emanuel syndrome is a rare chromosomal disorder characterized by severe mental retardation and multiple anomalies the syndrome is caused by chromosomal imbalance due to a supernumerary derivative chromosome 22 little is known regarding the characteristics of prenatal biochemical screening or ultrasonographic markers in this syndrome we aimed to identify a prenatal screening pattern characteristic of emanuel syndrome we report the prenatal characteristics of five fetuses with emanuel syndrome four of which were diagnosed prenatally we found no consistent pattern of prenatal biochemical markers or other prenatal characteristics nevertheless increased nt low papp a and ultrasound features such as intra uterine growth restriction posterior fossa cardiac and bowel abnormalities may be helpful in raising the suspicion for this rare genetic syndrome review of the biochemical screening results ultrasound findings and demographic characteristics of this emanuel syndrome case series as well as of the relevant literature fail to suggest a characteristic prenatal pattern.