Assessing the accuracy of ultrasound estimation of gestational age during routine antenatal care in in vitro fertilization (IVF) pregnancies

Introduction In the UK an accurate gestational age is confirmed by ultrasound measured foetal crown rump length (CRL) at 11 + 2–14 + 1 weeks of gestation. The currently recommended Robinson and Fleming crown rump length reference chart was develop in 1975. Advances in ultrasound technology and standardized crown rump length measurement training could mean this is now out of date. Our study aimed to assess its accuracy in current routine antenatal care. Methods Retrospective data from 178 IVF pregnancies seen for routine antenatal care at a UK Regional Maternity Unit between 1 January 2006 and 1 January 2016 was retrieved. We compared ultrasound calculated crown rump length gestational age taken at the routine First Trimester Screening Clinic (FTSC) with the ‘true’ gestational age calculated from the known IVF fertilization date. Results We identified a systematic overestimation of gestational age by ultrasound using the currently recommended crown rump length reference chart when compared to IVF gestational age. The mean overestimation was 3.0 days (95% CI: 2.7 to 3.4), p < 0.001. A range of alternative ultrasound reference charts also generated a systematic overestimation, ranging from 1.6 to 2.9 days ( p < 0.001, for each). Conclusions The current crown rump length reference chart systematically overestimates gestational age by an average of three days when assessed in IVF pregnancies. A systematic overestimation was also identified in alternative crown rump length reference charts. These differences, although slight, were systematic with implications for the accuracy of gestational age estimation particularly in pregnancies at risk of pre-term delivery or growth restriction. Our findings need confirming in larger, non IVF cohorts and could lead to the need for an updated crown rump length reference chart.

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First trimester ultrasound estimation of gestational age in pregnancies conceived after in vitro fertilization

European Journal of Obstetrics & Gynecology and Reproductive Biology ◽

10.1016/j.ejogrb.2011.11.019 ◽

2012 ◽

Vol 160 (2) ◽

pp. 151-155 ◽

Cited By ~ 12

Author(s):

Frank Shao-Ying Wu ◽

Yuh-Ming Hwu ◽

Robert Kuo-Kuang Lee ◽

Sheng-Hsiang Li ◽

Fang-Ju Sun ◽

...

Keyword(s):

In Vitro Fertilization ◽

Gestational Age ◽

First Trimester ◽

Vitro Fertilization ◽

First Trimester Ultrasound

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Sexual Difference in Early Fetal Crown-Rump Length versus Gestational Age in Pregnancies Arising from in vitro Fertilization

Gynecologic and Obstetric Investigation ◽

10.1159/000009945 ◽

1998 ◽

Vol 45 (3) ◽

pp. 151-153 ◽

Cited By ~ 4

Author(s):

Naohiro Tezuka ◽

Michio Banzai ◽

Satoshi Sato ◽

Hidekazu Saito ◽

Masahiko Hiroi

Keyword(s):

In Vitro Fertilization ◽

Gestational Age ◽

Sexual Difference ◽

Crown Rump Length ◽

Vitro Fertilization

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First-trimester screening for Down’s syndrome in in vitro fertilization pregnancies

Fertility and Sterility ◽

10.1016/s0015-0282(01)02871-0 ◽

2001 ◽

Vol 76 (6) ◽

pp. 1282-1283 ◽

Cited By ~ 24

Author(s):

Marko Niemimaa ◽

Seppo Heinonen ◽

Maija Seppälä ◽

Marita Hippeläinen ◽

Hannu Martikainen ◽

...

Keyword(s):

In Vitro Fertilization ◽

Down's Syndrome ◽

Down’S Syndrome ◽

First Trimester ◽

First Trimester Screening ◽

Vitro Fertilization ◽

Trimester Screening

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Mean gestational sac diameter to crown-rump length difference as a marker of first trimester pregnancy loss after in vitro fertilization

Fertility and Sterility ◽

10.1016/j.fertnstert.2016.07.969 ◽

2016 ◽

Vol 106 (3) ◽

pp. e342-e343

Author(s):

J.D. Kapfhamer ◽

S. Palaniappan ◽

K.M. Summers ◽

A. Mancuso ◽

G. Ryan ◽

...

Keyword(s):

In Vitro Fertilization ◽

Pregnancy Loss ◽

First Trimester ◽

Crown Rump Length ◽

Vitro Fertilization ◽

First Trimester Pregnancy ◽

Length Difference ◽

Trimester Pregnancy ◽

Gestational Sac

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Risk Assessment of the Increased Occurrence of Congenital Cardiac and Non-Cardiac Defects in Fetuses with a Normal Karyotype after Assisted Fertilization in Comparison to Natural Fertilization Based on Ultrasound Diagnostics

Journal of Clinical Medicine ◽

10.3390/jcm10235630 ◽

2021 ◽

Vol 10 (23) ◽

pp. 5630

Author(s):

Dawid Serafin ◽

Beniamin Oskar Grabarek ◽

Dariusz Boroń ◽

Andrzej Madej ◽

Bartosz Czuba

Keyword(s):

Assisted Reproduction ◽

Artificial Insemination ◽

Intrauterine Insemination ◽

Heart Defects ◽

First Trimester ◽

Ductus Venosus ◽

Crown Rump Length ◽

Vitro Fertilization ◽

Ultrasound Diagnostics

The goal of the study was to assess changes in parameters based on ultrasound examinations—these were Crown Rump Length (CRL), Nuchal Translucency (NT), Fetal Heart Rate (FHR), and Pulsatility Index for Ductus Venosus (DV-PI)—in the first trimester of pregnancy in women in which there was a natural initiation of the pregnancy due to spontaneous ovulation, women in which the pregnancy was initiated as a result of stimulated ovulation, as well as in the group in which pregnancy was achieved through the use of In-Vitro Fertilization (IVF)-assisted reproduction. A total of 1581 women became pregnant without the use of assisted reproduction methods. Out of 283 pregnancies, in 178 patients, induced ovulation was utilized. Next, 137 women had sexual intercourse and became pregnant; 41 of them became pregnant through Intrauterine Insemination (IUI) as a result of Artificial Insemination by Husband (AIH), and 13 became pregnant after Artificial Insemination by Donor (AID). The third group consisted of 105 women subjected to Controlled Ovarian Hyperstimulation (COH). In this group of pregnant women, 53 pregnancies were resultant of Intracytoplasmic Sperm Injection (ICSI), and 52 pregnancies were the result of Intracytoplasmic Morphologically selected Sperm Injection (IMSI). The obtained results did not indicate that the chosen method of fertilization or the chosen ovulation method had a statistically significant effect on the development risk of congenital heart or non-heart defects in the fetus.

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First Trimester Fetal Volume and Crown-Rump Length: Comparison Between Singletons and Twins Conceived by In Vitro Fertilization

Ultrasound in Medicine & Biology ◽

10.1016/j.ultrasmedbio.2008.02.005 ◽

2008 ◽

Vol 34 (9) ◽

pp. 1360-1364 ◽

Cited By ~ 21

Author(s):

Wellington P. Martins ◽

Rui A. Ferriani ◽

Carolina O. Nastri ◽

Francisco Mauad Filho

Keyword(s):

In Vitro Fertilization ◽

First Trimester ◽

Crown Rump Length ◽

Vitro Fertilization

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First-trimester screening with free β-hCG, PAPP-A, and nuchal translucency in pregnancies conceived by in vitro fertilization

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2004.10.029 ◽

2004 ◽

Vol 191 (6) ◽

pp. S44

Author(s):

Sriram C. Perni ◽

Mladen Predanic ◽

Alexander Friedman ◽

Claudel Jean-Pierre ◽

Robin B. Kalish ◽

...

Keyword(s):

In Vitro Fertilization ◽

First Trimester ◽

Nuchal Translucency ◽

First Trimester Screening ◽

Vitro Fertilization ◽

Trimester Screening ◽

Β Hcg

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Association Between Twin Discordance at 6–9 Weeks' of Gestation and Birthweight Complications

Twin Research and Human Genetics ◽

10.1375/twin.13.4.389 ◽

2010 ◽

Vol 13 (4) ◽

pp. 389-392 ◽

Cited By ~ 4

Author(s):

Kirsten Palmer ◽

Pavitra Delpachitra ◽

Joseph Onwude ◽

Luk Rombauts ◽

Simon Meagher ◽

...

Keyword(s):

Clinical Significance ◽

Gestational Age ◽

Small For Gestational Age ◽

First Trimester ◽

In Vitro Fertilisation ◽

Crown Rump Length ◽

Increased Risk ◽

Twin Pregnancies

AbstractTwins achieved through in-vitro fertilisation often undergo a viability ultrasound at 6–9 weeks of gestation. The presence of inter-twin crown-rump length discordance at this stage is not an uncommon finding; however the clinical significance of this is unknown. We analyzed 218 dichorionic twin pregnancies, producing two live fetuses > 24 weeks gestation, to determine whether inter-twin discordance (≥ 85th centile) in the mid-first trimester was associated with birthweight discordance (> 20%), or small for gestational age (< 10th centile). The incidence of birthweight discordance and small for gestational age infants were determined, with no increased risk found for the discordant population. This may provide some reassurance to treating clinicians.

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