The Impact of Prenatal Diagnosis of an Upper Extremity Anomaly on Pregnancy Outcome

Objective: Upper extremity anomalies (UEA) occur when there is an interruption in the normal process of embryonic limb development. The prenatal diagnosis of an UEA may impact the decision to deliver or terminate the pregnancy. We sought to elucidate factors associated with pregnancy outcome in the setting of a known UEA. Methods: We reviewed electronic medical records at three affiliated hospitals to identify mothers with an UEA diagnosed by prenatal ultrasound. Maternal demographics, anomaly type, and clinical management variables were collected. Patients were stratified by primary outcome of either delivery or elective termination. Multivariate analysis was performed to identify factors associated with pregnancy termination. Results: Thirty mother/child dyads were confirmed to have an UEA by prenatal ultrasound. Fourteen pregnancies resulted in live birth of the fetus (47%) and 16 pregnancies were terminated (53%). Pregnancies with multiple anomalies (P<0.05) and/or bilateral UEAs (P<0.05) were more likely to undergo termination. Consultation with an upper extremity surgeon was associated with delivery (P<0.05). Maternal demographics were not associated with pregnancy outcome. Conclusions: Fetal anomaly characteristics are associated with pregnancy outcome. Although prenatal consultation with an upper extremity surgeon was associated with delivery, this subset of patients were more likely to have isolated, unilateral anomalies.