1
|
Sofia-Gonçalves A, Guedes-Martins L. Nuchal Translucency and Congenital Heart Defects. Curr Cardiol Rev 2024; 20:1-13. [PMID: 38275068 PMCID: PMC11107467 DOI: 10.2174/011573403x264963231128045500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/18/2023] [Accepted: 10/17/2023] [Indexed: 01/27/2024] Open
Abstract
Nuchal translucency comprises a temporary accumulation of fluid in the subcutaneous tissue on the back of a fetus's neck, which accompanies the crown-rump length and is observed through an ultrasound performed between 11 and 13 weeks + 6 days gestation. Nuchal translucency is considered to be above normal when values are higher than the 95th/99th percentile or equal to or higher than 2.5/3.5 mm. The first connection between increased nuchal translucency and the presence of congenital heart defects is described in the study of Hyett et al., who observed that they are directly proportional. Since that time, several studies have been conducted to understand if nuchal translucency measurements can be used for congenital heart defect screening in euploid fetuses. However, there is great variability in the estimated nuchal translucency cutoff values for congenital heart defect detection. The purpose of this review was to understand how increased nuchal translucency values and congenital heart defects are related and to identify which of these defects are more frequently associated with an increase in these values.
Collapse
Affiliation(s)
- A. Sofia-Gonçalves
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313, Porto, Portugal
- Centro de Medicina Fetal, Medicina Fetal Porto - Centro Materno Infantil do Norte, 4099-001, Porto, Portugal
| | - L. Guedes-Martins
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313, Porto, Portugal
- Centro de Medicina Fetal, Medicina Fetal Porto - Centro Materno Infantil do Norte, 4099-001, Porto, Portugal
- Departamento da Mulher e da Medicina Reprodutiva, Centro Hospitalar Universitário do Porto EPE, Centro Materno Infantil do Norte, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
- Unidade de Investigação e Formação – Centro Materno Infantil do Norte, 4099-001, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-319, Porto, Portugal
| |
Collapse
|
2
|
Khair H, Hilary S, Al Awar S, Zareba K, Maki S, Sayed G, Mutare S, El-Hattab AW, Al Ibrahim AH. Perinatal Outcomes in Foetuses with Increased Nuchal Translucency and Normal Karyotype: A Retrospective Cohort Study from the United Arab Emirates. J Clin Med 2023; 12:6358. [PMID: 37835002 PMCID: PMC10573960 DOI: 10.3390/jcm12196358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/21/2023] [Accepted: 09/23/2023] [Indexed: 10/15/2023] Open
Abstract
This retrospective case-controlled study analysed the outcome of pregnancies with first-trimester enlarged nuchal translucency (NT) and a normal karyotype. A total of 479 pregnancies with first-trimester NT measurements were grouped as control (370 cases; normal NT) and study (109 cases; enlarged NT, ≥95th percentile; with normal karyotype). Adverse outcomes included miscarriage, intrauterine foetal death, termination of pregnancy, neonatal death, and structural/chromosomal/genetic abnormalities. The study was conducted between June 2016 and June 2022 at the Foetal Maternal Unit of Kanad Hospital, UAE. Overall, the live birth rate in the study group was significantly lower (74.3%) compared to the control (94.1%, p < 0.001). All pregnancy outcomes of this group significantly differed compared to the control. The observed miscarriage level was 9.2% (vs. 1.1%, p < 0.001), intrauterine foetal death was 2.8% (vs. 0%, p = 0.001), spontaneous preterm birthwas 11% (vs. 4.9%, p = 0.020), and termination of pregnancy was 3.7% (vs. 0%, p < 0.001). The presence of foetal abnormalities was also significantly higher in the enlarged NT group at 21% (vs. 3.3%, p < 0.001). Results indicate that enlarged NT is associated with adverse pregnancy outcomes even when the karyotype is normal. Based on these results, a comprehensive review of the guidelines for counselling and managing pregnancies with enlarged NT and a normal karyotype is recommended.
Collapse
Affiliation(s)
- Howaida Khair
- Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 15551, United Arab Emirates (K.Z.)
| | - Serene Hilary
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 15551, United Arab Emirates; (S.H.)
| | - Shamsa Al Awar
- Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 15551, United Arab Emirates (K.Z.)
| | - Kornelia Zareba
- Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 15551, United Arab Emirates (K.Z.)
| | - Sara Maki
- Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 15551, United Arab Emirates (K.Z.)
| | - Gehan Sayed
- Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 15551, United Arab Emirates (K.Z.)
| | - Sharon Mutare
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 15551, United Arab Emirates; (S.H.)
| | - Ayman W. El-Hattab
- Fetal Maternal Unit, Kanad Hospital, Al Ain P.O. Box 1016, United Arab Emirates
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
| | | |
Collapse
|
3
|
Sezer S, Oğlak SC, Kaya B, Behram M, Gedik Özköse Z, Süzen Çaypınar S, Acar Z, Gezdirici A, Bornaun H. Fetal left ventricular myocardial performance index measured at 11-14 weeks of gestation in fetuses with an increased nuchal translucency. J Obstet Gynaecol Res 2023; 49:1121-1128. [PMID: 36691372 DOI: 10.1111/jog.15551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 12/30/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE This study aimed to evaluate the effect of an increase in nuchal translucency (NT) thickness on the myocardial performance index (MPI) in fetuses without cardiac anomaly in the first trimester and to determine whether a difference in MPI between those with and without trisomy 21 in these fetuses could be determined. METHODS The study group consisted of 53 pregnancies complicated with increased NT thickness without any associated structural anomalies. Forty-six gestational age-matched pregnant women whose fetuses had normal NT thickness were enrolled as the control group. RESULTS In the increased NT thickness group, the mean isovolumetric relaxation time (IRT) value (0.050 ± 0.011 s) was significantly higher and the mean ejection time (ET) value (0.149 ± 0.010 s) was significantly lower than those values in the normal NT thickness group (0.045 ± 0.005 and 0.155 ± 0.009 s, p = 0.023 and p = 0.009, respectively). We found a significantly higher mean left MPI value in the increased NT thickness group (0.574 ± 0.153) versus the normal NT thickness group (0.487 ± 0.107, p < 0.001). Within the increased NT thickness group, the mean left MPI value was similar in the fetuses with normal karyotype and those with trisomy 21 (p = 0.419). CONCLUSION We demonstrated a significantly greater mean MPI value in the increased NT thickness group than in the normal NT thickness group. Within the increased NT thickness group, no differences in the left MPI value in the fetuses with normal karyotype and the fetuses with trisomy 21 were found.
Collapse
Affiliation(s)
- Salim Sezer
- Department of Perinatology, Esenyurt University Hospital, Istanbul, Turkey
| | - Süleyman Cemil Oğlak
- Department of Obstetrics and Gynecology, Health Sciences University, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Başak Kaya
- Department of Perinatology, Medipol University Hospital, Istanbul, Turkey
| | - Mustafa Behram
- Department of Perinatology, Health Sciences University, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Zeynep Gedik Özköse
- Department of Perinatology, Health Sciences University, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Sema Süzen Çaypınar
- Department of Perinatology, Health Sciences University, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Züat Acar
- Department of Perinatology, Health Sciences University, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Alper Gezdirici
- Department of Medical Genetics, Health Sciences University, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Helen Bornaun
- Department of Pediatric Cardiology, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
4
|
Boutot M, Yardin C, Martin R, Bourthoumieu S, Aubard V, Martin S, Aubard Y, Coste-Mazeau P. Follow-up of increased nuchal translucency: Results of a study of 398 cases. J Gynecol Obstet Hum Reprod 2022; 51:102482. [DOI: 10.1016/j.jogoh.2022.102482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 08/06/2022] [Accepted: 10/05/2022] [Indexed: 11/08/2022]
|
5
|
Role of Sonographic Second Trimester Soft Markers in the Era of Cell-Free DNA Screening Options: A Review. REPRODUCTIVE MEDICINE 2022. [DOI: 10.3390/reprodmed3030017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Soft markers are sonographic structural, nonspecific signs with little pathological significance, often transient, usually considered as normal variants. However, they may also be associated with chromosomal abnormalities. The most widely examined soft markers include absent or hypoplastic nasal bone (NB), intracardiac echogenic focus (IEF), ventriculomegaly (VM), thickened nuchal fold (NF), choroid plexus cyst (CPC), echogenic bowel, short long bones, and urinary tract dilation (UTD). Although the use of noninvasive prenatal testing (NIPT) has been spreading quickly in maternal–fetal medicine, it is not a diagnostic test and it still remains unavailable or cost-prohibitive for most of the population in many countries. After normal screening test results in the first trimester, there is no uniform consensus regarding the clinical significance of isolated soft markers for aneuploidy. Nowadays, the search for soft markers in an ultrasound is still part of clinical evaluation, and the interpretation of these findings is often a matter of debate. In the present review, we summarize the recent literature about the role of soft markers in the era of NIPT and propose an overview of the different clinical guidelines.
Collapse
|
6
|
Narava S, Balbir Singh S, Barpanda S, Bricker L. Outcome of pregnancies with first-trimester increased nuchal translucency and cystic hygroma in a tertiary maternity hospital in United Arab Emirates. Int J Gynaecol Obstet 2022; 159:841-849. [PMID: 35435254 DOI: 10.1002/ijgo.14222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 04/04/2022] [Accepted: 04/11/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To study the outcome of pregnancies with first-trimester increased nuchal translucency and cystic hygromas. METHODOLOGY Retrospective study of 132 pregnancies with first-trimester increased nuchal translucency and cystic hygromas, between January 2015 to December 2018 at Corniche Hospital, Abu Dhabi, UAE. Fetal karyotyping, detailed ultrasound at 18-22 weeks and fetal echocardiography were offered to all women. Adverse outcomes included miscarriage, intrauterine fetal death, termination of pregnancy, neonatal death and structural abnormalities. RESULTS Of the 132 pregnancies, 13 had NT > 95th percentile, 89 had NT ≥3 mm and 30 had cystic hygroma. Among 13 pregnancies with NT > 95th centile, 7.6% had abnormal karyotype. Among 89 pregnancies with NT ≥3 mm, 29.2% had abnormal karyotype, 13.4% miscarriage, 7.8% underwent TOP, 5.6% intrauterine fetal death, 1.1% neonatal death and 14.6% had structural abnormalities. Among 30 pregnancies with cystic hygroma, 40% had abnormal karyotype, 20% miscarriage, 13.3% TOP, 13.3% intrauterine fetal death, 6.6% had neonatal death and 20% had structural abnormalities. CONCLUSION In our study, karyotype abnormalities increased with increasing nuchal translucency with highest risk in fetuses with cystic hygromas. Increased nuchal translucency was associated with adverse pregnancy outcome, which was higher in the group with NT≥6 mm and cystic hygromas.
Collapse
Affiliation(s)
- Sumalatha Narava
- Department of Obstetrics and Gynaecology, Corniche Hospital, Abu Dhabi, United Arab Emirates
| | - Sushma Balbir Singh
- Department of Obstetrics and Gynaecology, Corniche Hospital, Abu Dhabi, United Arab Emirates
| | - Samikshyamani Barpanda
- Department of Obstetrics and Gynaecology, Corniche Hospital, Abu Dhabi, United Arab Emirates
| | - Leanne Bricker
- Fetal Medicine Department, Corniche Hospital, Abu Dhabi, United Arab Emirates
| |
Collapse
|
7
|
Buffin R, Fichez A, Decullier E, Roux A, Bin S, Combourieu D, Pastor‐Diez B, Huissoud C, Picaud J. Neurodevelopmental outcome at 2 years of corrected age in fetuses with increased nuchal translucency thickness and normal karyotype compared with matched controls. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:790-797. [PMID: 32149439 PMCID: PMC8251540 DOI: 10.1002/uog.22009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 02/24/2020] [Accepted: 03/02/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Increased nuchal translucency (NT) thickness is an antenatal marker of aneuploidy or malformation that can lead to termination of pregnancy. This study assessed the long-term neurodevelopmental prognosis of infants who had isolated increased NT in utero. METHODS This was a prospective cohort study of infants with a NT thickness > 95th percentile in the first trimester, but with a normal karyotype and no major anomalies, and controls with normal NT matched for birth weight, Apgar score, place of birth, parity and gestational age at birth. At 2 years of corrected age, all infants underwent the psychometric Brunet-Lézine test to evaluate their developmental quotient (DQ), overall (global) and specifically for the areas of posture, language, coordination and sociability. RESULTS A total of 203 chromosomally normal infants were included in the increased-NT group and 208 in the control group. The mean global DQ was significantly lower in the increased-NT group than in the control group (108.6 ± 9.7 vs 112.8 ± 8.3; P < 0.0001), but it was within the normal range expected for that age in both groups. Similarly, the mean DQs for coordination, sociability and language, but not for posture, were significantly lower in infants with increased NT than in controls. Only one case with increased NT had a DQ < 70 (defined as severe neurodevelopmental impairment), compared with none in the control group. The difference between the two groups remained significant for a NT threshold ≥ 99th percentile and when the data were adjusted for NT thickness, the infant's sex and the mother's educational level. In the increased-NT group, NT thickness was < 3.5 mm in over half (56%) of the infants, between 3.5 mm and 5 mm in 33% and > 5 mm in 11%, with a mean global DQ of 108.4, 110.1 and 109.7, respectively. CONCLUSIONS Infants who had isolated increased fetal NT in the first trimester had a significantly lower, but normal, DQ at a corrected age of 2 years, when compared with controls. The findings were independent of the infant's sex, fetal NT thickness and the mother's educational level. © 2020 Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- R. Buffin
- Hospices Civils de Lyon, Hôpital de la Croix‐RousseService de NéonatologieLyonFrance
- Hospices Civils de Lyon, Hôpital de la Croix‐RousseCentre Pluridisciplinaire de Diagnostic PrénatalLyonFrance
| | - A. Fichez
- Hospices Civils de Lyon, Hôpital de la Croix‐RousseCentre Pluridisciplinaire de Diagnostic PrénatalLyonFrance
| | - E. Decullier
- Hospices Civils de Lyon, Pole IMER, Unité de Recherche CliniqueLyonFrance
| | - A. Roux
- Hospices Civils de Lyon, Pole IMER, Unité de Recherche CliniqueLyonFrance
| | - S. Bin
- Hospices Civils de Lyon, Pole IMER, Unité de Recherche CliniqueLyonFrance
| | - D. Combourieu
- Hospices Civils de Lyon, Hôpital Mère EnfantCentre Pluridisciplinaire de Diagnostic PrénatalBronFrance
| | - B. Pastor‐Diez
- Hospices Civils de Lyon, Hôpital de la Croix‐RousseService de NéonatologieLyonFrance
| | - C. Huissoud
- Hospices Civils de Lyon, Hôpital de la Croix‐RousseCentre Pluridisciplinaire de Diagnostic PrénatalLyonFrance
| | - J.‐C. Picaud
- Hospices Civils de Lyon, Hôpital de la Croix‐RousseService de NéonatologieLyonFrance
- Hospices Civils de Lyon, Hôpital de la Croix‐RousseCentre Pluridisciplinaire de Diagnostic PrénatalLyonFrance
- Université Lyon 1Faculté de Médecine Lyon Sud Charles Mérieux, Pierre BéniteLyonFrance
| | | |
Collapse
|
8
|
Miranda J, Paz Y Miño F, Borobio V, Badenas C, Rodriguez-Revenga L, Pauta M, Borrell A. Should cell-free DNA testing be used in pregnancy with increased fetal nuchal translucency? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:645-651. [PMID: 31301176 DOI: 10.1002/uog.20397] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 06/11/2019] [Accepted: 06/14/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To assess the frequency of atypical chromosomal and submicroscopic anomalies, as well as fetal structural abnormalities, observed on first-trimester ultrasound scan in fetuses with nuchal translucency (NT) thickness > 99th centile, in order to evaluate the suitability of using standard cell-free DNA (cfDNA) testing as the sole screening test in these pregnancies. METHODS This was a retrospective cohort study of 226 fetuses with NT > 99th centile at 11-14 weeks' gestation, between January 2013 and December 2017, in a clinical setting in which greater than 95% of pregnant women receive first-trimester combined screening. All patients underwent genetic testing by means of quantitative fluorescence polymerase chain reaction and chromosomal microarray analysis, mainly in chorionic villus samples. We assessed the theoretical yield of two cfDNA testing models, targeted cfDNA (chromosomes 21, 18 and 13) and extended cfDNA (chromosomes 21, 18, 13 and sex chromosomes), and compared it with that of cytogenetic testing and ultrasound assessment in the first and second or third trimesters. RESULTS In the 226 fetuses analyzed, cytogenetic testing revealed 84 (37%) anomalies, including 68 typical aneuploidies (involving chromosomes 13, 18 or 21), six sex chromosome aneuploidies (four cases of monosomy X and two of trisomy X), three clinically relevant atypical chromosomal anomalies (one trisomy 22, one trisomy 21 mosaicism and one unbalanced translocation), five submicroscopic pathogenic variants and two cases with Noonan syndrome. Targeted and extended cfDNA testing would miss at least 12% (10/84) and 19% (16/84), respectively, of genetic anomalies, accounting for 4.4% and 7.1% of the fetuses with an increased NT, respectively. Finally, of the 142 fetuses with no identified genetic anomaly, a major fetal malformation was observed in 15 (10.6%) fetuses at the early anomaly scan, and in 19 (13.4%) in the second or third trimester. CONCLUSIONS cfDNA does not appear to be the appropriate genetic test in fetuses with NT > 99th centile, given that it would miss 12-19% of genetic anomalies in this group. Additionally, first-trimester ultrasound will identify a major structural abnormality in 11% of the fetuses with NT > 99th centile and no genetic anomaly. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- J Miranda
- Fetal i+D Fetal Medicine Research, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, Institut Clinic de Ginecologia, Obstetricia i Neonatologia, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
- Center for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
| | - F Paz Y Miño
- Fetal i+D Fetal Medicine Research, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, Institut Clinic de Ginecologia, Obstetricia i Neonatologia, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
- Center for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
| | - V Borobio
- Fetal i+D Fetal Medicine Research, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, Institut Clinic de Ginecologia, Obstetricia i Neonatologia, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
- Center for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
| | - C Badenas
- Biomedical Diagnostic Center, Hospital Clinic de Barcelona, IDIBAPS, Barcelona, Catalonia, Spain
- CIBER de Enfermedades Raras, Instituto de Salud Carlos III, Madrid, Spain
| | - L Rodriguez-Revenga
- Biomedical Diagnostic Center, Hospital Clinic de Barcelona, IDIBAPS, Barcelona, Catalonia, Spain
- CIBER de Enfermedades Raras, Instituto de Salud Carlos III, Madrid, Spain
| | - M Pauta
- BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, Institut Clinic de Ginecologia, Obstetricia i Neonatologia, Barcelona, Catalonia, Spain
| | - A Borrell
- Fetal i+D Fetal Medicine Research, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, Institut Clinic de Ginecologia, Obstetricia i Neonatologia, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
- Center for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
- CIBER de Enfermedades Raras, Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
9
|
Dai R, Yu Y, Xi Q, Hu X, Zhu H, Liu R, Wang R. Prenatal diagnosis of 4953 pregnant women with indications for genetic amniocentesis in Northeast China. Mol Cytogenet 2019; 12:45. [PMID: 31709014 PMCID: PMC6836356 DOI: 10.1186/s13039-019-0457-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 10/18/2019] [Indexed: 12/02/2022] Open
Abstract
Background Several different technologies are used for prenatal screening procedures and genetic diagnostic technologies. We aimed to investigate the rates of chromosomal abnormalities in cases with different abnormal prenatal indications and to determine the relationships between fetal chromosomal abnormalities and indicators of prenatal abnormalities in Northeast China. Methods We evaluated 4953 16- to 23-week singleton gestation cases using amniocentesis and a total of 3583 participants received serological screening. Fetal chromosomal analyses were performed for all samples using fluorescence in situ hybridization and karyotyping. Results Among these samples, 204 (4.12%) had fetal chromosomal abnormalities. A total of 3583 participants received serological screening, among whom 102 (2.85%) exhibited positive results. A total of 309 participants had ultrasonography; 42 (13.6%) of these had abnormalities. Among 97 participants who had non-invasive prenatal testing (NIPT), 59 (61%) had positive results. Among 1265 participants with advanced maternal age, 78 (6.2%) had abnormal results. Conclusion The serological screening and NIPT that were included in the prenatal screening methods all had false positive and false negative rates. Although they are both prenatal screening techniques, maternal serum screening cannot be replaced by NIPT. The pregnancy women should accept NIPT in a qualified prenatal diagnostic center. We recommend that pregnant women at high or critical risk undergoing prenatal screening should confirm the fetal karyotype through amniocentesis. Moreover, if women receive a positive result via NIPT, they should not have a pregnancy termination without undergoing further prenatal diagnosis.
Collapse
Affiliation(s)
- Rulin Dai
- Department of Reproductive Medicine, Department of Prenatal Diagnosis, First Hospital, Jilin University, 71 Xinmin Street, Changchun, 130021 Jilin Province People's Republic of China
| | - Yang Yu
- Department of Reproductive Medicine, Department of Prenatal Diagnosis, First Hospital, Jilin University, 71 Xinmin Street, Changchun, 130021 Jilin Province People's Republic of China
| | - Qi Xi
- Department of Reproductive Medicine, Department of Prenatal Diagnosis, First Hospital, Jilin University, 71 Xinmin Street, Changchun, 130021 Jilin Province People's Republic of China
| | - Xiaonan Hu
- Department of Reproductive Medicine, Department of Prenatal Diagnosis, First Hospital, Jilin University, 71 Xinmin Street, Changchun, 130021 Jilin Province People's Republic of China
| | - Haibo Zhu
- Department of Reproductive Medicine, Department of Prenatal Diagnosis, First Hospital, Jilin University, 71 Xinmin Street, Changchun, 130021 Jilin Province People's Republic of China
| | - Ruizhi Liu
- Department of Reproductive Medicine, Department of Prenatal Diagnosis, First Hospital, Jilin University, 71 Xinmin Street, Changchun, 130021 Jilin Province People's Republic of China
| | - Ruixue Wang
- Department of Reproductive Medicine, Department of Prenatal Diagnosis, First Hospital, Jilin University, 71 Xinmin Street, Changchun, 130021 Jilin Province People's Republic of China
| |
Collapse
|
10
|
Holzer I, Husslein PW, Bettelheim D, Scheidl J, Kiss H, Farr A. Value of increased nuchal translucency in the era of noninvasive prenatal testing with cell-free DNA. Int J Gynaecol Obstet 2019; 145:319-323. [PMID: 30901484 DOI: 10.1002/ijgo.12808] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/12/2018] [Accepted: 03/20/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the value of increased nuchal translucency (NT) at first-trimester screening (FTS) despite the superiority of noninvasive prenatal testing with cell-free DNA (cfDNA) for the detection of fetal aneuploidies. METHODS Retrospective analysis of all FTS data from 2005 to 2015 in our department. Only cases with increased NT and euploid karyotype were considered eligible for inclusion. Abnormal findings, diagnostic work-up, and perinatal outcomes were assessed. RESULTS Of 18 084 FTS results, 460 (2.5%) showed increased fetal NT, of which 242 (52.6%) underwent invasive karyotyping and 179 (74.0%) had an aneuploidy. Of the remaining 63 cases, 61 (96.8%) showed an additional sonographic finding at FTS and25 (78.1%) had a major anomaly at the second trimester organ scan. The outcome was termination of pregnancy in 28 (44.4%) cases, fetal demise in 5 (7.9%), delivery of an infant with malformation in 21 (33.3%), and delivery of a healthy infant in 7 (11.1%) cases. CONCLUSION All cases with increased NT would have been detected by cfDNA or by a major sonographic anomaly not later than the second trimester. Routine use of cfDNA, a basic sonogram, and an organ scan could reduce unnecessary work-up and anxiety.
Collapse
Affiliation(s)
- Iris Holzer
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Peter W Husslein
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Dieter Bettelheim
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Julia Scheidl
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Herbert Kiss
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Alex Farr
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
11
|
Tiyatha S, Sirilert S, Sekararithi R, Tongsong T. Association between unexplained thickened nuchal translucency and adverse pregnancy outcomes. Arch Gynecol Obstet 2018; 298:97-101. [PMID: 29779040 DOI: 10.1007/s00404-018-4790-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 05/16/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the association between unexplained increased nuchal translucency (INT) and adverse pregnancy outcomes. PATIENTS AND METHODS The prospective database of our fetal down screening project was accessed to retrieve the records with NT measurement and complete follow-up. Pregnancies with pre-existing medical diseases, fetal chromosomal or structural abnormalities were excluded. The selected pregnancies were classified into the INT groups (> 95th percentile), the normal (< 95th percentile) group. RESULTS Of 6026 available for analysis (INT:277; and normal: 5749), the abortion rate was significantly higher in the INT group, 18/277 (6.5%) versus 55/5749 (1.0%); p < 0.001. After excluding 73 cases ending-up with abortion, a total of 5953 women were analyzed for final pregnancy outcomes, including 260 (4.4%), and 5693 (95.6%) in the study group (INT), and the control group (normal NT), respectively. The rates of pre-eclampsia (7.3 vs. 4.1%; p: 0.018), preterm birth (12.7 vs. 8.4%; p: 0.023), fetal growth restriction (11.5 vs. 7.6%; p: 0.032), and low birth weight (16.5 vs. 10.0%; p: 0.002) were slightly, but significantly higher in the study group. CONCLUSIONS INT in the first trimester is associated with significantly increased risk of abortion, fetal growth restriction, preterm birth, low birth weight and pre-eclampsia.
Collapse
Affiliation(s)
- Santee Tiyatha
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Sirinart Sirilert
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Ratanaporn Sekararithi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Theera Tongsong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
| |
Collapse
|
12
|
Edwards L, Hui L. First and second trimester screening for fetal structural anomalies. Semin Fetal Neonatal Med 2018; 23:102-111. [PMID: 29233624 DOI: 10.1016/j.siny.2017.11.005] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Fetal structural anomalies are found in up to 3% of all pregnancies and ultrasound-based screening has been an integral part of routine prenatal care for decades. The prenatal detection of fetal anomalies allows for optimal perinatal management, providing expectant parents with opportunities for additional imaging, genetic testing, and the provision of information regarding prognosis and management options. Approximately one-half of all major structural anomalies can now be detected in the first trimester, including acrania/anencephaly, abdominal wall defects, holoprosencephaly and cystic hygromata. Due to the ongoing development of some organ systems however, some anomalies will not be evident until later in the pregnancy. To this extent, the second trimester anatomy is recommended by professional societies as the standard investigation for the detection of fetal structural anomalies. The reported detection rates of structural anomalies vary according to the organ system being examined, and are also dependent upon factors such as the equipment settings and sonographer experience. Technological advances over the past two decades continue to support the role of ultrasound as the primary imaging modality in pregnancy, and the safety of ultrasound for the developing fetus is well established. With increasing capabilities and experience, detailed examination of the central nervous system and cardiovascular system is possible, with dedicated examinations such as the fetal neurosonogram and the fetal echocardiogram now widely performed in tertiary centers. Magnetic resonance imaging (MRI) is well recognized for its role in the assessment of fetal brain anomalies; other potential indications for fetal MRI include lung volume measurement (in cases of congenital diaphragmatic hernia), and pre-surgical planning prior to fetal spina bifida repair. When a major structural abnormality is detected prenatally, genetic testing with chromosomal microarray is recommended over routine karyotype due to its higher genomic resolution.
Collapse
Affiliation(s)
- Lindsay Edwards
- Feto-Maternal Unit, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Lisa Hui
- Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Victoria, Australia; Department of Perinatal Medicine, Mercy Hospital for Women, Heidelberg, Victoria, Australia; Public Health Genetics Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
| |
Collapse
|
13
|
Roozbeh N, Azizi M, Darvish L. Pregnancy Outcome of Abnormal Nuchal Translucency: A Systematic Review. J Clin Diagn Res 2017; 11:QC12-QC16. [PMID: 28511453 DOI: 10.7860/jcdr/2017/23755.9384] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 11/01/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Nuchal Translucency (NT) is the sonographic form of subcutaneous gathering of liquid behind the foetal neck in the first trimester of pregnancy. There is association of increased NT with chromosomal and non-chromosomal abnormalities. AIM The purpose of this systemic review was to review the pregnancy outcome of abnormal nuchal translucency. MATERIALS AND METHODS The present systematic review was conducted by searching English language articles from sources such as International Medical Sciences, Medline, Web of science, Scopus, Google Scholar, PubMed, Index Copernicus, DOAJ, EBSCO-CINAHL. Persian articles were searched from Iranmedex and SID sources. Related key words were "outcome", "pregnancy", "abnormal", and "Nuchal Translucency" (NT). All, randomized, descriptive, analytic-descriptive, case control study conducted during 1997-2015 were included. RESULTS Including duplicate articles, 95 related articles were found. After reviewing article titles, 30 unrelated article and abstracts were removed, and 65 articles were evaluated of which 30 articles were duplicate. Finally 22 articles were selected for final analysis. Exclusion criteria were, case studies and reports and quasi experimental designs. This evaluation has optioned negative relationship between nuchal translucency and pregnancy result. Rate of cardiac, chromosomal and other defects are correlated with increased NT≥2.5mm. Cardiac disease which were associated to the increased NT are heart murmur, systolic organic murmur, Atrial Septal Defect (ASD), Ventricular Septal Defect (VSD), tricuspid valve insufficiency and pulmonary valve insufficiency, Inferior Vena Cava (IVC) and Patent Ductus Arteriosus (PDA). The most common problems that related with increased NT were allergic symptoms. CONCLUSION According to this systematic review, increased NT is associated with various foetal defects. To verify the presence of malformations, birth defect consultations with a perinatologist and additional tests are required.
Collapse
Affiliation(s)
- Nasibeh Roozbeh
- Faculty, Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar, Abbas, Iran
| | - Maryam Azizi
- Assistant Professor, Fertility and Infertility Research Center, Hormozgan University of Medical SciencesBandar Abbas, Iran
| | - Leili Darvish
- Faculty, Department of Radiology, Faculty of Para-Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| |
Collapse
|
14
|
Äyräs O, Eronen M, Tikkanen M, Rahkola-Soisalo P, Paavonen J, Stefanovic V. Long-term outcome in apparently healthy children with increased nuchal translucency in the first trimester screening. Acta Obstet Gynecol Scand 2016; 95:541-6. [PMID: 26918672 DOI: 10.1111/aogs.12878] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 02/15/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Increased nuchal translucency is known to be associated with chromosomal and structural defects and genetic syndromes. Little is known about the overall long-term outcome of euploid children after increased nuchal translucency. The aims of this study were to assess the additional structural defects diagnosed after discharge from the delivery hospital and the long-term overall outcome of euploid children after increased nuchal translucency and normal second trimester anomaly scan. MATERIAL AND METHODS All children from singleton euploid pregnancies during 2002-2007 with increased nuchal translucency in the first trimester screening, normal second trimester anomaly scan, and discharged as apparently healthy were included. Data on the structural defects and genetic disorders diagnosed until 2012 were retrieved from hospital databases and national registers. Previously published data of structural defects diagnosed after birth but before discharge and of severe neurodevelopmental impairment and genetic syndromes was added. RESULTS The cohort included 733 children. During the follow-up time (mean 6.5 years), major structural defects were observed in 10 (1.4%), genetic disorders in two (0.3%), and minor defects in 23 (3.1%) children. In addition, there were 42 previously published major structural defects and major neurodevelopmental impairment or genetic disorders. Adding these results together, major health problems were detected in 54 (7%) euploid children with increased fetal nuchal translucency and normal findings in second trimester anomaly scan. CONCLUSION Although only few additional major structural defects are diagnosed during the follow-up after increased fetal nuchal translucency, 7% of fetuses assumed to be healthy after second trimester anomaly scan have a major health impairment.
Collapse
Affiliation(s)
- Outi Äyräs
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki Finland, Helsinki, Finland
| | - Marianne Eronen
- Health Department, Social Insurance Institution of Finland, Helsinki, Finland
| | - Minna Tikkanen
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki Finland, Helsinki, Finland
| | - Päivi Rahkola-Soisalo
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki Finland, Helsinki, Finland
| | - Jorma Paavonen
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki Finland, Helsinki, Finland
| | - Vedran Stefanovic
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki Finland, Helsinki, Finland
| |
Collapse
|
15
|
Le Lous M, Bouhanna P, Colmant C, Rozenberg P, Quibel T. The performance of an intermediate 16th-week ultrasound scan for the follow-up of euploid fetuses with increased nuchal translucency. Prenat Diagn 2015; 36:148-53. [DOI: 10.1002/pd.4756] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 11/18/2015] [Accepted: 11/27/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Maela Le Lous
- Department of Obstetrics and Gynecology; Poissy-Saint Germain Hospital, Versailles-Saint Quentin University; Versailles France
| | - Philippe Bouhanna
- Department of Obstetrics and Gynecology; Poissy-Saint Germain Hospital, Versailles-Saint Quentin University; Versailles France
| | - Claire Colmant
- Department of Obstetrics and Gynecology, AP-HP; Kremlin-Bicêtre Hospital, University of Paris-Sud; Orsay France
| | - Patrick Rozenberg
- Department of Obstetrics and Gynecology; Poissy-Saint Germain Hospital, Versailles-Saint Quentin University; Versailles France
| | - Thibaud Quibel
- Department of Obstetrics and Gynecology; Poissy-Saint Germain Hospital, Versailles-Saint Quentin University; Versailles France
| |
Collapse
|
16
|
Grande M, Jansen FAR, Blumenfeld YJ, Fisher A, Odibo AO, Haak MC, Borrell A. Genomic microarray in fetuses with increased nuchal translucency and normal karyotype: a systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:650-658. [PMID: 25900824 DOI: 10.1002/uog.14880] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 04/09/2015] [Accepted: 04/10/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To estimate the incremental yield of detecting copy number variants (CNVs) by genomic microarray over karyotyping in fetuses with increased nuchal translucency (NT) diagnosed by first-trimester ultrasound. METHODS This was a systematic review conducted in accordance with PRISMA criteria. We searched PubMed, Ovid MEDLINE and Web of Science for studies published between January 2009 and January 2015 that described CNVs in fetuses with increased NT, usually defined as ≥ 3.5 mm, and normal karyotype. Search terms included: fetal or prenatal, nuchal translucency or cystic hygroma or ultrasound anomaly, array comparative genomic hybridization or copy number variants, with related search terms. Risk differences were pooled to estimate the overall and stratified microarray incremental yield using RevMan. Quality assessment of included studies was performed using the Quality Assessment tool for Diagnostic Accuracy Studies (QUADAS-2) checklist. RESULTS Seventeen studies met the inclusion criteria for analysis. Meta-analysis indicated an incremental yield of 5.0% (95% CI, 2.0-8.0%) for the detection of CNVs using microarray when pooling results. Stratified analysis of microarray results demonstrated a 4.0% (95% CI, 2.0-7.0%) incremental yield in cases of isolated NT and 7.0% (95% CI, 2.0-12.0%) when other malformations were present. The most common pathogenic CNVs reported were 22q11.2 deletion, 22q11.2 duplication, 10q26.12q26.3 deletion and 12q21q22 deletion. The pooled prevalence for variants of uncertain significance was 1%. CONCLUSION The use of genomic microarray provides a 5.0% incremental yield of detecting CNVs in fetuses with increased NT and normal karyotype.
Collapse
Affiliation(s)
- M Grande
- Department of Maternal-Fetal Medicine, Institute of Gynecology, Obstetrics and Neonatology, Hospital Clinic of Barcelona, Catalonia, Spain
| | - F A R Jansen
- Leiden University Medical Center, Department of Obstetrics and Fetal Medicine, Leiden, The Netherlands
| | - Y J Blumenfeld
- Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - A Fisher
- Elliot Health System, Manchester, NH, USA
| | - A O Odibo
- Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, University of South Florida, Tampa, FL, USA
| | - M C Haak
- Leiden University Medical Center, Department of Obstetrics and Fetal Medicine, Leiden, The Netherlands
| | - A Borrell
- Department of Maternal-Fetal Medicine, Institute of Gynecology, Obstetrics and Neonatology, Hospital Clinic of Barcelona, Catalonia, Spain
| |
Collapse
|
17
|
Mula R, Grande M, Bennasar M, Crispi F, Borobio V, Martinez JM, Gratacos E, Borrell A. Further insights into diastolic dysfunction in first-trimester trisomy-21 fetuses. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 45:205-210. [PMID: 24706444 DOI: 10.1002/uog.13380] [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: 11/14/2013] [Revised: 02/20/2014] [Accepted: 03/26/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To assess fetal cardiac function in first-trimester trisomy-21 fetuses as compared with fetuses with other aneuploidies, euploid fetuses with cardiac defects or isolated increased nuchal translucency (NT) and controls. METHODS During a 2.5-year period, NT, ductus venosus (DV) blood flow, diastolic filling time, early filling time, tricuspid flow, tricuspid and mitral valve E/A velocity ratios, left ventricle shortening fraction, left myocardial performance index and fetal heart rate were assessed in fetuses with a crown-rump length between 45 and 84 mm undergoing chorionic villus sampling at our center. Cardiac parameters among study groups were compared with the use of 95% CIs. RESULTS The study population comprised 28 fetuses with trisomy 21, 25 with other aneuploidies, 94 euploid fetuses with abnormal findings (27 with cardiac defects, 31 with other structural anomalies and 36 with isolated increased NT) and 271 controls. Trisomy-21 fetuses showed signs of diastolic dysfunction such as increased DV pulsatility index and E/A ratios together with a higher prevalence of tricuspid regurgitation. However, no differences were found in euploid fetuses with cardiac defects or isolated increased NT. CONCLUSIONS No signs of cardiac dysfunction were observed in euploid fetuses with increased NT or cardiac defects, while in trisomy-21 fetuses signs of diastolic dysfunction could be potentially attributed to volume overload.
Collapse
Affiliation(s)
- R Mula
- Maternal-Fetal Medicine Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Äyräs O, Eronen M, Tikkanen M, Rahkola-Soisalo P, Paavonen J, Stefanovic V. Long-term neurodevelopmental outcome of children from euploid pregnancies with increased nuchal translucency in the first trimester screening. Prenat Diagn 2015; 35:362-9. [PMID: 25511913 DOI: 10.1002/pd.4548] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 12/01/2014] [Accepted: 12/10/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess the long-term neurodevelopmental outcome of children born from singleton euploid pregnancies with increased fetal nuchal translucency (NT) in the first trimester ultrasound screening and without structural anomalies in the second trimester ultrasound screening. STUDY DESIGN This is a register-based retrospective cohort study carried out at a tertiary referral centre from 2002 to 2007. Children were followed up until 2012. All fetuses had increased NT (>95th percentile) at the first trimester ultrasound screening and normal findings in the second trimester ultrasound screening. Data about the neurodevelopmental outcome was retrieved from the hospital databases, The National Institute for Health and Welfare, and the Finnish Causes of Death Statistics Database. Information about received disability allowances was gathered from the Social Insurance Institute of Finland. RESULTS The study population consists of 691 children. The mean follow-up time was 6.5 years. Neurodevelopmental disorders occurred in 29 children (4.2%). Twelve of these 29 children (1.7%) had severe neurodevelopmental impairment. CONCLUSIONS The long-term neurodevelopmental outcome of children after increased fetal NT is reassuring. This information should be added to the parental counselling of such cases. © 2014 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- O Äyräs
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland
| | | | | | | | | | | |
Collapse
|
19
|
Arigita M, Grande M, Mula R, Borobio V, Sanchez A, Soler A, Borrell A. Nuchal translucency thickness in the prediction of unbalanced translocations. Prenat Diagn 2014; 34:982-5. [PMID: 24863889 DOI: 10.1002/pd.4409] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 04/24/2014] [Accepted: 05/07/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to assess the role of nuchal translucency (NT) in the prediction of unbalanced translocation in offspring of couples in which one of the parents is a balanced translocation carrier. MATERIAL AND METHODS From January 1996 to December 2012, fetal NT was measured before chorionic villus sampling in 86 pregnancies referred because of parental balanced translocation. RESULTS No significant differences in pregnancy characteristics and in NT expressed in millimetres or in multiples of the median (MoMs) were observed between the 41 fetuses with a normal karyotype [1.72 mm, 95% confidence interval (CI): 1.49-1.96; 1.14 MoM; 95% CI: 1.01-1.26], the 38 fetuses with balanced translocations (1.78 mm, 95% CI: 1.44-2.12; 1.22 MoM; 95% CI: 1.01-1.43) and the 7 fetuses with unbalanced translocations (2.21 mm, 95% CI: 1.33-3.09; 1.59 MoM; 95% CI: 0.72-2.45). The proportions of fetuses with NT above 95th centile in the three groups were 9.1% in fetuses with normal karyotype, 18.4% in balanced translocations and 28.6% in unbalanced translocations, not significantly different. CONCLUSION Although a trend to an increased NT was observed in fetuses with unbalanced translocation, no significant differences were reached. According to our results, a normal NT evaluation should not preclude the performance of CVS in pregnancies of balanced translocation parents.
Collapse
Affiliation(s)
- Marta Arigita
- Department of Obstetrics and Gynecology, Hospital General de l'Hospitalet, L'Hospitalet del Llobregat, Barcelona, Catalonia, Spain
| | | | | | | | | | | | | |
Collapse
|
20
|
Bakker M, Pajkrt E, Bilardo CM. Increased nuchal translucency with normal karyotype and anomaly scan: What next? Best Pract Res Clin Obstet Gynaecol 2014; 28:355-66. [DOI: 10.1016/j.bpobgyn.2013.10.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 09/23/2013] [Accepted: 10/14/2013] [Indexed: 11/28/2022]
|
21
|
Leanza V, Rubbino G, Leanza G. Case Report: Atypical Cornelia de Lange Syndrome. F1000Res 2014; 3:33. [PMID: 26834972 PMCID: PMC4706058 DOI: 10.12688/f1000research.3-33.v2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/19/2015] [Indexed: 11/20/2022] Open
Abstract
Cornelia de Lange Syndrome (CdLS) (also called Bushy Syndrome or Amsterdam dwarfism), is a genetic disorder that can lead to several alterations. This disease affects both physical and neuropsychiatric development. The various abnormalities include facial dysmorphia (arched eyebrows, synophrys, depressed nasal bridge, long philtrum, down-turned angles of the mouth), upper-extremity malformations, hirsutism, cardiac defects, and gastrointestinal alterations. The prevalence of this syndrome is approximately one per 15,000. Ultrasound is not the perfect means to diagnose CdLS, however, many abnormalities can be detected prenatally by scrupulous image observation. We report an atypical CdLS case characterized by increased nuchal translucency in the first trimester, normal karyotype, saddle nose, micrognathia with receding jaw, low set ears, facies senilis, arthrogryposis of the hands, absence of the Aranzio ductus venous, dilatation of gallbladder and bowel, a unique umbilical artery, increased volume of amniotic fluid, and intrauterine growth retardation ending with the interruption of pregnancy.
Collapse
Affiliation(s)
- Vito Leanza
- Surgery Department, Obstetrics and Gynecologic Unit “Ospedale Santo Bambino”, Catania University, Catania, Italy
| | - Gabriella Rubbino
- Surgery Department, Obstetrics and Gynecologic Unit “Ospedale Santo Bambino”, Catania University, Catania, Italy
| | - Gianluca Leanza
- Surgery Department, Obstetrics and Gynecologic Unit “Ospedale Santo Bambino”, Catania University, Catania, Italy
| |
Collapse
|
22
|
Leanza V, Rubbino G, Leanza G. Atypical Cornelia de Lange Syndrome: a case report. F1000Res 2014; 3:33. [PMID: 26834972 DOI: 10.12688/f1000research.3-33.v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2014] [Indexed: 05/24/2024] Open
Abstract
Cornelia de Lange Syndrome (CdLS) (also called Bushy Syndrome or Amsterdam dwarfism), is a genetic disorder that can lead to several alterations. This disease affects both physical and psychical development. The various abnormalities include facial dysmorphia (arched eyebrows, synophrys, depressed nasal bridge, long philtrum, down-turned angles of the mouth), upper-extremity malformations, hirsutism, cardiac defects, and gastrointestinal alterations. The prevalence of this syndrome is approximately one per 15,000. Ultrasound is not the perfect means to diagnose CdLS, however, many abnormalities can be detected prenatally by scrupulous image observation. We report an atypical CdLS case characterized by increased nuchal translucency in the first trimester, normal kariotype, saddle nose, micrognathia with receding jaw, low set ears, facies senilis, arthrogryposis of the hands, absence of the Aranzio ductus venous, dilatation of gallbladder and bowel, a unique umbilical artery, increased volume of amniotic fluid, and intrauterine growth retardation ending with the interruption of pregnancy.
Collapse
Affiliation(s)
- Vito Leanza
- Surgery Department, Obstetrics and Gynecologic Unit "Ospedale Santo Bambino", Catania University, Catania, Italy
| | - Gabriella Rubbino
- Surgery Department, Obstetrics and Gynecologic Unit "Ospedale Santo Bambino", Catania University, Catania, Italy
| | - Gianluca Leanza
- Surgery Department, Obstetrics and Gynecologic Unit "Ospedale Santo Bambino", Catania University, Catania, Italy
| |
Collapse
|
23
|
Significance of septa in first trimester increased nuchal translucency thickness. J Med Ultrason (2001) 2013; 41:51-6. [DOI: 10.1007/s10396-013-0464-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 04/26/2013] [Indexed: 10/26/2022]
|
24
|
Moczulska H, Janiak K, Słodki M, Respondek-Liberska M. Ultrasound and echocardiographic findings obtained in the second and third trimesters of gestation in fetuses with normal karyotype and increased nuchal translucency. J Ultrason 2013; 13:21-30. [PMID: 26673632 PMCID: PMC4613577 DOI: 10.15557/jou.2013.0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 11/15/2012] [Accepted: 01/28/2013] [Indexed: 11/26/2022] Open
Abstract
Introduction Numerous papers have proven that an increased nuchal translucency is connected with a raised risk of chromosomal aberrations, but few analyses are related to the further state of fetuses with a normal karyotype. The aim of the study The aim of the study was to estimate the risk of cardiac defects and other developmental disorders in fetuses with increased nuchal translucency and normal findings of a standard cytogenetic examination. Methods The authors carried out a retrospective analysis of 5183 examinations of 3376 patients who reported to the Department of Diagnosis and Prophylaxis of Congenital Malformations in the Polish Mother's Memorial Hospital in Łódź in the period from January 2008 to March 2011 for prenatal ultrasound and echocardiographic examinations. The authors analyzed the results of the examinations performed in the second and third trimesters of gestation in fetuses with an increased nuchal translucency of ≥3 mm in the first trimester and with a normal karyotype. Results Fifty-seven patients (1.7% of the examined group) fulfilled the criteria necessary to be included in the study. In 31 pregnant women (54%) structural defects or anomalies of the fetus were found. Cardiac anomalies were detected in 17 fetuses (29.8%). The authors detected various types of cardiac defects such as tetralogy of Fallot, ventricular septal defect, atrioventricular septal defect, transposition of the great arteries and hypoplastic left heart syndrome. Conclusions In more than half of the fetuses with an increased nuchal translucency (NT ≥ 3 mm) and a normal karyotype, developmental defects of various organs appeared in the further course of pregnancy: mainly heart defects that were either isolated, or accompanied other anomalies.
Collapse
Affiliation(s)
- Hanna Moczulska
- Zakład Diagnostyki i Profilaktyki Wad Wrodzonych, Instytut Centrum Zdrowia Matki Polki, Łódź, Polska
| | - Katarzyna Janiak
- Zakład Diagnostyki i Profilaktyki Wad Wrodzonych, Instytut Centrum Zdrowia Matki Polki, Łódź, Polska
| | - Maciej Słodki
- Zakład Diagnostyki i Profilaktyki Wad Wrodzonych, Instytut Centrum Zdrowia Matki Polki, Łódź, Polska
| | - Maria Respondek-Liberska
- Zakład Diagnostyki i Profilaktyki Wad Wrodzonych, Instytut Centrum Zdrowia Matki Polki, Łódź, Polska
| |
Collapse
|
25
|
Sotiriadis A, Papatheodorou S, Makrydimas G. Neurodevelopmental outcome of fetuses with increased nuchal translucency and apparently normal prenatal and/or postnatal assessment: a systematic review. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 39:10-19. [PMID: 22102486 DOI: 10.1002/uog.10143] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To systematically review and, when feasible, pool, published data regarding the prevalence of childhood neurodevelopmental delay in fetuses with increased first-trimester nuchal translucency (NT), normal karyotype and absence of structural defects or identifiable syndromes. METHODS MEDLINE and SCOPUS searches using combinations of the terms 'nuchal translucency' AND 'outcome*' were complemented by perusal of the references of the retrieved articles and an additional automated search using the 'search for related articles' PubMed function. Only children with a normal karyotype and no structural defects or syndromic abnormalities were included in the analysis. Between-studies heterogeneity was assessed using the I(2) statistic. RESULTS The total prevalence of developmental delay in all 17 studies was 28/2458 (1.14%; 95% CI, 0.79-1.64; I(2) = 57.6%). Eight studies (n = 1567) used NT > 99(th) centile as the cut-off; 15 children (0.96%; 95% CI, 0.58-1.58%) were reported as having developmental delay (I(2) = 72.2%). Four studies (n = 669) used the 95(th) centile as the cut-off for increased NT; seven children (1.05%; 95% CI, 0.51-4.88%) were reported as having developmental delay (I(2) = 29.2%). Five studies used 3.0 mm as the cut-off for increased NT; the pooled rate of developmental delay was six of 222 children (2.70%; 95% CI, 1.24-5.77%; I(2) = 0.0%). CONCLUSION The rate of neurodevelopmental delay in children with increased fetal NT, a normal karyotype, normal anatomy and no identifiable genetic syndromes does not appear to be higher than that reported for the general population. More large-scale, prospective case-control studies would be needed to enhance the robustness of the results.
Collapse
Affiliation(s)
- A Sotiriadis
- Fourth Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | |
Collapse
|
26
|
Miltoft CB, Ekelund CK, Hansen BM, Lando A, Petersen OB, Skovbo P, Jørgensen FS, Sperling L, Zingenberg H, Nikkila A, Shalmi AC, Stornes I, Ersbak V, Tabor A. Increased nuchal translucency, normal karyotype and infant development. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 39:28-33. [PMID: 21837765 DOI: 10.1002/uog.10060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To investigate whether chromosomally normal fetuses with a nuchal translucency (NT) ≥ 99th percentile(3.5 mm) in the first trimester have an increased risk of delayed development at 2 years of age. METHODS The study included children of women from 10 Danish hospitals who had fetal NT either ≥ 99th percentile (Group 1) or <95th percentile (Group 2) in the first trimester. The groups were matched by gender,gestational age at birth and maternal age. There were twice as many children in Group 2 as in Group 1. Follow-up was conducted at 2 years of age, infant development being assessed by the 'Ages and Stages Questionnaire'. The cutoff value for delayed development was defined as the 5th percentile from the first 100 questionnaires from Group 2. RESULTS In a 1-year period 202 of 33 266 fetuses (0.6%)had NT ≥ 3.5 mm. Of these, 99 (49.0%) were liveborn with normal karyotype and normal ultrasound findings during pregnancy. The response rate to the ASQ was 83.3% in Group 1 and 71.4% in Group 2. A low ASQ score was found in 1.3% (1/80) and 4.4% (6/137)in Groups 1 and 2, respectively (P = 0.265), but no difference was found in the mean ASQ score between the two groups (P = 0.160). CONCLUSION Fetuses with NT ≥ 99th percentile, normal karyotype and normal ultrasound findings during pregnancy had no increased risk of developmental delay at 2 years of age compared with fetuses with normal NT(<95th percentile).
Collapse
Affiliation(s)
- C B Miltoft
- Department of Fetal Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. caroline
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|