Three-dimensional ultrasonographic assessment of fetal hands and feet

Abstract

Objective: The aim of this study was to describe fetal hands and feet using three-dimensional ultrasonography.

Design: This was a randomized prospective study.

Methods: Ninety-seven fetuses from 12 to 40 weeks' gestation were studied with a specially developed trans-abdominal three-dimensional transducer (3.5 MHz). The imaging system used in this study can provide conventional two-dimensional ultrasound images and can also generate, within seconds, high-quality three-dimensional images in the surface and transparent modes with no need for an external workstation. The rate of visualization of the hands/fingers and feet/toes at each gestational-age interval was calculated using two-dimensional and three-dimensional ultrasonography.

Results: The ability to visualize fetal hands/fingers and feet/toes was better with three-dimensional than with two-dimensional ultrasonography in the late first trimester (detection rates were 65% and 41% by three-dimensional ultrasonography for hands and feet, respectively, and 41% and 12%, respectively, by two-dimensional ultrasonography). For the early second trimester, detection rates were 82% for hands and 72% for feet by three-dimensional ultrasonography, and 54% for hands and 45% for feet by two-dimensional ultrasonography. Optimal visualization of the fetal fingers using three-dimensional ultrasonography was achieved between 28 and 35 weeks of gestation, although at this stage there were no significant differences in detection rates for hands and feet between two- and three-dimensional imaging. During this period it was possible with three-dimensional ultrasonography adequately to depict at least one hand in 93% of the fetuses at 28-31 weeks and in 88% at 32-35 weeks. The percentage of visualization of at least one fetal foot between 16 and 35 weeks using three-dimensional ultrasonography ranged from 50 to 85%. Before 15 weeks or after 36 weeks, the respective percentages decreased.

Conclusions: Three-dimensional ultrasonography provides a novel means of visualizing fetal fingers and toes. Our observations suggest that three-dimensional ultrasonography may enhance the diagnostic potential of two-dimensional ultrasonography and might be useful in identifying fetal malformations and anatomical markers of chromosomal abnormalities prenatally in high-risk pregnancies.