Prenatal Ultrasound Evaluation of Congenital Hand Anomalies: Toward a Standardized Approach

Congenital hand anomalies affect approximately 22 per 10,000 live births and are classified by the International Federation of Societies for Surgery of the Hand using the Oberg-Manske-Tonkin system into malformations, deformations, and dysplasia. While current guidelines for routine fetal anomaly scans focus on confirming the presence and positioning of limbs and joints, detailed assessment of the hands, particularly the digits, is not routinely performed. However, hand anomalies are often associated with other structural or genetic conditions, which makes accurate prenatal detection essential. This pictorial assay proposes a practical and standardized protocol for advanced fetal hand evaluation during the mid-trimester scan, including the assessment of digit number, structure, and position. Enhanced diagnostic precision can improve genetic counseling and inform decisions regarding further investigations, such as whole-genome sequencing, or considerations about pregnancy continuation. Thus, the early and accurate identification of hand anomalies plays a critical role in multidisciplinary prenatal care. Moreover, an improved diagnosis will enable parents to better accept anomalies at birth.