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Visualization of the fetal anus by prenatal ultrasound for the diagnosis of anorectal malformations: is it feasible?

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Abstract

Purpose

The goal of this study was to determine the feasibility of identifying the anal dimple (AD) on routine prenatal ultrasound. Using the presence, absence, appearance, and location of the anal dimple as an indirect sign for possible underlying anorectal malformations (ARM), we hypothesize that evaluation of the anal dimple as part of the fetal anatomic survey may increase the sensitivity in detecting less severe ARMs.

Methods

In a prospective longitudinal observational study, pregnant women who underwent prenatal ultrasound (US) at the Colorado Fetal Care Center between January 2019 and 2020 were enrolled. The variables recorded included gestational age, singleton versus multiple pregnancy, gender of the fetus, visualization of the AD, and reason for non-visualization of the AD.

Results

A total of 900 ultrasounds were performed, evaluating 1044 fetuses, in 372 different pregnant women. Gestational ages ranged from 16 to 38 weeks. The AD was visualized in 612 fetuses (58.6%) and not seen in 432 (41.4%). The two most common reasons for non-visualization were extremes in gestational age (n = 155; 36%) and fetal position (n = 152; 35.3%). The optimal gestational age range for AD visualization was 28–33 weeks + 6 days, with 78.1% visualization rate.

Conclusion

Visualization of the anal dimple by ultrasound is feasible and may aid in the detection of less severe ARMs, ultimately impacting pregnancy management and family counseling. The optimal timing for anal dimple visualization is late second and third trimester.

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Acknowledgements

The authors would like to thank sonographers, Rachel Hauptman RDMS, Elizabeth Weisenborn BC-WHNP, RDMS, and Karen Paulson RNC, RDMS, for their contribution in acquiring the data.

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Authors and Affiliations

  1. International Center for Colorectal and Urogenital Care, Children’s Hospital Colorado, 13123 East 16th Avenue, Box 323, Anschutz Medical Campus, Aurora, CO, 80045, USA

    Andrea Bischoff, Michael V. Zaretsky, Jill Ketzer, Jennifer Hall, Luis de La Torre & Alberto Peña

  2. University of Colorado School of Medicine, Aurora, USA

    Andrea Bischoff, David M. Mirsky, Luis de La Torre, Alberto Peña & Mariana L. Meyers

  3. Department of Radiology, Lucile Packard Children’s Hospital, Palo Alto, USA

    Carolina V. A. Guimaraes

  4. Department of Radiology, Children’s Hospital Colorado, Aurora, USA

    David M. Mirsky & Mariana L. Meyers

  5. Colorado Fetal Care Center, Children’s Hospital Colorado, Aurora, USA

    David M. Mirsky, Michael V. Zaretsky & Mariana L. Meyers

  6. Department of Pediatric Surgery, Instituto Nacional de Pediatria, Mexico, Mexico

    Karla A. Santos-Jasso

  7. Department of Pediatric Surgery, Lucile Packard Children’s Hospital, Palo Alto, USA

    Claudia Mueller

Authors
  1. Andrea Bischoff
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  2. Carolina V. A. Guimaraes
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  3. David M. Mirsky
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  4. Karla A. Santos-Jasso
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  5. Michael V. Zaretsky
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  6. Jill Ketzer
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  7. Jennifer Hall
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  8. Claudia Mueller
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  9. Luis de La Torre
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  10. Alberto Peña
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  11. Mariana L. Meyers
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Corresponding author

Correspondence to Andrea Bischoff.

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Bischoff, A., Guimaraes, C.V.A., Mirsky, D.M. et al. Visualization of the fetal anus by prenatal ultrasound for the diagnosis of anorectal malformations: is it feasible?. Pediatr Surg Int 37, 425–430 (2021). https://doi.org/10.1007/s00383-020-04840-8

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  • DOI: https://doi.org/10.1007/s00383-020-04840-8

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