Outcome of isolated fetal talipes: a systematic review and meta‐analysis

INTRODUCTION: The aim of this systematic review was to explore the outcome of fetuses with a prenatal diagnosis of isolated talipes. MATERIAL AND METHODS: Medline, Embase, Cinahl and Clinicaltrials. gov databases were searched. The outcomes explored were: associated anomalies detected at follow-up ultrasound examination; fetal magnetic resonance imaging (MRI) and birth; chromosomal abnormalities detected with standard and chromosomal microarray analysis, intra-uterine, neonatal, perinatal death and termination of pregnancy; rate of surgical and non-surgical treatment; neurodevelopmental outcome; and false positive rate of prenatal diagnosis. Meta-analyses of proportions were used to combine data. RESULTS: Twenty-five studies (1567 fetuses) were included. Associated anomalies were detected in 7.8% (95% CI 0.1-29.3) of cases at follow up ultrasound, while in 4.0% (95% CI 0.1-13.2) of cases, fetal MRI identified anomalies not detected at ultrasound assessment. Similarly, 7.0% (95% CI 3.4-11.7) of cases labelled as isolated talipes on prenatal imaging were found to have associated anomalies at birth. Abnormal karyotype was present in 3.6% (95% CI 1.7-6.2) of fetuses, while no anomaly was found at chromosomal microarray analysis, although this outcome was reported by only one study. Intra-uterine death occurred in 0.99% (95% CI 0.4-1.9) of fetuses, while the corresponding figures for neonatal death and termination of pregnancy were 1.5% (95% CI 0.6-2.6) and 2.2% (95% CI 1.2-3.4) respectively. Surgical management of anomalies after birth was found in 41.7% (95% CI 27.0-57.2) of fetuses with isolated talipes, while 54.8% (95% CI 31.5-77.0) had non-surgical management of the anomalies after birth. Abnormal neurodevelopmental outcome was reported in 7.6% (95% CI 1.0-19.4) of children, although this analysis was affected by the very small number of included cases and short time at follow-up. CONCLUSIONS: Isolated talipes detected on prenatal ultrasound carries a generally good prognosis. The incidence of additional abnormalities detected on fetal MRI, aneuploidy, or neurodevelopmental disability is relatively low. However, longitudinal ultrasound assessment during pregnancy and a thorough postnatal evaluation is recommended to rule out associated anomalies which may significantly impact short- and long-term prognosis. This article is protected by copyright. All rights reserved.