OC104: Isolated gallbladder abnormality in utero: clinical significance as a screen for fetal anomaly

Abstract

Objectives: To examine the outcome of fetuses with short femur length (FL) at the time of the routine anomaly scan. Methods: This was a retrospective review of antenatal, pediatric and genetics records of pregnancies where ultrasound measurement of FL at 18–24 weeks of gestation was found to be below the 5th centile. All pregnancies had an ultrasound at 11–13 + 6 weeks to confirm pregnancy dating and also had nuchal translucency (NT) risk assessment. Results: There were 129 fetuses over a 6-year period. In 46 (35.7%) cases short FL was associated with other structural abnormalities. In this group skeletal dysplasias (n = 16), chromosomal abnormalities (n = 10) and genetic syndromes (n = 4) were the most common associations. Short FL was classified as isolated in the remaining 83 (64.3%) cases. There were no cases of chromosomal abnormalities in this group. Eleven (13%) were false positives with FL at subsequent scans within the normal range; all of these had a normal outcome. In the remaining 72 (87%) FL measurements were consistently below the fifth centile. Early severe fetal growth restriction (FGR) with abnormal umbilical artery Doppler requiring delivery before 37 weeks of gestation occurred in 33/83 (40%); 90% of these had abnormal uterine artery Doppler at the time of presentation. This cohort was complicated by pre-eclampsia in 12/33 (36%) cases, intauterine fetal death in 11/33 (30%), while a further two suffered a neonatal death. In 39/83 cases umbilical artery Doppler remained normal; five of these patients delivered before 37 weeks owing to pre-eclampsia or placental abruption (n = 3) or spontaneous preterm labour (n = 2), while in 34 delivery occurred after 37 weeks of gestation. Conclusions: In a population previously screened by NT, isolated short FL at the time of the routine anomaly scan is not associated with chromosomal abnormalities. Severe FGR associated with high mortality occurs in 40%, making uterine artery Doppler evaluation more useful than amniocentesis in these pregnancies.