Outcome of isolated fetal talipes: A systematic review and meta‐analysis. (6th June 2019)

• Record Type: Journal Article
• Authors: Di Mascio, Daniele; Buca, Danilo; Khalil, Asma; Rizzo, Giuseppe; Makatsariya, Alexander; Sileo, Filomena; Liberati, Marco; Benedetti Panici, Pierluigi; Acharya, Ganesh; D'Antonio, Francesco
• Is Part Of: Acta obstetricia et gynecologica Scandinavica. Volume 98:Number 11(2019)
• Page Start: 1367
• Page End: 1377
• Publication Date: 2019-06-06
• Subjects: clubfoot -- fetal MRI -- karyotype -- talipes equinovarus -- ultrasound; Gynecology -- Periodicals; Pregnancy -- Periodicals; Obstetrics -- Periodicals; 618.05
• DOI: 10.1111/aogs.13637
• Languages: English
• ISSNs: 0001-6349

Abstract

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.