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High cesarean section rate in trisomy 18 births: a potential indication for late prenatal diagnosis
Insights
Cesarean section rates for infants with trisomy 18 significantly increased over a 10-year period. Fetal indications, particularly fetal distress, drove this rise in cesarean deliveries for trisomy 18.
Area of Science:
- Perinatology
- Medical Genetics
- Obstetrics
Background:
- Trisomy 18 (Edwards syndrome) is a severe chromosomal abnormality.
- Management of pregnancies with trisomy 18 involves complex obstetric decisions.
- Cesarean section rates for trisomy 18 have not been extensively studied.
Purpose of the Study:
- To evaluate the trends and indications for primary cesarean section in infants diagnosed with trisomy 18.
- To compare cesarean section rates for trisomy 18 with state-wide rates.
- To identify obstetric features and potential benefits of prenatal diagnosis.
Main Methods:
- Retrospective review of obstetric records for 48 cases of trisomy 18.
- Data collected over a 10-year period (1969-1979) from three Philadelphia Genetic Centers.
- Analysis of cesarean section rates and indications, including fetal distress.
Main Results:
- Primary cesarean section rates for trisomy 18 increased from 20% (1969-1974) to 55.6% (1974-1979).
- These rates were substantially higher than Pennsylvania state averages (6.10% and 10.00%).
- In the later period, 13 of 15 cesarean sections were for fetal indications, with 11 diagnosed as fetal distress.
Conclusions:
- There was a marked increase in cesarean deliveries for trisomy 18, often driven by fetal indications.
- Clinical suspicion of trisomy 18 in the third trimester warrants careful obstetric management.
- Late-pregnancy prenatal cytogenetic diagnosis may offer benefits in selected trisomy 18 cases.
Abstract:
The frequency of and indications for primary cesarean section delivery of infants with trisomy 18 was evaluated retrospectively by reviewing the obstetric records of the 48 cases of trisomy 18 diagnosed over a 10-year period by three Genetic Centers in Philadelphia. From June, 1969, to June, 1974, four of 20 infants with trisomy 18 were delivered by primary cesarean section (20%). From June, 1974 to June, 1979, the primary cesarean section rate for trisomy 18 rose to 55.6% (15/28). These rates are considerably higher than those for the State of Pennsylvania during the same time intervals (6.10% and 10.00%, respectively). In the latter 5-year interval, 13 of 15 primary cesarean sections were performed for fetal indications, and "fetal distress" was diagnosed in 11 of the 13. The obstetric features of these pregnancies are reviewed. The basis for a clinical suspicion of trisomy 18 during the third trimester and the possible benefit of late-pregnancy prenatal cytogenetic diagnosis in selected cases are discussed.