Sonographic Nomogram of the Fetal Calf Between 15 and 42 Weeks’ Gestation Using 3-Dimensional Sonography

Hershkovitz, Reli; Tepper, R.

doi:10.7863/jum.2008.27.5.701

Cited by 4 publications

(15 citation statements)

References 7 publications

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“…Two obstetricians one junior and one senior, blinded to the outcome examined the stored images and calculated the following parameters (in accordance with those previously reported), as shown in Figure 1 3. the ratio between tibia length and calf width (T/C), measured at the upper third of the tibial bone from the posterior boundary of the tibia toward the posterior peripheral skin. 9 There were concordant measurement results for both operators, so the widest angle or the higher ratio was chosen. Whenever the clubfoot was bilateral, the side with the worst parameter was chosen for analysis.…”

Section: Methodsmentioning

confidence: 99%

“…The retrospective evaluation was performed on all cases where a multiplanar view of the fetal leg had been obtained at a second trimester scan using a volumetric US probe (GE E8, GE Voluson 730, Medical Systems, Zipf, Austria), and postnatal outcome and follow‐up were both available. Two obstetricians one junior and one senior, blinded to the outcome examined the stored images and calculated the following parameters (in accordance with those previously reported), as shown in Figure 1: the angle between the long axis of the foot and of the lower leg (Angle), with no angle considered normal, <80° mildly abnormal, 80°‐100° moderate, and >100° severe 7 ; the width, length and width‐to‐length ratio (W/L) of the foot, correlated with gestational age through linear equations 8 ; the ratio between tibia length and calf width (T/C), measured at the upper third of the tibial bone from the posterior boundary of the tibia toward the posterior peripheral skin 9 …”

Section: Methodsmentioning

confidence: 99%

“…Three series have analysed the prenatal parameters that could predict postnatal severity of isolated clubfoot. [7][8][9] Glotzbecker et al 7…”

Section: Both Formentioning

confidence: 99%

“…Evaluation of the placenta and amniotic fluid is necessary to exclude the possibility of oligohydramnios being the cause of fetal malposition. 6 There have been reports in the literature of prenatal parameters that may help to identify severe cases of clubfoot, [7][8][9] but none of these have been incorporated into a routine evaluation of the fetal legs and feet. The purpose of this study is to identify a possible correlation between the prenatal description of isolated clubfoot and its degree of severity after birth.…”

Section: Introductionmentioning

confidence: 99%

“…They analysed the plantar shape and deformity, translating what is done postnatally to the ultrasonographic evaluation of the fetus: more specifically, they measured the width, length and width-to-length ratio of the foot, correlatedwith gestational age through linear equations, and they found that the affected feet were wider and shorter than the normal feet, and had a greater width-to-length ratio and a smaller bi-malleolar angle. Hershkovitz and Tepper,9 on the other hand, worked on the threedimensional evaluation of the fetal leg with the multiplanar view, and analysed the ratio between the tibia length and calf width in order to define a nomogram for this value.Ours is the first series in which all these three parameters were analysed together so as to assess their correlation with the postnatal severity of clubfoot. Its main limitation is the retrospective nature of the study and the small number of cases, although 33 cases in 7 years are considerable for a relative uncommon anomaly.…”

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confidence: 99%

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Congenital isolated clubfoot: Correlation between prenatal assessment and postnatal degree of severity

et al. 2020

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Objective: Since prenatal diagnosis of isolated clubfoot has a false positive rate (FP) of 10%-40%, fetal parameters that might correlate with post-natal confirmation and grade of severity were investigated. Method: Retrospective analysis (2013-2019) of cases analysed with threedimensional multiplanar view. The following data were recorded: the angle between the long axis of foot and lower leg; width, length and width-to-length ratio (W/L) of the foot; tibia length and calf width (T/C) ratio. Severity after birth was assessed using the Pirani classification. Results: Diagnosis was confirmed in 45/53 neonates (84.9%, FP 15%). Values were higher for both angle and W/L in true vs false positive cases (median angle 100.4 versus 69.55 , p <.000; median W/L 0.53 vs 0.45, p = .001), no difference for T/C (3.77 vs 3.48, p = .8). The area under the curve for angle was 0.98 (CI 0.94-1.00), with a diagnostic cutoff of 84.7 (PPV of 100%, NPV of 66.7%). Median Pirani score, available for 33 neonates (73.3%) was 3 (IQR 3-4): only angle correlated with Pirani score (Spearman coefficient 0.36, p = .04) Conclusion: Measuring the angle between the foot and lower leg can reduce the FP rate of prenatal congenital clubfoot diagnosis and better predict the need for postnatal treatment.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…Three series have analysed the prenatal parameters that could predict postnatal severity of isolated clubfoot. [7][8][9] Glotzbecker et al 7…”

Section: Both Formentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Congenital isolated clubfoot: Correlation between prenatal assessment and postnatal degree of severity

et al. 2020

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Calf circumferences in fetuses and neonates with and without talipes equinovares. A prospective cohort study

Tjon

Witbreuk²,

Struijs³

et al. 2023

Prenatal Diagnosis

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Objective Children and adults with talipes equinovarus (TEV) have smaller calves and shorter feet compared to non‐affected controls. Do these changes have a prenatal onset? Methods A prospective cohort study (January 2020–July 2021) was conducted with serial ultrasonographic measurements at 20 and 28 weeks gestation and measurements directly and 6 weeks after birth. Calf circumference and width, foot length and length of humerus, ulna, radius, femur, tibia and fibula were measured in TEV and were compared to a control population. Calculated sample size necessitated a minimal population of 10 cases with TEV and 50 controls. Results Twenty cases with TEV and 62 controls were included. Fetal calf circumference (p < 0.001) and width (p < 0.001) were smaller in the TEV group in comparison to the control group, which persisted after birth. Growth in foot length (p < 0.001) and calf width (p 0.003) declined prenatally over time. The bone lengths and upper leg circumference were not smaller or shorter in TEV compared to controls. Conclusion This prospective cohort study demonstrated the prenatal onset of reduced calf and foot size in fetuses with TEV from 20 weeks and onwards, which persists directly after birth. To investigate whether reduction in circumference initiates TEV or is caused by TEV, further examination is needed.

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Improving Prenatal Diagnosis Precision for Congenital Clubfoot by Using Three-Dimensional Ultrasonography

Kim,

Seong,

Kim

et al. 2023

Preprint

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Prenatal diagnosis of clubfoot traditionally relied on two-dimensional ultrasonography. To enhance diagnosis and predict postnatal outcomes, we examined the parameters that differentiate pathological clubfoot using three-dimensional ultrasonography. In our retrospective study, we examined the findings of prenatal ultrasound and the postnatal outcomes of pregnancies with suspected congenital clubfoot between 2018 and 2021. Based on the three-dimensional perspective, we measured the angles of varus, equinus, calcaneopedal block and forefoot adduction and compared the sonographic variables between the postnatal treated and non-treated groups. We evaluated 31 pregnancies (47 feet) with suspected clubfoot using three-dimensional ultrasonography. After delivery, a total of 37 feet (78.7%) underwent treatment involving serial casting only or additional Achilles tenotomy. The treated group showed significantly greater hindfoot varus deviation (60.5° vs. 46.6°, p=0.026) and calcaneopedal block deviation (65.6° vs. 26.6°, p &lt;0.05) compared to the non-treated group. The calcaneopedal block had an area under the curve of 0.98 with a diagnostic threshold of 46.2 degrees (sensitivity of 97%, specificity of 90%, positive predictive value of 97%, and negative predictive value of 90%). During prenatal evaluation of clubfoot using three-dimensional ultrasonography, the calcaneopedal block deviation has the potential to predict postnatal treatment.

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Sonographic Nomogram of the Fetal Calf Between 15 and 42 Weeks’ Gestation Using 3-Dimensional Sonography

Cited by 4 publications

References 7 publications

Congenital isolated clubfoot: Correlation between prenatal assessment and postnatal degree of severity

Congenital isolated clubfoot: Correlation between prenatal assessment and postnatal degree of severity

Calf circumferences in fetuses and neonates with and without talipes equinovares. A prospective cohort study

Improving Prenatal Diagnosis Precision for Congenital Clubfoot by Using Three-Dimensional Ultrasonography

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