Management Considerations for Ongoing Pregnancies Complicated by Trisomy 13 and 18. Issue 5 (May 2016)

• Record Type: Journal Article
• Authors: Dotters-Katz, Sarah K.; Kuller, Jeffrey A.; Grace, Matthew R.; Laifer, Steven A.; Strauss, Robert A.
• Is Part Of: Obstetrical & gynecological survey. Volume 71:Issue 5(2016)
• Publication Date: 2016-05
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; Generative organs, Female -- Surgery -- Periodicals; 618
• DOI: 10.1097/OGX.0000000000000304
• Languages: English
• ISSNs: 0029-7828

Abstract

Abstract: Pregnancies complicated by trisomy 13 (T13) or trisomy 18 (T18) present unique challenges for obstetric management. From the initial diagnosis, the task of counseling these women and families is difficult because fetal and neonatal outcomes vary depending on the phenotype and degree of intervention chosen by the family. A literature review was performed using PubMed to gather information regarding obstetric management and outcomes of pregnancies complicated by T13 and T18. Spontaneous abortion and in uterofetal demise occur at rates well above those seen in chromosomally normal pregnancies. In addition, infants with T13 or T18 frequently have structural anomalies, which lead to worse prognoses and long-term survival. In cases in which a woman and her family desire to continue the pregnancy, multidisciplinary consultation with obstetrics, social work, genetics, and pediatrics can optimize care of both the fetus and the mother. Most commonly, prenatal care does not differ from routine. A detailed delivery plan should be generated, specifically discussing interventions for the patient and her fetus. When managing pregnancies complicated by T13 and T18, active, open, and frequent communication between the patient, her family, and a multidisciplinary health care team throughout the pregnancy is crucial. Target Audience: Obstetricians and gynecologists, family physicians Learning Objectives: After completing this activity, the learner should be better able to describe the in utero findings and neonatal outcomes for pregnancies complicated by T13 and T18, recognize central aspects to caring for women and families with pregnancies complicated by T13 and T18, and outline the antepartum and intrapartum management considerations for pregnant women T13 and T18.