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At Least an Infantogram if not Perinatal Autopsy

Research paper by Dipika Deka, Moumita Naha, Vatsla Dadhwal, Madhulika Kabra, Neerja Gupta

Indexed on: 19 Jul '14Published on: 19 Jul '14Published in: Journal of Fetal Medicine



Abstract

To study the feasibility and value of postmortem fetal infantogram (X-ray film) in pregnancies terminated for prenatally diagnosed fetal congenital malformations and stillborn fetuses with congenital anomalies. Forty-two fetuses were diagnosed antenatally by ultrasonography to have fetal congenital malformation, 36 couples opted for medical termination of pregnancy (MTP) and intrauterine death (IUD) occurred in six cases. Informed written consent for autopsy including infantogram was given by 41 couples, one couple permitted only radiographs. On infantogram, the antenatal ultrasound diagnoses were confirmed in all the cases of central nervous system anomalies, but were not useful for genitourinary anomalies or cardiac anomalies. In five cases of antenatally suspected skeletal anomalies, radiographs changed the diagnosis of thanatophoric dwarf to osteogenesis imperfecta type llC in one case and achondrogenesis type 1B in another case. Infantogram made the syndromic diagnosis in three cases—sirenomelia, Roberts syndrome and caudal regression syndrome. Congenital diaphragmatic hernia was diagnosed at infantogram in a case missed on ultrasound. In three cases of nonimmune hydrops, X-ray films correlated with ultrasound findings, but could not find the cause. If autopsy, the ‘goal standard’ test is refused or cannot be done, at least an infantogram should routinely be done in pregnancies terminated for prenatally diagnosed fetal congenital malformations and stillborn fetuses with congenital anomalies, as it is noninvasive, easily available and consent given. It may change the diagnosis and counseling for future pregnancies, hence very useful in perinatal medicine.