[How to assess the neutral position of the fetus for the crown-rump length measurement at the nuchal translucency scan]

Gynecol Obstet Fertil. 2016 Mar;44(3):146-50. doi: 10.1016/j.gyobfe.2016.02.007. Epub 2016 Mar 7.
[Article in French]


Objectives: The objective of this study was to establish a simple and reproducible method for the assessment of the fetal head position when measuring crown-rump length (CRL) at the nuchal translucency scan.

Methods: Two observers conducted a retrospective analysis of a consecutive series of 570 images of CRL collected by the French College of Fetal Echography (CFEF) national practice assessment program for the first-trimester scan. The images were deemed hyper-flexed if no fluid was visible between the chin and the chest of the fetus. The images were deemed hyper-extended if the angle between the palate and the CRL line was 90° or more. The images were deemed neutral if no hyper-extension nor hyper-flexion was observed.

Results: The proportion of agreement for a non-neutral position of the fetal head was 91.3% (kappa=0.80, 95% CI [0.75 to 0.86]). Images with a non-neutral position corresponded to poor CRL quality images according to the CFEF score (relative risk=4.2, 95% CI [2.9 to 6.1] for one observer and 4.9, 95% CI [3.3 to 7.2] for the other observer). Proportions of agreement for the hyper-flexion and for the hyper-extension were 94.6% (kappa=0.80, 95% CI [0.72 to 0.87]) and 96.8% (kappa=0.81, 95% CI [0.72 to 0.90]), respectively. No additional lines were drawn on the ultrasound images during the evaluation process.

Conclusions: The proposed method for evaluating the extent to which the fetal head has a non-neutral position at measurement of the CRL appears both simple and reproducible.

Keywords: Contrôle qualité; Crown-rump length; Fetal position; First-trimester; Longueur cranio-caudale; Position fœtale; Premier trimestre; Prenatal ultrasound; Quality assessment; Échographie.

MeSH terms

  • Crown-Rump Length*
  • Female
  • Fetus*
  • Head
  • Humans
  • Labor Presentation
  • Nuchal Translucency Measurement*
  • Pregnancy
  • Pregnancy Trimester, First
  • Retrospective Studies
  • Ultrasonography, Prenatal*