This study is important because it provides contemporary data that can be used to counsel women prenatally. In particular, the raised risk of preterm delivery and caesarean section as well as the increased severity of the condition when both feet are affected should be discussed. The poor perinatal outcome when additional anomalies are present and the increased risk of aneuploidy are also important factors.

No abstract

Free beta-HCG is a new analyte that has been suggested to be superior to total HCG when used in combination with alpha-fetoprotein (AFP) for Down syndrome risk screening in early pregnancy. We have evaluated this claim on 21 samples collected from Down syndrome pregnancies and 180 samples from unaffected pregnancies. The detection rates for the combination of AFP with free beta-HCG or the combination of AFP with total HCG were identical (71 per cent) but the initial screen positive rate (equivalent to the false-positive rate) was 7.5 per cent for AFP + free beta-HCG screening compared with 3.5 per cent for AFP + total HCG screening. We conclude that the case for free beta-HCG is unproven and suggest that further data be collected before free beta-HCG becomes acceptable.

Congenital talipes equinovarus (CTEV) is one of the most common developmental abnormalities affecting the lower limb. It may be associated with a variety of disorders and can be diagnosed antenatally using high-resolution ultrasound. Depending on severity, treatment usually involves passive manipulation of the affected joint or surgery. We investigated the medium-term childhood outcome of children diagnosed antenatally with isolated CTEV. Over a seven-year period, 174 cases of talipes were identified with 83 being isolated, which were subdivided into mild, moderate and severe classifications. 44 cases were unilateral and 39 were bilateral. The Ponseti technique, which involves serial casts often followed by tenotomy, was used in 85% of mild and moderate cases. Additional surgery was required in 69.3% of bilateral cases and in 60.4% in unilateral cases. In both cohorts surgical soft tissue release was required for in 85% of the unilateral severe and 95% in the bilateral severe groups respectively. In the unilateral group gait abnormalities were present in 22.2% of cases compared with 32.1% of bilateral cases. More severe CTEV resulted in the increased likelihood of gait and functional associations. Five percent of cases with bilateral talipes compared with none in the unilateral group had additional problems (learning and attention issues) at school, which was separate from the orthopaedic abnormality. Overall 92.3% of parents were satisfied with the outcome of postnatal treatment, however counselling regarding management, medium and long-term sequelae of CTEV are of paramount importance.