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Purpose <p>Accurate crown-rump length (CRL) measurement is fundamental for pregnancy dating and first-trimester screening. The Japanese standards established in 2003 using two-dimensional (2D) ultrasound require updating with modern imaging technology. This study aimed to establish new CRL reference standards for Japanese fetuses using three-dimensional (3D) ultrasound in precisely dated assisted reproductive technology (ART) pregnancies.</p> Methods <p>We conducted a multicenter retrospective cohort study of singleton ART pregnancies from 11 Japanese fertility centers (2020–2023), with pregnancy outcomes documented in 2024. Inclusion required term delivery (≥ 37&#xa0;weeks) and birth weight within the mean ± 1.5 SD. CRL measurements were performed centrally using standardized 3D ultrasound protocols. Polynomial regression models were used to generate reference equations.</p> Results <p>Of 2,356 datasets, 1,598 pregnancies met inclusion criteria. The mean maternal age was 36.3 ± 4.2&#xa0;years. Reproducibility was excellent [intra- and inter-observer intraclass correlation coefficients (ICC) &gt; 0.990]. No significant differences were found among ART methods in maternal age, gestational age at delivery, birth weight, or CRL growth pattern (<i>p</i> &gt; 0.01). Third-degree polynomial regression produced reference curves for the 10th, 50th, and 90th percentiles. Compared with 2003 standards, CRL values were consistently larger (<i>p</i> &lt; 0.001), and the growth trajectory showed no significant difference from the INTERGROWTH-21st international curve. Birth weights aligned with national standards, supporting general applicability.</p> Conclusion <p>These updated 3D ultrasound-based CRL reference standards for ART pregnancies modernize Japanese practice and establish a refined framework for accurate gestational dating and first-trimester screening.</p>

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Multicenter study of fetal crown-rump length measurement using 3D ultrasound in assisted reproductive technology pregnancies

  • 期刊论文

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  • 发表日期：

    2026年3月26日

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  • Ritsuko K. Pooh,
  • Megumi Machida,
  • Kohtaro Uenishi,
  • Takahito Miyake,
  • Toshiyuki Hata,
  • Rikikazu Sugiyama,
  • Masahide Shiotani,
  • Kenji Furui,
  • Tetsunori Mukaida,
  • Atsumi Yoshida,
  • Fumitoshi Koga,
  • Motowo Nabeta,
  • Koichi Kyono,
  • Yoshiharu Morimoto

摘要

Purpose

Accurate crown-rump length (CRL) measurement is fundamental for pregnancy dating and first-trimester screening. The Japanese standards established in 2003 using two-dimensional (2D) ultrasound require updating with modern imaging technology. This study aimed to establish new CRL reference standards for Japanese fetuses using three-dimensional (3D) ultrasound in precisely dated assisted reproductive technology (ART) pregnancies.

Methods

We conducted a multicenter retrospective cohort study of singleton ART pregnancies from 11 Japanese fertility centers (2020–2023), with pregnancy outcomes documented in 2024. Inclusion required term delivery (≥ 37 weeks) and birth weight within the mean ± 1.5 SD. CRL measurements were performed centrally using standardized 3D ultrasound protocols. Polynomial regression models were used to generate reference equations.

Results

Of 2,356 datasets, 1,598 pregnancies met inclusion criteria. The mean maternal age was 36.3 ± 4.2 years. Reproducibility was excellent [intra- and inter-observer intraclass correlation coefficients (ICC) > 0.990]. No significant differences were found among ART methods in maternal age, gestational age at delivery, birth weight, or CRL growth pattern (p > 0.01). Third-degree polynomial regression produced reference curves for the 10th, 50th, and 90th percentiles. Compared with 2003 standards, CRL values were consistently larger (p < 0.001), and the growth trajectory showed no significant difference from the INTERGROWTH-21st international curve. Birth weights aligned with national standards, supporting general applicability.

Conclusion

These updated 3D ultrasound-based CRL reference standards for ART pregnancies modernize Japanese practice and establish a refined framework for accurate gestational dating and first-trimester screening.