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A Practical Prenatal Ultrasound Classification System for Lower Limb Anomalies-PRELLIM Classification
Arda Arduç1,2, Margriet H M van Doesburg3, Melinda M E H Witbreuk4
1Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Prenatal Diagnosis
|September 6, 2025
Summary
A new prenatal classification system, PRELLIM (PREnatal Lower LIMb impairment), has been developed for fetal lower limb anomalies. This system enhances diagnostic consistency and supports prenatal counseling for these conditions.
Area of Science:
- Fetal Medicine
- Medical Diagnostics
- Congenital Anomalies
Background:
- Lack of a standardized prenatal classification for fetal lower limb anomalies.
- Need for improved diagnostic consistency and communication.
Purpose of the Study:
- Develop and evaluate the PRELLIM (PREnatal Lower LIMb impairment) classification system.
- Establish a sonographically-based prenatal classification for fetal lower limb anomalies.
Main Methods:
- Systematic literature review to identify existing classifications.
- Development of the PRELLIM classification based on sonographic features.
- Application of PRELLIM to a retrospective cohort of 643 fetuses with isolated lower limb anomalies.
Main Results:
- No existing standardized prenatal classification system was identified.
- PRELLIM categorizes anomalies into subgroups: absent/short, duplication, fusion, contracture, bowing, and other.
- Contractures were the most common anomaly (93.2%), followed by poly(syn)dactyly (4.0%).
Conclusions:
- PRELLIM is the first prenatal classification system for sonographically detectable lower limb anomalies.
- Aims to improve diagnostic consistency, interdisciplinary communication, and prenatal counseling.
- Facilitates better decision-making in managing fetal lower limb impairments.
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