Whole-exome sequencing for diagnosis of Peters-plus syndrome after prenatal diagnosis of recurrent low PAPP-A and multiple fetal anomalies in two consecutive pregnancies.

P Kamalapathy, J S Fonda Allen,C J Macri, A K Lawrence, D S Regier,E I Rubio

Journal of neonatal-perinatal medicine(2019)

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Abstract
 We report a case of two consecutive pregnancies in the same couple presenting with very low pregnancy-associated plasma protein A (PAPP-A), with both pregnancies affected by multiple anomalies of a similar phenotype identified during mid-trimester ultrasound, and eventual diagnosis of Peters-plus syndrome. This case is important in expanding the differential for very low PAPP-A. It also demonstrates the diagnostic value of whole-exome sequencing (WES) after prenatal diagnosis of recurrent fetal ultrasonographic findings. The importance and complexity of providing patient education to enable informed consent for next generation sequencing technologies is discussed.
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Key words
Peters-plus syndrome,fetal MRI,low PAPP-A ,prenatal diagnosis,ultrasound anomalies,whole-exome sequencing
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