Prognosis of 591 fetuses with ultrasonic soft markers during mid-term pregnancy

Abstract

The present study aimed to examine the value of ultrasonic soft markers in prenatal screening by analyzing the clinical outcome of fetuses with ultrasonic soft markers during the second trimester of pregnancy. A retrospective analysis was performed to evaluate the outcome of 591 fetuses with ultrasonic soft markers from January 2015 to August 2016 in Zhongnan Hospital of Wuhan University, China. It was found that 591 fetuses showed ultrasonic soft markers in 4927 cases with the occurrence rate being 12.0%. Among them, 564 fetuses (95.4%) were delivered and the remaining 27 cases (4.6%) were aborted. Five hundred and sixty-seven cases had single ultrasonic soft marker, including echogenic intracardiac focus (n=343), mild renal pelvis dilatation (n=116), short long bones (n=72), single umbilical artery (n=31), mild lateral ventriculomegaly (n=21), choroid plexus cysts (n=19), and echogenic bowel (n=13), with the disappearing rates in pregnancy being 97.1% (333/343), 77.6% (90/116), 0% (0/72), 0% (0/31), 57.1% (12/21), 89.5% (17/19) and 61.5% (8/13) respectively. The rate of pregnancy termination due to single ultrasonic soft marker was 3.4% (19/567), and that was 33.3% (8/24) due to two ultrasonic soft markers with the difference being statistically significant (P<0.05). The reasons of pregnancy termination included malformations (polycystic kidney, cleft lip and palate, congenital heart diseases, pcromphalus, hypospadias, hydrocephalus), chromosome abnormality, and stillbirth. It was concluded that single ultrasonic soft marker is usually transient manifestation in pregnancy. Without the other structural defects, single ultrasonic soft marker usually disappears spontaneously with favorable prognosis in a low-risk population. It is suggested that ultrasonic soft markers should be appropriately interpreted to avoid unnecessary invasive examination.

Keywords

fetus / ultrasonic soft marker / prognosis

References

[1] NguyenHT, BensonCB, BromleyB, et al. . Multidisciplinary consensus on the classification of prenatal and postnatal urinary tract dilation (UTD classification system). J Pediatr Urol, 2014, 10(6): 982-998 PMID: 25435247

[2] RanigaS, DesaiPD, ParikhH. Ultrasonographic soft markers of aneuploidy in second trimester: Are we lost. Med Gen Med, 2006, 8(1): 9

[3] Van den HofM, WilsonR. Fetal soft markers in obstetric ultrasound. J Obstet Gynaecol Can, 2005, 27(6): 592-636 PMID: 16100637

[4] ShanksAL, OdiboAO, GrayDL. Echogenic intracardiac foci associated with increased risk for fetal trisomy 21 or not. J Ultrasound Med, 2009, 28(12): 1639-1643 PMID: 19933476

[5] HavutcuAE, NikolopoulosG, AdinkraP, et al. . The association between fetal pyelectasis on second trimester ultrasound scan and aneuploidy among 25, 586 low-risk unselected women. Prenatal Diagn, 2002, 22: 1201-1206

[6] KimMK, KimM A, et al. . Outcome of isolated fetal renal pyelectasis diagnosed during midtrimester screening ultrasound and cut–off value to predict a persistent or progressive pyelectasis in utero. J Perinat Med, 2013, 41(4): 401-409 PMID: 23324372

[7] DiasCS, SilvaJM, PereiraAK, et al. . Diagnostic accuracy of renal pelvic dilatation for detecting surgically managed ureteropelvic junction obstruction. J Urol, 2013, 190(2): 661-666 PMID: 23416643

[8] ScalaC, FamiliariA, PinasA, et al. . Perinatal and longterm outcome in fetuses diagnosed with isolated unilateral ventriculomegaly: systematic review and metaanalysis. Ultrasound Obstet Gynecol, 2017, 49(4): 450-459 PMID: 27091707

[9] PaganiG, ThilaganathanB, PrefumoF. Neurodevelopmental outcome in isolated mild fetal ventriculomegaly: systematic review and meta-analysis. Ultrasound Obstet Gynecol, 2014, 44(3): 254-260 PMID: 24623452

[10] LopezJA, ReichD. Choroid plexus cysts. J Am Board Fam Med, 2006, 19(4): 422-425 PMID: 16809660

[11] DziegielewskaKM, EkJ, HabgoodMD, et al. . Development of the choroid plexus. Microsc Res Tech, 2001, 52(1): 5-20 PMID: 11135444

[12] DiPietroJA, CristofaloEA, VoegtlineKM, et al. . Isolated prenatal choroid plexus cysts do not affect child development. Prenat Diagn, 2011, 31(8): 745-749 PMID: 21484842 PMCID: 4511108

[13] MathiesenJM, AksglaedeL, SkibstedL, et al. . Outcome of fetuses with short femur length detected at second-trimester anomaly scan: a national survey. Ultrasound Obstet Gynecol, 2014, 44(2): 160-165 PMID: 24357398

[14] GoetzingerKR, CahillAG, MaconesGA, et al. . Isolated short femur length on second-trimester sonography: a marker for fetal growth restriction and other adverse perinatal outcomes. J Ultrasound Med, 2012, 31(12): 1935-1941 PMID: 23197546 PMCID: 3592208

[15] VenturaW, HuamanJ, NazarioCE, et al. . Perinatal outcomes after sonographic detection of isolated short femur in the second trimester. J Clin Ultrasound, 2012, 40(2): 63-67 PMID: 22031099

[16] PapageorghiouAT, FratelliN, LeslieK, et al. . Outcome of fetuses with antenatally diagnosed short femur. Ultrasound Obstet Gynecol, 2008, 31(5): 507-511 PMID: 18286672

[17] VoskampBJ, Fleurke-RozemaH, Oude-RengerinkK, et al. . Relationship of isolated single umbilical artery to fetal growth, aneuploidy and perinatal mortality: systematic review and meta-analysis. Ultrasound Obstet Gynecol, 2013, 42(6): 622-628 PMID: 23775879

[18] HsiehCC, ChaoAS, ChangYL, et al. . Outcome of congenital cystic adenomatoid malformation of the lung after antenatal diagnosis. Int J Gynaecol Obstet, 2005, 89(2): 99-102 PMID: 15847870

[19] BleuG, CoulonC, VaastP, et al. . Hyperechogenic fetal bowel: Which fetal and neonatal outcome? A French study of 149 cases. J Gynecol Obstet Biol Reprod, 2015, 44(6): 558-564

[20] GoetzingerKR, CahillAG, MaconesGA, et al. . Echogenic bowel on second-trimester ultrasound: Evaluating the risk of adverse pregnancy outcome. Obstet Gynecol, 2011, 117(6): 1341-1348 PMID: 21606744 PMCID: 3110147