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Das S, Sharma C, Yadav T, Dubey K, Shekhar S, Singh P, Singh K, Gothwal M, Jhirwal M, Shekhawat DS. Absent or hypoplastic nasal bone: What to tell the prospective parents? Birth Defects Res 2024; 116:e2348. [PMID: 38801241 DOI: 10.1002/bdr2.2348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 02/23/2024] [Accepted: 04/22/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Absent or hypoplastic nasal bone (AHNB) on first or second-trimester ultrasonography (USG) is an important soft marker of Down syndrome. However, due to its varied incidence in euploid and aneuploid fetuses, there is always a dilemma of whether to go for invasive fetal testing for isolated AHNB. This study aims to assess outcomes specifically within the context of Indian ethnicity women. MATERIALS AND METHODS This was a prospective observational study. All patients who reported with AHNB in the first- or second-trimester USG were included. Genetic counseling was done, and noninvasive and invasive testing was offered. Chromosomal anomalies were meticulously recorded, and pregnancy was monitored. RESULTS The incidence of AHNB in our study was 1.16% (47/4051). Out of 47 women with AHNB, the isolated condition was seen in 32 (0.78%) cases, while AHNB with structural anomalies was seen in nine cases (0.22%). Thirty-nine women opted for invasive testing. Six out of 47 had aneuploidy (12.7%), while two euploid cases (4.25%) developed nonimmune hydrops. The prevalence of Down syndrome in fetuses with AHNB was 8.5% (4/47) and 0.42% (17/4004) in fetuses with nasal bone present. This difference was statistically significant (p = .001). CONCLUSION The results indicate that isolated AHNB cases should be followed by a comprehensive anomaly scan rather than immediately recommending invasive testing. However, invasive testing is required when AHNB is associated with other soft markers or abnormalities. As chromosomal microarray is more sensitive than standard karyotype in detecting chromosomal aberrations, it should be chosen over karyotype.
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Affiliation(s)
- Shreya Das
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, Jodhpur, India
| | - Charu Sharma
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, Jodhpur, India
| | - Taruna Yadav
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Kalika Dubey
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, Jodhpur, India
| | - Shashank Shekhar
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, Jodhpur, India
| | - Pratibha Singh
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, Jodhpur, India
| | - Kuldeep Singh
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, India
| | - Meenakshi Gothwal
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, Jodhpur, India
| | - Manisha Jhirwal
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, Jodhpur, India
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Burn SC, Markese A, Bangdiwala A, Gill L, Jacobs K. Fetal Nasal Bone Length in the East African Population. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1007-1012. [PMID: 31791112 DOI: 10.1002/jum.15186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 09/23/2019] [Accepted: 10/30/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To establish normal ranges of fetal nasal bone length throughout gestation in the East African population and to subsequently compare these measurements with the standardized reference. METHODS A retrospective cross-sectional study was performed at the University of Minnesota from January 2011 to December 2016. Fetal nasal bone length measurements were generated in a midsagittal plane at an angle of insonation of 45° from ultrasound images of 1407 nonanomalous fetuses of 1130 mothers of East African decent between 14 and 40 weeks' gestation. The proportion of fetal nasal bone lengths of less than 5.2 mm at week 20 of gestation in the East African population was then compared with the 5% noted by the standardized reference by a χ2 test. RESULTS The fetal nasal bone length increased linearly with advancing gestational age in fetuses of East African mothers (R2 = 0.53; P < .0001). The fetal nasal bone lengths of the East African fetuses were found to be shorter at all ages of gestation compared with the standard reference. At 20 weeks' gestation 17% (95% confidence interval, 13%-22%) of the nasal bone lengths of the East African fetuses were less than 5.2 mm compared with 5% of white and African American fetuses. CONCLUSIONS Using the standard reference may lead to a greater than 3.5-fold overdiagnosis of hypoplastic nasal bones in the East African population. To improve aneuploidy risk stratification and patient counseling in the East African population, the introduction of a standardized East African-based fetal nasal bone length reference seems warranted.
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Affiliation(s)
- Sabrina C Burn
- Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Amy Markese
- Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Obstetrics and Gynecology, University of Colorado, Aurora, Colorado, USA
| | - Ananta Bangdiwala
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Lisa Gill
- Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Katherine Jacobs
- Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, Minnesota, USA
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Jain S, Khanduri S, Khan M, Khan S, Yadav VK, Khan BR, Sagar UF, Rajurkar M. Mid-Second Trimester Measurement of Nasal Bone Length in North Indian Population. J Clin Imaging Sci 2019; 9:14. [PMID: 31448165 PMCID: PMC6702858 DOI: 10.25259/jcis-15-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 03/19/2019] [Indexed: 11/09/2022] Open
Abstract
Objective: Our objective for this study was to establish a reference range of normal fetal nasal bone length (NBL) from 14 to 22 weeks in a North Indian population. Materials and Methods: Pregnant women with gestational age (GA) from 14 to 22 weeks undergoing ultrasonography with a single live fetus and no complications in the fetus or mother were selected for the study. The fetal nasal bone was measured in 2060 pregnant women from 2014 to 2018. The measurement was done by the double operator method; three measurements were taken for each woman when her fetus was in the midsagittal plane, and the nasal bone was located between a 45 and 135° angle to the ultrasound beam. We performed follow-up evaluations of all neonates. Results: The rate of growth of the fetal nasal bone during different weeks of gestation is described by an equation where NBL =0.365×GA+ 2.5885, with a fit estimate of R2 = 0.97, P < 0.001. The median NBL increased with GA from 2.9 mm at 14 weeks to 5.8 mm at 22 weeks in a linear relationship. Our results in the North Indian population are similar to those in the South Indian population and differ from those in Chinese and Japanese populations. Conclusions: The NBL in North Indian fetuses at 14–26 weeks of GA has a linear relationship to the week of gestation.
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Affiliation(s)
- Shreshtha Jain
- Department of Radiodiagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Sachin Khanduri
- Department of Radiodiagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Mazhar Khan
- Department of Radiodiagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Shahla Khan
- Department of Radiodiagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Vivek K Yadav
- Department of Radiodiagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Basmah R Khan
- Department of Radiodiagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Umar Faizan Sagar
- Department of Radiodiagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Mridul Rajurkar
- Department of Radiodiagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
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Du Y, Ren Y, Yan Y, Cao L. Absent fetal nasal bone in the second trimester and risk of abnormal karyotype in a prescreened population of Chinese women. Acta Obstet Gynecol Scand 2017; 97:180-186. [PMID: 29164604 PMCID: PMC5814939 DOI: 10.1111/aogs.13263] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 11/11/2017] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the value of absent fetal nasal bone in the prediction of fetal chromosomal abnormalities, according to whether it was associated with other soft markers or structural abnormalities in a prescreened population of Chinese pregnant women. MATERIAL AND METHODS In this retrospective cohort study, women whose fetuses had absent nasal bone detected during the second trimester ultrasound scan were followed. Fetal karyotyping was performed and pregnancy outcomes were recorded. The association between absent fetal nasal bone with abnormal karyotype was evaluated according to whether soft markers or structural abnormalities were also observed. RESULTS Fetal nasal bone was assessed in 56 707 singleton pregnancies. After exclusion of unqualified cases, 71 (71/56 707, 0.13%) fetuses were included in the final analyses, of which 16 (16/71, 22.54%) were detected to have chromosomal abnormalities, including 12 cases of trisomy-21, three of trisomy-18, and one of micro-deletion (in 7q). Among the 42 cases with isolated absence of nasal bone, two had trisomy-21 and one had a micro-deletion. Absence of nasal bone in association with other structural abnormalities had a higher rate of abnormal karyotypes compared with isolated absence of nasal bone [83.33% (10/12) vs. 7.14% (3/42), Fisher's exact test χ2 = 25.620, p < 0.001]. CONCLUSION Absent fetal nasal bone is a highly specific ultrasonographic soft marker that should be included in the routine second trimester ultrasound scan.
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Affiliation(s)
- Yan Du
- Office of Clinical Epidemiology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Yunyun Ren
- Ultrasound Department, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Yingliu Yan
- Ultrasound Department, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Li Cao
- Ultrasound Department, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
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Tomai XH, Phan TH. Fetal nasal bone length at 19-26 weeks' gestation in Vietnam. J Obstet Gynaecol Res 2016; 42:1245-1249. [PMID: 27307053 DOI: 10.1111/jog.13051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 03/18/2016] [Accepted: 04/11/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Xuan-Hong Tomai
- Department of Obstetrics and Gynaecology, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam.
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Papasozomenou P, Athanasiadis AP, Zafrakas M, Panteris E, Loufopoulos A, Assimakopoulos E, Tarlatzis BC. Fetal nasal bone length in the second trimester: comparison between population groups from different ethnic origins. J Perinat Med 2016; 44:229-35. [PMID: 25503860 DOI: 10.1515/jpm-2014-0296] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 11/10/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare normal ranges of ultrasonographically measured fetal nasal bone length in the second trimester between different ethnic groups. METHOD A prospective, non-interventional study in order to establish normal ranges of fetal nasal bone length in the second trimester in a Greek population was conducted in 1220 singleton fetuses between 18 completed weeks and 23 weeks and 6 days of gestation. A literature search followed in order to identify similar studies in different population groups. Fetal nasal bone length mean values and percentiles from different population groups were compared. RESULTS Analysis of measurements in the Greek population showed a linear association, i.e., increasing nasal bone length with increasing gestational age from 5.73 mm at 18 weeks to 7.63 mm at 23 weeks. Eleven studies establishing normal ranges of fetal nasal bone length in the second trimester were identified. Comparison of fetal nasal bone length mean values between the 12 population groups showed statistically significant differences (P<0.0001). CONCLUSION Normal ranges of fetal nasal bone length in the second trimester vary significantly between different ethnic groups. Hence, distinct ethnic nomograms of fetal nasal bone length in the second trimester should be used in a given population rather than an international model.
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Papasozomenou P, Athanasiadis AP, Zafrakas M, Panteris E, Mikos T, Daniilidis A, Loufopoulos A, Assimakopoulos E, Tarlatzis BC. Screening performance of different methods defining fetal nasal bone hypoplasia as a single and combined marker for the detection of trisomy 21 in the second trimester. J Matern Fetal Neonatal Med 2016; 29:3368-73. [PMID: 26635074 DOI: 10.3109/14767058.2015.1127344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate different methods of defining fetal nasal bone hypoplasia in the second trimester for the detection of trisomy 21. METHODS Prospective study in Greek women undergoing anomaly scan between 18 + 0 and 23 + 6 weeks. The following methods of defining nasal bone hypoplasia were evaluated, either as a single marker or in combination with others: (1) BPD to nasal bone length (NBL) ratio; (2) multiples of the median (MoM) of NBL, according to normal curves from a Greek population; (3-4) NBL < 2.5 percentile according to normal curves (3) commonly used internationally curves and (4) curves from a Greek population. RESULTS In total, 1301 singleton fetuses were evaluated - 10 with trisomy 21. The best detection rate of trisomy 21 was achieved when the applied method was nasal bone percentiles adjusted to maternal ethnicity, in combination with other markers (<2.5 percentile according to normal curves from a Greek population; p < 0.001; sensitivity 50%; specificity 94.8%; false-positive rate 5.2%; positive likelihood ratio 9.6). CONCLUSION Screening performance of fetal nasal bone hypoplasia in detecting trisomy 21 varies according to the method applied. The best screening performance is achieved by using percentiles adjusted to maternal ethnicity in combination with other markers of aneuploidy.
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Affiliation(s)
- Panayiota Papasozomenou
- a 1st Department of Obstetrics and Gynecology , Papageorgiou Hospital, Medical School, Aristotle University of Thessaloniki , Thessaloniki , Greece .,b Prenatal Diagnostic Center of Thessaloniki , Thessaloniki , Greece
| | - Apostolos P Athanasiadis
- a 1st Department of Obstetrics and Gynecology , Papageorgiou Hospital, Medical School, Aristotle University of Thessaloniki , Thessaloniki , Greece .,b Prenatal Diagnostic Center of Thessaloniki , Thessaloniki , Greece
| | - Menelaos Zafrakas
- a 1st Department of Obstetrics and Gynecology , Papageorgiou Hospital, Medical School, Aristotle University of Thessaloniki , Thessaloniki , Greece .,c Research Laboratory , School of Health and Medical Care, Alexander Technological Institute of Thessaloniki , Thessaloniki , Greece , and
| | - Eleftherios Panteris
- c Research Laboratory , School of Health and Medical Care, Alexander Technological Institute of Thessaloniki , Thessaloniki , Greece , and
| | - Themistokles Mikos
- a 1st Department of Obstetrics and Gynecology , Papageorgiou Hospital, Medical School, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Angelos Daniilidis
- d 2nd Department of Obstetrics and Gynecology , Hippokratio Hospital, Medical School, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Aristoteles Loufopoulos
- d 2nd Department of Obstetrics and Gynecology , Hippokratio Hospital, Medical School, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Efstratios Assimakopoulos
- d 2nd Department of Obstetrics and Gynecology , Hippokratio Hospital, Medical School, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Basil C Tarlatzis
- a 1st Department of Obstetrics and Gynecology , Papageorgiou Hospital, Medical School, Aristotle University of Thessaloniki , Thessaloniki , Greece
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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. [PMID: 24613561 DOI: 10.1016/j.ejogrb.2014.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Revised: 02/03/2014] [Accepted: 02/05/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the distribution of fetal nasal bone length (NBL) according to gestational age during the second trimester of pregnancy in a Turkish population. STUDY DESIGN Fetal NBL and other routine biometric measurements were evaluated retrospectively in 2327 fetuses between 15 and 24 weeks of gestation. The measurements were obtained via transabdominal ultrasound. The distribution of fetal NBL between 15 and 24 weeks of gestation was established, and percentiles were calculated. Relationships between fetal NBL and other parameters were assessed using regression analysis. RESULTS Mean (±standard deviation) fetal NBL ranged from 2.95±0.52 at 15 weeks of gestation to 6.26±0.77mm at 24 weeks of gestation. The fifth percentile for fetal NBL was 2.1mm at 15 weeks of gestation and 5.0mm at 24 weeks of gestation. A significant positive correlation was noted between fetal NBL and gestational age (NBL=gestational age×0.37-2.55; R(2)=0.59; p<0.01) and between fetal NBL and biparietal diameter (BPD) (NBL=BPD×0.11-0.33; R(2)=0.61; p<0.01). CONCLUSION Fetal NBL is less in Turkish subjects compared with non-Turkish subjects.
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Affiliation(s)
- G Goynumer
- Medeniyet University Goztepe Education and Research Hospital, Istanbul, Turkey
| | - R Arisoy
- Zeynep Kamil Gynaecologic and Paediatric Training and Research Hospital Department of Perinatology, Istanbul, Turkey.
| | - M Yayla
- International Hospital, Istanbul, Turkey
| | - E Erdogdu
- Zeynep Kamil Gynaecologic and Paediatric Training and Research Hospital Department of Perinatology, Istanbul, Turkey
| | - N Ergin
- International Hospital, Istanbul, Turkey
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Yang X, Zhen L, Pan M, Han J, Li D, Liao C. PT/NBL ratio assessment at mid-trimester in prenatal screening for Down syndrome in a Chinese population. J Matern Fetal Neonatal Med 2014; 27:1860-3. [PMID: 24476348 DOI: 10.3109/14767058.2014.885944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To investigate the ratio of prenasal thickness (PT) to nasal bone length (NBL) in normal and trisomy 21 fetuses in the second and third trimester in Chinese population. METHODS The NBL and PT were measured blindly by using 3D volumes in 143 normal fetuses and 31 trisomy 21 fetuses. RESULTS The mean PT (r = 0.83, p = 0.004) and NBL (r = 0.87, p = 0.0062) both increased with the gestation age, while the PT/NBL ratio (r = 0.12, p > 0.10) remained stable. There was significant difference between normal and trisomy 21 fetuses (p < 0.001). If we took the 95th of the normal fetuses as the cut-off value, the detection rate was only 46%. By using ROC curve to evaluate the screening value of PT/NBL ratio, the area under receiver operating characteristic (ROC) curve was 0.88 (95% confidence interval 0.81 to 0.94, p < 0.0001). CONCLUSIONS In Chinese population, the PT/NBL ratio is not a very strong ultrasound marker to predict trisomy 21 fetuses. However, it can be used as an ultrasound marker for Down syndrome screening during the second and third trimester of pregnancy.
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Affiliation(s)
- Xin Yang
- Prenatal Diagnostic Center, Guangzhou Maternal and Neonatal Hospital , Guangzhou, Guangdong , China
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Sharma A, Tayal T, B H N, Radhakrishnan P, Kaul A. Nasal bone length: the long and short of it. Evaluation of the reference values for the fetal nasal bone length at 16 to 25 weeks of gestational age in an Indian population. Prenat Diagn 2013; 33:800-3. [PMID: 23584923 DOI: 10.1002/pd.4114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 02/27/2013] [Accepted: 03/04/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To establish a reference interval range for the fetal nasal bone length (NBL) in an Indian population. METHODS A retrospective study of antenatal ultrasound records of fetuses at 16 to 25 weeks in singleton pregnancies. NBL, biparietal diameter (BPD) and femur length were noted in 6436 observations of singleton, euploid, nonmalformed pregnancies. RESULTS The 50th centile for NBLs increased from 3.4 to 6.9 mm from 16th to 25th week of gestational age. The relation between nasal bone and gestational age, BPD and femur length were found and noted. The NBLs were found to be shorter when compared with other ethnicities. CONCLUSIONS A reference range for fetal NBLs at 16 to 25 weeks in an Indian population and its relation with fetal biometry was established.
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Affiliation(s)
- Akshatha Sharma
- Apollo Centre for Fetal Medicine, Indraprastha Apollo Hospitals, New Delhi, India
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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 2013; 51:354-8. [PMID: 23040916 DOI: 10.1016/j.tjog.2012.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2012] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate the normal range of the fetal nasal bone length (NBL) in Taiwanese women using three-dimensional (3D) ultrasound, and compare the NBL of normal fetuses with Down syndrome to determine its significance in screening for trisomy 21. MATERIALS AND METHODS A total of 102 consecutive fetuses and another 7 fetuses with trisomy 21, determined by karyotyping at 15-22 weeks' gestation, were evaluated with 3D ultrasound before amniocentesis at Changhua Christian Hospital between November 2003 and April 2004. RESULTS The normal range for NBL in the second trimester in the Taiwanese population was investigated, and a linear relationship with gestational age was noted. The NBL increased with advancing gestational age (NBL in cm=0.0264×gestational age in weeks -0.042 (R(2)=0.2416). The median of the biparietal diameter/nasal bone length ratio had a stable value which tended to change minimally between 15 and 22 weeks of gestation. Chromosomally normal fetuses had statistically longer nasal bones than fetuses with Down syndrome (p=0.014). CONCLUSION We present a reference range for 3D ultrasound measurement of the fetal NBL. A short nasal bone at 15 to 22 weeks is associated with a high risk of trisomy 21.
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Affiliation(s)
- Pei-Yin Yang
- Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan
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Narayani BH, Radhakrishnan P. Mid-second Trimester Measurement of Nasal Bone Length in the Indian Population. J Obstet Gynaecol India 2013; 63:256-9. [PMID: 24431652 DOI: 10.1007/s13224-012-0335-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 12/01/2012] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The purpose of this study was to establish an Indian reference for normal fetal nasal bone length at 16-26 weeks of gestation. METHODS The fetal nasal bone was measured by ultrasound in 2,962 pregnant women at 16-26 weeks of gestation from 2004 to 2009 by a single operator, who performed three measurements for each woman when the fetus was in the midsagittal plane and the nasal bone was between a 45 and 135° angle to the ultrasound beam. All neonates were examined after delivery to confirm the absence of congenital abnormalities. RESULTS The median nasal bone length increased with gestational age from 3.3 mm at 16 weeks to 6.65 mm at 26 weeks in a linear relationship. The fifth percentile nasal bone lengths were 2.37, 2.4, 2.8, 3.5, 3.6, 3.9, 4.3, 4.6, 4.68, 4.54, and 4.91 mm at 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, and 26 weeks, respectively. CONCLUSIONS We have established the nasal bone length in South Indian fetuses at 16-26 weeks of gestation and there is progressive increase in the fifth percentile of nasal bone length with advancing gestational age. Hence, gestational age should be considered while defining hypoplasia of the nasal bone.
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Yanik FF, Eroglu D, Baser E, Dursun P, Kisa Karakaya B. Second trimester fetal nasal bone length in a low-risk Turkish population. Prenat Diagn 2011; 31:962-6. [DOI: 10.1002/pd.2811] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 05/15/2011] [Accepted: 05/16/2011] [Indexed: 11/08/2022]
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Mogra R, Schluter P, Ogle R, Walter M, Borg M, Hyett J. Normal ranges for fetal nasal bone length determined by ultrasound at 18-20 weeks of gestation in a multiethnic Australian population. Aust N Z J Obstet Gynaecol 2011; 51:347-52. [PMID: 21806576 DOI: 10.1111/j.1479-828x.2011.01315.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Absence or hypoplasia of the nasal bone is commonly reported in Down syndrome fetuses. We define normal ranges and the 2.5th centile for fetal nasal bone length (NBL) in a multiethnic Australian population at 18-20 weeks of gestation. METHODS A prospective cohort study of women attending for a routine anomaly scan. Ethnicity of the patient and their partner was recorded, and the nasal bone was measured three times. Two methods of nasal bone assessment were used to define normal ranges: a single (first) measurement and the mean value of three measurements. Mixed-effects regression models were employed to account for interoperator differences treating sonographers as random effects. Nonparametric methods were used to define the 2.5th centile for gestational age. RESULTS A total of 1199 women were included with a mean gestational age 19.1 (SD 0.4; range 18-20) weeks. There is significant linear relationship between NBL and gestational age (P<0.001). The mean of three nasal bone measurements had a smaller standard deviation than single nasal bone measurements. Nonparametric assessment was used to define the 2.5th centile, which is 4.4 mm at 18 weeks and 5.0 mm at 20 weeks of gestation. CONCLUSIONS This study provides a reference range for fetal NBL at 18-20 weeks of gestation in an unselected multiethnic Australian population. Whilst NBL increases linearly from 18 to 20 weeks, the data are not normally distributed and nonparametric techniques are required to define the 2.5th centile. The mixed-effects model also accounts for variation in sonographer measurements.
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Affiliation(s)
- Ritu Mogra
- Department of Obstetric and Gynaecological Ultrasound, Royal Prince Alfred Hospital, and Faculty of Obstetrics and Gynaecology, Central Clinical School, University of Sydney, Sydney, Australia.
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Mogra R, Schluter PJ, Ogle RF, O'Connell J, Fortus L, Hyett JA. A prospective cross-sectional study to define racial variation in fetal nasal bone length through ultrasound assessment at 18-20 weeks' gestation. Aust N Z J Obstet Gynaecol 2010; 50:528-33. [PMID: 21133863 DOI: 10.1111/j.1479-828x.2010.01226.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE An absent or short nasal bone is highly predictive of Down syndrome in Caucasian populations, but Asians may have shorter nasal bones - increasing the false positive rate of screening. We examine differences in nasal bone length (NBL) in Caucasian and Asian populations. METHODS This prospective cohort study involved pregnant women attending for their routine anomaly scan at 18-20 weeks' gestation. Ethnicity of the patient and their partner was recorded, and the nasal bone was measured three times. Mean NBL was calculated and used to investigate the effect of ethnicity first with a simple linear regression model and second with a mixed-effects regression model that accounted for variability of measurement between sonographers. RESULTS A total of 1087 families were involved in the study, including 592 (54%) Caucasians, 214 (20%) East Asians, 110 (10%) South Asians and 171 (16%) West Asians. Twenty-three sonographers performed the scans with an average of 19 scans each. There is no significant difference in NBL between Caucasian and Asian populations. The mixed-effects model shows that accounting for sonographer variation is important, with 6.7% of the total variance in measurement being related to this random effect. CONCLUSIONS There is no significant difference in NBL between Caucasian and Asian populations. It is reasonable to use criteria established in a Caucasian population to define the characteristics of an absent/short nasal bone in Asian fetuses. This finding also removes difficulties in counselling mixed race couples.
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Affiliation(s)
- Ritu Mogra
- Department of Obstetric and Gynaecological Ultrasound, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Normative curves of fetal nasal bone length for the ethnic Chinese population. Ir J Med Sci 2010; 180:73-7. [DOI: 10.1007/s11845-010-0520-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Accepted: 06/22/2010] [Indexed: 11/26/2022]
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Understanding the formation of maxillary sinus in Japanese human foetuses using cone beam CT. Surg Radiol Anat 2010; 32:745-51. [PMID: 20490493 PMCID: PMC2945628 DOI: 10.1007/s00276-010-0678-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Accepted: 05/06/2010] [Indexed: 11/26/2022]
Abstract
The formation of the maxillary sinus (MS) is tied to the maturation of the craniofacial bones during development. The MS and surrounding bone matrices in Japanese foetal specimens were inspected using cone beam computed tomography relative to the nasal cavity (NC) and the surrounding bones, including the palatine bone, maxillary process, inferior nasal concha and lacrimal bone. The human foetuses analysed were 223.2 ± 25.9 mm in crown-rump length (CRL) and ranged in estimated age from 20 to 30 weeks of gestation. The amount of bone in the maxilla surrounding the MS increased gradually between 20 and 30 weeks of gestation. Various calcified structures that formed the bone matrix were found in the cortical bone of the maxilla, and these calcified structures specifically surrounded the deciduous tooth germs. By 30 weeks of gestation, the uncinate process of the ethmoid bone formed a border with the maxilla. The distance from the midline to the maximum lateral surface border of the MS combined with the width from the midline to the maximum lateral surface border of the inferior nasal concha showed a high positive correlation with CRL in Japanese foetuses. There appears to be a complex correlation between the MS and NC formation during development in the Japanese foetus. Examination of the surrounding bone indicated that MS formation influences maturation of the maxilla and the uncinate process of the ethmoid bone during craniofacial bone development.
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Sutthibenjakul S, Suntharasaj T, Suwanrath C, Kor-anantakul O, Geater A. A Thai reference for normal fetal nasal bone length at 15 to 23 weeks' gestation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:49-53. [PMID: 19106356 DOI: 10.7863/jum.2009.28.1.49] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The purpose of this study was to establish a Thai reference for normal fetal nasal bone length at 15 to 23 weeks' gestation. METHODS The fetal nasal bone was measured by sonography in 295 pregnant women at 15 to 23 weeks' gestation from May to August 2005. One of the first 4 authors performed 3 measurements for each woman when the fetus was in the midsagittal plane and the nasal bone was close to a 45 degrees or 135 degrees angle to the ultrasound beam. All neonates were examined after delivery to confirm an absence of congenital abnormalities. RESULTS The median nasal bone length increased by gestational age from 3.6 mm at 15 weeks to 7.3 mm at 23 weeks in a linear relationship. The fifth percentile nasal bone lengths were 2.5, 3.04, 3.28, 3.64, 4.21, 4.82, 5.69, and 6.13 mm at 15, 16, 17, 18, 19, 20, 21, and 22 weeks, respectively. The median time for measurement was 5 minutes. CONCLUSIONS The nasal bone length in Thai fetuses at 15 to 23 weeks was found to be on average shorter than that in white and African American fetuses.
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Affiliation(s)
- Suchin Sutthibenjakul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
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Hung JH, Fu CY, Chen CY, Chao KC, Hung J. Fetal nasal bone length and Down syndrome during the second trimester in a Chinese population. J Obstet Gynaecol Res 2008; 34:518-23. [PMID: 18946935 DOI: 10.1111/j.1447-0756.2008.00747.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of the present study was to build a database of reference ranges of fetal nasal bone length (NBL) in a Chinese population. The accuracy rate of detecting Down syndrome was also analyzed using fetal NBL as a marker. METHODS The control group of fetuses included 342 normal singleton pregnancies with no chromosomal or congenital anomalies. The present study was a cross-section study and the control group was used to construct percentile values of NBL from 13 to 29 gestational weeks of age. Two-dimensional ultrasonography was used for the nasal bone studies. Measurements of NBL were collected and each fetus contributed a single value to the reference sample. During the study period, 14 fetuses with Down syndrome were examined. Measurement of fetal NBL was made during amniocentesis, with gestational age ranging from 13 to 19 weeks. RESULTS From 342 normal fetuses with gestational age ranging from 13 to 29 weeks, reference ranges of NBL were constructed. The reference ranges were constructed from the 100(1 - p)% reference range: Y +/- Zp x square root sigma 2, where Y = 25 - exp(3.58 - 0.044 x t + 0.0006 x t2), with Y being the fitted mean of regression model and t being gestational age (weeks). Using fetal NBL, the regression model was Pr(Down syndrome) = exp(W)/ [1 + exp(W)], where W = 0.62-4.80 x NBL (multiples of the median) in predicting Down syndrome. Fetal NBL was found to have a sensitivity and specificity of 0.78 and 0.78, respectively, in predicting Down syndrome in the second trimester of pregnancy. CONCLUSIONS Fetal NBL measurement can provide a simple and useful algorithm to predict Down syndrome during the second trimester of pregnancy.
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Affiliation(s)
- Jeng-Hsiu Hung
- Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital, Taipei branch, 289 Jianguo Road, Xindian City, Taipei 231, Taiwan.
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Moura FN, Fernandes PL, de Oliveira Silva-Junior G, Gomes de Souza MM, Mandarim-de-Lacerda CA. Nasal bone length in human fetuses by X-ray. Early Hum Dev 2008; 84:459-64. [PMID: 18234459 DOI: 10.1016/j.earlhumdev.2007.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2007] [Revised: 12/11/2007] [Accepted: 12/18/2007] [Indexed: 11/15/2022]
Abstract
BACKGROUND To construct a normal range for the prenatal nasal bone length (NBL) in Brazilians irrespective to the knowledge of the ethnic genetic background. STUDY DESIGN We studied 35 human fetuses (20 males, 15 females) ranging from 14 to 22 weeks of gestation. Gestational age (GA), crown-rump length (CRL), foot length (FL) and body mass (BM) were measured. The X-ray of the head lateral view was made with the specimens placed directly on the film and the NBL was measured. The NBL was correlated with the GA, the CRL, the FL, and the BM using log-transformed data and the allometric model log y=log a+b log x. RESULTS Correlations of the NBL growth with GA, CRL, FL, and BM were positive and significant (P<0.05), but NBL vs. BM showed the smallest R indicating this correlation as of little practical use. No sexual dimorphism in the NBL growth in the second trimester fetuses was observed. The NBL grew with positive allometry relative to GA, CRL and BM, but it was allometrically slightly negative relative to the FL in both genders. The NBL be allometrically positive against GA, CRL and BM means the bone grew with growth rates higher than those indices in the period analyzed, but not against FL. CONCLUSION NBL could be considered an auxiliary measurement in the assessment of the 2nd trimester fetal development because its strong correlation with GA, CRL and FL, even when nothing is known about the ethnicity of the population.
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Affiliation(s)
- Felipe Nobre Moura
- Department of Orthodontics of Dentistry School, Federal University of Rio de Janeiro, Brazil
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