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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 7  |  Issue : 3  |  Page : 134-138

Estimation of gestational age using fetal liver morphometry


1 Post Graduate Student, Department of Anatomy, Himalayan Institute of Medical Sciences, SRHU, Dehradun, India
2 Professor and Head of Department of Anatomy, Himalayan Institute of Medical Sciences, SRHU, Dehradun, India
3 Associate Professor, Himalayan Institute of Medical Sciences, SRHU, Dehradun, India

Date of Submission30-Mar-2018
Date of Acceptance14-Apr-2018
Date of Web Publication10-Sep-2020

Correspondence Address:
A Dubey
Department of Anatomy Himalayan Institute of Medical Science SRHU, Joly Grant, Dehraden - 248 140. Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


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  Abstract 


Background and Aim: The liver is a large organ in the body. Its various parameters can be utilized in determining the gestational age of the fetus and also in diagnosing pathologies affecting liver growth. The aim is to measure the various liver parameters in non deformed fetuses and to develop regression equations between the liver parameters and the gestational age. Materials and methods: The study was done on 30 aborted fetuses with varying gestational age from 13 to 32 weeks. Fetuses with any gross abnormalities were excluded. The crown rump length was measured for all. Dissection was done and the livers were removed weighed, length of right border, length of the border, width of superior surface, distance of porta hepatis to the right and left border were recorded using manual vernier caliper. Result: The various parameters of the liver showed a strong correlation with the CRL and hence the gestational age. Conclusion: The determination of the gestational age of the fetus using the correlation between the crown rump length and the liver morphometry can be done accurately.

Keywords: Fetus, liver, CRL, morphometry


How to cite this article:
Agnihotri D, Jethani S L, Dubey A, Singh D. Estimation of gestational age using fetal liver morphometry. Natl J Clin Anat 2018;7:134-8

How to cite this URL:
Agnihotri D, Jethani S L, Dubey A, Singh D. Estimation of gestational age using fetal liver morphometry. Natl J Clin Anat [serial online] 2018 [cited 2020 Dec 1];7:134-8. Available from: http://www.njca.info/text.asp?2018/7/3/134/294763




  Introduction Top


The liver is a large organ that occupies most of the upper region of the abdominal cavity. It lies under the cover of the ribs and costal cartilages and a part of it extends across the epigastric region[1]. The weight of the liver is approximately 5% of the total body weight at birth[2].

Majority of the studies done on fetal liver morphometry are radiology based. Anatomical dissections yield more precise and reliable information than radiological methods which can be used as guide for ultrasound investigations of the liver or other radiological investigations. Furthermore, the morphometry of the liver can be helpful for the evaluation of fetal autopsy materials in forensic medicine and fetal pathology[3]. Measurement of fetal liver length [FLL] may be useful for the diagnosis of diseases such as Rh isoimmunization, Bart’s disease, maternal diabetes, Intrauterine growth retardation, twin-to-twin transfusion syndrome [TTTS] and Down’s syndrome[4]. In pregnancy complicated by maternal diabetes mellitus, the fetal liver volume increases by approximately 20% at every week of gestation than the normal controls[5]. Significantly, decreased liver volumes are typical of fetuses with growth restriction[6]. In a study by Murao et al, the authors concluded that liver size can be used to assess fetal growth[7].

Embryologically, in the middle of the 3rd week an endodermal hepatic diverticulum appears at the distal end of the foregut consisting of rapidly proliferating cells that penetrate the septum transversum forming the liver[8]. The aim of the present study is to measure the various liver parameters and to develop regression equations between the liver parameters and the gestational age. This can be useful in determining pathologies of liver and in determination of gestational age in forensic settings.


  Materials and method Top


A total of 30 fetuses were obtained after due permission from the department of obstetrics and Gynaecology. Fetuses with gross anomalies were excluded.

The fetuses were fixed by injecting 10% formalin locally into the abdominal cavity, cranial cavity, thoracic cavity and also subcutaneously into the upper and lower limbs. The fetuses were then preserved in 10% formalin solution in jars.

Dissection was performed on all 30 fetuses. The fetus was placed in supine position. A vertical-incision was given from the suprasternal notch to umbilicus. A horizontal incision from both the ends of the vertical incision extending up to mid axillary line on either side were given. Skin was reflected as a flap laterally on both sides. Midline incision from xiphisternum upto umbilicus was given over the linea alba. Muscle layers were reflected in toto laterally up to mid axillary line on either side, along the subcostal margin above and a horizontal line from the level of umbilicus below. The liver was exposed and released from its attachments.

Crown Rump length [CRL] of all the fetuses was measured in millimetres using a Vernier Caliper. Gestational ages of fetuses were estimated using Boyd’s chart.


  Results Top


The results are tabulated in [Table 2].
Table 1: Distribution study population according to CRL

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Table 2: Parameters assessed

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The weight of the liver was measured using an electronic weighing scale. The length of right border was measured as the distance between the upper most and lower most point on right border. The length of left border was measured from the upper most and lower most point on the left border. The maximum width of superior surface was measured. Distance of the centre of porta hepatis were measured from the right border and left borders.

Statistical analysis was done using SPSS version 20. The Simple Linear Regression equations were derived for the correlation between the various fetal liver parameters [independent variables] and the crown rump length [dependent variable].
Figure 1: Measurement of width of superior surface [a] Measurement of length of right border [b] Measurement of left border [c] of the fetal liver.

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Figure 2: Measurement of distance of center of portahepatis from right [d] and the left [e] border of the fetal liver

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  Discussion Top


Our study was conducted on 30 aborted fetuses.. The weight of the liver, length of right and left border, width of superior surface and distance of centre of portahepatis to the right and left border were measured. These parameters were found to have a strong correlation with the crown rump length.

Study done by Tongprasert F et al using high- resolution real-time ultrasound in normal pregnancies concluded that fetal liver length (right border), gradually increases with advancing gestational age and this may be a useful tool in assessment of suspicion of fetal anaemia[9]. We observed that the fetal liver length of the right border increases significantly with the increase in gestational age.
Figure 3: The correlation between the crown rump length, CRL [mm] with the length of the right and left border of liver [mm] The increase in the length of the right and the left border of liver follow a similar pattern, but the values of the length of right border are more towards the intial and later periods of gestation.

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Figure 4:

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In a study conducted on fetal liver MRI by Takatuwa T images from 21 fetuses at 16-26 weeks of gestation and eight embryos at Carnegie stage [CS] 23, it was concluded that the four lobes were clearly recognizable in the fetal liver but not in the embryonic liver and the liver tended to grow along the transversal axis[10]. In our study we found that the growth of the fetal liver occurred along the transverse as well as the longitudinal axis.

Study done by Murao F et al on 378 fetal livers. Statistical analysis showed a highly significant correlation between fetal liver measurements and gestational age, also with the biparietal diameter and fetal femur length[11]. In our study we also found a significant correlation of the fetal liver measurements with the gestational age.

An ultrasonographic study by Perovic M on 331 women with singleton pregnancies who were at high risk of gestational diabetes mellitus [GDM] revealed that the fetal liver length had a strong correlation with the glucose levels and the fetal liver length could possibly serve as a valid marker for the prediction of GDM in high-risk populations[12]. The regression equations derived in our study for the normal parameters of liver can be used to predict maternal diabetes.

In a study by Roberts AB et al on 80 pregnant women with diabetes. It was concluded that fetal liver size is increased in pregnant women with diabetes[13]. In our study the normal fetal liver length showed a significant correlation with the gestational age and hence can be used to determine any pathology affecting the growth of the liver.


  Conclusion Top


In our study conducted on fetal liver, a strong correlation was seen between the morphometry of liver and the CRL. The parameters found in the normal fetal liver can be used as a guide in determining pathologies that affect liver growth like Down’s syndrome, maternal diabetes and growth restriction. The authors recommend future studies in large scrupls including samples from specific diseases.

Conflicts of interest : None

Financial support : None



 
  References Top

1.
Richard S. Snell. The abdomen: Part II- the abdominal cavity. In: Dr. Cristilda Felicia, editor. Clinical Anatomy by regions: 9th8 edition. Gurgaon: WoltersKluwer India Pvt Ltd; 2012.p.l57.  Back to cited text no. 1
    
2.
Moore KL, Persaud TVN. The Developing Human Embryology. 6th Ed. Philadelphia: WB Saunders Company; 1998. p. 108-125,272-82.  Back to cited text no. 2
    
3.
Albay S, Malas MA, Cetin E, Cankara N, Karahan N. Development of the liver during the fetal period. Saudi Med J. 2005;26[ 11 ]: 1710-5.  Back to cited text no. 3
    
4.
Toprak E, Bozkurt M, Karasu Y. Correlation between the fetal liver length and the crown rump length during the first trimester screening. JAREM. 2015;5:60-3.  Back to cited text no. 4
    
5.
Boito SM, Struijk PC, Ursem NT, Stijnen T, Wladimiroff JW. Assessment of fetal liver volume and umbilical venous volume flow in pregnancies complicated by insulin dependent diabetes mellitus.BJOG.2003; 110[11]: 1007-1013.  Back to cited text no. 5
    
6.
Szpinda M, Paruszewska-Achtel M, Wozniak A, Mila-Kierzenkowska C, Elminowska-Wenda G, Dombek M. Volumetric growth of the liver in the human fetus: an anatomical, hydrostatic and statistical study. Biomed research international. 2015;2015:858162.  Back to cited text no. 6
    
7.
Murao F, Seno D, Aoki S, Takamiya O, Yamamoto K, Iwanari O. Ultrasonographic measurement of prenatal fetal liver. Nippon SankaFujinkaGakkai Zasshi.l988;40:1550-4.  Back to cited text no. 7
    
8.
T.W Sandler. Digestive System. In: Dr. Cristilda Felicia, editor. Longman’s medical embryology: 11th edition. Gurgaon: Wolters Kluwer India Pvt Ltd; 2011.p.219.  Back to cited text no. 8
    
9.
Tongprasert F, Srisupundit K, Luewan S, Tongsong T. Normal length of the fetal liver from 14 to 40 weeks of gestational age. J ClinUtrasound 2011; 39 [2]:74-7.  Back to cited text no. 9
    
10.
Hamabe Y, Hirose A, Yamada S, Uwabe C, Okada T, Togashi K et al. Morphology and morphometry of fetal liver at 16-26 weeks of gestation by magnetic resonance imaging: comparison with embryonic live at Carnegie stage 23. Hepatol Res 2013; 43[6]:639- 47.  Back to cited text no. 10
    
11.
Murao F. Fetal liver measurements by ultrasonography. International journal of gynecology& obstetric 1987; 25 [5] :381 -5.  Back to cited text no. 11
    
12.
Perovic M. Relationship between mid trimester ultrasound fetal liver length measurements and gestational diabetes. Journal of diabetes 2015; 7: 497-505.  Back to cited text no. 12
    
13.
Roberts AB, Mitchell J, Murphy C, Koya H, Cundy T. Fetal liver length in diabetic pregnancy. Am JObstetGynecol1994; 170[5]:1308-12.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2]



 

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Abstract
Introduction
Materials and method
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