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Tonni G, Grisolia G, Bonasoni MP, Rizzo G, Werner H, Sepulveda W, Ruano R, Araujo Júnior E. Fetal Hands: A Comprehensive Review of Prenatal Assessment and Diagnosis Over the Past 40 Years. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:657-676. [PMID: 36526543 DOI: 10.1016/j.ultrasmedbio.2022.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/16/2022] [Accepted: 09/30/2022] [Indexed: 06/17/2023]
Abstract
Fetal skeletal dysplasias involving limbs and hands are rare congenital malformations. Prenatal two-dimensional ultrasound diagnosis of fetal limb defects has a sensitivity of about 30%; however, an increased detection rate may be obtained using three-dimensional (3-D) ultrasound in the rendering mode. 3-D ultrasound may be used as a complementary method providing additional information. Currently, magnetic resonance imaging (MRI), with the emergence of ultrafast imaging techniques and new sequences, allows for better diagnosis of several fetal skeletal dysplasias such as limb reduction defects and neuromuscular disorders. 3-D volumetric images from ultrasound or MRI scan data allow 3-D ultrasound reconstructions of virtual/physical models, and virtual reality can help researchers to improve our understanding of both normal and abnormal fetal limb/hand anatomy. In this article, we review the embryological development of fetal hands and their main anomalies including prenatal diagnostic methods, genetic counseling, the role of orthopedic and plastic surgery reconstruction, and new perspectives in fetal surgery.
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Affiliation(s)
- Gabriele Tonni
- Prenatal Diagnostic Centre, Department of Obstetrics and Neonatology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, Italy.
| | - Gianpaolo Grisolia
- Prenatal Diagnostic Centre, Department of Obstetrics and Neonatology, Carlo Poma Hospital, Mantua, Italy
| | - Maria Paola Bonasoni
- Human Pathology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Tor Vergata, Rome, Italy
| | - Heron Werner
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem (CDPI-DASA), Rio de Janeiro, Brazil
| | - Waldo Sepulveda
- FETALMED-Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
| | - Rodrigo Ruano
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
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Implementation of Exome Sequencing in Prenatal Diagnostics: Chances and Challenges. Diagnostics (Basel) 2023; 13:diagnostics13050860. [PMID: 36900003 PMCID: PMC10000387 DOI: 10.3390/diagnostics13050860] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 02/26/2023] Open
Abstract
Whole exome sequencing (WES) has become part of the postnatal diagnostic work-up of both pediatric and adult patients with a range of disorders. In the last years, WES is slowly being implemented in the prenatal setting as well, although some hurdles remain, such as quantity and quality of input material, minimizing turn-around times, and ensuring consistent interpretation and reporting of variants. We present the results of 1 year of prenatal WES in a single genetic center. Twenty-eight fetus-parent trios were analyzed, of which seven (25%) showed a pathogenic or likely pathogenic variant that explained the fetal phenotype. Autosomal recessive (4), de novo (2) and dominantly inherited (1) mutations were detected. Prenatal rapid WES allows for a timely decision-making in the current pregnancy, adequate counseling with the possibility of preimplantation or prenatal genetic testing in future pregnancies and screening of the extended family. With a diagnostic yield in selected cases of 25% and a turn-around time under 4 weeks, rapid WES shows promise for becoming part of pregnancy care in fetuses with ultrasound anomalies in whom chromosomal microarray did not uncover the cause.
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Travessa AM, Dias P, Santos A, Custódio S, Sousa A, Sousa AB. Upper limb phocomelia: A prenatal case of thrombocytopenia-absent radius (TAR) syndrome illustrating the importance of chromosomal microarray in limb reduction defects. Taiwan J Obstet Gynecol 2020; 59:318-322. [PMID: 32127157 DOI: 10.1016/j.tjog.2020.01.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2019] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To describe the ultrasonographic, pathologic and molecular findings in a fetus with TAR syndrome, and to illustrate the contribution of chromosomal microarray analysis (CMA) to the etiological investigation of fetal upper limb reduction defects. CASE REPORT A 35-year-old woman was referred for Genetic Counseling after pregnancy termination for severe upper limb bilateral phocomelia detected in the second trimester. Fetal autopsy showed severe shortening of the arms and forearms. The fetal skeletal survey confirmed the absence of the radii, ulnae and humeri. CMA revealed an interstitial deletion in 1q21 including the RBM8A gene. Subsequent Sanger sequencing of this gene identified a hypomorphic mutant allele, c.-21G > A, confirming the diagnosis of TAR syndrome. CONCLUSION The differential diagnosis of upper limb defects is broad. Identification of their cause is essential for adequate genetic counseling including prognosis and recurrence risk estimation. CMA should be considered in fetuses with upper limb reduction defects, especially when the thumbs are present.
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Affiliation(s)
- André M Travessa
- Medical Genetics Unit, Department of Pediatrics, Hospital de Santa Maria, North Lisbon Hospital Center, Lisbon, Portugal; Institute of Histology and Developmental Biology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
| | - Patrícia Dias
- Medical Genetics Unit, Department of Pediatrics, Hospital de Santa Maria, North Lisbon Hospital Center, Lisbon, Portugal
| | - Antónia Santos
- Center for Prenatal Diagnosis, Department of Obstetrics, Garcia de Orta Hospital, Almada, Portugal
| | - Sónia Custódio
- Medical Genetics Unit, Department of Pediatrics, Hospital de Santa Maria, North Lisbon Hospital Center, Lisbon, Portugal
| | - Ana Sousa
- Medical Genetics Unit, Department of Pediatrics, Hospital de Santa Maria, North Lisbon Hospital Center, Lisbon, Portugal
| | - Ana Berta Sousa
- Medical Genetics Unit, Department of Pediatrics, Hospital de Santa Maria, North Lisbon Hospital Center, Lisbon, Portugal; Laboratory of Basic Immunology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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MESH Headings
- Abnormalities, Drug-Induced/diagnosis
- Abnormalities, Multiple/diagnosis
- Abnormalities, Multiple/genetics
- Amniocentesis
- Amniotic Band Syndrome/complications
- Amniotic Band Syndrome/diagnosis
- Anal Canal/abnormalities
- Carpal Bones/abnormalities
- Carpal Bones/diagnostic imaging
- Chorionic Villi Sampling
- Congenital Bone Marrow Failure Syndromes/complications
- Congenital Bone Marrow Failure Syndromes/diagnosis
- Congenital Bone Marrow Failure Syndromes/genetics
- Diagnosis, Differential
- Esophagus/abnormalities
- Fanconi Anemia/complications
- Fanconi Anemia/diagnosis
- Fanconi Anemia/genetics
- Female
- Genetic Testing
- Heart Defects, Congenital/complications
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/genetics
- Heart Septal Defects, Atrial/complications
- Heart Septal Defects, Atrial/diagnosis
- Heart Septal Defects, Atrial/genetics
- Humans
- Kidney/abnormalities
- Limb Deformities, Congenital/complications
- Limb Deformities, Congenital/diagnosis
- Limb Deformities, Congenital/diagnostic imaging
- Limb Deformities, Congenital/genetics
- Lower Extremity Deformities, Congenital/complications
- Lower Extremity Deformities, Congenital/diagnosis
- Lower Extremity Deformities, Congenital/genetics
- Microarray Analysis
- Pregnancy
- Radius/abnormalities
- Radius/diagnostic imaging
- Spine/abnormalities
- Thrombocytopenia/complications
- Thrombocytopenia/diagnosis
- Thrombocytopenia/genetics
- Thumb/abnormalities
- Thumb/diagnostic imaging
- Trachea/abnormalities
- Trisomy 13 Syndrome/complications
- Trisomy 13 Syndrome/diagnosis
- Trisomy 13 Syndrome/genetics
- Trisomy 18 Syndrome/complications
- Trisomy 18 Syndrome/diagnosis
- Trisomy 18 Syndrome/genetics
- Ultrasonography, Prenatal
- Upper Extremity Deformities, Congenital/complications
- Upper Extremity Deformities, Congenital/diagnosis
- Upper Extremity Deformities, Congenital/genetics
- Valproic Acid/adverse effects
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Yang PY, Yeh GP, Hsieh CTC. Prenatal diagnosis of radial ray defects by ultrasound: A report of 6 cases. Taiwan J Obstet Gynecol 2018; 57:598-600. [PMID: 30122586 DOI: 10.1016/j.tjog.2018.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2018] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE All of the medical records of fetuses with the sonographic finding of radial ray defects (RRDs) between 2008 and 2015 were retrieved. The associated sonographic findings, cytogenetic results, and necropsy findings were correlated. CASE REPORT There were 6 cases of RRD. Three cases were bilateral and the other 3 cases were unilateral. The gestational ages at diagnosis were between 12 and 24 weeks gestation. All women carrying fetuses with RRDs opted to terminate the pregnancy. There were 2 cases of trisomy 18, one case of thrombocytopenia-absent radius syndrome, and 2 cases of isolated RRD. Both cases of trisomy 18 had other sonographic abnormalities. CONCLUSION RRD should be considered if a short radius and abnormal angulation of the wrist or thumb is noted. The use of 3-D ultrasound facilitates the diagnosis of RRD, even at early gestation, by providing a better surface appearance, panoramic views, and spatial orientation.
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Affiliation(s)
- Pei-Yin Yang
- Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan
| | - Guang-Perng Yeh
- Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan
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Tutschek B, Blaas HGK, Abramowicz J, Baba K, Deng J, Lee W, Merz E, Platt L, Pretorius D, Timor-Tritsch IE, Gindes L. Three-dimensional ultrasound imaging of the fetal skull and face. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:7-16. [PMID: 28229509 DOI: 10.1002/uog.17436] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 02/06/2017] [Accepted: 02/14/2017] [Indexed: 06/06/2023]
Affiliation(s)
- B Tutschek
- Prenatal Zurich, Zürich, Switzerland
- Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - H-G K Blaas
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, National Center for Fetal Medicine, St Olavs Hospital, Trondheim, Norway
| | - J Abramowicz
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | - K Baba
- Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - J Deng
- University College London, London, UK
| | - W Lee
- Baylor College of Medicine, Obstetrics & Gynecology, Houston, TX, USA
| | - E Merz
- Krankenhaus Nordwest - Centre for Prenatal Diagnosis and Therapy, Frankfurt, Germany
| | - L Platt
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - D Pretorius
- Department of Radiology, University of California San Diego, CA, USA
| | - I E Timor-Tritsch
- Department of Obstetrics and Gynecology, NYU School of Medicine, New York, NY, USA
| | - L Gindes
- Department of Obstetrics and Gynecology, Wolfson Medical Center, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Sevilla-Montoya R, Aguinaga M, Martínez A, Razo G, Molina B, Frías S, Grether P. Heterogeneous Diagnoses Underlying Radial Ray Anomalies. Indian J Pediatr 2017; 84:200-205. [PMID: 27987078 DOI: 10.1007/s12098-016-2270-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 11/23/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To review perinatal Radial Ray Anomaly (RRA) cases born at the National Institute of Perinatology, Mexico, and to reveal the heterogeneous diagnoses of these patients. METHODS All patients with RRA over a 18 mo period were included; 4/15 were detected prenatally and 11/15 postnatally. Karyotype was performed for all patients with bilateral RRA; and chromosomal breakage analysis, when the karyotype was normal. RESULTS Fifteen RRA patients were identified: one with trisomy 18, three with an isolated defect, six with monogenic disease, four with a genetic association and one with diabetic embryopathy. Five were stillborn and two died during the early neonatal period; all of whom presented with multiple defects. Three of the live born patients and one stillborn with multiple defects had Fanconi anemia. RRAs carry a high perinatal mortality rate (47%) when they occur in association with other defects. CONCLUSIONS The assessment of these patients needs to involve the combined use of ultrasound, clinical, genetic, cytogenetic and molecular testing. The present results indicate that the chromosome breakage test should always be performed to rule out Fanconi anemia in this group.
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Affiliation(s)
- Rosalba Sevilla-Montoya
- Departamento de Genética, Instituto Nacional de Perinatología, Montes Urales 800 Col. Lomas Virreyes, C.P 11000, Torre de investigación 2°, Piso, Ciudad de México, CP 11000, Mexico.
| | - Mónica Aguinaga
- Departamento de Genética, Instituto Nacional de Perinatología, Montes Urales 800 Col. Lomas Virreyes, C.P 11000, Torre de investigación 2°, Piso, Ciudad de México, CP 11000, Mexico
| | - Alejandro Martínez
- Departamento de Genética, Instituto Nacional de Perinatología, Montes Urales 800 Col. Lomas Virreyes, C.P 11000, Torre de investigación 2°, Piso, Ciudad de México, CP 11000, Mexico
| | - Guadalupe Razo
- Departamento de Genética, Instituto Nacional de Perinatología, Montes Urales 800 Col. Lomas Virreyes, C.P 11000, Torre de investigación 2°, Piso, Ciudad de México, CP 11000, Mexico
| | - Bertha Molina
- Laboratorio de Citogenética, Instituto Nacional de Pediatría/Instituto de Investigaciones Biomédicas UNAM, Insurgentes Sur 3700, Letra C, Col. Insurgentes Cuicuilco, CP 4530, Ciudad de México, Mexico
| | - Sara Frías
- Laboratorio de Citogenética, Instituto Nacional de Pediatría/Instituto de Investigaciones Biomédicas UNAM, Insurgentes Sur 3700, Letra C, Col. Insurgentes Cuicuilco, CP 4530, Ciudad de México, Mexico
| | - Patricia Grether
- Departamento de Genética, Instituto Nacional de Perinatología, Montes Urales 800 Col. Lomas Virreyes, C.P 11000, Torre de investigación 2°, Piso, Ciudad de México, CP 11000, Mexico
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Kikuchi N, Ohira S, Asaka R, Tanaka K, Takatsu A, Shiozawa T. Prenatal sonographic diagnosis of fetal valproate syndrome: a case report. J Med Case Rep 2016; 10:312. [PMID: 27809899 PMCID: PMC5094134 DOI: 10.1186/s13256-016-1094-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 10/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prenatal exposure of mother to valproate (VPA) causes teratogenic effects in the fetus, namely fetal valproate syndrome (FVS). We report a case of fetal valproate syndrome rarely diagnosed by prenatal sonographic examination. CASE PRESENTATION Our patient was a female infant who was born to a 27-year-old nulliparous Japanese woman with epilepsy. The mother was diagnosed with infantile epilepsy at 1 year of age and had been using three antiepileptic drugs, including valproate, but preconceptional counseling was not performed. At 25 weeks of gestation, contracture of the fetal right wrist joint suggestive of a radial ray defect was observed by transabdominal ultrasonography. The fetus demonstrated growth retardation starting from 32 weeks of gestation. In addition, saddle nose as a facial anomaly was detected by three-dimensional ultrasound at 37 weeks of gestation. Accordingly, we suspected that the fetus had fetal valproate syndrome. At 39 weeks of gestation, the mother delivered an infant weighing 2056 g. The neonate had characteristic features of fetal valproate syndrome, such as facial configuration, slight muscular hypotonia of the whole body, breathing problems, right-hand articular contracture accompanied by radial ray defect, and cardiovascular malformation. CONCLUSIONS When obstetricians manage epileptic pregnant women without enough preconceptional counseling or adjustment for antiepileptic drugs, careful sonographic observation of the fetus is mandatory.
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Affiliation(s)
- Norihiko Kikuchi
- Department of Obstetrics and Gynecology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Satoshi Ohira
- Department of Obstetrics and Gynecology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
| | - Ryoichi Asaka
- Department of Obstetrics and Gynecology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Kyoko Tanaka
- Department of Obstetrics and Gynecology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Akiko Takatsu
- Department of Obstetrics and Gynecology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Tanri Shiozawa
- Department of Obstetrics and Gynecology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
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Andrikopoulou M, Vahanian SA, Chavez MR, Murphy J, Hanna N, Vintzileos AM. Improving the ultrasound detection of isolated fetal limb abnormalities. J Matern Fetal Neonatal Med 2016; 30:46-49. [DOI: 10.3109/14767058.2016.1160048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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10
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Elmakky A, Stanghellini I, Landi A, Percesepe A. Role of Genetic Factors in the Pathogenesis of Radial Deficiencies in Humans. Curr Genomics 2016; 16:264-78. [PMID: 26962299 PMCID: PMC4765521 DOI: 10.2174/1389202916666150528000412] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 05/20/2015] [Accepted: 05/27/2015] [Indexed: 01/09/2023] Open
Abstract
Radial deficiencies (RDs), defined as under/abnormal development or absence of any of the
structures of the forearm, radial carpal bones and thumb, occur with a live birth incidence ranging
from 1 out of 30,000 to 1 out 6,000 newborns and represent about one third/one fourth of all the congenital
upper limb anomalies. About half of radial disorders have a mendelian cause and pattern of
inheritance, whereas the remaining half appears sporadic with no known gene involved. In sporadic
forms certain anomalies, such as thumb or radial hypoplasia, may occur either alone or in association
with systemic conditions, like vertebral abnormalities or renal defects. All the cases with a mendelian inheritance are syndromic
forms, which include cardiac defects (in Holt-Oram syndrome), bone marrow failure (in Fanconi anemia), platelet
deficiency (in thrombocytopenia-absent-radius syndrome), ocular motility impairment (in Okihiro syndrome). The
genetics of radial deficiencies is complex, characterized by genetic heterogeneity and high inter- and intra-familial clinical
variability: this review will analyze the etiopathogenesis and the genotype/phenotype correlations of the main radial deficiency
disorders in humans.
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Affiliation(s)
- Amira Elmakky
- Medical Genetics, Department of Medical and Surgical Sciences, University Hospital of Modena, Italy
| | - Ilaria Stanghellini
- Medical Genetics, Department of Medical and Surgical Sciences, University Hospital of Modena, Italy
| | - Antonio Landi
- Hand Surgery and Microsurgery, Department of Locomotor System Diseases, University Hospital of Modena, Modena, Italy
| | - Antonio Percesepe
- Medical Genetics, Department of Medical and Surgical Sciences, University Hospital of Modena, Italy
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Piper SL, Dicke JM, Wall LB, Shen TS, Goldfarb CA. Prenatal Detection of Upper Limb Differences With Obstetric Ultrasound. J Hand Surg Am 2015; 40:1310-1317.e3. [PMID: 26026354 PMCID: PMC4568827 DOI: 10.1016/j.jhsa.2015.04.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 04/10/2015] [Accepted: 04/10/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the sensitivity, specificity, and predictive values of prenatal ultrasound detection of fetal upper extremity anomalies at a single tertiary care center in a large patient cohort. Our secondary purpose was to assess factors affecting prenatal detection including the presence of associated anomalies. METHODS We performed a retrospective review of prenatal ultrasound and postnatal clinical records from each pregnancy evaluated with a prenatal ultrasound at the Washington University Department of Obstetrics and Gynecology over a 20-year period. We searched for upper extremity anomaly diagnosis codes pre- and postnatally and correlated with clinical postnatal follow-up to determine prevalence, sensitivity, specificity, predictive values, and associated conditions. RESULTS A total of 100,856 pregnancies were evaluated by prenatal ultrasound, which included 843 fetuses diagnosed with a musculoskeletal anomaly (prevalence, 1 of 120) and 642 with an upper extremity anomaly (prevalence, 1 of 157). The postnatally confirmed sensitivity for prenatal ultrasound detection of an upper extremity anomaly was 42%. Sensitivity was lower in cases isolated to the upper extremity (25% vs 55%). Sensitivity was highest for conditions affecting the entire upper extremity (70%-100%) and lowest for those affecting the digits alone (4%-19%). Fetuses with limb reduction defects, radial longitudinal deficiency, phocomelia, arthrogryposis, abnormal hand positioning, and cleft hand had a higher likelihood of having an associated anomaly. CONCLUSIONS At our tertiary referral center, there was a notable prevalence of upper extremity anomalies; however, the overall sensitivity for detecting them with prenatal ultrasound was low. This was disappointing given the value of prenatal identification of anomalies for parental counseling. Prenatal diagnosis of anomalies affecting the entire upper limb was more reliable than diagnosis of more distal anomalies. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic III.
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Affiliation(s)
- Samantha L. Piper
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, Saint Louis, MO 63110
| | - Jeffrey M. Dicke
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 660 S. Euclid Avenue, Saint Louis, MO 63110
| | - Lindley B. Wall
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, Saint Louis, MO 63110
| | - Tony S. Shen
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, Saint Louis, MO 63110
| | - Charles A. Goldfarb
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, Saint Louis, MO 63110
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Dicke JM, Piper SL, Goldfarb CA. The utility of ultrasound for the detection of fetal limb abnormalities--a 20-year single-center experience. Prenat Diagn 2015; 35:348-53. [PMID: 25475832 PMCID: PMC4403956 DOI: 10.1002/pd.4546] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 11/14/2014] [Accepted: 11/30/2014] [Indexed: 12/18/2022]
Abstract
Objective The standard obstetric ultrasound examination includes documentation of arms and legs. The purpose of this study is to review the efficacy of ultrasound for the detection of limb anomalies, the type and incidence of associated malformations and pregnancy outcomes. Method All cases of polydactyly (POD), abnormal hand position (AHP), limb reduction defects (LRD) and arthrogryposis (ART) scanned in our Unit between 1990 and 2010 were identified. Cases were categorized as isolated (ISO) or non-isolated (NISO). The accuracy of prenatal diagnosis, type and incidence of associated malformations and aneuploidy and pregnancy outcomes were determined. Results Most cases were NISO. The sensitivity of ultrasound was 19.1% for POD, 76.0% for AHP, 76.0% for LRD involving the long bones and 81.3% for ART. Cardiothoracic and facial defects were the most common accompanying malformations. The risk for aneuploidy ranged from 3.6% for POD to 47.2% for AHP. The live birth rate ranged from 85.5% for POD to 24.5% for AHP. Conclusion While imaging of the arms and legs allows detection of most cases of AHP, LRD involving the limbs and ART, a probable minimum of 20% to 25% of cases will escape prenatal diagnosis. Identification of these defects should prompt an extended anatomic survey and consideration of invasive testing for aneuploidy. © 2014 The Authors. Prenatal Diagnosis published by John Wiley & Sons Ltd.
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Affiliation(s)
- Jeffrey M Dicke
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
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Kotecha UH, Puri RD, Dash P, Bijarnia-Mahay S, Lall M, Verma IC. Need for Fetal Autopsy and Genetic Diagnosis in Fetal Limb Anomalies. JOURNAL OF FETAL MEDICINE 2014. [DOI: 10.1007/s40556-015-0029-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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VACTERL association with hydrocephalus in a fetus conceived by in vitro fertilization and embryo transfer. Taiwan J Obstet Gynecol 2013; 52:575-9. [DOI: 10.1016/j.tjog.2013.10.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Accepted: 05/04/2013] [Indexed: 11/18/2022] Open
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Gray BL, Calfee RP, Dicke JM, Steffen J, Goldfarb CA. The utility of prenatal ultrasound as a screening tool for upper extremity congenital anomalies. J Hand Surg Am 2013; 38:2106-11. [PMID: 24055134 DOI: 10.1016/j.jhsa.2013.08.091] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 08/07/2013] [Accepted: 08/08/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To quantify the detection rate and accuracy of prenatal ultrasound in patients with congenital upper extremity anomalies. METHODS A total of 100 patients with congenital upper extremity reduction or duplication anomalies were enrolled prospectively in this investigation at the initial visit to our congenital hand clinic. Demographic and pregnancy-related data were collected along with prenatal diagnoses. We recorded all ultrasound-identified upper extremity anomalies as reported by the parents. Finally, we compared the prenatal diagnosis with the final congenital hand clinic diagnosis. RESULTS The first ultrasound was performed at a mean 11 weeks' gestation, and patients underwent an average of 8 prenatal ultrasounds (range, 1-40 prenatal ultrasounds). Sixty patients underwent standard ultrasound and 40 had a 3-dimensional ultrasound as well. Of the 100 patients, 31 had an upper extremity anomaly by ultrasound. Of the 31 prenatal ultrasound diagnoses, 18 were confirmed as accurate during evaluation in the congenital hand clinic. Three-dimensional ultrasound was more sensitive for the detection of upper extremity anomalies. CONCLUSIONS The overall detection rate and accuracy of ultrasonography for upper extremity anomalies were low despite advancements in imaging technology. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic II.
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Affiliation(s)
- Benjamin L Gray
- Department of Orthopaedic Surgery, Shriners Hospital for Children and St. Louis Children's Hospital, St. Louis, MO; Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO
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Abstract
Introduction: The second trimester ultrasound remains an important screening tool for detecting fetal abnormalities. This pictorial guide for the second trimester ultrasound is designed to assist practitioners to produce a high quality diagnostic survey of the fetus by demonstrating and describing recommended images. Methods: Each image is discussed in detail and has an associated drawn line diagram to aid in the identification of the important features of that image. There is a description of the salient landmarks and relevant measurements. Result: The authors hope this article may act as a useful guide to all practitioners performing second trimester ultrasounds.
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Affiliation(s)
- Michael Bethune
- Medical Imaging DepartmentThe Mercy Hospital for WomenMelbourneVictoriaAustralia; Specialist Women's Ultrasound Box HillMelbourneVictoriaAustralia
| | - Ekaterina Alibrahim
- Medical Imaging Department The Mercy Hospital for Women Melbourne Victoria Australia
| | - Braidy Davies
- Medical Imaging Department The Mercy Hospital for Women Melbourne Victoria Australia
| | - Eric Yong
- Medical Imaging Department The Mercy Hospital for Women Melbourne Victoria Australia
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Prenatal diagnosis of bilateral ectrodactyly and radial agenesis associated with trisomy 10 mosaicism. Case Rep Genet 2013; 2013:592702. [PMID: 23401811 PMCID: PMC3557612 DOI: 10.1155/2013/592702] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 12/12/2012] [Indexed: 11/29/2022] Open
Abstract
Ectrodactyly or split hand and foot malformations (SHFMs) are rare malformations of the limbs, characterized by median clefts of the hands and feet, syndactyly, and aplasia and/or hypoplasia of the phalanges. They represent a clinically and genetically heterogeneous disorder, with both sporadic and familial cases. Most of the genomic rearrangements identified to date in some forms of SHFM are autosomal dominant traits, involving various chromosome regions. Bilateral radial ray defects comprise also a large heterogenous group of disorders, including trisomy 18, Fanconi anemia, and thrombocytopenia-absent-radius syndrome, not commonly associated with ectrodactyly. The present paper describes a case of ectrodactyly associated with bilateral radial ray defects, diagnosed in the first trimester of pregnancy, in a fetus affected by trisomy 10. Only four cases of sporadic and isolated ectrodactyly, diagnosed by ultrasonography between 14 and 22 weeks' gestation, have been reported. To our knowledge, the present case is the first report of mosaic trisomy 10 associated with SHFM and radial aplasia. Trisomy 10 is a rare lethal chromosomal abnormality, most frequently found in abortion products. Only six liveborn mosaic trisomy 10 infants, with severe malformations, dead in early infancy, have been reported. A severe clinical syndrome can be defined, comprising ear abnormalities, cleft lip/palate, malformations of eyes, heart, and kidneys, and deformity of hands and feet and most often associated with death neonatally or in early infancy.
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Pajkrt E, Cicero S, Griffin DR, van Maarle MC, Chitty LS. Fetal forearm anomalies: prenatal diagnosis, associations and management strategy. Prenat Diagn 2012; 32:1084-93. [DOI: 10.1002/pd.3962] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 07/24/2012] [Accepted: 07/24/2012] [Indexed: 11/10/2022]
Affiliation(s)
- Eva Pajkrt
- Academic Medical Centre; Amsterdam; The Netherlands
| | - Simona Cicero
- University College London Hospital NHS Foundation Trust; London; UK
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Clark DM, Sherer I, Deardorff MA, Byrne JLB, Loomes KM, Nowaczyk MJM, Jackson LG, Krantz ID. Identification of a prenatal profile of Cornelia de Lange syndrome (CdLS): a review of 53 CdLS pregnancies. Am J Med Genet A 2012; 158A:1848-56. [PMID: 22740382 DOI: 10.1002/ajmg.a.35410] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 03/14/2012] [Indexed: 11/07/2022]
Abstract
Cornelia de Lange Syndrome (CdLS) is a multisystem developmental disorder characterized by growth retardation, cognitive impairment, external and internal structural malformations, and characteristic facial features. Currently, there are no definitive prenatal screening measures that lead to the diagnosis of CdLS. In this study, documented prenatal findings in CdLS syndrome were analyzed towards the development of a prenatal profile predictive of CdLS. We reviewed 53 cases of CdLS (29 previously reported and 24 unreported) in which prenatal observations/findings were available. The review of these cases revealed a pattern of sonographic findings, including obvious associated structural defects, growth restriction, as well as a more subtle, but strikingly characteristic, facial profile, and suggestive of a recognizable prenatal ultrasonographic profile for CdLS. In addition, the maternal serum marker, PAPP-A, may be reduced and fetal nuchal translucency (NT) may be increased in some pregnancies when measured at an appropriate gestational age. In conclusion, CdLS can be prenatally diagnosed or readily ruled out in a family with a known mutation in a CdLS gene. The characteristic ultrasonographic profile may allow for prenatal diagnosis of CdLS in (1) subsequent pregnancies to a couple with a prior child with CdLS in whom a mutation has not been identified or (2) when there are unexplained pregnancy signs of fetal abnormality, such as oligo- or polyhydramnios, a low maternal serum PAPP-A level and/or increased NT, fetal growth retardation, or structural anomalies consistent with CdLS.
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Affiliation(s)
- Dinah M Clark
- Division of Genetics, The Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania 19104-4318, USA
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Dulnuan DJ, Matsuoka M, Uketa E, Hayashi K, Murotsuki J, Nishimura G, Hata T. Antenatal three-dimensional sonographic features of Roberts syndrome. Arch Gynecol Obstet 2011; 284:241-4. [DOI: 10.1007/s00404-011-1910-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 04/14/2011] [Indexed: 11/29/2022]
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Wu CJ, Huang KH, Liu JY. Prenatal 2D and 3D ultrasound diagnosis of radial ray defects. Int J Gynaecol Obstet 2011; 113:158-9. [PMID: 21429491 DOI: 10.1016/j.ijgo.2010.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2010] [Revised: 12/02/2010] [Accepted: 01/26/2011] [Indexed: 11/15/2022]
Affiliation(s)
- Chia-Jen Wu
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Weichert J, Schröer A, Beyer DA, Gillessen-Kaesbach G, Stefanova I. Cornelia de Lange syndrome: antenatal diagnosis in two consecutive pregnancies due to rare gonadal mosaicism ofNIPBLgene mutation. J Matern Fetal Neonatal Med 2011; 24:978-82. [DOI: 10.3109/14767058.2010.531312] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Approche de la dysmorphologie fœtale in utero. ACTA ACUST UNITED AC 2010; 38:677-85. [DOI: 10.1016/j.gyobfe.2010.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 06/07/2010] [Indexed: 11/20/2022]
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Witters I, Fryns JP. Trisomy 18 presenting with severe limb deformations. Prenat Diagn 2008; 28:549-50. [DOI: 10.1002/pd.2004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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