Challenges in the diagnosis of fetal non-chromosomal abnormalities at 11–13 weeks

Authors

  • Argyro Syngelaki,

    1. Harris Birthright Research Centre of Fetal Medicine, King's College Hospital, London, UK
    2. Department of Fetal Medicine, Medway Maritime Hospital, Gillingham, UK
    3. Department of Fetal Medicine, University College Hospital, London, UK
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  • Teodora Chelemen,

    1. Harris Birthright Research Centre of Fetal Medicine, King's College Hospital, London, UK
    2. Department of Fetal Medicine, Medway Maritime Hospital, Gillingham, UK
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  • Themistoklis Dagklis,

    1. Harris Birthright Research Centre of Fetal Medicine, King's College Hospital, London, UK
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  • Lindsey Allan,

    1. Harris Birthright Research Centre of Fetal Medicine, King's College Hospital, London, UK
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  • Kypros H. Nicolaides

    Corresponding author
    1. Harris Birthright Research Centre of Fetal Medicine, King's College Hospital, London, UK
    2. Department of Fetal Medicine, Medway Maritime Hospital, Gillingham, UK
    3. Department of Fetal Medicine, University College Hospital, London, UK
    • Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, Denmark Hill, London SE5 9RS, UK.
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Abstract

Objective

To examine the performance of the 11–13 weeks scan in detecting non-chromosomal abnormalities.

Methods

Prospective first-trimester screening study for aneuploidies, including basic examination of the fetal anatomy, in 45 191 pregnancies. Findings were compared to those at 20–23 weeks and postnatal examination.

Results

Aneuploidies (n = 332) were excluded from the analysis. Fetal abnormalities were observed in 488 (1.1%) of the remaining 44 859 cases; 213 (43.6%) of these were detected at 11–13 weeks. The early scan detected all cases of acrania, alobar holoprosencephaly, exomphalos, gastroschisis, megacystis and body stalk anomaly, 77% of absent hand or foot, 50% of diaphragmatic hernia, 50% of lethal skeletal dysplasias, 60% of polydactyly, 34% of major cardiac defects, 5% of facial clefts and 14% of open spina bifida, but none of agenesis of the corpus callosum, cerebellar or vermian hypoplasia, echogenic lung lesions, bowel obstruction, most renal defects or talipes. Nuchal translucency (NT) was above the 95th percentile in 34% of fetuses with major cardiac defects.

Conclusion

At 11–13 weeks some abnormalities are always detectable, some can never be and others are potentially detectable depending on their association with increased NT, the phenotypic expression of the abnormality with gestation and the objectives set for such a scan. Copyright © 2011 John Wiley & Sons, Ltd.

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