Reliability of fetal nasal bone length measurement at 11–14 weeks of gestation

BMC Pregnancy and Childbirth

Savitree Pranpanus¹  Tharangrut Hanprasertpong¹  Thitima Suntharasaj¹  Ounjai Kor-anantakul¹  Ninlapa Pruksanusak¹  Chitkasaem Suwanrath¹ 

[1] Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, THAILAND

关键词: Reproducibility;    Reliability;    First trimester;    Fetal nasal bone;    Ultrasound;   

Others  :  1151308
DOI  :  10.1186/1471-2393-13-7

 received in 2012-03-27, accepted in 2013-01-11,  发布年份 2013

【 摘 要 】

Background

Nasal bone assessment has been incorporated into Down syndrome screening in first trimester. Several studies have established the normal reference values for fetal nasal bone length in the first trimester, which were found to be varied by population. However, the study on reliability of nasal bone length measurement was limited with contradictory results. This study aimed to investigate the reliability of fetal nasal bone length measurement at 11–14 weeks of gestation in the Thai population.

Methods

A total of 111 pregnant women at 11–14 weeks of gestation attending for the routine first-trimester ultrasound examination were recruited. Each case was measured separately by two examiners. Examiner 1 performed the first measurement in all cases; any of the other 5 examiners consecutively performed the second measurement. Three independent measurements were performed by each examiner and they were blinded to the results of the others. Intraobserver and interobserver variabilities were evaluated with the intraclass correlation coefficient (ICC).

Results

Nasal bone measurement was successfully performed in 106/111 cases (95.5%) by at least one examiner; 89 cases were performed by two examiners. The intraobserver variability was excellent for all examiners (ICC, 0.840-0.939). The interobserver variability between different pairs of examiners varied from moderate to excellent (ICC, 0.467-0.962). The interobserver variability between examiner 1 and any other examiner was good (ICC, 0.749). The Bland-Altman plot of the interobserver differences of nasal bone length measurements between examiner 1 and any other examiner showed good agreement.

Conclusions

The reliability of the fetal nasal bone length measurement at 11–14 weeks of gestation was good. The nasal bone length measurement was reproducible. Ethnicity has an effect on fetal nasal bone length, but reliability of nasal bone length measurement is critical to accuracy of screening and should be audited on an ongoing basis.

【 授权许可】

   
2013 Suwanrath et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Spencer K, Spencer CE, Power M, Dawson C, Nicolaides KH: Screening for chromosomal abnormalities in the first trimester using ultrasound and maternal serum biochemistry in a one-stop clinic: a review of three years prospective experience. BJOG 2003, 110:281-286.
• [2]Krantz DA, Hallahan TW, Orlandi F, Buchanan P, Larsen JW Jr, Macri JN: First-trimester Down syndrome screening using dried blood biochemistry and nuchal translucency. Obstet Gynecol 2000, 96:207-213.
• [3]O'Leary P, Breheny N, Dickinson JE, Bower C, Goldblatt J, Hewitt B, Murch A, Stock R: First-trimester combined screening for Down syndrome and other fetal anomalies. Obstet Gynecol 2006, 107:869-876.
• [4]Down LJ: Observation on an ethnic classification of idiots. Clinical lectures and reports. London Hosp 1866, 3:259-262.
• [5]Cicero S, Curcio P, Papageorghiou A, Sonek J, Nicolaides K: Absence of nasal bone in fetuses with trisomy 21 at 11–14 weeks of gestation: an observational study. Lancet 2001, 358:1665-1667.
• [6]Cicero S, Bindra R, Rembouskos G, Spencer K, Nicolaides KH: Integrated ultrasound and biochemical screening for trisomy 21 using fetal nuchal translucency, absent fetal nasal bone, free beta-hCG and PAPP-A at 11 to 14 weeks. Prenat Diagn 2003, 23:306-310.
• [7]Cossi PS, Bussamra LC, Araujo Júnior E, Nardozza LM, Moron AF: Ethnic variation and variability of fetal nasal bone length at 11–15 weeks of gestation in a Brazilian population: preliminary results. Arch Gynecol Obstet 2008, 278:431-435.
• [8]Chen M, Lee CP, Tang R, Chan B, Ou CQ, Tang MH: First-trimester examination of fetal nasal bone in the Chinese population. Prenat Diagn 2006, 26:703-706.
• [9]Ozer A, Ozaksit G, Kanat-Pektas M, Ozer S: First trimester examination of fetal nasal bone in the Turkish population. J Obstet Gynaecol Res 2010, 36:739-744.
• [10]Casasbuenas A, Wong AE, Sepulveda W: First-trimester nasal bone length in a normal Latin American population. Prenat Diagn 2009, 29:108-112.
• [11]Cicero S, Bindra G, Rembouskos G, Tripsanas C, Nicolaides KH: Fetal nasal bone length in chromosomally normal and abnormal fetuses at 11–14 weeks of gestation. J Matern Fetal Neonatal Med 2002, 11:400-402.
• [12]Senat MV, Bernard JP, Boulvain M, Ville Y: Intra- and interoperator variability in fetal nasal bone assessment at 11–14 weeks of gestation. Ultrasound Obstet Gynecol 2003, 22:138-141.
• [13]Bekker MN, Twisk JW, van Vugt JM: Reproducibility of the fetal nasal bone length measurement. J Ultrasound Med 2004, 23:1613-1618.
• [14]Kanellopoulos V, Katsetos C, Economides DL: Examination of fetal nasal bone and repeatability of measurement in early pregnancy. Ultrasound Obstet Gynecol 2003, 22:131-134.
• [15]Nicolaides KH: Nuchal translucency and other first-trimester sonographic markers of chromosomal abnormalities. Am J Obstet Gynecol 2004, 191:45-67.
• [16]Cicero S, Dezerega V, Andrade E, Scheier M, Nicolaides KH: Learning curve for sonographic examination of the fetal nasal bone at 11–14 weeks. Ultrasound Obstet Gynecol 2003, 22:135-137.
• [17]Sonek JD, Cicero S, Neiger R, Nicolaides KH: Nasal bone assessment in prenatal screening for trisomy 21. Am J Obstet Gynecol 2006, 195:1219-1230.
• [18]Malone FD, Ball RH, Nyberg DA, Comstock CH, Saade G, Berkowitz RL, Dugoff L, Craigo SD, Carr SR, Wolfe HM, Tripp T, D’Alton ME: First-trimester nasal bone evaluation for aneuploidy in the general population. Obstet Gynecol 2004, 104:1222-1228.