Leena Mammen MD, PRESENTER: Nothing to Disclose

Abstract: HTML Purpose: To determine the outcome of fetuses diagnosed with clubfeet on prenatal ultrasound. Methods and Materials: We identified all fetuses scanned at our institution from May 1989 to May 2002 in whom clubfoot was diagnosed on prenatal ultrasound. From maternal and neonatal medical records, we collected the following information when available: clubfoot unilateral or bilateral, gestational age at diagnosis, other sonographic findings, and pregnancy outcome including pathology reports and neonatal findings at birth. Results: 121 fetuses had prenatal sonographic diagnosis of clubfoot. 22 had no follow-up information, 3 had fetal reduction procedures, and 9 had therapeutic abortions with fetal parts unevaluable at pathology. The remaining 87 fetuses comprise our study with outcome information from neonatal records in 51 and from pathology reports of therapeutic abortions in 36. The gestational age at diagnosis ranged from 12.3 to 39.2 weeks, with a mean of 22.2 weeks. 42 had unilateral (48%) and 45 had bilateral clubfoot (52%) on ultrasound. Of the 42 fetuses diagnosed with unilateral clubfoot by ultrasound, 18 proved to have unilateral clubfoot, 12 bilateral clubfeet, and 12 were normal (29% false positive rate). Of the 45 fetuses diagnosed with bilateral clubfeet, 4 proved to have unilateral clubfoot, 38 bilateral clubfeet, and 3 were normal (7% false positive rate). This false positive rate was significantly higher with unilateral clubfoot than bilateral (p<.05). Other anomalies were more common with bilateral clubfeet than with unilateral clubfoot 34/45 (76%) vs. 23/42 (55%), p<.05), the most common being other musculoskeletal anomalies, neural tube defects, and cardiovascular anomalies. Among fetuses in whom karyotype was available, abnormal chromosomes were found in 5 of 20 (25%) with unilateral clubfoot and 10 of 31 (32%) with bilateral clubfoot (p=.76). Conclusion: Fetuses with antenatal sonographic diagnosis of clubfoot often have other associated anomalies and/or aneuploidy. The false positive rate for diagnosis of clubfoot is higher for unilateral clubfoot than bilateral. The rates of other anomalies is higher with bilateral clubfeet than unilateral.      

Mammen MD, L, Outcome of Fetuses with Clubfeet Diagnosed by Prenatal Ultrasound.  Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL. http://archive.rsna.org/2003/3107080.html