Quality of first-trimester measurement of crown-rump length

Abstract

Objective: The purpose of this study was to evaluate the quality of crown-rump length (CRL) measurements in scans judged to be of high quality for the measurement of the nuchal translucency.

Study design: We analyzed prospective data on 68,250 scans by 1913 sonographers that were collected by the French College of Fetal Echography (CFEF) national practice assessment program for the first-trimester scan. The scans were evaluated according to the CFEF image scoring method (CFEF-ISM), which includes items to measure the quality of the scan for both nuchal translucency and the CRL measurements. The scans were classified into 4 quality groups with the use of the full CFEF-ISM score and then a shortened version of the CFEF-ISM that excluded the item on quality of CRL measurement. The proportion of scans with an inaccurate CRL measurement was compared across the different quality groups.

Results: Overall, 21.67% of scans were of insufficient quality for CRL measurement. Among 23,764 "excellent" scans according to the full CFEF-ISM, 965 scans (4.06%) had insufficient CRL quality vs 9.24% of scans with "excellent" quality on the short CFEF-ISM (relative risk, 2.27; 95% confidence interval, 2.11-2.44; P < .001).

Conclusion: High scores of the quality of nuchal translucency measurement do not guarantee accurate measurement of crown-rump length. Specific measures are needed to evaluate and to improve the quality of the measurement of crown-lump length.

Keywords: crown-rump length; prenatal screening; quality of care.