title: Association of isolated short femur in the mid-trimester fetus with perinatal outcome.
abstract: OBJECTIVE
  To evaluate the prevalence of fetal isolated short femur in a cohort of women screened for Down syndrome by the integrated test, and to compare the outcome of fetuses with isolated short femur in the mid-trimester with that of fetuses with normal femur length (controls).
  
  
  METHODS
  This was a retrospective cohort study of 1262 women booked for antenatal care and delivery at University College London Hospital. All women had integrated testing in the late first and early second trimesters and a detailed anomaly scan in the mid-trimester. All scan reports, screening results and neonatal data were analyzed statistically.
  
  
  RESULTS
  The fetal femur was short (< 5(th) percentile) in 5.1% of patients and 4.7% had isolated short femur. In pregnancies with isolated short femur, the birth weight was significantly lower and there were higher rates of small-for-gestational age (SGA) and low birth weight (LBW) infants, compared with controls (P < 0.01). The odds ratios for SGA and LBW in pregnancies with isolated short femur were 3.0 (95% CI, 1.5-5.9) and 2.60 (95% CI, 1.1-6.2), respectively. Isolated short femur was associated significantly with low levels of pregnancy-associated plasma protein-A (P = 0.001).
  
  
  CONCLUSIONS
  Isolated short femur in the mid-trimester fetus is associated with fetal growth restriction and SGA. In the context of normal Down syndrome screening and a normal anomaly scan, this marker should be regarded as a predictor for SGA, and fetal growth should be monitored during these pregnancies.
authors.affiliation: Department of Obstetrics and Gynaecology, University College London, London, UK. boazmd@smile.net.il
authors.forename: B
authors.initials: B
authors.lastname: Weisz
authors.forename: A L
authors.initials: AL
authors.lastname: David
authors.forename: L
authors.initials: L
authors.lastname: Chitty
authors.forename: D
authors.initials: D
authors.lastname: Peebles
authors.forename: P
authors.initials: P
authors.lastname: Pandya
authors.forename: P
authors.initials: P
authors.lastname: Patel
authors.forename: C H
authors.initials: CH
authors.lastname: Rodeck
mesh_terms: D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D004314:Down Syndrome / Q000097:blood / Q000000981:diagnostic imaging*; D005260:Female; D005269:Femur / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000196:embryology; D005317:Fetal Growth Retardation / Q000097:blood / Q000000981:diagnostic imaging*; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age / Q000097:blood; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second / Q000097:blood; D011266:Pregnancy-Associated Plasma Protein-A / Q000378:metabolism*; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal / Q000379:methods
chemical_list: D015415:Biomarkers; D011266:Pregnancy-Associated Plasma Protein-A