Ultrasonography of the fetal face in the second and third trimester of pregnancy

PhD ceremony: Ms. E.A.P. de Jong-Pleij, 14.30 uur, Academiegebouw, Broerstraat 5, Groningen

Dissertation: Ultrasonography of the fetal face in the second and third trimester of pregnancy

Promotor(s): prof. C.M. Bilardo

Faculty: Medical Sciences

The fetal face contains a lot of information. In addition to clear anomalies with clinical relevance that can be visualised in the face, dysmorphic traits can also serve as clues to diagnose syndromes. De Jong-Pleij evaluated several aspects of three-dimensional (3D) ultrasonography for the evaluation of the fetal face. The first section of the study compared 3D multiplanar ultrasound with two-dimensional (2D) ultrasound. It appears that with 3D ultrasound the profile is more accurately displayed, thereby improving the reproducibility and measurability of structures. De Jong-Pleij introduced two objective measures to assess the profile: the maxilla-nasion-mandible angle and the profile line. Subsequently, the impact of 3D ultrasonography on three facial markers (nasal bone length (NBL), prenasal thickness (PT) and frontomaxillary facial (FMF) angle) for trisomy 21 was evaluated. In stored volumes NBL and PT were easy to measure, while the measurement of the FMF angle was much more challenging. NBL measurements were systematically smaller than in 2D ultrasound-based publications. De Jong-Pleij introduced the NBL / PT ratio which proved to be a highly sensitive marker for trisomy 21. Finally, it was shown that there was a positive effect of seeing 3D images of the fetal face on the mother-fetus bonding. Surprisingly, this effect was not significantly higher than after seeing 2D images. It is reassuring that the mothers who did not consider the 3D imaging as a positive experience, showed no measurable adverse effect on the maternal-fetal bonding.