Fetal Thoracic Circumference*

Age
No. 2.5% 5% 10% 25% 50% 75% 90% 95% 97.5%
(wk)
16

5.9

6.4 7.0

8.0

9.1

17

22 6.8

7.3 7.9

8.9

10.0 11.2 12.2 12.8 13.3

18

31 7.7

8.2 8.8

9.8

11.0 12.1 13.1 13.7 14.2

19

21 8.6

9.1 9.7

10.7 11.9 13.0 14.0 14.6 15.1

20

20 9.5

10.0 10.6 11.7 12.8 13.9 15.0 15.5 16.0

21

30 10.4 11.0 11.6 12.6 13.7 14.8 15.8 16.4 16.9

22

18 11.3 11.9 12.5 13.5 14.6 15.7 16.7 17.3 17.8

23

21 12.2 12.8 13.4 14.4 15.5 16.6 17.6 18.2 18.8

24

27 13.2 13.7 14.3 15.3 16.4 17.5 18.5 19.1 19.7

25

20 14.1 14.6 15.2 16.2 17.3 18.4 19.4 20.0 20.6

26

25 15.0 15.5 16.1 17.1 18.2 19.3 20.3 21.0 21.5

27

24 15.9 16.4 17.0 18.0 19.1 20.2 21.3 21.9 22.4

28

24 16.8 17.3 17.9 18.9 20.0 21.2 22.2 22.8 23.3

29

24 17.7 18.2 18.8 19.8 21.0 22.1 23.1 23.7 24.2

30

27 18.6 19.1 19.7 20.7 21.9 23.0 24.0 24.6 25.1

31

24 19.5 20.0 20.6 21.6 22.8 23.9 24.9 25.5 26.0

32

28 20.4 20.9 21.5 22.6 23.7 24.8 25.8 26.4 26.9

33

27 21.3 21.8 22.5 23.5 24.6 25.7 26.7 27.3 27.8

34

25 22.2 22.8 23.4 24.4 25.5 26.6 27.6 28.2 28.7

35

20 23.1 23.7 24.3 25.3 26.4 27.5 28.5 29.1 29.6

36

23 24.0 24.6 25.2 26.2 27.3 28.4 29.4 30.0 30.6

37

22 24.9 25.5 26.1 27.1 28.2 29.3 30.3 30.9 31.5

38

21 25.9 26.4 27.0 28.0 29.1 30.2 31.2 31.9 32.4

39

26.8 27.3 27.9 28.9 30.0 31.1 32.2 32.8 33.3

40

27.7 28.2 28.8 29.8 30.9 32.1 33.1 33.7 34.2

Measurements in centimeters

10.3 11.3 11.9 12.4

From Chitkara U, Rosenberg J, Chervenak et al. Prenatal sonographic assessment of

the fetal thorax: Normal values. Am J Obstet Gynecol 156:1069, 1987.

Likelihood Ratio of Down Syndrome vs Normal Karyotype with use of Nuchal

Thickness above Expected Value

Change in
Likelihood
Nuchal
Ratio
Thickness (mm)
<0

0.52

0 to <0.5

0.97

0.5 to <1.0

0.95

1.0 to <1.5

1.88

1.5 to <2.0

6.33

>2.0

18.66

Expected Nuchal Thickness = 2.8444 - BPD x 0.0513 + BPD(2) x 0.0015

Likelihood Ratio = % Down syndrome / % Normals with given increased change in
Nuchal Thickness Value
Risk = Maternal Age Risk x Likelihood Ratio eg 1/270 x 1.88 = 1/144
*Risk may be calculated from multiple sonographic markers by multiplying the
likelihood ratios by the maternal age risk eg Maternal Age Risk x Humeral MoM,
Nuchal MoM, Hypoplastic 5th Digit MoM, etc
Adapted from:Bahado-Singh R, Deren O, Oz U, Tan A, Hunter D, Copel J, Mahoney
MJ. An alternative for women initially declining genetic amniocentesis: Individual
Down syndrome odds on the basis of maternal age and multiple ultrasonographic
markers. Am J Obstet Gynecol 179:514-9, 1998.

Ultrasound Criteria and Likelihood Ratios Assigned for Detection of Trisomy 21

Sonographic Finding Criteria

Likelihood Ratio
Assigned

Structural Defect

cardiac defect, cystic hygroma with or without

hydrops, cerebral ventricular dilatation

25

Nuchal Thickening

> 5 mm in the antero-posterior plane

18.6*

Echogenic Bowel

subjectively increased, grades 2 or 3

5.5*

Short Humerus

observed/predicted ratio <= 0.89

2.5

Short Femur

observed/predicted ratio <= 0.91

2.2*

Echogenic
Intracardiac Focus

present or absent

Renal Pyelectasis

> 3 mm in the antero-posterior plane

1.6*

Normal Ultrasound
Scan

none of the above

0.4

Likelihood ratio for each ultrasound marker is defined as: sensitivity / false-positive
rate as an isolated finding.
Asterisk indicates likelihood ratios assigned from data of Snijders RJM, Nicolaides
KH. Ultrasound Markers for Fetal Chromosomal Defects. Carnforth, UK: Parthenon
Publishing, 1996. Remaining data from Nyberg et al's institution.
From: Nyberg DA, Luthy DA, Resta RG, Nyberg BC, Williams MA. Age-adjusted
ultrasound risk assessment for fetal Down's syndrome during the second trimester:
description of the method and analysis of 142 cases. Ultrasound Obstet Gynecol 12:814, 1998.

Likelihood Ratio of Down Syndrome vs Normal Karyotype with use of Humerus

Length (MoM)
Humerus
Length
(Multiples of
Median)

Likelihood
Ratio

0.87

3.27

0.88

2.74

0.89

2.32

0.90

1.98

0.91

1.71

0.92

1.49

0.93

1.31

0.94

1.16

0.95

1.04

0.96

0.94

0.97

0.85

0.98

0.78

0.99

0.72

1.0

0.69

1.1

0.63

1.2

0.59

1.3

0.56

1.4

0.54

1.5

0.52

1.6

0.50

1.7

0.49

1.8

0.47

Expected Median Humerus Length = -6.30134 + BPD x 0.77612

Humerus Length MoM = Measured Humerus Length/Expected Median Value of
Humerus
Risk = Maternal Age Risk x Likelihood Ratio eg 1/270 x 1.49 = 1/181

*Risk may be calculated from multiple sonographic markers by multiplying the

likelihood ratios by the maternal age risk eg Maternal Age Risk x Humeral MoM,
Nuchal MoM, Hypoplastic 5th Digit MoM, etc
Adapted from:Bahado-Singh R, Deren O, Oz U, Tan A, Hunter D, Copel J, Mahoney
MJ. An alternative for women initially declining genetic amniocentesis: Individual
Down syndrome odds on the basis of maternal age and multiple ultrasonographic
markers. Am J Obstet Gynecol 179:514-9, 1998.

Maternal Age Specific Odds of Fetal Down's Syndrome During the 2nd
Trimester Based on Non-Structural Findings

Maternal PreAge
US
Odds

Normal
US
Scan

Inc.
Echogenic Short
Short Echogenic Renal
Nuchal
Bowel
Humerus Femur Intracardiac Pyelectasis
Thickness
Focus

(Years)

(1:_)

(1:_)

(1:_)

(1:_)

(1:_)

(1:_)

(1:_)

(1:_)

20

1176

1960

63

214

511

470

588

735

21

1160

1933

62

211

504

464

580

725

22

1136

1893

61

207

494

454

568

710

23

1114

1857

60

203

484

446

557

696

24

1087

1812

58

198

473

435

544

679

25

1040

1733

56

189

452

416

520

650

26

990

1650

53

180

430

396

495

619

27

928

1547

50

169

403

371

464

580

28

855

1425

46

155

372

342

428

534

29

760

1267

41

138

330

304

380

475

30

690

1150

37

125

300

276

345

431

31

597

995

32

109

260

239

299

373

32

508

847

27

92

221

203

254

318

33

421

702

23

77

183

168

211

263

34

342

570

18

62

149

137

171

214

35

274

457

15

50

119

110

137

171

36

216

360

12

39

94

86

108

135

37

168

280

31

73

67

84

105

38

129

215

23

56

52

65

81

39

98

163

18

43

39

49

61

40

74

123

13

32

30

37

46

41

56

93

10

24

22

28

35

42

42

70

18

17

21

26

43

31

52

13

12

16

19

44

23

38

10

12

14

From: Nyberg DA, Luthy DA, Resta RG, Nyberg BC, Williams MA. Age-adjusted
ultrasound risk assessment for fetal Down's syndrome during the second
trimester: description of the method and analysis of 142 cases. Ultrasound Obstet
Gynecol 12:8-14, 1998.

Estimtes of Maternal age-specific Risks for Trisomy 18 in Presence of Isolated

Choroid Plexus Cyst at Second-trimester Sonography (posterior probabilities)
Risk with
Isolated

Maternal
Age

Maternal Age-Associated base

Risk

20

1 / 4576

1 / 645

1 / 1154 - 1 / 376

21

1 / 4514

1 / 637

1 / 1138 - 1 / 371

22

1 / 4435

1 / 625

1 / 1119 - 1 / 364

23

1 / 4333

1 / 611

1 / 1093 - 1 / 356

24

1 / 4204

1 / 593

1 / 1060- 1 / 332

25

1 / 4045

1 / 570

1 / 1020 - 1 / 332

26

1 / 3850

1 / 543

1 / 971 - 1 / 316

27

1 / 3619

1 / 510

1 / 913 - 1 / 297

28

1 / 3351

1 / 473

1 / 845 - 1 / 275

29

1 / 3050

1 / 430

1 / 769 - 1 / 251

30

1 / 2724

1 / 384

1 / 687 - 1 / 224

31

1 / 2385

1 / 336

1 / 602 - 1 / 196

32

1 / 2046

1 / 289

1 / 516 - 1 / 168

33

1 / 1721

1 / 243

1 / 434 - 1 / 141

34

1 / 1420

1 / 200

1 / 358 - 1 / 117

35

1 / 1152

1 / 162

1 / 291 - 1 / 95

36

1 / 921

1 / 130

1 / 232 - 1 / 76

37

1 / 727

1 / 103

1 / 183 - 1 / 60

38

1 / 567

1 / 80

1 / 143 - 1 / 47

39

1 / 439

1 / 62

1 / 111 - 1 / 36

40

1 / 338

1 / 48

1 / 85 - 1 / 28

41

1 / 258

1 / 36

1 / 65 - 1 / 21

42

1 / 197

1 / 28

1 / 50 - 1 / 16

43

1 / 149

1 / 21

1 / 38 - 1 / 12

44

1 / 113

1 / 16

1 / 28 - 1 / 9

45

1 / 85

1 / 12

1 / 21 - 1 / 7

Choroid Plexus
Cyst

95% Confidence
Interval

From: Ghidini A, Strobelt N, Locatelli A, Mariani E, Piccoli MG, Vergani P. Isolated

fetal choroid plexus cysts: Role of ultrasonography in establishment of the risk of

trisomy 18. Am J Obstet Gynecol 182:972-7, 2000. Copyright 2000 by Mosby Inc.
with permission

Risk Modification based on Sonographic Findings and MultipleMarker Screening

Age-related risk of trisomy 18

Modified Risk

Isolated
Maternal
Choroid Choroid
Age
Unmodified Plexus Plexus
(Yr.)
risk
Cyst* Cyst**

Isolated
Choroid
Plexus
Cyst &
Normal
MMS***

20

1/4576

1/153

1/725

1/1804

21

1/4514

1/151

1/715

1/1779

22

1/4435

1/148

1/703

1/1749

23

1/4333

1/145

1/687

1/1708

24

1/4204

1/141

1/666

1/1658

25

1/4045

1/135

1/641

1/1595

26

1/3850

1/129

1/610

1/1518

27

1/3619

1/121

1/573

1/1427

28

1/3351

1/113

1/531

1/1362

29

1/3053

1/102

1/483

1/1203

30

1/2724

1/92

1/432

1/1074

31

1/2385

1/80

1/378

1/940

32

1/2046

1/69

1/324

1/806

33

1/1721

1/58

1/273

1/679

34

1/1420

1/48

1/225

1/560

35

1/1152

1/39

1/183

1/454

36

1/921

1/32

1/146

1/363

37

1/727

1/25

1/115

1/287

38

1/567

1/20

1/92

1/223

39

1/439

1/16

1/70

1/173

40

1/338

1/12

1/54

1/133

41

1/258

1/10

1/42

1/102

42

1/197

1/8

1/32

1/78

43

1/149

1/6

1/24

1/59

44

1/113

1/5

1/18

1/45

45

1/85

1/4

1/14

1/34

From: Gratton RJ, Hogge WA, Aston CE. Choroid plexus cysts and trisomy 18: Risk
modification based on maternal age and multiple-marker screening. Am J Obstet
Gynecol 175:1493-7, 1996 (Unmodified risk estimates are adapted from Snijders
RJM, Holzgreve W, Cuckle H, Nicolaides KH. Maternal age specific risk for
trisomies at 9-14 weeks gestation. Prenatal Diagn 14:543-52, 1994) MMS= multiplemarker screening
* Age-related risk of trisomy 18 in fetuses with choroid plexus cyst , with or without
other anomalies
**Age-related risk of trisomy 18 in fetuses with isolated choroid plexus cyst
***Age-related risk of trisomy 18 in fetuses with isolated choroid plexus cyst and
normal multiple-marker screen results

Fetal Thoracic Circumference*

Age
No. 2.5% 5% 10% 25% 50% 75% 90% 95% 97.5%
(wk)
16

5.9

6.4 7.0

8.0

9.1

17

22 6.8

7.3 7.9

8.9

10.0 11.2 12.2 12.8 13.3

18

31 7.7

8.2 8.8

9.8

11.0 12.1 13.1 13.7 14.2

19

21 8.6

9.1 9.7

10.7 11.9 13.0 14.0 14.6 15.1

20

20 9.5

10.0 10.6 11.7 12.8 13.9 15.0 15.5 16.0

21

30 10.4 11.0 11.6 12.6 13.7 14.8 15.8 16.4 16.9

22

18 11.3 11.9 12.5 13.5 14.6 15.7 16.7 17.3 17.8

23

21 12.2 12.8 13.4 14.4 15.5 16.6 17.6 18.2 18.8

24

27 13.2 13.7 14.3 15.3 16.4 17.5 18.5 19.1 19.7

25

20 14.1 14.6 15.2 16.2 17.3 18.4 19.4 20.0 20.6

26

25 15.0 15.5 16.1 17.1 18.2 19.3 20.3 21.0 21.5

27

24 15.9 16.4 17.0 18.0 19.1 20.2 21.3 21.9 22.4

28

24 16.8 17.3 17.9 18.9 20.0 21.2 22.2 22.8 23.3

29

24 17.7 18.2 18.8 19.8 21.0 22.1 23.1 23.7 24.2

30

27 18.6 19.1 19.7 20.7 21.9 23.0 24.0 24.6 25.1

31

24 19.5 20.0 20.6 21.6 22.8 23.9 24.9 25.5 26.0

32

28 20.4 20.9 21.5 22.6 23.7 24.8 25.8 26.4 26.9

33

27 21.3 21.8 22.5 23.5 24.6 25.7 26.7 27.3 27.8

34

25 22.2 22.8 23.4 24.4 25.5 26.6 27.6 28.2 28.7

35

20 23.1 23.7 24.3 25.3 26.4 27.5 28.5 29.1 29.6

36

23 24.0 24.6 25.2 26.2 27.3 28.4 29.4 30.0 30.6

37

22 24.9 25.5 26.1 27.1 28.2 29.3 30.3 30.9 31.5

38

21 25.9 26.4 27.0 28.0 29.1 30.2 31.2 31.9 32.4

39

26.8 27.3 27.9 28.9 30.0 31.1 32.2 32.8 33.3

40

27.7 28.2 28.8 29.8 30.9 32.1 33.1 33.7 34.2

Measurements in centimeters

10.3 11.3 11.9 12.4

From Chitkara U, Rosenberg J, Chervenak et al. Prenatal sonographic assessment of

the fetal thorax: Normal values. Am J Obstet Gynecol 156:1069, 1987.

Cardiac Abnormalities and the Four-Chamber View

Cardiac Anomalies with Abnormal Four-Chamber

View
Mitral Atresia
Triscuspid Atresia
Aortic Atresia
Pulmonary Atresia
Atrioventricular Septal Defect (AV-canal)
Severe Aortic Stenosis
Severe Pulmonary Stenosis with Intact Interventricular
SeptumComplete Anomalous Pulmonary Venous
Drainage without Pulmonary Venous Obstruction
Severe Coarctation of the Aorta
Interrupted Aortic Arch
Double Inlet Ventricle
Severe Ebstein's Anomaly with Tricuspid Dysplasia
Large Ventricular Septal Defect
Very Large Atrial Septal Defect
Cardiac Anomalies with Usually Normal FourChamber View
Transposition of the Great Arteries
Tetralogy of Fallot
Pulmonary Atresia with Ventricular Septal Defect
Double Outlet Right Ventricle
Truncus Arteriosus Communis
Mild Ebstein's Anomaly
Small Ventricular Septal Defect
Small Atrial Septal Defect
Mild/Moderate Aortic Stenosis
Mild/Moderate Pulmonary Stenosis
Mild/Moderate Coarctation of the Aorta
Partial Anomalous Pulmonary Venous Drainage

From: Gembruch U. Prenatal diagnosis of congenital heart disease. Prenatal

Diagnosis 17:1283-1298, 1997 J. Wiley & Sons
Adapted from Sharland GK, Allan LD. Screening for congenital heart disease
prenatally. Results of a 2 1/2 year study in the South East Thames region, Br. J.
Obstet. Gynaecol 99:220-225, 1992

Groups of Abnormal Three-vessel Views and Congenital Heart Diseases

Group

Subgroup

Congenital heart
disease
coarctation of aorta

small ascending aorta

and large main
pulmonary artery

interruption of aortic
arch
aortic atresia
hypoplastic left heart
syndrome
tetralogy of Fallot

Group 1:

small main pulmonary

artery and large
ascending aorta

Abnormal
vessel size

pulmonary atresia with

VSD
pulmonary atresia with
IVS
Ebstein's anomaly

dilated main
pulmonary artery

pulmonary valve
stenosis
pulmonary
regurgitation

dilated ascending aorta

aortic valve stenosis

aortic regurgitation

dilated superior vena

cava

interruption of inferior
vena cava with azygos
continuation
right-side heart failure

Group 2:
abnormal
alignment

tetralogy of Fallot
anterior displacement
of aorta with small
double-outlet right
main pulmonary artery
ventricle with
subpulmonary stenosis
side-by-side
relationship with same
arterial size

double-outlet right
ventricle
some complete TGA

side-by-side
relationship with small
aorta

double-outlet right
ventricle or some
complete TGA with
subaortic stenosis
complete TGA

right anterior aorta

some double-outlet
right ventricle
corrected TGA

Group 3:
Abnormal
arrangement

left anterior aorta

double-inlet left
ventricle
some double-outlet
right ventricle

left-sided superior vena absence of right

cave
superior vena cave
truncus arteriosus

Group 4:

one artery

Abnormal
vessel number two superior venae
cavae

pulmonary atresia with

VSD and absent main
pulmonary artery
bilateral supenor venae
cavae

Amniotic Fluid Index Values in Normal Pregnancy (Moore & Cayle)

AFI (mm) Percentile Values

Week 2.5th 5th 50th 95th 97.5th Number

16

73

79 121 185 201

32

17

77

83 127 194 211

26

18

80

87 133 202 220

17

19

83

90 137 207 225

14

20

86

93 141 212 230

25

21

88

95 143 214 233

14

22

89

97 145 216 235

14

23

90

98 146 218 237

14

24

90

98 147 219 238

23

25

89

97 147 221 240

12

26

89

97 147 223 242

11

27

85

95 146 226 245

17

28

86

94 146 228 249

25

29

84

92 145 231 254

12

30

82

90 145 234 258

17

31

79

88 144 238 263

26

32

77

86 144 242 269

25

33

74

83 143 245 274

30

34

72

81 142 248 278

31

35

70

79 140 249 279

27

36

68

77 138 249 279

39

37

66

75 135 244 275

36

38

65

73 132 239 269

27

39

64

72 127 226 255

12

40

63

71 123 214 240

64

41

63

70 116 194 216

162

42

63

69 110 175 192

30

Moore TR, Cayle JE. The amniotic fluid index in normal human pregnancy. Am J
Obstet Gynecol 162:1168-73, 1990.

Associated Incidence of Diagnosis Congenital Heart Disease

Diagnosis

Associated
Incidence of
CHD (%)

Central Nervous System

Hydrocephalus

12

Dandy-Walker syndrome

Agenesis of corpus callosum

15

Meckel-Gruber syndrome

14

Mediastinum
Tracheoesophageal fistula

33

Esophageal atresia, tracheoesophageal

fistula

30

Abnormalities of cardiac position (situs

abnormality)

60

Gastrointestinal
Duodenal atresia

17

Jejunal Atresia

Anorectal anomalies

22

Imperforate Anus

11

Omphalocele

30

Gastroschisis

Diaphragmatic Hernia

15

Genitourinary
Renal Agenesis-Unilateral

17

Renal Agenesis-Bilateral

43

Horseshoe Kidney

40

Renal Dysplasia

Ureteral Obstruction

Other

Twins
Conjoined

25

Monoamniotic

Skeletal Anomalies
Short-rib Polydactyly

40

Thrombocytopenia with absent Radius

33

Fanconi

14

Apert

10

Carpenter

Robin

Arthrogryposis

30

Holt-Oram

50

Ellis-van Creveld

50

Adapted from: Hess LW, et al. Fetal echocardiography. In: Roberts W, ed. Obstet
Gynecol Clin North Amer 17(1):51, 1990

Length of Fetal Long Bones (mm) vs Menstrual Age

Tibia
(%)

Fibula
(%)

Femur
(%)

Humerus Ulna
(%)
(%)

Radius
(%)

Week

5th 50th 95th 5th 50th 95th 5th 50th 95th 5th 50th 95th 5th 50th 95th 5th 50th 95th

12

13

13

10

11

16

11

16

10

15

10

14

16

12 17

22

13 18

23

15 20

24

15 20

25

13 18

23

13 18

22

17

15 20

25

13 21

28

18 23

27

18 22

27

16 21

26

14 20

26

18

17 22

27

15 23

31

21 25

30

20 25

30

19 24

29

15 22

29

19

20 25

30

19 26

33

24 28

33

23 28

33

21 26

31

20 24

29

20

22 27

33

21 28

36

26 31

36

25 30

35

24 29

34

22 27

32

21

25 30

35

24 31

37

29 34

38

28 33

38

26 31

36

24 29

33

22

27 32

38

27 33

39

32 36

41

30 35

40

28 33

38

27 31

34

23

30 35

40

28 35

42

35 39

44

33 38

42

31 36

41

26 32

39

24

32 37

42

29 37

45

37 42

46

35 40

45

33 38

43

26 34

42

25

34 40

45

34 40

45

40 44

49

37 42

47

35 40

45

31 36

41

26

37 42

47

36 42

47

42 47

51

39 44

49

37 42

47

32 37

43

27

39 44

49

37 44

50

45 49

54

41 46

51

39 44

49

33 39

45

28

41 46

51

38 45

53

47 52

56

43 48

53

41 46

51

33 40

48

29

43 48

53

41 47

54

50 54

59

45 50

55

43 48

53

36 42

47

30

45 50

55

43 49

56

52 56

61

47 51

56

44 49

54

36 42

47

31

47 52

57

42 51

59

54 59

63

48 53

58

46 51

56

38 44

50

32

48 54

59

42 52

63

56 61

65

50 55

60

48 53

58

37 45

53

33

50 55

60

46 54

62

58 63

67

51 56

61

49 54

59

41 46

51

34

52 57

62

46 55

65

60 65

69

53 58

63

51 56

61

40 47

53

35

53 58

64

51 57

62

62 67

71

54 59

64

52 57

62

41 48

54

36

55 60

65

54 58

63

64 68

73

56 61

65

53 58

63

39 48

57

37

56 61

67

54 59

65

65 70

74

57 62

67

55 60

65

45 49

53

From:Sherer DM, Ghezzi F, Cohen J, Romero R. Fetal Skeletal Anomalies in

Sonography in Obstetrics and Gynecology:Principles and Practice Ed by AC Fleischer
et al., Appleton & Lange, Stamford, 1996.

Teratogens and Cardiac Abnormalities

Potential
Teratogen

Freq./
Cardiac
Most Common Malformations
Defects
(%)

Drugs
Alcohol

30

VSD, PDA, ASD

Amphetamines

VSD, PDA, ASD, TGA

Hydantoin

PS, AS, CA, PDA

Trimethadione

30

TGA, TF, HLHS

Lithium

10

Ebstein, TA, ASD

Thalidomide

10

TF, VSD, ASD, Truncus Art.

Retinoic Acid

10

VSD

35

PA Stenosis, PDA, VSD, ASD

Infections
Rubella

Maternal Conditions
Diabetes
Mellitus

TGA,VSD,CA

SLE

40

Heart Block

Phenylketonuria

10

TF, VSD, ASD

VSD=ventricular septal defect, PDA=patent ductus

arteriosus, ASD=atrial septal defect, TGA=transposition of
great arteries, PS=pulmonary valve stenosis, AS=aortic
stenosis, CA=coarctation of the aorta, TF=tetralogy of
Fallot, HLHS=hypoplastic left-heart syndrome,
TA=tricuspid atresia

Adapted from Hess LW, Hess DB, McCaul JF, Perry KG. Fetal Echocardiography.
Obstetrics and Gynecology Clinics of North America.; WB Saunders and Company
17:41-79, 1990

PREDICTED MENSTRUAL AGE

FOR FEMUR LENGTHS (1.0 cm - 7.9 cm)
Femur Menstrual
Femur
Menstrual
Length Age
Length(cm) Age (wks)
(cm) (wks)
1.0

12.8

4.5

24.5

1.1

13.1

4.6

24.9

1.2

13.4

4.7

25.3

1.3

13.6

4.8

25.7

1.4

13.9

4.9

26.1

1.5

14.2

5.0

26.5

1.6

14.5

5.1

27.0

1.7

14.8

5.2

27.4

1.8

15.1

5.3

27.8

1.9

15.4

5.4

28.2

2.0

15.7

5.5

28.7

2.1

16.0

5.6

29.1

2.2

16.3

5.7

29.6

2.3

16.6

5.8

30.0

2.4

16.9

5.9

30.5

2.5

17.2

6.0

30.9

2.6

17.6

6.1

31.4

2.7

17.9

6.2

31.9

2.8

18.2

6.3

32.3

2.9

18.6

6.4

32.8

3.0

18.9

6.5

33.3

3.1

19.2

6.6

33.8

3.2

19.6

6.7

34.2

3.3

19.9

6.8

34.7

3.4

20.3

6.9

35.2

3.5

20.7

7.0

35.7

3.6

21.0

7.1

36.2

3.7

21.4

7.2

36.7

3.8

21.8

7.3

37.2

3.9

22.1

7.4

37.7

4.0

22.5

7.5

38.3

4.1

22.9

7.6

38.8

4.2

23.3

7.7

39.3

4.3

23.7

7.8

39.8

4.4

24.1

7.9

40.4

VARIABILITY ESTIMATES (+ 2 SD)

12-18 wks

+ 1.0 wks

18-24 wks

+ 1.8 wks

24-30 wks

+ 2.0 wks

30-36 wks

+ 2.4 wks

36-42 wks

+ 3.2 wks

From Hadlock FP, et al: Fetal femur length as a predictor of menstrual age:
sonographically measured. Amer J Roentgenol 138:875-878, 1982.

PREDICTED MENSTRUAL AGE FOR ABDOMINAL CIRCUMFERENCE

MEASUREMENTS (10-36 cm)
Abdominal
Menstrual Abdominal
Menstrual
Circumference Age
Circumference Age
(cm)
(wks)
(cm)
(wks)
10.0

15.6

23.5

27.7

10.5

16.1

24.0

28.2

11.0

16.5

24.5

28.7

11.5

16.9

25.0

29.2

12.0

17.3

25.5

29.7

12.5

17.8

26.0

30.1

13.0

18.2

26.5

30.6

13.5

18.6

27.0

31.1

14.0

19.1

27.5

31.6

14.5

19.5

28.0

32.1

15.0

20.0

28.5

32.6

15.5

20.4

29.0

33.1

16.0

20.8

29.5

33.6

16.5

21.3

30.0

34.1

17.0

21.7

30.5

34.6

17.5

22.2

31.0

35.1

18.0

22.6

31.5

35.6

18.5

23.1

32.0

36.1

19.0

23.6

32.5

36.6

19.5

24.0

33.0

37.1

20.0

24.5

33.5

37.6

20.5

24.9

34.0

38.1

21.0

25.4

34.5

38.7

21.5

25.9

35.0

39.2

22.0

26.3

35.5

39.7

22.5

26.8

36.0

40.2

23.0

27.3
VARIABILITY ESTIMATES (+ 2 SD)

12-18 wks

+ 1.9 wks

18-24 wks

+ 2.0 wks

24-30 wks

+ 2.2 wks

30-36 wks

+ 3.0 wks

36-42 wks

+ 2.5 wks

From Hadlock FP, Deter RL, Harrist RB, Park SK: Fetal abdominal circumference as
a predictor of menstrual age. AJR 139:367, 1982. Copyright by The American
Roentgen Ray Society, 1982.

PERCENTILE VALUES FOR FETAL ABDOMINAL CIRCUMFERENCE

Abdominal Circumference (cm)
MenstrualWeeks 3rd 10th 50th 90th 97th
14

6.4 6.7

7.3

7.9

8.3

15

7.5 7.9

8.6

9.3

9.7

16

8.6 9.1

9.9

10.7 11.2

17

9.7 10.3 11.2 12.1 12.7

18

10.9 11.5 12.5 13.5 14.1

19

11.9 12.6 13.7 14.8 15.5

20

13.1 13.8 15.0 16.3 17.0

21

14.1 14.9 16.2 17.6 18.3

22

15.1 16.0 17.4 18.8 19.7

23

16.1 17.0 18.5 20.0 20.9

24

17.1 18.1 19.7 21.3 22.3

25

18.1 19.1 20.8 22.5 23.5

26

19.1 20.1 21.9 23.7 24.8

27

20.0 21.1 23.0 24.9 26.0

28

20.9 22.0 24.0 26.0 27.1

29

21.8 23.0 25.1 27.2 28.4

30

22.7 23.9 26.1 28.3 29.5

31

23.6 24.9 27.1 29.4 30.6

32

24.5 25.8 28.1 30.4 31.8

33

25.3 26.7 29.1 31.5 32.9

34

26.1 27.5 30.0 32.5 33.9

35

26.9 28.3 30.9 33.5 34.9

36

27.7 29.2 31.8 34.4 35.9

37

28.5 30.0 32.7 35.4 37.0

38

29.2 30.8 33.6 36.4 38.0

39

29.9 31.6 34.4 37.3 38.9

40

30.7 32.4 35.3 38.2 39.9

Adapted from Hadlock FP, Deter RL, Harrist RB, Park SK: Estimating fetal age:
computer-assisted analysis of multiple fetal growth parameters. Radiology 152:497501, 1984.

PREDICTED MENSTRUAL AGE FOR HEAD CIRCUMFERENCE

MEASUREMENTS (8.5-36.0 CM)

Head
Circumference(cm)

Menstrual
Menstrual
Head
Age
Age
Circumference(cm)
(wks)
(wks)

8.5

13.7

22.5

24.4

9.0

14.0

23.0

24.9

9.5

14.3

23.5

25.4

10.0

14.6

24.0

25.9

10.5

15.0

24.5

26.4

11.0

15.3

25.0

26.9

11.5

15.6

25.5

27.5

12.0

15.9

26.0

28.0

12.5

16.3

26.5

28.6

13.0

16.6

27.0

29.2

13.5

17.0

27.5

29.8

14.0

17.3

28.0

30.3

14.5

17.7

28.5

31.0

15.0

18.1

29.0

31.6

15.5

18.4

29.5

32.2

16.0

18.8

30.0

32.8

16.5

19.2

30.5

33.5

17.0

19.6

31.0

34.2

17.5

20.0

31.5

34.9

18.0

20.4

32.0

35.5

18.5

20.8

32.5

36.3

19.0

21.2

33.0

37.0

19.5

21.6

33.5

37.7

20.0

22.1

34.0

38.5

20.5

22.5

34.5

39.2

21.0

23.0

35.0

40.0

21.5

23.4

35.5

40.8

22.0

23.9

36.0

41.6

VARIABILITY ESTIMATES (+ 2 SD)

12-18 wks

+ 1.3 wks

18-24 wks

+ 1.6 wks

24-30 wks

+ 2.3 wks

30-36 wks

+ 2.7 wks

34-42 wks

+ 3.4 wks

From Hadlock FP, Deter RL, Harrist RB, Park SK: Fetal head circumference: relation
to menstrual age. Amer J Roentgenol 138:649, 1982. Copyright by The American
Roentgen Ray Society, 1982

REDICTED MENSTRUAL AGE (WEEKS) FROM CRL MEASUREMENTS

(CM)
CRL MA CRL MA CRL MA CRL MA CRL MA CRL MA
0.2

5.7 2.2

8.9 4.2

11.1 6.2

12.6 8.2

14.2 10.2 16.1

0.3

5.9 2.3

9.0 4.3

11.2 6.3

12.7 8.3

14.2 10.3 16.2

0.4

6.1 2.4

9.1 4.4

11.2 6.4

12.8 8.4

14.3 10.4 16.3

0.5

6.2 2.5

9.2 4.5

11.3 6.5

12.8 8.5

14.4 10.5 16.4

0.6

6.4 2.6

9.4 4.6

11.4 6.6

12.9 8.6

14.5 10.6 16.5

0.7

6.6 2.7

9.5 4.7

11.5 6.7

13.0 8.7

14.6 10.7 16.6

0.8

6.7 2.8

9.6 4.8

11.6 6.8

13.1 8.8

14.7 10.8 16.7

0.9

6.9 2.9

9.7 4.9

11.7 6.9

13.1 8.9

14.8 10.9 16.8

1.0

7.2 3.0

9.9 5.0

11.7 7.0

13.2 9.0

14.9 11.0 16.9

1.1

7.2 3.1

10.0 5.1

11.8 7.1

13.3 9.1

15.0 11.1 17.0

1.2

7.4 3.2

10.1 5.2

11.9 7.2

13.4 9.2

15.1 11.2 17.1

1.3

7.5 3.3

10.2 5.3

12.0 7.3

13.4 9.3

15.2 11.3 17.2

1.4

7.7 3.4

10.3 5.4

12.0 7.4

13.5 9.4

15.3 11.4 17.3

1.5

7.9 3.5

10.4 5.5

12.1 7.5

13.6 9.5

15.3 11.5 17.4

1.6

8.0 3.6

10.5 5.6

12.2 7.6

13.7 9.6

15.4 11.6 17.5

1.7

8.1 3.7

10.6 5.7

12.3 7.7

13.8 9.7

15.5 11.7 17.6

1.8

8.3 3.8

10.7 5.8

12.3 7.8

13.8 9.8

15.6 11.8 17.7

1.9

8.4 3.9

10.8 5.9

12.4 7.9

13.9 9.9

15.7 11.9 17.8

2.0

8.6 4.0

10.9 6.0

12.5 8.0

14.0 10.0 15.9 12.0 17.9

2.1

8.7 4.1

11.0 6.1

12.6 8.1

14.1 10.1 16.0 12.1 18.0

* The 95% confidence interval is + 8% of the predicted age.

From Hadlock FP, Shah YP, Kanon DJ, Lindsey JV: Fetal crown-rump length:
reevaluation of relation to menstrual age (5-18 weeks) with high-resolution real-time
US. Radiology 182:501-505, 1992.

PREDICTED MENSTRUAL AGE FOR BIPARIETAL DIAMETER

MEASUREMENTS (2.6 cm - 9.7 cm)
BPD
(cm)

Menstrual
BPD
Age
(cm)
(wks)

Menstrual
Age
(wks)

2.6

13.9

6.2

25.3

2.7

14.2

6.3

25.7

2.8

14.5

6.4

26.1

2.9

14.7

6.5

26.4

3.0

15.0

6.6

26.8

3.1

15.3

6.7

27.2

3.2

15.6

6.8

27.6

3.3

15.9

6.9

28.0

3.4

16.2

7.0

28.3

3.5

16.5

7.1

28.7

3.6

16.8

7.2

29.1

3.7

17.1

7.3

29.5

3.8

17.4

7.4

29.9

3.9

17.7

7.5

30.4

4.0

18.0

7.6

30.8

4.1

18.3

7.7

31.2

4.2

18.6

7.8

31.6

4.3

18.9

7.9

32.0

4.4

19.2

8.0

32.5

4.5

19.5

8.1

32.9

4.6

19.9

8.3

33.3

4.7

20.2

8.3

33.8

4.8

20.5

8.4

34.2

4.9

20.8

8.5

34.7

5.0

21.2

8.6

35.1

5.1

21.5

8.7

35.6

5.2

21.8

8.8

36.1

5.3

22.2

8.9

36.5

5.4

22.5

9.0

37.0

5.5

22.8

9.1

37.5

5.6

23.2

9.2

38.0

5.7

23.5

9.3

38.5

5.8

23.9

9.4

38.9

5.9

24.2

9.5

39.4

6.0

24.6

9.6

39.9

6.1

25.0

9.7

40.5

VARIABILITY ESTIMATES (+ 2
SD)
12-18 wks

+ 1.2 wks

18-24 wks

+ 1.7 wks

24-30 wks

+ 2.2 wks

30-36 wks

+ 3.1 wks

36-42 wks

+ 3.2 wks

From Hadlock FP, Deter RL, Harris RB, et al: Fetal biparietal diameter: a critical reevaluation of the relation to menstrual age by means of realtime ultrasound. J
Ultrasound Med 1:97-104, 1982.
From Hadlock FP, Deter LR, Harrist RB, et al: Estimating fetal age: computerassisted analysis of multiple fetal growth parameters. Radiology 152:497-501, 1984.

Gestational Sac Measurement

Mean
Mean
Gestational
Predicted
Predicted Gestational Age
Age
Gestational
Gestational (weeks)
(weeks)
Sac (cm)
Sac (cm)
1.0

5.0

3.6

8.8

1.1

5.2

3.7

8.9

1.2

5.3

3.8

9.0

1.3

5.5

3.9

9.2

1.4

5.6

4.0

9.3

1.5

5.8

4.1

9.5

1.6

5.9

4.2

9.6

1.7

6.0

4.3

9.7

1.8

6.2

4.4

9.9

1.9

6.3

4.5

10.0

2.0

6.5

4.6

10.2

2.1

6.6

4.7

10.3

2.2

6.8

4.8

10.5

2.3

6.9

4.9

10.6

2.4

7.0

5.0

10.7

2.5

7.2

5.1

10.9

2.6

7.3

5.2

11.0

2.7

7.5

5.3

11.2

2.8

7.6

5.4

11.3

2.9

7.8

5.5

11.5

3.0

7.9

5.6

11.6

3.1

8.0

5.7

11.7

3.2

8.2

5.8

11.9

3.3

8.3

5.9

12.0

3.4

8.5

6.0

12.2

From Hellman LM, Kobayashi M, Fillisti L et al.: Growth and development of the
human fetus prior to the twentieth week of gestation. Amer J Obstet Gynecol 103:789,
1969

RELATION BETWEEN MEAN SAC DIAMETER, MENSTRUAL AGE, AND

HUMAN CHORIONIC GONADOTROPIN (First IRP)

MEAN GESTATIONAL
SAC DIAMETER (MM)

MENSTRUAL AGE
(WKS)

PREDICTED HCG (IU/L), RANGE =

95% PREDICTION INTERVAL

4.6

1,710 (1,050-2,800)

4.7

2,320 (1,440-3,760)

4.9

3,100 (1,940-4,980)

5.1

4,090 (2,580-6,530)

5.3

5,340 (3,400-8,450)

5.4

6,880 (4,420-10,810)

5.6

8,770 (5,680-13,660)

10

5.7

11,040 (7,220-17,050)

11

5.9

13,730 (9,050-21,0408)

12

6.0

16,870 (11,230-25,640)

13

6.1

20,480 (13,750-30,880)

14

6.3

24,560 (16,650-36,750)

15

6.4

29,110 (19,910-43,220)

16

6.6

34,100 (23,530-50,210)

17

6.7

39,460 (27,470-57,640)

18

6.9

45,120 (31,700-65,380)

19

7.0

50,970 (36,130-73,280)

20

7.1

56,900 (40,700-81,150)

21

7.3

62,760 (45,300-88,790)

22

7.4

68,390 (49,810-95,990)

23

7.6

73,640 (54,120-102,540)

24

7.7

78,350 (58,100-108,230)

25

7.9

82,370 (61,640-112,870)

26

8.0

85,560 (64,600-116,310)

27

8.3

87,820 (66,900-118,420)

28

8.4

89,050 (68,460-119,130)

29

8.6

89,230 (69,220-118,420)

30

8.7

88,340 (69,150-116,310)

From: Daya S, Woods S, Ward S, Lappalainen R, Caco C, J Clin Ultrasound 19:139142, 1991
Predicted HCG from MSD is from Nyberg D, et al, Radiology 158;393-396, 1986
(HCG calibrated against the First International Reference Preparation)