Anogenital distance and anal position index in cadaveric human fetuses

Springer Science and Business Media LLC - Tập 98 - Trang 155-163 - 2022
Hakan Taşkınlar1, Özlem Elvan2, Caner İsbir1, İsa Kıllı1, Ali Naycı1
1School of Medicine, Department of Pediatric Surgery, Çiftlikköy Campus, Mersin University, Yenişehir, Turkey
2School of Health, Department of Anatomy, Mersin University, Yenişehir, Turkey

Tóm tắt

The aim of this study is to contribute to the determination of the normal values of human anogenital distance (AGD) and anal position index (API) in the antenatal period. 59 formalin-fixed human fetuses were examined. AGD was measured by the distance between the center of the anus and the posterior fourchette in females, and the distance between the center of the anus and the posterior scrotal raphe in males. API in female fetuses was determined with the formula API = fourchette–center of anus/fourchette-coccyx formula, and API = posterior scrotal raphe-center of anus/posterior scrotal raphe-coccyx in males. The mean AGDs of the female and male fetuses in the second trimester were 5.60 ± 1.60 mm and 9.64 ± 2.75 mm and 12.88 ± 4.14 mm and 17.26 ± 5.55 mm in the third trimester, respectively. The AGD values were found to be significantly higher in the males (p = 0.002). While the API values detected in the female and male fetuses were 0.43 ± 0.085 and 0.55 ± 0.072 in the second trimester, they were 0.46 ± 0.079 and 0.55 ± 0.058 in the third trimester. The API values were found to be significantly higher in the male fetuses (p < 0.001). When the distribution of API values of the fetuses in the second and third trimesters was examined, no significant difference was found (p = 0.499). In addition, no significant correlation was found between API and AGD values and percentile groups of fetuses (p ˃ 0.05). The AGD and API differed significantly between female and male fetuses starting from the antenatal second trimester, and the difference was preserved independently of the fetal percentile in the later stages of pregnancy.

Tài liệu tham khảo

Aydin E, Holt R, Chaplin D, Hawkes R, Allison C, Hackett G, Austin T, Tsompanidis A, Gabis L, Ziv SI, Baron-Cohen S (2019) Fetal anogenital distance using ultrasound. Prenat Diagn 39:527–535. https://doi.org/10.1002/pd.5459 Baron-Cohen S, Auyeung B, Nørgaard-Pedersen B, Hougaard DM, Abdallah MW, Melgaard L, Cohen AS, Chakrabarti B, Ruta L, Lombardo MV (2015) Elevated fetal steroidogenic activity in autism. Mol Psychiatry 20:369–376. https://doi.org/10.1038/mp.2014.48 Broome DR, Hayman LA, Herrick RC, Braverman RM, Glass RB, Fahr LM (1998) Postnatal maturation of the sacrum and coccyx: MR imaging, helical CT, and conventional radiography. AJR Am J Roentgenol 170(4):1061–1066. https://doi.org/10.2214/ajr.170.4.9530059 Callegari C, Everett S, Ross M, Brasel JA (1987) Anogenital ratio: measure of fetal virilization in premature and full-term newborn infants. J Pediatr 111:240–243. https://doi.org/10.1016/s0022-3476(87)80075-6 Chan WT, Lee HC, Wang WN, Yeung CY, Jiang CB (2009) Determination of the normal position of the anus in Taiwanese infants. Pediatr Neonatol 50:158–161. https://doi.org/10.1016/S1875-9572(09)60055-3 (PMID: 19750890) Colmant C, Morin-Surroca M, Fuchs F, Fernandez H, Senat MV (2013) Non-invasive prenatal testing for fetal sex determination: is ultrasound still relevant? Eur J Obstet Gynecol Reprod Biol 171:197–204. https://doi.org/10.1016/j.ejogrb.2013.09.005 Cools M, Nordenström A, Robeva R, Hall J, Westerveld P, Flück C, Köhler B, Berra M, Springer A, Schweizer K, Pasterski V (2018) Caring for individuals with a difference of sex development (DSD): a consensus statement. Nat Rev Endocrinol 14:415–429. https://doi.org/10.1038/s41574-018-0010-8 Davari HA, Hosseinpour M (2006) The anal position index: a simple method to define the normal position of the anus in neonate. Acta Paediatr 95:877–880. https://doi.org/10.1080/08035250500449882 Dean A, Sharpe RM (2013) Clinical review: anogenital distance or digit length ratio as measures of fetal androgen exposure: relationship to male reproductive development and its disorders. J Clin Endocrinol Metab 98:2230–2238. https://doi.org/10.1210/jc.2012-4057 Dean A, Smith LB, Macpherson S, Sharpe RM (2012) The effect of dihydrotestosterone exposure during or prior to the masculinization programming window on reproductive development in male and female rats. Int J Androl 35:330–339. https://doi.org/10.1111/j.1365-2605.2011.01236.x Efrat Z, Akinfenwa OO, Nicolaides KH (1999) First-trimester determination of fetal gender by ultrasound. Ultrasound Obstet Gynecol 13:305–307. https://doi.org/10.1046/j.14690705 Eisenberg ML, Hsieh TC, Lipshultz LI (2013) The relationship between anogenital distance and age. Andrology 1:90–93. https://doi.org/10.1111/j.2047-2927.2012.00019.x Ertürk N, Kandemir Ö (2017) Determination of normal anal position index using a modified technique in Turkish neonates. J Indian Assoc Pediatr Surg 22:29–32. https://doi.org/10.4103/0971-9261.194617 Genç A, Taneli C, Tansuğ N, Kasirga E, Yilmaz D, Küçükoğlu T, Onağ A (2002) Evaluation of the location of the anus by a modified technique in the neonate. J Pediatr Surg 37:80–82. https://doi.org/10.1053/jpsu.2002.29432 Gilboa Y, Perlman S, Kivilevitch Z, Messing B, Achiron R (2017) Prenatal anogenital distance is shorter in fetuses with hypospadias. J Ultrasound Med 36:175–182 Hernández-Peñalver AI, Sánchez-Ferrer ML, Mendiola J, Adoamnei E, Prieto-Sanchez MT, Corbalan-Biyang S, Carmona-Barnosi A, Nieto A, Torres-Cantero AM (2018) Assessment of anogenital distance as a diagnostic tool in polycystic ovary syndrome. Reprod Biomed Online 37:741–749. https://doi.org/10.1111/j.2047-2927.2012.00019.x Isbir C, Elvan Ö, Taşkınlar H, Çetin Z, Temel G (2020) Assessment of clitoral anatomy in human fetuses. Surg Radiol Anat: SRA 42:453–459. https://doi.org/10.1007/s00276-019-02383-9 Kluth D, Hillen M, Lambrecht W (1995) The principles of normal and abnormal hindgut development. J Pediatr Surg 30(8):1143–1147. https://doi.org/10.1016/0022-3468(95)90007-1 Loreto-Gómez C, Farías P, Moreno-Macías H, Romano-Riquer SP, Riojas-Rodríguez H (2017) Anogenital distance: a longitudinal evaluation of its variants and indices in boys and girls of Sonora, Mexico. Reprod Toxicol 73:167–174. https://doi.org/10.1016/j.reprotox.2017.08.011 Mackanjee HR, Iliescu BM, Dawson WB (1996) Assessment of postnatal gestational age using sonographic measurements of femur length. J Ultrasound Med 15:115–120. https://doi.org/10.7863/jum.1996.15.2.115 Najdi N, Safi F, Hashemi-Dizaji S, Sahraian G, Jand Y (2019) First trimester determination of fetal gender by ultrasonographic measurement of anogenital distance: a cross-sectional study. Int J Reprod Biomed 17:51–56. https://doi.org/10.18502/ijrm.v17i1.3820 Núñez-Ramos R, Fabbro MA, González-Velasco M, Núñez Núñez R, Romanato B, Vecchiato L, D’Agostino S, Blesa Sánchez E (2011) Determination of the anal position in newborns and in children with chronic constipation: comparative study in two European healthcare centres. Pediatr Surg Int 27:1111–1115. https://doi.org/10.1007/s00383-011-2914-4 Pang D (1993) Sacral agenesis and caudal spinal cord malformations. Neurosurgery 32(5):755–779. https://doi.org/10.1227/00006123-199305000-00009 Papadopoulou E, Vafeiadi M, Agramunt S, Basagana X, Mathianaki K, Karacosta P, Spanaki A, Koutis A, Chatzi L, Vrijheid M, Kogevinas M (2013) Anogenital distances in newborns and children from Spain and Greece: predictors, tracking and reliability. Paediatr Perinat Epidemiol 27:89–99. https://doi.org/10.1111/ppe.12022 Pedreira DA, Yamasaki A, Czeresnia CE (2001) Fetal phallus “erection” interfering with the sonographic determination of fetal gender in the first trimester. Ultrasound Obstet Gynecol 18:402–404. https://doi.org/10.1046/j.0960-7692.2001.00532.x Reisner SH, Sivan Y, Nitzan M, Merlob P (1984) Determination of anterior displacement of the anus in newborn infants and children. Pediatrics 73:216–217 Romano-Riquer SP, Hernández-Avila M, Gladen BC, Cupul-Uicab LA, Longnecker MP (2007) Reliability and determinants of anogenital distance and penis dimensions in male newborns from Chiapas, Mexico. Paediatr Perinat Epidemiol 21:219–228. https://doi.org/10.1111/j.1365-3016.2007.00810.x Salazar-Martinez E, Romano-Riquer P, Yanez-Marquez E, Longnecker MP, Hernandez-Avila M (2004) Anogenital distance in human male and female newborns: a descriptive, cross-sectional study. Environ Health 3:8. https://doi.org/10.1186/1476-069X-3-8 Sathyanarayana S, Beard L, Zhou C, Grady R (2010) Measurement and correlates of ano-genital distance in healthy, newborn infants. Int J Androl 33:317–323. https://doi.org/10.1111/j.1365-2605.2009.01044.x Suryana Y, Makhmudi A (2018) Assessment of the normal anal position index (API) of Indonesian neonates. J Med Sci 50:431–435. https://doi.org/10.19106/JMedScie/005004201807 Thankamony A, Pasterski V, Ong KK, Acerini CL, Hughes IA (2016) Anogenital distance as a marker of androgen exposure in humans. Andrology 4:616–625. https://doi.org/10.1111/andr.12156 Van Der Straaten S, Springer A, Zecic A et al (2020) The external genitalia score (EGS): a European multicenter validation study. J Clin Endocrinol Metab 105:142. https://doi.org/10.1210/clinem/dgz142 Vocel J, Marková H (1978) Význam vrásnĕní plosky a délky nohy pro upresnĕní gestacního vĕku novorozence [Signifivance of sole dermatoglyphics and of foot length in the accurate determination of gestational age in newborn infants]. Cesk Pediatr 33:618–620 Welsh M, Saunders PT, Fisken M, Scott HM, Hutchinson GR, Smith LB, Sharpe RM (2008) Identification in rats of a programming window for reproductive tract masculinization, disruption of which leads to hypospadias and cryptorchidism. J Clin Invest 118:1479–1490. https://doi.org/10.1172/JCI34241 Woon JT, Stringer MD (2012) Clinical anatomy of the coccyx: a systematic review. Clin Anat 25(2):158–167. https://doi.org/10.1002/ca.21216