Reference Ranges and Z ‐Score Equations for 19 Fetal Cardiac Biometry Structures From 18 to 34 Weeks' Gestation

Objective To determine equations for calculating the Z ‐scores of fetal cardiac structures between 18 +0 and 34 +6 weeks of gestation, create percentile reference tables and curves for the structures, and assess the intra‐ and inter‐observer reproducibility of the measurements. Methods A cross‐sectional study was conducted involving 340 normal fetuses from singleton pregnancies between 18 and 34 weeks of gestational age (GA). Nineteen cardiac structures were evaluated: diameters of the mitral, tricuspid, aortic, and pulmonary valve annuli; length, diameter, and area of the left and right ventricles; cardiac area and circumference; and diameters of the ascending aorta, aortic isthmus, main pulmonary artery, right pulmonary artery, left pulmonary artery, and ductus arteriosus. Regression analysis was performed to determine the equations for the mean and standard deviation of all structures using GA, biparietal diameter (BPD), and femur length (FL) as independent variables. Results All equations had high coefficients of determination ( R 2 ). The best performance was achieved using the GA ( R 2 .819–.944), followed by FL ( R 2 .813–.937) and BPD ( R 2 .792–.934). The structure that demonstrated the highest R 2 was the cardiac circumference and the smallest was the ductus arteriosus. Reference tables of percentiles 1, 5, 10, 50, 90, 95, and 99, and reference curves of Z ‐scores were created for all 19 cardiac structures, depending on the GA. All measurements demonstrated good and excellent reproducibility with an inter‐observer intraclass correlation coefficient (ICC) of 0.774–0.972 and intra‐observer ICC of 0.938–0.993. Conclusions Equations were produced to calculate Z ‐scores as well as percentile tables and curves for 19 fetal heart structures. All the measurements demonstrated good reproducibility.