Medical error: the child was born without arms. This baby was born without arms and legs. See how he takes his first steps

For people born without limbs, there was one road - to the circus.
Now this is not the case, but despite the new technological capabilities, the life of such people is extremely difficult. What is especially offensive - absolutely healthy people ruin their lives, not feeling what happiness it is to be born full.

The name of the syndrome of this genetic disorder comes from the Greek "tetra", which means "four", and "amelia" (stress on the penultimate syllable), which means "no limb."

Even before I was born, my parents knew that I would not have three limbs. They gave me life. It's just a miracle that the Lord allowed me to pass this gift on, says 24-year-old Melek from Denmark.
She has no legs and no right hand, but she gave birth and is now raising a son.

"Mehmet goes to work, and I take care of my son and cook. The only thing I can't do myself is to wash the Seimi - it's hard to keep him."
She met her future husband Mehmet in the company of friends.
“I had a lot of girls,” Mehmet says. - But he loved no one as much as Melek. Many advised me to leave her, but for such words I am ready to kill.

Wendy was born without arms or legs due to the medications her mother took during her pregnancy.
She went to a regular school where she wrote with her mouth. Her first real friend appeared at the age of 13.
She learned to drive a car with a modified, especially for her, control panel.

Wendy is a 31-year-old woman from Los Angeles who lives with husband Anthony and their two children. The eldest son Kaylin is 6 years old, and the youngest Jeremy is 8 months old.
Throughout her life, Wendy knew that her disability would not interfere with the fulfillment of her dreams.

Wendy uses her shoulder and lower torso to move. She also has an electric stroller with a joystick at shoulder level.

Little Peruvian Jovana Yumbo Ruiz was born with a rare syndrome - tetra-amelia, i.e. without limbs.
Her parents live in a small, poor village in the Peruvian hinterland.

But, thanks to the fact that her story was shown on television, the capital's doctors became interested in her case, and now the girl is in the medical adaptation center in Lima.

Despite her illness, the girl remains cheerful, a smile never leaves her face. She presses a pencil with her cheek to her shoulder and draws, eats with a spoon, knows how to take toys with her mouth. The girl has developed an amazing flexibility of the back and neck, she can move quite quickly and dexterously on the floor.
Dr. Luis Rubio intends to perform an operation to implant a bionic arm in the girl, which could be controlled by transmitting signals from the pectoral muscles.

Even healthy children are not always able to master a musical instrument. 14-year-old girl Veronica Lazareva, who was born without arms and legs, succeeded in a short time.

She independently turns on the instrument and sings in a clear and gentle voice, accompanying herself.
On Veronica's desk is a solfeggio notebook, where notes are neatly written. The young singer is writing, holding a pen in her mouth.

Chelninskie Izvestia has told many times about this courageous girl. Veronica lived in the Children's Home and once on New Year's Eve wrote a letter to Santa Claus that she really wants to live in a family where she would be loved. And a miracle happened!

Accidentally seeing a photo of Veronica in our newspaper, her mother Tatyana Lazareva, who by this time had married for the second time and had given birth to a son, immediately recognized her daughter in the girl. She left Veronica in the hospital on the advice of doctors, who were sure that the child would not survive. She went to the Children's Home to hug her and no longer let go of her.

Rosemary was born with a severe genetic disorder: hypoplasia.
The girl's legs were severely deformed and insensitive, the feet looked in different directions. Rose's legs could get tangled somewhere, she could cut and burn them. When Rose was two years old, her mother decided to amputate the girl's legs. So Rose, the half girls, began a relatively normal life.

“Imagine a Barbie with her legs ripped off. This will be me. Almost normal, only slightly shorter - there are no 4 vertebrae.

My parents made the right decision - I can't imagine my life in a wheelchair. There were pros and cons.
I'm glad they cut off my legs. Generally speaking, it's easier for me to walk on my hands - it's almost like walking on my feet. "

At school they tried to force her to walk on artificial legs, she recalls this time with a shudder.

She moves on her hands and on a skateboard.
“School was a nightmare. They wanted to fit everyone to the same standard and appearance and made me walk on fake legs. Terrible.

In the 9th grade, my patience ran out and I decided to be myself. I came to school on a skateboard, climbed onto a chair, all the students stared at me. I was terribly proud that I dared.

Rosemary met future husband Dave Siggins at work. Dave worked in a parts store, Rose worked in a car service. At first, they talked on the phone for a long time, joked, even flirted.

Rose really liked him and they became friends. Dave was more than just a friend to her, but she couldn't take the first step on her own. And Dave took the first step. Not just a first step, but an offer on the air of state television.

Nicholas Vujicic was born in Melbourne, Australia, to a family of Serbian immigrants. Mother is a nurse. The father is a pastor.

At first, the mother could not bring herself to take her son in her arms. “I had no idea how I would take the child home, what to do with him, how to take care of him,” recalls Dushka Vuychich.

Nick has a semblance of a foot instead of a left leg. Thanks to this, the boy learned to walk, swim, skate, play on the computer and write. Parents made sure that their son was taken to a regular school.

At the age of eight, Nicholas decided to drown himself in the bathtub. He asked his mother to take him there.
“I turned my face into the water, but it was very difficult to resist. Nothing worked.

Now he has learned to swim!

At nineteen, Nick studied financial planning at university.
He wrote a book about his life, typing 43 words per minute on his computer. In between his work trips, he goes fishing, plays golf and surfs.

“I don't always get up in the morning with a smile on my face. Sometimes my back hurts, - says Nick, - But because there is great strength in my principles, I continue to take small steps forward, baby steps.

He is on the road ten months a year, two months at home. He traveled to more than two dozen countries, more than three million people heard him - in schools, nursing homes, prisons.
It happens that Nick speaks at stadiums with many thousands of people. He performs about 250 times a year.
Nick receives about three hundred offers for new performances a week. He became a professional speaker.

“Last year I met people who had a son without arms and legs. The doctors said:“ He will be a plant for the rest of his life. - another person of the same kind. And they had hope. "

“It happens in life that you fall, and it seems that you have no strength to rise. Then you wonder if you have any hope ... I have no arms or legs! It seems that if I try to climb at least a hundred times, I will not succeed. But after another defeat, I do not give up hope. I will try over and over again. I want you to know that failure is not the end. The main thing is how you finish. Are you going to finish strong? Then you will find the strength to rise - in this way. "

He leans on his forehead, then helps himself with his shoulders and stands up.
The women in the audience begin to cry.

Faith is a bipedal dog.
The dog was born without front legs, but has learned to walk perfectly on its hind legs - like a human being.

Faith now visits orphanages and hospitals to inspire limb-less people.

These are violations of the shape of the limbs, existing at the time of birth, which are formed as a result of a violation of the normal formation of the limbs in the prenatal period.
In most cases cause of congenital anomalies of the upper limbs unknown. These defects can occur as a consequence of hereditary characteristics (gene changes). This pathology is characterized by the fact that it occurs in the same family. There are also many known cases of anomalies resulting from damage to the embryo during the first 3 months of its development, for example, during the period of an infectious disease of a pregnant woman, during X-ray irradiation or when exposed to toxic chemical factors. Later damage leads to maturation disorders, and in the most severe cases lead to fetal death.
Congenital anomalies are a special group of deformities of the upper limb. These defects of the upper limb can be divided into two types: underdevelopment of the hand in the longitudinal type and underdevelopment of the hand in the transverse type.
General functional and clinical and radiological signs of defects in both groups are limited or complete absence of the function of grasping and holding objects, as well as atrophy of soft tissues and bones of the hand, forearm, shoulder, delay in osteogenesis processes and shortening of the affected arm in comparison with the healthy one from 1, 5 cm until it is completely lost (amelia). Moreover, the severity of developmental defects can be different. It happens that they are detected immediately after birth, and it happens that - after several weeks or months when violations of certain functions of the limb are detected.

The most common congenital malformations of the upper limb are:
- congenital limb amputations
- partial underdevelopment of the limb (perversion of the development of individual segments or joints)
- amniotic constrictions
- excessive growth of the limb or congenital shortening of the limb
- congenital false joints

Congenital limb amputations.
Congenital limb amputations are the complete absence of the entire limb or its distal part. Partial underdevelopment of the limb is the absence or underdevelopment of the distal parts of the limb or the abnormal development of individual bones, muscles, joints, for example, congenital clubhand, defects in the development of fingers, congenital synostosis of the bones of the forearm, etc.
Congenital limb amputations are of two types:
1) Amelia- complete absence of a limb.
2) - congenital amputation stump.
Ectrodactyly is the absence of a distal limb with normal development of the proximal limb. In this case, there is a congenital amputation stump. In this case, there may be an absence or underdevelopment of all 4 limbs or (most often) one of them. This leads not only to cosmetic deformity, but also to significant dysfunction of the limb.
In the treatment of this pathology, rational prosthetics are used, and the patient is also taught to use vicious limbs. In this case, the upper limbs are equipped with bioelectric or cosmetic prostheses or special working devices.
With ectrodactyly, there is no phantom pain. Diseases of the stump, characteristic of post-traumatic amputations, are usually not observed. It should be noted that by the age of two, the child can be rationally prosthetic and taught to use the prosthesis. Children are remarkably adaptable to their defects.

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Partial limb underdevelopment has several forms:
a) hemimelia- this is when there are underdeveloped fingers or a hand at the end of the amputation stump
b) peromelia- when, in the complete absence of a limb, there may be a slight rudiment in its place
v) phocomelia- This is a developmental defect in which there is an absence of proximal parts of the limb, and the existing excess of skin and subcutaneous tissue in its appearance resembles a seal's fin.
Such limb defects are not cured. Only prosthetics of patients is possible.

Amniotic constrictions.
Amniotic constrictions are congenital filamentous depressions along segments of the limbs or fingers. They can be circular or they can be half the circumference of the segment. Amniotic constrictions cover soft tissues and squeeze them down to the bone. Depressions are the result of the intrauterine formation of simon threads - strands and bridges, which are located between the walls of the amnion. Tightness is an anomaly in the development of the amnion. Most often they arise as a result of an inflammatory process in the uterus.
Diagnosing amniotic constrictions is fairly straightforward. Most often, constrictions are found on the legs, forearm, fingers. In some cases, there are several constrictions on one segment. Due to deep crossovers, trophic disturbances can form, which contribute to the development of elephantiasis, partial gigantism, trophic ulcers, etc.
As for the treatment of amniotic constrictions, it is, as a rule, operative, especially when complications arise. Basically, a one-stage or two-stage dissection of the constrictions with skin grafting of the resulting skin defect is performed. It happens that amputation is required (especially with deep constrictions with signs of circulatory disorders in the distal parts of the fingers). In other cases, no treatment is required.

Limb growth disorder.
Limb overgrowth is either gigantism of the entire limb or rapid growth of a portion of a limb. Most often, the lower limb is affected, and with partial damage to the limb, damage to its distal parts, more often one of the fingers, is observed.
Treatment for limb growth impairment can be either in the form of corrective operations, which are a decrease in the volume or length of the limb, or operations are performed aimed at stunting growth by destroying the epiphyseal growth zone (epiphysiodesis). In some cases, the enlarged bone is resected.
Congenital shortening is much more common than gigantism. For the upper limb, this is just a cosmetic defect. With congenital shortening of the segments of the lower extremity, either wearing special shoes is required, which will compensate for the shortening, or the shortened segment is lengthened using compression-distraction devices for external fixation (Ilizarov, Kalnberz, Volkov-Oganesyan apparatus, etc.).

Congenital false joints.
Congenital false joints - pseudoarthrosis - is a defect in the integrity of the length of the tubular bone with pathological mobility, which is observed from birth. This defect can occur on any segment, but is most common on the lower leg.
It is generally accepted that pseudoarthrosis most often occurs as a result of trauma during pregnancy, however, given the plastic capabilities of the child's skeleton, it is impossible to fully agree with such views on the occurrence of congenital false joints. Often, false joints are formed in the focus of fibrous osteodysplasia. The resulting fractures in the focus of osteodysplasia and in adults do not heal well due to the existing, undifferentiated osteogenic tissue, which interferes with normal osteogenesis. Quite often, in children with congenital false joints, foci of fibrous osteodysplasia in other bones are revealed.
Congenital pseudarthrosis resembles in its appearance a post-traumatic pseudarthrosis, with all clinical (pathological mobility in the area of ​​the pseudarthrosis) and radiological signs (osteoscleosis, obliteration of the medullary canal, endplates at the ends of fragments).
Treatment this pathology is very complex. Various bone grafting operations do not always lead to positive results. Quite often, resorption of the transplanted healthy bone occurs in the area of ​​the congenital pseudarthrosis, and it is absorbed precisely along the area of ​​the former pseudarthrosis.

The following developmental abnormalities of the upper limb also occur:
- congenital clubhand
- chronic subluxation of the hand
- congenital fusion of the forearm bones
- anomalies in the development of fingers

Congenital clubhand.
Congenital clubhand is a pathology of the upper limb, which can be the result of congenital shortening of the tendons of the muscles and ligaments of the palmar-radial side, and congenital clubhand can also form due to the underdevelopment or absence of the radius. As for the first type of clubhand, it can be considered as a persistent congenital contracture of the wrist joint in the position of flexion and adduction of the hand. This pathology can be one-sided and two-sided and is often accompanied by an underdevelopment of the first toe. This leads to its displacement towards the radial side. The finger becomes at a right angle to the forearm, while the grasping function of the hand sharply suffers.
With underdevelopment of the radius, clubhand treatment is carried out with certain difficulties. In some cases, in children over 10 years of age, arthrodesis of the wrist joint is performed in the correct position of the hand.

Chronic subluxation of the hand
Chronic subluxation of the hand (Madelung deformity) is a complex deformity that involves all components of the wrist and forearm. This pathology of the upper limb is characterized by the gradual development of the so-called "bayonet hand" as a result of its displacement in relation to the forearm to the palmar side with simultaneous displacement to the ulnar or radial side. This disease in most cases occurs in adolescent girls. The deformity is based on slow or perverted growth of the ray in the area of ​​the distal epiphyseal cartilage, which is congenital or acquired. At the same time, this disease is characterized by the preservation of the normal growth of the ulna.
Diagnosis of the disease is not particularly difficult. This deformation develops gradually. First, a curvature of the ray appears with a bulge in the dorsal-ray side. The head of the ulna will stand on the rear of the wrist joint, the ray is shortened, curved. As a result, the development of chronic subluxation of the hand occurs - the axis of the hand does not coincide with the axis of the forearm.
Correction of this deformity is possible no earlier than at the age of 14 years, when (basically) the growth of bones in length ends. During the operation, the head of the ulna is resected, the beam is lengthened and, with the help of an external fixation device, the deformity of the hand and forearm is corrected. It should be noted that with this treatment, the functional and cosmetic results are good, especially in children with terminated growth.

Congenital fusion of the forearm bones.
Congenital fusion of the forearm bones - congenital radioulnar synostosis is an anomaly in the development of the upper limb, which leads to the impossibility of pronation-supination movements.
This type of pathology is quite common and accounts for about 9% of all orthopedic pathology of the upper limb. In most cases, boys are sick. Left-sided pathology is often hereditary.
Fusion of the forearm bones always occurs in the proximal part of the limb. Healthy bones almost never grow together. It is believed that the cause of the development of pathology is a violation of the embryogenesis of the mesenchyme, which occurs in the early embryonic period. Underdevelopment of the bones of the forearm is often combined with underdevelopment of the distal articular surface of the shoulder. The forearm is fixed in extreme pronation position. The radial head is usually deformed - elongated and displaced in the proximal direction. As a rule, with this pathology of the development of the upper limb, a violation of the relationship between the humerus and the bones of the forearm occurs. The capsule and joint ligaments are thickened. In some cases, the annular ligament of the ray is not detected. Pronators are, as it were, hypertrophied, which is the result of their cicatricial degeneration. The same changes can be observed during surgery and in the biceps brachii. The neurovascular bundle is topographically located correctly.
Radioulnar synostosis most often develops on deformed, underdeveloped bones. It is only proximal and at different lengths - from 1 to 12 cm. The fusion of the bones is so direct that when examined, the impression of a new homogeneous bone is created. Proximal synostoses can be in the following forms: metaepiphyseal, metaphyseal and abortive - in the form of connective tissue syndesmosis.
It is usually possible to diagnose this disease no earlier than at the age of two. At the same time, parents pay attention to the fact that the diseased hand is fixed in the position of extreme pronation, supination is not possible, which leads to a significant difficulty in the function of the hand.
With regard to treatment, surgical treatment is successful only in cases of some abortive forms. Arthroplasty surgery usually does not lead to the desired result.

Finger anomalies
Finger malformations can be of the following types:
a) syndactyly
b) polydactyly
c) ectrodactyly.

Syndactyly- this is the fusion of the fingers together. It is a fairly common pathology, accounts for half of all orthopedic diseases of the upper limb and occurs in 1-2 cases per 3000 newborns. Fusion of fingers can be complete and partial, fusion of two or more fingers can be observed. This pathology is often found in combination with other deformities and underdevelopments, not only of the hand, but also of other localizations. The following forms of syndactyly are distinguished:
1. Skin form. Most common. It is characterized by the fusion of the fingers together along the entire length - from the base to the nails. More often than others, the third and fourth fingers grow together. In this case, only joint movements of the fused fingers are possible.
2. Webbed form. With this form of syndactyly, the fingers grow together, as a rule, partially, and a membrane is formed between them, like in waterfowl, which consists of two sheets of skin. All fingers of the hand can connect, but more often the first and second. At the same time, the mobility in the joints of the fingers is preserved. If the membrane is rather large, the movements of the fingers can be autonomous.
3. Bone form. Bony forms of fusion of the fingers are possible both in the area of ​​one phalanx, and throughout the entire finger. In the terminal form, only the nail phalanges grow together. At the same time, their underdevelopment is determined.
This pathology has a rather favorable prognosis. Treatment is applied only operatively, using dermatoplastic methods. A prerequisite for success is the formation of an interdigital fold. The optimal age for surgery is 5-6 years, but the operation can be performed earlier, especially in bone forms of syndactyly, when favorable conditions are created for the development of more complex deformities of the nail phalanges with the growth of the fingers of the hand in length. In such cases, conditions are first created for the normal development of the finger, and then the surgical treatment ends in full.

Polydactyly most often it occurs in the form of six-fingered, but there are also more fingers. In most cases, there is an extra little finger. Sometimes it hangs on a cutaneous pedicle, and in some cases, a normally functioning toe with a common metacarpophalangeal joint appears.
Also a type of polydactyly is the double first toe. Sometimes the bifurcation of the 1st finger can be along its entire length, while its function may be quite adequate. In the treatment of this pathology, only an operative method is used, which is the removal of an accessory finger.

This is an anomaly in the development of the hand, which is not only a decrease in the number of fingers, but also has a characteristic appearance: a hand in the form of a pincer with two fingers, or the entire hand is bifurcated and the fingers are located on both sides of the hand. Treatment for this anomaly is only surgical and is carried out to improve the function of the hand. The optimal age for surgery is adolescence.

It must be said that with congenital and amputation defects of the upper limbs of children of early preschool age, physical exercises with anomalies of the upper limb are used to increase the range of motion in the remaining joints of the affected limb, as well as to strengthen the muscles of the shoulder girdle, to achieve maximum involvement of the stump in various movement, the formation of compensatory grips and the movement of various objects and toys with the help of stumps.
Classes for anomalies of the upper limb are carried out individually with each child, at least 2-3 times a day. The duration of the lesson should be up to 15 minutes, 10-12 exercises are performed. First, passive exercises are used, then active-passive ones. Most of the exercises are simulated or playful.
After every two or three exercises, it is advisable to use massage movements (light stroking, kneading) in such a way that by the end of the session the hands and shoulder girdle, back, legs and abdomen of the child are massaged.

As for the general treatment for anomalies of the upper limb, it is prescribed strictly individually and aims to promote the growth and development of the limb in such a way as to achieve its optimal functioning by reaching adulthood.

Officially, Alexander Serov has only one daughter, Michelle, born in a marriage with Elena Stebneva. However, very juicy details from the singer's life have recently emerged. It turns out that the artist's first child was born without his right hand, and his illegitimate daughter from America does not want to have anything to do with him.

More recently, the terrible truth about the birth of Serov's first child was revealed. Alexander and Elena had a baby without a right hand. During childbirth, the artist was on tour in another city. Upon learning of the birth of a special child, the singer immediately rushed to his wife. He ran through the capital's hospitals, trying to find help, but doctors advised to put a prosthesis. But a couple of days after birth, the baby died, his little heart stopped beating.

Doctors suggested that the child was poisoned with pills while still in the womb, not wanting him to appear. That is why the baby was born with a defect and very weak. According to the site uznayvse.ru, terrible rumors reached Alexander Serov that the first child was not from him. Elena tried to get rid of an unborn baby, conceived out of wedlock, and stuffed herself with potent medications.

A year later, Stebneva gave birth to Alexander a healthy girl, who was named Michelle. It was recently revealed that she has a half-sister living in America. Alice is the fruit of the passionate love of the singer and poetess Valentina Arishina. However, the girl considers Serov a stranger and does not want to have anything to do with him.

In the "Secret to a Million" program, Serov said that he was not going to communicate with Alice until she herself took the initiative. Such a message greatly angered the girl and she published her commentary on her biological father in her microblog. “I just wanted to say that I have a wonderful family and I have no interest or desire to get in touch with a man named Alexander Serov. I know there are different situations and stories. But there are people I will never understand. They behave unworthy of the title of artist, man, father, human. In any case, libel must be held accountable. I have no doubt that this moment will come. We never asked for anything. There is a person in my life whom I can call a father. He always helped me and still helps me. With regard to Alexander Serov, I can say that he is not interesting to me as a person. I'm not interested in communicating with him. I wish he would leave me and my family alone. I would like to put a big and fat point in this story, ”said the singer's heiress.

By the way, in the program “Live” with Andrey Malakhov, he called his daughter Michelle a bastard when he found out that she had made friends with her half-sister Alice.

What do you think about the behavior of a famous musician?

All people need to learn from their children their willpower and ability to cope with difficulties. An example of this is the story of Camden, a 4-year-old boy from Texas.

Camden is an unusual child - he has no arms or legs. His mother knew about this long before he was born.

Katie Widdon was 18 weeks pregnant and during an ultrasound she learned the terrible news - her baby was diagnosed with pathologies of limb development. However, the mother-to-be decided to give birth. She admits that she was at a loss - Katie thought that her boy would be a vegetable.

However, Widdon soon realized that she was wrong. When Camden was only 2 months old, he was already trying to play with toys using his underdeveloped hands. It was then that Katie realized that her boy would be trying to lead a normal life.

The baby's mother was not mistaken. Camden is not discouraged - he even helps Katie to keep an eye on her younger brother (in addition to Camden, the Widdon family has two more children) and to clean the house.
Katie has her own blog on YouTube and is an avid user of social networks. Mom talks about Camden's successes in her videos and posts. And recently, Katie posted a video of the boy taking his first steps.

The first child is a girl, was born without a pen in June 2013. The first pregnancy, I was 24, my husband was 31. Both had no bad habits, no serious illnesses. There are no people with disabilities among the closest relatives. We do not know the reason for such an anomaly in our daughter, so I am listing everything that happened to me during pregnancy.

My work was pretty intense until the 30th week. It took about an hour to get to work, on the bus.

The pregnancy was difficult. Threats at 12, 14, 18, 34 weeks (bloody discharge, hypertonicity). Each time in the hospital preservation therapy - papaverine (1st trimester), magnesium (2nd trimester), "Ginipral" (3rd trimester), something hemostatic (I can't remember the name anymore). At home she took folic acid, Magne B6, vitamins (1st trimester), Ginipral (2nd and 3rd trimesters).

At the beginning of pregnancy (about 9-11 weeks), an analysis performed in the ZhK showed a slightly increased level of the hormone 17-op, and Dexamethasone was prescribed. But my gynecologist told me not to take it, because in her opinion, during pregnancy, this analysis is not indicative. Do not judge strictly, but I trusted the doctor I checked. I began to take the drug "Dexamethasone" only from the 14th week, after the first threat of miscarriage, as prescribed by the doctor of the hospital where the treatment was taking place.

Screening at 12 weeks showed nothing unusual. Ultrasound at 20 weeks showed a slight presence of suspended matter in the waters, which was attributed to the recently passed SARS. Our special pen was not seen on any of the 8 ultrasounds, for which my husband and I are very grateful. After all, I could get very nervous and lose her ...

During pregnancy, she had ARVI a couple of times.

Breech presentation, CS for 38-39 weeks.

My husband and I are not looking for someone to blame. We love our daughter and in every possible way contribute to her full development, we do not hide her, on the contrary, we try to walk more and communicate with children in order to prevent isolation.

We have several questions:

1. What is the chance to bear and give birth to a second / third healthy child in our case?

2. Are there any tests, examinations that we should undergo before conception?

3. Can such an anomaly be inherited?