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Biparietal diameter at 11-13 weeks' gestation in fetuses with open spina bifida.
MedLine Citation:
PMID:  23362051     Owner:  NLM     Status:  Publisher    
OBJECTIVE: Studies have suggested that biparietal diameter (BPD), measured at 11-13 weeks' gestation, is reduced in open spina bifida. The aims of this study were to ascertain the reported association between reduced BPD in the first trimester and open spina bifida, and to investigate its predictive value in a single centre study. METHODS: This was a retrospective study in which BPD was measured at 11-13 weeks in 27 fetuses with isolated open spina bifida subsequently diagnosed at 16-24 weeks, and 7,775 unaffected controls. BPD values were converted into multiples of the expected median (MoM), after adjustment for crown-rump length and maternal characteristics. Multivariate logistic regression analysis was used to examine which of the maternal characteristics were significantly associated with spina bifida. The performance of screening was determined by receiver operating characteristic (ROC) curve analysis. BPD values at 11-13 weeks were compared with those measured in the second trimester using Z-scores. RESULTS: BPD values at 11-13 weeks were below the 5(th) centile in 44.4% of cases. In these fetuses, the BPD MoM value was significantly smaller than in the control group (0.930 vs 0.998 MoM, p<0.0001). Multivariate logistic regression analysis showed a significant contribution from maternal age (p=0.008) and BMI (p=0.028) to the association between BPD MoM and spina bifida. The detection rate using the BPD measurements in the first trimester was 55.6% for a false positive rate of 11.6%. In fetuses with open spina bifida, the BPD value Z-scores were significantly lower at 16-24 weeks compared to those recorded at 11-13 weeks [median -1.71 (range -3.98, 2.00) vs -1.30 (-3.75, 2.61), respectively, p=0.006]. CONCLUSION: Fetuses with open spina bifida have a smaller BPD in the first trimester. This property may be useful in early screening. It is likely that a combination of maternal characteristics such as age and BMI, fetal BPD and maternal serum AFP measured in the first trimester would provide a clinically useful screening test for open spina bifida.
Asma Khalil; Amy Coates; Aris Papageorghiou; Amar Bhide; Basky Thilaganathan
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-29
Journal Detail:
Title:  Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology     Volume:  -     ISSN:  1469-0705     ISO Abbreviation:  Ultrasound Obstet Gynecol     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-30     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9108340     Medline TA:  Ultrasound Obstet Gynecol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013 ISUOG. Published by John Wiley & Sons, Ltd.
Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St George's Hospital Medical School, London, UK.
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