Fetal Transcerebellar Diameter to Abdominal Circumference Ratio (TCD/AC) in the Assessment of Normal Fetal Growth

Dhumale, Hema; Pujar, Yeshita; Shravage, Jyotsana C; Bellad, MB; Sherigar, Bhavana; Durdi, Geeta; Amber, Sheetal S

doi:10.5005/jp-journals-10009-1166

Cited by 6 publications

(7 citation statements)

References 10 publications

(23 reference statements)

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“…23 Dhumale et al have also assessed normal fetal growth with TCD/AC ratio and gestational ratio ranging from 18 to 34 weeks and found to be constant with a mean of 13.56±1.21 (SD). 24 The study findings was found to be consistent with the findings of the Meyer et al 25 On comparing various parameters of HC/AC in diagnosing asymmetrical IUGR with various studies like Belizan et al showed elevated cut off values with 82% sensitivity, 94% specificity, 62% positive predictive value and 98% negative predictive value. 26 The study findings of PPV was found to be contradictory with the findings of Divon et al, Meyer et al and Kurjak et al with positive predictive values of 67%, 75.6% and 80% respectively.…”

Section: Apgar Scoresupporting

confidence: 86%

Efficacy of trans-cerebellar diameter/abdominal circumference ratio versus head circumference/abdominal circumference ratio in prediction of asymmetrical intrauterine growth retardation

Maryi¹,

Indirani

Vinothkumar

2022

Int J Reprod Contracept Obstet Gynecol

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Background: Determination of gestational age is an important step of pregnancy management and foetal development evaluation in obstetrics. Any error in this gestational age estimation results in prematurity or post maturity and in case if the expected date of delivery is not known, there is high chance of perinatal mortality in the near outcome. Hence it is important in achieving an uneventful gestation to have a sensitive, specific and age independent obstetric biometric parameter that stays constant throughout the gestation. Trans-cerebellar diameters (TCD)/ abdominal circumference (AC) ratio are reliable, constant predictors to assess the gestational age and to evaluate fetal growth. Aim was to compare the accuracy of TCD/ AC ratio with head circumference (HC)/ AC ratio in predicting asymmetrical IUGR.Methods: A prospective study was conducted over a period of one year on 100 clinically suspected IUGR pregnancies who were evaluated with BPD, HC, AC and FL along with TCD were measured for assessing the sonological gestational age. Two morphometric ratios-TCD/AC and HC/AC were calculated. Estimated fetal weight was calculated for all these pregnancies and its percentile was determined. Then those clinically suspected IUGR cases were followed up to delivery and post-delivery new Ballord score and CAN score (clinical assessment of nutritional status at birth) were calculated.Results: In the present study, the sensitivity, specificity, PPV, NPV and DA were 83.93%, 65.91%, 75.81%, 76.32% and 76% respectively for TCD/AC ratio versus respectively for HC/AC ratio in predicting IUGR. Conclusions: Both ratios were gestational age independent and can be used in detecting IUGR with good diagnostic accuracy. However, TCD/AC ratio had a better diagnostic validity and accuracy compared to HC/AC ratio in predicting asymmetric IUGR.

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Section: Apgar Scoresupporting

confidence: 86%

Efficacy of trans-cerebellar diameter/abdominal circumference ratio versus head circumference/abdominal circumference ratio in prediction of asymmetrical intrauterine growth retardation

Maryi¹,

Indirani

Vinothkumar

2022

Int J Reprod Contracept Obstet Gynecol

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“…These results are consistent with the regression results, where the AUC was also low. Comparing the diagnostic value of previous and current cutoff data, the significance is inconclusive and difficult to compare with other studies due to smaller case numbers and different cutoff values [15,17,26,[33][34][35]. The diverse populations studied could explain the variance between TCD/AC ratios, resulting in differing cutoff values.…”

Section: Discussionmentioning

confidence: 88%

“…TCD/AC ratio: In theory, the TCD/AC-ratio is a perfect parameter for the detection of FGR, as chronic fetal hypoxia affects the TCD less than other biometric parameters and the AC is a more sensitive parameter for fetal growth than BPD or FL. This is particularly the case in fetuses of uncertain gestational age, as the TCD/AC ratio remained relatively constant throughout gestation [ 13 , 14 , 17 , 33 , 34 ]. In a prospective study of 825 low-risk pregnancies and 158 pregnancies at risk of growth retardation, Meyer et al demonstrated that the TCD/AC ratio has a high sensitivity (83.9%) for SGA and noted that the TCD/AC ratio is an accurate, gestational-age-independent method of identifying SGA infants [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…Both are affected by fetal malnutrition [ 12 ]. In addition, several authors have suggested that the ratio of transcerebellar diameter/AC (TCD/AC) is a suitable method for assessing fetal growth, especially in FGR [ 10 , 13 , 14 , 15 , 16 , 17 ]. HC/AC is another ratio and compares the preserved organ in the malnourished fetus to its most vulnerable organ and is of considerable value in identifying asymmetrical growth restricted fetuses [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

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Fetal Growth Restriction: Comparison of Biometric Parameters

Marchand

Köppe²,

Köster³

et al. 2022

JPM

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The aim of this study was to identify growth-restricted fetuses using biometric parameters and to assess the validity and clinical value of individual ultrasound parameters and ratios, such as transcerebellar diameter/abdominal circumference (TCD/AC), head circumference/abdominal circumference (HC/AC), and femur length/abdominal circumference (FL/AC). In a retrospective single-center cross-sectional study, the biometric data of 9292 pregnancies between the 15th and 42nd weeks of gestation were acquired. Statistical analysis included descriptive data, quantile regression estimating the 10th and 90th percentiles, and multivariable analysis. We obtained clinically noticeable results in predicting small-for-gestational-age (SGA) and fetal growth restriction (FGR) fetuses at advanced weeks of gestation using the AC with a Youden index of 0.81 and 0.96, respectively. The other individual parameters and quotients were less suited to identifying cases of SGA and FGR. The multivariable analysis demonstrated the best results for identifying SGA and FGR fetuses with an area under the curve of 0.95 and 0.96, respectively. The individual ultrasound parameters were better suited to identifying SGA and FGR than the ratios. Amongst these, the AC was the most promising individual parameter, especially at advanced weeks of gestation. However, the highest accuracy was achieved with a multivariable model.

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“…Several studies demonstrated good correlation between TCD and AC [8]. Many studies have shown that TCD/AC ratio is a stable, gestational age independent parameter after 20 weeks of gestation [9,10]. Increased TCD/AC values are suspicious of fetal growth restriction [3,11] and may be useful in the early detection of fetal IUGR.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Transcerebellar Diameter/ Abdominal Circumference Versus Head Circumference/Abdominal Circumference in Predicting Asymmetric Intrauterine Growth Retardation

Bhimarao

Nagaraju

Bhat

et al. 2015

JCDR

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Background: The high incidence of IUGR and its low recognition lead to increasing perinatal morbidity and mortality for which prediction of IUGR with timely management decisions is of paramount importance. Many studies have compared the efficacy of several gestational age independent parameters and found that TCD/AC is a better predictor of asymmetric IUGR. Aim:To compare the accuracy of transcerebellar diameter/ abdominal circumference with head circumference/abdominal circumference in predicting asymmetric intrauterine growth retardation after 20 weeks of gestation. Materials and Methods:The prospective study was conducted over a period of one year on 50 clinically suspected IUGR pregnancies who were evaluated with 3.5 MHz frequency ultrasound scanner by a single sonologist. BPD, HC, AC and FL along with TCD were measured for assessing the sonological gestational age. Two morphometric ratios-TCD/AC and HC/AC were calculated.Estimated fetal weight was calculated for all these pregnancies and its percentile was determined. Statistical Methods:The TCD/AC and HC/AC ratios were correlated with advancing gestational age to know if these were related to GA. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy (DA) for TCD/AC and HC/AC ratios in evaluating IUGR fetuses were calculated. Results:In the present study, linear relation of TCD and HC in IUGR fetuses with gestation was noted. The sensitivity, specificity, PPV, NPV & DA were 88%, 93.5%, 77.1%, 96.3% & 92.4% respectively for TCD/AC ratio versus 84%, 92%, 72.4%, 95.8% & 90.4% respectively for HC/AC ratio in predicting IUGR. Conclusion:Both ratios were gestational age independent and can be used in detecting IUGR with good diagnostic accuracy. However, TCD/AC ratio had a better diagnostic validity and accuracy compared to HC/AC ratio in predicting asymmetric IUGR.

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Fetal Transcerebellar Diameter to Abdominal Circumference Ratio (TCD/AC) in the Assessment of Normal Fetal Growth

Cited by 6 publications

References 10 publications

Efficacy of trans-cerebellar diameter/abdominal circumference ratio versus head circumference/abdominal circumference ratio in prediction of asymmetrical intrauterine growth retardation

Efficacy of trans-cerebellar diameter/abdominal circumference ratio versus head circumference/abdominal circumference ratio in prediction of asymmetrical intrauterine growth retardation

Fetal Growth Restriction: Comparison of Biometric Parameters

Efficacy of Transcerebellar Diameter/ Abdominal Circumference Versus Head Circumference/Abdominal Circumference in Predicting Asymmetric Intrauterine Growth Retardation

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