Diagnostic ultrasound ( PDFDrive )

CHAPTER 40 The Fetal Musculoskeletal System 1409
Other indings may include micrognathia, ventriculomegaly,
myelomeningocele, and cardiac abnormalities.
SUMMARY
he inding of a skeletal dysplasia and the subsequent communication
of the indings are challenging tasks requiring empathy and
support. In some cases, it may not be possible to establish a
speciic diagnosis and counseling will have to be based on
prognosis estimated from ultrasound indings. he implications
should be discussed in simple terms permitting the parents to
make an informed decision about the management of the
pregnancy, the delivery, and postnatal care. his discussion
typically involves a multidisciplinary team who provide the most
up-to-date information to the parents about options, possible
outcomes, and implications for a future pregnancy. he team
will usually involve an imaging specialist, maternal-fetal medicine
experts, medical geneticists, and the neonatology team. Additional
consultation with orthopedic surgeons, palliative treatment groups,
social workers, and supportive organizations may be helpful for
the family. he mode of delivery should be discussed in advance,
especially in conditions associated with fetal macrocrania, in
which vaginal delivery at term may not be possible. Ater delivery
or pregnancy termination, the diagnosis should be conirmed
by radiographic, photographic, and histomorphic analysis. Cell
culture and DNA should be banked and used for further molecular
investigation. he parents should be seen at a later time to discuss
the results and the implications these results may have on their
future reproductive plans.
Acknowledgments
Special thanks to all the staf at Medical Imaging and Maternal
Fetal Medicine Departments at Sunnybrook Health Science Center
and the Mount Sinai Hospital in Toronto who have provided
many wonderful images and generously shared their knowledge
and work.
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