Impact of fetal counseling on outcome of antenatal congenital surgical anomalies

• Published in: Pediatric surgery international 2017-02, Vol.33 (2), p.203-212
• Main Authors: Sharma, Shilpa, Bhanot, Ranjana, Deka, Dipika, Bajpai, Minu, Gupta, Devendra K.
• Format: Article
• Language: English
• Subjects: Abortion, Eugenic - statistics & numerical data; Congenital Abnormalities - diagnostic imaging; Congenital Abnormalities - mortality; Congenital Abnormalities - surgery; Counseling - methods; Female; Fetal Diseases - diagnostic imaging; Fetal Diseases - mortality; Fetal Diseases - surgery; Gestational Age; Humans; Infant, Newborn; Medicine; Medicine & Public Health; Original Article; Pediatric Surgery; Pediatrics; Pregnancy; Prospective Studies; Surgery; Ultrasonography, Prenatal
• ISSN: 0179-0358; 1437-9813
• DOI: 10.1007/s00383-016-4015-x

Aim To analyze the impact of counseling on antenatal congenital surgical anomalies (ACSA). Methods Cases presenting with ACSA for fetal counseling and those presenting in post-natal period following diagnosis of ACSA (PACSA) for surgical opinion were analyzed for spectrum, presentation and outcome. Results 117 cases including ACSA(68);PACSA(49) were analyzed. Gestational age at diagnosis of ACSA;PACSA was 17–37;17–39 weeks (median 24;32 weeks). Diagnoses in ACSA;PACSA included urological (26;31), neurological (10;5), congenital diaphragmatic hernia (CDH)(5;1), gastrointestinal (5;5), lung and chest anomalies (5;1), intraabdominal cysts (4;1), abdominal wall defects (4;0), tumors (3;3), limb anomaly (1;1), esophageal atresia (1;1), conjoint twins (1;0), hepatomegaly (1;0), and major cardiac anomalies (2;0). Two antenatal interventions were done for ACSA; vesicoamniotic shunt and amnioinfusion for oligohydramnios. 17;24 ACSA;PACSA required early surgical intervention in post-natal period. Nine ACSA underwent medical termination of pregnancy and 4 had intrauterine demise. Nine ACSA babies died including two CDH, one gastroschisis, one duodenal atresia, one conjoint twins, one megacystitis with motility disorder and three posterior urethral valves. All PACSA babies survived. Conclusion Fetal counseling for CSA portrays true outcome of ACSA with 32.3% (22/68) mortality versus 0% for PACSA due to selection bias. However, fetal counseling ensures optimal perinatal care.