Application of a novel prenatal vertical cranial biometric measurement can improve accuracy of microcephaly diagnosis<i>in utero</i>

Leibovitz, Z.; Shiran, C.; Haratz, K.K.; Tamarkin, Mordechai; Gindes, L.; Schreiber, Letizia; Malinger, G.; Ben-Sira, Liat; Lev, Dorit; Shapiro, I.; Bakry, H.; Weizman, B.; Zreik, A.; Kidron, Dvora; Egenburg, S.; Arad, Ayala; Lerman‐Sagie, Tally

doi:10.1002/uog.15886

Cited by 10 publications

(8 citation statements)

References 14 publications

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“…Subsequently, several studies sought to improve the accuracy of the prenatal detection of microcephaly and reduce the high false-positive rate found after labor. Leibovitz et al [18] constructed a reference range for a novel biometric measure, the foramen-to-cranium distance (FCD), defined as the distance between the foramen magnum and upper inner cranial border along the posterior wall of the brainstem. When it was applied to 25 fetuses diagnosed with microcephaly, the rate of false positives was reduced.…”

Section: Discussionmentioning

confidence: 99%

Association of term isolated microcephaly with mode of delivery and perinatal outcome - a retrospective case-control analysis

Bardin

Krispin

Salman

et al. 2021

BMC Pregnancy Childbirth

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Background We aimed to evaluate the association of isolated fetal microcephaly measured by ultrasound prior to delivery at term with mode of delivery and perinatal outcome. Methods A single-center retrospective study was conducted in 2012–2016. Fetal microcephaly was defined as head circumference > 2 standard deviations of the mean for gestational age and sex. We compared the obstetric, delivery, and outcome parameters of women in whom ultrasound performed up to 10 days prior to term delivery showed isolated fetal microcephaly (study group) or normal head circumference (reference group). Exclusion criteria were intrauterine fetal death, birthweight below the 10th percentile, and antepartum cesarean delivery for any indication. Results Of 3677 women included in the study, 26 (0.7%) had a late ultrasound finding of isolated fetal microcephaly. Baseline characteristics were similar in the two groups except for estimated fetal weight based on abdominal circumference and biparietal diameter, which was lower in the microcephaly group (3209.8 ± 557.6 vs. 2685.8 ± 420.8 g, p < .001). There was no significant between-group difference in rate of vaginal operative deliveries (11.7% vs 14.8%, respectively, p = 0.372). The study group had no intrapartum cesarean deliveries compared to 6.3% of the reference group (NS). Compared to controls, neonates in the study group were smaller (3323.2 ± 432.2 vs. 2957.0 ± 330.4 g, p < .001), with lower birthweight percentile (60.5 ± 26.5 vs. 33.6 ± 21.5%, p < .001) and were more often males (48.2 vs. 90.0%, p < .001). No significant differences were noted in perinatal outcomes between the groups, including admission to neonatal intensive care unit, intraventricular hemorrhage, 5-min Apgar score < 7, asphyxia, seizures, and sepsis. Conclusions Isolated microcephaly in term fetuses is not advantageous for a vaginal delivery, nor does it does not pose a greater than normal risk of adverse perinatal outcome.

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Section: Discussionmentioning

confidence: 99%

Association of term isolated microcephaly with mode of delivery and perinatal outcome - a retrospective case-control analysis

Bardin

Krispin

Salman

et al. 2021

BMC Pregnancy Childbirth

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“…A new vertical cranial biometric measurement was used to address this entity: the foramen magnum-to-cranium distance (FCD). The FCD is measured between the foramen magnum and the upper inner cranial border along the posterior wall of the brainstem, in a precise mid-sagittal plane using a three-dimensional multiplanar display of a sagittal acquired sonographic volume of the fetal head ( Leibovitz et al, 2016b ). A normal reference range was developed based on measurements of 396 healthy fetuses between 15 and 40 weeks of pregnancy and an optimal FCD cut-off was defined and combined with HC to give maximal positive predictive value.…”

Section: How To Improve Detection and Diagnostic Accuracymentioning

confidence: 99%

Small size, big problems: insights and difficulties in prenatal diagnosis of fetal microcephaly

Haddad,

Hadi,

Leibovitz

et al. 2024

Front. Neurosci.

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Microcephaly is a sign, not a diagnosis. Its incidence varies widely due to the differences in the definition and the population being studied. It is strongly related to neurodevelopmental disorders. Differences in definitions and measurement techniques between fetuses and newborns pose a great challenge for the diagnosis and prognostication of fetal microcephaly. A false positive diagnosis can result (in countries where it is legal) in erroneous termination of pregnancy, where a false negative diagnosis might lead to the birth of a microcephalic newborn. Microcephaly in growth restricted fetuses deserves special attention and separate evaluation as it is an important prognostic factor, and not necessarily part of the general growth retardation. Several genetic syndromes incorporating microcephaly and intrauterine growth retardation (IUGR) are discussed. Deceleration of the head circumference (HC) growth rate even when the HC is still within normal limits might be the only clue for developing microcephaly and should be considered during fetal head growth follow up. Combining additional parameters such as a positive family history, associated anomalies, and new measurement parameters can improve prediction in about 50% of cases, and thus should be part of the prenatal workup. Advances in imaging modalities and in prenatal genetic investigation along with the emergence of new growth charts can also improve diagnostic accuracy. In this article, we review the different definitions and etiologies of fetal microcephaly, discuss difficulties in diagnosis, investigate the reasons for the low yield of prenatal diagnosis, and provide improvement suggestions. Finally, we suggest an updated algorithm that will aid in the diagnosis and management of fetal microcephaly.

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“…Workup of fetal microcephaly includes confirmation of gestational age, information regarding family history of MIC and intellectual disability and parental consanguinity, measurement of parental HC, dedicated neurosonography, brain MRI, maternal serological tests for TORCH infection (Zika virus in endemic regions), detailed ultrasound scan for fetal growth and anatomy, and amniocentesis for CMA and WES [ 95 ]. The measurement of the foramen magnum-to-cranium distance for evaluation of fetal head growth in the vertical dimension can improve the accuracy of fetal MIC diagnosis [ 100 ].…”

Section: Malformations Of Cortical Developmentmentioning

confidence: 99%

Fetal Brain Development: Regulating Processes and Related Malformations

Leibovitz

Lerman‐Sagie

Haddad

2022

Life

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This paper describes the contemporary state of knowledge regarding processes that regulate normal development of the embryonic–fetal central nervous system (CNS). The processes are described according to the developmental timetable: dorsal induction, ventral induction, neurogenesis, neuronal migration, post-migration neuronal development, and cortical organization. We review the current literature on CNS malformations associated with these regulating processes. We specifically address neural tube defects, holoprosencephaly, malformations of cortical development (including microcephaly, megalencephaly, lissencephaly, cobblestone malformations, gray matter heterotopia, and polymicrogyria), disorders of the corpus callosum, and posterior fossa malformations. Fetal ventriculomegaly, which frequently accompanies these disorders, is also reviewed. Each malformation is described with reference to the etiology, genetic causes, prenatal sonographic imaging, associated anomalies, differential diagnosis, complimentary diagnostic studies, clinical interventions, neurodevelopmental outcome, and life quality.

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Application of a novel prenatal vertical cranial biometric measurement can improve accuracy of microcephaly diagnosisin utero

Abstract: Objective To construct a reference range for a new vertical measurement of the fetal head and to assess whether its combination with fetal head circumference (HC) can prevent the misdiagnosis of microcephaly in fetuses with an acrocephalic-like head deformation. Methods

Cited by 10 publications

References 14 publications

Association of term isolated microcephaly with mode of delivery and perinatal outcome - a retrospective case-control analysis

Association of term isolated microcephaly with mode of delivery and perinatal outcome - a retrospective case-control analysis

Small size, big problems: insights and difficulties in prenatal diagnosis of fetal microcephaly

Fetal Brain Development: Regulating Processes and Related Malformations

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