Case Report

Pregnancy in a Patient With Mosaic Turner Syndrome: A Case Report

Abstract

Turner Syndrome (TS) is a chromosomal sex disorder, phenotypically characterized by short stature, webbed neck, cubitus valgus, and rarely with slight intellectual disability. A majority of TS patients (95%-98%) have infertility due to ovarian failure. Pregnancy in TS patients is an unusual case; however, pregnancy could rarely occur in mosaicism TS patients without any assistance. Pregnancy in such patients is associated with high risks of maternal mortality, spontaneous abortion, as well as the congenital and karyotype abnormalities of the fetus. A 30-year-old pregnant woman has referred to our genetics lab with a history of polyabortivity. Her menarche occurred at the age of 13 years and her menstruation was claimed to be in a regular cycle. The patient’s two first pregnancies resulted in stillbirth, whereas the third one was delivered through caesarian surgery, but spoiled after 8 days. Our case was characterized by mosaicism 45, X/45, XX, after referring as a multi-abortion case. The fourth pregnancy has happened at the age of 31 years and a healthy embryo with normal heart function was diagnosed by sonography in 17 weeks of gestation. The result of amniocentesis confirmed a healthy female embryo with 46, XX karyotype. Spontaneous pregnancy is regarded as a precarious situation terrifying by abortion or malignancy; also, chromosomal abnormalities, like trisomy 21 and TS, are prevalent in offspring. Therefore, it is strongly recommended to have cohort studies based on karyotype characterization to decrease the patient’s concerns as well as to follow more practical clinical approaches.

[1] Saenger P, Wikland KA, Conway G, Davenport M, Gravholt CH, Hintz R, et al. Recommendations for the diagnosis and management of Turner syndrome. The Journal of Clinical Endocrinology & Metabolism. 2001; 86(7):3061-9. [DOI:10.1210/jcem.86.7.7683] [PMID]
[2] Bouchlariotou S, Tsikouras P, Dimitraki M, Athanasiadis A, Papoulidis I, Maroulis G, et al. Turner’s syndrome and pregnancy: has the 45, X/47, XXX mosaicism a different prognosis? Own clinical experience and literature review. The Journal of Maternal-Fetal & Neonatal Medicine. 2011; 24(5):668-72. [DOI:10.3109/1476 7058.2010.520769] [PMID]
[3] Kesler SR. Turner syndrome. Child and Adolescent Psychiatric Clinics of North America. 2007; 16(3):709-22. [DOI:10.1016/j. chc.2007.02.004]
[4] Bouet PE, Godbout A, El Hachem H, Lefebvre M, Bérubé L, Dionne MD, et al. Fertility and pregnancy in Turner syndrome. Journal of Obstetrics and Gynaecology Canada. 2016; 38(8):712-8. [DOI:10.1016/j.jogc.2016.02.007] [PMID]
[5] Foudila T, Söderström-Anttila V, Hovatta O. Turner’s syndrome and pregnancies after oocyte donation. Human Reproduction. 1999; 14(2):532-5. [DOI:10.1093/humrep/14.2.532] [PMID]
[6] Singh DN, Hara S, Foster HW, Grimes EM. Reproductive performance in women with sex chromosome mosaicism. Obstetrics & Gynecology. 1980; 55(5):608-11. [PMID]
[7] Swapp G, Johnston A, Watt J, Couzin D, Stephen G. A fertile woman with non‐mosaic Turner’s syndrome. Case report and review of the literature. British Journal of Obstetrics and Gynaecology. 1989; 96(7):876-80. [DOI:10.1111/j.1471-0528.1989.tb03332.x] [PMID]
[8] Bondy CA, Turner Syndrome Study Group. Care of girls and women with Turner syndrome: A guideline of the Turner Syndrome Study Group. The Journal of Clinical Endocrinology & Metabolism. 2007; 92(1):10-25. [DOI:10.1210/jc.2006-1374] [PMID]
[9] Simpson JL, Rajkovic A. Ovarian differentiation and gonadal failure. American Journal of Medical Genetics. 1999; 89(4):186- 200. [DOI:10.1002/(sici)1096-8628(19991229)89:4<186::aidajmg3>
3.0.co;2-5]
[10] Hovatta O. Pregnancies in women with Turner’s syndrome. Annals of Medicine. 1999; 31(2):106-10. [DOI:10.3109/07853899908998785] [PMID]
[11] Gravholt CH, Viuff MH, Brun S, Stochholm K, Andersen NH. Turner syndrome: Mechanisms and management. Nature Reviews Endocrinology. 2019; 15(10):601-14.
[12] Birkebaek NH, Crüger D, Hansen J, Nielsen J, Bruun-Petersen G. Fertility and pregnancy outcome in Danish women with Turner syndrome. Clinical Genetics. 2002; 61(1):35-9. [DOI:10.1034/ j.1399-0004.2002.610107.x] [PMID]
[13] Bryman I, Sylvén L, Berntorp K, Innala E, Bergström I, Hanson C, et al. Pregnancy rate and outcome in Swedish women with Turner syndrome. Fertility and Sterility. 2011; 95(8):2507-10. [DOI:10.1016/j.fertnstert.2010.12.039] [PMID]
[14] Hadnott TN, Gould HN, Gharib AM, Bondy CA. Outcomes of spontaneous and assisted pregnancies in Turner syndrome: The U.S. National Institutes of Health experience. Fertility and Sterility. 2011; 95(7):2251-6. [DOI:10.1016/j.fertnstert.2011.03.085] [PMID] [PMCID]
[15] Bernard V, Donadille B, Zenaty D, Courtillot C, Salenave S, Brac de la Perrière A, et al. Spontaneous fertility and pregnancy outcomes amongst 480 women with Turner syndrome. Human Reproduction. 2016; 31(4):782-8. [DOI:10.1093/humrep/dew012] [PMID]
[16] Tuke MA, Ruth KS, Wood AR, Beaumont RN, Tyrrell J, Jones SE, et al. Mosaic Turner syndrome shows reduced penetrance in an adult population study. Genetics in Medicine. 2019; 21(4):877-86. [DOI:10.1038/s41436-018-0271-6] [PMID] [PMCID]
[17] Hewitt JK, Jayasinghe Y, Amor DJ, Gillam LH, Warne GL, Grover S, et al. Fertility in Turner syndrome. Clinical Endocrinology. 2013; 79(5):606-14. [DOI:10.1111/cen.12288] [PMID]
Files
IssueVol 5 No 2 (2020): Spring QRcode
SectionCase Report(s)
DOI https://doi.org/10.18502/crcp.v5i2.3843
Keywords
Turner syndrome Pregnancy Mosaicism Abortion Chromosomal disorder

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Shahrokhi Sabzevar S, Mirzaei F, Tanipour MH, Eslahi A, Hasanzadeh Nazarabadi M. Pregnancy in a Patient With Mosaic Turner Syndrome: A Case Report. CRCP. 2020;5(2):58-62.