Prenatal diagnosis of isolated clubfoot: diagnostic accuracy
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The correlation of grade of severity assigned prenatally for isolated congenital talipes equinovarus (cTEV) and the postnatal outcome has never been reported before. Third-degree cTEV is directly associated with a long time of rehabilitation session, higher rates of Achilles tendon tenotomy, higher risk of relapse, and higher risk of major surgery.

The objective was to evaluate the concordance between prenatal and postnatal diagnosis of congenital talipes equinovarus (cTEV), rates of surgery, and postnatal outcomes in relation to the prenatal classification of severity.

This is a retrospective observational cohort study on fetuses with a prenatal diagnosis of cTEV. All cases of isolated cTEV in singleton pregnancies were included. Postnatally, the Ponseti method was applied. Children were followed up postnatally for at least two years, with a specific focus on neurodevelopmental outcomes. The cohort included 81 fetuses with a prenatal diagnosis of cTEV confirmed postnatally in 86.4% of cases.

- Concordance between prenatal and postnatal assessment was good for both laterality and degree of severity.

- The average Pirani score, number of casts, and rates of Achilles tendon tenotomy were higher for III degrees cTEV.

- Within this group only, the rate of relapse was 11% and the rate of major surgery was 6%. The postnatal outcome was normal in 68.6% of newborns, while 14% of cases had a diagnosis of minor additional findings and 17% had an impairment of neurological development.

- None of the outcomes were statistically correlated to the prenatal assessment of laterality or degree.

The accuracy of prenatal ultrasound for isolated cTEV is 86% with a false-positive diagnosis of 14%. The grade of cTEV assigned prenatally correlates to postnatal severity and longer orthopedic rehabilitation in terms of the number of casts and need for surgery.

European Journal Obstetrics & Gynecology and Reproductive Biology
Source: https://doi.org/10.1016/j.ejogrb.2021.07.009
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