1
|
Di Mascio D, Buca D, Khalil A, Rizzo G, Makatsariya A, Sileo F, Liberati M, Benedetti Panici P, Acharya G, D'Antonio F. Outcome of isolated fetal talipes: A systematic review and meta-analysis. Acta Obstet Gynecol Scand 2019; 98:1367-1377. [PMID: 31034582 DOI: 10.1111/aogs.13637] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 04/16/2019] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The aim of this systematic review was to explore the outcome of fetuses with a prenatal diagnosis of isolated talipes. MATERIAL AND METHODS Medline, Embase, Cinahl, and Clinicaltrials.gov databases were searched. The outcomes explored were: associated anomalies detected at follow-up ultrasound examination; fetal magnetic resonance imaging (MRI) and birth; chromosomal abnormalities detected with standard and chromosomal microarray analysis, intrauterine, neonatal, and perinatal death, and termination of pregnancy; rate of surgical and nonsurgical treatment; neurodevelopmental outcome; and false-positive rate of prenatal diagnosis. Meta-analyses of proportions were used to combine data. RESULTS Twenty-five studies (1567 fetuses) were included. Associated anomalies were detected in 7.8% (95% CI 0.1%-29.3%) of cases at follow-up ultrasound, and in 4.0% (95% CI 0.1%-13.2%) of cases, fetal MRI identified anomalies not detected at ultrasound assessment. Similarly, 7.0% (95% CI 3.4%-11.7%) of cases labeled as isolated talipes on prenatal imaging were found to have associated anomalies at birth. Abnormal karyotype was present in 3.6% (95% CI 1.7%-6.2%) of fetuses, whereas no anomaly was found at chromosomal microarray analysis, although this outcome was reported by only 1 study. Intrauterine death occurred in 0.99% (95% CI 0.4%-1.9%) of fetuses, whereas the corresponding figures for neonatal death and termination of pregnancy were 1.5% (95% CI 0.6%-2.6%) and 2.2% (95% CI 1.2%-3.4%), respectively. Surgical management of anomalies after birth was found in 41.7% (95% CI 27.0%-57.2%) of fetuses with isolated talipes, and 54.8% (95% CI 31.5%-77.0%) had nonsurgical management of the anomalies after birth. Abnormal neurodevelopmental outcome was reported in 7.6% (95% CI 1.0%-19.4%) of children, although this analysis was affected by the small number of included cases and short time of follow up. CONCLUSIONS Isolated talipes detected on prenatal ultrasound carries a generally good prognosis. The incidence of additional abnormalities detected on fetal MRI, aneuploidy, or neurodevelopmental disability is relatively low. However, longitudinal ultrasound assessment during pregnancy and a thorough postnatal evaluation are recommended to rule out associated anomalies that may significantly impact short- and long-term prognosis.
Collapse
Affiliation(s)
- Daniele Di Mascio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University, Rome, Italy
| | - Danilo Buca
- Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Asma Khalil
- Fetal Medicine Unit, Saint George's Hospital, London, UK
- Vascular Biology Research Center, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Giuseppe Rizzo
- Division of Maternal and Fetal Medicine, Ospedale Cristo Re, University of Rome Tor Vergata, Rome, Italy
- Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Alexander Makatsariya
- Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Filomena Sileo
- Fetal Medicine Unit, Saint George's Hospital, London, UK
| | - Marco Liberati
- Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | | | - Ganesh Acharya
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Francesco D'Antonio
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
- Department of Obstetrics and Gynecology, University Hospital of Northern Norway, Tromsø, Norway
| |
Collapse
|
2
|
Kadia BM, Aroke D, Tianyi FL, Bechem NN, Dimala CA. Spina bifida cystica and severe congenital bilateral talipes equinovarus in one twin of a monoamniotic pair: a case report. BMC Res Notes 2017; 10:771. [PMID: 29282147 PMCID: PMC5745804 DOI: 10.1186/s13104-017-3108-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 12/20/2017] [Indexed: 09/15/2023] Open
Abstract
Background Spina bifida and congenital talipes equinovarus (CTEV) are common congenital malformations which may occur together and increase morbidity. Monozygous twins are particularly at risk of these malformations and discordance in one type of malformation is typical. The occurrence of both spina bifida and CTEV in one twin of a monozygotic pair is rare. Case presentation A 22 year-old Cameroonian primigravida at 36 weeks of a twin gestation was received in our district hospital at the expulsive phase of labour on a background of sub-optimal antenatal care. A caesarean section indicated for cephalo-pelvic disproportion was performed and life monoamniotic male twins were extracted. The first twin was normal. The second twin had spina bifida cystica and severe bilateral CTEV. Routine postnatal care was ensured and at day 2 of life, the affected twin was evacuated to a tertiary hospital for proper management. He was later on reported dead from complications of hydrocephalus. Conclusions Spina bifida cystica with severe bilateral CTEV in one twin of a monoamniotic pair illustrates the complexity in the interplay of causal factors of these malformations even among monozygotic twins who are assumed to share similar genetic and environmental features. The occurrence and poor outcome of the malformations was probably potentiated by poor antenatal care. With postnatal diagnoses, a better outcome was difficult to secure even with prompt referral. Early prenatal diagnoses and appropriate counseling of parents are cardinal.
Collapse
Affiliation(s)
- Benjamin Momo Kadia
- Foumbot District Hospital, Foumbot, Cameroon.,Grace Community Health and Development Association, Kumba, Cameroon
| | - Desmond Aroke
- Health and Human Development (2HD) Research Network, Douala, Cameroon. .,Mbengwi District Hospital, Mbengwi, Cameroon.
| | | | | | - Christian Akem Dimala
- Health and Human Development (2HD) Research Network, Douala, Cameroon.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Department of Orthopaedics, Southend University Hospital, Essex, UK
| |
Collapse
|
3
|
Stone P, Martis W, Crawford H. Idiopathic congenital talipes equinovarus; not always an isolated anomaly. A review of long-term outcomes. J Matern Fetal Neonatal Med 2017; 31:2693-2698. [DOI: 10.1080/14767058.2017.1353967] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Peter Stone
- Department of Obstetrics and Gynaecology, University of Auckland, Grafton, New Zealand
| | - Walston Martis
- Department of Obstetrics and Gynaecology, University of Auckland, Grafton, New Zealand
| | | |
Collapse
|
4
|
Huntley JS, Howard JJ. QUESTION 2: What is the predictive value of an antenatal ultrasound showing apparently isolated talipes equinovarus? Arch Dis Child 2016; 101:1073-1078. [PMID: 28245180 DOI: 10.1136/archdischild-2016-311594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 09/21/2016] [Indexed: 11/03/2022]
|
5
|
Glotzbecker MP, Estroff JA, Curtis TA, Kalish LA, Spencer SA, Parad RB, Kasser JR, Mahan ST. Prospective Evaluation of a Prenatal Sonographic Clubfoot Classification System. Fetal Diagn Ther 2013; 34:236-40. [DOI: 10.1159/000354554] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 07/16/2013] [Indexed: 11/19/2022]
|
6
|
Liao H, Cai A, Wang B, Wang X, Yan Z, Li J. Value of the fetal plantar shape in prenatal diagnosis of talipes equinovarus. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:997-1002. [PMID: 22733848 DOI: 10.7863/jum.2012.31.7.997] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the value of the fetal plantar shape in prenatal diagnosis of talipes equinovarus. METHODS A case-control study was conducted between September 2009 and February 2011. We measured the width and length of 249 feet (156 fetuses) included in this study and then calculated the width to length ratio. All of the fetuses were followed to obtain the pregnancy outcomes and confirm whether the deformity existed; then the bimalleolar angle of each foot with talipes equinovarus was measured. Independent samples t tests were performed to compare the foot width, length, and width to length ratio between normal and talipes equinovarus groups. We also assessed the correlation between the width to length ratio and bimalleolar angle in the talipes equinovarus cases with the Pearson correlation coefficient. RESULTS Statistically significant differences were shown between the two groups (P< .001) for the three foot measurements, and a significant negative correlation was found between the width to length ratio and bimalleolar angle of the affected foot (r = -0.857). CONCLUSIONS The fetal plantar shape can provide valuable information for prenatal diagnosis of clubfoot. Compared with a normal foot, a clubfoot tends to be wider and shorter. A higher width to length ratio is associated with a smaller bimalleolar angle and indicates a more severe talipes equinovarus deformity.
Collapse
Affiliation(s)
- Huifang Liao
- Department of Ultrasound, Shengjing Hospital of China Medical University, 36 Sanhao St 110004, Shenyang, Liaoning, China
| | | | | | | | | | | |
Collapse
|
7
|
Hartge DR, Gaertner S, Weichert J. Prenatal detection and postnatal outcome of congenital talipes equinovarus in 106 fetuses. Arch Gynecol Obstet 2012; 286:831-42. [DOI: 10.1007/s00404-012-2325-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 03/29/2012] [Indexed: 11/29/2022]
|
8
|
Agarwal A, Qureshi NA, Kumar P, Garg A, Gupta N. Ultrasonographic evaluation of Achilles tendons in clubfeet before and after percutaneous tenotomy. J Orthop Surg (Hong Kong) 2012; 20:71-4. [PMID: 22535815 DOI: 10.1177/230949901202000114] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To measure the size of the Achilles tendons in congenital clubfeet using ultrasonography before and after percutaneous tenotomy. METHODS 15 boys and 12 girls (39 feet) aged one to 11 (mean, 5) months with idiopathic clubfeet underwent percutaneous tenotomy (Ponseti method). The size of each Achilles tendon was measured ultrasonographically by a single radiologist before and after surgery. In patients with unilateral clubfoot, the normal foot was used as a referent. Longitudinal scans assessed the echotexture, echogenicity, and continuity of the tendon. Transverse scans assessed the shape, echotexture, echogenicity, thickness, and width of the tendon. The size of the Achilles tendon was estimated as an elliptical area using the formula: pi(thickness)x(width)/4. RESULTS Before tenotomy, homogenous, hyperechoic, and linear continuous shadows were noted in longitudinal scans of both the normal and affected Achilles tendons. In transverse scans, the tendons were elliptical, homogenous, and echogenic in appearance. Four weeks after tenotomy, the tendons appeared as heterogeneous, linear continuous shadows with regular margins irrespective of patient age. There was decreased echogenicity in the treated foot. The transverse section of the tendons was elliptical with a heterogeneous echotexture that was predominantly hypoechoic. There was no significant difference in normal, unilateral, and bilateral tendons before and after tenotomy. CONCLUSION The study reasserts functional continuity of the Achilles tendons 4 weeks after tenotomy using clinical and ultrasonographic methods.
Collapse
Affiliation(s)
- Anil Agarwal
- Department of Orthopaedics, CNBC, Geeta Colony, Delhi, India.
| | | | | | | | | |
Collapse
|
9
|
Radler C, Myers AK, Burghardt RD, Arrabal PP, Herzenberg JE, Grill F. Maternal attitudes towards prenatal diagnosis of idiopathic clubfoot. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 37:658-662. [PMID: 21229570 DOI: 10.1002/uog.8932] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/24/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To examine maternal attitudes towards prenatal diagnosis of idiopathic clubfoot and to determine the incidence of false-negative ultrasound examinations. METHODS Surveys were mailed to mothers of patients with clubfoot born between 2000 and 2007 who were treated at either Sinai Hospital of Baltimore or Orthopaedic Hospital Speising. Exclusion criteria were underlying syndrome, genetic abnormality and multiple pregnancy. The survey asked the mother whether she had had any ultrasound examinations before her child was born, whether any of these had shown clubfoot, and whether she would have preferred to find out about her child's clubfoot before birth or after birth. RESULTS Mothers completed 220 (USA, 105 surveys; Austria, 115 surveys) of 401 mailed surveys. The prenatal detection rate was 60% in the USA compared with 25% in Austria (P = 0.001). Overall, 74% of mothers indicated a preference for prenatal diagnosis and 24% indicated a preference for postnatal diagnosis of the condition. Of 92 patients diagnosed prenatally, 96% of mothers indicated a preference for a prenatal diagnosis. Of 128 patients diagnosed postnatally, 58% of mothers indicated a preference for prenatal diagnosis, 38% for postnatal diagnosis and 4% were undecided. CONCLUSIONS The diagnosis of clubfoot is still often missed during routine ultrasound examination. When a prenatal diagnosis is made, most mothers appreciate having this information. However, when prenatal diagnosis is missed, a significant proportion of mothers seem to accept the false-negative diagnosis retrospectively.
Collapse
Affiliation(s)
- C Radler
- Orthopaedic Hospital Speising, Vienna, Austria
| | | | | | | | | | | |
Collapse
|
10
|
The non-surgical management of Congenital Talipes Equino Varus (CTEV) in the first year of life: An Irish perspective. Int J Orthop Trauma Nurs 2011. [DOI: 10.1016/j.ijotn.2010.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
11
|
Abstract
Congenital clubfoot is a relatively common lower limb deformity that is increasingly managed by non-operative methods of serial manipulation and immobilization. This review looks at aetiology, examination techniques and severity scoring, and provides an overview of operative and non-operative methods of treatment.
Collapse
Affiliation(s)
- Henry B Colaço
- Department of Trauma and Orthopaedics at Eastbourne District General Hospital, Eastbourne, East Sussex BN21 2UN
| | | | | | | |
Collapse
|
12
|
Canto MJ, Cano S, Palau J, Ojeda F. Prenatal diagnosis of clubfoot in low-risk population: associated anomalies and long-term outcome. Prenat Diagn 2008; 28:343-6. [PMID: 18382991 DOI: 10.1002/pd.1984] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To evaluate associated congenital anomaly risk, need for surgical treatment and long-term outcome in prenatally diagnosed clubfoot. METHODS A retrospective study of 20 663 pregnant women who underwent routine ultrasound scanning at 18 to 22 weeks of gestation. Clubfoot was considered as complex or isolated if other structural or chromosomal abnormalities were also present or not. RESULTS Forty-two cases of congenital clubfoot were diagnosed (incidence: 0.2%), 28 of them (66.6%) were isolated and 14 (33.3%) were complex, of which 3 (7.1%) had an abnormal karyotype and 11 (26.2%) had an associated structural anomaly. The false-positive rate was 2.3% (1 out of 32 liveborns). Out of the 41 confirmed affected fetuses, the defect was unilateral in 12 (29.3%) and bilateral in 29 (70.7%) cases. Surgery was necessary in 12 of the newborns (38.7%). The presence of a bilateral clubfoot was unrelated to either the presence of associated anomalies (p = 0.40) or to the necessity of surgery (p = 0.48). CONCLUSIONS We provide outcome data about fetuses prenatally diagnosed for clubfoot. One-third are complex cases associated with other congenital anomalies. For isolated clubfoot, the risk of requiring surgery is about 40%. The detection of a bilateral defect does not worsen the prognosis.
Collapse
Affiliation(s)
- M J Canto
- Hospital General de Granollers, Barcelona, Spain.
| | | | | | | |
Collapse
|
13
|
|
14
|
Offerdal K, Jebens N, Blaas HGK, Eik-Nes SH. Prenatal ultrasound detection of talipes equinovarus in a non-selected population of 49 314 deliveries in Norway. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2007; 30:838-44. [PMID: 17787031 DOI: 10.1002/uog.4079] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVES To evaluate prenatal ultrasound detection of talipes equinovarus (TEV) in a large non-selected population and to study trends in detection rates over time, as well as the prevalence and outcome of isolated TEV and TEV with associated anomalies. METHODS All cases of pre- or postnatally diagnosed TEV between 1987 and 2004 within a non-selected population of 49 314 deliveries were investigated. The study period was divided into three 6-year periods to shed light on changes in detection rates and other aspects of the anomaly over time. RESULTS A total of 113 cases of TEV were registered during the 18-year period, of which 49% had isolated TEV and 51% had associated anomalies. During the three 6-year periods, there was a significant improvement (P = 0.006) in the overall detection of TEV from 43% to 67% and 77%, respectively. The detection rate for isolated TEV increased over time. Isolated bilateral TEV cases were detected more than twice as often as isolated unilateral TEV. The three largest groups of associated anomalies were syndromes/sequences (26%), chromosome aberrations (26%), and musculoskeletal disorders (24%). Pregnancies were terminated in 23% of the cases, all with severe additional anomalies. Treatment of TEV included surgery in 86% of the cases. CONCLUSION The overall detection rate of TEV improved significantly over time. Prenatal detection was higher when TEV was bilateral and when other associated anomalies were present. Parents should be informed that, in suspected isolated TEV, associated anomalies might remain undetected prenatally.
Collapse
Affiliation(s)
- K Offerdal
- National Center for Fetal Medicine, Women and Children's Centre, St. Olavs University Hospital and Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway.
| | | | | | | |
Collapse
|
15
|
Cohen-Overbeek TE, Grijseels EWM, Lammerink EAG, Hop WCJ, Wladimiroff JW, Diepstraten AFM. Congenital talipes equinovarus: comparison of outcome between a prenatal diagnosis and a diagnosis after delivery. Prenat Diagn 2006; 26:1248-53. [PMID: 17099928 DOI: 10.1002/pd.1596] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To establish the impact on outcome of prenatally versus postnatally detected talipes equinovarus (TEV). METHODS The prenatal group was represented by pregnancies with sonographically detected TEV of which 18 were isolated and 39 were complex. The postnatal group contained 64 infants with an isolated and 10 infants with a complex TEV detected at birth. Treatment consisted of redressement followed by surgical postero-lateral or postero-medial release at the University Paediatric Orthopaedic Centre. The postnatal isolated TEV group underwent redressement treatment at the University Centre (subset A, n = 39) or at a regional general hospital (subset B, n = 25). RESULTS For isolated TEV, statistically significant difference existed for the surgical procedure (p < 0.001), age at surgery (p < 0.01) and admission time (p < 0.001) between the prenatal and postnatal subset B and between the postnatal subsets A and B. For the complex TEV, no significant difference was found for these variables between the six surviving infants of the prenatal group and the postnatal group. CONCLUSION Prenatal detection of isolated TEV results in earlier and less complicated postnatal surgery and a shorter admission time, provided treatment is arranged at a paediatric orthopaedic centre. After prenatal detection of a complex TEV, survival is low and determined by associated anomalies.
Collapse
Affiliation(s)
- T E Cohen-Overbeek
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands.
| | | | | | | | | | | |
Collapse
|
16
|
Abstract
Congenital talipes equinovarus (CTEV) and other skeletal abnormalities can be diagnosed prenatally by ultrasound scan. If diagnosed, clinicians should be cautiously optimistic with the parents, particularly if the talipes diagnosed is isolated and not associated with other foetal abnormalities. There is no correlation between the prenatal appearance of the foot and the state of the foot at birth, nor with the necessity for surgical intervention.
Collapse
|
17
|
Mohammed NB, Biswas A. Three-dimensional ultrasound in prenatal counselling of congenital talipes equinovarus. Int J Gynaecol Obstet 2002; 79:63-5. [PMID: 12399101 DOI: 10.1016/s0020-7292(02)00174-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The fetus of a 35-year-old woman, gravida 5, para 3, was diagnosed with isolated left-sided congenital talipes equinovarus on routine ultrasound at 22 weeks of gestation. Parents were counselled about the abnormality but still ultrasound pictures made it difficult for them to understand the nature of the defect. A three-dimensional ultrasound scan helped the couple to understand the abnormality, make an informed choice-with self-confidence-regarding pregnancy continuation, and plan for postnatal management.
Collapse
Affiliation(s)
- N B Mohammed
- Antenatal Diagnostic Centre, Department of Obstetrics and Gynaecology, National University of Singapore, Singapore
| | | |
Collapse
|
18
|
Bakalis S, Sairam S, Homfray T, Harrington K, Nicolaides K, Thilaganathan B. Outcome of antenatally diagnosed talipes equinovarus in an unselected obstetric population. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2002; 20:226-229. [PMID: 12230442 DOI: 10.1046/j.1469-0705.2002.00780.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To investigate the natural history and outcome of fetal talipes diagnosed by routine ultrasound scanning at 18-23 weeks' gestation. PATIENTS AND METHODS This was a retrospective study of 103 228 pregnancies undergoing routine ultrasound scanning at 18-23 weeks' gestation. A computer search was made to identify all cases of fetal talipes and the records of these patients were examined to determine the incidence of other defects and pregnancy outcome. RESULTS The incidence of fetal talipes following routine ultrasound examination was 0.10% (107/103 228) and was bilateral in 64 (59.8%) and unilateral in 43 (40.2%) cases. In 52 (48.6%) cases, talipes was of complex etiology, as it was associated with other defects, while, in 55 (51.4%) cases, it was classified as idiopathic. In 19% of cases, an initial diagnosis of idiopathic talipes was changed to complex, because of the subsequent development of associated features. Perinatal death and long-term neurodevelopmental or musculoskeletal problems were significantly more common when the talipes was complex rather than idiopathic (odds ratio, 150; 95% confidence interval, 34-665). Adverse outcomes were also seen more frequently with bilateral compared to unilateral talipes (odds ratio, 3.44; 95% confidence interval, 1.50-7.90). CONCLUSION The outcome of antenatally detected talipes is mainly dependent on the presence or absence of other defects. A significant proportion of cases, thought to be idiopathic at presentation, will develop associated complex features when reassessed on subsequent scans or postnatally.
Collapse
Affiliation(s)
- S Bakalis
- Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St George's Hospital Medical School, London, UK
| | | | | | | | | | | |
Collapse
|
19
|
(i) Congenital talipes equinovarus (clubfoot): an overview of the aetiology and treatment. ACTA ACUST UNITED AC 2002. [DOI: 10.1054/cuor.2002.0251] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
20
|
|
21
|
Carroll SG, Lockyer H, Andrews H, Abdel-Fattah S, McMillan D, Kyle PM, Soothill PW. Outcome of fetal talipes following in utero sonographic diagnosis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2001; 18:437-440. [PMID: 11844161 DOI: 10.1046/j.0960-7692.2001.00509.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVES To examine the association between fetal talipes and other defects, and outcome in relation to postnatal surgery. METHODS All cases of talipes presenting to the fetal medicine unit between 1993 and 1998 and cases of isolated talipes presenting to the ultrasound department between 1991 and 1998 were examined. The infants were followed-up to determine the number of cases that had structural or positional talipes and the number of cases requiring surgery. RESULTS There were 76 cases, 59 of which attended the fetal medicine unit and 17 the ultrasound department. Postnatal follow-up details were available in 31 of the 40 live births. There were three neonates with unilateral talipes at birth who were thought to have bilateral talipes on prenatal ultrasound and one neonate had bilateral talipes at birth who had been thought to have unilateral talipes prenatally. In two (6.4%) neonates in whom talipes was not confirmed at birth the abnormality was diagnosed prenatally. Of the 29 neonates with confirmed talipes at birth, the defect was structural in 26 (90%) cases and positional in three. Surgery was necessary in 21 (72%) of the 29 cases and 18 (86%) of those undergoing surgery required only one operation. When live births with associated anomalies were excluded, there were 24 cases with confirmed isolated talipes and 18 (75%) required surgery. CONCLUSIONS This study provides long-term outcome data which can be used to complement current prenatal counseling and shows that in cases of fetal talipes diagnosed prenatally, 90% have a structural rather than a positional deformity. For isolated talipes three quarters of children will require surgery and in the majority of cases only one operation on the foot is necessary. Parents should be made aware of the small possibility of a false-positive diagnosis and discrepancy between the ultrasound and postnatal diagnoses of laterality.
Collapse
Affiliation(s)
- S G Carroll
- Fetal Medicine Unit, St Michael's Hospital, Bristol, UK.
| | | | | | | | | | | | | |
Collapse
|