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Chen CP. Chromosomal abnormalities associated with fetal megacystis. Taiwan J Obstet Gynecol 2024; 63:17-18. [PMID: 38216262 DOI: 10.1016/j.tjog.2023.11.006] [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] [Accepted: 11/02/2023] [Indexed: 01/14/2024] Open
Abstract
Fetal megacystis has been reported to be associated with chromosomal abnormalities, megacystis-microcolon-intestinal hypoperistalsis syndrome (MMIHS), obstructive uropathy, prune belly syndrome, cloacal anomalies, limb-body wall complex, amniotic band syndrome, anorectal malformations, VACTERL association (vertebral anomalies, anal atresia, cardiac malformations, tracheo-esophageal fistula, renal anomalies and limb abnormalities) and fetal overgrowth syndrome such as Bechwith-Wiedemann syndrome and Sotos syndrome. This review provides an overview of chromosomal abnormalities associated with fetal megacystis which is useful for genetic counseling and fetal therapy at prenatal diagnosis of fetal megacystis.
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Affiliation(s)
- Chih-Ping Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan; School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan; Institute of Clinical and Community Health Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Obstetrics and Gynecology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Medical Laboratory Science and Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan.
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2
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Rajs B, Nocuń A, Matyszkiewicz A, Pasternok M, Kołodziejski M, Wiercińska E, Wiecheć M. First-trimester presentation of ultrasound findings in trisomy 13 and validation of multiparameter ultrasound-based risk calculation models to detect trisomy 13 in the late first trimester. J Perinat Med 2021; 49:341-352. [PMID: 33068386 DOI: 10.1515/jpm-2020-0383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/19/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To identify the most common ultrasound patterns of markers and anomalies associated with Patau syndrome (PS), to explore the efficacy of multiparameter sonographic protocols in detecting trisomy 13 (T13) and to analyze the influence of maternal age (MA) on screening performance. METHODS The project was a prospective study based on singleton pregnancies referred for a first-trimester screening examination. The scan protocol included nuchal translucency (NT), fetal heart rate (FHR), secondary ultrasound markers [nasal bone (NB), tricuspid regurgitation (TR), ductus venosus reversed a-wave (revDV)] and major anomaly findings. RESULTS The study population comprised 6133 pregnancies: 6077 cases of euploidy and 56 cases of T13. Statistically significant differences were found in MA, FHR, NT, absence of NB, presence of revDV, TR and single umbilical artery. Fourteen cases of T13 (25%) demonstrated no markers of aneuploidy. The best general detection rate (DR) (DR of 78.6% with an false positive rate (FPR) of 1.2%) was obtained for a cutoff of 1/300 utilizing the "NT+T13" algorithm. The logistic regression model revealed that the central nervous system (CNS) anomalies had the greatest odds ratio (of 205.4) for T13. CONCLUSIONS The effectiveness of the multiparameter sonographic protocol used for T13 screening showed promising results in patients older than 36 years and suboptimal results in patients between 26 and 36 years old. When screening for T13 left heart defects, CNS anomalies, abdominal anomalies, FHR above the 95th percentile, increased NT, revDV and lack of NB should receive specific attention.
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Affiliation(s)
- Bartosz Rajs
- Department of Gynecology and Obstetrics, Jagiellonian University in Krakow, Krakow, Poland
| | | | - Anna Matyszkiewicz
- Department of Gynecology and Obstetrics, Jagiellonian University in Krakow, Krakow, Poland
- Ultrasound Group Practice "MWU DOBREUSG", Krakow, Poland
| | | | - Michał Kołodziejski
- Department of Gynecology and Obstetrics, Jagiellonian University in Krakow, Krakow, Poland
| | - Ewa Wiercińska
- Voivodship Sanitary-Epidemiological Station in Krakow, Krakow, Poland
| | - Marcin Wiecheć
- Department of Gynecology and Obstetrics, Jagiellonian University in Krakow, Krakow, Poland
- Ultrasound Group Practice "MWU DOBREUSG", Krakow, Poland
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3
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Kepple JW, Fishler KP, Peeples ES. Surveillance guidelines for children with trisomy 13. Am J Med Genet A 2021; 185:1631-1637. [PMID: 33709620 DOI: 10.1002/ajmg.a.62133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Trisomy 13 is one of the three most common aneuploidy syndromes in live-born infants. It is associated with mortality rates as high as 90% within the first year of life, in large part, due to the high prevalence of severe congenital abnormalities that increase mortality and morbidity. However, life-saving and life-prolonging medical interventions are being performed at a higher rate for these infants, resulting in increased rates of survival. Although cardiac complications have been well described in infants with trisomy 13, these patients also experience other complications such as respiratory, neurological, genitourinary, abdominal, otolaryngologic, and orthopedic complications that can impact their quality of life. The goal of this review is to present a comprehensive description of complications in children with trisomy 13 to aid in the development of monitoring and treatment guidelines for the increasing number of providers who will be caring for these patients throughout their lives. Where the evidence is available, this review presents screening recommendations to allow for more rapid detection and documentation of these complications.
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Affiliation(s)
| | - Kristen P Fishler
- Munroe-Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Eric S Peeples
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Tekesin I. The diagnostic value of a detailed first trimester anomaly scan in fetuses with increased nuchal translucency thickness. J Perinat Med 2019; 47:241-246. [PMID: 30218607 DOI: 10.1515/jpm-2018-0145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/15/2018] [Indexed: 11/15/2022]
Abstract
Objectives To assess the diagnostic value of an early anomaly scan in fetuses with increased nuchal translucency (NT) in the prediction of aneuploidy. Methods In this study we analyzed the data of pregnant women obtained at their first trimester screening in our unit. The detailed examination routinely includes measurement of NT and a scan for anatomical defects. For fetuses with an NT≥3.5 mm, the diagnostic power of early major sonographic findings (MSF) regarding abnormal karyotype was calculated. Results A total of 7352 first trimester examinations were screened. Two hundred and twenty-two fetuses with an NT≥3.5 mm were analyzed. The median gestational age was 12.5 weeks (range 11.0-14.6) and the median NT was 5.1 mm (range 3.5-15.3). MSF were detected in 51.8% of fetuses with increased NT. Among 115 fetuses with MSF, 91 were aneuploid, yielding a positive predictive value for aneuploidy of 79.1%. In the absence of MSF, the negative predictive value was 70.1%. The presence of MSF was significantly predictive for aneuploidy both in bivariate and multivariate regression analysis. Conclusion Our study underlines the importance of a detailed anatomical ultrasound in fetuses with increased NT, as MSF occurred frequently. However, the diagnostic value of MSF regarding aneuploidies appears to be moderate.
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Affiliation(s)
- Ismail Tekesin
- Prenatal Unit Stuttgart, Alte Poststr. 3, D-70173 Stuttgart, Germany, Tel.: +497114006010, Fax: +4971140060120
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5
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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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6
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Sepulveda W. Discordant results between fetal cell-free DNA in maternal plasma and chorionic villus sampling in a first-trimester fetus with increased nuchal translucency and megacystis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 44:369. [PMID: 24832209 DOI: 10.1002/uog.13412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 05/06/2014] [Indexed: 06/03/2023]
Affiliation(s)
- W Sepulveda
- Maternal-Fetal Diagnostic Center, Las Condes, Santiago, Chile
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7
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Verweij EJ, de Boer MA, Oepkes D. Non-invasive prenatal testing for trisomy 13: more harm than good? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 44:112-114. [PMID: 24753041 DOI: 10.1002/uog.13388] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 04/07/2014] [Accepted: 04/11/2014] [Indexed: 06/03/2023]
Abstract
A 35-year-old primigravida, pregnant after in-vitro fertilization, was seen because of a trisomy 13/trisomy 18 (T13/T18) risk of 1:55, based on the result of her first-trimester combined test. She elected for non-invasive prenatal testing (NIPT) at 14 + 5 weeks' gestation, which was positive for T13. After counseling, the patient elected to undergo amniocentesis. Quantitative fluorescence polymerase chain reaction (QF-PCR) showed no signs of trisomy, and full karyotyping confirmed a normal 46,XY result. Analysis of the published literature on NIPT for T13 gives an overall detection rate of 91.6%, with a false-positive rate of 0.097%. Based on this detection rate, hypothetical calculations show that the positive predictive value is highly dependent on the prevalence of the disease, resulting in an unfavorable balance between benefit and harm in a general population.
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Affiliation(s)
- E J Verweij
- Leiden University Medical Center, Department of Obstetrics, Leiden, The Netherlands
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8
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Prenatal Screening Using Maternal Markers. J Clin Med 2014; 3:504-20. [PMID: 26237388 PMCID: PMC4449694 DOI: 10.3390/jcm3020504] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 03/28/2014] [Accepted: 03/28/2014] [Indexed: 11/17/2022] Open
Abstract
Maternal markers are widely used to screen for fetal neural tube defects (NTDs), chromosomal abnormalities and cardiac defects. Some are beginning to broaden prenatal screening to include pregnancy complications such as pre-eclampsia. The methods initially developed for NTDs using a single marker have since been built upon to develop high performance multi-maker tests for chromosomal abnormalities. Although cell-free DNA testing is still too expensive to be considered for routine application in public health settings, it can be cost-effective when used in combination with existing multi-maker marker tests. The established screening methods can be readily applied in the first trimester to identify pregnancies at high risk of pre-eclampsia and offer prevention though aspirin treatment. Prenatal screening for fragile X syndrome might be adopted more widely if the test was to be framed as a form of maternal marker screening.
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Khalil A, Papageorghiou A, Bhide A, Akolekar R, Thilaganathan B. Biparietal diameter at 11 to 13 weeks' gestation in fetuses with holoprosencephaly. Prenat Diagn 2013; 34:134-8. [DOI: 10.1002/pd.4269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 11/03/2013] [Accepted: 11/03/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Asma Khalil
- Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology; St George's Hospital Medical School; London UK
| | - Aris Papageorghiou
- Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology; St George's Hospital Medical School; London UK
| | - Amar Bhide
- Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology; St George's Hospital Medical School; London UK
| | - Ranjit Akolekar
- Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology; St George's Hospital Medical School; London UK
| | - Basky Thilaganathan
- Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology; St George's Hospital Medical School; London UK
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Tonks AM, Gornall AS, Larkins SA, Gardosi JO. Trisomies 18 and 13: trends in prevalence and prenatal diagnosis - population based study. Prenat Diagn 2013; 33:742-50. [PMID: 23553654 DOI: 10.1002/pd.4117] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 02/27/2013] [Accepted: 03/25/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to determine trends in prenatal detection and current estimates of prevalence for trisomies 18 (T18) and 13 (T13) and their implications for screening policy. METHODS We conducted a cohort study from a population-based regional anomaly register covering 995 003 births (1995-2009). RESULTS There were 786 affected cases. Total prevalence of T18 increased from 3.95 in 1995-1999 to 6.94 per 10 000 births in 2005-2009 (annual trend χ(2) = 25.99, p < 0.001) and live birth prevalence, when adjusted for in utero attrition, increased from 1.47 to 2.30 per 10 000 births over the same time (annual trend χ(2) = 6.36, p = 0.01). For T18 and T13 combined, the proportion of cases diagnosed by prenatal karyotype or suspected by ultrasound increased from 85.1% (165/194) in 1995-1999 to 95.2% (299/314) in 2005-2009 (p < 0.001). In 2005-2009, 50.3% of prenatal cytogenetic diagnoses for T18 and 38.5% of T13 were made after the discovery of first trimester ultrasound anomalies, and the majority, 56.4% (185/328), of affected pregnancies were karyotyped or had ended before 18 weeks. CONCLUSION T18 is increasing in prevalence because of maternal age and earlier surveillance. Prenatal diagnosis occurs mostly in the first trimester, without the intrinsic structures of a formal screening programme. These findings support the extension of first trimester combined screening to include T18 and T13.
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Affiliation(s)
- A M Tonks
- West Midlands Perinatal Institute, Birmingham, UK.
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11
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Ashoor G, Syngelaki A, Wang E, Struble C, Oliphant A, Song K, Nicolaides KH. Trisomy 13 detection in the first trimester of pregnancy using a chromosome-selective cell-free DNA analysis method. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 41:21-25. [PMID: 22996646 DOI: 10.1002/uog.12299] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/29/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To assess the performance of chromosome-selective sequencing of maternal plasma cell-free DNA (cfDNA) in non-invasive prenatal testing for trisomy 13. METHODS Two-phase case-control study on a single plasma sample per case. The first phase was used to optimize the trisomy 13 algorithm, which was then applied to a second dataset to determine the risk score for trisomy 13 by laboratory personnel who were blinded to the fetal karyotype. RESULTS In the first phase, trisomy 13 risk scores were given for 11 cases of trisomy 13 and 145 euploid cases at 11-13 weeks' gestation. The test identified seven (63.6%) cases of trisomy 13 with no false positives. The trisomy 13 algorithm was subsequently modified and the trisomy 13 risk score was > 99% in all 11 cases of trisomy 13 and < 0.01% in all 145 euploid cases. In the second phase, the new algorithm was used to generate trisomy 13 risk scores for 10 cases of trisomy 13 and 1939 euploid cases. The trisomy 13 risk scores were > 99% in eight (80.0% (95% confidence interval (CI), 49.0-94.3%)) cases of trisomy 13. In the 1939 euploid cases the risk score for trisomy 13 was < 0.01% in 1937 (99.9%), 0.79% in one, and > 99% in one. Therefore, at the predefined risk cut-off of 1% for classifying a sample as high or low risk, the false-positive rate (FPR) was 0.05% (95% CI, 0.0-0.3%). CONCLUSIONS Chromosome-selective sequencing of cfDNA can detect the majority of cases of trisomy 13 at an FPR of less than 0.1%.
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Affiliation(s)
- G Ashoor
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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Sonographic markers of aneuploidies at 6-10 weeks of gestation. Early Hum Dev 2011; 87:453-6. [PMID: 21592687 DOI: 10.1016/j.earlhumdev.2011.01.045] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2010] [Revised: 01/27/2011] [Accepted: 01/31/2011] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To determine if sonographic features of live embryos at 6-10 weeks' gestation are altered in aneuploidies. METHODS Embryonic crown rump length (CRL), embryonic heart rate, gestational sac diameter (GSD) and yolk sac diameter (YSD) were measured by transvaginal sonography in 5603 live embryos from singleton pregnancies at 6-10 weeks' gestation. The measurements were expressed as differences from the expected normal mean for CRL (delta values) and median delta values in the aneuploid cases were compared to the euploid group. RESULTS 5393 pregnancies resulted in the live birth of phenotypically normal neonates and these cases constituted the euploid group. In 55 cases there was subsequent prenatal diagnosis of aneuploidies (trisomy 21, n=28; trisomy 18, n=10; trisomy 13, n=10; triploidy, n=4; Turner syndrome, n=3). The median and interquartile range (IQR) of delta embryonic heart rate in trisomy 18 was -19.44 (-23.77 to -7.20)bpm and in trisomy 13 it was 11.12 (7.25 to 20.39)bpm, which were significantly lower and higher, respectively, than in euploid embryos (median -0.05, IQR -6.18 to 6.21bpm). The median delta YSD in trisomy 21 was higher than in euploid fetuses (median 0.56, IQR 0.23 to 0.79 and median -0.17, IQR -3.11 to 2.82 mm). There were no other significant differences in measurements between the groups. CONCLUSION At 6-10 weeks' gestation there are sonographically detectable differences between euploid and trisomic embryos.
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13
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Rapid aneuploidy diagnosis by multiplex ligation-dependent probe amplification and array comparative genomic hybridization in pregnancy with major congenital malformations. Taiwan J Obstet Gynecol 2011; 50:85-94. [DOI: 10.1016/j.tjog.2010.05.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2010] [Indexed: 12/18/2022] Open
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14
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Affiliation(s)
- Kypros H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital,London, UK and Department of Fetal Medicine, University College Hospital, London, UK.
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15
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Chen CP. Prenatal sonographic features of fetuses in trisomy 13 pregnancies. IV. Taiwan J Obstet Gynecol 2010; 49:3-12. [PMID: 20466286 DOI: 10.1016/s1028-4559(10)60002-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2009] [Indexed: 10/19/2022] Open
Abstract
Prenatal ultrasound is a powerful tool to detect structural abnormalities associated with the fetuses in trisomy 13 pregnancies. This article provides a comprehensive review of the prenatal sonographic markers of trisomy 13 in the first trimester, including fetal nuchal translucency thickness, fetal heart rate, fetal nasal bone, fetal tricuspid regurgitation, ductus venous flow, fetal crown-rump length, fetal trunk and head volume, fetal frontomaxillary facial angle, gestational sac volume and umbilical cord diameter, along with biochemical markers such as maternal serum free beta-human chorionic gonadotropin, maternal serum pregnancy-associated plasma protein-A, maternal serum placental growth factor, and the fetal and total cell-free DNA concentration in the maternal circulation.
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Affiliation(s)
- Chih-Ping Chen
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan.
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16
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Kagan KO, Staboulidou I, Syngelaki A, Cruz J, Nicolaides KH. The 11-13-week scan: diagnosis and outcome of holoprosencephaly, exomphalos and megacystis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 36:10-14. [PMID: 20564304 DOI: 10.1002/uog.7646] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To determine the prevalence and outcome of fetuses with holoprosencephaly, exomphalos and megacystis diagnosed at 11-13 weeks of gestation. METHODS As part of a prospective screening study for trisomy 21 in singleton pregnancies at 11 + 0 to 13 + 6 weeks' gestation, transabdominal ultrasound examination was performed to diagnose holoprosencephaly, exomphalos and megacystis. Fetal karyotype and pregnancy outcome in fetuses with these defects were examined. RESULTS Screening was carried out in 57 119 pregnancies. The prevalence of holoprosencephaly, exomphalos and megacystis was 1 : 1298, 1 : 381 and 1 : 1632, respectively. Chromosomal abnormalities, mainly trisomies 18 and 13, were found in 65.9% of fetuses with holoprosencephaly, in 55.3% with exomphalos and in 31.4% with megacystis. There was spontaneous resolution of the defect by 20 weeks in 92.5% of euploid fetuses with exomphalos containing only bowel and in 90% of the euploid fetuses with megacystis and bladder length of < or = 15 mm. CONCLUSIONS A high proportion of fetuses with holoprosencephaly, exomphalos and megacystis diagnosed at 11-13 weeks of gestation are aneuploid, but in the majority of cases exomphalos and megacystis represent temporary abnormalities that resolve spontaneously.
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Affiliation(s)
- K O Kagan
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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17
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Chen CP. Prenatal Sonographic Features of Fetuses in Trisomy 13 Pregnancies (III). Taiwan J Obstet Gynecol 2009; 48:342-9. [DOI: 10.1016/s1028-4559(09)60322-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Chen CP. Prenatal Sonographic Features of Fetuses in Trisomy 13 Pregnancies (I). Taiwan J Obstet Gynecol 2009; 48:210-7. [DOI: 10.1016/s1028-4559(09)60292-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Spencer K, Cowans NJ. ADAM12 as a marker of trisomy 18 in the first and second trimester of pregnancy. J Matern Fetal Neonatal Med 2009; 20:645-50. [PMID: 17701664 DOI: 10.1080/14767050701483389] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND ADAM12 (a disintegrin and metalloprotease 12) is a placentally derived glycoprotein that appears to be involved in growth and differentiation. The maternal serum concentration of ADAM12 appears to be a very good marker of trisomy 21 in the early first trimester when levels are reduced, and in the second trimester around 16-18 weeks levels are elevated. One small preliminary study of first trimester pregnancies with trisomy 18 found reduced levels in the maternal serum, and we examine herein the potential of ADAM12 as a marker of trisomy 18 in both the first and second trimester of pregnancy. MATERIALS AND METHODS The concentration of ADAM12 was determined by a time-resolved immunofluorometric assay in 132 first and 12 second trimester cases of trisomy 18, and 389 first and 341 second trimester gestational age-matched control pregnancies. Medians of normal pregnancies were established by polynomial regression and used to determine the population distribution parameters for the trisomy 18 and control groups. Correlation with previously established pregnancy-associated plasma protein-A (PAPP-A) and free beta-human chorionic gonadotropin (beta-hCG) multiples of the median (MoMs) and nuchal translucency thickness (NT) MoM were determined and used to model the performance of first trimester screening with ADAM12 in combination with other first trimester markers. RESULTS The maternal serum concentration of ADAM12 in the first trimester was significantly reduced with a median MoM of 0.829 (p < 0.001) and a mean log10 MoM SD of 0.2663 compared to 0.3353 in the controls. In the second trimester small series ADAM12 was significantly increased with a median MoM of 2.09 (p = 0.001) and a mean log10 MoM SD of 0.2607 compared to 0.4318 in controls. There was a significant correlation of ADAM12 MoM with gestational age (r = 0.510) in trisomy 18 cases, and the median MoM increased from 0.51 at 10 weeks to 1.28 at 13 weeks and 2.09 across the 14-18 week window. ADAM12 was correlated with PAPP-A (r = 0.1918) in the first trimester of cases with trisomy 18 but less so with NT (r = 0.1594) and free beta-hCG (r = 0.0938). Modeled detection rates incorporating ADAM12, free beta-hCG, and NT were 92% at 1% false positive rate (88% at 0.5%) A combination of all four markers had a detection rate of 96.5% at a false positive rate of 1% (95% at 0.5%). CONCLUSION ADAM12 may be a useful addition to early screening for trisomy 18 alongside other chromosomal anomalies, particularly if biochemical screening can occur before 10 weeks.
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Affiliation(s)
- Kevin Spencer
- Prenatal Screening Unit, Clinical Biochemistry Department, Harold Wood Hospital, Romford, UK.
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Kagan KO, Wright D, Valencia C, Maiz N, Nicolaides KH. Screening for trisomies 21, 18 and 13 by maternal age, fetal nuchal translucency, fetal heart rate, free -hCG and pregnancy-associated plasma protein-A. Hum Reprod 2008; 23:1968-75. [PMID: 18544579 DOI: 10.1093/humrep/den224] [Citation(s) in RCA: 139] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- Karl O Kagan
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, Denmark Hill, London SE5 8RX, UK
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Borenstein M, Persico N, Dagklis T, Faros E, Nicolaides KH. Frontomaxillary facial angle in fetuses with trisomy 13 at 11 + 0 to 13 + 6 weeks. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2007; 30:819-23. [PMID: 17729372 DOI: 10.1002/uog.5135] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To investigate the frontomaxillary facial (FMF) angle in fetuses with trisomy 13 at 11 + 0 to 13 + 6 weeks of gestation. METHODS A three-dimensional (3D) volume of the fetal head was obtained before karyotyping at 11 + 0 to 13 + 6 weeks of gestation in 23 fetuses with trisomy 13. The FMF angle, defined as the angle between the upper surface of the maxilla and the frontal bone in a midsagittal view of the fetal face, was measured and compared to the angle in 500 chromosomally normal fetuses. RESULTS In 10 of 12 (83.3%) fetuses with trisomy 13 and holoprosencephaly, the FMF angle was above the 95(th) centile of the normal range. In the 11 fetuses with no holoprosencephaly, the FMF angle was not significantly different from normal. There was no significant difference in the FMF angle between the trisomy 13 fetuses with and without facial cleft. CONCLUSIONS In fetuses with trisomy 13, the FMF angle at 11 + 0 to 13 + 6 weeks of gestation is increased only in cases with associated holoprosencephaly.
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Affiliation(s)
- M Borenstein
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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Watson WJ, Miller RC, Wax JR, Hansen WF, Yamamura Y, Polzin WJ. Sonographic detection of trisomy 13 in the first and second trimesters of pregnancy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:1209-14. [PMID: 17715315 DOI: 10.7863/jum.2007.26.9.1209] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE The purpose of this study was to examine sonographic findings in fetuses with trisomy 13. METHODS A retrospective review of the cytogenetic laboratory databases at 6 tertiary referral centers identified all cases of trisomy 13. The prenatal sonographic studies in fetuses of less than 22 weeks' gestation, done before invasive testing for karyotype, were reviewed for anatomic and biometric findings. We defined abnormal fetal biometric findings as a biometric measurement (biparietal diameter, abdominal circumference, or femur length) below the fifth percentile in the second trimester. RESULTS There were 8 cases of trisomy 13 found in the first trimester and 54 cases found in the second trimester, a total of 62 in all. In the first trimester, 6 of 8 had an anomaly identified (4 with cystic hygroma). In the second trimester, 49 of 54 were identified by sonography; 45 had an anomaly, and 4 had an abnormal fetal biometric measurement without an anomaly. The 5 missed diagnoses had early gestational age (<17 weeks; n = 3) or an inadequate survey secondary to poor visualization. Overall, 22 of 54 fetuses with trisomy 13 had an abnormal biometric measurement. The most common anomalies detected in the second trimester were heart defects (n = 34), central nervous system anomalies (n = 30), facial clefts (n = 19), abnormal hands (n = 13), and genitourinary anomalies (n = 9). CONCLUSIONS Targeted sonography identified abnormal fetal anatomy or abnormal biometric measurements in 95% of fetuses with trisomy 13 in the second trimester after 17 weeks' gestation. A biometric measurement below the fifth percentile was noted in nearly half of cases in the second trimester.
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Affiliation(s)
- William J Watson
- Department of Maternal-Fetal Medicine, Mayo Clinic College of Medicine, 200 First St SW, Charlton 3B, Rochester, MN 55905, USA.
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Spencer K. Aneuploidy screening in the first trimester. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2007; 145C:18-32. [PMID: 17290444 DOI: 10.1002/ajmg.c.30119] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This article reviews the performance of first trimester screening for chromosomal anomalies using various combinations of ultrasound and maternal serum biochemical modalities. Detection rates in excess of 90% can be routinely achieved for Trisomy 21, Trisomy 13, Trisomy 18 using a combination of fetal nuchal translucency (NT) thickness and maternal serum free ss-hCG and PAPP-A at 11 + 0 to 13 + 6 weeks of gestation.
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Affiliation(s)
- Kevin Spencer
- Prenatal Screening Unit, Clinical Biochemistry Department, Harold Wood Hospital, Romford, UK.
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Sepulveda W, Lutz I, Be C. Holoprosencephaly at 9 weeks 6 days in a triploid fetus: two- and 3-dimensional sonographic findings. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:411-4. [PMID: 17324996 DOI: 10.7863/jum.2007.26.3.411] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Affiliation(s)
- Waldo Sepulveda
- Department of Obstetrics and Gynecology, Fetal Medicine Center, Clinica Las Condes, Casilla 208, Santiago 20, Chile.
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Capobianco G, Cherchi PL, Ambrosini G, Cosmi E, Andrisani A, Dessole S. Alobar holoprosencephaly, mobile proboscis and trisomy 13 in a fetus with maternal gestational diabetes mellitus: a 2D ultrasound diagnosis and review of the literature. Arch Gynecol Obstet 2006; 275:385-7. [PMID: 17047972 DOI: 10.1007/s00404-006-0264-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2006] [Accepted: 09/25/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Alobar holoprosencephaly is a rare and severe brain malformation due to early arrest in brain cleavage and rotation. CASE REPORT We report a congenital anomalous fetus with alobar holoprosencephaly, prenatally diagnosed by two-dimensional (2D) sonography at the 40 weeks of gestation. The mother was affected by gestational diabetes mellitus and was obese (BMI > 30 kg/m(2)). 2D Ultrasound depicted the cerebral malformation, cyclopy, proboscis, cardiac defects (atrial septal defect, hypoplastic left heart, anomalous communication between right ventricle and aorta) and extremities defects. The newborn died just after delivery. External examination confirmed a mobile proboscis-like nose on the normal nose position. The fetus had both claw hands. The right and left feet showed to be equine. Autopsy confirmed the ultrasound diagnosis and chromosome analysis revealed trisomy 13 (47,XY,+13). Fetopathologic examination showed cyclopy, proboscis and alobar holoprosencephaly of the fetus, which was consistent with Patau syndrome. CONCLUSION The teratogenic effect of diabetes on fetus has been described, but no previous clinical case of a congenital anomalous fetus with trisomy 13 and maternal gestational diabetes has been reported. This case report is the first to describe 2D ultrasound diagnosis of alobar holoprosencephaly and trisomy 13 with maternal gestational diabetes mellitus.
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Affiliation(s)
- Giampiero Capobianco
- Department of Pharmacology, Gynaecology and Obstetrics, University of Sassari, Viale San Pietro 12, Sassari 07100, Italy.
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