title: Fetal outcome of trisomy 18 diagnosed after 22 weeks of gestation: Experience of 123 cases at a single perinatal center.
abstract: To investigate the pregnancy outcome of the fetuses with trisomy 18, we studied 123 cases of trisomy 18 who were born at our hospital from 1993 to 2009. Among them, 95.9% were diagnosed with trisomy 18 prenatally. Prenatal ultrasound findings showed fetal growth restriction in 77.2%, polyhydramnios in 63.4% and congenital heart defects in 95.1%. For 18 cases, cesarean section (C-section) was chosen, and for 75 cases, transvaginal delivery was chosen. Premature delivery occurred in 35.5%. Stillbirths occurred in 50 cases (40.7%). Fetal demise before onset of labor occurred in 30 cases and fetal demise during labor occurred in 20 cases which was 26.7% of vaginal deliveries. Among the 73 live-born infants, the survival rate for 24 h, 1 week, 1 month and 1 year were 63%, 43%, 33% and 3%. The median survival time was 3.5 days. There was no significant difference between the survival time of C-section and that of vaginal delivery. However, for the births involving breech presentation, the survival time of C-section was significantly longer than that of vaginal delivery. When the fetus is diagnosed with trisomy 18, the parents have to make many choices. These findings constitute critical information in prenatal counseling to the couples whose fetuses have been found to have trisomy 18, especially when they choose palliative approaches in the perinatal management.
authors.affiliation: Division of Obstetrics and Gynecology, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan.|Department of Obstetrics and Gynecology, Yokohama City University, Yokohama, Kanagawa, Japan.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Nagase
authors.affiliation: Division of Obstetrics and Gynecology, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ishikawa
authors.affiliation: Division of Neonatology, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan.
authors.forename: Katsuaki
authors.initials: K
authors.lastname: Toyoshima
authors.affiliation: Division of Neonatology, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan.
authors.forename: Yasufumi
authors.initials: Y
authors.lastname: Itani
authors.affiliation: Division of Pediatrics, Saitama Citizens Medical Center, Saitama, Saitama, Japan.
authors.forename: Noritaka
authors.initials: N
authors.lastname: Furuya
authors.affiliation: Division of Medical Genetics, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Kurosawa
authors.affiliation: Department of Obstetrics and Gynecology, Yokohama City University, Yokohama, Kanagawa, Japan.
authors.forename: Fumiki
authors.initials: F
authors.lastname: Hirahara
authors.affiliation: Department of Integrated Women's Health, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan.
authors.forename: Michiko
authors.initials: M
authors.lastname: Yamanaka
mesh_terms: D000015:Abnormalities, Multiple / Q000000981:diagnostic imaging* / Q000235:genetics / Q000401:mortality; D000293:Adolescent; D000328:Adult; D002887:Chromosomes, Human, Pair 18; D000013:Congenital Abnormalities / Q000000981:diagnostic imaging* / Q000235:genetics / Q000401:mortality; D005260:Female; D005313:Fetal Death; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging / Q000401:mortality; D006801:Humans; D050498:Live Birth; D008297:Male; D008423:Maternal Age; D008875:Middle Aged; D011247:Pregnancy; D011296:Prenatal Diagnosis; D011379:Prognosis; D012189:Retrospective Studies; D050497:Stillbirth; D062606:Tertiary Care Centers; D014314:Trisomy; D000073842:Trisomy 18 Syndrome; D055815:Young Adult
keywords: management; palliative care; prenatal ultrasound findings; prognosis; trisomy 18