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Outcome of Fetuses With Clubfeet Diagnosed by Prenatal Sonography

Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts USA.

Address correspondence and reprint requests to Leena Mammen, MD, 1757 Asbury Rd, East Grand Rapids, MI 49506 USA. E-mail: ljmammen{at}hotmail.com.

Objective. To determine the outcome of fetuses with clubfoot diagnosed by prenatal sonography. Methods. We identified all fetuses scanned at our institution from May 1989 to May 2002 in whom clubfoot was suspected or diagnosed on prenatal sonography. From maternal and neonatal medical records, we collected the following information when available: unilateral or bilateral clubfoot, gestational age at diagnosis, other sonographic findings, and pregnancy outcome, including pathologic reports and neonatal findings at birth. Results. One hundred twenty-one fetuses had prenatal sonographic suspicion or diagnosis of clubfoot. Twenty-two had no follow-up information, and 12 fetuses were terminated with fetal parts that could not be evaluated at pathologic examination, leaving 87 study cases. Outcome information was from neonatal records in 51 and from pathologic reports in 36. The gestational age at diagnosis ranged from 12.3 to 39.2 weeks, with a mean of 22.2 weeks. Forty-two (48%) had unilateral clubfoot, and 45 (52%) had bilateral clubfoot on sonography. The false-positive rate was significantly higher with unilateral clubfoot than bilateral clubfoot (12 [29%] of 42 versus 3 [7%] of 45; P < .05). Other anomalies were more common with bilateral clubfoot than with unilateral clubfoot (34 [76%] of 45 versus 23 [55%] of 42; P < .05), the most common being other musculoskeletal anomalies, neural tube defects, and cardiovascular anomalies. Of fetuses with information about chromosomes, the rates of aneuploidy were similar for unilateral and bilateral clubfoot (5 [28%] of 18 versus 10 [32%] of 31; P > .05). Conclusions. Fetuses with an antenatal sonographic diagnosis of clubfoot often have other anomalies, aneuploidy, or both. The false-positive rate for diagnosis of clubfoot is higher for unilateral clubfoot than bilateral clubfoot. The rate of associated anomalies is higher with bilateral clubfoot than unilateral clubfoot.

Key Words: aneuploidy • congenital anomalies • fetal sonography • musculoskeletal sonography

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