the first trimester.
Abstract

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