The purpose of this study was to review the current challenges that the diagnosis and clinical management of hyperextension of the fetal neck represent and to describe the clinical significance and differential diagnosis of this entity, detected by ultrasound prior to the onset of labour.
A case of hyperextension the fetal neck is presented. The key points in the diagnosis and management of fetuses with these sonographic finding are reviewed. Hyperextension of the fetal neck is a sonographic finding amenable to prenatal ultrasound diagnosis. The initial finding is a hyperextension, referred to the persistence of the cervical spine in extreme extension, with an extension angle of at least 150 degrees persisting for the duration of the scan.
The patient was referred to a reference hospital where an intrauterine septum was described and confirmed in week 21, with a less marked fetal hyperextension. After birth the Neonatal Pediatric service had difficulty passing nasogastric tube and a loop at the level of the upper third of the esophagus was observed in the chest radiography. She was transferred to a reference hospital for suspected oesophageal atresia that was confirmed and treated with surgery. Long term outcome was favorable.
The identification of a fetus with HFN should prompt a detailed search for structural abnormalities, although these may not all be identifiable prior to delivery. After birth, an oesophageal atresia was confirmed and treated with surgery with a favorable long term outcome. Persistent HFN can be associated with normal outcome as in this case. Prenatal counseling should be offered in case of suspected diagnosis.