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Que Y, Cai M, Yang F, Ji Q, Zhang S, Huang W, Gao Y, Zhou B, Huang H, Cao H, Lin N. Ultrasonographic characteristics, genetic features, and maternal and fetal outcomes in fetuses with omphalocele in China: a single tertiary center study. BMC Pregnancy Childbirth 2023; 23:679. [PMID: 37726736 PMCID: PMC10510157 DOI: 10.1186/s12884-023-05999-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/14/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Patients with omphalocele, a midline abdominal wall defect at the umbilical cord base, have a low survival rate. However, the long-term outcomes of fetuses with prenatally diagnosed omphalocele have scarcely been studied. Therefore, we investigated the ultrasonographic features, genetic characteristics, and maternal and fetal outcomes of fetuses with omphalocele and provided a reference for the perinatal management of such cases. METHODS A total of 120 pregnant females with fetal omphalocele were diagnosed using prenatal ultrasonography at the Fujian Provincial Maternity and Child Health Hospital from January 2015 to March 2022. Amniotic fluid or cord blood samples were drawn at different gestational weeks for routine karyotype analysis, chromosomal microarray analysis (CMA) detection, and whole exome sequencing (WES). The maternal and fetal outcomes were followed up. RESULTS Among the 120 fetuses, 27 were diagnosed with isolated omphalocele and 93 with nonisolated omphalocele using prenatal ultrasonography. Cardiac anomalies were the most observed cause in 17 fetuses. Routine karyotyping and CMA were performed on 35 patients, and chromosomal abnormalities were observed in five patients, trisomy 18 in three, trisomy 13 in one, and chromosome 8-11 translocation in one patient; all were non-isolated omphalocele cases. Six nonisolated cases had normal CMA results and conventional karyotype tests, and further WES examination revealed one pathogenic variant and two suspected pathogenic variants. Of the 120 fetuses, 112 were successfully followed up. Eighty of the 112 patients requested pregnancy termination. Seven of the cases died in utero. A 72% 1-year survival rate was observed from the successful 25 live births. CONCLUSION The prognosis of fetuses with nonisolated omphalocele varies greatly, and individualized analysis should be performed to determine fetal retention carefully. Routine karyotyping with CMA testing should be provided for fetuses with omphalocele. WES is an option if karyotype and CMA tests are normal. If the fetal karyotype is normal and no associated abnormalities are observed, fetuses with omphalocele could have a high survival rate, and most will have a good prognosis.
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Affiliation(s)
- Yanting Que
- College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Meiying Cai
- Medical Genetic Diagnosis and Therapy Center, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defects, Fujian Maternity and Child Health Hospital, Fujian Medical University, Fuzhou, China
| | - Fang Yang
- Department of Gynecology, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Qingqiang Ji
- Department of Gynecology, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Shuqi Zhang
- College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Wenhui Huang
- College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Yashi Gao
- College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Bojing Zhou
- College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Hailong Huang
- Medical Genetic Diagnosis and Therapy Center, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defects, Fujian Maternity and Child Health Hospital, Fujian Medical University, Fuzhou, China.
| | - Hua Cao
- Medical Genetic Diagnosis and Therapy Center, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defects, Fujian Maternity and Child Health Hospital, Fujian Medical University, Fuzhou, China.
| | - Na Lin
- Medical Genetic Diagnosis and Therapy Center, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defects, Fujian Maternity and Child Health Hospital, Fujian Medical University, Fuzhou, China.
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Bedei I, Gloning KP, Joyeux L, Meyer-Wittkopf M, Willner D, Krapp M, Scharf A, Degenhardt J, Heling KS, Kozlowski P, Trautmann K, Jahns KM, Geipel A, Tekesin I, Elsässer M, Wilhelm L, Gottschalk I, Baumüller JE, Birdir C, Schröer A, Zöllner F, Wolter A, Schenk J, Gehrke T, Spaeth A, Axt-Fliedner R. Turner syndrome-omphalocele association: Incidence, karyotype, phenotype and fetal outcome. Prenat Diagn 2023; 43:183-191. [PMID: 36600414 DOI: 10.1002/pd.6302] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 12/12/2022] [Accepted: 01/02/2023] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Omphalocele is known to be associated with genetic anomalies like trisomy 13, 18 and Beckwith-Wiedemann syndrome, but not with Turner syndrome (TS). Our aim was to assess the incidence of omphalocele in fetuses with TS, the phenotype of this association with other anomalies, their karyotype, and the fetal outcomes. METHOD Retrospective multicenter study of fetuses with confirmed diagnosis of TS. Data were extracted from a detailed questionnaire sent to specialists in prenatal ultrasound. RESULTS 680 fetuses with TS were included in this analysis. Incidence of small omphalocele in fetuses diagnosed ≥12 weeks was 3.1%. Including fetuses diagnosed before 12 weeks, it was 5.1%. 97.1% (34/35) of the affected fetuses had one or more associated anomalies including increased nuchal translucency (≥3 mm) and/or cystic hygroma (94.3%), hydrops/skin edema (71.1%), and cardiac anomalies (40%). The karyotype was 45,X in all fetuses. Fetal outcomes were poor with only 1 fetus born alive. CONCLUSION TS with 45,X karyotype but not with X chromosome variants is associated with small omphalocele. Most of these fetuses have associated anomalies and a poor prognosis. Our data suggest an association of TS with omphalocele, which is evident from the first trimester.
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Affiliation(s)
- Ivonne Bedei
- Department of Prenatal Diagnosis and Fetal Therapy, Justus-Liebig University Giessen, Giessen, Germany
| | | | - Luc Joyeux
- Division of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA.,Texas Children's Fetal Center, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA.,Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.,MyFetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
| | | | - Daria Willner
- Center for Prenatal Medicine and Human Genetics, Hamburg, Germany
| | - Martin Krapp
- Center for Prenatal Medicine on Elbe, Hamburg, Germany
| | | | | | - Kai-Sven Heling
- Center of Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - Peter Kozlowski
- Praenatal.de, Prenatal Medicine and Genetics Düsseldorf, Düsseldorf, Germany
| | | | - Kai M Jahns
- Department of Internal Medicine, Johannes Gutenberg University, Mainz, Germany
| | - Annegret Geipel
- Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | | | - Michael Elsässer
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Ingo Gottschalk
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University of Cologne, Cologne, Germany
| | | | - Cahit Birdir
- Department of Obstetrics and Gynecology, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | | | - Felix Zöllner
- Department of Prenatal Diagnosis and Fetal Therapy, Justus-Liebig University Giessen, Giessen, Germany
| | - Aline Wolter
- Department of Prenatal Diagnosis and Fetal Therapy, Justus-Liebig University Giessen, Giessen, Germany
| | - Johanna Schenk
- Department of Prenatal Diagnosis and Fetal Therapy, Justus-Liebig University Giessen, Giessen, Germany
| | - Tascha Gehrke
- Department of Prenatal Diagnosis and Fetal Therapy, Justus-Liebig University Giessen, Giessen, Germany
| | - Alicia Spaeth
- Department of Prenatal Diagnosis and Fetal Therapy, Justus-Liebig University Giessen, Giessen, Germany
| | - Roland Axt-Fliedner
- Department of Prenatal Diagnosis and Fetal Therapy, Justus-Liebig University Giessen, Giessen, Germany
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3
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Fetal Omphalocele: Review of Predictive Factors Important for Antenatal Counseling? Obstet Gynecol Surv 2022; 77:683-695. [DOI: 10.1097/ogx.0000000000001073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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4
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Ectopia Cordis: Case of an Early Diagnosis and Review of Literature. JOURNAL OF FETAL MEDICINE 2022. [DOI: 10.1007/s40556-022-00352-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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McNickle L, Visa A, Clarke S, Yardley I, Tan YW. Exomphalos with intestinal fistulation: Case series and systematic review for clinical characterization, management and embryopathogenesis. J Pediatr Surg 2022; 57:661-669. [PMID: 34311970 DOI: 10.1016/j.jpedsurg.2021.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/29/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Exomphalos with intestinal fistulation (EIF) is a rare variant of exomphalos with intestine opening to the surface of an intact sac, and may result in a diagnostic challenge. We report 3 new cases and conducted a systematic review of the literature, to characterize its association with the type of exomphalos and vitellointestinal duct (VI) as well as to evaluate its management and outcomes. METHODS A literature search from PubMed using keywords pertaining to exomphalos and fistulation was used to identify all unique cases reported between 1950 and 2020, in addition to the case series reported here, to establish the clinical presentation, histological findings, management and outcomes. RESULTS We found a total of 28 cases of EIF, of which 25 had been reported in 70 years from 19 reports. There was a male predominance (4-to-1 ratio). The majority presented as an exomphalos minor (n = 23, 82%) with a prolapsing patent VI duct (n = 16, 57%), most had evidence of Meckel's diverticulum (n = 25, 89%). All but one case were managed by fistula excision with or without ileal resection and anastomosis, followed by primary closure of the abdominal wall defect. All patients, except one with Trisomy 13 who received only palliative care, underwent surgery. Post-operative complications occurred in 7 patients (25%). Congenital anomalies were present in 12 (43%) and none had Beckwith-Wiedemann syndrome. Mortality occurred in 4 patients (14%) between 3 and 17 days. One EIF with exomphalos major failed early conservative treatment due to sac disintegration and sepsis, requiring staged closure, but had a good outcome. DISCUSSION EIF is a rare entity usually associated with exomphalos minor and vitelline duct involvement. EIF presentation is variable but primary surgery is the mainstay of treatment with generally good outcomes. Common features of EIF suggest a different embryopathogenesis to other forms of exomphalos.
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Affiliation(s)
- Luke McNickle
- Department of Paediatric Surgery, Evelina London Children's Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK
| | - Arjun Visa
- Department of Paediatric Surgery, Evelina London Children's Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK
| | - Simon Clarke
- Chelsea Children's Hospital, Chelsea and Westminster Hospital, 369 Fulham Road, Chelsea, London SW10 9NH, UK
| | - Iain Yardley
- Department of Paediatric Surgery, Evelina London Children's Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK
| | - Yew-Wei Tan
- Department of Paediatric Surgery, Evelina London Children's Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK; Chelsea Children's Hospital, Chelsea and Westminster Hospital, 369 Fulham Road, Chelsea, London SW10 9NH, UK.
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6
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Shi X, Tang H, Lu J, Yang X, Ding H, Wu J. Prenatal genetic diagnosis of omphalocele by karyotyping, chromosomal microarray analysis and exome sequencing. Ann Med 2021; 53:1285-1291. [PMID: 34374610 PMCID: PMC8366676 DOI: 10.1080/07853890.2021.1962966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/27/2021] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES The aim of this study is to share our experience in the prenatal diagnosis of omphalocele by karyotyping, chromosomal microarray analysis (CMA) and whole exome sequencing (WES). METHODS In this retrospective study, 81 cases of omphalocele were identified from 2015 to 2020. Associated anomalies and prenatal diagnosis based on karyotyping, CMA and WES were analysed. RESULTS Fifty-eight (71.6%) of the 81 foetuses had other ultrasound anomalies. Giant omphalocele was present in 11 cases (13.6%) and small omphalocele was present in 70 cases (86.4%). Chromosomal abnormalities were found in 24 foetuses (29.6%, 24/81), the most common of which were trisomy 18 (58.8%, 11/24) and trisomy 13 (29.2%, 7/24). Compared to isolated omphalocele, non-isolated omphalocele was accompanied by an increased prevalence of chromosomal abnormalities (4.3% (1/23) vs. 39.7% (23/58), χ2 = 8.226, p = .004). All chromosomal abnormalities were found in small omphalocele. Aside from aneuploidy, CMA showed one pathogenic copy number variants (CNVs) for a detection rate of 1.2%, one variants of unknown significance (VOUS) and one instance of loss of heterozygosity (LOH). WES was performed on 3 non-isolated cases, and one was found to have pathogenic variants. CONCLUSIONS The most common genetic cause of omphalocele is aneuploidy and the prevalence of chromosomal abnormalities is increased with non-isolated and small omphalocele. CMA and WES can be useful for providing further genetic information to assist in prenatal counselling and pregnancy management.
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Affiliation(s)
- Xiaomei Shi
- Gentic Medical Center, Guangdong Women and Children Hospital, Guangzhou, PR China
| | - Hui Tang
- Gentic Medical Center, Guangdong Women and Children Hospital, Guangzhou, PR China
| | - Jian Lu
- Gentic Medical Center, Guangdong Women and Children Hospital, Guangzhou, PR China
| | - Xiue Yang
- Gentic Medical Center, Guangdong Women and Children Hospital, Guangzhou, PR China
| | - Hongke Ding
- Gentic Medical Center, Guangdong Women and Children Hospital, Guangzhou, PR China
| | - Jing Wu
- Gentic Medical Center, Guangdong Women and Children Hospital, Guangzhou, PR China
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Adams AD, Stover S, Rac MW. Omphalocele-What should we tell the prospective parents? Prenat Diagn 2021; 41:486-496. [PMID: 33540475 DOI: 10.1002/pd.5886] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 12/13/2020] [Accepted: 12/15/2020] [Indexed: 01/05/2023]
Abstract
An omphalocele is a congenital defect in the abdominal wall characterized by absent abdominal muscles, fascia, and skin. The characteristic ultrasound appearance includes a midline defect with herniation of abdominal contents into the base of the umbilical cord. Other anatomic abnormalities are seen in approximately 50% of cases, most notably cardiac defects (19%-32%). Approximately, 50% of cases are associated with genetic and multiple malformation syndromes including trisomy 13/18, pentalogy of Cantrell and Beckwith-Wiedemann syndrome. Therefore, a thorough evaluation is recommended, including detailed anatomic survey, fetal echocardiogram, genetic counseling, and prenatal diagnostic testing. Overall prognosis depends on the size of the omphalocele, genetic studies, and associated anomalies. Early prenatal diagnosis remains important in order to provide parental counseling and assist in pregnancy management. Delivery should occur at a tertiary care center. Timing and mode of delivery should be based on standard obstetric indications with cesarean delivery reserved for large omphalocele (>5 cm) or those that involve the fetal liver. Neonatal management involves either primary or staged reduction, both of which can be associated with a prolonged neonatal hospitalization.
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Affiliation(s)
- April D Adams
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, Texas, USA.,Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Samantha Stover
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Martha W Rac
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, Texas, USA
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Grover R, Collins AL, Wellesley D. Exomphalos without other prenatally detected anomalies: Perinatal outcomes from 22 years of population-based data. Prenat Diagn 2020; 40:1310-1314. [PMID: 32643302 DOI: 10.1002/pd.5782] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 06/08/2020] [Accepted: 07/04/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To ascertain the perinatal outcomes for an apparently isolated exomphalos detected by prenatal ultrasound. METHOD Our dataset captures cases from 614 321 births in the Wessex region of England and the Channel Isles on all cases of pre- or postnatally diagnosed exomphalos from 1994 to 2015. Ascertainment was >95%. RESULTS Three hundred and thirty five cases were reported to the register: 28 (8%) were not detected prenatally, 18 (6%) had already died in utero, 169 (55%) cases were found to have additional anomalies on first tertiary ultrasound scan and one case was lost to follow-up. Therefore 119 (39%) cases had an apparently isolated exomphalos. Of the 119 cases with only an exomphalos detected on first tertiary ultrasound scan, 25 (21%) had a chromosome abnormality. Of those with a normal or untested karyotype, 61% were confirmed to be an isolated anomaly after birth, 13% had an additional heart abnormality, 9% had Beckwith-Wiedemann syndrome and 11% had additional problems diagnosed postnatally. CONCLUSION Our large population-based dataset with an average of 1 year's postnatal follow-up suggests that more than one-third of apparently isolated prenatal cases of exomphalos will have an additional finding detected after birth. These data should help assist clinicians in their prenatal counseling.
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Affiliation(s)
- Rose Grover
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
| | - Amanda L Collins
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
| | - Diana Wellesley
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
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Giant Isolated Omphalocele: Role of Prenatal Diagnosis in Prognostic Asessment and Perinatal Management. Case Rep Med 2020; 2020:4578912. [PMID: 32565822 PMCID: PMC7303742 DOI: 10.1155/2020/4578912] [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] [Received: 12/04/2019] [Revised: 03/07/2020] [Accepted: 05/22/2020] [Indexed: 11/18/2022] Open
Abstract
Omphalocele is a congenital malformation of the abdominal wall consisting of a protrusion of the abdominal contents at the base of the umbilical cord. It has a high association with genetic and structural defects; however, if the latter is ruled out, its prognosis improves significantly. Prenatal diagnosis has a key role in this condition as omphalocele can be diagnosed by ultrasound in the first trimester scan, enabling a coordinated approach strategy to achieve the best perinatal results. We present a case report of a pregnant patient with a fetus having a giant omphalocele in which prenatal diagnosis played a decisive role, allowing the coordination of a multidisciplinary team, which was crucial in the immediate care of the newborn.
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Peters NCJ, Hijkoop A, Lechner RL, Eggink AJ, van Rosmalen J, Tibboel D, Wijnen RMH, IJsselstijn H, Cohen-Overbeek TE. The validity of the viscero-abdominal disproportion ratio for type of surgical closure in all fetuses with an omphalocele. Prenat Diagn 2019; 39:1070-1079. [PMID: 31410858 PMCID: PMC6899735 DOI: 10.1002/pd.5546] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/21/2019] [Accepted: 07/21/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine the predictive value of the fetal omphalocele circumference/abdominal circumference (OC/AC) ratio for type of surgical closure and survival and to describe the trajectory of OC/AC ratio throughout gestation. METHODS This cohort study included all live-born infants prenatally diagnosed with an omphalocele in our tertiary centre (2000-2017) with an intention to treat. The OC/AC ratio and liver position were determined using 2D ultrasound at three periods during gestation (11-16, 17-26, and/or 30-38 weeks). Primary outcome was type of closure; secondary outcome was survival. In the secondary analyses, the predictive value of the OC/AC-ratio trend for type of closure and survival was assessed. RESULTS Primary closure was performed in 37/63 (59%) infants, and 54/63 (86%) survived. The OC/AC ratio was predictive for type of closure and survival in all periods. Optimal cut-off values for predicting closure decreased throughout gestation from 0.69 (11-16 weeks) to 0.63 (30-38 weeks). Repeated OC/AC-ratio measurements were available in 33 (73%) fetuses. The trend of the OC/AC ratio throughout gestation was not significantly associated with type of closure. All infants without liver herniation underwent primary closure. CONCLUSION Type of omphalocele surgical closure and survival can be predicted prenatally on the basis of the OC/AC ratio and liver herniation independent of associated anomalies. LEARNING OBJECTIVE The reader will be able to use the OC/AC ratio throughout gestation in all omphalocele cases for prediction of type of closure and survival and thus patient counselling.
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Affiliation(s)
- Nina C J Peters
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Fetal Medicine, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Annelieke Hijkoop
- Department of Paediatric Surgery and Paediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Rosan L Lechner
- Department of Paediatric Surgery and Paediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Alex J Eggink
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Fetal Medicine, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | - Dick Tibboel
- Department of Paediatric Surgery and Paediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - René M H Wijnen
- Department of Paediatric Surgery and Paediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Hanneke IJsselstijn
- Department of Paediatric Surgery and Paediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Titia E Cohen-Overbeek
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Fetal Medicine, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
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Abstract
Omphalocele (exomphalos) is one of the most common abdominal wall defects. The size of the defect and the severity of the associated anomalies determine the overall morbidity and mortality. Routine prenatal screening and diagnosis of the abdominal wall defect and concurrent anomalies is important as it allows for effective prenatal counseling and optimal perinatal management. The purpose of this article is to discuss the approach to prenatal diagnosis and management of omphalocele.
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Affiliation(s)
- Mariatu A Verla
- Texas Children's Fetal Center, Baylor College of Medicine, 6701 Fannin St, Suite 1210, Houston, TX, United States; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Candace C Style
- Texas Children's Fetal Center, Baylor College of Medicine, 6701 Fannin St, Suite 1210, Houston, TX, United States; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Oluyinka O Olutoye
- Texas Children's Fetal Center, Baylor College of Medicine, 6701 Fannin St, Suite 1210, Houston, TX, United States; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States.
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Sokołowski Ł, Respondek-Liberska M, Krekora M, Płużańska J, Słodki M. Congenital Heart Defects Coexisting with Omphalocele - the Important Prognostic Factor. PRENATAL CARDIOLOGY 2018. [DOI: 10.1515/pcard-2018-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction: The aim of this study was to evaluate the following parameters of fetuses and neonates with omphalocele: the prevalence of coexisting congenital heart defects (CHD), abnormalities in heart function and the impact of coexisting CHD on fetal and neonatal survival. Material and methods: The study group consisted of 69 fetuses with omphalocele diagnosed and monitored at the Department of Prenatal Cardiology in our Institute in the years 2007-2017. The retrospective analisis of patients' data was performed. For statistical analysis we used Chi-square test, t-Student test and U Mann-Whitney test.. Results: In the studied group omphalocele was an isolated defect in 31.9% of the cases (22/69), in 68.1% (47/69) coexisting defects were present, in 49.3% (34/69) the coexisting defect was CHD. The most common CHD coexisting with omphalocele were ventricular septal defect (VSD), double outlet right ventricle (DORV) and atrio-ventricular septal defect (AVSD). Abnormalities of heart function were present in 43.5% (30/69) of fetuses with omphalocele: 23.5% (8/34) with normal heart anatomy and in 62.9% (22/35) with CHD. Statistically significant differences between the group with normal heart anatomy and the group with CHD regarded: Cardiovascular Profile Score (CVPS) (median 10 points vs median 9 points, U Mann-Whitney test p=0.034), neonatal birth weight(mean 3253 g vs median 2700 g, U Mann-Whitney test p=0.003), Apgar score (median 8 vs median 7, U Mann-Whitney test p=0.038) and survival rate until discharge from hospital (85% vs 52.9%, Chi-square test p=0.034). The comparison of data from 2007-2017 with data obtained from similar analysis performed in our center in 1999-2006, revealed significant improvement in the early detection of omphalocele (median 14.5 weeks of gestation vs mean 25.4 weeks of gestation), gestational age of delivery (mean 38 weeks of gestation vs mean 34 weeks of gestation) and survival rate until discharge both in neonates with normal heart anatomy and coexisting CHD (85% and 52.9% vs 70% and 23% respectively) . Conclusions: 1. The presence of coexisting CHD is an important prognostic factor in fetuses and neonates with omphalocele, so early fetal echocardiography should be performed in every case of omphalocele. 2. During the last decade (2007-2017), in contrast to years 1999-2006, we observed significant improvement in early and complete prenatal diagnosis of omphalocele. 3. We observed improvement in strategy of obstetrical management resulting in delivering neonates in a more advanced gestational age both in the group with normal heart anatomy and the group with coexisting CHD.
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Affiliation(s)
- Łukasz Sokołowski
- Department of Prenatal Cardiology Polish Mother's Memorial Hospital Research Institute, Lodz , Poland
- Department of Obstetrics, Perinatology and Gynaecology Polish Mother's Memorial Hospital Research Institute, Lodz , Poland
| | - Maria Respondek-Liberska
- Department of Prenatal Cardiology Polish Mother's Memorial Hospital Research Institute, Lodz , Poland
- Department of Diagnosis and Prevention of Fetal Malformations, Medical University, Lodz , Poland
| | - Michał Krekora
- Department of Obstetrics, Perinatology and Gynaecology Polish Mother's Memorial Hospital Research Institute, Lodz , Poland
| | - Joanna Płużańska
- Department of Pediatric Cardiology, Polish Mother's Memorial Hospital Research Institute, Lodz , Poland
| | - Maciej Słodki
- Department of Prenatal Cardiology Polish Mother's Memorial Hospital Research Institute, Lodz , Poland
- Faculty of Health Sciences, The State University of Applied Sciences in Plock, Plock , Poland
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Oakes MC, Porto M, Chung JH. Advances in prenatal and perinatal diagnosis and management of gastroschisis. Semin Pediatr Surg 2018; 27:289-299. [PMID: 30413259 DOI: 10.1053/j.sempedsurg.2018.08.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Gastroschisis is a congenital, ventral wall defect associated with bowel evisceration. The defect is usually to the right of the umbilical cord insertion and requires postnatal surgical correction. The fetus is at risk for complications such as intrauterine growth restriction, preterm delivery, and intrauterine fetal demise. In addition, complex cases, defined by the presence of intestinal complications such as bowel atresia, stenosis, perforation, or ischemia, occur in up to one third of pregnancies affected by gastroschisis. As complex gastroschisis is associated with increased morbidity and mortality, research has focused on the prenatal detection of this high risk subset of cases. The purpose of this review is to discuss the prenatal, diagnostic approach to the identification of gastroschisis, to describe potential signs of complex gastroschisis on prenatal ultrasound, to review current guidelines for antepartum management and delivery planning, and to summarize results of both past and current intervention trials in fetuses with gastroschisis.
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Affiliation(s)
- Megan C Oakes
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California Irvine Medical Center, Orange, CA, USA
| | - Manuel Porto
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California Irvine Medical Center, Orange, CA, USA
| | - Judith H Chung
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California Irvine Medical Center, Orange, CA, USA.
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15
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Wagner P, Sonek J, Hoopmann M, Abele H, Kagan KO. First-trimester screening for trisomies 18 and 13, triploidy and Turner syndrome by detailed early anomaly scan. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:446-451. [PMID: 26611869 DOI: 10.1002/uog.15829] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 11/12/2015] [Accepted: 11/19/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To examine the performance of first-trimester ultrasound screening for trisomies 18 and 13, triploidy and Turner syndrome based on fetal nuchal translucency thickness (NT), additional fetal ultrasound markers including anatomy of the nasal bone (NB), blood flow across the tricuspid valve (TV) and through the ductus venosus (DV) and a detailed fetal anomaly scan at 11-13 weeks' gestation. METHODS This was a retrospective case-matched study involving pregnant women at 11-13 weeks' gestation. The study population consisted of fetuses with trisomy 18, trisomy 13, triploidy or Turner syndrome. For each fetus with an abnormal karyotype, 50 randomly selected euploid fetuses were added to the study population. In all cases, the crown-rump length and NT were measured. In addition NB, TV flow and DV flow were examined. The summed risk for trisomies 21, 18 and 13 was computed based on: first, maternal age (MA); second, MA and fetal NT; third, MA, NT and one of the markers NB, TV flow or DV flow; fourth, MA, NT and all these markers combined; fifth, MA, NT and fetal anomalies; and, finally, MA, NT, all markers and fetal anomalies. RESULTS The study population consisted of 4550 euploid and 91 aneuploid fetuses. Median NT was 1.8 mm in euploid fetuses and 4.8, 6.8, 1.8 and 10.0 mm in fetuses with trisomy 18, trisomy 13, triploidy and Turner syndrome, respectively. The NB, TV flow and DV flow were abnormal in 48 (1.1%), 34 (0.7%) and 99 (2.2%) euploid fetuses, respectively, and in 42 (46.2%), 31 (34.1%) and 62 (68.1%) aneuploid fetuses, respectively. At least one defect was found in 60 (1.3%) euploid and in 76 (83.5%) aneuploid fetuses. For a false-positive rate of 3%, the detection rate for screening based on MA and fetal NT was 75.8%. It increased to 84.6-86.8% when including one of the additional ultrasound markers and it was 90.1% when all three markers were included. When screening was based on MA, fetal NT and a detailed anomaly scan, the detection rate was 94.5% and increased to 95.6% with the addition of NB, TV flow and DV flow. CONCLUSION A detailed anomaly scan at 11-13 weeks' gestation can identify about 95% of fetuses with trisomy 18, trisomy 13, triploidy and Turner syndrome. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- P Wagner
- Department of Obstetrics and Gynaecology, University of Tuebingen, Tuebingen, Germany
| | - J Sonek
- Fetal Medicine Foundation USA, Dayton, OH, USA
- Division of Maternal Fetal Medicine, Wright State University, Dayton, OH, USA
| | - M Hoopmann
- Department of Obstetrics and Gynaecology, University of Tuebingen, Tuebingen, Germany
| | - H Abele
- Department of Obstetrics and Gynaecology, University of Tuebingen, Tuebingen, Germany
| | - K O Kagan
- Department of Obstetrics and Gynaecology, University of Tuebingen, Tuebingen, Germany.
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2014 First-trimester ultrasound forum from the Korean Society of Ultrasound in Obstetrics and Gynecology. Obstet Gynecol Sci 2015; 58:1-9. [PMID: 25629012 PMCID: PMC4303746 DOI: 10.5468/ogs.2015.58.1.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 08/01/2014] [Accepted: 10/01/2014] [Indexed: 12/13/2022] Open
Abstract
A first-trimester ultrasound scan has become an essential part of antenatal care. The Korean Society of Ultrasound in Obstetrics and Gynecology held a first-trimester ultrasound forum on April 5, 2014. The forum aimed to present an updated review of the literature on the topic of first-trimester ultrasound in specific lectures and to host a panel discussion on several important issues regarding first-trimester scans. The forum provided evidence- and consensus-based best practice patterns for obstetricians in Korea. Here, we report the review and checklists presented from the forum.
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Mlczoch E, Carvalho JS. Interrupted inferior vena cava in fetuses with omphalocele. Case series of fetuses referred for fetal echocardiography and review of the literature. Early Hum Dev 2015; 91:1-6. [PMID: 25460249 DOI: 10.1016/j.earlhumdev.2014.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 09/07/2014] [Accepted: 11/01/2014] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Congenital heart disease is reported in 15-45% of omphalocele cases. Associated abnormalities of systemic veins have occasionally been reported in children and rarely documented in the fetus. We report a case series of interrupted inferior vena cava (Int-IVC) in association with omphalocele and review the literature. METHODS From our fetal database we identified all cases of omphalocele referred for fetal echocardiography (FE) between 1997 and 2012. We reviewed pre and postnatal medical records and performed a literature search from 1975 to present to identify previous relevant publications. RESULTS Of 9627 fetuses referred for FE, 34 had an omphalocele. Gestational age at FE was 17(+6) to 26(+4)weeks. Seven of the 34 fetuses were shown to have an Int-IVC with azygos continuation to a right-sided superior vena cava (SVC). The heart was structurally normal in all but one case. The abdominal wall defect was large and contained liver in all. There were three fetal demises and one neonatal death. Three cases were operated successfully. Since 1975, we identified 12 publications reporting omphalocele with systemic venous abnormalities. Abnormal IVC angulation may lead to surgical complications. Failure of IVC formation is likely to be a developmental rather than a situs abnormality. Int-IVC with a dilated azygos influences venous access and may predispose to venous thrombosis. CONCLUSION We have documented an association between large omphalocele and Int-IVC with azygos continuation to the SVC. In this small series, this did not have surgical implications. It will however, influence route of any future cardiac catheterisation and may have long-term implications.
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Affiliation(s)
- Elisabeth Mlczoch
- Fetal Medicine Unit, St George's Hospital NHS Trust, London, UK; Brompton Centre for Fetal Cardiology, Royal Brompton Hospital NHS Foundation Trust, London, UK
| | - Julene S Carvalho
- Fetal Medicine Unit, St George's Hospital NHS Trust, London, UK; Brompton Centre for Fetal Cardiology, Royal Brompton Hospital NHS Foundation Trust, London, UK; St George's University of London, UK.
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Abstract
PURPOSE OF REVIEW To review prognostic parameters reported recently in the evaluation of abdominal wall defects in the first trimester. RECENT FINDINGS Evaluation of abdominal wall defects in the first trimester is based principally on associated structural or chromosomal anomalies. In the case of gastroschisis, which is rarely associated with other anomalies, evaluation of prenatal or postnatal outcome is based mainly on the course of pregnancy. In the case of isolated omphalocele in the first trimester, recent studies have evaluated parameters that could help predict prenatal or postnatal outcome. SUMMARY We review recent studies using new parameters to diagnose abdominal wall defects in the first trimester and to provide early prenatal counselling to parents regarding prenatal and postnatal prognosis.
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Gamba P, Midrio P. Abdominal wall defects: prenatal diagnosis, newborn management, and long-term outcomes. Semin Pediatr Surg 2014; 23:283-90. [PMID: 25459013 DOI: 10.1053/j.sempedsurg.2014.09.009] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Omphalocele and gastroschisis represent the most frequent congenital abdominal wall defects a pediatric surgeon is called to treat. There has been an increased reported incidence in the past 10 years mainly due to the diffuse use of prenatal ultrasound. The early detection of these malformations, and related associated anomalies, allows a multidisciplinary counseling and planning of delivery in a center equipped with high-risk pregnancy assistance, pediatric surgery, and neonatology. At present times, closure of defects, even in multiple stages, is always possible as well as management of most of cardiac-, urinary-, and gastrointestinal-associated malformations. The progress, herein discussed, in the care of newborns with abdominal wall defects assures most of them survive and reach adulthood. Some aspects of transition of medical care will also be considered, including fertility and cosmesis.
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Affiliation(s)
- Piergiorgio Gamba
- Pediatric Surgery, Department of Woman and Child Health, University Hospital, Via Giustiniani 3, Padua 35121, Italy.
| | - Paola Midrio
- Pediatric Surgery, Department of Woman and Child Health, University Hospital, Via Giustiniani 3, Padua 35121, Italy
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Prefumo F, Izzi C. Fetal abdominal wall defects. Best Pract Res Clin Obstet Gynaecol 2013; 28:391-402. [PMID: 24342556 DOI: 10.1016/j.bpobgyn.2013.10.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 10/08/2013] [Indexed: 11/27/2022]
Abstract
The most common fetal abdominal wall defects are gastroschisis and omphalocele, both with a prevalence of about three in 10,000 births. Prenatal ultrasound has a high sensitivity for these abnormalities already at the time of the first-trimester nuchal scan. Major unrelated defects are associated with gastroschisis in about 10% of cases, whereas omphalocele is associated with chromosomal or genetic abnormalities in a much higher proportion of cases. Challenges in management of gastroschisis are related to the prevention of late intrauterine death, and the prediction and treatment of complex forms. With omphalocele, the main difficulty is the exclusion of associated conditions, not all diagnosed prenatally. An outline of the postnatal treatment of abdominal wall defects is given. Other rarer forms of abdominal wall defects are pentalogy of Cantrell, omphalocele, bladder exstrophy, imperforate anus, spina bifida complex, prune-belly syndrome, body stalk anomaly, and bladder and cloacal exstrophy; they deserve multidisciplinary counselling and management.
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Affiliation(s)
- Federico Prefumo
- Prenatal Diagnosis Unit, Department of Obstetrics and Gynaecology, University of Brescia, Brescia, Italy.
| | - Claudia Izzi
- Prenatal Diagnosis Unit, Department of Obstetrics and Gynaecology, University of Brescia, Brescia, Italy
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Kiyohara MY, Brizot ML, Liao AW, Francisco RP, Tannuri AC, Krebs VL, Zugaib M. Should We Measure Fetal Omphalocele Diameter for Prediction of Perinatal Outcome? Fetal Diagn Ther 2013; 35:44-50. [DOI: 10.1159/000355936] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Accepted: 09/23/2013] [Indexed: 11/19/2022]
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Tassin M, Descriaud C, Elie C, Debarge VH, Dumez Y, Perrotin F, Benachi A. Omphalocele in the first trimester: prediction of perinatal outcome. Prenat Diagn 2013; 33:497-501. [DOI: 10.1002/pd.4102] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Mikaël Tassin
- Department of Obstetrics, Necker Hospital; Universite Paris Descartes; Paris France
| | - Céline Descriaud
- Department of Obstetrics and Gynecology; University of Tours; Tours France
| | - Caroline Elie
- Department of Obstetrics, Necker Hospital; Universite Paris Descartes; Paris France
| | | | - Yves Dumez
- Department of Obstetrics, Necker Hospital; Universite Paris Descartes; Paris France
| | - Franck Perrotin
- Department of Obstetrics and Gynecology; University of Tours; Tours France
| | - Alexandra Benachi
- Department of Obstetrics, Necker Hospital; Universite Paris Descartes; Paris France
- Department of Obstetrics and Gynecology; Hôpital Antoine Béclère; Clamart France
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Donnelly JC, Malone FD. Early fetal anatomical sonography. Best Pract Res Clin Obstet Gynaecol 2012; 26:561-73. [PMID: 22776410 DOI: 10.1016/j.bpobgyn.2012.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 06/13/2012] [Indexed: 11/25/2022]
Abstract
Over the past decade, prenatal screening and diagnosis has moved from the second into the first trimester, with aneuploidy screening becoming both feasible and effective. With vast improvements in ultrasound technology, sonologists can now image the fetus in greater detail at all gestational ages. In the hands of experienced sonographers, anatomic surveys between 11 and 14 weeks can be carried out with good visualisation rates of many structures. It is important to be familiar with the normal development of the embryo and fetus, and to be aware of the major anatomical landmarks whose absence or presence may be deemed normal or abnormal depending on the gestational age. Some structural abnormalities will nearly always be detected, some will never be and some are potentially detectable depending on a number of factors.
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Affiliation(s)
- Jennifer C Donnelly
- Royal College of Surgeons in Ireland, Rotunda Hospital, Parnell Square, Dublin, Ireland.
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