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Buijtendijk MF, Bet BB, Leeflang MM, Shah H, Reuvekamp T, Goring T, Docter D, Timmerman MG, Dawood Y, Lugthart MA, Berends B, Limpens J, Pajkrt E, van den Hoff MJ, de Bakker BS. Diagnostic accuracy of ultrasound screening for fetal structural abnormalities during the first and second trimester of pregnancy in low-risk and unselected populations. Cochrane Database Syst Rev 2024; 5:CD014715. [PMID: 38721874 PMCID: PMC11079979 DOI: 10.1002/14651858.cd014715.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
BACKGROUND Prenatal ultrasound is widely used to screen for structural anomalies before birth. While this is traditionally done in the second trimester, there is an increasing use of first-trimester ultrasound for early detection of lethal and certain severe structural anomalies. OBJECTIVES To evaluate the diagnostic accuracy of ultrasound in detecting fetal structural anomalies before 14 and 24 weeks' gestation in low-risk and unselected pregnant women and to compare the current two main prenatal screening approaches: a single second-trimester scan (single-stage screening) and a first- and second-trimester scan combined (two-stage screening) in terms of anomaly detection before 24 weeks' gestation. SEARCH METHODS We searched MEDLINE, EMBASE, Science Citation Index Expanded (Web of Science), Social Sciences Citation Index (Web of Science), Arts & Humanities Citation Index and Emerging Sources Citation Index (Web of Science) from 1 January 1997 to 22 July 2022. We limited our search to studies published after 1997 and excluded animal studies, reviews and case reports. No further restrictions were applied. We also screened reference lists and citing articles of each of the included studies. SELECTION CRITERIA Studies were eligible if they included low-risk or unselected pregnant women undergoing a first- and/or second-trimester fetal anomaly scan, conducted at 11 to 14 or 18 to 24 weeks' gestation, respectively. The reference standard was detection of anomalies at birth or postmortem. DATA COLLECTION AND ANALYSIS Two review authors independently undertook study selection, quality assessment (QUADAS-2), data extraction and evaluation of the certainty of evidence (GRADE approach). We used univariate random-effects logistic regression models for the meta-analysis of sensitivity and specificity. MAIN RESULTS Eighty-seven studies covering 7,057,859 fetuses (including 25,202 with structural anomalies) were included. No study was deemed low risk across all QUADAS-2 domains. Main methodological concerns included risk of bias in the reference standard domain and risk of partial verification. Applicability concerns were common in studies evaluating first-trimester scans and two-stage screening in terms of patient selection due to frequent recruitment from single tertiary centres without exclusion of referrals. We reported ultrasound accuracy for fetal structural anomalies overall, by severity, affected organ system and for 46 specific anomalies. Detection rates varied widely across categories, with the highest estimates of sensitivity for thoracic and abdominal wall anomalies and the lowest for gastrointestinal anomalies across all tests. The summary sensitivity of a first-trimester scan was 37.5% for detection of structural anomalies overall (95% confidence interval (CI) 31.1 to 44.3; low-certainty evidence) and 91.3% for lethal anomalies (95% CI 83.9 to 95.5; moderate-certainty evidence), with an overall specificity of 99.9% (95% CI 99.9 to 100; low-certainty evidence). Two-stage screening had a combined sensitivity of 83.8% (95% CI 74.7 to 90.1; low-certainty evidence), while single-stage screening had a sensitivity of 50.5% (95% CI 38.5 to 62.4; very low-certainty evidence). The specificity of two-stage screening was 99.9% (95% CI 99.7 to 100; low-certainty evidence) and for single-stage screening, it was 99.8% (95% CI 99.2 to 100; moderate-certainty evidence). Indirect comparisons suggested superiority of two-stage screening across all analyses regarding sensitivity, with no significant difference in specificity. However, the certainty of the evidence is very low due to the absence of direct comparisons. AUTHORS' CONCLUSIONS A first-trimester scan has the potential to detect lethal and certain severe anomalies with high accuracy before 14 weeks' gestation, despite its limited overall sensitivity. Conversely, two-stage screening shows high accuracy in detecting most fetal structural anomalies before 24 weeks' gestation with high sensitivity and specificity. In a hypothetical cohort of 100,000 fetuses, the first-trimester scan is expected to correctly identify 113 out of 124 fetuses with lethal anomalies (91.3%) and 665 out of 1776 fetuses with any anomaly (37.5%). However, 79 false-positive diagnoses are anticipated among 98,224 fetuses (0.08%). Two-stage screening is expected to correctly identify 1448 out of 1776 cases of structural anomalies overall (83.8%), with 118 false positives (0.1%). In contrast, single-stage screening is expected to correctly identify 896 out of 1776 cases before 24 weeks' gestation (50.5%), with 205 false-positive diagnoses (0.2%). This represents a difference of 592 fewer correct identifications and 88 more false positives compared to two-stage screening. However, it is crucial to acknowledge the uncertainty surrounding the additional benefits of two-stage versus single-stage screening, as there are no studies directly comparing them. Moreover, the evidence supporting the accuracy of first-trimester ultrasound and two-stage screening approaches primarily originates from studies conducted in single tertiary care facilities, which restricts the generalisability of the results of this meta-analysis to the broader population.
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Affiliation(s)
- Marieke Fj Buijtendijk
- Department of Medical Biology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
| | - Bo B Bet
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Mariska Mg Leeflang
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Harsha Shah
- Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Tom Reuvekamp
- Department of Medical Biology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Timothy Goring
- Department of Medical Biology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Daniel Docter
- Department of Medical Biology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Melanie Gmm Timmerman
- Department of Medical Biology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Yousif Dawood
- Department of Medical Biology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Malou A Lugthart
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Bente Berends
- Department of Medical Biology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Jacqueline Limpens
- Medical Library, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Eva Pajkrt
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Maurice Jb van den Hoff
- Department of Medical Biology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, Netherlands
| | - Bernadette S de Bakker
- Department of Medical Biology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- Department of Paediatric Surgery, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, Netherlands
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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.
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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
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3
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Yin YN, Cao L, Wang J, Chen YL, Yang HO, Tan SB, Cai K, Chen ZQ, Xiang J, Yang YX, Geng HR, Zhou ZY, Shen AN, Zhou XY, Shi Y, Zhao R, Sun K, Ding C, Zhao JY. Proteome profiling of early gestational plasma reveals novel biomarkers of congenital heart disease. EMBO Mol Med 2023; 15:e17745. [PMID: 37840432 DOI: 10.15252/emmm.202317745] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/17/2023] Open
Abstract
Prenatal diagnosis of congenital heart disease (CHD) relies primarily on fetal echocardiography conducted at mid-gestational age-the sensitivity of which varies among centers and practitioners. An objective method for early diagnosis is needed. Here, we conducted a case-control study recruiting 103 pregnant women with healthy offspring and 104 cases with CHD offspring, including VSD (42/104), ASD (20/104), and other CHD phenotypes. Plasma was collected during the first trimester and proteomic analysis was performed. Principal component analysis revealed considerable differences between the controls and the CHDs. Among the significantly altered proteins, 25 upregulated proteins in CHDs were enriched in amino acid metabolism, extracellular matrix receptor, and actin skeleton regulation, whereas 49 downregulated proteins were enriched in carbohydrate metabolism, cardiac muscle contraction, and cardiomyopathy. The machine learning model reached an area under the curve of 0.964 and was highly accurate in recognizing CHDs. This study provides a highly valuable proteomics resource to better recognize the cause of CHD and has developed a reliable objective method for the early recognition of CHD, facilitating early intervention and better prognosis.
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Affiliation(s)
- Ya-Nan Yin
- Institute for Developmental and Regenerative Cardiovascular Medicine, MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Institutes of Biomedical Sciences, Human Phenome Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Li Cao
- National Health Commission (NHC) Key Laboratory of Neonatal Diseases, School of Life Sciences, Obstetrics and Gynecology Hospital of Fudan University, Children's Hospital of Fudan University, Fudan University, Shanghai, China
| | - Jie Wang
- National Health Commission (NHC) Key Laboratory of Neonatal Diseases, School of Life Sciences, Obstetrics and Gynecology Hospital of Fudan University, Children's Hospital of Fudan University, Fudan University, Shanghai, China
| | - Yu-Ling Chen
- Institute for Developmental and Regenerative Cardiovascular Medicine, MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hai-Ou Yang
- International Peace Maternity and Child Health Hospital of China Welfare Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Su-Bei Tan
- State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Institutes of Biomedical Sciences, Human Phenome Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ke Cai
- Institute for Developmental and Regenerative Cardiovascular Medicine, MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhe-Qi Chen
- Institute for Developmental and Regenerative Cardiovascular Medicine, MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Health Commission (NHC) Key Laboratory of Neonatal Diseases, School of Life Sciences, Obstetrics and Gynecology Hospital of Fudan University, Children's Hospital of Fudan University, Fudan University, Shanghai, China
| | - Jie Xiang
- Institute for Developmental and Regenerative Cardiovascular Medicine, MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Health Commission (NHC) Key Laboratory of Neonatal Diseases, School of Life Sciences, Obstetrics and Gynecology Hospital of Fudan University, Children's Hospital of Fudan University, Fudan University, Shanghai, China
| | - Yuan-Xin Yang
- Institute for Developmental and Regenerative Cardiovascular Medicine, MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Health Commission (NHC) Key Laboratory of Neonatal Diseases, School of Life Sciences, Obstetrics and Gynecology Hospital of Fudan University, Children's Hospital of Fudan University, Fudan University, Shanghai, China
| | - Hao-Ran Geng
- Institute for Developmental and Regenerative Cardiovascular Medicine, MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Health Commission (NHC) Key Laboratory of Neonatal Diseases, School of Life Sciences, Obstetrics and Gynecology Hospital of Fudan University, Children's Hospital of Fudan University, Fudan University, Shanghai, China
| | - Ze-Yu Zhou
- Institute for Developmental and Regenerative Cardiovascular Medicine, MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Health Commission (NHC) Key Laboratory of Neonatal Diseases, School of Life Sciences, Obstetrics and Gynecology Hospital of Fudan University, Children's Hospital of Fudan University, Fudan University, Shanghai, China
| | - An-Na Shen
- Institute for Developmental and Regenerative Cardiovascular Medicine, MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Health Commission (NHC) Key Laboratory of Neonatal Diseases, School of Life Sciences, Obstetrics and Gynecology Hospital of Fudan University, Children's Hospital of Fudan University, Fudan University, Shanghai, China
| | - Xiang-Yu Zhou
- National Health Commission (NHC) Key Laboratory of Neonatal Diseases, School of Life Sciences, Obstetrics and Gynecology Hospital of Fudan University, Children's Hospital of Fudan University, Fudan University, Shanghai, China
| | - Yan Shi
- Institute for Developmental and Regenerative Cardiovascular Medicine, MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rui Zhao
- Institute for Developmental and Regenerative Cardiovascular Medicine, MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kun Sun
- Institute for Developmental and Regenerative Cardiovascular Medicine, MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chen Ding
- State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Institutes of Biomedical Sciences, Human Phenome Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jian-Yuan Zhao
- Institute for Developmental and Regenerative Cardiovascular Medicine, MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- International Human Phenome Institutes (Shanghai), Shanghai, China
- School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China
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4
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Bhoi NR, Chandra V, Murdia K, Jhamb T. Isolated Increased Nuchal Translucency With Normal Chromosomal Study: A Case Report. Cureus 2023; 15:e49209. [PMID: 38143692 PMCID: PMC10739557 DOI: 10.7759/cureus.49209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 12/26/2023] Open
Abstract
Increased nuchal translucency (NT) leads to a higher risk of fetal structural abnormalities. The measurement between 11 and 14 weeks gestation is a reliable marker for associated chromosomal abnormalities. Here, we present the case of a 33-year-old female with isolated high NT in the range of 5.6 mm at 12 weeks of gestational age. She was evaluated for chromosomal and structural abnormality and followed up meticulously. None of the tests showed any chromosomal or obvious structural abnormality. Fetal echocardiography revealed no structural cardiac defect. The pregnancy was uneventful and she delivered a healthy baby at term through lower (uterine)-segment cesarean section. The baby girl is living in good health without any developmental abnormalities. Although there is a high risk of chromosomal/structural defects with increased NT, it is not mandatory to terminate the pregnancy without a thorough evaluation.
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Affiliation(s)
- Nihar R Bhoi
- Reproductive Medicine, Indira IVF Hospital Private Limited, Udaipur, IND
| | - Vipin Chandra
- Clinical Research and Operations, Indira IVF Hospital Private Limited, Udaipur, IND
| | - Kshitiz Murdia
- Reproductive Medicine, Indira IVF Hospital Private Limited, Udaipur, IND
| | - Taruna Jhamb
- Reproductive Medicine, Indira IVF Hospital Private Limited, Udaipur, IND
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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.
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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
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6
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Zhang H, Wang S, Feng C, Zhao H, Zhang W, Sun Y, Yang H. Chromosomal abnormalities and structural defects in fetuses with increased nuchal translucency at a Chinese tertiary medical center. Front Med (Lausanne) 2023; 10:1158554. [PMID: 37287743 PMCID: PMC10243215 DOI: 10.3389/fmed.2023.1158554] [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: 02/04/2023] [Accepted: 04/17/2023] [Indexed: 06/09/2023] Open
Abstract
Objectives To explore the pregnancy outcomes of fetuses with increased NT thickness. Methods This was a retrospective study of fetuses with increased NT (≥95th centile) at 11-14 weeks of gestation between January 2020 and November 2020. Results Among 264 fetuses with increased NT, the median of CRL and NT was 61.2 mm and 2.41 mm. Among them, 132 pregnancy women chose invasive prenatal diagnosis (43 cases of chorionic villus sampling (CVS), 89 cases of amniocentesis). Eventually, 16 cases of chromosomal abnormalities were discovered, including 6 cases (6.4%) of trisomy 21, 4 cases (3%) of trisomy 18, 1 case (0.8%) of 45, XO, 1 case (0.8%) of 47, XXY and 4 cases (3.03%) of CNV abnormalities. The major structural defects included hydrops (6.4%), cardiac defects (3%), and urinary anomalies (2.7%). The incidences of chromosomal abnormalities and structural defects in the NT < 2.5 mm group were 1.3 and 6%, while the incidences were 8.8 and 28.9% in the NT≥2.5 group. Conclusion Increased NT was associated with high risk of chromosomal abnormalities and structural anomalies. Chromosomal abnormalities and structural defects could be detected when NT thickness was between 95th centile and 2.5 mm.
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Affiliation(s)
- Huijing Zhang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Shuang Wang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Chunli Feng
- Department of Ultrasound, Tongliao Second People’s Hospital, Tongliao, Inner Mongolia, China
| | - Hongyan Zhao
- Department of Obstetrics and Gynecology, Chengde Central Hospital, Chengde, Hebei, China
| | - Weiwei Zhang
- Department of Ultrasound, Aerospace Central Hospital, Beijing, China
| | - Yu Sun
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Huixia Yang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
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7
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Obut M, Akay A, Müjde IC, Çelik ÖY, Öncü AK, Acar Z, Seker E, Saglam E, Iskender C. Does the Presence of Extended Jugular Lymphatic Sacs Add More Risk to Nuchal Thickness for Genetic and Structural Abnormality? J Med Ultrasound 2023; 31:119-126. [PMID: 37576423 PMCID: PMC10413408 DOI: 10.4103/jmu.jmu_225_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/05/2022] [Accepted: 07/05/2022] [Indexed: 08/15/2023] Open
Abstract
Background The risks added by extended jugular lymphatic sacs (EJLS) to increased nuchal translucency (NT) including genetic and structural abnormalities and pregnancy outcomes have not been previously investigated, which this study aims to investigate. Methods The data of 155 singleton pregnancies with increased fetal NT (≥95th percentile) of these 20 with fetal EJLS were evaluated retrospectively. Patients were stratified according to NT thickness such that ≥95th percentile - 3.5 mm, 3.6-4.4 mm, 4.5-5.4 mm, 5.5-6.4 mm, ≥6.5 mm, and grouped according to the presence of EJLS. Pregnancy outcomes, genetic and structural abnormalities were assessed by comparing EJLS with non-EJSL cases (n-EJLS). Results Associated with NT, the incidence of the presence of EJLS increased with NT, from 4.5% at the ≥95th percentile - 3.5 mm to 30.8% when NT ≥5.5 mm. In the n-EJLS group, the proportion of fetuses with structural and genetic abnormalities increased as the measurement of NT increased. This correlation was not observed in the EJLS group. Compared to n-EJLS, cases with EJLS had a higher rate of fetal structural (38.5% vs. 75%, P = 0.003) and genetic (18.5% vs. 45%, P = 0.005) anomalies and a lower term live birth rate (59.3% vs. 15%, P < 0.001). Conclusion The increasing rate of EJLS was seen as NT increased. Compared to n-EJLS, the EJLS cases had a higher rate poor pregnancy outcomes and fetal genetic and structural abnormalities.
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Affiliation(s)
- Mehmet Obut
- Department of Perinatology, Etlik Zübeyde Hanim Women’s Health Training and Research Hospital, Ankara, Turkey
| | - Arife Akay
- Department of Gynecology and Obstetrics, Etlik Zübeyde Hanim Women’s Health Training and Research Hospital, Ankara, Turkey
| | - Ibanoglu Can Müjde
- Department of Gynecology and Obstetrics, Etlik Zübeyde Hanim Women’s Health Training and Research Hospital, Ankara, Turkey
| | - Özge Yucel Çelik
- Department of Perinatology, Etlik Zübeyde Hanim Women’s Health Training and Research Hospital, Ankara, Turkey
| | - Asya Kalayci Öncü
- Department of Gynecology and Obstetrics, Etlik Zübeyde Hanim Women’s Health Training and Research Hospital, Ankara, Turkey
| | - Zuat Acar
- Department of Perinatology, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Erdal Seker
- Department of Perinatology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Erkan Saglam
- Department of Perinatology, Etlik Zübeyde Hanim Women’s Health Training and Research Hospital, Ankara, Turkey
| | - Cantekin Iskender
- Department of Perinatology, Etlik Zübeyde Hanim Women’s Health Training and Research Hospital, Ankara, Turkey
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Tonni G, Bonasoni MP, Grisolia G, Bellotti M, Araujo Júnior E. Heterotaxy Syndrome with Increased Nuchal Translucency and Normal Karyotype Associated with Complex Systemic Venous Return. Ultrasound Diagnosis with Autopsy Correlation. Fetal Pediatr Pathol 2022; 41:852-860. [PMID: 34629036 DOI: 10.1080/15513815.2021.1988011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: Prenatal ultrasound (US) detection of heterotaxy syndrome can be challenging, especially in identifying cardiovascular and associated anomalies. We present a new case of heterotaxy syndrome with anomalous systemic venous return (ASVR) fully displayed at autopsy. Case report: Left heterotaxy syndrome was diagnosed in a 19 weeks' of gestation fetus with right-sided stomach. The heart showed both ventricles with left morphology, a large ventricular septal defect, persistent left superior vena cava draining into the coronary sinus, ASVR with interrupted inferior vena cava (IVC) and azygous continuation. Autopsy dissection further identified the azygous draining into the left lower pulmonary vein (LLPV). Prenatal a-CGH on villous sampling showed 22q13.1 microduplication inherited from the father, not contributory to the phenotype. Conclusion/discussion: Heterotaxy syndrome requires US accuracy for anomaly identification, as they allow legal termination of pregnancy. Our case is unusual as IVC drained into the azygous vein and then into the LLPV.
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Affiliation(s)
- Gabriele Tonni
- Department of Obstetrics and Neonatology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL di Reggio Emilia, Reggio Emilia, Italy
| | - Maria Paola Bonasoni
- Department of Pathology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL di Reggio Emilia, Reggio Emilia, Italy
| | - Gianpaolo Grisolia
- Department of Obstetrics and Gynecology, Carlo Poma Hospital, Mantua, Italy
| | | | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), Sao Paulo, Brazil
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Karim JN, Bradburn E, Roberts N, Papageorghiou AT. First-trimester ultrasound detection of fetal heart anomalies: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:11-25. [PMID: 34369613 PMCID: PMC9305869 DOI: 10.1002/uog.23740] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/09/2021] [Accepted: 07/16/2021] [Indexed: 05/05/2023]
Abstract
OBJECTIVES To determine the diagnostic accuracy of ultrasound at 11-14 weeks' gestation in the detection of fetal cardiac abnormalities and to evaluate factors that impact the detection rate. METHODS This was a systematic review of studies evaluating the diagnostic accuracy of ultrasound in the detection of fetal cardiac anomalies at 11-14 weeks' gestation, performed by two independent reviewers. An electronic search of four databases (MEDLINE, EMBASE, Web of Science Core Collection and The Cochrane Library) was conducted for studies published between January 1998 and July 2020. Prospective and retrospective studies evaluating pregnancies at any prior level of risk and in any healthcare setting were eligible for inclusion. The reference standard used was the detection of a cardiac abnormality on postnatal or postmortem examination. Data were extracted from the included studies to populate 2 × 2 tables. Meta-analysis was performed using a random-effects model in order to determine the performance of first-trimester ultrasound in the detection of major cardiac abnormalities overall and of individual types of cardiac abnormality. Data were analyzed separately for high-risk and non-high-risk populations. Preplanned secondary analyses were conducted in order to assess factors that may impact screening performance, including the imaging protocol used for cardiac assessment (including the use of color-flow Doppler), ultrasound modality, year of publication and the index of sonographer suspicion at the time of the scan. Risk of bias and quality assessment were undertaken for all included studies using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. RESULTS The electronic search yielded 4108 citations. Following review of titles and abstracts, 223 publications underwent full-text review, of which 63 studies, reporting on 328 262 fetuses, were selected for inclusion in the meta-analysis. In the non-high-risk population (45 studies, 306 872 fetuses), 1445 major cardiac anomalies were identified (prevalence, 0.41% (95% CI, 0.39-0.43%)). Of these, 767 were detected on first-trimester ultrasound examination of the heart and 678 were not detected. First-trimester ultrasound had a pooled sensitivity of 55.80% (95% CI, 45.87-65.50%), specificity of 99.98% (95% CI, 99.97-99.99%) and positive predictive value of 94.85% (95% CI, 91.63-97.32%) in the non-high-risk population. The cases diagnosed in the first trimester represented 63.67% (95% CI, 54.35-72.49%) of all antenatally diagnosed major cardiac abnormalities in the non-high-risk population. In the high-risk population (18 studies, 21 390 fetuses), 480 major cardiac anomalies were identified (prevalence, 1.36% (95% CI, 1.20-1.52%)). Of these, 338 were detected on first-trimester ultrasound examination and 142 were not detected. First-trimester ultrasound had a pooled sensitivity of 67.74% (95% CI, 55.25-79.06%), specificity of 99.75% (95% CI, 99.47-99.92%) and positive predictive value of 94.22% (95% CI, 90.22-97.22%) in the high-risk population. The cases diagnosed in the first trimester represented 79.86% (95% CI, 69.89-88.25%) of all antenatally diagnosed major cardiac abnormalities in the high-risk population. The imaging protocol used for examination was found to have an important impact on screening performance in both populations (P < 0.0001), with a significantly higher detection rate observed in studies using at least one outflow-tract view or color-flow Doppler imaging (both P < 0.0001). Different types of cardiac anomaly were not equally amenable to detection on first-trimester ultrasound. CONCLUSIONS First-trimester ultrasound examination of the fetal heart allows identification of over half of fetuses affected by major cardiac pathology. Future first-trimester screening programs should follow structured anatomical assessment protocols and consider the introduction of outflow-tract views and color-flow Doppler imaging, as this would improve detection rates of fetal cardiac pathology. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- J. N. Karim
- Nuffield Department of Women's & Reproductive HealthUniversity of OxfordOxfordUK
| | - E. Bradburn
- Nuffield Department of Women's & Reproductive HealthUniversity of OxfordOxfordUK
| | - N. Roberts
- Bodleian Health Care LibrariesUniversity of OxfordOxfordUK
| | - A. T. Papageorghiou
- Nuffield Department of Women's & Reproductive HealthUniversity of OxfordOxfordUK
- Oxford Maternal & Perinatal Health Institute, Green Templeton CollegeUniversity of OxfordOxfordUK
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Shi X, Liu Q, He W, Liu Y, Rao T, Fang L, Wu J. Prenatal and perinatal outcomes of twin pregnancy discordant for one fetus with nuchal translucency above the 95th percentile. J Matern Fetal Neonatal Med 2020; 35:3152-3157. [PMID: 32907415 DOI: 10.1080/14767058.2020.1814242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To compare prenatal and perinatal outcomes of twin pregnancies in which one twin the nuchal translucency (NT) was above the 95th percentile in dichorionic twins (DCT) and monochorionic twins (MCT). METHOD In this retrospective study, 93 twin pregnancies (186 fetuses) in which one twin the NT was above the 95th percentile and the co-twin had normal NT were analyzed. Results of of G-banding and Chromosomal microarray (CMA), ultrasound findings and pregnancy outcomes were reviewed. RESULTS Totally, 57 pregnancies (114 fetuses) were DCT and 36 pregnancies (72 fetuses) were MCT. Karyotyping and CMA results shown that clinically significant chromosomal abnormalities were found in 16 fetuses, including 13 aneuploidies, 2 chromosomal mosaic and 1 pathological Copy number variations (CNVs) (14 were DCT and 2 were MCT). Overall, the incidence of fetal chromosomal abnormalities was 12.3% (14/114) in DCT and 2.8%(2/72) in MCT (χ2 = 3.932, p = 0.047). Among the cases with normal prenatal diagnosis result, structural abnormalities were found in four fetuses (4.0%, 4/100) in DCT and two fetuses (2.9%, 2/70) in MCT (p > 0.999). There were one intrauterine fetal demises (IUFD) and two miscarry in DCT. One IUFD, three subsequently developed Twin-to-Twin Transfusion Syndrome (TTTS) and four developed selective intrauterine growth restriction (sIUGR) in MCT. Totally, the overall fetal survival rate was 85.1% (97/114) in DCT and 80.6% (58/72) in MCT (χ2 = 0.653, p = 0.419). CONCLUSION Compared to MCT, the incidence of chromosomal abnormalities in DCT discordant for one fetus with NT above the 95th percentile was higher. The risk of structural abnormalities and the rate of fetal survival for both MCT and DCT was similar.
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Affiliation(s)
- Xiaomei Shi
- Gentic Medical Center, Guangdong Women and Children Hospital, Guangzhou, China
| | - Qian Liu
- Gentic Medical Center, Guangdong Women and Children Hospital, Guangzhou, China
| | - Wei He
- Gentic Medical Center, Guangdong Women and Children Hospital, Guangzhou, China
| | - Yishan Liu
- Gentic Medical Center, Guangdong Women and Children Hospital, Guangzhou, China
| | - Tengzi Rao
- Gentic Medical Center, Guangdong Women and Children Hospital, Guangzhou, China
| | - Liyuan Fang
- Gentic Medical Center, Guangdong Women and Children Hospital, Guangzhou, China
| | - Jing Wu
- Gentic Medical Center, Guangdong Women and Children Hospital, Guangzhou, China
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Minnella GP, Crupano FM, Syngelaki A, Zidere V, Akolekar R, Nicolaides KH. Diagnosis of major heart defects by routine first-trimester ultrasound examination: association with increased nuchal translucency, tricuspid regurgitation and abnormal flow in ductus venosus. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:637-644. [PMID: 31875326 DOI: 10.1002/uog.21956] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 05/21/2023]
Abstract
OBJECTIVE To examine the association between fetal major heart defects and increased nuchal translucency thickness (NT), tricuspid regurgitation and abnormal flow in the ductus venosus in a large population of singleton pregnancies undergoing routine ultrasound examination at 11-13 weeks' gestation. METHODS This was a retrospective study of prospectively collected data from singleton pregnancies attending for a routine ultrasound scan at 11-13 weeks' gestation, which included examination of fetal anatomy, measurement of NT and assessment of blood flow across the tricuspid valve and in the ductus venosus, according to a standardized protocol. The incidence of fetal NT ≥ 95th and ≥ 99th percentiles, tricuspid regurgitation and reversed a-wave in the ductus venosus in fetuses with and those without a major heart defect was determined and the performance of each marker and their combination in the detection of major heart defects was calculated. RESULTS The study population of 93 209 pregnancies with no apparent chromosomal abnormality included 211 (0.23%) with a fetal major heart defect and 92 998 morphologically normal neonates. In 113 (53.6%) cases with a major heart defect, the diagnosis was made at the 11-13-week scan, in 82 (38.9%) at the 18-24-week scan, in 10 (4.7%) at the third-trimester scan and in six (2.8%) postnatally. At the 11-13-week scan, we diagnosed all cases of tricuspid or pulmonary atresia and polyvalvular dysplasia, > 90% of cases of hypoplastic left heart syndrome or atrioventricular septal defect, about 60% of complex heart defects and cases of left atrial isomerism (interrupted inferior vena cava with normal intracardiac anatomy), 30-40% of cases of tetralogy of Fallot and arch abnormalities, 25% of tricuspid valve abnormalities and about 15% of cases of transposition of the great arteries, but none of aortic or pulmonary stenosis or common arterial trunk. Fetal NT ≥ 95th or ≥ 99th percentile, tricuspid regurgitation or abnormal ductus venosus flow was observed in 77 (36.5%), 45 (21.3%), 61 (28.9%) and 58 (27.5%) fetuses with a major heart defect, respectively, and in 5678 (6.1%), 857 (0.9%), 1136 (1.2%) and 1644 (1.8%) of those without a heart defect. Any one of NT ≥ 95th percentile, tricuspid regurgitation or abnormal flow in the ductus venosus was found in 117 (55.5%; 95% CI, 48.5-62.3%) fetuses with a heart defect and in 8166 (8.8%; 95% CI, 8.6-9.0%) of those without a heart defect. Any one of NT ≥ 99th percentile or the other two markers was found in 99 (46.9%; 95% CI, 40.0-53.9%) fetuses with a heart defect and in 3517 (3.8%; 95% CI, 3.7-3.9%) of those without a heart defect. CONCLUSION At 11-13 weeks' gestation, measurement of fetal NT and assessment of flow across the tricuspid valve and in the ductus venosus can lead to early diagnosis of major heart defect. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- G P Minnella
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - F M Crupano
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - A Syngelaki
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - V Zidere
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - R Akolekar
- Fetal Medicine Unit, Medway Maritime Hospital, Gillingham, UK
- Institute of Medical Sciences, Canterbury Christ Church University, Chatham, UK
| | - K H Nicolaides
- Fetal Medicine Research Institute, King's College Hospital, London, UK
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Berger VK, Norton ME, Sparks TN, Flessel M, Baer RJ, Currier RJ. The utility of nuchal translucency ultrasound in identifying rare chromosomal abnormalities not detectable by cell-free DNA screening. Prenat Diagn 2019; 40:185-190. [PMID: 31652356 DOI: 10.1002/pd.5583] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/01/2019] [Accepted: 08/17/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Victoria K Berger
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA.,Division of Medical Genetics, Department of Pediatrics, University of California, San Francisco, CA
| | - Mary E Norton
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA.,Division of Medical Genetics, Department of Pediatrics, University of California, San Francisco, CA
| | - Teresa N Sparks
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA.,Division of Medical Genetics, Department of Pediatrics, University of California, San Francisco, CA
| | - Monica Flessel
- Genetic Disease Screening Program, California Department of Public Health, Richmond, CA
| | - Rebecca J Baer
- Department of Pediatrics, University of California, San Diego, CA
| | - Robert J Currier
- Department of Pediatrics, University of California, San Francisco, CA
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13
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Tekesin I. Pregnancy outcome in foetuses with increased nuchal translucency - 10-years' experience in a prenatal medical practice. J OBSTET GYNAECOL 2019; 40:455-460. [PMID: 31416379 DOI: 10.1080/01443615.2019.1621822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This retrospective study describes pregnancy outcome for foetuses with increased nuchal translucency (NT) in relation to the degree of increase in a local specialised medical practice. Data from 7352 first trimester pregnancies examined by a single observer between 10/07 and 07/17 were screened. Three hundred and ninety-three foetuses (5.3%) that had an increased NT ≥ 95th percentile and available pregnancy outcome were identified. For this population, the frequencies of chromosomal abnormality, foetal malformation, intrauterine death (IUD) and termination of pregnancy (TOP) were determined in relation to the degree of NT thickness. Favourable pregnancy outcome decreased from 77.8% (lowest NT group, 95th percentile-3.5 mm) to 5% (highest NT ≥ 6.5 mm), whereas chromosomal abnormalities rose from 18.1% to 70%. An abnormal karyotype occurred in 39.2% of foetuses with increased NT. In euploid foetuses, cardiac defects were the most common structural abnormalities. The data largely matches with earlier studies conducted in large hospital-based settings. However, a rather high proportion of foetuses with abnormal karyotype was observed.IMPACT STATEMENTWhat is already known on this subject? Increased NT is associated with chromosomal abnormalities as well as an adverse perinatal outcome also in foetuses with a normal karyotype. The prevalence of an adverse outcome increases with NT thickness. These studies were conducted more than 10 years ago mainly in academic settings.What do the results of this study add? This study describes pregnancy outcome of a population of foetuses with increased NT that were examined in a medical practice by a single observer over a period of 10 years with state of the art ultrasound equipment. We observed a relatively large proportion of foetuses with abnormal karyotype. In euploid foetuses, increased NT was associated with a wide range of foetal malformations and genetic syndromes.What are the implications of these findings for clinical practice and/or further research? Even mildly increased NT thickness is associated with an adverse pregnancy outcome, underlining the importance of thorough ultrasound examinations. Specialised prenatal medical practices can provide state-of the art technology and provide improve parental counselling.
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Tekesin I. The diagnostic value of a detailed first trimester anomaly scan in fetuses with increased nuchal translucency thickness. J Perinat Med 2019; 47:241-246. [PMID: 30218607 DOI: 10.1515/jpm-2018-0145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/15/2018] [Indexed: 11/15/2022]
Abstract
Objectives To assess the diagnostic value of an early anomaly scan in fetuses with increased nuchal translucency (NT) in the prediction of aneuploidy. Methods In this study we analyzed the data of pregnant women obtained at their first trimester screening in our unit. The detailed examination routinely includes measurement of NT and a scan for anatomical defects. For fetuses with an NT≥3.5 mm, the diagnostic power of early major sonographic findings (MSF) regarding abnormal karyotype was calculated. Results A total of 7352 first trimester examinations were screened. Two hundred and twenty-two fetuses with an NT≥3.5 mm were analyzed. The median gestational age was 12.5 weeks (range 11.0-14.6) and the median NT was 5.1 mm (range 3.5-15.3). MSF were detected in 51.8% of fetuses with increased NT. Among 115 fetuses with MSF, 91 were aneuploid, yielding a positive predictive value for aneuploidy of 79.1%. In the absence of MSF, the negative predictive value was 70.1%. The presence of MSF was significantly predictive for aneuploidy both in bivariate and multivariate regression analysis. Conclusion Our study underlines the importance of a detailed anatomical ultrasound in fetuses with increased NT, as MSF occurred frequently. However, the diagnostic value of MSF regarding aneuploidies appears to be moderate.
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Affiliation(s)
- Ismail Tekesin
- Prenatal Unit Stuttgart, Alte Poststr. 3, D-70173 Stuttgart, Germany, Tel.: +497114006010, Fax: +4971140060120
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15
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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.
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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.
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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.
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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
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Zalel Y, Zemet R, Kivilevitch Z. The added value of detailed early anomaly scan in fetuses with increased nuchal translucency. Prenat Diagn 2017; 37:235-243. [DOI: 10.1002/pd.4997] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 12/17/2016] [Accepted: 12/19/2016] [Indexed: 12/30/2022]
Affiliation(s)
- Yaron Zalel
- Department of Obstetrics and Gynecology; The Chaim-Sheba Medical Center at Tel-Hashomer, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University; Tel-Aviv Israel
| | - Roni Zemet
- Department of Obstetrics and Gynecology; The Chaim-Sheba Medical Center at Tel-Hashomer, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University; Tel-Aviv Israel
| | - Zvi Kivilevitch
- Department of Obstetrics and Gynecology; The Chaim-Sheba Medical Center at Tel-Hashomer, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University; Tel-Aviv Israel
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Mario Sarti A, Okido MM, Araujo Júnior E, Cavalli RDC, Quintana SM, Duarte G, Marcolin AC. A structurally normal fetus at the 11- to 14-week ultrasound does not guarantee a newborn without congenital anomalies: a cohort study. J Matern Fetal Neonatal Med 2016; 29:3960-6. [PMID: 26857452 DOI: 10.3109/14767058.2016.1152246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The objective of this study was to analyze the influence of maternal demographic characteristics and abnormal first-trimester sonographic markers on congenital anomalies (CAs) at birth when the fetus is structurally normal at the 11- to 14-week ultrasound. METHODS This prospective cohort study comprised high-risk women undergoing routine antenatal care. Detailed assessments of fetal anatomy and first-trimester sonographic markers were performed at 11-14 weeks of pregnancy. Multilevel regression analysis was used to determine the effects of maternal characteristics and abnormal first-trimester sonographic markers on the incidence of CA at birth. RESULTS Three hundred and ten patients were evaluated, and 41 patients (13.2%) had an anomalous newborn. The presence of a specific indication at the first-trimester ultrasound (OR: 2.72; CI 95% 1.09-6.74) or a nuchal translucency (NT) thickness greater than 2.5 mm increased the risk of CA at birth by three fold (OR: 3.10; CI 95% 1.07-9.59). High adjusted risks for trisomies 21, 18 and 13 increased the likelihood of having a structurally abnormal newborn by five, twelve and six fold, respectively. CONCLUSION Increased NT and/or high adjusted risks for trisomies 21, 18, and 13 increase the risk of CA at birth, even in fetuses with a structurally normal 11- to 14-week ultrasound scan.
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Affiliation(s)
- Angelo Mario Sarti
- a Department of Gynecology and Obstetrics , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil and
| | - Marcos Masaru Okido
- a Department of Gynecology and Obstetrics , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil and
| | - Edward Araujo Júnior
- b Department of Obstetrics , Paulista School of Medicine - Federal University of São Paulo , São Paulo , Brazil
| | - Ricardo de Carvalho Cavalli
- a Department of Gynecology and Obstetrics , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil and
| | - Silvana Maria Quintana
- a Department of Gynecology and Obstetrics , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil and
| | - Geraldo Duarte
- a Department of Gynecology and Obstetrics , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil and
| | - Alessandra Cristina Marcolin
- a Department of Gynecology and Obstetrics , Ribeirão Preto Medical School, University of São Paulo , Ribeirão Preto , Brazil and
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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
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Baer RJ, Norton ME, Shaw GM, Flessel MC, Goldman S, Currier RJ, Jelliffe-Pawlowski LL. Risk of selected structural abnormalities in infants after increased nuchal translucency measurement. Am J Obstet Gynecol 2014; 211:675.e1-19. [PMID: 24949541 DOI: 10.1016/j.ajog.2014.06.025] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 05/08/2014] [Accepted: 06/11/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE We sought to examine the association between increased first-trimester fetal nuchal translucency (NT) measurement and major noncardiac structural birth defects in euploid infants. STUDY DESIGN Included were 75,899 singleton infants without aneuploidy or critical congenital heart defects born in California in 2009 through 2010 with NT measured between 11-14 weeks of gestation. Logistic binomial regression was employed to estimate relative risks (RRs) and 95% confidence intervals (CIs) for occurrence of birth defects in infants with an increased NT measurement (by percentile at crown-rump length [CRL] and by ≥3.5 mm compared to those with measurements <90th percentile for CRL). RESULTS When considered by CRL adjusted percentile and by measurement ≥3.5 mm, infants with a NT ≥95th percentile were at risk of having ≥1 major structural birth defects (any defect, RR, 1.6; 95% CI, 1.3-1.9; multiple defects, RR, 2.1; 95% CI, 1.3-3.4). Infants with a NT measurement ≥95th percentile were at particularly high risk for pulmonary, gastrointestinal, genitourinary, and musculoskeletal anomalies (RR, 1.6-2.7; 95% CI, 1.1-5.4). CONCLUSION Our findings demonstrate that risks of major pulmonary, gastrointestinal, genitourinary, and musculoskeletal structural birth defects exist for NT measurements ≥95th percentile. The ≥3-fold risks were observed for congenital hydrocephalus; agenesis, hypoplasia, and dysplasia of the lung; atresia and stenosis of the small intestine; osteodystrophies; and diaphragm anomalies.
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Conde-Agudelo A, Bird S, Kennedy SH, Villar J, Papageorghiou AT. First- and second-trimester tests to predict stillbirth in unselected pregnant women: a systematic review and meta-analysis. BJOG 2014; 122:41-55. [PMID: 25236870 DOI: 10.1111/1471-0528.13096] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Several biophysical and biochemical tests have been proposed to predict stillbirth but their predictive ability remains unclear. OBJECTIVE To assess the accuracy of tests performed during the first and/or second trimester of pregnancy to predict stillbirth in unselected women with singleton, structurally and chromosomally normal fetuses through use of formal methods for systematic reviews and meta-analytic techniques. SEARCH STRATEGY Electronic databases, bibliographies and conference proceedings. SELECTION CRITERIA Observational studies that evaluated the predictive accuracy for stillbirth of tests performed during the first two trimesters of pregnancy. DATA COLLECTION AND ANALYSIS Two reviewers selected studies, assessed risk of bias and extracted data. Summary receiver operating characteristic curves, pooled sensitivities, specificities and likelihood ratios (LRs) were generated. Data were synthesised separately for stillbirth as a sole category and for specific stillbirth categories. MAIN RESULTS Seventy-one studies, evaluating 16 single and five combined tests, met the inclusion criteria. A uterine artery pulsatility index >90th centile during the second trimester and low levels of pregnancy-associated plasma protein A (PAPP-A) during the first trimester had a moderate to high predictive accuracy for stillbirth related to placental abruption, small-for-gestational-age or pre-eclampsia (positive and negative LRs from 6.3 to 14.1, and from 0.1 to 0.4, respectively). All biophysical and biochemical tests assessed had a low predictive accuracy for stillbirth as a sole category. CONCLUSIONS Currently, there is no clinically useful first-trimester or second-trimester test to predict stillbirth as a sole category. Uterine artery pulsatility index and maternal serum PAPP-A levels appeared to be good predictors of stillbirth related to placental dysfunction disorders.
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Affiliation(s)
- A Conde-Agudelo
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD and Detroit, MI, USA
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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]
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Nafziger E, Vilensky JA. The anatomy of nuchal translucency at 10-14 weeks gestation in fetuses with Trisomy 21: An incredible medical mystery. Clin Anat 2014; 27:353-9. [DOI: 10.1002/ca.22376] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 01/03/2014] [Accepted: 01/03/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Elizabeth Nafziger
- Department of Anatomy and Cell Biology; Indiana University School of Medicine; Fort Wayne Indiana
| | - Joel A. Vilensky
- Department of Anatomy and Cell Biology; Indiana University School of Medicine; Fort Wayne Indiana
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Khalil A, Nicolaides KH. Fetal heart defects: potential and pitfalls of first-trimester detection. Semin Fetal Neonatal Med 2013; 18:251-60. [PMID: 23751926 DOI: 10.1016/j.siny.2013.05.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Congenital heart defects (CHDs) are the leading cause of infant mortality due to birth defects. In the last 15 years, with the shift in screening for aneuploidies to the first trimester, extensive research has concentrated on early screening and detection of CHDs. Early detailed assessment of the fetal heart requires a high level of expertise in early anomaly scanning and fetal echocardiography. However, the detection of major CHDs at 11-13 weeks is influenced by their association with easily detectable markers, such as the nuchal translucency, ductus venosus blood flow and tricuspid regurgitation, and a policy decision as to the objectives of this scan and the allocation of resources necessary to achieve them. The use of transvaginal ultrasound and newer techniques are likely to improve the detection rate. However, the limitations of fetal echocardiography in the first trimester must be borne in mind, and follow-up at mid-gestational echocardiography is prudent in some cases.
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Affiliation(s)
- Asma Khalil
- Department of Fetal Medicine, St George's Hospital, University of London, UK
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25
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Sotiriadis A, Papatheodorou S, Eleftheriades M, Makrydimas G. Nuchal translucency and major congenital heart defects in fetuses with normal karyotype: a meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 42:383-389. [PMID: 23606595 DOI: 10.1002/uog.12488] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 03/24/2013] [Accepted: 04/09/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To pool published data regarding the sensitivity and specificity of nuchal translucency (NT) in the diagnosis of major congenital heart defects (CHDs) in fetuses with normal karyotype. METHODS MEDLINE and Scopus searches using combinations of the terms 'nuchal' and 'cardiac*' were complemented by perusal of references of the retrieved articles and an additional automated search using the 'search for related articles' function on PubMed. Only fetuses with normal karyotype and major CHDs were analyzed. Weighted estimates were made and summary receiver-operating characteristics curves were constructed. RESULTS The analysis included 20 studies (205 232 fetuses; 537 cases with major CHDs). The pooled sensitivity and specificity of NT > 95(th) centile for diagnosis of major CHDs was 44.4% (95% CI, 39.5-49.5) and 94.5% (95% CI, 94.4-94.6), respectively. The pooled sensitivity and specificity of NT > 99(th) centile was 19.5% (95% CI, 15.9-23.5) and 99.1% (95% CI, 99.1-99.2), respectively. For the subgroup of studies in which NT was measured by Fetal Medicine Foundation-certified operators, the pooled sensitivity and specificity of NT > 95(th) centile was 45.6% (95% CI, 39.6-51.7) and 94.7% (95% CI, 94.6-94.9), respectively. The corresponding estimates for NT > 99(th) centile were 21.0% (95%CI, 16.5-26.1) and 99.2% (95% CI, 99.2-99.3). The pooled positive likelihood ratio for NT > 99(th) centile was 30.5 (95% CI, 24.3-38.6). There was high across-studies heterogeneity for most estimates. CONCLUSION Approximately 44% of chromosomally normal fetuses with CHDs have NT > 95(th) centile and 20% have NT > 99(th) centile. However, there is high heterogeneity across studies, which largely remains even in subgroup analyses of studies of apparently similar design, potentially indicating the presence of some residual unidentified bias.
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Affiliation(s)
- A Sotiriadis
- Second Department of Obstetrics and Gynecology, Ippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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26
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Zhu S, Cao L, Zhu J, Kong L, Jin J, Qian L, Zhu C, Hu X, Li M, Guo X, Han S, Yu Z. Identification of maternal serum microRNAs as novel non-invasive biomarkers for prenatal detection of fetal congenital heart defects. Clin Chim Acta 2013; 424:66-72. [DOI: 10.1016/j.cca.2013.05.010] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 05/13/2013] [Accepted: 05/14/2013] [Indexed: 10/26/2022]
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Shamshirsaz AA, Salmanian B, Ravangard SF, Shamshirsaz AA, Javadian P, Borgida A, Turner G, Feldman D, Spiel M, Benn P, Campbell WA. Nuchal translucency and cardiac abnormalities in euploid singleton pregnancies. J Matern Fetal Neonatal Med 2013; 27:495-9. [DOI: 10.3109/14767058.2013.819336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Äyräs O, Tikkanen M, Eronen M, Paavonen J, Stefanovic V. Increased nuchal translucency and pregnancy outcome: a retrospective study of 1063 consecutive singleton pregnancies in a single referral institution. Prenat Diagn 2013; 33:856-62. [DOI: 10.1002/pd.4143] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Outi Äyräs
- Department of Obstetrics and Gynecology; Helsinki University Central Hospital; Helsinki Finland
| | - Minna Tikkanen
- Department of Obstetrics and Gynecology; Helsinki University Central Hospital; Helsinki Finland
| | - Marianne Eronen
- Health Department; The Social Insurance Institution of Finland; Helsinki Finland
| | - Jorma Paavonen
- Department of Obstetrics and Gynecology; Helsinki University Central Hospital; Helsinki Finland
| | - Vedran Stefanovic
- Department of Obstetrics and Gynecology; Helsinki University Central Hospital; Helsinki Finland
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Salman Guraya S. The associations of nuchal translucency and fetal abnormalities; significance and implications. J Clin Diagn Res 2013; 7:936-41. [PMID: 23814750 PMCID: PMC3681077 DOI: 10.7860/jcdr/2013/5888.2989] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 03/07/2013] [Indexed: 11/24/2022]
Abstract
This review of literature describes the first-trimester nuchal translucency (NT) which forms the basis of new form of screening which can lead to a significant improvement in detection of congenital anomalies as compared to second trimester screening programs, the so called genetic-sonogram. A growing body of evidence-based studies has demonstrated that fetal NT can be a powerful prenatal screening tool and combined with first trimester serum markers, it can be incredibly promising in near future. It should be expressed as Multiple of median (MoM) and maintained and monitored like any laboratory analyte. The aim of this review was to investigate the different hypotheses on the aetiology of increased NT. Using a computerized database (PubMed), articles on the aetiology of first-trimester NT were retrieved. Furthermore, the cited references of the retrieved articles were used to find additional articles. Based on ultrasonography, the associations of increased NT fetuses are described in relation with Down syndrome, Cardiac anomalies, and a diverse range of other anomalies. The review concludes that first trimester NT ultrasound has the potential to be used as an important tool for the detection of various congenital abnormalities and an early management can be implemented to reduce the mental trauma of expecting mothers by proper counseling and early diagnosis. For the precise measurements, it should be implemented in a meticulous and coherent manner.
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Affiliation(s)
- Shaista Salman Guraya
- Assistant Professor, Department of Radiology, Consultant Radiologist, College of Medicine, Taibah University, Almadinah, Almunawwarah Kingdom of Saudi Arabia
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Lepage N, Chaudhry A, Konforte D, Shaw J, Veljkovic K, Dennis A, Rashid S, Farrell SA. Standardized Procedural Practices of the Ontario Prenatal Screening Program for aneuploidies and open neural tube defects. Clin Biochem 2012; 45:1152-7. [PMID: 22732525 DOI: 10.1016/j.clinbiochem.2012.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 06/13/2012] [Accepted: 06/14/2012] [Indexed: 01/23/2023]
Abstract
BACKGROUND/OBJECTIVES The Ontario Prenatal Screening Program (OPSP) follows internationally recognized standardized procedures for laboratories and genetics clinics. However, it has been found that some procedures are subject to interpretation, so the current procedures are designed to facilitate a unified approach in the interpretation of literature recommendations. In Ontario, the OPSP offers multiple screening modalities with integrated prenatal screening (including both first and second trimester markers) being the most commonly chosen option. Other screening modalities include first trimester screening, second trimester quad screening, serum integrated screening, and NT-Quad. METHODS The standardization was based on a literature review and on current practices in Ontario. RESULTS/DISCUSSION The main finding of the review was a paucity of published data relating to the procedures and the decision-making processes involved in prenatal screening. The purpose of this publication is to provide the most up-to-date and pertinent information for clinical laboratory professionals involved with prenatal screening for Down syndrome, trisomy 18 and open neural tube defects.
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Affiliation(s)
- Nathalie Lepage
- Department of Pathology and Laboratory Medicine, University of Ottawa and Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
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Sairam S, Carvalho JS. Early fetal echocardiography and anomaly scan in fetuses with increased nuchal translucency. Early Hum Dev 2012; 88:269-72. [PMID: 22464566 DOI: 10.1016/j.earlhumdev.2012.02.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 02/22/2012] [Indexed: 11/25/2022]
Abstract
Nuchal translucency (NT) identified at the time of the 11-14 week scan has been established as one of the best tools for screening for Down syndrome. It has also proven to be of value in screening for other conditions such as cardiac defects and extra-cardiac structural abnormalities. In this article, we present data from our fetal medicine unit that highlight the importance of using NT measurement as a stratifying tool when referring for early scans. We propose that, whenever possible, in selected cases with increased NT, provision should be made for additional early scans at 14-18 weeks of gestation with a view to providing information on fetal structural integrity well ahead of the routine scheduled appointments. Early scans should incorporate detailed assessment of the fetal cardiac as well as extra-cardiac anatomy to diagnose or rule out major structural defects. This strategy will provide reassurance to a large number of prospective parents.
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Affiliation(s)
- Shanthi Sairam
- Fetal Medicine Unit, St. George's Hospital NHS Trust, Blackshaw Road, London SW17 0QT, United Kingdom.
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Mogra R, Alabbad N, Hyett J. Increased nuchal translucency and congenital heart disease. Early Hum Dev 2012; 88:261-7. [PMID: 22482746 DOI: 10.1016/j.earlhumdev.2012.02.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 02/22/2012] [Indexed: 10/28/2022]
Abstract
Sonographic assessment of fetal nuchal translucency (NT) thickness is the cornerstone of screening for chromosomal abnormality at 11-13(+6) weeks gestation. This marker was first recognized in pregnancies being karyotyped for advanced maternal age, but its underlying pathophysiology remains to be fully determined. Although increased NT is clearly associated with changes in both lymphatic and cardiac development, neither is an obvious causative agent. The association with cardiac defects has now being subjected to a significant amount of research, with a large body of evidence showing that this marker is also a screening tool for major cardiac defects - although it performs more modestly than for chromosomal abnormality. The field continues to change rapidly. Recent evidence that uses a combination of increased NT, tricuspid regurgitation and abnormal flow in the 'a' wave of the ductus venosus can provide an effective screening strategy to predict many major cardiac defects at this early stage of pregnancy.
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Affiliation(s)
- Ritu Mogra
- Discipline of Obstetrics and Gynaecology, Central Clinical School, Faculty of Medicine, University of Sydney, Australia
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Abstract
The objective of this study was to examine the performance of early fetal echocardiography as a screening tool for major cardiac defects in a high-risk population. Fetal echocardiograms performed at 12 to 16 weeks were reviewed. Cases that did not undergo a follow-up echocardiogram at 18 to 22 weeks were excluded. Results of the early and follow-up echocardiograms were compared. Over a 4-year period, 119 early fetal echocardiograms were recorded. Of those, 81 (68%) had follow-up fetal echocardiograms. Results of the early echocardiogram were normal in 77 of 81 (95.1%) cases. Of these, the follow-up was normal in 75 of these 77 cases; in the remaining 2, the follow-up raised suspicion for a ventricular septal defect (VSD) in one and persistent left superior vena cava in the other. On the other hand, the early echocardiogram was abnormal in 4 (4.9%) cases: (1) atrioventricular canal defect, with the follow-up demonstrating a VSD; (2) hypoplastic right ventricle and transposition of the great arteries, confirmed on follow-up; (3) VSD and coarctation of the aorta, confirmed on follow-up. In the fourth case, the early echocardiogram suspected a VSD and right-left disproportion, yet the follow-up was normal. In conclusion, early fetal echocardiography appears to be a reasonable screening tool for major cardiac defects.
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Affiliation(s)
- Fadi G. Mirza
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York
| | - Samuel T. Bauer
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York
| | - Ismee A. Williams
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Lynn L. Simpson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York
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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).
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Affiliation(s)
- C B Miltoft
- Department of Fetal Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. caroline
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Mula R, Goncé A, Bennásar M, Arigita M, Meler E, Nadal A, Sánchez A, Botet F, Borrell A. Increased nuchal translucency and normal karyotype: perinatal and pediatric outcomes at 2 years of age. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 39:34-41. [PMID: 21837766 DOI: 10.1002/uog.10059] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To assess the perinatal and pediatric outcomes up to 2 years of age in singleton karyotypically normal fetuses with increased nuchal translucency (NT) above the 99(th) percentile. METHODS Singleton fetuses with NT above the 99(th) percentile and normal karyotype scanned in our center from 2002 to 2006 were included. Work-up included first- and second-trimester anomaly scan, first- and second-trimester fetal echocardiography, and in selected cases infection screening and genetic testing. Among survivors, a pediatric follow-up up to 2 years of age was undertaken. RESULTS During this 4-year period, 171 singleton fetuses with NT above the 99(th) percentile and normal karyotype were included in the study. There were seven spontaneous fetal losses, 38 terminations of pregnancy and two postnatal deaths. Among the 124 (72.5%) survivors, 12 (9.7%) were born with structural abnormalities. Neurodevelopmental follow-up was completed in 108 (87.1%) of the 124 survivors and four (3.7%) showed moderate to severe impairment. Overall, a structural abnormality or genetic syndrome was diagnosed in 50 fetuses/newborns. Prenatal diagnosis was achieved for 83.8% (31/37) of the structural abnormalities and 69.2% (9/13) of the genetic syndromes. Interestingly, a single umbilical artery was found in six fetuses with no structural defects at birth, five of which had a long-term favorable outcome (4.5%), and in one 22q11 microdeletion syndrome was diagnosed at 2 years of age. CONCLUSION Singleton fetuses with an increased NT above the 99(th) percentile and normal karyotype showed a 63% intact survival. Long-term neurodevelopmental outcome among survivors did not appear to differ from that reported for the general population.
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Affiliation(s)
- R Mula
- Department of Maternal-Fetal Medicine, University of Barcelona, Barcelona, Spain
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Lin SY, Lee CN, Shih JC, Lin CH, Su YN. Two cases of Lowe syndrome presenting as increased fetal nuchal translucency. J Perinat Med 2011; 39:483-5. [PMID: 21692684 DOI: 10.1515/jpm.2011.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Syngelaki A, Chelemen T, Dagklis T, Allan L, Nicolaides KH. Challenges in the diagnosis of fetal non-chromosomal abnormalities at 11-13 weeks. Prenat Diagn 2011; 31:90-102. [PMID: 21210483 DOI: 10.1002/pd.2642] [Citation(s) in RCA: 287] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Argyro Syngelaki
- Harris Birthright Research Centre of Fetal Medicine, King's College Hospital, London, UK
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Abstract
Women with abnormal results of first trimester screening but with a normal karyotype are at risk for adverse pregnancy outcomes. A nuchal translucency of greater than 3.5 mm is associated with an increased risk of subsequent pregnancy loss, fetal infection, fetal heart abnormalities, and other structural abnormalities. Abnormal levels of first trimester analytes are also associated with adverse pregnancy outcomes, but the predictive value is less impressive. As a single marker, pregnancy-associated plasma protein (PAPP)-A level less than 1st percentile has a good predictive value for subsequent fetal growth restriction. Women with PAPP-A level less than 5th percentile should undergo subsequent risk assessment with routine maternal serum afetoprotein screening with the possible addition of uterine artery pulsatility index assessment in the midtrimester.
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Affiliation(s)
- Laura Goetzl
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425, USA.
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Abstract
The first trimester (11-13 +6 weeks) ultrasound examination is useful for several reasons: determination of an accurate date of confinement, diagnostic purposes, and screening for fetal defects. Nuchal translucency measurement combined with maternal serum markers (free b-human chorionic gonadotropin and pregnancy-associated plasma protein A) is the mainstay of first-trimester screening for chromosomal defects. However, over the past decade additional ultrasound markers have been developed that improve the performance of this type of screening. The novel markers include evaluation of the nasal bone, fronto-maxillary angle measurement, and Doppler evaluations of the blood flow across the tricuspid valve and in the ductus venosus.
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Affiliation(s)
- J Sonek
- Wright State University, Dayton, OH, USA.
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Hourrier S, Salomon LJ, Dreux S, Muller F. Screening for adverse pregnancy outcome at early gestational age. Clin Chim Acta 2010; 411:1547-52. [DOI: 10.1016/j.cca.2010.06.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Revised: 06/21/2010] [Accepted: 06/22/2010] [Indexed: 10/19/2022]
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Bilardo CM, Timmerman E, Pajkrt E, van Maarle M. Increased nuchal translucency in euploid fetuses--what should we be telling the parents? Prenat Diagn 2010; 30:93-102. [PMID: 20077440 DOI: 10.1002/pd.2396] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Nuchal translucency (NT) measurement between 11 and 14 weeks' gestation is an undisputed marker for aneuploidies. When conventional karyotyping is normal, enlarged NT is a strong marker for adverse pregnancy outcome, associated with miscarriage, intrauterine death, congenital heart defects, and numerous other structural defects and genetic syndromes. The risk of adverse outcome is proportional to the degree of NT enlargement. Although the majority of structural anomalies are amenable to ultrasound detection, unspecified genetic syndromes involving developmental delay may only emerge after birth. Concern over these prenatally undetectable conditions is a heavy burden for parents. However, following detection of enlarged NT the majority of babies with normal detailed ultrasound examination and echocardiography will have an uneventful outcome with no increased risk for developmental delay when compared to the general population. Counseling should emphasize this to help parents restore hope in normal pregnancy outcome and infant development.
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Affiliation(s)
- C M Bilardo
- Department of Obstetrics and Gynaecology, Fetal Medicine Unit Academic Medical Centre, Amsterdam, The Netherlands.
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Sananes N, Guigue V, Kohler M, Bouffet N, Cancellier M, Hornecker F, Hunsinger MC, Kohler A, Mager C, Neumann M, Schmerber E, Tanghe M, Nisand I, Favre R. Nuchal translucency and cystic hygroma colli in screening for fetal major congenital heart defects in a series of 12,910 euploid pregnancies. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 35:273-279. [PMID: 20069678 DOI: 10.1002/uog.7534] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Many studies have shown that an increased nuchal translucency (NT) may be a good marker of fetal heart malformation, but the extent to which NT is suitable for identifying the population at risk remains unclear. We aimed to determine the value of NT measurement and of the presence of cystic hygroma colli in the screening of euploid fetuses for congenital heart defects (CHD). METHODS We carried out a retrospective analysis of 12 910 euploid pregnancies examined between January 1995 and August 2007 at our institution. The screening performance of NT measurements in identifying fetuses with CHD was assessed, with comparison between the use of cut-offs defined as absolute values, multiples of the median (MoM) and percentiles. The presence of cystic hygroma colli was also assessed in the prediction of CHD. RESULTS The incidence of major CHD was 3.4 per thousand (44/12 910). The sensitivity of NT measurement in screening for major CHD was 54.5% if the threshold was set at the 95(th) percentile, 45.4% if it was set at 3 mm, 27.3% for 3.5 mm, 50.0% for 1.5 MoM and 45.5% for 1.75 MoM. The false-positive rates for these thresholds were 8.4, 6.6, 1.7, 8.9 and 6.3%, respectively. The incidence of major CHD was 1.2% (10/813) in cases of thick NT (> 95(th) centile) and 4.3% (13/304) in cases of hygroma colli. CONCLUSIONS NT measurement during the first trimester is potentially useful for screening for fetal major CHD. Screening performance is consistent whether NT values are expressed as MoMs, percentiles or absolute values. The incidence of major CHD seems to be higher in cases of cystic hygroma colli.
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Affiliation(s)
- N Sananes
- Department of Ultrasound and Fetal Medicine, CMCO-SIHCUS, Strasbourg, France
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Abstract
Abstract
For many years, the main use of ultrasound in the first trimester of pregnancy was to confirm viability and to establish gestational age. Indeed, the crown-rump length measurement in the first trimester remains the most accurate method to estimate the gestational age even today. However, improvements in ultrasound equipment and improvement in our understanding of normal and abnormal fetal development allows us now to perform a much more complete first trimester fetal evaluation. This pertains not only to the diagnosis of fetal anomalies but also to screening for fetal defects. The combination of the nuchal translucency measurement and maternal serum biochemistries (free β-hCG and PAPP-A) has been shown to be an extremely efficient way to screen for fetal aneuploidy. The addition of other first trimester markers such as the nasal bone evaluation, frontomaxillary facial angle measurement, and Doppler evaluation of blood flow across the tricuspid valve and through the ductus venosus improves the screening performance even further by increasing the detection rates and decreasing the false positive rates. Several of the first trimester markers also are useful in screening for cardiac defects. Furthermore, significant nuchal translucency thickening has been associated with a variety of genetic and nongenetic syndromes. A recently described first trimester marker called the intracerebral translucency appears to hold great promise in screening for open spine defects. Finally, it appears that a first trimester evaluation (uterine artery Doppler and the measurement of certain biochemical markers in the maternal serum) significantly improves the assessment of the risk of preeclampsia.
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Schou KV, Kirchhoff M, Nygaard U, Jørgensen C, Sundberg K. Increased nuchal translucency with normal karyotype: a follow-up study of 100 cases supplemented with CGH and MLPA analyses. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 34:618-622. [PMID: 19953565 DOI: 10.1002/uog.7468] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To evaluate whether high-resolution comparative genomic hybridization (HR-CGH) and subtelomeric and syndrome-specific multiplex ligation-dependent probe amplification (MLPA) would detect minor chromosomal aberrations in fetuses with increased nuchal translucency thickness (NT) and normal karyotype on conventional karyotyping. METHODS Chorionic villus samples from 100 fetuses with NT > or = 99(th) percentile and normal G-banding analysis and MLPA for detection of aneuploidies for chromosomes 13, 18, 21, X and Y were included. Examinations were supplemented by HR-CGH and MLPA for syndromes and subtelomeric regions. Pregnancy outcome was followed up. RESULTS Among 80 liveborn children who were followed up, three (4%) had syndromes involving mental retardation, including a case of Sotos syndrome caused by a de novo mutation. 15% of fetuses were lost during pregnancy due to abnormalities and termination. The rate of adverse outcome overall was 18%. HR-CGH and MLPA did not detect any chromosomal aberrations associated with the syndromes. CONCLUSION The rate of adverse outcome was similar to levels recorded in the literature. Using CGH and MLPA did not increase the detection rate of genetic disease, which supports the current approach of repeated ultrasound examinations in these high-risk pregnancies.
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Affiliation(s)
- K V Schou
- Departments of Fetal Medicine and Ultrasound, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Clur SA, Ottenkamp J, Bilardo CM. The nuchal translucency and the fetal heart: a literature review. Prenat Diagn 2009; 29:739-48. [PMID: 19399754 DOI: 10.1002/pd.2281] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In this overview the current knowledge of the relationship between an increased nuchal translucency (NT) measurement and fetal heart structure and function in chromosomally normal fetuses is reviewed. Relevant pathophysiological theories behind the increased NT are discussed. Fetuses with an increased NT have an increased risk for congenital heart disease (CHD) with no particular bias for one form of CHD over another. This risk increases with increasing NT measurement. Although the NT measurement is only a modestly effective screening tool for all CHD when used alone, it may indeed be effective in identifying specific CHD "likely to benefit" from prenatal diagnosis. The combination of an increased NT, tricuspid regurgitation and an abnormal ductus venosus (DV) Doppler flow profile, is a strong marker for CHD. A fetal echocardiogram should be performed at 20 weeks' gestation in fetuses with an NT > or = 95th percentile but < 99th percentile. When the NT measurement is > or = 99th percentile, or when tricuspid regurgitation and/or an abnormal DV flow pattern is found along with the increased NT, an earlier echocardiogram is indicated, followed by a repeat scan at around 20 weeks' gestation. The resultant increased demand for early fetal echocardiography and sonographers with this special expertise needs to be planned and provided for.
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Affiliation(s)
- S A Clur
- Department of Pediatric Cardiology of the Emma Children's Hospital, Academic Medical Centre, Meibergdreef 9, Amsterdam, The Netherlands.
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Alexioy E, Alexioy E, Trakakis E, Kassanos D, Farmakidis G, Kondylios A, Laggas D, Salamalekis E, Florentin L, Kanavakis E, Basios G, Trompoukis P, Georgiadoy L, Panagiotopoulos T. Predictive value of increased nuchal translucency as a screening test for the detection of fetal chromosomal abnormalities. J Matern Fetal Neonatal Med 2009; 22:857-62. [DOI: 10.1080/14767050902994572] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Prevalence of increased nuchal translucency in fetuses with congenital cardiac disease and a normal karyotype. Cardiol Young 2009; 19:441-5. [PMID: 19638249 DOI: 10.1017/s1047951109990655] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Our aims were to estimate the prevalence of increased nuchal translucency in fetuses with a normal karyotype that were subsequently diagnosed with congenital cardiac disease on fetal echocardiography, and to assess whether there is a link between increased nuchal translucency and specific congenital cardiac malformations. METHODS We reviewed all patients referred to King's College Hospital and the Evelina Children's Hospital in London for fetal echocardiography between January 1998 and December 2007. We investigated the proportion of chromosomally normal fetuses with congenitally malformed hearts in which nuchal thickness was increased, both overall and with specific defects. RESULTS We identified 2133 fetuses with congenital cardiac disease by prenatal echocardiography. Of those, 707 were excluded due to abnormal karyotype, and 690 were excluded due to unknown karyotype. The remaining 736 were eligible for inclusion. Among 481 fetuses with documented congenital cardiac disease and normal chromosomes, making up 23% of the overall cohort, 224 had increased nuchal thickness defined as equal or greater than 2.5 millimetres, this being 0.47 of the inclusive cohort, with 95% confidence intervals from 0.42 to 0.51. These proportions were significantly higher than the expected proportion of the normal population, which was 0.05 (p < 0.001). The only diagnosis for which the proportion of fetuses with nuchal translucency measurement equal or greater than 2.5 millimetres was higher than the others was atrioventricular septal defect, with 0.62 of this cohort having abnormal values, with 95% confidence intervals from 0.47 to 0.77 (p = 0.038). CONCLUSION We found that nearly half of prenatally diagnosed fetuses with congenitally malformed hearts, when examined ultrasonically in the first or early-second trimester, had increased nuchal thickness. We recommend, therefore, referral of all fetuses with increased nuchal translucency for fetal echocardiography.
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Sheizaf B, Sheiner E, Fink M, Hershkovitz R, Mazor M, Wiznitzer A. A significant linear association exists between nuchal translucency thickness and adverse perinatal outcome in euploid fetuses. J Matern Fetal Neonatal Med 2009; 22:479-84. [DOI: 10.1080/14767050802676717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Prenatal screening for serious congenital heart defects using nuchal translucency: a meta-analysis. Prenat Diagn 2008; 28:1094-104. [DOI: 10.1002/pd.2124] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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