Diagnostic accuracy of isolated clubfoot in twin compared to singleton gestations

Abstract

Background Our objective was to determine the predictive value of the prenatal diagnosis of isolated clubfoot in twin gestations compared to singleton gestations. Methods A prospectively entered ultrasound database was reviewed for all pregnancies scanned at our institution from 2002 to 2014. Cases of suspected clubfoot were identified. Neonates with associated anomalies or aneuploidy, and patients who delivered at other institutions were excluded. Neonatal charts were reviewed for the confirmation of clubfoot. The chi-squared (χ2) test, Fisher’s exact test and the Mann-Whitney U test were used in the analysis, with p < 0.05 considered significant. Results Of those women who had prenatal ultrasound and subsequently delivered at our hospital, 84 pregnancies had isolated clubfoot suspected in the antenatal period. Of these pregnancies, 20 were twin gestations and 64 were singleton gestations. Overall, 51/84 (60.7%) pregnancies had clubfoot confirmed during the neonatal period. Of the twin pregnancies, only 35% (7/20) had a confirmed diagnosis of clubfoot at birth compared to 68.8% (44/64) of the singleton pregnancies (P = 0.008). Gestational age at diagnosis, breech presentation, neonatal gender, unilateral vs. bilateral clubfoot and suspicion of clubfoot in the presenting twin (Twin A) vs. the non-presenting twin (Twin B) did not correlate with an accurate diagnosis of clubfoot in twins. Conclusion False-positive prenatal diagnosis of isolated clubfoot is more common in twin gestations compared to singletons. This may be due to transient malpositioning or a result of diminished space. Obstetric providers should consider the possibility of a false-positive diagnosis and use caution when counseling patients about a prenatal suspicion for clubfoot, especially in twin gestations.

Prenatal Diagnosis of Clubfoot: Where Are We Now? Systematic Review and Meta-Analysis

“…The 23 selected studies included a total of 2318 patients who were prenatally diagnosed with clubfoot by US and/or MRI, some included karyotyping through amniocentesis and/or CVS. 11 of the studies included information about whether or not the diagnosis was confirmed after birth (accuracy) [ 1 , 10 , 11 , 12 , 13 , 14 , 16 , 22 , 23 , 25 , 27 ], the rest of the studies were used to obtain information about the main methodology used for prenatal diagnosis of clubfoot, but did not provide any detail about its accuracy; therefore, this item was not assessed. The minimum age was the first trimester of pregnancy (the week was not specified) [ 8 , 18 , 23 , 25 , 26 ] while the maximum reported age was 28 weeks of pregnancy [ 20 ].…”

“…The final studies selected by the reviewers included the following levels of evidence: 19 level III retrospective studies [ 1 , 2 , 7 , 9 , 10 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 21 , 22 , 25 , 26 , 27 ], 3 level II prospective comparative studies [ 8 , 11 , 20 ], 1 descriptive study of level III [ 19 ] ( Table 1 ).…”

“…In all of the selected studies US was used as the primary diagnostic instrument. Thirteen of the studies [ 1 , 7 , 8 , 10 , 11 , 12 , 15 , 16 , 17 , 19 , 21 , 23 , 26 ] used the US exclusively, while in the rest of the studies [ 2 , 9 , 13 , 14 , 18 , 20 , 22 , 24 , 25 , 27 ] US was used in combination with other procedures such as MRI [ 2 , 9 , 20 ] or karyotyping [ 13 , 14 , 18 , 22 , 24 , 25 , 27 ] ( Table 1 ). Based on the data available and on the studies in which this item was present, the accuracy of this test averaged 80.9%.…”

“…According to Sterne et al [ 29 ], meta-analyses should include research with a low or moderate risk of bias, therefore all publications should be included in the quantitative analysis. However, only 12 [ 1 , 2 , 10 , 11 , 12 , 13 , 14 , 16 , 22 , 23 , 25 , 27 ] of the 23 articles were examined since they contained data on the accuracy. Two groups were compared in terms of accuracy, the first “Genetic” [ 13 , 14 , 22 , 25 , 27 ] in which all or some patients underwent the karyotype, and the second “Imaging” [ 1 , 2 , 10 , 11 , 12 , 16 , 23 ] in which all patients underwent only US or MRI.…”

“…Congenital talipes equinovarus (CTEV), or Clubfoot, is a congenital birth defect with a reported incidence of 1–2.5 cases per 1000 births [ 1 ]. It consists of a structural abnormality causing an inversion of the forefoot and heel and may be associated with a variety of other birth defects, chromosomal abnormalities, and musculoskeletal disorders [ 2 ].…”