Clinical significance of prenatally diagnosed clenched hand: genetic associations and pregnancy outcomes

To evaluate associated anomalies, genetic findings, and pregnancy outcomes of fetuses with clenched hand detected on prenatal ultrasonography. This retrospective cohort study included 40 pregnancies with a prenatal diagnosis of clenched hand managed at Ankara Bilkent City Hospital, a tertiary referral center, between January 2020 and October 2025. Prenatal screening results, ultrasound findings, invasive prenatal diagnostic testing, associated fetal anomalies, and pregnancy outcomes were analyzed. Cases in which clenched hand was secondary to arthrogryposis multiplex congenita, fetal akinesia–hypokinesia sequence, neuromuscular disorders, or functional central nervous system disorders causing hand contractures were also excluded. The mean gestational age at diagnosis was 22.15 ± 5.5 weeks. Associated anomalies were present in all cases. Skeletal and facial anomalies were the most common associated findings (80%), followed by central nervous system (75%), cardiac (70%), and gastrointestinal anomalies (67.5%). Prenatal invasive diagnostic testing was performed in 28 cases (70%), revealing trisomy 18 in 18 (45%), trisomy 13 in 2 (5%), and euploidy in 8 (20%). Pregnancy termination was performed in 19 cases (47.5%), intrauterine fetal demise occurred in 6 (15%), and 15 pregnancies (37.5%) resulted in live birth. Among live-born infants, early neonatal death occurred in 12 cases because of severe congenital anomalies and chromosomal abnormalities. Clenched hand is an important prenatal sonographic finding strongly associated with chromosomal abnormalities, particularly trisomy 18, and multiple structural anomalies. Its detection should prompt detailed fetal anatomical assessment and comprehensive genetic evaluation. Given the high rates of adverse pregnancy outcomes, accurate prenatal counseling and multidisciplinary perinatal management are essential.