Increased nuchal translucency and pregnancy outcomes: experience of Başkent University Ankara Hospital

Nihal Şahin Uysal,Çağrı Gülümser,Filiz Bilgin Yanık,Zerrin Yılmaz Çelik

doi:10.4274/tjod.galenos.2019.51482

Nihal Şahin Uysal, Çağrı Gülümser + Show 2 more

Open Access

https://doi.org/10.4274/tjod.galenos.2019.51482

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Abstract

Objective:First trimester nuchal translucency (NT) measurement is considered to be an important tool in antenatal follow-up. This study aimed to evaluate the outcomes of pregnancies with increased NT at Başkent University Ankara Hospital between 2004 and 2016.Materials and Methods:Patients with NT measurements ≥1.5 multiples of median (MoM) were divided into two groups; group I included increased NT cases without fetal anomalies (either abnormal fetal karyotype or congenital structural anomalies) or loss (intrauterine fetal death), and group II included increased NT cases with fetal anomalies or loss. The groups were compared with each other with respect to maternal demographic features and NT measurements.Results:Karyotype analyses were normal in 73.1% of cases with increased NT (57/78). Among those, 21.1% (12/57) had structural anomalies, and to specify, 9.6% (5/52 over 18 weeks) had cardiac anomalies. Although maternal demographic features did not differ significantly, NT measurements, both as millimeters and MoM, were significantly higher in group II (p<0.05). According to the receiver operating characteristic (ROC) curves, the optimal cut-off values for NT measurements for predicting fetal anomalies or loss were 3.05 mm and 2.02 MoM. NT measurement >7 millimeters or NT MoM >4.27 resulted in poor fetal outcomes without exception.Conclusion:Higher NT measurements indicate poorer pregnancy outcomes. Our study indicates that fetal echocardiography must be considered for all cases with increased NT.

Highlights

Nuchal translucency (NT) is the sonographic visualization of subcutaneous fluid accumulation behind the fetal neck in the first trimester
Of the 52 pregnancies with normal karyotypes that continued beyond 18 weeks of gestation, cardiac anomalies were detected in 5 cases (9.6%), including aortic coarctation, complex cardiac anomalies, and ventricular septal defects in 1, 2, and 2 fetuses, respectively
There was no significant difference in maternal age, gravidity, parity, or crown-rump length (CRL) at the time of NT measurement between groups I and II

Summary

Introduction

Nuchal translucency (NT) is the sonographic visualization of subcutaneous fluid accumulation behind the fetal neck in the first trimester. Ultrasonographic NT measurement at 11-136 gestational weeks of pregnancy was introduced into clinical practice in the 1990s as a new method of aneuploidy screening, combined with maternal age and serum biochemical markers[1]. The definitions may vary in the literature, any value ≥3.5 mm is ≥99th percentile for any gestational age between 11-136 weeks and considered to be absolutely abnormal, requiring fetal karyotyping as well as detailed anatomic examination with fetal echocardiography in the second trimester. The aim of this study was to evaluate the outcomes of pregnancies with increased NT detected at 11-136 gestational weeks at Başkent University Ankara Hospital from 2004 to 2016.

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