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Monier I, Hachem S, Goffinet F, Martinez-Marin A, Khoshnood B, Lelong N. Population-based surveillance of congenital anomalies over 40 years (1981-2020): Results from the Paris Registry of Congenital Malformations (remaPAR). J Gynecol Obstet Hum Reprod 2024; 53:102780. [PMID: 38552958 DOI: 10.1016/j.jogoh.2024.102780] [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: 12/21/2023] [Revised: 02/13/2024] [Accepted: 03/25/2024] [Indexed: 04/01/2024]
Abstract
INTRODUCTION Registries of congenital anomalies (CAs) play a key role in the epidemiological surveillance of CAs. The objective was to estimate the prevalence of CAs and proportions of prenatal diagnosis, terminations of pregnancy for fetal anomaly (TOPFA) and infant mortality in the Paris Registry of Congenital Malformations (remaPAR) over 40 years, from 1981 to 2020. MATERIAL AND METHODS remaPAR records all births (live births, stillbirths ≥22 weeks of gestation and TOPFA at any gestational age) with CAs detected prenatally until the early neonatal period. We estimated the prevalence of CAs and proportions of prenatal diagnosis, TOPFA and infant mortality, overall and for a selected group of CAs in 3-year intervals. RESULTS The prevalence of CAs remained stable during the study period: 2.9 % of total births and 2.1 % of live births. Genetic anomalies were the most frequent subgroup (about 23 %), followed by congenital heart defects (about 22 %) and limb defects (about 20 %). Among non-genetic anomalies, the prevalence per 10,000 births was the highest for hypospadias (about 18 %) and the lowest for bilateral renal agenesis (about 1 %). Prenatal diagnoses increased from about 17 % in the 1980s to approximately 70 % in the most recent period (2018-2020), whereas the proportion of early TOPFA <16 weeks of gestation increased from 0.4 % to 14 %. Infant mortality ranged from 0 % for transverse limb reduction defects to 86 % for hypoplastic left heart syndrome. CONCLUSION The overall prevalence of CAs was fairly stable in Paris from 1981 to 2020. Prenatal diagnoses substantially increased, accompanied by much smaller increases in TOPFA.
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Affiliation(s)
- Isabelle Monier
- Université Paris Cité, Centre of Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRA, Paris, France.
| | - Sara Hachem
- Université Paris Cité, Centre of Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRA, Paris, France
| | - François Goffinet
- Université Paris Cité, Centre of Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRA, Paris, France; Port-Royal Maternity Unit, Groupe hospitalier Cochin Broca Hôtel-Dieu, AP-HP, Université Paris, FHU Prema, Paris, France
| | - Audrey Martinez-Marin
- Université Paris Cité, Centre of Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRA, Paris, France
| | - Babak Khoshnood
- Université Paris Cité, Centre of Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRA, Paris, France
| | - Nathalie Lelong
- Université Paris Cité, Centre of Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRA, Paris, France
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Fuchs F, Borrego P, Amouroux C, Antoine B, Ollivier M, Faure JM, Lopez C, Forgues D, Faure A, Merrot T, Boulot P, Jeandel C, Philibert P, Gaspari L, Sultan C, Paris F, Kalfa N. Prenatal imaging of genital defects: clinical spectrum and predictive factors for severe forms. BJU Int 2019; 124:876-882. [PMID: 30776193 DOI: 10.1111/bju.14714] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To report the clinical spectrum of genital defects diagnosed before birth, identify predictive factors for severe phenotypes at birth, and determine the rate of associated malformations. PATIENTS AND METHODS A retrospective study (2008-2017) of 4580 fetuses, identified prenatally with abnormalities evaluated by our Reference Center for Fetal Medicine, included cases with fetal sonographic findings of abnormal genitalia or uncertainty of fetal sex determination. Familial, prenatal and postnatal data were collected via a standardised questionnaire. RESULTS In all, 61 fetuses were included. The positive predictive value (PPV) of the prenatal diagnosis of genital defects was 90.1%. Most cases were 46,XY-undervirilized boys, 42 cases (68.8%), which included 29 with mid-penile or posterior hypospadias, nine with anterior hypospadias, and epispadias, micropenis, scrotal transposition, and buried penis (one each). In all, 46,XX-virilized girls were identified in seven cases (11.5%), which included four with congenital adrenal hyperplasia, two with isolated clitoromegaly, and one with ovotestis. Other defects included prune belly syndrome and persistent cloaca (six cases). Early detection during the second trimester (58.1% vs 18.8%, P = 0.03), intra-uterine growth restriction (IUGR) (45.2% vs 9.1%, P = 0.06), and curvature of the penis (38.7% vs 0%, P = 0.02), were more frequently related to severe defects in male newborns. Associated malformations (14 cases, 22.9%) and genetic defects (six) were frequent in undervirilized boys. CONCLUSION Prenatal imaging of genital defects leads to a wide range of phenotypes at birth. Its PPV is high and extra-urinary malformations are frequent. Early diagnosis during the second trimester, associated IUGR, and curvature of the genital tubercle, should raise suspicion of a severe phenotype and may justify delivery near a multidisciplinary disorders/differences of sex development team.
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Affiliation(s)
- Florent Fuchs
- Service de Gynécologie-Obstétrique, Hôpital Arnaud de Villeneuve - CHU Montpellier
| | - Paula Borrego
- Unité de Chirurgie Viscérale et Urologique Pédiatrique, Hôpital Lapeyronie - CHU Montpellier, Montpellier, France.,Université de Montpellier, Montpellier, France
| | - Cyril Amouroux
- Université de Montpellier, Montpellier, France.,Unité d'Endocrinologie-Gynécologie Pédiatrique, Département de Pédiatrie, Hôpital Arnaud de Villeneuve - CHU Montpellier, Montpellier, France.,National Reference Network DSD DevGen, Centre Constitutif Sud. - CHU Montpellier, Montpellier, France
| | - Benoît Antoine
- Service de Gynécologie-Obstétrique, Hôpital Arnaud de Villeneuve - CHU Montpellier
| | - Margot Ollivier
- Unité de Chirurgie Viscérale et Urologique Pédiatrique, Hôpital Lapeyronie - CHU Montpellier, Montpellier, France.,Université de Montpellier, Montpellier, France.,National Reference Network DSD DevGen, Centre Constitutif Sud. - CHU Montpellier, Montpellier, France
| | - Jean-Michel Faure
- Service de Gynécologie-Obstétrique, Hôpital Arnaud de Villeneuve - CHU Montpellier
| | - Christophe Lopez
- Unité de Chirurgie Viscérale et Urologique Pédiatrique, Hôpital Lapeyronie - CHU Montpellier, Montpellier, France.,Université de Montpellier, Montpellier, France.,National Reference Network DSD DevGen, Centre Constitutif Sud. - CHU Montpellier, Montpellier, France
| | - Dominique Forgues
- Unité de Chirurgie Viscérale et Urologique Pédiatrique, Hôpital Lapeyronie - CHU Montpellier, Montpellier, France.,Université de Montpellier, Montpellier, France
| | - Alice Faure
- Service de Chirurgie Pédiatrique, Hôpital La Timone, APHM, Marseille, France
| | - Thierry Merrot
- Service de Chirurgie Pédiatrique, Hôpital La Timone, APHM, Marseille, France
| | - Pierre Boulot
- Service de Gynécologie-Obstétrique, Hôpital Arnaud de Villeneuve - CHU Montpellier
| | - Claire Jeandel
- Université de Montpellier, Montpellier, France.,Unité d'Endocrinologie-Gynécologie Pédiatrique, Département de Pédiatrie, Hôpital Arnaud de Villeneuve - CHU Montpellier, Montpellier, France.,National Reference Network DSD DevGen, Centre Constitutif Sud. - CHU Montpellier, Montpellier, France
| | - Pascal Philibert
- Université de Montpellier, Montpellier, France.,Unité d'Endocrinologie-Gynécologie Pédiatrique, Département de Pédiatrie, Hôpital Arnaud de Villeneuve - CHU Montpellier, Montpellier, France.,National Reference Network DSD DevGen, Centre Constitutif Sud. - CHU Montpellier, Montpellier, France
| | - Laura Gaspari
- Université de Montpellier, Montpellier, France.,Unité d'Endocrinologie-Gynécologie Pédiatrique, Département de Pédiatrie, Hôpital Arnaud de Villeneuve - CHU Montpellier, Montpellier, France.,National Reference Network DSD DevGen, Centre Constitutif Sud. - CHU Montpellier, Montpellier, France
| | - Charles Sultan
- Université de Montpellier, Montpellier, France.,Unité d'Endocrinologie-Gynécologie Pédiatrique, Département de Pédiatrie, Hôpital Arnaud de Villeneuve - CHU Montpellier, Montpellier, France.,National Reference Network DSD DevGen, Centre Constitutif Sud. - CHU Montpellier, Montpellier, France
| | - Françoise Paris
- Université de Montpellier, Montpellier, France.,Unité d'Endocrinologie-Gynécologie Pédiatrique, Département de Pédiatrie, Hôpital Arnaud de Villeneuve - CHU Montpellier, Montpellier, France.,National Reference Network DSD DevGen, Centre Constitutif Sud. - CHU Montpellier, Montpellier, France
| | - Nicolas Kalfa
- Unité de Chirurgie Viscérale et Urologique Pédiatrique, Hôpital Lapeyronie - CHU Montpellier, Montpellier, France.,Université de Montpellier, Montpellier, France.,National Reference Network DSD DevGen, Centre Constitutif Sud. - CHU Montpellier, Montpellier, France
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Nemec SF, Kasprian G, Brugger PC, Bettelheim D, Nemec U, Krestan CR, Rotmensch S, Rimoin DL, Graham JM, Prayer D. Abnormalities of the penis in utero--hypospadias on fetal MRI. J Perinat Med 2011; 39:451-6. [PMID: 21631398 DOI: 10.1515/jpm.2011.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To demonstrate the visualization of penile abnormalities on fetal magnetic resonance imaging (MRI). METHODS This retrospective study included five fetuses (25+0 to 31+6 gestational weeks) with penile abnormalities, positively depicted on fetal MRI, using prenatal ultrasonography (US) as a standard of reference. On MRI, the penis, as well as the scrotum and testicles, were evaluated. All fetal organs were reviewed to define penile abnormalities as isolated or in association with other anomalies. Furthermore, US and MRI findings were compared. RESULTS Posterior hypospadias were demonstrated in all five fetuses, and abnormal testicular descent in two. Associated anomalies were present in all five fetuses on MRI, including abdominal/urogenital pathologies in four; brain pathologies in three; and craniofacial, cardiac, musculoskeletal, pathologies each in one fetus, and intrauterine growth retardation in one fetus. Compared to US, additional MRI findings were shown in four of five fetuses. CONCLUSIONS Our MRI results demonstrate the visualization of fetal penile abnormalities and associated pathologies, which may provide information for perinatal management. MRI may show additional findings compared to prenatal US in certain cases.
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Affiliation(s)
- Stefan F Nemec
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
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Fang KH, Wu JL, Chen M, Yeh GP, Chou PH, Hsu JC, Hsieh CTC. Prenatal Sonographic Features of Hypospadia: Two- and Three-Dimensional Findings. Taiwan J Obstet Gynecol 2006; 45:53-5. [PMID: 17272209 DOI: 10.1016/s1028-4559(09)60191-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To present our experience of applying three-dimensional ultrasonography in prenatal diagnosis of hypospadia. CASE REPORT A 28-year-old woman, gravida 1, para 0, visited our hospital at 17 weeks' gestation. No gross anomaly was found on the scan at 21 weeks' gestation. Fetal growth was appropriate for gestational age on two-dimensional (2D) ultrasonography at 27 weeks' gestation, but an abnormally curved and shortened fetal penis was found incidentally. Three-dimensional (3D) imaging in surface-rendered mode was used to reconstruct the fetal penis. Multiplanar and surface-rendered images were obtained in the midsagittal, axial, and coronal planes to precisely delineate the ventral curvature of the penis. At 39 weeks' gestation, a term newborn was delivered by vacuum extraction. On examination, the fetus was confirmed to have hypospadia. Karyotyping revealed 46,XY. CONCLUSION 2D ultrasonography could only give indirect clues of hypospadia that was later more precisely delineated by 3D ultrasonography in surface-rendered mode.
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Affiliation(s)
- Kung-Hong Fang
- Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan
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