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O'Keefe H, Shenfine R, Brown M, Beyer F, Rankin J. Are non-invasive or minimally invasive autopsy techniques for detecting cause of death in prenates, neonates and infants accurate? A systematic review of diagnostic test accuracy. BMJ Open 2023; 13:e064774. [PMID: 36609326 PMCID: PMC9827258 DOI: 10.1136/bmjopen-2022-064774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 12/04/2022] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To assess the diagnostic accuracy of non-invasive or minimally invasive autopsy techniques in deaths under 1 year of age. DESIGN This is a systematic review of diagnostic test accuracy. The protocol is registered on PROSPERO. PARTICIPANTS Deaths from conception to one adjusted year of age. SEARCH METHODS MEDLINE (Ovid), EMBASE (Ovid), CINAHL (EBSCO), the Cochrane Library, Scopus and grey literature sources were searched from inception to November 2021. DIAGNOSTIC TESTS Non-invasive or minimally invasive diagnostic tests as an alternative to traditional autopsy. DATA COLLECTION AND ANALYSIS Studies were included if participants were under one adjusted year of age, with index tests conducted prior to the reference standard.Data were extracted from eligible studies using piloted forms. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2. A narrative synthesis was conducted following the Synthesis without Meta-Analysis guidelines. Vote counting was used to assess the direction of effect. MAIN OUTCOME MEASURES Direction of effect was expressed as percentage of patients per study. FINDINGS We included 54 direct evidence studies (68 articles/trials), encompassing 3268 cases and eight index tests. The direction of effect was positive for postmortem ultrasound and antenatal echography, although with varying levels of success. Conversely, the direction of effect was against virtual autopsy. For the remaining tests, the direction of effect was inconclusive.A further 134 indirect evidence studies (135 articles/trials) were included, encompassing 6242 perinatal cases. The addition of these results had minimal impact on the direct findings yet did reveal other techniques, which may be favourable alternatives to autopsy.Seven trial registrations were included but yielded no results. CONCLUSIONS Current evidence is insufficient to make firm conclusions about the generalised use of non-invasive or minimally invasive autopsy techniques in relation to all perinatal population groups.PROSPERO registration numberCRD42021223254.
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Affiliation(s)
- Hannah O'Keefe
- NIHR Innovation Observatory, Newcastle University, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Rebekka Shenfine
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Melissa Brown
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona Beyer
- NIHR Innovation Observatory, Newcastle University, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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2
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Katsanevakis E, Tzitzikalakis C, Karagioti N, Tziomaki M, Perdikaris P, Papanikolaou A, Gkogkos P, Tsagkas N. Fetal Hand Abnormalities in the First-Trimester Scan: A Report of Two Cases. Cureus 2022; 14:e23189. [PMID: 35444909 PMCID: PMC9009976 DOI: 10.7759/cureus.23189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 11/05/2022] Open
Abstract
Two cases of fetal hand abnormalities are presented in this report. The first one is a case of unilateral fetal syndactyly detected in the first trimester routine scan, resulting in the early diagnosis of a severe genetic condition by invasive testing and early termination of pregnancy. By doing so, we ensured that the woman was managed in the most appropriate way. In the second case, we describe a fetus with bilateral hand polydactyly, which was combined with a cardiac defect - incompatible with extrauterine life. This was once again diagnosed during the first trimester scan. An uncomplicated termination of pregnancy was achieved in the first trimester of pregnancy.
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Li Q, Zhang Z, Wang J, Zhang H, Zhu H, Lai Y, Liu S, Wang H, Hu T. Prenatal diagnosis of genetic aberrations in fetuses with short femur detected by ultrasound: A prospective cohort study. Prenat Diagn 2021; 41:1153-1163. [PMID: 34185917 DOI: 10.1002/pd.6006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 06/16/2021] [Accepted: 06/18/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To investigate the genetic aberrations in fetuses with short femur and explore the relationships with respect to degree of femoral shortening and the initial diagnostic gestational age GA. METHODS Singleton pregnancies with fetal short femur who consented to amniocentesis and to single nucleotide polymorphism (SNP) array and Sanger sequencing for G380R mutations in FGFR3 gene were enrolled in this 5-year period prospective study. Clinical follow-up assessments were performed after birth. RESULTS Of a total of 161 fetuses, the prevalence of genetic aberrations was 16.2% (26/161), comprised of 65.4% (17/26) with chromosomal abnormalities and 34.6% (9/26) with G380R mutations. All fetuses with chromosomal abnormalities had FL 2-4SDs below GA. Fewer chromosomal abnormalities were detected in fetuses with short femurs presenting in the third trimester. Significantly more FGFR3 mutations were detected in fetuses with FL below -4SDs. All fetuses with FL 2-4SDs below GA diagnosed as achondroplasia were between 22 and 24 gestational weeks, and all of those diagnosed in third trimester had FL below -4SDs. CONCLUSION In this small cohort study, we demonstrated that different degrees of femur shortness may be attributed to different genetic aberrations. SNP array should be regarded as the first-tier test for fetuses with FL 2-4SDs below GA. The prognoses for fetuses with FL 2-4SDs below GA was significantly better than those with FL below 4SDs.
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Affiliation(s)
- Qinqin Li
- Department of Obstetrics & Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Zhu Zhang
- Department of Obstetrics & Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Jiamin Wang
- Department of Obstetrics & Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Haixia Zhang
- Department of Obstetrics & Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Hongmei Zhu
- Department of Obstetrics & Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Yi Lai
- Department of Obstetrics & Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Shanling Liu
- Department of Obstetrics & Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - He Wang
- Department of Obstetrics & Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Ting Hu
- Department of Obstetrics & Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
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4
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Massalska D, Bijok J, Kucińska-Chahwan A, Zimowski JG, Ozdarska K, Panek G, Roszkowski T. Triploid pregnancy-Clinical implications. Clin Genet 2021; 100:368-375. [PMID: 34031868 DOI: 10.1111/cge.14003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 11/28/2022]
Abstract
Triploidy is a life-limiting genetic aberration resulting from an extra haploid set of chromosomes of paternal (diandric triploidy) or maternal origin (digynic triploidy). Triploidy affects around 1%-2% of all conceptions. The majority of cases is miscarried at early developmental stages. In consequence of genomic imprinting, parental origin affects the phenotype of triploid pregnancies as well as the prevalence and spectrum of related maternal complications. Distinctive ultrasound features of both triploid phenotypes as well as characteristic patterns of biochemical markers may be useful in diagnosis. Molecular confirmation of the parental origin allows to predict the risk of complications, such as gestational trophoblastic neoplasia, hyperthyroidism, hypertension, or preeclampsia associated with the paternal origin of triploidy. Diagnosis of partial hydatidiform mole associated with diandric triploidy is challenging especially in the first trimester pregnancy loss due to the limitations of both histopathology and ultrasound. We present important clinical aspects of triploid pregnancies and indicate unresolved issues demanding further studies.
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Affiliation(s)
- Diana Massalska
- Department of Gynecologic Oncology and Obstetrics, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Julia Bijok
- Department of Gynecologic Oncology and Obstetrics, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Anna Kucińska-Chahwan
- Department of Gynecologic Oncology and Obstetrics, Centre of Postgraduate Medical Education, Warsaw, Poland
| | | | - Katarzyna Ozdarska
- Department of Genetics, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Grzegorz Panek
- Department of Gynecologic Oncology and Obstetrics, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Tomasz Roszkowski
- Department of Gynecologic Oncology and Obstetrics, Centre of Postgraduate Medical Education, Warsaw, Poland
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Fontoura Oliveira A, Torrão MM, Nogueira R, Ferreira M. Recurrent fetal triploidy: is there a genetic cause? BMJ Case Rep 2021; 14:14/3/e239843. [PMID: 33653854 PMCID: PMC7929808 DOI: 10.1136/bcr-2020-239843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Triploidy is currently understood as a sporadic genetic disorder, with no recognisable risk of recurrence nor identifiable risk factors. In cases of triploidy, chances of thriving through the second trimester of fetal development are very slim, with most of these pregnancies ending as early miscarriage. We report a case of repeated triploid pregnancies in the same woman, from different fathers, achieving the second trimester of pregnancy; elective termination was decided in both cases, after an amniocentesis revealing a triploid karyotype. Both triploid pregnancies are described and compared; prenatal laboratorial markers, sonographic features, clinical course and pathological findings are analysed and matched with fetal autopsy and placental pathological study. Reported findings strongly point to recurrent triploidy of maternal origin, and so the possibility of a genetic predisposition should be considered. Investigation is required to assess the presence of an underlying genetic mechanism in this setting, thus enabling a better genetic/obstetric counselling.
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Affiliation(s)
| | - Maria Manuel Torrão
- Department of Gynecology and Obstetrics, Centro Hospitalar do Médio Ave EPE, Santo Tirso, Portugal
| | - Rosete Nogueira
- Surgical Sciences Research Domain, Life and Health Sciences Research Domain (ICVS), Braga, Portugal,Laboratory of Pathology, CGC Genetics Centro de Genetica Clinica, Porto, Portugal
| | - Manuela Ferreira
- Department of Gynecology and Obstetrics, Centro Hospitalar do Médio Ave EPE, Santo Tirso, Portugal
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6
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Vakrilova L, Hitrova-Nikolova S, Bradinova I. Triploidy in a Live-Born Extremely Low Birth Weight Twin: Clinical Aspects. J Pediatr Genet 2020; 11:227-231. [DOI: 10.1055/s-0040-1716828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
AbstractTriploidy is a rare chromosomal aberration characterized by a karyotype with 69 chromosomes. Triploid fetuses usually are miscarried in early pregnancy. We present a case of a triploid twin and a genetically unaffected co-twin, conceived through in vitro fertilization. A discordant growth was registered at 20 weeks of gestation. Cesarean section was performed at 355/7 gestational week. The second twin was extremely growth restricted female (780 g) with oligohydramnios and severe respiratory distress, and died at 20 hours of age. The autopsy revealed unilobar left lung, bilobar right lung, and cysts of the terminal bronchioles. Quantitative fluorescent polymerase chain reaction detected triploidy compatible pattern. So, early intrauterine growth restriction may be a sign of triploidy, which must be proven by pre or postnatal genetic testing.
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Affiliation(s)
- Liliya Vakrilova
- Department of Obstetrics and Gynecology, Medical University of Sofia, Sofia, Bulgaria
- Neonatology Clinic, University Hospital of Obstetrics and Gynecology “Maichin Dom,” Sofia, Bulgaria
| | - Stanislava Hitrova-Nikolova
- Department of Obstetrics and Gynecology, Medical University of Sofia, Sofia, Bulgaria
- Neonatology Clinic, University Hospital of Obstetrics and Gynecology “Maichin Dom,” Sofia, Bulgaria
| | - Irena Bradinova
- Department of Obstetrics and Gynecology, Medical University of Sofia, Sofia, Bulgaria
- National Genetic Laboratory, University Hospital of Obstetrics and Gynecology “Maichin dom,” Sofia, Bulgaria
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Lugthart MA, Horenblas J, Kleinrouweler EC, Engels M, Knegt AC, Huijsdens K, van Leeuwen E, Pajkrt E. Prenatal sonographic features can accurately determine parental origin in triploid pregnancies. Prenat Diagn 2020; 40:705-714. [PMID: 32039494 PMCID: PMC7317806 DOI: 10.1002/pd.5666] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 02/02/2020] [Accepted: 02/05/2020] [Indexed: 11/12/2022]
Abstract
Objective To describe the prenatal sonographic features and maternal biochemical markers in triploid pregnancies and to assess whether prenatal phenotype can determine genetic origin. Methods We performed a retrospective multicenter cohort study that included all triploid pregnancies diagnosed between 2000 and 2018 in two Fetal Medicine Units in Amsterdam. Fetal growth, presence of structural anomalies, extra‐fetal anomalies, and maternal biochemical markers were retrieved. Asymmetrical intrauterine growth restriction was diagnosed when the head‐to‐abdominal circumference (HC/AC) ratio was >95th centile. Parental origin was analyzed via molecular genotyping in 46 cases (38.3%). Results One hundred and twenty triploid pregnancies were identified, of which 86 cases (71.6%) were detected before 18 weeks of gestation. Triploidy of maternal origin was found in 32 cases (69.6%) and was associated with asymmetrical growth restriction, a thin placenta, and low pregnancy‐associated plasma protein A and free beta‐human chorionic gonadotrophin (β‐hCG) levels. Triploidy of paternal origin was found in 14 cases (30.4%) and was associated with an increased nuchal translucency, placental molar changes, and a high free β‐hCG. Prospective prediction of the parental origin of the triploidy was made in 30 of the 46 cases based on phenotypical ultrasound presentation, and it was correct in all cases. Conclusion Asymmetrical growth restriction with severe HC/AC discrepancy is pathognomonic of maternal triploidy. Placental molar changes indicate a paternal triploidy. Moreover, triploidy can present with an abnormal first trimester combined test, with serum levels on the extreme end. When available results of maternal serum markers can support the diagnosis of parental origin of the triploidy, an accurate assessment of the parental origin based on prenatal sonographic features is possible, making DNA analysis redundant.
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Affiliation(s)
- Malou A Lugthart
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Judith Horenblas
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Emily C Kleinrouweler
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Melanie Engels
- Department of Obstetrics and Gynecology, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Alida C Knegt
- Department of Clinical Genetics and Genome Diagnostics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Karin Huijsdens
- Department of Genome Diagnostics, UMC Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Elisabeth van Leeuwen
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Eva Pajkrt
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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8
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Chuang TY, Chang SY, Chen CP, Lin MH, Chen CY, Chen SW, Chern SR, Lee CC, Town DD, Wang W. Digynic triploidy in a fetus presenting with semilobar holoprosencephaly. Taiwan J Obstet Gynecol 2019; 57:881-884. [PMID: 30545546 DOI: 10.1016/j.tjog.2018.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2018] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE We present digynic triploidy in a fetus with semilobar holoprosencephaly (HPE). CASE REPORT A 32-year-old, gravid 1, para 0, woman underwent prenatal ultrasound examination at 12 weeks of gestation, and the ultrasound showed relative macrocephaly, a small non-cystic placenta, and a fetus with absent nasal bone and semilobar HPE. The pregnancy was terminated subsequently, and a 50-g fetus was delivered with a relatively enlarged head and premaxillary agenesis. The placenta was small and non-cystic. Postnatal cytogenetic analysis of the umbilical cord revealed a karyotype of 69, XXX. Postnatal DNA marker analysis using quantitative fluorescent polymerase chain reaction assays and the polymorphic short tandem repeat markers for chromosome 18 and 20 on the placental tissues showed a diallelic pattern with a dosage of 1:2 (paternal allele to maternal allele ratio), indicating a maternal origin of the triploidy. CONCLUSION Fetuses with digynic triploidy may present relative macrocephaly, semilobar HPE and a small placenta on prenatal ultrasound.
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Affiliation(s)
- Tzu-Yun Chuang
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Shu-Yuan Chang
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chih-Ping Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan; Department of Biotechnology, Asia University, Taichung, Taiwan; School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan; Institute of Clinical and Community Health Nursing, National Yang-Ming University, Taipei, Taiwan; Department of Obstetrics and Gynecology, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Ming-Huei Lin
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan; MacKay Medical College, New Taipei City, Taiwan
| | - Cheng-Yu Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Shin-Wen Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Schu-Rern Chern
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chen-Chi Lee
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Dai-Dyi Town
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Wayseen Wang
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan; Department of Bioengineering, Tatung University, Taipei, Taiwan
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9
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Okumura M, Fushida K, Francisco RPV, Schultz R, Zugaib M. Triploid twin gestation with single fetal demise associated with partial mole and pre-eclampsia. Australas J Ultrasound Med 2017; 20:174-177. [PMID: 34760492 DOI: 10.1002/ajum.12064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Both partial mole and twin gestation are conditions associated with the risk of the early onset of pre-eclampsia. In cases of twin gestation, the death or selective termination of a severely growth-restricted fetus may lead to the reversal of maternal pre-eclampsia because of the involution or death of the pathological placenta, as has been reported by some authors. This case demonstrates that in a twin triploid gestation, in spite of the demise of one of the fetuses, the respective partial molar placenta can continue to grow and may contribute to the development or to the worsening of the pre-eclampsia.
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Affiliation(s)
- Maria Okumura
- Department of Obstetrics Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | - Koji Fushida
- Department of Obstetrics Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | | | - Regina Schultz
- Division of Pathology Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | - Marcelo Zugaib
- Department of Obstetrics Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
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10
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Massalska D, Bijok J, Ilnicka A, Jakiel G, Roszkowski T. Triploidy - variability of sonographic phenotypes. Prenat Diagn 2017; 37:774-780. [DOI: 10.1002/pd.5080] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 05/23/2017] [Accepted: 05/25/2017] [Indexed: 01/28/2023]
Affiliation(s)
- Diana Massalska
- I Department of Obstetrics and Gynecology; Centre of Postgraduate Medical Education; Warsaw Poland
| | - Julia Bijok
- I Department of Obstetrics and Gynecology; Centre of Postgraduate Medical Education; Warsaw Poland
| | - Alicja Ilnicka
- Department of Genetics; Institute of Psychiatry and Neurology; Warsaw Poland
| | - Grzegorz Jakiel
- I Department of Obstetrics and Gynecology; Centre of Postgraduate Medical Education; Warsaw Poland
| | - Tomasz Roszkowski
- I Department of Obstetrics and Gynecology; Centre of Postgraduate Medical Education; Warsaw Poland
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11
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Abstract
OBJECTIVES Triploidy (69, XXX; 69, XXY; 69, XYY) accounts for 1% of conceptions, but the affected fetus often does not survive past the first trimester. Fetal development in triploidy is rare. A consecutive series was used to describe the fetal and placental phenotypes and compare them with previous publications. METHODS Fifty-four triploid fetuses were identified in the Active Malformations Surveillance Program between 1972 and 2012 at Brigham and Women's Hospital in Boston. The phenotype was described from prenatal imaging and autopsy findings. RESULTS The diagnosis was confirmed by chromosome analysis in 53 of the 54 fetuses. Twenty-seven (50%) of the affected fetuses were identified during pregnancy. The abnormalities identified by prenatal ultrasound included renal malformations, heart defects, hydrocephalus, holoprosencephaly, and myelomeningocele. At autopsy, syndactyly, usually between fingers 3 and 4, was identified in 37 (69%) of the fetuses. Thirteen (24%) of the infants had the histologic features of a partial hydatidiform mole in the placenta. CONCLUSIONS The presence of major malformations and growth restriction during pregnancy makes triploidy a potential diagnosis. There are no obligate clinical features in triploidy. Syndactyly, especially 3-4 syndactyly of the hands, is a distinctive feature. Cystic changes in the placenta can be seen by ultrasound during pregnancy. There was no difference in the phenotype between triploid infants associated with partial moles and those with nonmolar placentas.
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Affiliation(s)
- M Hassan Toufaily
- From the Medical Genetics Unit, MassGeneral Hospital for Children, Harvard Medical School, Boston, MA Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Drucilla J Roberts
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Marie-Noel Westgate
- From the Medical Genetics Unit, MassGeneral Hospital for Children, Harvard Medical School, Boston, MA Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Lewis B Holmes
- From the Medical Genetics Unit, MassGeneral Hospital for Children, Harvard Medical School, Boston, MA Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Liau J, Romine L, Korty LA, Chao C, White K, Harmon S, Ho Y, Hull AD, Pretorius DH. Simplifying the Ultrasound Findings of the Major Fetal Chromosomal Aneuploidies. Curr Probl Diagn Radiol 2014; 43:300-16. [DOI: 10.1067/j.cpradiol.2014.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 04/24/2014] [Indexed: 11/22/2022]
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13
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Barzilay E, Harel Y, Haas J, Berkenstadt M, Katorza E, Achiron R, Gilboa Y. Prenatal diagnosis of amniotic band syndrome - risk factors and ultrasonic signs. J Matern Fetal Neonatal Med 2014; 28:281-3. [PMID: 24735486 DOI: 10.3109/14767058.2014.915935] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of this study was to describe our experience with amniotic band syndrome (ABS), define specific sonographic characteristics and common features. METHODS Patients diagnosed with ABS underwent detailed ultrasound evaluation at the time of diagnosis and during follow-up. Their ultrasound examinations and medical records concerning the current pregnancy and past medical records were analyzed. RESULTS Ten pregnancies were diagnosed with ABS. Most pregnancies were diagnosed at the beginning of the second trimester. Two cases were bichorionic twin pregnancies involving one of the fetuses and these were the only women who continued their pregnancies to term. The other eight cases with ABS chose to terminate their pregnancies. One pregnancy was conceived following trachelectomy. We found a significantly higher rate of prior uterine surgeries (p = 0.008) in patient with ABS compared to control. In three cases, all above 15 weeks of gestation, a small vestige at the distal part of the amputated limb was observed. CONCLUSIONS ABS diagnosed in early pregnancy can be a sporadic event. However, there is a higher risk of ABS in pregnancies preceded by uterine procedures. The ultrasonic vestige sign at the amputated limb may contribute to the diagnosis of ABS.
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Affiliation(s)
- Eran Barzilay
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center , Tel-Hashomer , Israel
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14
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First-trimester sonographic demonstration of digynic triploidy. Taiwan J Obstet Gynecol 2013; 52:613-5. [DOI: 10.1016/j.tjog.2013.10.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 09/30/2013] [Indexed: 11/18/2022] Open
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15
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Prenatal Diagnosis and Molecular Analysis of Triploidy in a Fetus With Intrauterine Growth Restriction, Relative Macrocephaly and Holoprosencephaly. Taiwan J Obstet Gynecol 2009; 48:323-6. [DOI: 10.1016/s1028-4559(09)60318-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Koifman A, Nevo O, Toi A, Chitayat D. Diagnostic Approach to Prenatally Diagnosed Limb Abnormalities. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.cult.2008.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Chen CP. Chromosomal abnormalities associated with neural tube defects (I): full aneuploidy. Taiwan J Obstet Gynecol 2008; 46:325-35. [PMID: 18182338 DOI: 10.1016/s1028-4559(08)60002-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Fetuses with neural tube defects (NTDs) carry a risk of chromosomal abnormalities. The risk varies with maternal age, gestational age at diagnosis, association with other structural abnormalities, and family history of chromosome aberrations. This article provides an overview of chromosomal abnormalities associated with NTDs in embryos, fetuses, and newborn patients, and a comprehensive review of numerical chromosomal abnormalities associated with NTDs, such as trisomy 18, trisomy 13, triploidy, trisomy 9, trisomy 2, trisomy 21, trisomy 7, trisomy 8, trisomy 14, trisomy 15, trisomy 16, trisomy 5 mosaicism, trisomy 11 mosaicism, trisomy 20 mosaicism, monosomy X, and tetraploidy. NTDs may be associated with aneuploidy. Perinatal identification of NTDs should alert one to the possibility of chromosomal abnormalities and prompt a thorough cytogenetic investigation and genetic counseling.
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Affiliation(s)
- Chih-Ping Chen
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan.
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Chen CP, Chang TY, Liu YP, Chern SR, Wang W. Prenatal Magnetic Resonance Imaging Evaluation of a Digynic Triploid Fetus. Taiwan J Obstet Gynecol 2007; 46:284-5. [DOI: 10.1016/s1028-4559(08)60036-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Breathnach FM, Fleming A, Malone FD. The second trimester genetic sonogram. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2007; 145C:62-72. [PMID: 17304556 DOI: 10.1002/ajmg.c.30116] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The genetic sonogram, a fetal anatomic survey targeted at identifying features associated with aneuploidy, is carried out between 15 and 20 weeks' gestation. It has evolved as an adjunctive screening tool capable of further refining the individualized risk-calculation for trisomy that is based on maternal age or serum screening markers. The significance of a range of major structural anomalies and so-called "soft-markers" for trisomy, detected both in isolation and in combination, has been widely investigated. This review serves to describe the key components of the second trimester genetic sonogram and to illustrate how these markers are integrated into risk assessment for aneuploidy.
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Affiliation(s)
- Fionnuala M Breathnach
- Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland
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21
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Salomon LJ, Bernard JP, Nizard J, Ville Y. First-trimester screening for fetal triploidy at 11 to 14 weeks: a role for fetal biometry. Prenat Diagn 2005; 25:479-83. [PMID: 15966039 DOI: 10.1002/pd.1170] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Intrauterine growth restriction in triploidy has been reported as early as in the first trimester. This study was undertaken to evaluate the ability of first-trimester crown rump length (CRL)-based charts to detect triploid fetuses. MATERIAL AND METHODS Analysis of fetal biometry in cases of triploidy diagnosed in the first trimester over the last three years. Biometry for abdominal circumference (AC), head circumference (HC) and biparietal diameter (BPD) was analyzed in relation to both gestational age (GA)-based charts and to CRL-based charts. RESULTS Five cases of fetal triploidy were diagnosed at 11 to 14 weeks. Screening based on nuchal translucency (NT) and maternal age showed a risk > 1/300 in only one of the 5 cases of triploid fetus. In all of these five cases, CRL-based biometry was grossly abnormal, although it was abnormal in only two of these five cases in relation to GA-based charts. CONCLUSION First-trimester CRL-based biometry charts seem to reflect early asymmetrical growth delay in triploidy more accurately than GA-based charts. CRL-based biometry is likely to improve the early detection of triploid pregnancies without leading to dating error.
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Affiliation(s)
- L J Salomon
- Service de Gynécologie-Obstétrique, Centre Hospitalier Intercommunal de Poissy-St Germain, 10 rue Champ Gaillard, Poissy, France
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22
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Holder-Espinasse M, Devisme L, Thomas D, Boute O, Vaast P, Fron D, Herbaux B, Puech F, Manouvrier-Hanu S. Pre- and postnatal diagnosis of limb anomalies: A series of 107 cases. ACTA ACUST UNITED AC 2004; 124A:417-22. [PMID: 14735595 DOI: 10.1002/ajmg.a.20359] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This is a 3-year retrospective study of 107 cases presenting with limb anomalies detected either on prenatal ultrasound scan, or after birth. These limb malformations are developmental anomalies, and can be isolated, syndromic, or associated with multiple malformations. Cases were ascertained through the prenatal diagnosis center, the pediatrics department, and the feto-pathology department. Several criteria were analyzed including sex ratio, prenatal diagnosis, karyotype, termination of pregnancies, clinical or pathological examination, pediatric or surgical and/or genetic assessment, and whether or not a diagnosis was made. Positional deformities and syndactyly were excluded. Limb anomalies were detected prenatally in 45% of the cases, and a diagnosis was made in 78%, including isolated, syndromic, or chromosomal anomalies. Sixty-one per cent of the infants had follow-up, either pediatric, surgical, or genetic. Prenatal multidisciplinary assessment is fundamental to assist with counseling, as is the post-natal follow-up of the infant. The diagnosis, if made, will obviously influence the information that will be given to the parents and the management of the malformation. If the pregnancy is terminated, feto-pathological examination is essential to help make a diagnosis, and guide recurrence risks. We are currently undertaking a prospective study, and we will develop a protocol of investigations in the future, depending on the type of the malformation identified.
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Affiliation(s)
- Colleen O'Connor
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA
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Shipp TD, Benacerraf BR. Second trimester ultrasound screening for chromosomal abnormalities. Prenat Diagn 2002; 22:296-307. [PMID: 11981910 DOI: 10.1002/pd.307] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The use of prenatal ultrasound has proven efficacious for the prenatal diagnosis of chromosomal abnormalities. The first sonographic sign of Down syndrome, the thickened nuchal fold, was first described in 1985. Since that time, multiple sonographically-identified markers have been described as associated with Down syndrome. The genetic sonogram, involving a detailed search for sonographic signs of aneuploidy, can be used to both identify fetuses at high risk for aneuploidy and, when normal, can be used to decrease the risk for aneuploidy for a pregnancy when no sonographic markers are identified. Combining the genetic sonogram with maternal serum screening may be the best method of assessing aneuploidy risk for women who desire such an assessment in the second trimester. Trisomy 18, Trisomy 13, and triploidy are typically associated with sonographically identified abnormalities and have a high prenatal detection rate. The use of the described sonographic signs in low-risk women requires further investigation, however, patients at increased risk for aneuploidy due to advanced maternal age or abnormal serum screening can benefit from a genetic sonogram screening for sonographic signs of aneuploidy to adjust their baseline risk of an affected fetus.
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Affiliation(s)
- Thomas D Shipp
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Genest DR. Partial hydatidiform mole: clinicopathological features, differential diagnosis, ploidy and molecular studies, and gold standards for diagnosis. Int J Gynecol Pathol 2001; 20:315-22. [PMID: 11603213 DOI: 10.1097/00004347-200110000-00001] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Partial hydatidiform mole is optimally diagnosed histopathologically when four microscopic features coexist: 1) two populations of villi, 2) enlarged villi (> or = 3-4 mm) with central captivation, 3) irregular villi with geographic, scalloped borders with trophoblast inclusions, and 4) trophoblast hyperplasia (usually focal and involving syncytiotrophoblast). Pathologic mimics of partial mole include Beckwith-Wiedemann syndrome, placental angiomatous malformation, twin gestation with complete mole and existing fetus, early complete hydatidiform mole, and hydropic spontaneous abortion. Because partial hydatidiform mole results from diandric triploidy, flow cytometry (or another method to assess ploidy) can be utilized by pathologists for supporting diagnostic classification of problematic specimens, or for educational or quality assurance purposes. Confirmation of the histopathologic diagnosis by ploidy or molecular studies is important for scientific reports of partial hydatidiform mole, especially when unusual or aggressive outcomes (such as choriocarcinoma) are reported.
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Affiliation(s)
- D R Genest
- Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
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Abstract
A variety of ultrasound findings can be identified in fetuses with fetal aneuploidy. Typical findings vary with both the chromosome abnormality and gestational age at time of the ultrasound examination. Increased NT is the primary marker during the first trimester, whereas a variety of markers may be seen during the second trimester. The presence of ultrasound markers increases the risk for fetal aneuploidy, whereas a normal ultrasound reduces the risk. Optimal risk assessment includes consideration of other risk factors including maternal age, family history, and biochemical markers. It is expected that combined risks, incorporating ultrasound findings and biochemistry, will be available in the near future. How first-trimester screening is integrated with second-trimester screening remains to be determined.
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Affiliation(s)
- D A Nyberg
- Center for Perinatal Studies, Seattle Medical Center, Departments of Radiology and Obstetrics and Gynecology, University of Washington Hospital, Seattle, Washington, USA
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Chen CP. A digynic triploid fetus presenting with intrauterine growth restriction, severe oligohydramnios and relative macrocephaly on prenatal ultrasound. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2000; 16:291-292. [PMID: 11169300 DOI: 10.1046/j.1469-0705.2000.00269.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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