Exalto, N.

Steegers, Eric

English

EUR Research Repository

Robinson’s crown–rump length curve: amajor step towards human embryonichealth evaluationNIEK EXALTO AND ERIC AP STEEGERS, ERASMUS MEDICAL CENTRE,ROTTERDAM, THE NETHERLANDS..................................................................................................................................................................Huch P. Robinson was the first to pub-lish on crown–rump length (CRL)under ‘preliminary communications’ (BMJ1973;4:28–31). This was only 10 yearsafter Ian Donald introduced ultrasoundand the full bladder technique in obstetricsand gynaecology. For his study in Glasgow,Robinson used a Diasonograph NE 4102(Nuclear Enterprises), a so-called mechani-cal sector B-scan. This was a ‘black andwhite’ scan, before the introduction ofgreyscale and long before real-time ultra-sound. A total of 214 examinations wereperformed on 80 women (between 6 and14 weeks of gestation) with certain datesof the last menstrual period and a regularmenstrual cycle. In 20 cases of embryonicdeath, the ‘in utero’ CRL was comparedwith ‘in vivo’ measurements directly afterthe miscarriage. A highly significant corre-lation between these values was observed.Two years later, in 1975, Robinson andFleming published their revised CRL curvebased on 334 measurements, criticallyevaluating potential sources of randomerrors (Br J Obstet Gynaecol 1975;82:702–10). These sources included operatorjudgement, machine settings and measure-ment from photographs, which was thecommon procedure in those days. Theprecision of Robinson’s measurements isremarkable in the light of the tremendousimprovement of the technique since 1975(Figure 1). It is furthermore amazing thatthe Robinson Curve has been chosen asone of the four studies with the highestmethodological quality scores in a system-atic review of charts (Napolitano et al.BJOG 2014;121:556–65).Between 1972 and 1979, Robinson wasthe first to publish on early pregnancyfetal heart rate, ‘gestation sac’ volume,empty sacs, early fetal death, hydatidiformmoles and comparisons of CRL measure-ments by real-time and conventional Bscanners. Robinson can be regarded asthe founder of early pregnancy ultrasoundand for initiating Embryonic Medicine.Encouraged by Robinson, others also pub-lished on this topic. Mantoni and Pedersonwere the first to describe embryonicgrowth delay before early fetal death ineight cases of miscarriage (Br J ObstetGynaecol 1982;89:525–7). Many otherstudies on the relationship between asmall CRL and a higher risk of miscarriageand of structural and chromosomal abnor-malities followed. Measurement of CRLbecame the worldwide method of choicefor pregnancy dating as last menstrual per-iod data have always been subject torecall errors.In recent Embryonic Health programmestudies, using sophisticated CRL measure-ment tools like V-Scope 3D-VirtualReality – allowing very precise calliperpositioning – differences were foundbetween early and late first-trimesterembryonic growth coinciding with changesin uterine nourishment from histiotrophicto haemochorial (van Uitert et al. HumReprod 2013;28:1753–61) Within thisRotterdam periconception cohort (PredictStudy), it was also demonstrated with thesetechniques that periconceptional character-istics also influence embryonic growth.Larger embryos were seen in older moth-ers, and where there was strong adherenceto an energy-rich diet; smaller embryoswere seen in the presence of smoking,alcohol use, an adverse cardiovascular riskprofile and no folic acid supplementation.Robinson probably was not aware of thetremendous impact his scientific workwould have on contemporary knowledgeof early pregnancy physiology and its piv-otal impact on optimising prenatal care.Disclosure of interestsNone declared. Completed disclosure ofinterests form available to view online assupporting information.&Figure 1. Technical improvements in first-trimester ultrasound. (A) Robinson 1973 BMJ, sector B-scan, 9 weeks; (B) Robinson 1975BJOG, sector B-scan, 14 weeks; (C) linear array; (D) greyscale; (E) phased array; (F) 3D/4D view; (G) HD live; (H) V-Scope virtualreality.1ª 2018 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf ofRoyal College of Obstetricians and Gynaecologists..This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use,distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Robinson's crown-rump length curve: a major step towards human embryonic health evaluation

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Robinson's crown-rump length curve: a major step towards human embryonic health evaluation

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