Gestational age assessment by ultrasound cerebellar measurements in fetal and perinatal deaths.

Background

Perinatal mortality remains high in low- and middle-income countries. Accurate assessment of fetal gestational age (GA) is crucial to distinguish between prematurity and intrauterine growth restriction, two conditions commonly associated with perinatal mortality that require different preventive strategies and management. Ultrasound measurements of the cerebellum have been shown to be accurate in assessing GA during pregnancy, but their post-mortem performance has not yet been evaluated.

Objective

We aimed to explore the feasibility and validity of GA estimation in fetal and perinatal deaths by ultrasound measurements of the cerebellum.

Study design

This is an observational cross-sectional study. Between August 2020 and November 2022 post-mortem cerebellar ultrasound measurements were conducted in a tertiary referral hospital in Barcelona, Spain. Extrauterine assessment included transcerebellar diameter, cerebellar vermis height and cerebellar vermis. Moreover, intrauterine ultrasound and autopsy direct cerebellar assessments were undertaken in a subset of cases. A total of 137 fetal and perinatal deaths [63 (46.0%) fetal deaths, 69 (50.4%) stillbirths and 5 (3.6%) neonates] were included. First, we correlated different types of transcerebellar diameter measurements between them (intrauterine, extrauterine and autopsy-based). Then, we evaluated the relationship between the extrauterine cerebellar ultrasound measurements and GA, and their performance across trimesters of gestation and in different abnormalities.

Results

GA ranged from 15.2 to 40.6 weeks. High correlation was observed between extrauterine, intrauterine, and autopsy transcerebellar measurements (p<0.001), and between all extrauterine cerebellar measurements and GA (p<0.001). Extrauterine transcerebellar diameter was identified as the strongest predictor of GA (R=0.88; p<0.001), and its accuracy was not affected by the trimester of gestation, intrauterine growth restriction or central nervous system alterations.

Conclusions

This study shows the feasibility and accuracy of post-mortem GA evaluation by extrauterine ultrasound measurements of the cerebellum, especially of transcerebellar diameter. Implementation of this method as part of post-mortem assessment could improve cause of death attribution, especially in resource-constrained settings.

Article info

Journal issue:

Volume: not provided
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Doi:

10.1016/j.ajog.2024.11.016

More resources:

Elsevier Science

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