Prenatal Sonographic Diagnosis of Focal Musculoskeletal Anomalies

Focal musculoskeletal anomalies vary, and can manifest as part of a syndrome or be accompanied by numerous other conditions such as genetic disorders, karyotype abnormalities, central nervous system anomalies and other skeletal anomalies. Isolated focal musculoskeletal anomaly does, however, also occur; its early prenatal diagnosis is important in deciding prenatal care, and also helps in counseling parents about the postnatal effects of numerous possible associated anomalies. We have encountered 50 cases involving focal musculoskeletal anomalies, including focal limb dysplasia [radial ray abnormality (n=3), mesomelic dysplasia (n=1)]; anomalies of the hand [polydactyly (n=8), syndactyly (n=3), ectrodactyly (n=1), clinodactyly (n=6), clenched hand (n=5)]; anomalies of the foot [clubfoot (n=10), rockerbottom foot (n=5), sandal gap deformity (n=1), curly toe (n=2)]; amniotic band syndrome (n=3); and anomalies of the focal spine [block vertebra (n=1), hemivertebra (n=1)]. Among these 50 cases, five [polydactyly (n=1), syndactyly (n=2) and curly toe (n=2)] were confirmed by postnatal physical evaluation, two (focal spine anomalies) were diagnosed after postnatal radiologic examination, and the remaining 43 were proven at autopsy

FIGO consensus guidelines on placenta accreta spectrum disorders : Prenatal diagnosis and screening

Peer reviewe

The incidence of isolated single umbilical artery in twins and adverse pregnancy outcomes

OBJECTIVES: To estimate the incidence of single umbilical artery (SUA) in twin pregnancies and to investigate whether SUA in twin gestations is associated with adverse obstetric outcomes. METHODS: Retrospective cohort study of consecutive twin pregnancies over 17 years at a tertiary care hospital. Primary exposure was SUA in one or both twins documented at routine second trimester anatomic survey. Adverse obstetric outcomes included small for gestational age (SGA), placental abruption, and preterm birth, evaluated in univariable and multivariable analyses. Analysis was performed both at the pregnancy level and at the fetal level using paired analyses to account for the non-independence of twin pairs. RESULTS: Of 2,378 twin pregnancies without major anatomic abnormalities, 1.7% (n=40) had SUA. Only 1 pregnancy (one monochorionic twin pair) was complicated by both twins having SUA. Twin fetuses with SUA are at increased risk for SGA (aOR 2.1 (1.2-4.1), p=0.03) after adjusting for pertinent confounding factors, similar to the findings of previous studies in singleton pregnancies. In addition, twins with SUA may be at increased risk for preterm delivery before 28 weeks compared to twin pregnancies with normal three-vessel umbilical cords (aOR 3.2 (1.3-7.89.4), p=0.01). CONCLUSIONS: The incidence of SUA in twin gestations in this cohort is significantly less than recently published data. Similar to reports in singleton gestations, SUA appears to be associated with an increased risk for SGA in twins