I-44: Increased Nuchal Translucency at 11-14 Weeks of Gestation As A Marker for Adverse Pregnancy Outcomes

Background: To evaluate the association of increased fetal nuchal translucency( NT) and adverse pregnancy outcomes. Materials and Methods: In a prospective study, 2221 women who were conceived after Assisted Conception were investigated by sonography independent of multiplicity between 11 and 13 weeks' gestation. We performed 2899 NT examinations during the study period(21 March 2010 to 21 March 2013). All cases with an increased NT (>95th percentile for a given crown rump length (CRL)) were referred to amniocentesis and karyotyping, genetic counseling, and fetal echocardiography.Maternal and fetal data (NT, caryotype, pregnancy outcome) and infant follow-up of fetuses were analyzed. Results: The NT was abnormal in 41 (41/2899=1.14 %) fetuses .The mean age of participant was 32.6 ± 4.72 (24-43years) and the mean duration of infertility was 5.71±4.2. Thirteen fetuses underwent first-trimester fetal reduction for multiplicity. Six out of 28 remained fetuses ( 24%) detected with abnormal karyotypes either by amniocentesis or fetal pathology. Three cases of Down syndrome and two cases of Turner syndrome confirmed by amniocentesis and one case of triploid chromosomal disorder reported after fetal pathology. Elective terminations of pregnancy due to multiple anomalies occurred in two cases. The loss of fetuses due to intrauterine fetal demise (IUFD) occurred in six cases. Overall adverse pregnancy outcomes were reported in 15 cases ( 53%). It is noteworthy that adverse pregnancy outcomes also occurred for eight fetuses with normal amniocentesis(2/8= 25%).Thirteen cases of normal infants were born finally(13/28= 47%). Conclusion: First-trimester increased NT thickness is associated with an increased risk of subsequent pregnancy complications and adverse pregnancy outcome. The need for prenatal screening is extra important in the case of assisted conception due to more concern over specific anomalies, multiplicity and poor outcome pregnancies. In cases of increased NT, parents should be offered a detailed fetal evaluation (genetic sonography) at 18-22 weeks of gestation. Triple Test, amniocentesis, fetal echocardiography and follow-up after birth are necessary. In the case of normal follow-up scans fetuses could have a good prognosis for a normal early childhood.