title: Prognostic value of a simplified anatomically based nomenclature for fetal nuchal lymphatic anomalies.
abstract: OBJECTIVE
  To propose an anatomic classification for fetal nuchal lymphatic anomalies that will be clinically useful and to evaluate the classification's value in predicting chromosomal abnormalities, pregnancy outcomes, other associated fetal anomalies, and spontaneous resolution of these lesions.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Tertiary academic hospital and affiliated tertiary children's hospital.
  
  
  METHODS
  Mother-baby pairs diagnosed with fetal nuchal lymphatic anomalies in a prenatal ultrasound database. Anomalies were classified as nuchal thickening, dorsal lymphatic malformation, or ventral lymphatic malformation. Pregnancy outcomes, prevalence of chromosomal and anatomic abnormalities, and rates of spontaneous lesion resolution were determined for each group.
  
  
  RESULTS
  The study included 189 patients: 58 with nuchal thickening, 120 with dorsal lymphatic malformation, and 11 with ventral lymphatic malformation. In fetuses for whom chromosomal analysis was available, chromosomal abnormalities were strongly associated with dorsal lymphatic malformations (83%), less associated with nuchal thickening (29%), and not associated with ventral lymphatic malformations. Dorsal lymphatic malformation predicted high rates of elective (43%) and spontaneous (20%) termination of pregnancy and showed the strongest association with cardiac, renal, and skeletal anomalies. Nuchal thickening was more likely to resolve in utero than dorsal lymphatic malformations, while no ventral lymphatic malformation resolved spontaneously.
  
  
  CONCLUSIONS
  Fetal nuchal anomalies demonstrate significant and clinically important prognostic differences depending on their anatomic location. The simple classification system proposed here therefore provides useful information to clinicians involved in the pre- and postnatal management of children with these anomalies.
authors.affiliation: Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon, USA.
authors.forename: Beck
authors.initials: B
authors.lastname: Longstreet
authors.affiliation: Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA Balakrishnan.Karthik@mayo.edu.
authors.forename: Karthik
authors.initials: K
authors.lastname: Balakrishnan
authors.affiliation: Seattle Children's Hospital Research Foundation, Seattle, Washington, USA.
authors.forename: Babette
authors.initials: B
authors.lastname: Saltzman
authors.affiliation: Division of Otolaryngology-Head & Neck Surgery, Seattle Children's Hospital, Seattle, Washington, USA.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Perkins
authors.affiliation: Department of Radiology, University of Washington, Seattle, Washington, USA.
authors.forename: Manjiri
authors.initials: M
authors.lastname: Dighe
mesh_terms: D002869:Chromosome Aberrations; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D044148:Lymphatic Abnormalities / Q000000981:diagnostic imaging* / Q000453:epidemiology; D048208:Nuchal Translucency Measurement; D011247:Pregnancy; D011256:Pregnancy Outcome; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D009626:Terminology as Topic; D016216:Ultrasonography, Prenatal
keywords: cervical lymphatic malformation; fetal nuchal anomaly; outcomes; prenatal diagnosis; prognosis