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Savarirayan R, Rossiter JP, Hoover-Fong JE, Irving M, Bompadre V, Goldberg MJ, Bober MB, Cho TJ, Kamps SE, Mackenzie WG, Raggio C, Spencer SS, White KK. Best practice guidelines regarding prenatal evaluation and delivery of patients with skeletal dysplasia. Am J Obstet Gynecol 2018; 219:545-562. [PMID: 30048634 DOI: 10.1016/j.ajog.2018.07.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/15/2018] [Accepted: 07/17/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Skeletal dysplasia comprises a heterogeneous and collectively common group of inherited disorders of development, growth, and maintenance of the human skeleton. There is potential for increased perinatal morbidity and mortality in pregnant women who themselves have skeletal dysplasia, and for affected fetuses where skeletal dysplasia is suspected in utero. OBJECTIVE We sought to establish guidelines for perinatal health care professionals who should be aware of these risks, to optimize maternal and child health pregnancy outcomes through best prenatal and delivery management practices. STUDY DESIGN A panel of 13 multidisciplinary international experts participated in a Delphi process, which comprised consideration of thorough literature review and a list of 54 possible care recommendations subject to 2 rounds of anonymous voting and a face-to-face meeting. Those recommendations with >80% agreement were considered as consensual. RESULTS During the first round, consensus was reached to support 30 out of the 54 statements. After the panel discussion, the group reached consensus on 40 statements. These statements include guidelines for the evaluation and treatment of pregnant women with skeletal dysplasia and for the unborn child with or suspected to have skeletal dysplasia. CONCLUSION Consensus-based best practice guidelines are provided as a minimum of standard care to minimize associated health risks, and improve clinical outcomes for patients with skeletal dysplasia.
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Kumar M, Thakur S, Haldar A, Anand R. Approach to the diagnosis of skeletal dysplasias: Experience at a center with limited resources. JOURNAL OF CLINICAL ULTRASOUND : JCU 2016; 44:529-539. [PMID: 27218215 DOI: 10.1002/jcu.22371] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 04/06/2016] [Accepted: 04/23/2016] [Indexed: 06/05/2023]
Abstract
PURPOSE A fetus with skeletal disorder poses diagnostic challenges in a resource-poor setting with limited management options. The objective of the study was to develop a step-by-step approach for the diagnosis of skeletal dysplasia in light of the limited resources available. METHODS An algorithmic approach was used. The assessment for lethality was the first step, followed by the evaluation for fractures. In cases without evidence of fracture, severe constriction of thorax or associated polydactyly were searched for. In cases without severe thoracic constriction, the severity of micromelia was evaluated. After delivery, fetal examination was done to ascertain the etiology. RESULTS During the 6-year period, 41 cases with shortened long bones were fully evaluated. Lethality was suspected in 30 cases. Fracture and beading were present in eight cases, and severe thoracic constriction with polydactyly was observed in seven cases. Mild micromelia was seen in 19 cases and severe micromelia in 7 cases. Among lethal skeletal dysplasias, thanatophoric dysplasia was most common (six cases). Among nonlethal skeletal dysplasias, achondroplasia was seen in eight cases. CONCLUSIONS Lethality of skeletal dysplasia could be predicted on prenatal ultrasound with 100% accuracy. The step-by-step approach was helpful to characterize skeletal dysplasias. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:529-539, 2016.
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Affiliation(s)
- Manisha Kumar
- Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, Bhagat Singh Marg, New Delhi, 110001, India.
| | - Seema Thakur
- Genetics, Fortis La Femme, GK II, New Delhi, India
| | - Arunima Haldar
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College, Bhagat Singh Marg, New Delhi, 110001, India
| | - Rama Anand
- Department of Radiodiagnosis, Lady Hardinge Medical College, Bhagat Singh Marg, New Delhi, 110001, India
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Lyons K, Cassady C, Mehollin-Ray A, Krishnamurthy R. Current Role of Fetal Magnetic Resonance Imaging in Body Anomalies. Semin Ultrasound CT MR 2015; 36:310-23. [PMID: 26296482 DOI: 10.1053/j.sult.2015.05.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Fetal MR body applications have become more common in recent years as both in utero therapies, including fetoscopic surgery, and improvements in perinatal care have increased the demand for precise antenatal anatomic detail. This article discusses the variety of fast imaging sequences available to the fetal imager and describes their applications to both common and unusual congenital pathologies, including of the neck, chest, abdomen/pelvis and musculoskeletal systems.
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Affiliation(s)
- Karen Lyons
- EB Singleton Department of Diagnostic Radiology, Texas Children׳s Hospital, Baylor College of Medicine, Houston, TX
| | - Christopher Cassady
- EB Singleton Department of Diagnostic Radiology, Texas Children׳s Hospital, Baylor College of Medicine, Houston, TX.
| | - Amy Mehollin-Ray
- EB Singleton Department of Diagnostic Radiology, Texas Children׳s Hospital, Baylor College of Medicine, Houston, TX
| | - Rajesh Krishnamurthy
- EB Singleton Department of Diagnostic Radiology, Texas Children׳s Hospital, Baylor College of Medicine, Houston, TX
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Nelson DB, Dashe JS, McIntire DD, Twickler DM. Fetal skeletal dysplasias: sonographic indices associated with adverse outcomes. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:1085-1090. [PMID: 24866616 DOI: 10.7863/ultra.33.6.1085] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To assess the utility of biometric indices and amniotic fluid volume in identifying fetuses with lethal skeletal dysplasia. METHODS A review of pregnancies with sonographic diagnosis of skeletal dysplasia between January 1997 and March 2012 from a single institution was conducted. Biometric indices and amniotic fluid volumes were reviewed from the initial targeted sonograms and all subsequent examinations. Outcomes were verified in all cases. Pregnancies that resulted in fetal or neonatal death were considered to have lethal dysplasia, and those with survival to hospital discharge were considered to have nonlethal dysplasia. RESULTS Of 45 fetuses with suspected skeletal dysplasia, 27 (60%) survived to hospital discharge; 9 (20%) died in the immediate neonatal period; 2 (4%) resulted in stillbirth; and in 7 cases (16%), pregnancy termination was elected. Those with lethal dysplasia were more likely to have hydramnios on initial detection than those who survived to hospital discharge (83% versus 27%; P < .01). Pregnancies complicated by lethal skeletal dysplasia had a significantly lower femur length-to-abdominal circumference ratio and were more likely to have a ratio below 0.16 than those with neonatal survival (91% versus 11%; P < 0.01). The lowest femur length-to-abdominal circumference ratio and the proportion with a ratio below 0.16 at any point in gestation were significantly different between those with lethal and nonlethal dysplasia (P< .01). As fetal size increased with advancing gestation, the relationship of sonographic parameters (eg, femur length-to-abdominal circumference ratio) became more pronounced. There was no infant survival when hydramnios was encountered at any point during gestation in the setting of a femur length-to-abdominal circumference ratio below 0.16. CONCLUSIONS In our series, a femur length-to-abdominal circumference ratio below 0.16 in conjunction with hydramnios effectively identified fetuses with lethal skeletal dysplasia.
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Affiliation(s)
- David B Nelson
- Departments of Obstetrics and Gynecology (D.B.N., J.S.D., D.D.M.) and Radiology (D.M.T.), University of Texas Southwestern Medical Center, Dallas, Texas USA.
| | - Jodi S Dashe
- Departments of Obstetrics and Gynecology (D.B.N., J.S.D., D.D.M.) and Radiology (D.M.T.), University of Texas Southwestern Medical Center, Dallas, Texas USA
| | - Donald D McIntire
- Departments of Obstetrics and Gynecology (D.B.N., J.S.D., D.D.M.) and Radiology (D.M.T.), University of Texas Southwestern Medical Center, Dallas, Texas USA
| | - Diane M Twickler
- Departments of Obstetrics and Gynecology (D.B.N., J.S.D., D.D.M.) and Radiology (D.M.T.), University of Texas Southwestern Medical Center, Dallas, Texas USA
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Abstract
In this review, we discuss aspects of the prenatal diagnosis of fetal skeletal malformations, concentrating on the advantages offered by different imaging techniques and the approaches that are of value in evaluating a suspected skeletal dysplasia. We also briefly address the findings in some of the commoner malformations of the fetal skeleton that may be encountered.
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Affiliation(s)
- Ann-Edwidge Noel
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Richard N Brown
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
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Ciasca ES, Peixoto-Filho FM, Daltro P, Werner H, Viana A, Sá RAMD. Prenatal Diagnosis of Proximal Femoral Focal Deficiency Combining Ultrasound and Computer Tomography. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/act.2013.23018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Vasilj O, Mišković B. Diagnosis and counseling of thanatophoric dysplasia with four-dimensional ultrasound. J Matern Fetal Neonatal Med 2012; 25:2786-8. [PMID: 22734441 DOI: 10.3109/14767058.2012.704451] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Thanatophoric dysplasia is a severe skeletal disorder with estimated frequency of 0.2-0.5 per 10,000 births. Affected infants die shortly after birth. The diagnosis of thanatophoric dysplasia can be made by two-dimensional ultrasound but the perception of these images is very difficult for the patients. The use of four-dimensional real time ultrasound gives the physician the possibility to discuss and counsel the patients with images that are more understandable to the general public.
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Affiliation(s)
- Oliver Vasilj
- Department of Obstetrics and Gynecology, Clinical Hospital Sveti Duh, Zagreb, Croatia.
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Schramm T, Gloning KP, Minderer S, Daumer-Haas C, Hörtnagel K, Nerlich A, Tutschek B. Prenatal sonographic diagnosis of skeletal dysplasias. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 34:160-170. [PMID: 19548204 DOI: 10.1002/uog.6359] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To assess the types and numbers of cases, gestational age at specific prenatal diagnosis and diagnostic accuracy of the diagnosis of skeletal dysplasias in a prenatal population from a single tertiary center. METHODS This was a retrospective database review of type, prenatal and definitive postnatal diagnoses and gestational age at specific prenatal diagnosis of all cases of skeletal dysplasias from a mixed referral and screening population between 1985 and 2007. Prenatal diagnoses were grouped into 'correct ultrasound diagnosis' (complete concordance with postnatal pediatric or pathological findings) or 'partially correct ultrasound diagnosis' (skeletal dysplasias found postnatally to be a different one from that diagnosed prenatally). RESULTS We included 178 fetuses in this study, of which 176 had a prenatal ultrasound diagnosis of 'skeletal dysplasia'. In 160 cases the prenatal diagnosis of a skeletal dysplasia was confirmed; two cases with skeletal dysplasias identified postnatally had not been diagnosed prenatally, giving 162 fetuses with skeletal dysplasias in total. There were 23 different classifiable types of skeletal dysplasia. The specific diagnoses based on prenatal ultrasound examination alone were correct in 110/162 (67.9%) cases and partially correct in 50/162 (30.9%) cases, (160/162 overall, 98.8%). In 16 cases, skeletal dysplasia was diagnosed prenatally, but was not confirmed postnatally (n = 12 false positives) or the case was lost to follow-up (n = 4). The following skeletal dysplasias were recorded: thanatophoric dysplasia (35 diagnosed correctly prenatally of 40 overall), osteogenesis imperfecta (lethal and non-lethal, 31/35), short-rib dysplasias (5/10), chondroectodermal dysplasia Ellis-van Creveld (4/9), achondroplasia (7/9), achondrogenesis (7/8), campomelic dysplasia (6/8), asphyxiating thoracic dysplasia Jeune (3/7), hypochondrogenesis (1/6), diastrophic dysplasia (2/5), chondrodysplasia punctata (2/2), hypophosphatasia (0/2) as well as a further 7/21 cases with rare or unclassifiable skeletal dysplasias. CONCLUSION Prenatal diagnosis of skeletal dysplasias can present a considerable diagnostic challenge. However, a meticulous sonographic examination yields high overall detection. In the two most common disorders, thanatophoric dysplasia and osteogenesis imperfecta (25% and 22% of all cases, respectively), typical sonomorphology accounts for the high rates of completely correct prenatal diagnosis (88% and 89%, respectively) at the first diagnostic examination.
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Affiliation(s)
- T Schramm
- Prenatal Medicine Munich, Munich, Germany.
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Naki MM, Gür D, Zemheri E, Tekcan C, Kanadikirik F, Has R. Short rib-polydactyly syndrome. Arch Gynecol Obstet 2004; 272:173-5. [PMID: 15605271 DOI: 10.1007/s00404-004-0696-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2004] [Accepted: 09/07/2004] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Short rib-polydactyly syndrome (SRPD) is an autosomal recessive, lethal skeletal dysplasia. It is characterized by short limb dwarfism, short ribs with thoracic hypoplasia, polydactyly, and multiple anomalies of major organs. CASE REPORT We report a case of SRPD subtype II (Majewski) that was detected in the 36th week of gestation, showing hydropic change, narrow thorax, shortened limbs, protuberant abdomen, micromelia, polydactyly and extremely low set ears, depressed nasal bridge, and cleft palate. The family was informed of the fatal outcome of the condition. Delivery was induced, and the baby died just after the birth. DISCUSSION Prenatal diagnosis is established with postmortem radiographic and pathologic examinations.
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Affiliation(s)
- M M Naki
- Department of Obstetrics and Gynecology, SSK Göztepe Training Hospital, Istanbul, Turkey.
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Gonçalves LF, Espinoza J, Mazor M, Romero R. Newer imaging modalities in the prenatal diagnosis of skeletal dysplasias. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2004; 24:115-120. [PMID: 15287046 DOI: 10.1002/uog.1712] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- L F Gonçalves
- Department of Obstetrics Gynecology, Wayne State University, Detroit, MI, USA
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Abstract
The skeletal dysplasias are a large, heterogeneous group of genetic conditions characterized by abnormal development, growth and maintenance of the elements (bones) that comprise the human skeleton. Many result in disproportionate short stature. The classification of these disorders has evolved over the past 30 years from purely clinical-pathological descriptions to a nosology that now also reflects their underlying molecular aetiology. Accurate diagnosis of these disorders requires comprehensive documentation of the history, analysis of longitudinal growth patterns, rigorous clinical evaluation of the individual and family, complete radiographic survey and, when available, examination of chondro-osseous specimens. The specific genetic defects underlying many of these conditions have now been elucidated, allowing links to be established between phenotype and genotype. Management revolves around treatment to prevent or minimize medical complications, psychosocial support of patients and their families, education of the medical profession and wider community and modification of the environment where appropriate.
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Affiliation(s)
- Ravi Savarirayan
- Genetic Health Services Victoria, 10th Floor, Royal Children's Hospital, Parkville 3052, Australia
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Kölble N, Sobetzko D, Ersch J, Stallmach T, Eich G, Huch R, Huch A, Superti-Furga A, Wisser J. Diagnosis of skeletal dysplasia by multidisciplinary assessment: a report of two cases of thanatophoric dysplasia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2002; 19:92-98. [PMID: 11851976 DOI: 10.1046/j.0960-7692.2001.00496.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Skeletal dysplasias, a heterogeneous group of bone growth disorders, can be detected by routine prenatal ultrasound examination. As it is difficult to make a specific diagnosis, prediction of prognosis is of importance for obstetric management. In order to specify diagnosis, radiological, pathological and molecular genetic examination are often required. Our report describes two cases of thanatophoric dysplasia with different fetal sonographic findings. The classical classification of type I and II seems to be ambiguous as, in both cases, the same mutation in the fibroblast growth factor receptor 3 gene was found. The importance of comprehensive multidisciplinary assessment is emphasized.
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Affiliation(s)
- N Kölble
- Unit of Perinatal Physiology, Department of Obstetrics, University Hospital, Zurich, Switzerland.
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