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Lee S, Lee HM, Han YJ, Kim MY, Boo HY, Chung JH. Clinical Utility of Increased Nuchal Translucency at 11-13 Weeks of Gestation in Twin Pregnancies Based on the Chorionicity. J Clin Med 2021; 10:jcm10030433. [PMID: 33498637 PMCID: PMC7865212 DOI: 10.3390/jcm10030433] [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: 12/14/2020] [Revised: 01/16/2021] [Accepted: 01/20/2021] [Indexed: 11/22/2022] Open
Abstract
To assess clinical implications of increased nuchal translucency (INT) in twin pregnancies based on the chorionicity. This was a retrospective review of the twin pregnancies who underwent first trimester ultrasound with nuchal translucency (NT) measurement at 11–13 weeks of gestation from January 2006 to December 2014. Data were collected using the OB database and the chart review. Pregnancy outcomes, including gestational weeks at the delivery, abnormal fetal karyotypes, fetal structural anomalies, and twin-specific complications, were analyzed. A total of 1622 twin pregnancies with INT ≥ 95th percentile in one or both fetuses were identified. In all twin pregnancies with INT, abnormal fetal karyotypes were identified in 17 (8.6%) patients (odds ratio = 13.28, CI = 5.990–29.447, p = 0.000) and twin-specific complications were identified in 23 (11.6%) patients (odds ratio = 2.398, CI = 1.463–3.928, p = 0.001) compared to those with normal NT. Among the INT group, when the groups were subdivided into monochorionic (MC) and dichorionic (DC) pregnancies, 14.8% and 29.6% of the MC pregnancies had structural anomalies in one or both fetuses (odds ratio = 5.774, 95% CI = 1.445–23.071, p = 0.01) and twin-specific complications (odds ratio = 4.379, 95% CI = 1.641–11.684, p = 0.03), respectively, compared to DC pregnancies with 2.9% for structural anomalies and 8.8% for twin-specific complications. The prevalence of abnormal fetal karyotypes was not statistically different in patients with INT when compared between MC and DC pregnancies (p = 0.329). INT was associated with a higher rate of twin-specific complications and fetal structural anomalies in MC twin pregnancies rather than abnormal fetal karyotype. Therefore, NT measurement in MC twin pregnancies can be a useful tool for predicting adverse pregnancy outcomes. Appropriate counseling and surveillance based on the chorionicity are imperative in the prenatal care of twin pregnancies.
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Affiliation(s)
- SiWon Lee
- Department of Obstetrics and Gynecology, Mount Sinai Medical Center, Miami Beach, FL 33109, USA;
| | - Hyun-Mi Lee
- Department of Obstetrics and Gynecology, CHA Ilsan Medical Center, CHA University, Goyang 10414, Korea; (H.-M.L.); (H.Y.B.)
| | - You Jung Han
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul 06135, Korea; (Y.J.H.); (M.Y.K.)
| | - Moon Young Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul 06135, Korea; (Y.J.H.); (M.Y.K.)
| | - Hye Yeon Boo
- Department of Obstetrics and Gynecology, CHA Ilsan Medical Center, CHA University, Goyang 10414, Korea; (H.-M.L.); (H.Y.B.)
| | - Jin Hoon Chung
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
- Correspondence: ; Tel.: +82-2-3010-3645
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Simpson L, Maturen KE, Feldstein VA, Oliver ER, Poder L, Strachowski LM, Sussman BL, Weber TM, Winter T, Zelop CM, Glanc P. ACR Appropriateness Criteria® Nuchal Translucency Evaluation at 11 to 14 Weeks of Gestation. J Am Coll Radiol 2020; 17:S447-S458. [PMID: 33153556 DOI: 10.1016/j.jacr.2020.09.007] [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: 08/26/2020] [Accepted: 09/01/2020] [Indexed: 11/20/2022]
Abstract
A fetus with an increased nuchal translucency at 11 to 14 weeks gestation is at risk for aneuploidy, genetic syndromes, structural anomalies, and intrauterine fetal demise in both single and twin gestations. In addition to referral to genetics for counseling and consideration of diagnostic genetic testing, a detailed anatomic survey and fetal echocardiogram are indicated in the second trimester to screen for congenital malformations and major heart defects. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Lynn Simpson
- Columbia University, New York, New York; American College of Obstetricians and Gynecologists.
| | | | | | - Edward R Oliver
- Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Liina Poder
- University of California San Francisco, San Francisco, California
| | | | - Betsy L Sussman
- The University of Vermont Medical Center, Burlington, Vermont
| | | | - Tom Winter
- University of Utah, Salt Lake City, Utah
| | - Carolyn M Zelop
- Valley Hospital, Ridgewood, New Jersey and NYU School of Medicine, New York, New York; American College of Obstetricians and Gynecologists
| | - Phyllis Glanc
- Specialty Chair, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Smith J, Treadwell MC, Berman DR. Role of ultrasonography in the management of twin gestation. Int J Gynaecol Obstet 2018. [PMID: 29536536 DOI: 10.1002/ijgo.12483] [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: 12/22/2022]
Abstract
Twins represent 1%-2% of all pregnancies, yet continue to account for a disproportionate share of neonatal adverse events including neonatal intensive care admission, morbidity, and mortality. Ultrasonography is central to the proper diagnosis of the type of twinning. Ideally, ultrasonography is performed before 14 weeks of gestation to determine chorionicity and amnionicity. Correct identification of the chorionicity in a twin pregnancy facilitates proper counseling and management of the gestation, including ultrasonography follow-up. Herein, the different types of twinning are reviewed, together with the implications for ultrasonography monitoring of each specific type of twin gestation.
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Affiliation(s)
- Jessica Smith
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Marjorie C Treadwell
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Deborah R Berman
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
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Audibert F, Gagnon A. No. 262-Prenatal Screening for and Diagnosis of Aneuploidy in Twin Pregnancies. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:e347-e361. [DOI: 10.1016/j.jogc.2017.06.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Audibert F, Gagnon A. N o 262-Dépistage et diagnostic prénatals de l’aneuploïdie en ce qui concerne les grossesses gémellaires. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:e329-e346. [DOI: 10.1016/j.jogc.2017.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Massively Parallel Sequencing (MPS) of Cell-Free Fetal DNA (cffDNA)
for Trisomies 21, 18, and 13 in Twin Pregnancies. Twin Res Hum Genet 2017; 20:242-249. [DOI: 10.1017/thg.2017.23] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Massively parallel sequencing (MPS) technology has become increasingly available
and has been widely used to screen for trisomies 21, 18, and 13 in singleton
pregnancies. This study assessed the performance of MPS testing of cell-free
fetal DNA (cffDNA) from maternal plasma for trisomies 21, 18, and 13 in twin
pregnancies. Ninety-two women with twin pregnancies were recruited. The results
were identified through karyotypes of amniocentesis or clinical examination and
follow-up of the neonates. Fluorescent in-situ hybridization was used to examine
the placentas postnatally in cases of false-positive results. The fetuses with
autosomal trisomy 21 (n = 2) and trisomy 15 (n
= 1) were successfully detected via MPS testing of cffDNA. There was one
false-positive for trisomy 13 (n = 1), and fluorescence in-situ
hybridization (FISH) identified confined placental mosaicism in this case. For
twin pregnancies undergoing second-trimester screening for trisomy, MPS testing
of cffDNA is feasible and can enhance the diagnostic spectrum of non-invasive
prenatal testing, which could effectively reduce invasive prenatal diagnostic
methods. In addition to screening for trisomy 21, 18, and 13 by cffDNA, MPS can
detect fetal additional autosomal trisomy. False-positive results cannot
completely exclude confined placental mosaicism.
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Abstract
The choice of screening or invasive procedure in twin pregnancies is a personal choice of whether the patient wishes to take a small risk of having a baby with a serious disorder versus a small risk of having a complication because she wishes to avoid that. How to interpret such risks has profound effects on the perceived value of techniques, either leading to a decision to screening or going directly to chorionic villus sampling. There are profound issues surrounding the data and the interpretation of the data. No single short review can exhaustively examine all of the issues.
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Affiliation(s)
- Mark I Evans
- Fetal Medicine Foundation of America, USA; Comprehensive Genetics, 131 East 65th Street, New York, NY 10065, USA; Mt. Sinai School of Medicine, New York, NY, USA.
| | | | - Shara M Evans
- Comprehensive Genetics, 131 East 65th Street, New York, NY 10065, USA; University of Colorado, Aurora, CO, USA
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Huang X, Zheng J, Chen M, Zhao Y, Zhang C, Liu L, Xie W, Shi S, Wei Y, Lei D, Xu C, Wu Q, Guo X, Shi X, Zhou Y, Liu Q, Gao Y, Jiang F, Zhang H, Su F, Ge H, Li X, Pan X, Chen S, Chen F, Fang Q, Jiang H, Lau TK, Wang W. Noninvasive prenatal testing of trisomies 21 and 18 by massively parallel sequencing of maternal plasma DNA in twin pregnancies. Prenat Diagn 2014; 34:335-40. [PMID: 24357023 DOI: 10.1002/pd.4303] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 11/04/2013] [Accepted: 12/12/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The objective of this study is to assess the performance of noninvasive prenatal testing for trisomies 21 and 18 on the basis of massively parallel sequencing of cell-free DNA from maternal plasma in twin pregnancies. METHOD A double-blind study was performed over 12 months. A total of 189 pregnant women carrying twins were recruited from seven hospitals. Maternal plasma DNA sequencing was performed to detect trisomies 21 and 18. The fetal karyotype was used as gold standard to estimate the sensitivity and specificity of sequencing-based noninvasive prenatal test. RESULTS There were nine cases of trisomy 21 and two cases of trisomy 18 confirmed by karyotyping. Plasma DNA sequencing correctly identified nine cases of trisomy 21 and one case of trisomy 18. The discordant case of trisomy 18 was an unusual case of monozygotic twin with discordant fetal karyotype (one normal and the other trisomy 18). The sensitivity and specificity of maternal plasma DNA sequencing for fetal trisomy 21 were both 100% and for fetal trisomy 18 were 50% and 100%, respectively. CONCLUSION Our study further supported that sequencing-based noninvasive prenatal testing of trisomy 21 in twin pregnancies could be achieved with a high accuracy, which could effectively avoid almost 95% of invasive prenatal diagnosis procedures.
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Affiliation(s)
- Xuan Huang
- Fetal Medicine Center, Department of Obstetrics and Gynecology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
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Gagnon A, Audibert F. Prenatal screening and diagnosis of aneuploidy in multiple pregnancies. Best Pract Res Clin Obstet Gynaecol 2013; 28:285-94. [PMID: 24485166 DOI: 10.1016/j.bpobgyn.2013.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 12/17/2013] [Indexed: 11/29/2022]
Abstract
Prenatal screening for aneuploidy has changed significantly over the last 30 years, from being age-based to maternal serum and ultrasound based techniques. Multiple pregnancies present particular challenges with regards to screening as serum-based screening techniques are influenced by all feti while ultrasound-based techniques can be fetus specific. Tests currently available tend to not perform as well in multiple compared to singleton pregnancies. Considerations must be given to these variations when discussing and performing screening for aneuploidy in this situation. Prenatal invasive diagnosis techniques in multiple pregnancies bring their own challenges from a technical and counselling point of view, in particular with regards to sampling error, mapping and assignment of results and management of abnormal results. This review addresses these particular challenges and provides information to facilitate care.
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Affiliation(s)
- Alain Gagnon
- University of British Columbia, Vancouver, British Columbia, Canada.
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Boyle B, McConkey R, Garne E, Loane M, Addor MC, Bakker MK, Boyd PA, Gatt M, Greenlees R, Haeusler M, Klungsøyr K, Latos-Bielenska A, Lelong N, McDonnell R, Métneki J, Mullaney C, Nelen V, O'Mahony M, Pierini A, Rankin J, Rissmann A, Tucker D, Wellesley D, Dolk H. Trends in the prevalence, risk and pregnancy outcome of multiple births with congenital anomaly: a registry-based study in 14 European countries 1984-2007. BJOG 2013; 120:707-16. [PMID: 23384325 DOI: 10.1111/1471-0528.12146] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the public health consequences of the rise in multiple births with respect to congenital anomalies. DESIGN Descriptive epidemiological analysis of data from population-based congenital anomaly registries. SETTING Fourteen European countries. POPULATION A total of 5.4 million births 1984-2007, of which 3% were multiple births. METHODS Cases of congenital anomaly included live births, fetal deaths from 20 weeks of gestation and terminations of pregnancy for fetal anomaly. MAIN OUTCOME MEASURES Prevalence rates per 10,000 births and relative risk of congenital anomaly in multiple versus singleton births (1984-2007); proportion prenatally diagnosed, proportion by pregnancy outcome (2000-07). Proportion of pairs where both co-twins were cases. RESULTS Prevalence of congenital anomalies from multiple births increased from 5.9 (1984-87) to 10.7 per 10,000 births (2004-07). Relative risk of nonchromosomal anomaly in multiple births was 1.35 (95% CI 1.31-1.39), increasing over time, and of chromosomal anomalies was 0.72 (95% CI 0.65-0.80), decreasing over time. In 11.4% of affected twin pairs both babies had congenital anomalies (2000-07). The prenatal diagnosis rate was similar for multiple and singleton pregnancies. Cases from multiple pregnancies were less likely to be terminations of pregnancy for fetal anomaly, odds ratio 0.41 (95% CI 0.35-0.48) and more likely to be stillbirths and neonatal deaths. CONCLUSIONS The increase in babies who are both from a multiple pregnancy and affected by a congenital anomaly has implications for prenatal and postnatal service provision. The contribution of assisted reproductive technologies to the increase in risk needs further research. The deficit of chromosomal anomalies among multiple births has relevance for prenatal risk counselling.
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Affiliation(s)
- B Boyle
- Centre for Maternal Fetal and Infant Research, University of Ulster, Newtownabbey, UK
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Prats P, Rodríguez I, Comas C, Puerto B. First trimester risk assessment for trisomy 21 in twin pregnancies combining nuchal translucency and first trimester biochemical markers. Prenat Diagn 2012; 32:927-32. [PMID: 22752980 DOI: 10.1002/pd.3934] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 05/29/2012] [Accepted: 05/30/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The aim is to describe the performance of first-trimester combined risk assessment in twin pregnancies. METHODS Maternal serum free beta-human chorionic gonadotrophin and pregnancy-associated plasma protein A (PAPP-A) were determined at 8 to 12 weeks and fetal nuchal translucency (NT) was measured at 11 to 13+6 weeks. The individual risk was estimated for each fetus using the combined test in dichorionic twins. In monochorionic twins, the mean risk assessment of the two fetuses was used. An invasive diagnostic procedure was offered when the risk was ≥ 1 : 270 in either one of the fetuses. RESULTS From February 2007 to June 2011, 447 twin pregnancies were enrolled in this study. There were 402 (89.9%) dichorionic and 45 (10.1%) monochorionic twins. In dichorionic twins, mean crown-rump length (CRL) was 63.9 mm; median NT multiples of the median (MoM) was 0.97; median Β-hCG was MoM 1.74; median PAPP-A was 1.72. In monochorionic twins, mean CRL was 61.9 mm; median NT MoM was 0. 98; median Β-hCG MoM was 1.44; and median PAPP-A was 1.51. Two pregnancies with Down syndrome were detected by first trimester screening, both in dichorionic twins. The false positive rate was 5.7% (95% confidence interval 4.1-7.3) and 4.4% (95% confidence interval 0.1-8.8%) in dichorionic and monochorionic twins, respectively. CONCLUSIONS The combined test in twins appears to be a good method for Down syndrome screening with a high detection rate and an acceptable false-positive rate.
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Affiliation(s)
- Pilar Prats
- Fetal Medicine Service, Department of Obstetrics, Gynecology and Reproductive Medicine, Institut Universitari Dexeus, Barcelona, Spain.
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Alvarado EA, Pacheco RPF, Alderete FG, de León Luís JA, de la Cruz ÁA, Quintana LO. Selective termination in dichorionic twins discordant for congenital defect. Eur J Obstet Gynecol Reprod Biol 2012; 161:8-11. [DOI: 10.1016/j.ejogrb.2011.11.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 09/20/2011] [Accepted: 11/13/2011] [Indexed: 11/24/2022]
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Audibert F, Gagnon A, Douglas Wilson R, Audibert F, Blight C, Brock JA, Cartier L, Désilets VA, Gagnon A, Johnson JA, Langlois S, Murphy-Kaulbeck L, Okun N, Pastuck M, Senikas V, Langlois S, Chitayat D, Désilets VA, Geraghty MT, Marcadier J, Nelson TN, Skidmore D, Siu V, Tihy F. Prenatal Screening for and Diagnosis of Aneuploidy in Twin Pregnancies. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2011. [DOI: 10.1016/s1701-2163(16)34963-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Maternal serum screening for neural tube defects and fetal aneuploidy in the second trimester has been incorporated into obstetrical practice over the past two decades. Now, as a result of several multicenter trials, first trimester screening between 11 and 14 weeks has been shown to be an effective and reliable screening test for Down syndrome and trisomy 18. This policy updates the American College of Medical Genetics policy statement entitled Second Trimester Maternal Serum Screening for Fetal Open Neural Tube Defects and Aneuploidy (2004), incorporates First trimester diagnosis and screening for fetal aneuploidy (2008) and complements the sections of American College of Medical Genetic’s Standards and Guidelines for Clinical Genetics Laboratories entitled Prenatal Screening for Down syndrome (2005) and Prenatal Screening for Open Neural Tube Defects (2005).
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Affiliation(s)
- Deborah A Driscoll
- Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine and Health System, Philadelphia, 19104, USA.
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Anorectal malformation and Down's syndrome in monozygotic twins. J Pediatr Surg 2009; 44:e13-6. [PMID: 19231514 DOI: 10.1016/j.jpedsurg.2008.10.116] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2008] [Revised: 10/29/2008] [Accepted: 10/30/2008] [Indexed: 11/22/2022]
Abstract
Anorectal malformation (ARM) can be divided in high, intermediate, and low forms according to the level of termination of the rectum in relation to the pubococcygeal and ischiatic lines. Patients with Down's syndrome have a high incidence of gastrointestinal anomalies, such as tracheoesophageal fistula, duodenal obstruction, annular pancreas, Hirschsprung's disease, and ARM. In these children, ARM is generally low with or without a fistula. The mode of inheritance of ARM and its genetic relation with Down's syndrome is not known, even if the association (ARM-Down's syndrome) seems not to be coincidental. We describe here a very rare case of monozygotic twins born with the association of ARM and Down's syndrome.
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