Second-trimester fetal head circumference in >350.000 pregnancies: Outcome and suggestion for sex-dependent cutoffs for small heads

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OBJECTIVE: To explore the relationship between small fetal second-trimester head circumference (HC) and pregnancy outcome, and identify a cutoff point for offering genetic testing.

METHOD: Data from second-trimester scans in Denmark were linked to national registers. Fetuses with anomalies diagnosed before this scan were excluded. Fetuses were grouped according to HC z-score.

RESULTS: We included 352,515 singleton fetuses. The mean HC was significantly larger among males than among females with z-scores averaging 0.52 more in males. Small HC was associated with chromosomal anomaly, malformations of the CNS and heart, miscarriage/perinatal death, termination, preterm delivery, and intrauterine growth restriction (test for trend: p<0.001 for all outcomes). Fetuses in the group with z-score <-3 had the highest incidence of adverse outcome, irrespective of fetal sex. In the groups with z-scores between -3 and -2.5, and between -2.5 and -2, risk of adverse outcome was lower for females than males for all outcome categories.

CONCLUSION: Small HC in second trimester is a prognostic marker for adverse outcome. The smaller the HC, the higher the risk of adverse outcome. We suggest an HC cutoff point of -2 SD for males and -2.5 SD for females for offering genetic testing.

TidsskriftPrenatal Diagnosis
StatusUdgivet - 20 jun. 2019

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