Abstract
BackgroundPrenatal diagnostics ultrasound was established in Russia in 2000 as a routine method of screening for birth defects. The aims of the current study were twofold: to assess changes in birth defects prevalence at birth and perinatal mortality after ultrasound screening was implemented and to estimate prenatal detection rates for congenital malformations in the city of Monchegorsk (Murmansk County, North-West Russia).MethodsThe Murmansk County Birth Registry and the Kola Birth Registry were the primary sources of information, and include 30 448 pregnancy outcomes in Monchegorsk for the period 1973–2011. Data from these registries were supplemented with information derived from hospital records about pregnancy terminations for 2000–2007.ResultsThe total number of newborns with any kind of birth defects in Monchegorsk during 1973–2011 was 1099, of whom 816 were born in the 1973–2000 period. The prevalence of defects at birth increased from 34.2/1000 (95 % CI = 31.9-36.5) to 42.8/1000 newborns (95 % CI = 38.0-47.7) after prenatal ultrasound screening was formally implemented. We observed significant decreases (p < 0.05) in the birth prevalence of congenital malformations of the circulatory system, the musculoskeletal system (including deformations), and other (excluding multiple); those of the urinary system increased from 0.9/1000 to 17.1/1000 (p < 0.0001). The perinatal mortality among newborns with any kind of malformation decreased from 106.6 per 1000 newborns with birth defects (95 % CI = 84.3-129.1) to 21.2 (95 % CI = 4.3-38.1). Mothers who had undergone at least one ultrasound examination during pregnancy (n = 9883) had a decreased risk of having a newborn die during the perinatal period [adjusted OR = 0.49 (95 % CI = 0.27-0.89)]. The overall prenatal detection rate was 34.9 % with the highest for malformations of the nervous system.ConclusionImproved detection of severe malformations with subsequent pregnancy termination was likely the main contributor to the observed decrease in perinatal mortality in Murmansk County, Russia.
Highlights
Prenatal diagnostics ultrasound was established in Russia in 2000 as a routine method of screening for birth defects
The effectiveness of Prenatal screening (PS) can be estimated by the prenatal detection rate, which represents the proportion of birth defects (BD) recognized before delivery
Prevalence of birth defects at birth before and after the establishment of PS There were 1099 newborns with any kind of BD during 1973–2011 in Monchegorsk; 816 of them were born in the pre-screening period (1973–2000) and 283 were born after its formal implementation (Table 1)
Summary
Prenatal diagnostics ultrasound was established in Russia in 2000 as a routine method of screening for birth defects. The aims of the current study were twofold: to assess changes in birth defects prevalence at birth and perinatal mortality after ultrasound screening was implemented and to estimate prenatal detection rates for congenital malformations in the city of Monchegorsk (Murmansk County, North-West Russia). The first assessments of impacts of PS on perinatal mortality were presented in the early 1990s They were based on randomized control studies and considered controversial. The effectiveness of PS can be estimated by the prenatal detection rate, which represents the proportion of BD recognized before delivery. It depends on the type of defect, quality of equipment and experience of the operator. The reported average ultrasound detection rates ranged widely: 5.7 % (Klinefelter syndrome) to 78.6 % (triploidy); for Down syndrome it was 26.4 % [6], and 19.9 % for cardiovascular malformations (11 % for isolated cases and 40 % for multiple malformations) [7]
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