W Sepulveda1, A E Wong, A Casasbuenas. 1. Fetal Medicine Center, Department of Obstetrics and Gynecology, Clinica Las Condes, Santiago, Chile. fetalmed@yahoo.com
Abstract
OBJECTIVE: To review our experience with first-trimester screening of chromosomal abnormalities in multiple pregnancies using nuchal translucency (NT) thickness measurement and nasal bone assessment. METHODS: Cases of multiple pregnancy presenting for first-trimester ultrasound evaluation and with viable fetuses measuring between 45 and 84 mm were recruited for this study. Crown-rump length, NT thickness, the presence or absence of the nasal bone and chorionicity were determined and the information prospectively collected in a dedicated database. RESULTS: There were 206 twin pregnancies, eight sets of triplets, and one set of quadruplets, totalling 440 screened fetuses. Information on perinatal outcome was available in all cases. The NT thickness was measured in all cases and was found to be greater than the 95(th) percentile in six (8.6%) of the 70 monochorionic fetuses and in 10 (2.7%) of the 370 dichorionic fetuses (P < 0.05, Fisher's exact test). The nasal bone was successfully assessed in 421 of the 440 (95.7%) fetuses and found to be absent in only four cases, three of which were found to have aneuploidy. Chromosomal abnormalities were diagnosed in six fetuses from one monochorionic and four dichorionic twin pregnancies. Five of the six affected cases were associated with increased NT thickness (sensitivity 83.3%), whereas the nasal bone was absent in only three of the aneuploid fetuses (sensitivity 50%). CONCLUSIONS: First-trimester ultrasound screening for chromosomal abnormalities using NT thickness in multiple pregnancies is highly sensitive. However, nasal bone assessment is not only limited in sensitivity but also more challenging in multiple than in singleton pregnancies owing to difficulties in obtaining adequate views of the fetal face.
OBJECTIVE: To review our experience with first-trimester screening of chromosomal abnormalities in multiple pregnancies using nuchal translucency (NT) thickness measurement and nasal bone assessment. METHODS: Cases of multiple pregnancy presenting for first-trimester ultrasound evaluation and with viable fetuses measuring between 45 and 84 mm were recruited for this study. Crown-rump length, NT thickness, the presence or absence of the nasal bone and chorionicity were determined and the information prospectively collected in a dedicated database. RESULTS: There were 206 twin pregnancies, eight sets of triplets, and one set of quadruplets, totalling 440 screened fetuses. Information on perinatal outcome was available in all cases. The NT thickness was measured in all cases and was found to be greater than the 95(th) percentile in six (8.6%) of the 70 monochorionic fetuses and in 10 (2.7%) of the 370 dichorionic fetuses (P < 0.05, Fisher's exact test). The nasal bone was successfully assessed in 421 of the 440 (95.7%) fetuses and found to be absent in only four cases, three of which were found to have aneuploidy. Chromosomal abnormalities were diagnosed in six fetuses from one monochorionic and four dichorionic twin pregnancies. Five of the six affected cases were associated with increased NT thickness (sensitivity 83.3%), whereas the nasal bone was absent in only three of the aneuploid fetuses (sensitivity 50%). CONCLUSIONS: First-trimester ultrasound screening for chromosomal abnormalities using NT thickness in multiple pregnancies is highly sensitive. However, nasal bone assessment is not only limited in sensitivity but also more challenging in multiple than in singleton pregnancies owing to difficulties in obtaining adequate views of the fetal face.