1
|
Khalil A, Papageorghiou A, Bhide A, Akolekar R, Thilaganathan B. Biparietal diameter at 11 to 13 weeks' gestation in fetuses with holoprosencephaly. Prenat Diagn 2013; 34:134-8. [DOI: 10.1002/pd.4269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 11/03/2013] [Accepted: 11/03/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Asma Khalil
- Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology; St George's Hospital Medical School; London UK
| | - Aris Papageorghiou
- Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology; St George's Hospital Medical School; London UK
| | - Amar Bhide
- Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology; St George's Hospital Medical School; London UK
| | - Ranjit Akolekar
- Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology; St George's Hospital Medical School; London UK
| | - Basky Thilaganathan
- Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology; St George's Hospital Medical School; London UK
| |
Collapse
|
2
|
Sepulveda W, Wong AE. First trimester screening for holoprosencephaly with choroid plexus morphology ('butterfly' sign) and biparietal diameter. Prenat Diagn 2013; 33:1233-7. [PMID: 24018978 DOI: 10.1002/pd.4235] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Revised: 09/04/2013] [Accepted: 09/04/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether choroid plexus morphology ('butterfly' sign) and biparietal diameter (BPD) are effective sonographic screening tools for holoprosencephaly (HPE) in the first trimester. METHODS An axial view of the fetal head was obtained routinely to determine the presence of the 'butterfly' sign in pregnancies presenting for sonographic screening at 11-13 weeks of gestation. The same view was also used to obtain BPD measurements. The definitive diagnosis of HPE was established by the sonographic demonstration of an anterior cerebral monoventricular cavity and thalamic fusion. RESULTS During a 9-year study period, 11 068 live fetuses were screened. There were 11 cases of HPE (prevalence 1/1006); all of them were detected by demonstration of an absent 'butterfly' sign with no false-positive cases. The BPD was less than the 5th percentile in 40% of the cases. CONCLUSIONS The 'butterfly' sign appears to be a highly sensitive marker for HPE in the first trimester. On the other hand, BPD measurements had a lower sensitivity, implying that microcephaly is not a prominent first-trimester feature in these cases. Incorporation of the 'butterfly' sign into the first trimester anatomy scan is simple and can facilitate the identification of the vast majority of fetuses with HPE in the first trimester.
Collapse
Affiliation(s)
- Waldo Sepulveda
- Fetal Medicine Center, Department of Obstetrics and Gynecology, Clinica Las Condes, Santiago, Chile
| | | |
Collapse
|
3
|
Abstract
Diabetes mellitus is responsible for nearly 10% of fetal anomalies in diabetic pregnancies. Although aggressive perinatal care and glycemic control are available in developed countries, the birth defect rate in diabetic pregnancies remains higher than that in the general population. Major cellular activities (ie, proliferation and apoptosis) and intracellular metabolic conditions (ie, nitrosative, oxidative, and endoplasmic reticulum stress) have been shown to be associated with diabetic embryopathy using animal models. Translating advances made in animal studies into clinical applications in humans requires collaborative efforts across the basic research, preclinical, and clinical communities.
Collapse
Affiliation(s)
- Zhiyong Zhao
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
| | | |
Collapse
|
4
|
Diawara FM, Diallo M, Camara M, Traore M. Sonographic Detection of Holoprosencephaly With Cyclopia and Proboscis. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2009. [DOI: 10.1177/8756479309347781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The incidence of holoprosencephaly is about 1 in 10,000 to 20,000 births. There are three major forms: alobar, semilobar, and lobar. The alobar form with cyclopia is very rare. The author describes a transabdominal sonographic diagnosis of an alobar form of holoprosencephaly at 20 weeks’ gestational age. The fetus presented with cyclopia, proboscis, absence of ears and nose, polydactyly, hydrocephalus, macrocephaly, and polyhydramnios. After counseling, termination of pregnancy was performed. Two years later, a subsequent pregnancy was normal.
Collapse
|
5
|
Chen CP. Prenatal Sonographic Features of Fetuses in Trisomy 13 Pregnancies (I). Taiwan J Obstet Gynecol 2009; 48:210-7. [DOI: 10.1016/s1028-4559(09)60292-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
6
|
Blaas HGK, Eik-Nes SH. Sonoembryology and early prenatal diagnosis of neural anomalies. Prenat Diagn 2009; 29:312-25. [PMID: 19194866 DOI: 10.1002/pd.2170] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In the following review, the early development of the central nervous system (CNS), as described by embryologists and anatomists in modern embryological textbooks, is compared with sonoanatomic descriptions from two-dimensional (2D) and three-dimensional (3D) ultrasound studies, week by week in the first trimester. The anatomic descriptions are limited to details that are of interest for the understanding of ultrasound examinations. Further, the detection of main CNS anomalies including spina bifida during the first trimester are presented and discussed. Empty or enlarged brain cavities, or abnormal contours of the head and spine are important diagnostic markers for the detection of CNS anomalies in the very early pregnancy.
Collapse
Affiliation(s)
- H-G K Blaas
- National Center for Fetal Medicine, Norwegian University of Science and Technology, Department of Laboratory Medicine, Children's and Women's Health, University Hospital Trondheim, Norway.
| | | |
Collapse
|
7
|
Volpe P, Campobasso G, De Robertis V, Rembouskos G. Disorders of prosencephalic development. Prenat Diagn 2009; 29:340-54. [PMID: 19184971 DOI: 10.1002/pd.2208] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Abnormal ventral induction may result in disorders of formation, cleavage, and midline development of prosencephalic structures. Holoprosencephaly is a developmental field defect of impaired cleavage of prosencephalon. The most widely accepted classification of holoprosencephaly recognizes three major varieties: the alobar, semilobar and lobar types, according to the severity of the malformation. The brain malformations, characterized by the fusion of the cerebral hemisphere along the midline are commonly associated with facial anomalies. Corpus callosum agenesis and septo-optic dysplasia are disorders of prosencephalic midline development, and usually have less severe presentations but still, affected subjects may suffer from neurodevelopmental retardation, and/or endocrinologic and visual disorders. In this article we report an up-to-date of pathogenesis, prenatal sonographic findings, differential diagnosis and prognosis of the aforementioned anomalies.
Collapse
Affiliation(s)
- P Volpe
- Fetal Medicine Unit, Di Venere and Sarcone Hospitals, Bari, Italy.
| | | | | | | |
Collapse
|
8
|
Dane B, Dane C, Aksoy F, Yayla M. Semilobar holoprosencephaly with associated cyclopia and radial aplasia: first trimester diagnosis by means of integrating 2D-3D ultrasound. Arch Gynecol Obstet 2009; 280:647-51. [PMID: 19221775 DOI: 10.1007/s00404-009-0975-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Accepted: 01/30/2009] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Holoprosencephaly (HPE) is commonly associated with facial malformations. We present a case of semilobar HPE associated with distal limb defect which was detected at 12 weeks of gestation. CASE The fetus had a crown-rump length of 60 mm (12 weeks-4 days), had nuchal translucency thickness of 1.5 mm. Initial two-dimensional (2D) ultrasound revealed the absence of nasal bone, decreased BPD and abnormal profile. Transvaginal 2D ultrasound was effective in the detection of HPE (partially absence of the interhemispheric fissure, fused thalami, the choroid plexuses were not visualized bilateraly: absent 'butterfly' sign), cylopia, absence of the nose and unilateral radial aplasia. Three dimensional (3D) ultrasound provided a better visualization of the associated anomalies. The necropsy result confirmed the sonographic findings: the diagnosis was semilobar HPE, cyclopia, absence of the nose, and the absence of the radius and the thumb in the left arm. DISCUSSION Transvaginal 2D sonographic examination is effective in detection of the cases with HPE at first trimester. Fetal morphological study through 3D ultrasound may facilitate the diagnosis of associated anomalies.
Collapse
Affiliation(s)
- Banu Dane
- Department of Gynecology and Obstetrics, Haseki Training and Research Hospital, Istanbul, Turkey.
| | | | | | | |
Collapse
|
9
|
Timor-Tritsch IE, Monteagudo A, Santos R. Three-dimensional inversion rendering in the first- and early second-trimester fetal brain: its use in holoprosencephaly. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 32:744-750. [PMID: 18956427 DOI: 10.1002/uog.6245] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES To explore the feasibility and added value of three-dimensional (3D) inversion rendering of the developing embryonic/fetal ventricular system, and to apply this display technique to enhance the sonographic examination of holoprosencephaly. METHODS 3D volumes of the embryonic/fetal brain were acquired from four normal fetuses at 8-11 postmenstrual weeks, and four fetuses diagnosed with holoprosencephaly between 9 and 14 postmenstrual weeks. The volumes were then analyzed offline to obtain inversion rendered 3D shapes of the ventricular systems. RESULTS All inversion rendering displays were successful and provided the opportunity to study normal as well as pathological aspects of the early fetal brain. CONCLUSIONS Inversion rendering of early fetal brain ventricles is feasible and should be attempted if additional information about the early normal or pathological fetal brain is needed. It may have scientific value in embryologic or genetic studies.
Collapse
Affiliation(s)
- I E Timor-Tritsch
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY 10016, USA.
| | | | | |
Collapse
|
10
|
Sepulveda W, Lutz I, Be C. Holoprosencephaly at 9 weeks 6 days in a triploid fetus: two- and 3-dimensional sonographic findings. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:411-4. [PMID: 17324996 DOI: 10.7863/jum.2007.26.3.411] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Affiliation(s)
- Waldo Sepulveda
- Department of Obstetrics and Gynecology, Fetal Medicine Center, Clinica Las Condes, Casilla 208, Santiago 20, Chile.
| | | | | |
Collapse
|
11
|
Abstract
Screening for fetal chromosome abnormalities, particularly for trisomy 21, has made dramatic advances. Better screening demonstrates that "high-risk" patients--particularly over age 35--can have lower risk of defects than younger unscreened women. This has caused reduction of amniocentesis for older patients and made screening available for younger patients who have the universal 2% to 3% risk. This means lower procedural-related losses of normal fetuses, and better resource allocation. The trend toward first-trimester detection of structural defects continues; a normal survey is reassuring and helps exclude major defects. Based on screening results, patients can be triaged into early follow-up and possible amniocentesis as 14 to 16 weeks, or a later detailed anatomic survey at 18 to 20 weeks.
Collapse
Affiliation(s)
- David A Nyberg
- Fetal and Women's Center of Arizona, 9440 E. Ironwood Square Drive, Scottsdale, AZ 85258, USA.
| | | | | | | |
Collapse
|
12
|
Abstract
Most published data on the detection of fetal anomalies at 11-14 weeks are from specialized centres with considerable experience in fetal anomaly scanning. However, there is still limited information on the feasibility and limitations of the screening of these anomalies compared with the now classical mid-gestation screening. This review indicates that overall, the detection rate of fetal anomalies at 11-14 weeks is 44% compared with 74% by the mid-pregnancy scan. Major abnormalities of the fetal head, abdominal wall and urinary tract, and of the umbilical cord and placenta, can be reliably detected at 10-11 weeks of gestation. Detection of other anomalies such as spina bifida, diaphragmatic hernia or heart defects is limited before 13 weeks of gestation. So far it cannot be stated that routine first trimester screening can be used on a large scale to evaluate the fetal spine and heart in the general population. In particular, in screening for congenital heart defects, the ability to perform a full cardiac examination increases from 20% at 11 weeks to 92% at 13 weeks. The early prenatal diagnosis of these anomalies may be improved by screening at 13-14 weeks rather than during the first trimester.
Collapse
Affiliation(s)
- Boaz Weisz
- Department of Obstetrics and Gynaecology, University College London, WC1E 6HX, London, UK.
| | | | | |
Collapse
|
13
|
Bernard JP, Drummond CL, Zaarour P, Molho M, Ville Y. A new clue to the prenatal diagnosis of lobar holoprosencephaly: the abnormal pathway of the anterior cerebral artery crawling under the skull. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2002; 19:605-607. [PMID: 12099261 DOI: 10.1046/j.1469-0705.2002.00729.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
We report a case of a 24-week-old fetus with cerebral anomalies suggestive of lobar holoprosencephaly including an unusual course of the anterior cerebral artery on Doppler examination. This abnormal trajectory of the anterior cerebral artery in holoprosencephalic brains has been described by pathologists, neurosurgeons and radiologists but our case indicates that this finding may be a useful adjunct to confirm such a difficult diagnosis prenatally.
Collapse
Affiliation(s)
- J P Bernard
- Department of Obstetrics and Gynecology, CHI Poissy/St. Germain, France
| | | | | | | | | |
Collapse
|
14
|
Abstract
Congenital anomalies of the central nervous system (CNS) are among the most frequent malformations. Current ultrasound equipment can give a precise diagnosis of many of these lesions from early gestation. High-resolution transvaginal probes play a major role both in allowing an early diagnosis and for better defining subtle details of both normal and abnormal cerebral anatomy. The diagnostic accuracy of prenatal ultrasound is, however, heavily dependent upon the expertise of the sonologist, the type of equipment employed, and the time dedicated to the scan. Fetal sonography is effective in identifying neural tube defects, although alpha-fetoprotein screening seems to give a greater sensitivity. The accuracy of ultrasound in the identification of CNS malformations other than neural tube defects remains unclear because of the ascertainment biases of the few large prospective studies that have been conducted to date.
Collapse
Affiliation(s)
- Gianluigi Pilu
- Department of Obstetrics and Gynecology, Policlinico S. Orsola-Malpighi, Bologna, Italy.
| | | |
Collapse
|
15
|
Blaas HGK, Eriksson AG, Salvesen KA, Isaksen CV, Christensen B, Møllerløkken G, Eik-Nes SH. Brains and faces in holoprosencephaly: pre- and postnatal description of 30 cases. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2002; 19:24-38. [PMID: 11851965 DOI: 10.1046/j.0960-7692.2001.00154.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To investigate the prenatal appearance of the holoprosencephaly spectrum. METHODS A database of 1750 fetuses with congenital anomalies identified by ultrasound was prospectively collected from 1987 to 2000. Among them, 30 cases (1.7%) with holoprosencephaly were prenatally identified and described. RESULTS The prevalence of holoprosencephaly in the Health Region of the National Center for Fetal Medicine in Norway was 1.26 : 10 000; the sex distribution (male : female) was 1.4 : 1. Holoprosencephaly was found in one dichorionic twin pregnancy and one pair of conjoined twins. Among the 30 cases of holoprosencephaly, 18 were alobar, five were semilobar, two were lobar, two were lobar variants, and three were anencephalic. The facial features varied considerably. Sixty-seven per cent (20/30) had associated structural anomalies that were not related to the cerebral and facial holoprosencephaly condition. Thirty-seven per cent (11/30) had detectable chromosome aberrations and 23% (7/30) had nonchromosomal syndromal origin. The size or shape of the head was abnormal in 83% (25/30) of holoprosencephaly cases. CONCLUSION This study indicates that holoprosencephaly represents a heterogeneous entity with different etiologies and clinical appearances. The fact that holoprosencephaly features are found associated with particular conditions such as fronto-nasal dysplasia (2/30; 6.7%), agnathia-otocephaly (3/30; 10%), and anencephaly (3/30; 10%), suggests that these may be underreported conditions in other large holoprosencephaly series.
Collapse
Affiliation(s)
- H G K Blaas
- National Center for Fetal Medicine, Department of Obstetrics and Gynecology, Trondheim University Hospital, Norway.
| | | | | | | | | | | | | |
Collapse
|
16
|
Blaas HG. Holoprosencephaly at 10 weeks 2 days (CRL 33 mm). ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2000; 15:86-87. [PMID: 10776022 DOI: 10.1046/j.1469-0705.2000.00062.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- H G Blaas
- Department of Obstetrics and Gynecology, University Hospital of Trondheim, Norway
| |
Collapse
|
17
|
Blaas HG, Eik-Nes SH, Vainio T, Isaksen CV. Alobar holoprosencephaly at 9 weeks gestational age visualized by two- and three-dimensional ultrasound. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2000; 15:62-65. [PMID: 10776015 DOI: 10.1046/j.1469-0705.2000.00005.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
We present the ultrasound detection of alobar holoprosencephaly (HPE) with cyclopia in an embryo of 9 weeks 2 days last menstrual period (LMP)-based gestational age; the crown-rump length (CRL) was 22 mm. The use of three-dimensional (3-D) ultrasound made additional diagnostic ultrasound tomograms possible, and the volume reconstructions improved the imaging and the understanding of the condition.
Collapse
Affiliation(s)
- H G Blaas
- National Center for Fetal Medicine, Trondheim University Hospital, Norwegian University of Science and Technology, Norway
| | | | | | | |
Collapse
|