Fetuses with PKS exhibited a very t

Fetuses with PKS exhibited a very typical growth pattern characterized by increased BPD and HC, usually above the 90th percentile, accompanied with femoral growth delay, which is significantly below the 10th percentile for gestational age. In our study, the HC percentile of four fetuses was 100th, 90th, 99th, and 32th respectively. But the percentile of FL was higher than 10th, except that of fetus 4 (2th). This further illustrated the varity of ultrasound manifestations of PKS. Karaman et al. presented 15 children with PKS, two of whom were macrosomia [13]. Salzano et al. summarized all the previously published reports of PKS and obtained the percentage of fetal macrosomia was 14% (26/190) [3]. The ultrasound findings of fetus 1 and fetus 3 were decribed as fetal macrosomia shown in Table 2 due to the high percentile of HC and AC. Compared with previous literatures, 2 cases of macrosomia were found in 4 cases of PKS fetus in this study, with higher proportion. Although the number of cases was relatively small, it also showed the difficulty of PKS in prenatal diagnosis. In case of the wide phenotypic spectrum of PKS, we strongly recommend that even if each of these abnormal ultrasound findings is non-specific, PKS should be highly suspected when rhizomelic limbs shortening, polyhydramnios and fetal macrosomia are observed simultaneously. Thicken nuchal fold and cerebral ventriculomegaly were also found in our study, which were consistent with the ultrasound findings reported in previous literature [14, 15].