Document Detail

Clinical implications of intra- and inter-observer reproducibility of first trimester measurements performed with transvaginal ultrasound between 6 and 9 weeks gestation.
MedLine Citation:
PMID:  21077156     Owner:  NLM     Status:  Publisher    
OBJECTIVE: To assess intra- and inter-observer agreement of routinely performed measurements used to assess the likelihood of miscarriage in the first trimester of pregnancy: crown-rump length (CRL) and mean gestation sac diameter (MSD) with transvaginal ultrasonography. METHODS: A cross-sectional study of CRL and gestation sac (GS) measurements in first trimester pregnancies was conducted in a fetal medicine referral center with a predominantly Caucasian population. Gestational age (GA) ranged from 6 to 9 weeks. All patients underwent a transvaginal ultrasound examination with high-resolution Voluson E8 equipment. Two measurements of CRL and three diameters of GS were collected from two observers. Agreement within and between observers for CRL and between observers for MSD was analyzed using 95% prediction intervals, 95% limits of agreement in the framework of Bland-Altman plots, and the intra-class correlation coefficient (ICC). RESULTS: In total 54 patients were included in the study. Intra- and inter-observer ICC's were high for the CRL measurement, ranging between 0.992 and 0.993 for intra-observer agreement on 54 patients and 0.993 for inter-observer agreement on 44 patients. For the MSD, inter-observer ICC was 0.952. Limits of agreement were ± 8.91 and ± 11.37 percent of the mean of both measurements for intra-observer CRL and ± 14.64 percent for inter-observer CRL agreement. For MSD, the limits of agreement were ± 18.78%. An MSD measurement of 20 mm by the first observer leads to a range from 16.8 to 24.5 mm for the second observer. For a CRL measurement of 6 mm by the first observer the range for the second observer is 5.4 mm to 6.7 mm. CONCLUSION: For dating purposes, there is reasonable reproducibility for CRL measurements in the first trimester of pregnancy before 9 weeks using transvaginal ultrasonography. When diagnosing miscarriage based on measurements of CRL care must be taken for values around any decision boundary. For MSD, the higher inter-observer variability we have observed has implications for the diagnosis of miscarriage based on measurements of MSD in the absence of a visible embryo or yolk sac. Copyright © 2010 ISUOG. Published by John Wiley & Sons, Ltd.
Anne Pexsters; Jan Luts; Dominique Van Schoubroeck; Cecilia Bottomley; Ben Van Calster; Sabine Van Huffel; Yazan Abdallah; Thomas D'Hooghe; Christoph Lees; Dirk Timmerman; Tom Bourne
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2010-11-12
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:  2010 Nov 
Date Detail:
Created Date:  2010-11-15     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9108340     Medline TA:  Ultrasound Obstet Gynecol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Department of Obstetrics and Gynaecology, University Hospitals, KU Leuven, Belgium.
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