August 2025
| Obtain the following | General comment | Specific comments |
| Accurate gestational age | LMP or early dating ultrasound | If unable to obtain accurate dating, consider BPD to FL ratios |
| Measure all long bones | Compare length with normative values for gestational age Are any bones missing? Determine the pattern and degree of limb shortening | Limb shortening in skeletal dysplasia can involve the entire limb (micromelia, which can be mild, severe, severe/bowed); the proximal humerus or femur (rhizomelia); the middle portion of the radius, ulna, tibia or fibula (mesomelia); or the hands and feet (acromelia) |
| Measure foot length | Calculate femur to foot length ratio | <0.9 abnormal |
| Assess the shape and contour of long bones | Bowing, angulations, fractures | If fractures, query occasional or numerous |
| Determine if decreased mineralization | Determine if diffuse or focal | If focal, specifically determine if the calvarium or spine or specific bones appear "absent" |
| Determine if this may be a life-limiting condition | Obtain axial, coronal, sagittal images of the thorax | Look for narrow AP diameter on sagittal Look for bell-shape thorax on coronal |
| Obtain chest circumference | Chest circumference <5th percentile suspicious | |
| Determine if ribs appear short | Ribs should encircle >70% thoracic circumference | |
| Obtain chest to abdomen circumference ratio | Chest to abdomen ratio <0.6 is a concern for life-limiting condition | |
| Obtain femur length to abdominal circumference ratio | <0.16 concern is a concern for life-limiting condition | |
| Consider obtaining lung volume | ||
| Skull | Shape, size, mineralization | Assess for cloverleaf deformity, macrocranium, compressibility |
| Facial profile | Look for frontal bossing, micrognathia, flat nasal bridge, cleft lip/palate | |
| Vertebrae/spine | Degree and pattern of demineralization, shape, alignment | Is there platyspondyly? |
| Abnormal posturing of joints | Query kyphoscoliosis, fixed contractures | |
| Hands and feet | Postural deformities, abnormal number of digits | |
| Scapulae size and shape | Hypoplastic or dysplastic | Think campomelic dysplasia |
| Growth parameters | Placental and well-being parameters | Is there fetal growth restriction? |
| Fetal anatomic survey and assessment of amniotic fluid volume | Extra-skeletal anomalies affect prognosis |
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