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PRENATAL DIAGNOSIS OF SKELETAL DYSPLASIAS

Published online by Cambridge University Press:  01 May 2008

LYN S CHITTY
Affiliation:
Reader in Genetics and Fetal Medicine, Institute of Child Health and UCLH, London.
DAVID GRIFFIN
Affiliation:
Consultant Obstetrician, Watford District General Hospital, Hertfordshire

Extract

Skeletal anomalies occur with a frequency of around 1:500 and can present a diagnostic challenge when detected prenatally. Increasingly more sophisticated imaging such as MRI or CT may elucidate features more easily interpreted by postnatal radiologists. The aetiology of these anomalies is varied and includes aneuploidy, genetic syndromes, skeletal dysplasias, teratogens, disruption and maternal disease, making a multidisciplinary approach to the diagnosis essential. The estimated prevalence of skeletal dysplasias varies from 2–3/10,000 to 4–7/10,000 and diagnosis may require biochemical, cytogenetic, molecular genetic or haematological investigation. Clinical genetic input is often required as the family history or parental examination may yield valuable clues to the diagnosis. This review will briefly describe the normal embryology and sonographic appearances of fetal limb development and go on to suggest a systematic approach to the diagnosis of fetal skeletal dysplasias.

Type
Research Article
Copyright
Copyright © Cambridge University Press 2008

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References

REFERENCES

1Orioli, IM, Castilla, EE, Barbosa-Netos. The birth prevalance rates for the skeletal dysplasias. J Med Genet 1986; 23: 328–32.CrossRefGoogle ScholarPubMed
2Winter, RM, Baraitser, M. Winter-Baraitser London Medical Databases. Version 1.0, 2006.Google Scholar
3Chitty, LS, Wilson, L, Griffin, DR. Diagnosis and Management of Fetal Skeletal Anomalies. In: Fetal Medicine: Basic Science and Clinical Practice, 2nd ed in press 2008.Google Scholar
4Brown, N, Lumley, J, Tickle, C, Keene, J. Congenital limb reduction defects. Clues from developmental biology, teratology and epidemiology. 1996; HMSO Stationary Office.Google Scholar
5Brons, JTJ, van der harten, JJ, van Geijn, HP. Ultrasonic and radiologic aspects of early ossification in the normal fetus and the fetus affected by skeletal dyplasia. MD Thesis. 1988; 1533.Google Scholar
6Chitty, LS, Campbell, S and Altman, DG. Measurement of the fetal mandible – feasibility and construction of a centile chart. Prenat Diagn 1993, 13: 749–56.CrossRefGoogle ScholarPubMed
7Chitty, LS, Altman, DG, Henderson, A and Campbell, S. Charts of fetal size: 2. Head measurements. Br J Obstet Gynecol 1994; 101: 3543.Google Scholar
8Chitty, LS, Altman, DG, Henderson, A, Campbell, S. Charts of fetal size: 3. Abdominal circumference. Br J Obstet Gynaecol 1994; 101: 132—35.Google Scholar
9Chitty, LS, Altman, DG, Henderson, A and Campbell, S. Charts of fetal size: 4. Femur length. Br J Obstet Gynaecol 1994; 101: 125–31.CrossRefGoogle ScholarPubMed
10Chitty, LS, Altman, DG. Charts of fetal size: kidney and renal pelvis measurements. Prenat Diagn 2003; 23: 891–97.Google Scholar
11Chitty, LS, Altman, DG. Charts of fetal size: Limb bones. Br J Obstet Gynaecol 2002; 109; 919–29.Google Scholar
12Chitty, LS, Altman, DG. Charts of fetal size. In: Dewbury K, Meire H, Cosgrove D, Farrant P (eds). Churchill Livingstone, 2001; Vol 13 Clinical Ultrasound.Google Scholar
13Rosati, P, Guariglia, L. Transvaginal fetal biometry in early pregnancy. Early Hum Dev 1997; 49: 9196.CrossRefGoogle ScholarPubMed
14Spranger, J. International classification of osteochondrondrodystrophies. The internataional working group on constitutional diseases of bone. 1992; Eur J Pediatr 151: 407415.Google Scholar
15Superti-Furga, A, Bonafe, L, Rimoin, D. Molecular-pathogenetic classification of genetic disorders of the skeleton. 2002; Am J Med Genet 106: 282–93.CrossRefGoogle Scholar
16Hall, CM. International nosology and classification of constitutional disorders of bone (2001). Am J Med Genet 2002; 113: 6577.CrossRefGoogle ScholarPubMed
17Maron, JL, Bianchi, DW. Prenatal Diagnosis Using Cell-Free Nucleic Acids in Maternal Body Fluids: A Decade Of Progress. Am J Med Genet 2007; Part C (Seminars In Medical Genetics) 145: 517.Google Scholar
18Hyett, JA, Griffin, DR, Chitty, LS. Short femora – achondroplasia or IUGR: use of growth patterns as an aid to diagnosis. J Obs Gyn 2002; 22: (Supp.1)S32.Google Scholar
19Makrydimas, G, Souka, A, Skentou, H, Lolis, D, Nicolaides, K. Osteogenesis imperfecta and other skeletal dysplasias presenting with increased nuchal translucency in the first trimester. Am J Med Genet 2001; 98: 117–20.Google Scholar
20Karnes, PS, Day, D, Berry, SA, Pierpont, MEM. Jarcho-Levin syndrome: four new cases and classification of subtypes. Am J Med Genet 1991; 40: 264–70.CrossRefGoogle ScholarPubMed
21Tan, AWC, Chitty, LS. Early onset skeletal dysplasias: Differentiating lethal from non-lethal. J Obstet Gynaecol 2006; 26 suppl 1: S62.Google Scholar
22Tavormina, PL, Shiang, R, Thompson, LM, Zhu, YZ, Wilkin, DJ, Lachman, RS et al. Thanatophoric dysplasia (types I and II) caused by distinct mutations in fibroblast growth factor receptor 3. Nature Genetics 1995; 9: 321–28.Google Scholar
23Pollitt, R, McMahon, R, Nunn, J, Bamford, R, Afifi, A, Bishop, N, Dalton, A. Mutation analysis of COL1A1 and COL1A2 in patients diagnosed with osteogenesis imperfecta type I–IV. Hum Mutat 2006; 27: 716.CrossRefGoogle ScholarPubMed
24Thompson, EM, Young, ID, Hall, CM, Pembrey, ME. Recurrence risks and prognosis in severe sporadic osteogenesis imperfecta. J Med Genet 1987; 24: 390405.Google Scholar
25Cole, WG, Dalgleish, R. Syndrome of the month. Perinatal lethal osteogenesis imperfecta. J Med Genet 1995; 32: 284–89.Google Scholar
26Engelbert, RH, Uiterwaal, CS, Gulmans, VA, Pruijs, H, Helders, PJ. Osteogenesis imperfecta in childhood: prognosis for walking. J Pediatr 2000; 137: 397402.CrossRefGoogle ScholarPubMed
27Smith, R. Severe osteogenesis imperfecta: new therapeutic options?. Br Med J 2001; 322: 6364.CrossRefGoogle ScholarPubMed
28Hyett, JA, Gardiner, G, Stojilkovic-Mikic, T, Finning, KM, Martin, PG, Rodeck, CH, Chitty, LS. Reduction in diagnostic and therapeutic interventions by non-invasive determination of fetal sex in early pregnancy. Prenat Diagn 2005; 25: 1111–116Google Scholar
29Mansour, S, Offiah, AC, McDowall, S, Sim, P, Tolmie, J, Hall, C. The phenotype of survivors of campomelic dysplasia. J Med Genet 2002; 39: 597602CrossRefGoogle ScholarPubMed
30Rousseau, F, Bonaventure, J, Legeai-Mallet, L, Pelet, A, Rozet, JM, Maroteau, P et al. Mutations in the gene encoding fibroblast growth factor receptor-3 in achondroplasia. Nature 1994; 371: 252–54.Google Scholar
31Wilkin, DJ, Szabo, JK, Cameron, R, Henderson, S, Bellus, GA, Mack, ML et al. Mutations in fibroblast growth factor receptor 3 in sporadic cases of achondroplasia occur exclusively on the paternally derived chromosome. Am J Hum Genet 1998; 63: 711–16.Google Scholar
32Li, Y, Godelieve, C, Page-Christiaens, ML, Gille, JJP, Holzgreve, W, Hahn, S. Non-invasive prenatal diagnosis of achondroplasia using size-fractionated cell-free DNA by MALDI-TOF MS assay. Prenat Diagn 2007; 27: 1117.Google Scholar
33Ruiz-Perez, V, Ide, SE, Strom, TM, Lorenz, B, Wilson, D, Woods, K, et al. Mutations in a new gene in Ellis-van Creveld syndrome and Weyers acrodental dysostosis. Nature Genetics 2000; 24: 283–86.Google Scholar
34Ruiz-Perez, VL, Tompson, SW, Blair, HJ, Espinoza-Valdez, C, Lapunzina, P, Silva, EO et al. Mutations in Two Nonhomologous Genes in a Head-to-Head Configuration Cause Ellis-van Creveld syndrome. Am J Hum Genet 2003; 72: 728–32. Epub 2003 Feb 4.Google Scholar
35Wax, JR, Carpenter, M, Smith, W, Grimes, C, Pinette, MG, Blackstone, J, Cartin, A. Second-trimester sonographic diagnosis of diastrophic dysplasia: report of 2 index cases. J Ultrasound Med 2003; 22: 805808.Google Scholar
36Irving, M, Chitty, LS, Mansour, S, Hall, CM. Chondrodysplasia punctata: a clinical diagnostic and radiological review. Clin Dysmorph 2008; in press.CrossRefGoogle Scholar
37Horton, WA, Machado, MA, Chou, JW, Campbell, D. Achondrogenesis type II: abnormalities of extracellular matrix. Pediatr Res 1987; 22: 324–29.CrossRefGoogle ScholarPubMed
38Hunter, AGW, Bankier, A, Rogers, JG, Sillence, D, Scott, C Jr. Medical complications of achondroplasia: a multicentre patient review. J Med Genet 1998; 35: 705–12.CrossRefGoogle ScholarPubMed
39den Hollander, NS, van der Harten, HJ, Laudy, JA, van de Weg, P, Wladimiroff, JW. Early transvaginal ultrasonographic diagnosis of Beemer-Langer dysplasia: a report of two cases. Ultrasound Obstet Gynecol 1998; 11: 298302.Google Scholar
40Kwok, C, Weller, PA, Guioli, S, Mansour, S, Zuffardi, O et al. Mutations in SOX9, the gene responsible for campomelic dysplasia and autosomal sex reversal. Am J Hum Genet 1995; 57: 10281036.Google ScholarPubMed
41Mansour, S, Hall, CM, Pembrey, ME, Young, ID. A clinical and genetic study of campomelic dysplasia. J Med Genet 1995; 32: 415–20.CrossRefGoogle ScholarPubMed
42Pryde, PG, Bawle, E, Brandt, F, Romero, R, Treadwell, MC, Evans, MI. Prenatal diagnosis of nonrhizomelic chondrodysplasia punctata (Conradi-Hünermann syndrome). Am J Med Genet 1993; 47: 426–31.CrossRefGoogle ScholarPubMed
43Severi, FM, Bocchi, C, Sanseverino, F, Petraglia, F. Prenatal ultrasonographic diagnosis of diastrophic dysplasia at 13 weeks of gestation. J Matern Fetal Neonatal Med 2003; 13: 282–84.CrossRefGoogle ScholarPubMed
44Henthorn, PS, Whyte, MP. Infantile hypophosphatasia: successful prenatal assessment by testing for tissue-non-specific alkaline phosphatase isoenzyme gene mutations. Prenat Diagn 1995; 15: 10011006.Google Scholar
45Mornet, E, Muller, F, Ngo, S, Taillandier, A, Simon-Bouy, B, Maire, I et al. Correlation of alkaline phosphatase (ALP) determination and analysis of the tissue non-specific ALP gene in prenatal diagnosis of severe hypophosphatasia. Prenat Diagn 1999; 19: 755–57Google Scholar
46Sinico, M, Levaillant, JM, Vergnaud, A, Blondeau, JR, Encha-Razavi, F, Mornet, E et al. Specific osseous spurs in a lethal form of hypophosphatasia correlated with 3D prenatal ultrasonographic images. Prenat Diagn 2007; 27: 222–27.Google Scholar
47Tongsong, T, Pongsatha, S. Early prenatal sonographic diagnosis of congenital hypophosphatasia. Ultrasound Obstet Gynecol 2000; 15: 252–55.Google Scholar
48Chen, CP, Chang, TY, Tzen, CY, Wang, W. Second-trimester sonographic detection of short rib-polydactyly syndrome type II (Majewski) following an abnormal maternal serum biochemical screening result. Prenat Diagn 2003; 23: 353–55.CrossRefGoogle ScholarPubMed
49Elçioglu, NH, Hall, CM. Diagnostic dilemmas in the short rib-polydactyly syndrome group. Am J Med Genet 2002; 111: 392400.CrossRefGoogle ScholarPubMed
50Pepin, M, Atkinson, M, Starman, BJ, Byers, PH. Strategies and outcomes of prenatal diagnosis for Osteogenesis imperfecta: a review of biochemical and molecular studies completed in 129 pregnancies. Prenat Diagn 1997; 17: 559–70.Google Scholar
51Sillence, DO, Senn, A, Danks, DM. Genetic heterogeneity in osteogenesis imperfecta. J Med Genet 1979; 16: 101–16.Google Scholar
52Lund, AM, Nicholls, AC, Schwartz, M, Skovby, F. Parental mosaicism and autosomal dominant mutations causing structural abnormalities of collagen I are frequent in families with osteogenesis imperfecta type III/IV. Acta Paediatr 1997; 86: 711–18.Google Scholar
53Sillence, DO, Barlow, KK, Cole, WG, Dietrich, S, Garber, AP, Rimoin, DL. Osteogenesis imperfecta type III: delineation of the phenotype with reference to genetic heterogeneity. Am. J Med Genet 23: 821–32.Google Scholar
54Basbug, M, Serin, IS, Ozcelik, B, Gunes, T, Akcakus, M, Tayyar, M. Prenatal ultrasonographic diagnosis of rhizomelic chondrodysplasia punctata by detection of rhizomelic shortening and bilateral cataracts. Fetal Diagn Ther 2005.CrossRefGoogle Scholar
55Hertzberg, BS, Kliewer, MA, Decker, M, Miller, CR, Bowie, JD. Antenatal ultrasonographic diagnosis of rhizomelic chondrodysplasia punctata. J Ultrasound Med 1999; 18: 715–18.CrossRefGoogle ScholarPubMed
56Chitty, LS, Tan, AW, Nesbit, DL, Hall, CM, Rodeck, CH. Sonographic diagnosis of SEDC and double heterozygote of SEDC and achondroplasia-a report of six pregnancies. Prenat Diagn 2006; 26: 861–65.CrossRefGoogle ScholarPubMed
57Tiller, GE, Rimoin, DL, Murray, LW, Cohn, DH. Tandem duplication within a type II collagen gene (COL2A1) exon in an individual with spondyloepiphyseal dysplasia. Proc Nat Acad Sci 1990; 87: 3889–893.Google Scholar
58Aughton, DJ, Kelley, RI, Metzenberg, A, Pureza, V, Pauli, RM. X-linked dominant chondrodysplasia punctata (CDPX2) caused by single gene mosaicism in a male. Am J Med Genet 2003; 116: 255–60.Google Scholar