Open AccessCare Pathway for Foetal Joint Contractures, Foetal Akinesia Deformation Sequence, and Arthrogryposis Multiplex Congenita
Author(s) -
Jill K Tjon,
M. B. TanSindhunata,
Marianna Bugiani,
M.M.E.H. Witbreuk,
J.A. van der Sluijs,
Marjan M. Weiss,
Mirjam M. van Weissenbruch,
Laura A. van de Pol,
Annemieke I. Buizer,
Margriet H M van Doesburg,
Petra C.A.M. Bakker,
Bloeme J van der Knoop,
Ingeborg H. Linskens,
J.I.P. de Vries
Publication year - 2021
Publication title -
fetal diagnosis and therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.976
H-Index - 60
eISSN - 1421-9964
pISSN - 1015-3837
DOI - 10.1159/000520869
Subject(s) - arthrogryposis multiplex congenita , arthrogryposis , medicine , prenatal diagnosis , multidisciplinary approach , genetic counseling , muscle contracture , genetic testing , joint contracture , contracture , prenatal care , pediatrics , obstetrics , surgery , fetus , pregnancy , genetics , population , social science , environmental health , sociology , biology
The majority of arthrogryposis multiplex congenita (AMC) and lethal forms of AMC such as foetal akinesia deformation sequence (FADS) cases are missed prenatally. We have demonstrated the additional value of foetal motor assessment and evaluation in a multidisciplinary team for the period 2007–2016. An applied care pathway was developed for foetuses presenting with joint contracture(s) in one anatomic region (e.g., talipes equinovarus [TEV]), more than one body part with non-progressive contractures and motility (AMC) and with deterioration over time (FADS). Methods: The multidisciplinary team of Amsterdam University Medical Centre Expertise Centre FADS and AMC developed the care pathway. Additional tools are provided including a motor assessment by ultrasound examination and a post-mortem assessment form. Results: An eight-step care pathway is presented with a proposed timing for prenatal sonographic examination, genetic examinations, multidisciplinary meetings, prenatal and postnatal counselling of the parents by a specialist also treating after birth, and the follow-up of prenatal and postnatal findings with counselling for future pregnancies. Discussion/Conclusion: The scheduled serial structural and motor sonograpahic assessment together with follow-up examinations and genetic analysis should be tailored per prenatal centre per available resources. The multidisciplinary care pathway may pave the way to increase the detection rate and diagnosis of isolated contracture(s), TEV with underlying genetic causes, and the rare phenotypes AMC/FADS and prompt treatment after birth within expertise teams.