Prenatal diagnosis of isolated clubfoot: Diagnostic accuracy and long-term postnatal outcomes

• Published in: European journal of obstetrics & gynecology and reproductive biology Vol. 264; pp. 60 - 64
• Main Authors: Fantasia, Ilaria, Dibello, Daniela, Di Carlo, Valentina, Colin, Giulia, Barbieri, Moira, Belcaro, Chiara, Magni, Elena, Faletra, Flavio, Laura, Travan, Stampalija, Tamara
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01-09-2021
• Subjects: Clubfoot; Neurodevelopmental delay; Pirani score; Ponseti method; Prenatal diagnosis; Prenatal diagnosis; Pirani score; Neurodevelopmental delay; Clubfoot; Ponseti method
• ISSN: 0301-2115; 1872-7654
• DOI: 10.1016/j.ejogrb.2021.07.009

•Correlation between prenatal talipes degree and postnatal outcome has never been reported.•Prenatally diagnosed third degree talipes are associated with higher risk of postnatal surgery.•The risk for adverse neurological outcomes seems not to be related to the degree of severity.
To evaluate concordance between prenatal and postnatal diagnosis of congenital talipes equinovarus (cTEV), rates of surgery and postnatal outcomes in relation to the prenatal classification of severity.
This is a retrospective observational cohort study on fetuses with a prenatal diagnosis of cTEV between 2004 and 2018. All cases of isolated cTEV in singleton pregnancies were included. Postnatally, the Ponseti method was applied. Children were followed-up postnatally for at least two years, with a specific focus on neurodevelopmental outcome.
The cohort included 81 fetuses with a prenatal diagnosis of cTEV confirmed postnatally in 86.4% of cases. Concordance between prenatal and postnatal assessment was good for both laterality and degree of severity (k = 0.61 and 0.66, respectively). The average Pirani score, number of casts and rates of Achilles tendon tenotomy were higher for III degree cTEV (p < 0.001). Within this group only, the rate of relapse was 11% and the rates of major surgery was 6%. The postnatal outcome was normal in 68.6% newborns, while 14% of cases had a diagnosis of minor additional findings and 17% had an impairment of neurological development. None of the outcome was statistically correlated to the prenatal assessment of laterality or degree.
The accuracy of prenatal ultrasound for isolated cTEV is 86% with a false positive diagnosis of 14%. The grade of cTEV assigned prenatally correlates to postnatal severity and longer orthopedic rehabilitation in terms of number of casts and need of surgery. The assessment of the correlation between cTEV and neurological impairment requires further prospective studies on larger cohorts.