Gestational age assessment by ultrasound cerebellar measurements in fetal and perinatal deaths
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Updated: Jul 22, 2026
Murine Fetal Echocardiography
Published on: February 15, 2013
Núria Peñuelas1, Adela Saco1, Lorena Marimón2
1ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.
Insights
Postmortem ultrasound of the cerebellum accurately estimates fetal gestational age, aiding in distinguishing prematurity from growth restriction. This method is feasible and reliable, especially in resource-limited settings.
Area of Science:
- Medical Imaging
- Perinatology
- Forensic Pathology
Background:
- Perinatal mortality rates are high in low- and middle-income countries.
- Accurate gestational age assessment is vital for differentiating prematurity and intrauterine growth restriction, which require distinct management strategies.
- While cerebellar ultrasound is accurate for in-vivo gestational age assessment, its postmortem utility was unexamined.
Purpose of the Study:
- To determine the feasibility and validity of estimating gestational age in fetal and perinatal deaths using postmortem cerebellar ultrasound measurements.
- To assess the accuracy of extrauterine cerebellar measurements compared to intrauterine and autopsy-based assessments.
Main Methods:
- An observational, cross-sectional study involving 137 fetal and perinatal deaths.
- Postmortem cerebellar ultrasound measurements (transcerebellar diameter, vermis height, vermis length) were performed.
- Correlations between extrauterine, intrauterine, and autopsy measurements were analyzed, along with the relationship between extrauterine measurements and gestational age.
Main Results:
- A high correlation was found between all cerebellar measurements (extrauterine, intrauterine, autopsy) and gestational age (P<.001).
- Extrauterine transcerebellar diameter was the strongest predictor of gestational age (R²=0.88, P<.001).
- Accuracy was unaffected by gestational trimester, intrauterine growth restriction, or central nervous system abnormalities.
Conclusions:
- Postmortem ultrasound of the cerebellum, particularly transcerebellar diameter, is a feasible and accurate method for determining gestational age.
- This technique can enhance postmortem assessments, improving cause of death attribution, especially in resource-constrained environments.
Background:
Perinatal mortality remains high in low- and middle-income countries. Accurate assessment of fetal gestational age is crucial to distinguish between prematurity and intrauterine growth restriction, 2 conditions commonly associated with perinatal mortality that require different preventive strategies and management. Ultrasound measurements of the cerebellum have been shown to be accurate in assessing gestational age during pregnancy, but their postmortem performance has not yet been evaluated.
Objective:
We aimed to explore the feasibility and validity of gestational age estimation in fetal and perinatal deaths by ultrasound measurements of the cerebellum.
Study Design:
This is an observational cross-sectional study. Between August 2020 and November 2022 postmortem cerebellar ultrasound measurements were conducted in a tertiary referral hospital in Barcelona, Spain. Extrauterine assessment included transcerebellar diameter, cerebellar vermis height, and cerebellar vermis length. Moreover, intrauterine ultrasound and autopsy direct cerebellar assessments were undertaken in a subset of cases. A total of 137 fetal and perinatal deaths [63 (46.0%) fetal deaths, 69 (50.4%) stillbirths, and 5 (3.6%) neonates] were included. First, we correlated different types of transcerebellar diameter measurements between them (intrauterine, extrauterine, and autopsy-based). Then, we evaluated the relationship between the extrauterine cerebellar ultrasound measurements and gestational age, and their performance across trimesters of gestation and in different central nervous system abnormalities.
Results:
Gestational age ranged from 15.2 to 40.6 weeks. High correlation was observed between extrauterine, intrauterine, and autopsy transcerebellar measurements (P<.001) and between all extrauterine cerebellar measurements and gestational age (P<.001). Extrauterine transcerebellar diameter was identified as the strongest predictor of gestational age (coefficient of determination=0.88; P<.001), and its accuracy was not affected by the trimester of gestation, intrauterine growth restriction, or central nervous system alterations.
Conclusion:
This study shows the feasibility and accuracy of postmortem gestational age evaluation by extrauterine ultrasound measurements of the cerebellum, especially of transcerebellar diameter. Implementation of this method as part of postmortem assessment could improve cause of death attribution, especially in resource-constrained settings.
