Multiple congenital contractures (congenital multiple arthrogryposis)

Artrogriposis múltiple congénita: espectro de deformidades en el miembro superior, a propósito de una serie de casos

Introducción. La artrogriposis múltiple comprende un grupo complejo de patologías que producen disminución de la movilidad articular. Su tratamiento está enfocado en mejorar la movilidad con rehabilitación y cirugía en algunos casos.Objetivo. Mostrar las deformidades por artrogriposis en el miembro superior, los tipos de tratamiento y sus resultados.Materiales y métodos. Se estudiaron 27 casos (19 operados) que fueron agrupados de acuerdo a compromiso distal en dedos o muñeca o proximal en codo y hombroResultados. El compromiso principal fue de muñecas y dedos, solo se presentaron dos casos con afectación única del codo. Las cirugías comprendieron z-plastias, liberación de placa palmar y fijación de articulaciones; en la muñeca se realizó liberación de partes blandas, fijación provisional y artrodesis. Se dio un caso de liberación del tríceps, otro de liberación de un pterigio y otro de transferencia muscular para flexión de codo.Conclusión. En miembros superiores hay disminución o ausencia de pliegues en zonas de flexión, rotación interna del hombro, limitación marcada de flexión de codo y de la muñeca en flexión y desviación cubital. En los dedos se encontró camptodactilia y aducción del pulgar. Las cirugías mejoraron la función para las actividades diarias. El tratamiento es individualizado y de acuerdo al grado de afectación.

Arthrogryposis: an update on clinical aspects, etiology, and treatment strategies

Arthrogryposes - multiple joint contractures - are a clinically and etiologically heterogeneous class of diseases, where accurate diagnosis, recognition of the underlying pathology and classification are of key importance for the prognosis as well as for selection of appropriate management. This treatment remains challenging and optimally in arthrogrypotic patients should be carried out by a team of specialists familiar with all aspects of arthrogryposis pathology and treatment modalities: rehabilitation, orthotics and surgery. In this comprehensive review article, based on literature and clinical experience, the authors present an update on current knowledge on etiology, classifications and treatment options for skeletal deformations possible in arthrogryposis.

Recommendations on routine mid-trimester anomaly scan

The purpose of this paper is to discuss the minimal requirements of the routine mid-trimester anomaly scan in Asian countries after taking into account various factors, including local circumstances, medical practice, guidelines, and availability of experienced sonographers and high-resolution ultrasound machines, which affect the prenatal detection rate of fetal anomalies. In general, a routine mid-trimester anomaly scan includes the assessment of the number of fetuses, fetal cardiac activity, size, anatomy, liquor and placental location. The most controversial issue is which fetal structures should at least be examined. We discussed the requirements of a basic routine scan, as well as the optional views, which can be obtained if feasible to improve the detection of fetal, placental or maternal abnormalities. Routine anomaly scan remains a clinical challenge.

Diagnosing arthrogryposis multiplex congenita: a review

Arthrogryposis multiplex congenita (AMC) refers either to a syndromic or to a nonsyndromic group of conditions with varied etiology and complex clinical features, including multiple congenital contractures in different body areas. Its etiology still remains unclear but generally any cause that leads to reduced fetal movement may lead to congenital contractures and in severe cases to fetal akinesia deformation sequence (FADS). It affects approximately 1 in 2-3000 live births with an approximately equal gender ratio. There are many known subgroups of AMC differing in signs, symptoms, and causes. The primary diagnosis is made when a lack of mobility and an abnormal position is noted in routine ultrasound scanning. Early diagnosis, prenatal evaluation, and further surveillance via image scanning (ultrasound and MRI) give the opportunity for family counseling concerning neonatal morbidity and mortality and labor or delivery planning. Better understanding of the ultrasound findings and the etiology of this clinical situation offers the opportunity for careful prenatal assessment.

Arthrogryposis multiplexa congenita: an epidemiologic study of nearly 9 million births in 24 EUROCAT registers

OBJECTIVE

To examine the occurrence of arthrogryposis multiplex congenita (AMC) in Europe and to identify possible risk factors.

STUDY DESIGN

Retrospective population-based epidemiological study using EUROCAT congenital anomaly registries. The study population included all cases of AMC (based on WHO ICD-9 or ICD-10 codes) that were livebirths (LB), fetal deaths (FD) from 20 weeks gestation and underwent termination of pregnancy for fetal anomaly (TOPFA), 1980-2006.

RESULTS

Among 8.9 million births covered by 24 EUROCAT congenital anomaly registries, 757 AMC cases were reported. This gives a prevalence of 8.5 per 100,000. Five hundred and four (67%) AMC cases were LB, 199 (26%) cases were TOPFA, and FD occurred in 54 (7%) cases. First week survival status was known for 381 of the 504 LB (76%), of whom 87 (23%) died within the first week of life. Perinatal mortality associated with AMC was 32%. Two hundred and eighty-two (37%) cases had isolated AMC, 90 (12%) had additional syndrome or chromosomal anomalies and 385 (51%) had other major malformations. The same or similar anomaly was reported in 13% of siblings and in 12% of the mother's own family background. Information on prenatal testing was available for 521 cases of which 360 tested positive for a congenital anomaly, representing a sensitivity of 69%. Information on maternal illness before and during pregnancy and medication use in the first trimester was available for approximately a third of the mothers, of whom the vast majority reported no maternal illness or medication use.

CONCLUSION

AMC is a rare occurrence, with a reported prevalence of 1:12,000. In this study, while information on potential risk factors such as maternal disease or maternal use of drugs was limited, they did not appear to be associated with the occurrence of AMC. AMC was lethal in a third of cases, either in utero or during the first week of life, although this may not be solely attributed to AMC as most cases had additional malformations.

Distal arthrogryposis syndrome

A 5-month-old male infant presented with weak cry, decreased body movements, tightness of whole body since birth, and one episode of generalized seizure on day 4 of life. He was born at term by elective caesarian section performed for breech presentation. The child had failure to thrive, contractures at elbow and knee joints, hypertonia, microcephaly, small mouth, retrognathia, and camptodactyly. There was global developmental delay. Abdominal examination revealed umbilical and bilateral inguinal hernia. Visual evoked response and brainstem evoked response audiometry were abnormal. Nerve conduction velocity was normal. Magnetic resonance imaging of brain revealed paucity of white matter in bilateral cerebral hemispheres with cerebellar and brain stem atrophy. The differential diagnoses considered in the index patient were distal arthrogryposis (DA) syndrome, cerebroculofacioskeletal syndrome, and Pena Shokier syndrome. The index patient most likely represents a variant of DA: Sheldon Hall syndrome.

Intrauterine fetal death after multiple umbilical cord torsion-complication of a twin pregnancy following assisted reproduction

BACKGROUND

Patients requiring assisted reproductive techniques may have a higher rate of congenital malformations. Some rare complications of pregnancy might be related to such abnormalities. Torsions of the umbilical cord resulting in fetal death have previously been described exclusively in pregnancies following spontaneous conception.

CASE

The case of 37 year old gravida I, para O woman with a twin pregnancy after intracytoplasmatic sperm injection and intrauterine death of one twin at approximately 30 weeks' gestation is presented. The surviving twin was delivered by cesarean section at 31 weeks after spontaneous onset of labor and recurrent fetal bradycardia. The intraoperative situs showed that the demised twin had suffered from multiple umbilical cord torsions leading to intrauterine hypoperfusion.

CONCLUSION

Umbilical torsion leading to fetal death might represent a previously unrecognized complication in women requiring assisted reproductive techniques, but this problem is known to occur in pregnancies achieved by natural methods.

Arthrogryposis Multiplex Congenita

Arthrogryposis multiplex congenita (AMC) is a disorder that encompasses a range of severity of congenital joint contractures from mild to severe. The etiologies of this condition are numerous but can generally be classified into endogenous and exogenous factors. Endogenous factors are related to those conditions that originate within the fetus and can further be classified into central nervous system disorders, musculoskeletal abnormalities, and abnormalities of the joints and connective tissues. The sonographic presentation of AMC includes decreased or absent fetal movement with contractures of multiple extremities. Treatment and medical management of AMC depends on the severity of the contractures and the absence or presence of associated syndromes. Accurate diagnosis of AMC allows for accurate prenatal counseling regarding future morbidity and mortality of the fetus and includes options regarding treatment, medical management, and pregnancy termination depending on the severity of the condition.