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Obstetrics & Gynecology 2006;108:846-853
© 2006 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Temporal Relationship Between Increased Nuchal Translucency and Enlarged Jugular Lymphatic Sac

Mireille N. Bekker, MD1,3, Jos W. R. Twisk, PhD2, Margot M. Bartelings, MD, PhD3, Adriana C. Gittenberger-de Groot, PhD3 and John M. G. van Vugt, MD, PhD1

From the Departments of 1Obstetrics and Gynecology and 2Clinical Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands; and 3Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, the Netherlands.

OBJECTIVE: To study the relationship between the volume of the jugular lymphatic sacs and nuchal translucency thickness in fetuses with increased nuchal translucency with advancing gestation.

METHODS: Seventy-four fetuses with a nuchal translucency greater than the 95th percentile were examined weekly between 11 and 17 weeks of gestational age. The fetal neck region was studied by ultrasonography, followed by measurement of nuchal translucency and jugular lymphatic sacs. The measurements were analyzed using multilevel analysis. In case of termination of pregnancy postmortem examination was performed.

RESULTS: In 40 euploid fetuses and 34 aneuploid fetuses, 159 measurements of jugular lymphatic sac volume and nuchal translucency thickness were analyzed. The volume of the jugular lymphatic sacs and gestational age showed a quadratic relation, which differed between euploid and aneuploid fetuses (P<.01). The maximum volumes were larger and present longer in fetuses with aneuploidy than in euploid fetuses (P<.01). In case of a cardiac anomaly, jugular lymphatic sac volume was larger than in cardiac normal fetuses (nonsignificant).

Furthermore, the development of jugular lymphatic sac volume and increased nuchal translucency were related, whereby an increase of the nuchal translucency preceded enlargement of the jugular lymphatic sacs (P<.001). In each fetus an increase in jugular lymphatic sac volume was followed by a decrease with advancing gestation. The gestational age at maximum jugular lymphatic sac volume differed between fetuses, indicating a fetus-specific pattern. Nuchal translucency development showed a similar pattern. Postmortem examination confirmed distension of the jugular lymphatic sacs in all cases.

CONCLUSION: Increased nuchal translucency is associated with abnormal lymphatic development, in which nuchal translucency enlargement precedes enlargement of jugular lymphatic sacs on ultrasound examination. Aneuploid fetuses have a more disturbed lymph angiogenesis.

LEVEL OF EVIDENCE: III






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