Füsun VAROL, Cem YENER, Havva SÜTÇÜ, Esra ALTAN, Sinan ATEŞ, Cenk SAYIN

MEASUREMENT OF FETAL NASAL BONE LENGTH, PRENASAL THICKNESS AND CORPUS CALLOSUM LENGTH OF FETUSES IN THRACE REGION OF TURKEY

Aim: The nasal bone can be imaged with ultrasonography from the 10th week of pregnancy. In situations where the nasal bone isaplastic or hypoplastic, the risk of chromosomal anomalies increases. Thickening of the prenasal soft tissue is also apparent in the vastmajority of second-trimester fetuses with Down syndrome. In addition to these, corpus callosum is an another fetal structure that can bevisualized from 18th weeks of the gestation by ultrasound. Agenesis or dysgenesis of it is related with neuro-disabilities. In this study ourobjective was to provide reference charts for fetal nasal bone length, prenasal thickness and corpus callosum length obtained byprenatal sonography between 19th and 23rd weeks of pregnancy.Materials and Methods: The medical records of pregnant women who were followed-up in Trakya University School of Medicine,Department of Obstetrics & Gynecology, Division of Perinatology during the time period of 1st of January 2018 to 31st of December2019 were reviewed retrospectively. We studied 167 patients in between 19th and 23rd weeks of pregnancy.Results: Nasal bone length, prenasal thickness and corpus callosum length increased as the gestation proceeded. Mean±SD for nasalbone length, prenasal thickness and corpus callosum length (mm) between 19th and 23rd weeks were 6.65±0.7, 4±0.5, 20.1±1.4respectively.Conclusion: Ultrasound measurements of nasal bone length, prenasal thickness and corpus callosum can be performed within thesecond-trimester anomaly scan, and these measurements appear to be highly necessary because these measurement sensitive forprenatal diagnosis of chromosomal abnormalities and genetic syndromes.

Türkiye’nin Trakya Bölgesi’nde Fetal Nazal Kemik Uzunluk, Prenazal Kalınlık ve Korpus Kallozum Ölçümü

Amaç: Nazal kemik fetüste onuncu haftadan itibaren ultrason ile tespit edilebilir. Nazal kemik aplazisi ya da hipoplazisi durumunda kromozomal anomali riski artar. Prenazal kalınlık artışı da Down sendromlu fetüslerde ikinci trimester sırasında sıklıkla gözlenir. Bunlara ek olarak, korpus kallozum da on sekizinci haftadan itibaren fetüslerde ultrason ile tespit edilebilir. Bu yapının agenezisi ya da disgenezisi nöral bozuklulara sebep olur. Bu çalışmada on dokuz ile yirmi üçüncü hafta arasındaki fetüslerde nazal kemik uzunluğu, prenazal kalınlık ve korpus kallozum uzunluğu için nomogram hazırlamayı amaçladık. Materyal ve Metot: 1 Aralık 2018 ile 31 Aralık 2019 tarihleri arasında Trakya Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Kliniği Perinatoloji Polikliniğinde tarafımızca takip edilen gebelerin dosyaları incelendi. Çalışmaya 19 ile 23 gebelik hafta arasındaki 167 hasta alındı. Bulgular: Nazal kemik uzunluğu, prenazal kalınlık ve korpus kallozum uzunluğu gebelik haftası ilerledikçe artmış gözlendi. Nazal kemik uzunluğu, prenazal kalınlık ve korpus kallozum (mm) uzunluğu için Mean±SD sırasıyla 6.65±0.7, 4±0.5, 20.1±1.4 bulundu. Sonuç: İkinci trimester ultrason muayenesi sırasında nazal kemik uzunluğu, prenazal kalınlık ve korpus kallozum uzunluğu ölçülebilir. Bu ölçümler kromozomal anomaliler ve genetik hastalıkların prenatal tanısında önemlidir.

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1. Rembouskos G, Cicero S, Longo D, Vandecruys H, Nicolaides KH. Assessment of the fetal nasal bone at 11-14 weeks of gestation by three-dimensional ultrasound. Ultrasound Obstet Gynecol. 2004;23(3):232-6.

2. Alldred SK, Takwoingi Y, Guo B, Pennant M, Deeks JJ, Neilson JP, et al. First trimester ultrasound tests alone or in combination with first trimester serum tests for Down's syndrome screening. Cochrane Database Syst Rev. 2017;3(3):CD012600.

3. Agathokleous M, Chaveeva P, Poon LC, Kosinski P, Nicolaides KH. Meta-analysis of second-trimester markers for trisomy 21. Ultrasound Obstet Gynecol. 2013;41(3):247-61.

4. Persico N, Borenstein M, Molina F, Azumendi G, Nicolaides KH. Prenasal thickness in trisomy-21 fetuses at 16-24 weeks of gestation. Ultrasound Obstet Gynecol. 2008;32(6):751-4.

5. Liberati M, Melchiorre K, D'Emilio I, Guanciali-Franchi PE, Iezzi I, Rotmensch S, et al. Fetal facial profile in Pallister-Killian syndrome. Fetal Diagn Ther. 2008;23(1):15-.

6. Craven I, Bradburn MJ, Griffiths PD. Antenatal diagnosis of agenesis of the corpus callosum. Clin Radiol. 2015;70(3):248- 53.

7. Malinger G, Zakut H. The corpus callosum: normal fetal development as shown by transvaginal sonography. AJR Am J Roentgenol. 1993;161(5):1041-1043.

8. Paladini D, Pastore G, Cavallaro A, Massaro M, Nappi C. Agenesis of the fetal corpus callosum: sonographic signs change with advancing gestational age. Ultrasound Obstet Gynecol. 2013;42(6):687-90.

9. Narayani BH, Radhakrishnan P. Mid-second Trimester Measurement of Nasal Bone Length in the Indian Population. J Obstet Gynaecol India. 2013;63(4):256-9.

10. Kanagawa T, Fukuda H, Kinugasa Y, Son M, Shimoya K, Murata Y, et al. Mid-second trimester measurement of fetal nasal bone length in the Japanese population. J Obstet Gynaecol Res. 2006;32(4):403-7.

11. Yang PY, Wu JL, Yeh GP, Tsung-Che Hsieh C. Three-dimensional ultrasonography measurement of fetal nasal bone length during the midtrimester in Taiwanese women. Taiwan J Obstet Gynecol. 2012;51(3):354-8.

12. Altunkeser A, Körez MK. Reference ranges for foetal nasal bone length, prenasal thickness, and interocular distance at 18 to 24 weeks' gestation in low-risk pregnancies. BMC Pregnancy Childbirth. 2017;17(1):416.

13. Goynumer G, Arisoy R, Yayla M, Erdogdu E, Ergin N. Fetal nasal bone length during the second trimester of pregnancy in a Turkish population. Eur J Obstet Gynecol Reprod Biol. 2014;176:96-8.

14. Bromley B, Lieberman E, Shipp TD, Benacerraf BR. Fetal nose bone length: a marker for Down syndrome in the second trimester. J Ultrasound Med. 2002;21(12):1387-1394.

15. Cusick W, Provenzano J, Sullivan CA, Gallousis FM, Rodis JF. Fetal nasal bone length in euploid and aneuploid fetuses between 11 and 20 weeks' gestation: a prospective study. J Ultrasound Med. 2004;23(10):1327-33.

16. Maymon R, Levinsohn-Tavor O, Cuckle H, et al. Second trimester ultrasound prenasal thickness combined with nasal bone length: a new method of Down syndrome screening. Prenat Diagn. 2005;25(10):906-11.

17. De Jong-Pleij EA, Vos FI, Ribbert LS, Pistorius LR, Tromp E, Bilardo CM. Prenasal thickness-to-nasal bone length ratio: a strong and simple second- and third-trimester marker for trisomy 21. Ultrasound Obstet Gynecol. 2012;39(2):185-90.

18. Szabó A, Szili K, Szabó JT, Sikovanyecz J, Isaszegi D, Horváth E, et al. Nasal bone length: prenasal thickness ratio: a strong 2D ultrasound marker for Down syndrome. Prenat Diagn. 2014;34(12):1139-45.

19. Luders E, Thompson PM, Toga AW. The development of the corpus callosum in the healthy human brain. J Neurosci. 2010;30(33):10985-90.

20. Jeret JS, Serur D, Wisniewski K, Fisch C. Frequency of agenesis of the corpus callosum in the developmentally disabled population as determined by computerized tomography. Pediatr. Neurosurg. 1985;12:101-3.

21. Moutard ML, Kieffer V, Feingold J, Kieffer F, Lewin F, Adamsbaum C, et al. Agenesis of corpus callosum: prenatal diagnosis and prognosis. Childs Nerv Syst. 2003;19(7-8):471-6.

22. Govil-Dalela T, Kumar A, Agarwal R, Chugani HT. Agenesis of the Corpus Callosum and Aicardi Syndrome: A Neuroimaging and Clinical Comparison. Pediatr Neurol. 2017;68:44-48.e2.

23. Romaniello R, Marelli S, Giorda R, Bedeschi MF, Bonaglia MC, Arrigoni F, et al. Clinical Characterization, Genetics, and Long-Term Follow-up of a Large Cohort of Patients With Agenesis of the Corpus Callosum. J Child Neurol. 2017 Jan;32(1):60-71.

24. Santo S, D'Antonio F, Homfray T, Rich P, Pilu G, Bhide A, et al. Counseling in fetal medicine: agenesis of the corpus callosum. Ultrasound Obstet Gynecol. 2012;40(5):513-21.

25. Achiron R, Achiron A. Development of the human fetal corpus callosum: a high-resolution, cross-sectional sonographic study. Ultrasound Obstet Gynecol. 2001;18(4):343-347.

26. Zhang HC, Yang J, Chen ZP, Ma XY. Sonographic study of the development of fetal corpus callosum in a Chinese population. J Clin Ultrasound. 2009;37(2):75-7.