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Crash sign: a new first-trimester sonographic marker of spina bifida

Fred Ushakov, Adalina Sacco, Elena Andreeva, Stefania Tudorache, Thomas Everett, Anna L David, Pranav P Pandya
Ultrasound in Obstetrics & Gynecology 2019 April 11

OBJECTIVES: To describe a new first trimester sonographic sign associated with open fetal spina bifida ("crash sign") where there is posterior displacement and deformation of the mesencephalon against the occipital bone in the axial view, and to evaluate its clinical usefulness in the first trimester diagnosis of spina bifida.

METHODS: This was a retrospective review of patients referred to three fetal medicine centres in the first trimester (11-13+6 weeks) with suspected spina bifida. Spina bifida was confirmed by direct visualisation of the spinal defect by two experts and, where possible, examined at fetal post-mortem. Images were reviewed for the presence of the crash sign. A control group of 55 first trimester scans not affected by spina bifida was created and reviewed by two assessors blinded to the pregnancy diagnosis.

RESULTS: The crash sign was present in 48 out of 53 confirmed cases of spina bifida. Of these patients, 27 had isolated spina bifida and 21 had other associated anomalies. Of the five cases without crash sign, one had isolated spina bifida and four had other associated anomalies. The crash sign was not reported in any of the control patients.

CONCLUSIONS: We have described the use of a new first trimester sonographic marker for the diagnosis of spina bifida. Our results suggest that the crash sign may be a useful tool in the first trimester detection of spina bifida. Prospective evaluation of the crash sign would be beneficial, ideally in a routine clinical screening ultrasound setting. This article is protected by copyright. All rights reserved.


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