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Yang L, Chen H, Li F, Liao J, Lin X. The Sonographic Features of Malformation in Fetal Echogenic Bowel and Its Relationship With Chromosome Abnormalities. Ultrasound Q 2022; 38:284-290. [PMID: 35420062 DOI: 10.1097/ruq.0000000000000609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The aims of this study were to analyze the sonographic features and clinical prognosis of fetal echogenic bowel (FEB) and to evaluate the value of FEB in the prediction of fetal chromosomal abnormalities. Eight hundred eighty-two fetuses with FEB were selected. The ultrasonographic features and the chromosomal examination were retrospectively analyzed. Among the 882 FEB, 272 (30.8%) cases had malformation. The most common malformation was cardiovascular malformation (21.6%), followed by urinary malformation (9.0%), craniocerebral malformation (6.8%), and gastrointestinal malformations (5.6%). According to other combined ultrasound abnormalities, the FEBs were divided into 4 groups: isolated FEB group (490 cases), ultrasound soft indicators group (130 cases), single malformation group (117 cases), and multiple malformation group (145 cases). A total of 45 cases (5.1%) were detected with chromosomal abnormalities. Compared with isolated FEB group, the rate of chromosomal abnormality in other 3 groups was significantly higher. Among 490 cases of isolated FEB, 114 cases of isolated FEB group with adverse pregnancy outcomes were selected as the experimental group, and 376 cases of FEB group with good prognosis were selected as the control group. There were significant differences of the location, shape, intensity, and progression between the 2 groups. Multivariate logistic regression analysis showed that central location and progression of FEB were independent risk predictors of poor prognosis. The combined malformation rate is high for FEB fetuses. The fetal systems should be carefully examined when FEB is found in prenatal ultrasound.
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Affiliation(s)
| | | | | | | | - Xiangbo Lin
- Obstetrics, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou City, China
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2
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Popa ZL, Margan MM, Petre I, Bernad E, Stelea L, Chiriac VD, Craina M, Ciuca IM, Bina AM. A Cross-Sectional Study of the Marital Attitudes of Pregnant Women at Risk for Cystic Fibrosis and Psychological Impact of Prenatal Screening. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148698. [PMID: 35886548 PMCID: PMC9317754 DOI: 10.3390/ijerph19148698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/10/2022] [Accepted: 07/15/2022] [Indexed: 12/04/2022]
Abstract
Cystic fibrosis (CF) is one of the most frequent genetic disorders in those with Northern European ancestry. Prenatal testing for cystic fibrosis may be used to plan and prepare for the birth of a child with the disease or to determine whether to terminate the pregnancy. The accessibility of prenatal detection for women with a high genetic risk of delivering a child with cystic fibrosis is determined by CF carriers and those affected by the disease. Moreover, prenatal testing for CF is mainly dependent on invasive diagnostic tests that can influence the mental health of the pregnant woman, and it is assumed that the birth of a CF child will have a serious influence on the couple’s subsequent family planning and marital behavior. The purpose of this research was to examine the marital attitudes of women at risk for cystic fibrosis and the psychological effect of screening for CF among pregnant women. The study followed a cross-sectional design with five questionnaires comprising Prenatal Attachment Interview (PAI), Maternal Antenatal Attachment Scale (MAAS), Pregnancy-Related Anxiety Questionnaire (PRAQ-R2), the Prenatal Psychosocial Profile (PPP), and the Marital Intimacy Questionnaire (MIQ). A total of 84 pregnant women were included in the “carriers” group for CFTR and 91 in the “non-carrier” group. CFTR-carrier mothers were likely to be more affectionate to the fetus, with better maternal–fetal quality and intensity of attachment. The same group of pregnant women was less scared of giving birth or worried about bearing a physically or mentally handicapped child compared to women who were expecting the prenatal diagnosis test for being at risk of delivering a newborn with malformations. CFTR-carrier pregnant women did not score significantly different results in the Prenatal Psychosocial Profile regarding stress levels, social support, and self-esteem. It was also found that intimacy and consensus problems inside the marriage were significantly more often experienced by CFTR carriers. Based on the current findings, it is likely that CFTR-carrier mothers have a better perception of the possible pregnancy outcomes by knowing their abnormal gene carrier status. Therefore, the psychological impact of invasive diagnostic tests is lower in this category compared with those who are unaware of the possible pregnancy outcomes. However, we promote a future analysis for pregnant women with moderate risk of giving birth to a child with single-gene mutations such as cystic fibrosis or other congenital malformations that undergo noninvasive prenatal diagnosis tests, as they become more accurate and might cause lower pre-diagnosis stress levels.
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Affiliation(s)
- Zoran Laurentiu Popa
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (Z.L.P.); (I.P.); (E.B.); (L.S.); (V.D.C.); (M.C.)
- Centre for Translational Research and Systems Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
| | - Madalin-Marius Margan
- Department of Microscopic Morphology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
- Correspondence: ; Tel.: +40-726-277-354
| | - Izabella Petre
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (Z.L.P.); (I.P.); (E.B.); (L.S.); (V.D.C.); (M.C.)
| | - Elena Bernad
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (Z.L.P.); (I.P.); (E.B.); (L.S.); (V.D.C.); (M.C.)
| | - Lavinia Stelea
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (Z.L.P.); (I.P.); (E.B.); (L.S.); (V.D.C.); (M.C.)
| | - Veronica Daniela Chiriac
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (Z.L.P.); (I.P.); (E.B.); (L.S.); (V.D.C.); (M.C.)
| | - Marius Craina
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (Z.L.P.); (I.P.); (E.B.); (L.S.); (V.D.C.); (M.C.)
| | - Ioana Mihaela Ciuca
- Department of Pediatrics, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
| | - Anca Mihaela Bina
- Centre for Translational Research and Systems Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
- Department III Functional Sciences, Discipline Pathophysiology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
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3
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Sussman BL, Chopra P, Poder L, Bulas DI, Burger I, Feldstein VA, Laifer-Narin SL, Oliver ER, Strachowski LM, Wang EY, Winter T, Zelop CM, Glanc P. ACR Appropriateness Criteria® Second and Third Trimester Screening for Fetal Anomaly. J Am Coll Radiol 2021; 18:S189-S198. [PMID: 33958112 DOI: 10.1016/j.jacr.2021.02.017] [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: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 11/28/2022]
Abstract
The Appropriateness Criteria for the imaging screening of second and third trimester fetuses for anomalies are presented for fetuses that are low risk, high risk, have had soft markers detected on ultrasound, and have had major anomalies detected on ultrasound. 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)
- Betsy L Sussman
- The University of Vermont Medical Center, Burlington, Vermont.
| | - Prajna Chopra
- Research Author, The University of Vermont Medical Center, Burlington, Vermont
| | - Liina Poder
- Panel Chair, University of California San Francisco, San Francisco, California
| | - Dorothy I Bulas
- Children's National Hospital and George Washington University, Washington, District of Columbia, Chair, ACR International Outreach Committee, Director, Fetal Imaging Prenatal Pediatric Institute, Childrens National Hospital
| | | | | | | | - Edward R Oliver
- Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Eileen Y Wang
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, American College of Obstetricians and Gynecologists
| | - 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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Mekki C, Aissat A, Mirlesse V, Mayer Lacrosniere S, Eche E, Le Floch A, Whalen S, Prud’Homme C, Remus C, Funalot B, Castaigne V, Fanen P, de Becdelièvre A. Prenatal Ultrasound Suspicion of Cystic Fibrosis in a Multiethnic Population: Is Extensive CFTR Genotyping Needed? Genes (Basel) 2021; 12:genes12050670. [PMID: 33946859 PMCID: PMC8145404 DOI: 10.3390/genes12050670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 11/23/2022] Open
Abstract
In families without a Cystic Fibrosis (CF) history, fetal ultrasound bowel abnormalities can unexpectedly reveal the disease. Isolated or in association, the signs can be fetal bowel hyperechogenicity, intestinal loop dilatation and non-visualization of fetal gallbladder. In these cases, search for CF transmembrane conductance regulator (CFTR) gene mutations is part of the recommended diagnostic practices, with a search for frequent mutations according to ethnicity, and, in case of the triad of signs, with an exhaustive study of the gene. However, the molecular diagnosis remains a challenge in populations without well-known frequent pathogenic variants. We present a multiethnic cohort of 108 pregnancies with fetal bowel abnormalities in which the parents benefited from an exhaustive study of the CFTR gene. We describe the new homozygous p.Cys1410* mutation in a fetus of African origin. We did not observe the most frequent p.Phe508del mutation in our cohort but evidenced variants undetected by our frequent mutations kit. Thanks to the progress of sequencing techniques and despite the difficulties of interpretation occasionally encountered, we discuss the need to carry out a comprehensive CFTR study in all patients in case of fetal bowel abnormalities.
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Affiliation(s)
- Chadia Mekki
- Departement de Genetique, DMU Biologie-Pathologie, GH Mondor-Chenevier, AP-HP, F-94010 Creteil, France; (C.M.); (A.A.); (A.L.F.); (B.F.); (P.F.)
| | - Abdel Aissat
- Departement de Genetique, DMU Biologie-Pathologie, GH Mondor-Chenevier, AP-HP, F-94010 Creteil, France; (C.M.); (A.A.); (A.L.F.); (B.F.); (P.F.)
- INSERM, IMRB, Paris Est Creteil University, F-94010 Creteil, France
| | - Véronique Mirlesse
- Service D’echographie Gynecologique et Obstetricale, GH Bichat-C Bernard, AP-HP, F-75018 Paris, France; (V.M.); (E.E.)
- Service Medecine Fœtale, Centre Hospitalo Universitaire de Geneve (HUG), S-1205 Geneve, Switzerland
| | - Sophie Mayer Lacrosniere
- Département de Gastro-Enterologie, Pneumologie, Mucoviscidose et Nutrition Pediatrique, CRCM, Université Paris 7, Hopital Robert Debre, AP-HP, F-75019 Paris, France;
| | - Elsa Eche
- Service D’echographie Gynecologique et Obstetricale, GH Bichat-C Bernard, AP-HP, F-75018 Paris, France; (V.M.); (E.E.)
| | - Annick Le Floch
- Departement de Genetique, DMU Biologie-Pathologie, GH Mondor-Chenevier, AP-HP, F-94010 Creteil, France; (C.M.); (A.A.); (A.L.F.); (B.F.); (P.F.)
| | - Sandra Whalen
- Service de Genetique, Hopital Trousseau, AP-HP, F-75012 Paris, France; (S.W.); (C.P.)
| | - Cecile Prud’Homme
- Service de Genetique, Hopital Trousseau, AP-HP, F-75012 Paris, France; (S.W.); (C.P.)
| | - Christelle Remus
- Service de Genetique, Centre Hospitalier Intercommunal de Creteil, F-94010 Creteil, France;
| | - Benoit Funalot
- Departement de Genetique, DMU Biologie-Pathologie, GH Mondor-Chenevier, AP-HP, F-94010 Creteil, France; (C.M.); (A.A.); (A.L.F.); (B.F.); (P.F.)
- INSERM, IMRB, Paris Est Creteil University, F-94010 Creteil, France
- Service de Genetique, Centre Hospitalier Intercommunal de Creteil, F-94010 Creteil, France;
| | - Vanina Castaigne
- Service d’Obstetrique et Gynecologie, Centre Hospitalier Intercommunal de Creteil, F-94010 Creteil, France;
| | - Pascale Fanen
- Departement de Genetique, DMU Biologie-Pathologie, GH Mondor-Chenevier, AP-HP, F-94010 Creteil, France; (C.M.); (A.A.); (A.L.F.); (B.F.); (P.F.)
- INSERM, IMRB, Paris Est Creteil University, F-94010 Creteil, France
| | - Alix de Becdelièvre
- Departement de Genetique, DMU Biologie-Pathologie, GH Mondor-Chenevier, AP-HP, F-94010 Creteil, France; (C.M.); (A.A.); (A.L.F.); (B.F.); (P.F.)
- INSERM, IMRB, Paris Est Creteil University, F-94010 Creteil, France
- Correspondence:
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D'Amico A, Buca D, Rizzo G, Khalil A, Silvi C, Makatsariya A, Nappi L, Liberati M, D'Antonio F. Outcome of fetal echogenic bowel: A systematic review and meta-analysis. Prenat Diagn 2021; 41:391-399. [PMID: 31981377 DOI: 10.1002/pd.5638] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/16/2019] [Accepted: 12/08/2019] [Indexed: 02/05/2023]
Abstract
The main aim of this systematic review was to explore the outcome of fetuses with isolated echogenic bowel (EB) on antenatal ultrasound. Inclusion criteria were singleton pregnancies with isolated EB no associated major structural anomalies at the time of diagnosis. The outcomes observed were: chromosomal anomalies, cystic fibrosis (CF), associated structural anomalies detected only at follow-up scans and at birth, regression during pregnancy, congenital infections, intra-uterine (IUD), neonatal (NND) and perinatal (PND) death. Twenty-five studies (12 971 fetuses) were included. Chromosomal anomalies occurred in 3.3% of the fetuses, mainly Trisomy 21 and aneuploidies involving the sex chromosomes. Cystic fibrosis occurred in 2.2%. Congenital infections affected 2.2%, mainly congenital Cytomegalovirus (CMV) infection. The majority of fetuses with EB experienced regression or disappearance of the EB at follow-up scans. Associated anomalies were detected at a follow-up scan in 1.8%. Associated anomalies were detected at birth and missed at ultrasound in 2.1% of cases. IUD occurred in 3.2% of cases while the corresponding figures for NND and PND were 0.4% and 3.1%. Fetuses with EB are at increased risk of adverse perinatal outcome, highlighting the need for a thorough antenatal management and postnatal follow-up. Assessment during pregnancy and after birth should be performed in order to look for signs of fetal aneuploidy, congenital infections and associated structural anomalies.
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Affiliation(s)
- Alice D'Amico
- Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Danilo Buca
- Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Giuseppe Rizzo
- Division of Maternal and Fetal Medicine, Ospedale Cristo Re, University of Rome Tor Vergata, Rome, Italy
- Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Asma Khalil
- Fetal Medicine Unit, St George's University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Claudia Silvi
- Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Alexander Makatsariya
- Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Luigi Nappi
- Department of Obstetrics and Gynecology, University of Foggia, Foggia, Italy
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Marco Liberati
- Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Francesco D'Antonio
- Department of Obstetrics and Gynecology, University of Foggia, Foggia, Italy
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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6
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Paddock M, Beattie G, Froste D, Offiah AC, Nicholl R. Should postnatal ultrasound be performed when isolated echogenic bowel has been reported on the antenatal ultrasound? Arch Dis Child 2020; 105:98-101. [PMID: 31558444 DOI: 10.1136/archdischild-2019-317693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Michael Paddock
- Medical Imaging Department, Barnsley Hospital NHS Foundation Trust, Barnsley, UK .,Academic Unit of Child Health, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - George Beattie
- Medical Imaging Department, Barnsley Hospital NHS Foundation Trust, Barnsley, UK
| | - Daniel Froste
- Library, Knowledge and Information Service, Barnsley Hospital NHS Foundation Trust, Barnsley, UK
| | - Amaka C Offiah
- Academic Unit of Child Health, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Richard Nicholl
- Neonatal Unit, Northwick Park Hospital, London, UK.,Department of Evidence Based Medicine, Northwick Park Hospital, London, UK
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7
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Kessels SJM, Carter D, Ellery B, Newton S, Merlin TL. Prenatal genetic testing for cystic fibrosis: a systematic review of clinical effectiveness and an ethics review. Genet Med 2019; 22:258-267. [PMID: 31467445 DOI: 10.1038/s41436-019-0641-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 08/13/2019] [Indexed: 01/08/2023] Open
Abstract
PURPOSE We aimed to assess the clinical value of prenatal testing for cystic fibrosis (CF) and whether ethical considerations would affect endpoint selection. METHODS To determine effectiveness, we conducted a systematic literature review whose protocol outlined search strategies across eight databases, study inclusion criteria, and prespecified literature screening, data extraction, and synthesis processes. We conducted a scoping search on ethical considerations. RESULTS The genetic test showed good diagnostic performance. A change in clinical management was observed: termination of pregnancy (TOP) occurred in most cases where two pathogenic variants were identified in a fetus of carrier parents (158/167; 94.6%). The TOP rate was lower in pregnancies where CF was diagnosed after fetal echogenic bowel detection (~65%). TOP and caring for a child with CF were both associated with poor short-term parental psychological outcomes. Ethical analyses indicated that informed decisions should have been the main endpoint, rather than CF-affected births prevented. CONCLUSION CF testing leads to fewer CF-affected births. It is difficult to assess whether this means the test is valuable, since patients may not value TOP primarily in terms of maternal or fetal health outcomes, psychological or otherwise. The value of testing should arguably be measured in terms of improving patient autonomy rather than health.
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Affiliation(s)
- Sharon J M Kessels
- Adelaide Health Technology Assessment (AHTA), School of Public Health, The University of Adelaide, Adelaide, SA, Australia
| | - Drew Carter
- Adelaide Health Technology Assessment (AHTA), School of Public Health, The University of Adelaide, Adelaide, SA, Australia.
| | - Benjamin Ellery
- Adelaide Health Technology Assessment (AHTA), School of Public Health, The University of Adelaide, Adelaide, SA, Australia
| | - Skye Newton
- Adelaide Health Technology Assessment (AHTA), School of Public Health, The University of Adelaide, Adelaide, SA, Australia
| | - Tracy L Merlin
- Adelaide Health Technology Assessment (AHTA), School of Public Health, The University of Adelaide, Adelaide, SA, Australia
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8
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Mallmann MR, Reutter H, Gottschalk I, Geipel A, Berg C, Gembruch U. Prenatal Diagnosis of Enterolithiasis in 20 Cases. Fetal Diagn Ther 2019; 46:266-273. [PMID: 30879001 DOI: 10.1159/000496843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 01/09/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Enterolithiasis is a sonographic sign defined by hyperechogenic foci within the - often distended - fetal bowel. OBJECTIVES We report on a series of 20 cases with enterolithiasis diagnosed prenatally and illustrate the spectrum of associated malformations. METHOD This was a retrospective study involving 20 fetuses with enterolithiasis at two large tertiary referral centers in Germany over a 17-year period (2000-2017). RESULTS Median diagnosis was made with ultrasound at 18+2 weeks of gestation (IQR25,75: 14+5, 26+5). Additional malformations included urogenital malformations (cloacal malformation in 7/20 fetuses [35%] and kidney defects in 7/20 fetuses [35%]), cardiac malformations (3/20 fetuses [15%]), and vertebral malformations (5/20 fetuses [25%]). Of 20 fetuses, 14 could be attributed to the anorectal malformation spectrum, 3/20 fetuses presented with caudal regression syndrome, and 1 fetus with bilateral kidney agenesis, congenital diaphragmatic aplasia, and enterovesical fistula, respectively. CONCLUSION Enterolithiasis is a rare prenatal sonographic feature. Because of the frequent occurrence of uro-recto-genital malformations, thorough prenatal counseling should be performed.
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Affiliation(s)
- Michael R Mallmann
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany.,Department of Obstetrics and Gynecology, University of Cologne, Cologne, Germany
| | - Heiko Reutter
- Department of Neonatology and Pediatric Intensive Care, University of Bonn, Bonn, Germany.,Institute of Human Genetics, University of Bonn, Bonn, Germany
| | - Ingo Gottschalk
- Department of Obstetrics and Gynecology, University of Cologne, Cologne, Germany
| | - Annegret Geipel
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - Christoph Berg
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany.,Department of Obstetrics and Gynecology, University of Cologne, Cologne, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany,
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9
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Kaplan R, Adams S. Incidental Fetal Ultrasound Findings: Interpretation and Management. J Midwifery Womens Health 2018; 63:323-329. [PMID: 29763964 DOI: 10.1111/jmwh.12754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 02/27/2018] [Accepted: 03/08/2018] [Indexed: 12/13/2022]
Abstract
Ultrasonography is a common component of prenatal care worldwide and is often used in early pregnancy to determine gestational age, number of fetuses, fetal cardiac activity, and placental location. Patients and their families may also consider ultrasonography a social event, as it provides confirmation and reassurance of a normal pregnancy. Ultrasound screening is typically scheduled in the second trimester to visualize fetal anatomy and confirm gestational age. Most ultrasound examinations are reassuring, but some incidentally identify structural anomalies and soft markers for aneuploidy, making it necessary for health care providers to correctly interpret these findings. The health care provider's ability to prepare patients prior to the ultrasound and deliver the necessary information needed to make informed decisions regarding any follow-up screening or diagnostic testing is critical to reducing parental anxiety. Preparation for the anatomic survey should include counseling for normal and abnormal findings. The ethical concepts of patient autonomy and shared decision making are used as a guide in providing this critical information and enabling informed choices during follow-up for incidental ultrasound findings.
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10
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Miller ME, Allen VM, Brock JAK. Incidence and Carrier Frequency of CFTR Gene Mutations in Pregnancies With Echogenic Bowel in Nova Scotia and Prince Edward Island. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:896-902. [PMID: 29503250 DOI: 10.1016/j.jogc.2017.11.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 11/07/2017] [Accepted: 11/07/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Fetal echogenic bowel (echogenic bowel) is associated with cystic fibrosis (CF), with a reported incidence ranging from 1% to 13%. Prenatal testing for CF in the setting of echogenic bowel can be done by screening parental or fetal samples for pathogenic CFTR variants. If only one pathogenic variant is identified, sequencing of the CFTR gene can be undertaken, to identify a second pathogenic variant not covered in the standard screening panel. Full gene sequencing, however, also introduces the potential to identify variants of uncertain significance (VUSs) that can create counselling challenges and cause parental anxiety. To provide accurate counselling for families in the study population, the incidence of CF associated with echogenic bowel and the carrier frequency of CFTR variants were investigated. METHODS All pregnancies for which CF testing was undertaken for the indication of echogenic bowel (from Nova Scotia and Prince Edward Island) were identified (January 2007-July 2017). The CFTR screening and sequencing results were reviewed, and fetal outcomes related to CF were assessed. RESULTS A total of 463 pregnancies with echogenic bowel were tested. Four were confirmed to be affected with CF, giving an incidence of 0.9% in this cohort. The carrier frequency of CF among all parents in the cohort was 5.0% (1 in 20); however, when excluding parents of affected fetuses, the carrier frequency for the population was estimated at 4.1% (1 in 25). CFTR gene sequencing identified an additional VUS in two samples. CONCLUSION The incidence of CF in pregnancies with echogenic bowel in Nova Scotia and Prince Edward Island is 0.9%, with an estimated population carrier frequency of 4.1%. These results provide the basis for improved counselling to assess the risk of CF in the pregnancy, after parental carrier screening, using Bayesian probability. Counselling regarding VUSs should be undertaken before gene sequencing.
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Affiliation(s)
- Michelle E Miller
- Department of Obstetrics and Gynecology, Memorial University, St. John's, NL
| | - Victoria M Allen
- Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS
| | - Jo-Ann K Brock
- Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS; Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax, NS.
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Findley R, Allen VM, Brock JAK. Adverse Perinatal Conditions Associated With Prenatally Detected Fetal Echogenic Bowel in Nova Scotia. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 40:555-560. [PMID: 29274932 DOI: 10.1016/j.jogc.2017.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 09/28/2017] [Accepted: 09/29/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study sought to estimate the association of adverse perinatal outcomes with pregnancies complicated by fetal echogenic bowel. METHODS Data for pregnancies complicated with echogenic bowel identified in the second trimester were derived from the tertiary referral IWK Health Centre (Halifax, NS) Viewpoint Ultrasound Database augmented by medical chart review. The study was undertaken between 2003 and 2014. Rates of positive cytomegalovirus and toxoplasmosis infection were determined using maternal serology and amniocentesis results. Rates of intrauterine growth restriction, abnormal karyotype, cystic fibrosis, antenatal bleeding, and bowel abnormalities were also determined. Neonatal information included newborn urine culture results and postnatal genetic testing. Univariate analyses compared rates of infection with isolated echogenic bowel and echogenic bowel with other ultrasound findings, with statistical significance set at P <0.05. RESULTS There were 422 pregnancies identified prenatally with echogenic bowel (82% had isolated echogenic bowel). Of these, 92 (22%) had at least one of the foregoing associated abnormalities. Three percent of women had serologic test results positive for cytomegalovirus or toxoplasmosis, with <1% documented newborn infections. Cystic fibrosis and other genetic diagnoses were observed in 8%, intrauterine growth restriction in 14%, antenatal bleeding in 19%, and bowel abnormalities in 3% of the cases of echogenic bowel. Pregnancies with isolated echogenic bowel had an 80% reduction in risk for these significant outcomes, in contrast to a four- to 11-fold increased risk of specific outcomes when additional ultrasound findings were present. CONCLUSION An overall rate of adverse conditions of 22% with prenatally detected echogenic bowel serves to inform women and health care providers and emphasizes the importance of careful screening fetal ultrasound studies and timely referral for comprehensive assessment with findings of echogenic bowel for evaluation for associated findings.
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Affiliation(s)
- Rachelle Findley
- Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS
| | - Victoria M Allen
- Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS
| | - Jo-Ann K Brock
- Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS; Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax, NS.
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Ronin C, Mace P, Stenard F, Loundou A, Capelle M, Mortier I, Pellissier MC, Sigaudy S, Levy A, D’ercole C, Hoffmann P, Merrot T, Lopater J, De Lagausie P, Philip N, Bretelle F. Antenatal prognostic factor of fetal echogenic bowel. Eur J Obstet Gynecol Reprod Biol 2017; 212:166-170. [DOI: 10.1016/j.ejogrb.2017.01.060] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 01/29/2017] [Accepted: 01/31/2017] [Indexed: 10/20/2022]
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Ekin A, Gezer C, Taner CE, Ozeren M. The effect of associated structural malformations in the prediction of chromosomal abnormality risk of fetuses with echogenic bowel. J Matern Fetal Neonatal Med 2014; 29:41-5. [PMID: 25385269 DOI: 10.3109/14767058.2014.986091] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Our aim is to determine the frequency of chromosomal abnormalities and also to identify the role of structural malformations on the chromosomal abnormality risk among fetuses with echogenic bowel. METHODS Over a 6-year period fetuses with echogenic bowel (FEB) were retrospectively evaluated. The pregnancies with intra-amniotic bleeding history, congenital infection, cystic fibrosis and intrauterine growth retardation were excluded from the study. Types and frequency of sonographically detected fetal malformations were identified. Chromosomal abnormality incidences according to association with soft markers and major fetal abnormalities were compared. RESULTS Of the 281 fetuses with echogenic bowel, 105 (37.37%) were isolated, 78 (27.76%) were associated with soft markers and 98 (34.87%) were associated with major abnormalities. There were 30 (10.7%) fetuses with abnormal karyotypes. The chromosomal abnormality rate of the groups of isolated FEB, FEB + soft markers and FEB + major abnormalities were 6.7%, 7.7% and 17.4%, respectively. CONCLUSIONS Chromosomal abnormality risk in fetuses with echogenic bowel should be evaluated according to additional sonographic findings. Association of structural malformations increases the chromosomal abnormality risk, although this risk is not significant with the presence of soft markers alone.
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Affiliation(s)
- Atalay Ekin
- a Department of Perinatology , Izmir Tepecik Training and Research Hospital , Izmir , Turkey
| | - Cenk Gezer
- a Department of Perinatology , Izmir Tepecik Training and Research Hospital , Izmir , Turkey
| | - Cuneyt Eftal Taner
- a Department of Perinatology , Izmir Tepecik Training and Research Hospital , Izmir , Turkey
| | - Mehmet Ozeren
- a Department of Perinatology , Izmir Tepecik Training and Research Hospital , Izmir , Turkey
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