1
|
Das S, Sharma C, Yadav T, Dubey K, Shekhar S, Singh P, Singh K, Gothwal M, Jhirwal M, Shekhawat DS. Absent or hypoplastic nasal bone: What to tell the prospective parents? Birth Defects Res 2024; 116:e2348. [PMID: 38801241 DOI: 10.1002/bdr2.2348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 02/23/2024] [Accepted: 04/22/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Absent or hypoplastic nasal bone (AHNB) on first or second-trimester ultrasonography (USG) is an important soft marker of Down syndrome. However, due to its varied incidence in euploid and aneuploid fetuses, there is always a dilemma of whether to go for invasive fetal testing for isolated AHNB. This study aims to assess outcomes specifically within the context of Indian ethnicity women. MATERIALS AND METHODS This was a prospective observational study. All patients who reported with AHNB in the first- or second-trimester USG were included. Genetic counseling was done, and noninvasive and invasive testing was offered. Chromosomal anomalies were meticulously recorded, and pregnancy was monitored. RESULTS The incidence of AHNB in our study was 1.16% (47/4051). Out of 47 women with AHNB, the isolated condition was seen in 32 (0.78%) cases, while AHNB with structural anomalies was seen in nine cases (0.22%). Thirty-nine women opted for invasive testing. Six out of 47 had aneuploidy (12.7%), while two euploid cases (4.25%) developed nonimmune hydrops. The prevalence of Down syndrome in fetuses with AHNB was 8.5% (4/47) and 0.42% (17/4004) in fetuses with nasal bone present. This difference was statistically significant (p = .001). CONCLUSION The results indicate that isolated AHNB cases should be followed by a comprehensive anomaly scan rather than immediately recommending invasive testing. However, invasive testing is required when AHNB is associated with other soft markers or abnormalities. As chromosomal microarray is more sensitive than standard karyotype in detecting chromosomal aberrations, it should be chosen over karyotype.
Collapse
Affiliation(s)
- Shreya Das
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, Jodhpur, India
| | - Charu Sharma
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, Jodhpur, India
| | - Taruna Yadav
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Kalika Dubey
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, Jodhpur, India
| | - Shashank Shekhar
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, Jodhpur, India
| | - Pratibha Singh
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, Jodhpur, India
| | - Kuldeep Singh
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, India
| | - Meenakshi Gothwal
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, Jodhpur, India
| | - Manisha Jhirwal
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, Jodhpur, India
| | | |
Collapse
|
2
|
Bansal V, Jhaveri R. Prenatal Invasive Testing at a Tertiary Referral Center in India: A Report of 433 Cases Under a Single Operator. J Obstet Gynaecol India 2022; 72:47-58. [PMID: 35125738 PMCID: PMC8804047 DOI: 10.1007/s13224-021-01496-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/30/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE OF THE STUDY Chromosomal aneuploidies are major causes of perinatal death and childhood handicap. Awareness about screening and prenatal diagnosis for these disorders among obstetricians and primary care physicians is increasing. Since invasive tests like amniocentesis or chorionic villus sampling (CVS) are associated with a risk of miscarriage these tests should be carried out judiciously in pregnancies considered to be at high risk for aneuploidies and other genetic disorders. The purpose of our study was to examine the patterns, trends and outcomes of the various screening procedures and invasive tests results. METHODOLOGY Retrospective observational study done over a period of 3 years and one month including 433 pregnant women with high risk for genetic disorders undergoing invasive prenatal testing like chorionic villus sampling, amniocentesis or cordocentesis. Data were collected from our department records regarding the maternal age, indication for invasive testing, past obstetric history, family history of genetic syndromes, ultrasound findings in the current sonographic examination and the results of the tests done. Any immediate or late complications of the procedure if any were telephonically addressed. RESULTS A total of 436 procedures on 433 patients (418 singleton,12 single fetus of twin, 3 both fetuses of twins) were done out of which 281 were amniocentesis(64.4%), 153 were chorionic villus sampling (35.1%) and 2 were cordocentesis(< 1%). Of the 436 procedures, 373(85.5%) were done for positive screening tests for chromosomal aneuploidies and 63(14.4%) were done for previous history of genetic syndromes. The positive predictive value of biochemical marker alone was around 2.7% and higher around 13% for a combined first trimester or a second-trimester screen along with ultrasound abnormalities. The higher the biochemical risk does not translate into higher chance of chromosomal abnormality. Nineteen percentage of fetuses with NT above 95th centile had chromosomal abnormality. Twenty-one percentage of fetuses with absent nasal bone in our study had trisomy 21. CONCLUSION Aneuploidy screening is the most common indication for prenatal invasive testing with dual marker combined with nuchal translucency, nasal bone, tricuspid regurgitation and ductus venosus flow providing the best detection rates. The chance of an affected fetus in a patient with aneuploidy screen positive overall is only 6.7%.
Collapse
Affiliation(s)
- Vandana Bansal
- Department of Fetal Medicine, Surya Mother & Child Hospital, Santacruz (West), Mumbai, India
- Nowrosjee Wadia Maternity Hospital, Parel, Mumbai, India
| | - Rujul Jhaveri
- Dept. Of Fetal Medicine, Surya Hospital, Mumbai, India
| |
Collapse
|
3
|
Burn SC, Markese A, Bangdiwala A, Gill L, Jacobs K. Fetal Nasal Bone Length in the East African Population. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1007-1012. [PMID: 31791112 DOI: 10.1002/jum.15186] [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: 07/28/2019] [Revised: 09/23/2019] [Accepted: 10/30/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To establish normal ranges of fetal nasal bone length throughout gestation in the East African population and to subsequently compare these measurements with the standardized reference. METHODS A retrospective cross-sectional study was performed at the University of Minnesota from January 2011 to December 2016. Fetal nasal bone length measurements were generated in a midsagittal plane at an angle of insonation of 45° from ultrasound images of 1407 nonanomalous fetuses of 1130 mothers of East African decent between 14 and 40 weeks' gestation. The proportion of fetal nasal bone lengths of less than 5.2 mm at week 20 of gestation in the East African population was then compared with the 5% noted by the standardized reference by a χ2 test. RESULTS The fetal nasal bone length increased linearly with advancing gestational age in fetuses of East African mothers (R2 = 0.53; P < .0001). The fetal nasal bone lengths of the East African fetuses were found to be shorter at all ages of gestation compared with the standard reference. At 20 weeks' gestation 17% (95% confidence interval, 13%-22%) of the nasal bone lengths of the East African fetuses were less than 5.2 mm compared with 5% of white and African American fetuses. CONCLUSIONS Using the standard reference may lead to a greater than 3.5-fold overdiagnosis of hypoplastic nasal bones in the East African population. To improve aneuploidy risk stratification and patient counseling in the East African population, the introduction of a standardized East African-based fetal nasal bone length reference seems warranted.
Collapse
Affiliation(s)
- Sabrina C Burn
- Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Amy Markese
- Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Obstetrics and Gynecology, University of Colorado, Aurora, Colorado, USA
| | - Ananta Bangdiwala
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Lisa Gill
- Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Katherine Jacobs
- Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, Minnesota, USA
| |
Collapse
|
4
|
Arjunan S, Thomas M. A Review of Ultrasound Imaging Techniques for the Detection of Down Syndrome. Ing Rech Biomed 2020. [DOI: 10.1016/j.irbm.2019.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
5
|
Jain S, Khanduri S, Khan M, Khan S, Yadav VK, Khan BR, Sagar UF, Rajurkar M. Mid-Second Trimester Measurement of Nasal Bone Length in North Indian Population. J Clin Imaging Sci 2019; 9:14. [PMID: 31448165 PMCID: PMC6702858 DOI: 10.25259/jcis-15-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 03/19/2019] [Indexed: 11/09/2022] Open
Abstract
Objective: Our objective for this study was to establish a reference range of normal fetal nasal bone length (NBL) from 14 to 22 weeks in a North Indian population. Materials and Methods: Pregnant women with gestational age (GA) from 14 to 22 weeks undergoing ultrasonography with a single live fetus and no complications in the fetus or mother were selected for the study. The fetal nasal bone was measured in 2060 pregnant women from 2014 to 2018. The measurement was done by the double operator method; three measurements were taken for each woman when her fetus was in the midsagittal plane, and the nasal bone was located between a 45 and 135° angle to the ultrasound beam. We performed follow-up evaluations of all neonates. Results: The rate of growth of the fetal nasal bone during different weeks of gestation is described by an equation where NBL =0.365×GA+ 2.5885, with a fit estimate of R2 = 0.97, P < 0.001. The median NBL increased with GA from 2.9 mm at 14 weeks to 5.8 mm at 22 weeks in a linear relationship. Our results in the North Indian population are similar to those in the South Indian population and differ from those in Chinese and Japanese populations. Conclusions: The NBL in North Indian fetuses at 14–26 weeks of GA has a linear relationship to the week of gestation.
Collapse
Affiliation(s)
- Shreshtha Jain
- Department of Radiodiagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Sachin Khanduri
- Department of Radiodiagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Mazhar Khan
- Department of Radiodiagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Shahla Khan
- Department of Radiodiagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Vivek K Yadav
- Department of Radiodiagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Basmah R Khan
- Department of Radiodiagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Umar Faizan Sagar
- Department of Radiodiagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Mridul Rajurkar
- Department of Radiodiagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| |
Collapse
|
6
|
Sensitivity of Nasal Bone as Aneuploidy Marker—First Trimester versus Second Trimester Assessment. JOURNAL OF FETAL MEDICINE 2017. [DOI: 10.1007/s40556-017-0128-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
7
|
Tomai XH, Phan TH. Fetal nasal bone length at 19-26 weeks' gestation in Vietnam. J Obstet Gynaecol Res 2016; 42:1245-1249. [PMID: 27307053 DOI: 10.1111/jog.13051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 03/18/2016] [Accepted: 04/11/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Xuan-Hong Tomai
- Department of Obstetrics and Gynaecology, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam.
| | | |
Collapse
|
8
|
Papasozomenou P, Athanasiadis AP, Zafrakas M, Panteris E, Mikos T, Daniilidis A, Loufopoulos A, Assimakopoulos E, Tarlatzis BC. Screening performance of different methods defining fetal nasal bone hypoplasia as a single and combined marker for the detection of trisomy 21 in the second trimester. J Matern Fetal Neonatal Med 2016; 29:3368-73. [PMID: 26635074 DOI: 10.3109/14767058.2015.1127344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate different methods of defining fetal nasal bone hypoplasia in the second trimester for the detection of trisomy 21. METHODS Prospective study in Greek women undergoing anomaly scan between 18 + 0 and 23 + 6 weeks. The following methods of defining nasal bone hypoplasia were evaluated, either as a single marker or in combination with others: (1) BPD to nasal bone length (NBL) ratio; (2) multiples of the median (MoM) of NBL, according to normal curves from a Greek population; (3-4) NBL < 2.5 percentile according to normal curves (3) commonly used internationally curves and (4) curves from a Greek population. RESULTS In total, 1301 singleton fetuses were evaluated - 10 with trisomy 21. The best detection rate of trisomy 21 was achieved when the applied method was nasal bone percentiles adjusted to maternal ethnicity, in combination with other markers (<2.5 percentile according to normal curves from a Greek population; p < 0.001; sensitivity 50%; specificity 94.8%; false-positive rate 5.2%; positive likelihood ratio 9.6). CONCLUSION Screening performance of fetal nasal bone hypoplasia in detecting trisomy 21 varies according to the method applied. The best screening performance is achieved by using percentiles adjusted to maternal ethnicity in combination with other markers of aneuploidy.
Collapse
Affiliation(s)
- Panayiota Papasozomenou
- a 1st Department of Obstetrics and Gynecology , Papageorgiou Hospital, Medical School, Aristotle University of Thessaloniki , Thessaloniki , Greece .,b Prenatal Diagnostic Center of Thessaloniki , Thessaloniki , Greece
| | - Apostolos P Athanasiadis
- a 1st Department of Obstetrics and Gynecology , Papageorgiou Hospital, Medical School, Aristotle University of Thessaloniki , Thessaloniki , Greece .,b Prenatal Diagnostic Center of Thessaloniki , Thessaloniki , Greece
| | - Menelaos Zafrakas
- a 1st Department of Obstetrics and Gynecology , Papageorgiou Hospital, Medical School, Aristotle University of Thessaloniki , Thessaloniki , Greece .,c Research Laboratory , School of Health and Medical Care, Alexander Technological Institute of Thessaloniki , Thessaloniki , Greece , and
| | - Eleftherios Panteris
- c Research Laboratory , School of Health and Medical Care, Alexander Technological Institute of Thessaloniki , Thessaloniki , Greece , and
| | - Themistokles Mikos
- a 1st Department of Obstetrics and Gynecology , Papageorgiou Hospital, Medical School, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Angelos Daniilidis
- d 2nd Department of Obstetrics and Gynecology , Hippokratio Hospital, Medical School, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Aristoteles Loufopoulos
- d 2nd Department of Obstetrics and Gynecology , Hippokratio Hospital, Medical School, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Efstratios Assimakopoulos
- d 2nd Department of Obstetrics and Gynecology , Hippokratio Hospital, Medical School, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Basil C Tarlatzis
- a 1st Department of Obstetrics and Gynecology , Papageorgiou Hospital, Medical School, Aristotle University of Thessaloniki , Thessaloniki , Greece
| |
Collapse
|