Outcome of isolated fetal talipes: A systematic review and meta‐analysis

Abstract

Introduction The aim of this systematic review was to explore the outcome of fetuses with a prenatal diagnosis of isolated talipes. Material and methods Medline, Embase, Cinahl, and Clinicaltrials.gov databases were searched. The outcomes explored were: associated anomalies detected at follow‐up ultrasound examination; fetal magnetic resonance imaging (MRI) and birth; chromosomal abnormalities detected with standard and chromosomal microarray analysis, intrauterine, neonatal, and perinatal death, and termination of pregnancy; rate of surgical and nonsurgical treatment; neurodevelopmental outcome; and false‐positive rate of prenatal diagnosis. Meta‐analyses of proportions were used to combine data. Results Twenty‐five studies (1567 fetuses) were included. Associated anomalies were detected in 7.8% (95% CI 0.1%‐29.3%) of cases at follow‐up ultrasound, and in 4.0% (95% CI 0.1%‐13.2%) of cases, fetal MRI identified anomalies not detected at ultrasound assessment. Similarly, 7.0% (95% CI 3.4%‐11.7%) of cases labeled as isolated talipes on prenatal imaging were found to have associated anomalies at birth. Abnormal karyotype was present in 3.6% (95% CI 1.7%‐6.2%) of fetuses, whereas no anomaly was found at chromosomal microarray analysis, although this outcome was reported by only 1 study. Intrauterine death occurred in 0.99% (95% CI 0.4%‐1.9%) of fetuses, whereas the corresponding figures for neonatal death and termination of pregnancy were 1.5% (95% CI 0.6%‐2.6%) and 2.2% (95% CI 1.2%‐3.4%), respectively. Surgical management of anomalies after birth was found in 41.7% (95% CI 27.0%‐57.2%) of fetuses with isolated talipes, and 54.8% (95% CI 31.5%‐77.0%) had nonsurgical management of the anomalies after birth. Abnormal neurodevelopmental outcome was reported in 7.6% (95% CI 1.0%‐19.4%) of children, although this analysis was affected by the small number of included cases and short time of follow up. Conclusions Isolated talipes detected on prenatal ultrasound carries a generally good prognosis. The incidence of additional abnormalities detected on fetal MRI, aneuploidy, or neurodevelopmental disability is relatively low. However, longitudinal ultrasound assessment during pregnancy and a thorough postnatal evaluation are recommended to rule out associated anomalies that may significantly impact short‐ and long‐term prognosis.

Diagnostic accuracy of prenatal ultrasound in identifying the level of the lesion in fetuses with open spina bifida: A systematic review and meta‐analysis

“…Moreover, the development of 3D ultrasonography brings new possibilities to early diagnosis: 3D ultrasound makes it possible to identify the whole spine and to examine images in sections and in different planes at the same time. Furthermore, in the past few years, the use of antenatal MRI has significantly expanded in many fields of maternal and fetal medicine; 11,41,44 however, the most important role remains the evaluation of fetal nervous system 45,46 : although in our study the level of agreement between prenatal imaging and postnatal assessment was similar for MRI and ultrasound. Fetal MRI is frequently performed as a secondary imaging tool to assess neural tube defects, rule out additional central nervous system (CNS) and non‐CNS anomalies, and influence management decisions 27 …”

“…Despite this, assessment of the level of the lesion on ultrasound has not yet been standardized and there is still large heterogeneity among different centers in the diagnostic criteria used to determine the level of the lesion, such as the most cephalic vertebra with evidence of laminar separation 30 or the first vertebra showing widening of the ossification centers 29 . Many authors also considered T12 the insertion of the most caudal rib and the iliac crests a landmark to locate L5 level 41 . Identifying conus medullaris might be also helpful during spinal examination, as it usually ends at L4 level between 13 and 18 weeks and then tends to migrate, so it may often be recognized at L3 between 19 and 36 weeks of gestation and at L2 after 36 weeks 42 .…”

“…level. 41 Identifying conus medullaris might be also helpful during spinal examination, as it usually ends at L4 level between 13 and 18 weeks and then tends to migrate, so it may often be recognized at L3 between 19 and 36 weeks of gestation and at L2 after 36 weeks. 42 The detection rate of spina bifida in second trimester routine ultrasound nowadays is very high, mostly because examination of the spine has become mandatory and a longitudinal scan of the fetal spine should also always be obtained at a basic assessment.…”

Clubfoot management in the Middle East: a survey-based review

“…Available evidence suggests that false positive rate can be lowered to around 10% if the diagnosis is performed in the second trimester (54,55). This is of paramount importance as parents can be prepared for the diagnosis, and counselled for the disease, the presence (or not) of associated conditions and the path of the treatment, before birth of their awaited child (54,56). They will also be oriented to seek care as soon as possible after birth increasing the chance of presenting optimal care for their children (52,53,56).…”

Study of amniotic fluid in pregnant women infected with SARS-CoV-2 in first and second trimester. Is there evidence of vertical transmission?

“…Ultrasound revealed unilateral talipes equinovarus as the only finding. The pregnant woman is informed that 7% of the cases diagnosed as prenatally isolated have anomalies associated at birth and that 3.6% of the fetuses had an abnormal karyotype [1] requesting an invasive prenatal diagnosis, so it is carried out an amniocentesis. The karyotype was normal.…”