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Abstract
Aneuploidies occur in about 5% of clinically recognized pregnancies. Facial gestalt is a vital tool for the clinical diagnosis of trisomy 21. Facial anomalies are subtle in fetal life and challenging for a clinician not familiar with perinatal dysmorphology. Here, we present the facial profile and additional features in six fetuses with Down syndrome as a visual aid. We present the facial photographs of six fetuses with genetically confirmed trisomy 21. These photographs will serve as a diagnostic aid for trisomy 21 in perinatal dysmorphology. We noted punctate calcifications in two fetuses with trisomy 21.
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Rossi AC, Prefumo F. Correlation between fetal autopsy and prenatal diagnosis by ultrasound: A systematic review. Eur J Obstet Gynecol Reprod Biol 2016; 210:201-206. [PMID: 28061423 DOI: 10.1016/j.ejogrb.2016.12.024] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 11/30/2016] [Accepted: 12/19/2016] [Indexed: 11/29/2022]
Abstract
The objective of this study was to review literature about the correlation between fetal autopsy and ultrasound findings of fetal malformations. Search in PubMed, Medline, EMBASE, Clinicl trials.org, reference list was performed. Inclusion criteria for studies selection were: fetal autopsy performed after termination of pregnancy (TOP) or stillbirth, TOP for fetal anomalies, prenatal diagnosis of malformations, data reported as proportional rates. EXCLUSION CRITERIA case reports, non English language, data reported in graphs or percentage. From each article: sample size, type of malformation, indication for TOP, autopsy findings. Fetal anomalies were grouped in central nervous system (CNS), genitourinary (GU), congenital heart defects (CHD), gastrointestinal (GI), thorax, limbs, skeleton, genetics (TOP for abnormal karyotype), multiples (TOP for multiple severe malformations for which a single indication for TOP/stillbirth could not be identified). Correspondence between autopsy and ultrasound was defined as agreement (same diagnosis), additional (additional findings undetected by ultrasound), unconfirmed (false positive and false negative ultrasound). PRISMA guidelines were followed. From 19 articles, 3534 fetuses underwent autopsy, which confirmed prenatal ultrasound in 2401 (68.0%) fetuses, provided additional information in 794 (22.5%) fetuses, and unconfirmed prenatal ultrasound in 329 (9.2%) fetuses. The latter group consisted of 3.2% false positive and 2.8% false negative cases. The additional findings changed the final diagnosis in 3.8% of cases. The most frequent indication for TOP/stillbirth was CNS anomalies (36.3%), whereas thorax anomalies represented the less frequent indication (1.7%). The highest agreement between autopsy and prenatal ultrasound was observed in CNS (79.4%) and genetics (79.2%), followed by GU anomalies (76.6%), skeleton (76.6%), CHD (75.5%), thorax (69.7%); GI (62.6%), multiple (37.0%), limbs (23.3%). In spite of the high agreement between prenatal ultrasound and autopsy, fetal examination is mandatory because in a minority of cases it discloses additional findings or changes the final diagnosis and genetic counselling.
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Affiliation(s)
- A Cristina Rossi
- Clinic of Obstetrics and Gynecology, Ospedale della Murgia, Bari, Italy.
| | - Federico Prefumo
- Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
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Boecking CA, Drey EA, Kerns JL, Finkbeiner WE. Correlation of Prenatal Diagnosis and Pathology Findings Following Dilation and Evacuation for Fetal Anomalies. Arch Pathol Lab Med 2016; 141:267-273. [PMID: 27763778 DOI: 10.5858/arpa.2016-0029-oa] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT -Despite increased use of dilation and evacuation in the setting of fetuses with developmental anomalies, the pathology examination of fragmented specimens obtained by this technique has been understudied. OBJECTIVES -To correlate pathologic findings in second-trimester fetal dilation and evacuation specimens with prenatal diagnoses established through ultrasound and/or chromosome studies to determine the value of pathology examination for supplementing or correcting clinical diagnoses. DESIGN -In this retrospective study, clinical and pathology findings were correlated in 448 dilation and evacuation specimens performed for second-trimester termination of pregnancy for fetal anomalies discovered on ultrasound examination (278 cases) or chromosome analysis (170 cases). RESULTS -In 109 of the 170 cases with chromosomal abnormalities (64%), pathologists identified at least 1 congenital defect associated with the respective karyotype. In 278 cases with ultrasound-detected anomalies, pathologists confirmed the major congenital defect in 116 fetal specimens (42%). Evaluating for congenital central nervous system and body wall/diaphragm pathologic findings proved challenging owing to tissue disruption. However, taking all categories into account, pathology studies corrected ultrasound diagnoses in 152 of 413 cases (37%) and yielded additional diagnostic findings in 137 cases (33%). CONCLUSIONS -In a substantial number of cases, examination of fragmented fetuses corrected or refined prenatal diagnoses, demonstrating a role for detailed pathology examination of dilation and evacuation specimens in quality control of prenatal imaging studies and for potentially aiding subsequent genetic counseling.
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Leguy MC, Brun S, Pidoux G, Salhi H, Choiset A, Menet MC, Gil S, Tsatsaris V, Guibourdenche J. Pattern of secretion of pregnancy-associated plasma protein-A (PAPP-A) during pregnancies complicated by fetal aneuploidy, in vivo and in vitro. Reprod Biol Endocrinol 2014; 12:129. [PMID: 25543334 PMCID: PMC4293003 DOI: 10.1186/1477-7827-12-129] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 12/12/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Pregnancy-associated placental protein-A (PAPP-A) is a metalloprotease which circulates as an hetero-tetramer in maternal blood. Its maternal serum concentration in fetal trisomy 21 is decreased during the first trimester, so that PAPP-A is a useful screening biomarker. However, the regulation of PAPP-A placental secretion is unclear. We therefore investigated the secretion of PAPP-A in pregnancies complicated by fetal aneuploidies, both in vivo and in vitro. METHODS Maternal serum collected between 10 WG and 33 WG during 7014 normal pregnancies and 96 pregnancies complicated by fetal trisomy 21, 18, and 13 were assayed for PAPP-A using the Immulite 2000xpi system®. The pregnancies were monitored using ultrasound scanning, fetal karyotyping and placental analysis. Villous cytotrophoblasts were isolated from normal and trisomic placenta and cultured to investigate PAPP-A secretion in vitro (n=6). RESULTS An increased nuchal translucency during the first trimester is a common feature of many chromosomal defect but each aneuploidy has its own syndromic pattern of abnormalities detectable at the prenatal ultrasound scanning and confirmed at the fetal examination thereafter. PAPP-A levels rise throughout normal pregnancy whereas in trisomy 21, PAPP-A levels were significantly decreased, but only during the first trimester. PAPP-A levels were decreased in trisomy 13 and sharply in trisomy 18, whatever the gestational age. In vitro, PAPP-A secretion was decreased in aneuploidy, and associated with decreased hCG secretion in Trisomy 21 and 18. These biochemical profiles did not appear to be linked to any specific histological lesions affecting the placenta. CONCLUSIONS These profiles may reflect different quantitative and qualitative placental dysfunctions in the context of these aneuploidies.
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Affiliation(s)
| | - Stephanie Brun
- />Maternity CHU Bordeaux, Place Amélie Raba-Léon, Bordeaux, France
| | | | - Houria Salhi
- />Foeto-pathology CHU Cochin AP-HP, 27 rue du Fbg St Jacques, Paris, France
| | - Agnes Choiset
- />Cytogenetic CHU Cochin AP-HP, 27 rue du Fbg St Jacques, Paris, France
| | | | - Sophie Gil
- />INSERM UMR 1139, 4 av de l’observatoire, Paris, France
- />PremUp foundation, 27 rue du Fbg St Jacques, Paris, France
- />Faculté de Pharmacie, Université Paris Descartes, 4 av de l’observatoire, Paris, France
| | - Vassilis Tsatsaris
- />INSERM UMR 1139, 4 av de l’observatoire, Paris, France
- />PremUp foundation, 27 rue du Fbg St Jacques, Paris, France
- />Maternity CHU Cochin AP-HP, 27 rue du Fbg St Jacques, Paris, France
| | - Jean Guibourdenche
- />Hormonology CHU Cochin AP-HP, 27 rue du Fbg St Jacques, Paris, France
- />INSERM UMR 1139, 4 av de l’observatoire, Paris, France
- />PremUp foundation, 27 rue du Fbg St Jacques, Paris, France
- />Faculté de Pharmacie, Université Paris Descartes, 4 av de l’observatoire, Paris, France
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Liau J, Romine L, Korty LA, Chao C, White K, Harmon S, Ho Y, Hull AD, Pretorius DH. Simplifying the Ultrasound Findings of the Major Fetal Chromosomal Aneuploidies. Curr Probl Diagn Radiol 2014; 43:300-16. [DOI: 10.1067/j.cpradiol.2014.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 04/24/2014] [Indexed: 11/22/2022]
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Iliescu DG, Cara ML, Tudorache S, Antsaklis P, Novac LV, Antsaklis A, Cernea N. Agenesis of ductus venosus in sequential first and second trimester screening. Prenat Diagn 2014; 34:1099-105. [DOI: 10.1002/pd.4434] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 05/12/2014] [Accepted: 05/13/2014] [Indexed: 11/11/2022]
Affiliation(s)
- D. G. Iliescu
- Department of Obstetrics and Gynecology, Prenatal Diagnostic Unit; University of Medicine and Pharmacy Craiova; Craiova Romania
| | - M. L. Cara
- Department of Obstetrics and Gynecology, Prenatal Diagnostic Unit; University of Medicine and Pharmacy Craiova; Craiova Romania
| | - S. Tudorache
- Department of Obstetrics and Gynecology, Prenatal Diagnostic Unit; University of Medicine and Pharmacy Craiova; Craiova Romania
| | - P. Antsaklis
- Department of Obstetrics and Gynecology; University of Athens; Athens Greece
| | - L. V. Novac
- Department of Obstetrics and Gynecology, Prenatal Diagnostic Unit; University of Medicine and Pharmacy Craiova; Craiova Romania
| | - A. Antsaklis
- Department of Obstetrics and Gynecology; University of Athens; Athens Greece
| | - N. Cernea
- Department of Obstetrics and Gynecology, Prenatal Diagnostic Unit; University of Medicine and Pharmacy Craiova; Craiova Romania
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Onkar D, Onkar P, Mitra K. Evaluation of Fetal Central Nervous System Anomalies by Ultrasound and Its Anatomical Co-relation. J Clin Diagn Res 2014; 8:AC05-7. [PMID: 25120962 DOI: 10.7860/jcdr/2014/8052.4437] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 04/19/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Central nervous system anomalies are often severe and are the most common indications for therapeutic abortions. Ultrasound examination helps to identify and evaluate them well before birth. OBJECTIVES Present study was undertaken to evaluate the incidence of central nervous system anomalies in utero by ultrasound and to confirm them by autopsy or postnatal examination. METHOD Ultrasound screening of 7485 pregnant women was performed. Pregnancy with ultrasound findings of central nervous system anomalies were followed up. Prenatal ultrasound findings were confirmed by autopsy in cases of therapeutic abortions and fetal losses. In case of live birth postnatal findings were noted. RESULTS Ultrasound detected central nervous system malformations in 24 fetuses. Ultrasound findings were matching in 83% on autopsy. Autopsy and postnatal findings together were matching with ultrasound in 85.7%. Two cases had additional minor findings on autopsy. CONCLUSION The incidence of central nervous system malformations on ultrasound was 0.31%. Autopsy and postnatal examination showed high degree of correlation with ultrasound findings.
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Affiliation(s)
- Deepali Onkar
- Associate Professor, Department of Anatomy, NKP Salve Institute of Medical Sciences and Research Centre , Nagpur, India
| | - Prashant Onkar
- Associate Professor, Department of Anatomy, NKP Salve Institute of Medical Sciences and Research Centre , Nagpur, India
| | - Kajal Mitra
- Associate Professor, Department of Anatomy, NKP Salve Institute of Medical Sciences and Research Centre , Nagpur, India
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Lal AK, Kominiarek MA, Sprawka NM. Induction of labor compared to dilation and evacuation for postmortem analysis. Prenat Diagn 2014; 34:547-51. [PMID: 24578263 DOI: 10.1002/pd.4346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 02/10/2014] [Accepted: 02/22/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study aimed to evaluate the ability to obtain autopsy and cytogenetics after midtrimester termination. METHODS A retrospective cohort study of women undergoing termination, via induction or dilation and evacuation (D&E), at 16 0/7-23 6/7 weeks was performed. Exclusion criteria were elective termination, preterm labor, PPROM, and no autopsy or cytogenetic exam performed. The ability to obtain cytogenetics and autopsy as well as complications rates were compared between the two groups with Chi-square tests. RESULTS Of the 469 women who met the inclusion criteria, 158 had an induction and 312 had a D&E. The induction of labor group had higher mean gestational ages, p < 0.01. Successful autopsy was more likely in the induction group, 94.3%, versus D&E group, 34.7%, p = 0.01. There was no difference in ability to obtain cytogenetics between the two groups, 89.1% in the induction group, and 92.3% in D&E group, p = 0.4. There was a difference in the total complication rates between the groups, 9.8% (26) in the induction versus 6.4% (20) in the D&E group, p < 0.01; however, there was no difference in major complications. CONCLUSIONS Midtrimester terminations by induction were more likely to have successful autopsies when compared with D&E. The ability to obtain cytogenetics was similar regardless of termination mode.
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Affiliation(s)
- A K Lal
- Department of Obstetrics and Gynecology, University of Illinois at Chicago Medical Center, Chicago, IL, USA
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HDlive imaging of the face of fetuses with autosomal trisomies. J Med Ultrason (2001) 2014; 41:339-42. [PMID: 27277908 DOI: 10.1007/s10396-014-0523-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 01/17/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND Our objective is to present our experience of facial dysmorphism reconstructed employing conventional three-dimensional (3D) ultrasound and HDlive in fetuses with autosomal trisomies. METHODS Seven fetuses with autosomal trisomies (one case of trisomy 13, three of trisomy 18, and three of trisomy 21) at 16-38 weeks' gestation were studied using 3D ultrasound and HDlive. RESULTS In one case of trisomy 21 at 29 weeks and 5 days, upward slanting eyes, a flattened nose, low-set ears, and the corners of the mouth turned down were noted employing HDlive. In the other two cases of trisomy 21, both techniques showed the same facial findings. In one case of trisomy 18 at 27 weeks and 6 days, a small head accompanied by a prominent back portion of the head, low-set ears, a small jaw, upturned nose, narrow eyelid folds, and widely spaced eyes were identified using HDlive. In the other two cases of trisomy 18, HDlive showed more detailed features of the fetal face compared to conventional 3D ultrasound. In the single case of trisomy 13 at 31 weeks and 1 day, cleft lip and close-set eyes were recognized with both 3D ultrasound and HDlive. CONCLUSION HDlive can provide clearer facial images than conventional 3D ultrasound. In particular, HDlive is superior to conventional 3D ultrasound for the depiction of eye fissures because of its shadowing effect. HDlive may be a useful diagnostic modality for the antenatal evaluation of subtle fetal facial dysmorphism.
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Gawron LM, Hammond C, Ernst LM. Perinatal pathologic examination of nonintact, second-trimester fetal demise specimens: the value of standardization. Arch Pathol Lab Med 2013; 137:1083-7. [PMID: 23899064 DOI: 10.5858/arpa.2012-0010-oa] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Management of second-trimester intrauterine fetal demise via dilation and evacuation results in nonintact specimens for pathologic examination. Surgical pathology examination is often mandated; however, evidence on expected findings and specimen evaluation guidelines are lacking. OBJECTIVES To assess pathologic findings of nonintact, second-trimester fetal demise specimens, through comparison of anatomic abnormalities identified on standardized perinatal examination to individualized general pathology examinations. DESIGN Single institution, retrospective chart review of 14- to 24-week gestational size fetal demise cases was conducted from May 2006 to October 2010. Suspected abnormalities, chromosomal and pathologic diagnoses were collected. A general surgical pathology examination occurred between May 2006 and October 2008, while a perinatal pathologist examined specimens between October 2008 and October 2010. Statistical analysis consisted of t tests and χ(2) tests by Stata/SE 12.1. RESULTS One hundred eighteen specimens were included and mean gestational size was 16.0 weeks (standard deviation, 1.6 weeks). Perinatal pathologic evaluation diagnosed significantly more abnormalities than did general pathologic examination (77.3% [34 of 44] versus 9.5% [7 of 75], P < .001). Forty-eight abnormalities were identified: 77.0% (n = 37) were placental and 23.0% (n = 11) were fetal. Chromosomal analysis was done on 73.7% (n = 87 of 118) with 12.6% (n = 11 of 87) showing abnormalities. Among aneuploid specimens, the perinatal pathologist confirmed abnormalities in 66.7% (n = 4 of 6) of cases while general pathologists confirmed abnormalities in 0% (n = 0 of 5) (P = .02). CONCLUSIONS Systematic surgical pathology examination of nonintact, second-trimester fetal demise specimens yields increased information on fetal or placental abnormalities, which may be clinically useful. Institutions with high-risk obstetrical practices and dilation and evacuation providers should consider integrating a standardized perinatal checklist into educational and practice guidelines.
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Affiliation(s)
- Lori M Gawron
- Section of Family Planning and Contraception, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA.
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Ernst LM, Gawron L, Fritsch MK. Pathologic Examination of Fetal and Placental Tissue Obtained by Dilation and Evacuation. Arch Pathol Lab Med 2013; 137:326-37. [DOI: 10.5858/arpa.2012-0090-ra] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—Dilation and evacuation (D&E) is an alternative method to induction of labor for pregnancy termination and intrauterine fetal demise, and it is the most common mode of second-trimester uterine evacuation in the United States. Many D&E specimens are examined in surgical pathology, and there is little information available in surgical pathology textbooks or the literature to assist pathologists in these examinations.
Objective.—To provide an overview of the D&E procedure, discuss related legal issues, provide guidelines for routine pathologic examination of D&E specimens, and demonstrate the importance of careful pathologic examination of D&E specimens.
Data Sources.—Case-derived material and literature review.
Conclusions.—Pathologic examination of D&E specimens has been understudied. However, the available literature and our experience support the fact that careful pathologic examination of D&E specimens can identify significant fetal and placental changes that can confirm clinical diagnoses or provide definitive diagnosis, assist in explaining the cause of intrauterine fetal demise, and identify unexpected anomalies that may provide further clues to a diagnostic syndrome or mechanism of anomaly formation.
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Affiliation(s)
- Linda M. Ernst
- From the Departments of Pathology (Drs Ernst and Fritsch) and Obstetrics and Gynecology (Dr Gawron), Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lori Gawron
- From the Departments of Pathology (Drs Ernst and Fritsch) and Obstetrics and Gynecology (Dr Gawron), Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael K. Fritsch
- From the Departments of Pathology (Drs Ernst and Fritsch) and Obstetrics and Gynecology (Dr Gawron), Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Ramalho C, Brandão O, Matias A, Montenegro N. Phenotypic variability in fetuses with down syndrome: a case-control pathological evaluation. Fetal Diagn Ther 2011; 30:207-14. [PMID: 21952468 DOI: 10.1159/000329309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Accepted: 05/10/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Evaluation of morphological and morphometric characteristics of fetuses with Down syndrome based on a detailed postmortem examination and comparison of these fetuses with a control group of fetuses with normal karyotype to improve the prenatal knowledge of Down syndrome characteristics. MATERIAL AND METHODS A case-control study was undertaken in a tertiary referral hospital. The Down syndrome fetuses (50) were compared with chromosomally normal fetuses (47) matched for gestational age. Biometric and morphological parameters were compared. RESULTS The biometry of fetuses with Down syndrome differs from control fetuses only in the occipitofrontal diameter and in the nasal bone length. There were craniofacial anomalies in 96% of fetuses with Down syndrome and in 51% of fetuses with normal karyotype. With the exception of small ears, all craniofacial features analyzed were significantly different between Down syndrome fetuses and control fetuses. All extremity features of fetuses with Down syndrome were significantly different from fetuses without Down syndrome. There were 31 fetuses with Down syndrome (62%) with 55 internal anomalies. Nineteen fetuses (38.8%) showed 27 cardiac anomalies. Six fetuses had more than one anomaly. There were 18 fetuses (36%) with 28 noncardiac anomalies. DISCUSSION The importance of studying the morphological characteristics of fetuses with Down syndrome is the contribution to a better knowledge of fetal characteristics and probably to optimize prenatal diagnosis.
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Affiliation(s)
- C Ramalho
- Center of Prenatal Diagnosis, Department of Gynecology and Obstetrics, Centro Hospitalar S. João, Medical Faculty of Porto, Porto, Portugal.
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Devore GR. Genetic sonography: the historical and clinical role of fetal echocardiography. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 35:509-521. [PMID: 20443195 DOI: 10.1002/uog.7652] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Defant J, Gambello MJ, Monga M, Langlois PH, Noblin SJ, Vidaeff AC. Fetal trisomy 21 and the risk of preeclampsia. J Matern Fetal Neonatal Med 2009; 23:55-9. [DOI: 10.3109/14767050903118288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Laury A, Sanchez-Lara PA, Pepkowitz S, Graham JM. A study of 534 fetal pathology cases from prenatal diagnosis referrals analyzed from 1989 through 2000. Am J Med Genet A 2007; 143A:3107-20. [DOI: 10.1002/ajmg.a.32094] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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