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© 2008 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 27:1297-1303 • 0278-4297

Nomograms of the Axial Transverse Diameter of the Fetal Foramen Magnum Between 14 and 40 Weeks’ Gestation

David M. Sherer, MD, Margarita Sokolovski, RDMS, Mudar Dalloul, MD, Stephen T. Onesti, MD, John C. Pezzullo, PhD and Ovadia Abulafia, MD

Divisions of Maternal-Fetal Medicine (D.M.S., M.S., M.D.) and Gynecologic Oncology (O.A.), Department of Obstetrics and Gynecology, and Department of Neurosurgery (S.T.O.), State University of New York, Downstate Medical Center, Brooklyn, New York USA; and Department of Medicine, Georgetown University, Washington, DC USA (J.C.P.).

Address correspondence to David M. Sherer, MD, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York, Downstate Medical Center, 450 Clarkson Ave, Box 24, Brooklyn, NY 11203 USA. E-mail: dmsherer{at}aol.com

Objective. The purpose of this study was to create reference range nomograms of the axial transverse diameter of the fetal foramen magnum (TDFM) between 14 and 40 weeks’ gestation.

Methods. This cross-sectional study included pregnant patients between 14 and 41 weeks’ gestation. Inclusion criteria consisted of well-established dates (confirmed by early sonography) and nonanomalous singleton fetuses with intact amniotic membranes. Sonographic measurements included biparietal diameter, head circumference, abdominal circumference, femur length, humerus length, transcerebellar diameter, and sonographically estimated fetal weight. Values of the TDFM were each calculated as the mean of 3 separate measurements. The 5th, 50th, and 95th percentiles were estimated at each week of gestational age (GA) by least squares regression for the mean and SD of the TDFM as functions of GA. R2 and associated P values for the relationships between the TDFM and other biometric measurements were calculated.

Results. The study included 602 consecutive patients meeting the inclusion criteria. The mean maternal age ± SD was 27.5 ± 6.4 years; median gravidity, 3 (range, 1–12); and median parity, 1 (range, 0–7). The mean TDFM was 13.5 ± 3.7 mm. The reference curve formulas for the mean and SD of the TDFM (mm) were TDFM = –12.58 + GA/0.5616 – GA2/24.9 + GA3/2430.7, and SDTDFM = 1.05 – GA/19.4 + GA2/588.8. The TDFM correlated significantly and strongly with biparietal diameter, head circumference, abdominal circumference, humerus length, femur length, transcerebellar diameter, and estimated fetal weight (all R2 ≥ 0.90; all P < .0001).

Conclusions. We present reference range nomograms of the TDFM between 14 and 40 weeks’ gestation.

Key Words: fetal biometry • fetus • foramen magnum • nomogram • prenatal sonography

Abbreviations: GA, gestational age • SAR, scaled absolute residual • TDFM, transverse diameter of the fetal foramen magnum

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Copyright © 2008 by the American Institute of Ultrasound in Medicine.