Abstract
Purpose: Prenatal diagnostic accuracy has improved; however, the pediatric surgeon’s role remains unclear. This paper aimed to determine the prenatal diagnoses made and the role of pediatric surgeons. Methods: A 6-year retrospective review of 904 pregnancies managed at our institute was conducted. They were classified as a normal pregnancy (NP, n=194), abnormal pregnancy maternal factor (MF, n=449), or abnormal pregnancy fetal factor (FF, n=261). Results: In the FF group, the identified conditions were twin pregnancies (n=75), intrauterine growth restriction (IUGR) (n=49), breech presentation (n=26), arrested development (n=19), hypoamnion (n=42), fetal distress (n=16), hydramnios (n=10), abnormal heart sounds (n=5), meconium staining (n=5), surface anomaly (n=4), calcification (n=2), fetal hydrops (n=2), fetal death (n=2), bowel dilatation (n=2), abdominal mass (n=1) and diaphragmatic hernia (n=1). Case of twin pregnancies, breech presentation, arrested development, IUGR, hypoamnion, abnormal heart sounds, meconium staining and fetal hydrops did not require surgery. Of the 16 cases of fetal distress, 1 had biliary atresia. Of the 10 cases of hydramnios, 1 had meconium peritonitis. Of the 4 with surface anomalies, 3 had gastroschisis. Of the 2 with calcification, 1 had meconium peritonitis. Of the two fetal deaths, 1 had anal atresia suggesting a chromosomal abnormality. Of the 2 cases of bowel dilatation, 1 had bowel atresia. The abnormal mass was caused by adrenal bleeding. These diagnoses were made at an average of 27.4 gestational weeks; however, 2 cases of gastroschisis, suggesting a body stalk anomaly; diaphragmatic hernia; and brain cysts were diagnosed before 20 weeks and were aborted. After delivery, the mortality rate was 0% in neonates treated by pediatric surgeons and neonatologists. Conclusion: Fetal abnormalities are rare; however, early aggressive management with the cooperation of obstetricians and parents is crucial for pediatric surgeons to minimize the effects of anomalies.
Highlights
There has been significant progress in making prenatal diagnose over the resent decades with advances in research, technology and skill [1]
Routine blood investigations available to all pregnant women can determine the risk of common chromosome abnormalities; chorionic villus sampling (CVS) and amniocentesis have been used to diagnose almost all conditions with a known genetic cause [4]
This study aimed to investigate the prenatal diagnoses that are made and the role of the pediatric surgeon
Summary
There has been significant progress in making prenatal diagnose over the resent decades with advances in research, technology and skill [1]. Routine blood investigations available to all pregnant women can determine the risk of common chromosome abnormalities; chorionic villus sampling (CVS) and amniocentesis have been used to diagnose almost all conditions with a known genetic cause [4]. The acceptance of greatly improved non-invasive risk assessment for common fetal aneuploidies such as cell-free DNA (cfDNA) testing technologies of the maternal plasma (non-invasive prenatal testing (NIPT) or non-invasive prenatal screening (NIPS)) has resulted in a significant decline in invasive testing requiring CVS or amniocentesis [5]. The importance of counseling for surgical anomalies has been the focus for the last 2 decades since Crombeholme et al described these anomalies [7]; in the era of prenatal medicine, the role of the pediatric surgeon in prenatal care remains unclear. This study aimed to investigate the prenatal diagnoses that are made and the role of the pediatric surgeon
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