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Increased detection of cystic hygroma: a "technology-induced phenomenon"
O Geifman-Holtzman1, H E Drury, L B Holmes
1Department of Obstetrics and Gynecology, SUNY Health Science Center, Syracuse, USA.
Insights
The detection of cystic hygroma, a congenital abnormality, significantly increased from 1973 to 1990 due to widespread prenatal ultrasound use. This led to earlier diagnosis and higher termination rates for affected pregnancies.
Area of Science:
- Medical Science
- Obstetrics and Gynecology
- Pediatrics
Background:
- Cystic hygroma is a congenital malformation affecting fetal development.
- Early detection is crucial for management and parental decision-making.
Purpose of the Study:
- To analyze the trends in cystic hygroma detection rates over two decades.
- To investigate the impact of diagnostic methods on detection rates and pregnancy outcomes.
Main Methods:
- Retrospective analysis of data from an urban hospital-based Active Malformations Surveillance Program (1973-1990).
- Inclusion of infants and fetuses identified through pediatric examinations, autopsies, and prenatal ultrasonography.
- Subdivision of cases based on maternal factors, associated abnormalities, and birth status.
Main Results:
- A significant increase in cystic hygroma prevalence was observed, rising from 0.08 to 1.45 per 1,000 live births among non-transfer mothers.
- Prenatal ultrasonography became the primary diagnostic tool by 1989-1990, shifting diagnosis from post-birth to pre-natal.
- Seventy-one percent of diagnosed pregnancies were terminated, correlating with increased prenatal ultrasound screening.
Conclusions:
- The rise in cystic hygroma detection is largely attributed to advancements in prenatal ultrasound technology and increased screening frequency.
- Widespread use of prenatal ultrasound has altered diagnostic timelines and influenced pregnancy termination decisions.
- Improved imaging technology and sonographer expertise have enhanced the identification of fetal abnormalities like cystic hygroma.
Abstract:
In this study, we have determined the increasing rate of detection of cystic hygroma in an urban hospital-based Active Malformations Surveillance Program during 1973-1974, 1979-1980, 1984-1985, and 1989-1990. All affected infants were identified from a review of the findings in either the findings in the pediatricians' examinations, the autopsy reports or the reports of finding in prenatal ultrasonography. The infants were subdivided by maternal transfer status and age (> or = 5 or < 35), the presence of associated chromosome abnormalities and malformations and birth status. Eighty-four affected infants and fetuses were identified, 47 of whose mothers were nontransfers. Among the maternal nontransfers, the prevalence rate of cystic hygroma increased from 0.08/1,000 in 1973-1974 to 1.45/1,000 in 1988-1990. Initially, the diagnosis was made at birth in liveborn or stillborn infants, but by 1989-1990, only by prenatal ultrasonography. Most (71%) of the pregnancies with affected fetuses were terminated by choice following diagnosis with prenatal ultrasonography. A marked increase in the frequency of examination by sonography during pregnancy was observed among a comparison group of women between 1974 and 1989. The progressive increase in the detection of cystic hygroma in this time period was one effect of this more extensive use of prenatal ultrasound, better equipment, and more experienced sonographers.