Perinatal lethal skeletal dysplasia: a case report

Authors

  • Sunita Dubey Department of Obstetrics & Gynaecology, GMCH 32, Sec 32, Chandigarh, India
  • Poonam Goel Department of Obstetrics & Gynaecology, GMCH 32, Sec 32, Chandigarh, India
  • Meesha Verma Department of Obstetrics & Gynaecology, GMCH 32, Sec 32, Chandigarh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20151630

Keywords:

Skeletal dysplasia, Osteogenesis imperfect, Perinatal hypophosphatasia, Achondrogenesis, Campomelic dysplasia

Abstract

The word dysplasia originates from ancient Greek words dys (anomalous) and plasia (formation). Skeltal dysplasia (SD) is a heterogeneous group of congenital anomalies characterized by abnormalities in the development of the bone and cartilage tissue. This results in mark disproportion of the long bones, the spine and fetal head relation to the trunk. Perinatal lethal skeletal dysplasia leads to still birth or early neonatal death due to pulmonary hypoplasia. 30 yrs old G3P3L2 at 32 weeks presented with leaking per vaginum. Her serial scan was done as she had previous stillborn male child with short limbs. Her antenatal scan revealed short limbs from 24 weeks. From18 weeks to 24 weeks she did not underwent any sonography. She went into spontaneous labor and delivered still born male baby with clinical and radiological features suggestive of skeletal dysplasia. Skeletal dysplasia can be diagnosed on antenatal 2 D ultrasound from 14 - 16 weeks onwards. Prenatal genetic testing should be done to diagnose the genetic anomaly and patient should be referred to higher institute for this test. Even if genetic test not done even then termination of pregnancy should be considered based on ultrasound diagnosis especially with family history because of poor fetal prognosis and long term morbidity if survived.

References

Camera G, Mastroiacovo P. Birth prevalance of skeletal dysplasias in the Italian multicentric monitoring system for birth defects. Prog Clin Biol Res. 1982;104:441.

Weldner BM, Persson PH, Ivarsson SA. Prenatal diagnosis of dwarfism by ultrasound screening. Arch Dis Child. 1985;60:1070.

Waller DK, Correa A, Vo TM. The population-based prevalence of achondroplasia and thanatophoric dysplasia in selected regions of the US. Am J Med Genet A. 2008;146A:2385.

Connor JM, Connor RA, Sweet EM. Lethal neonatal chondrodysplasias in the West of Scotland 1970-1983 with a description of a thanatophoric, dysplasialike, autosomal recessive disorder, Glasgow variant. Am J Med Genet. 1985;22:243.

Byers PH, Steiner RD. Osteogenesis imperfecta. Annu Rev Med. 1992;43:269-82.

Ward LM, Rauch F, Travers R, Chabot G, Azouz EM, Lalic L. Osteogenesis imperfecta type VII: An autosomal recessive form of brittle bone disease. Bone. 2002;31:12–8.

Glorieux FH, Rauch F, Plotkin H, Ward L, Travers R, Roughley P. Type V osteogenesis imperfecta: A new form of brittle bone disease. J Bone Miner Res. 2000;15:1650–8.

Campbell J, Henderson A, Campbell S. The fetal femur/foot length ratio: A new parameter to assess dysplasia limb reduction, Obstet Gynecol. 1988;72:181-4.

Krakow D, Lachman RS, Rimoin DL. Guidelines for the prenatal diagnosis of fetal skeletal dysplasias. Genet Med. 2009;11:127.

Munoz C, Filly RA, Golbus MS. Osteogenesis imperfecta type II: prenatal sonographic diagnosis. Radiology. 1990;174:181.

Mansour S, Hall CM, Pembrey ME, Young ID. A clinical and genetic study of campomelic dysplasia. J Med Genet. 1995;32:415.

Velagaleti GV, Bien-Willner GA, Northup JK. Position effects due to chromosome breakpoints that map approximately 900 Kb upstream and approximately 1.3 Mb downstream of SOX9 in two patients with campomelic dysplasia. Am J Hum Genet. 2005;76:652.

Taybi H, Lachman RS. Radiology of Syndromes, Metabolic Disorders and Skeletal Dysplasias. 4th ed.Philadelphia: Mosby. 1996:628-30.

Zankl A, Mornet E, Wong S. Specific ultrasonographic features of perinatal lethal hypophosphatesia. Am J Med Genet Part A. 2008;146A:1200-4.

Glanc P, Chitayat D, Unger S. The fetal musculoskeletal system. In: Rumack CM, Wilson SR, Charboneau JW, Levine D, eds. Diagnostic ultrasound. 4th ed. Philadelphia: Elsevier Mosby. 2011:1389–423.

Vandevijver N, De Die-Smulders CE, Offermans JP, Van Der Linden ES, Arends JW, Sastrowijoto SH. Lethal hypophosphatasia, spur type: case report and fetopathological study. Genet Couns. 1998;9:205–9.

Hall CM. International nosology and classification of constitutional disorders of bone (2001). Am J Med Genet. 2002;113:65.

Chen CP, Chern SR, Shih JC. Prenatal diagnosis and genetic analysis of type I and type II thanatophoric dysplasia. Prenat Diagn. 2001;21:89.

Rachel C, Cheng EY, Mack S, Pepin MG, Byers PH. Osteogenesis Imperfecta: Mode of Delivery and Neonatal Outcome. Obstetrics & Gynecology. 2001;97 (1).

Downloads

Published

2016-12-16

Issue

Section

Case Reports