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. 2025 Oct;45(11):1442-1449.
doi: 10.1002/pd.6885. Epub 2025 Sep 6.

A Practical Prenatal Ultrasound Classification System for Lower Limb Anomalies-PRELLIM Classification

Arda Arduç  1   2 , Margriet H M van Doesburg  3 , Melinda M E H Witbreuk  4 , Merel C Van Maarle  5 , Elisabeth van Leeuwen  1   2 , Eva Pajkrt  1   2 , Ingeborg H Linskens  1   2
Affiliations

A Practical Prenatal Ultrasound Classification System for Lower Limb Anomalies-PRELLIM Classification

Arda Arduç et al. Prenat Diagn. 2025 Oct.

Abstract

Objective: To address the current lack of a prenatal classification system for fetal lower limb anomalies, we developed and evaluated the PRELLIM (PREnatal Lower LIMb impairment) classification.

Method: A systematic literature review was conducted to identify existing classifications. Based on sonographic features, we developed the PRELLIM classification and applied it to a retrospective cohort of fetuses with isolated lower limb anomalies assessed between 2007 and 2024 at Amsterdam UMC's fetal medicine unit.

Results: No standardized prenatal classification system for lower limb anomalies was found. PRELLIM distinguishes isolated and non-isolated anomalies and categorizes them into clinically relevant subgroups (absent/short, duplication, fusion, contracture, bowing and other). It was applied to 643 fetuses with isolated lower limb anomalies. Contractures were most common (n = 599; 93.2%), followed by poly(syn)dactyly (n = 26; 4.0%), reduction defects (n = 9; 1.5%), bowing (n = 5; 0.8%), and a case of sirenomelia (0.1%). Three additional cases (0.4%) were classified as "other": two lymphangiomas and one amniotic band with lower leg constriction.

Conclusion: PRELLIM is the first prenatal classification tailored to sonographically detectable lower limb anomalies. It aims to enhance diagnostic consistency, improve interdisciplinary communication, and support prenatal counseling and decision-making.

Keywords: classification; lower limb anomalies; prenatal ultrasound.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Suggested PRELLIM classification. In case of bilateral, each limb should be described separately. * In case of an intercalary reduction defect, the part of the affected limb should be mentioned separately. ** There is a long list of other rare and non‐rare limb anomalies that could be included in the other group.
See this image and copyright information in PMC

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