Clinical scenario

A 25-year-old, non-smoker, expectant mother in her first pregnancy, had her ‘anomaly ultrasound scan’ at 20 weeks. This showed an apparently isolated (ie, no associated intrauterine anomalies) talipes equinovarus (TEV), or clubfoot. There was no family history of any musculoskeletal condition. After the scan, she asked what the chances are that her child will (i) be normal, (ii) have associated anomalies not picked up on the ultrasound scan or (iii) have isolated idiopathic clubfoot.

Clinical question

For an antenatal ultrasound scan showing an apparently isolated TEV deformity, what does the evidence suggest as the postnatal sequelae?

Search

A primary search was performed (21 May 2016) in PubMed: (antenatal[All Fields] OR prenatal[All Fields] OR anomaly[All Fields]) AND ((“Ultrasound”[Journal] OR “ultrasound”[All Fields] OR “Appl Radiol”[Journal] OR “ultrasound”[All Fields]) OR (“scan”[All Fields]) AND (clubfeet[All Fields] OR clubfoot[All Fields] OR talipes[All Fields] OR equinovarus[All Fields]) (accessed 21 May 2016). A secondary search of the Cochrane database did not retrieve additional material. The titles and abstracts of the 140 retrievals were screened for relevance; 98 were excluded, leaving 42 for full-paper retrieval. Further articles were excluded on the basis of (i) describing ≤5 fetally diagnosed isolated TEV cases (eg, case reports and small series) or (ii) having no relevant original data (eg, review articles).1

Twenty-three studies (22 retrospective case series2–23 and 1 prospective observational study24) with patient data subsequent to ultrasound scans showing an apparent isolated TEV (defined as an intrauterine clubfoot deformity without other associated congenital anomalies identified) were examined. Seven were excluded as they did not adequately define the key population (fetally diagnosed isolated TEV), either because apparent isolated TEV and ‘complex’ cases were inappropriately treated as a homogeneous group …