Sonographic Estimation of Gestational Age from 20 to 40 Weeks by Fetal Kidney Lengths' Measurements Among Pregnant Women in Portharcourt, Nigeria

Background: Ultrasonography has become an indispensible tool in the management of obstetric patients. Accurate determination of fetal gestational age (FGA) has posed great challenge to patient management as the accuracy of traditional biometric parameters decreases with advance in gestation age. Accuracy of fetal kidney length (FKL) in the determination of FGA at third trimester has been documented in other population. This study is aimed to create baseline reference values of fetal kidney lengths in a Nigerian population as previous studies show population specific variations.

Methods: This prospective cross sectional study was carried out on 534 pregnant women between 20 and 40 weeks of gestation who met the inclusion criteria at Diamond Biomedical Services Ltd. A pilot study was conducted on 20 patients to determine the reproducibility and reliability of ultrasound measurement of FKL. Fetal kidney lengths were calculated as mean of three separate measurements. The 5th, 50th and 95th percentiles were calculated using least squared regression analysis. Third polynomial regression models were used to establish the relationship between right and left FKL and FGA.

Results: Both FKL measurements are highly reproducible with excellent correlation and agreement within and between sonographers. It correlates strongly with gestational age while the relationships between right and left kidney lengths with gestational age were established using the following regression equations: RKL =  - 11.18 + 1.193 × FGA - 0.0350 × FGA2 + 0.00037 × FGA3 and LKL =  - 12.57 + 1.332 × FGA - 0.0390 × FGA2 + 0.00040 × FGA3 for right and left kidneys respectively.

Conclusion: Nigerian population specific baseline reference values of FKLs for the estimation of FGA should be adopted rather than relying on the Caucasians values as universal patterns.