Skip to main content

Advertisement

SpringerLink
Log in

Impact of fetal counseling on outcome of antenatal congenital surgical anomalies

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Sixty-third World Health Assembly report on birth defects (2010). apps.who.int/gb/ebwha/pdf_files/WHA63/A63_10-en.pd

  2. World Health Organization (2008) The global burden of disease: 2004 update. World Health Organization, Geneva

  3. Crombleholme TM, D’Alton M, Cendron M et al (1996) Prenatal diagnosis and the pediatric surgeon: the impact of prenatal consultation on perinatal management. J Pediatr Surg 31:156–162 (discussion 162–163)

    Article  CAS  PubMed  Google Scholar 

  4. Dibbins AW, Curci MR, McCrann DJ Jr (1985) Prenatal diagnosis of congenital anomalies requiring surgical correction. Implications for the future. Am J Surg 149:528–533

    Article  CAS  PubMed  Google Scholar 

  5. Wilcox DT, Karamanoukian HL, Glick PL (1993) Antenatal diagnosis of pediatric surgical anomalies. Counseling the family. Pediatr Clin North Am 40:1273–1287

    Article  CAS  PubMed  Google Scholar 

  6. Benn PA, Egan JF, Fang M, Smith-Bindman R (2004) Changes in the utilization of prenatal diagnosis. Obstet Gynecol 103:1255–1260

    Article  PubMed  Google Scholar 

  7. EUROCAT European survellience of congenital anomalies. http://www.eurocat-network.eu/. Accessed 26 Sept 2016

  8. The Congenital Malformations Registry of the New York State, Department of Health. www.health.ny.gov › Diseases and Conditions. Accessed 26 Sept 2016

  9. Fetal Care Research Foundation—Birth Defects Registry of India (BDRI)—a ‘Saving Babies’ Project. http://www.fcrf.org.in/bdri_abus.asp. Accessed 26 Sept 2016

  10. Tibrewal NS, Pai PM (1974) Congenital malformations in newborn period. Indian Pediatr 11:403–407

    Google Scholar 

  11. Kulshreshta R, Nath LM, Upadhyay P (1983) Congenital malformations in live born infants in a rural community. Indian Pediatr 20:45–49

    Google Scholar 

  12. Verma IC, Mathews AR (1983) Congenital malformations in India. In: Satyavati GV (ed) Peoples of India: some genetic aspects. Indian Council of Medical Research, New Delhi, p 70

    Google Scholar 

  13. Verma M, Chhatwal J, Singh D (1991) Congenital malformations-a retrospective study of 10,000 cases. Indian Pediatr 28:245–252

    Article  Google Scholar 

  14. Chaturvedi P, Banerjee KS (1993) An epidemiological study of congenital malformations in newborn. Indian J Pediatr 60:645

    Article  CAS  PubMed  Google Scholar 

  15. Swain S, Agrawal A, Bhatia BD (1994) Congenital malformations at birth. Indian Pediatr 31:1187–1191

    CAS  PubMed  Google Scholar 

  16. Kumar V, Singh AJ, Marwaha RK (1994) An epidemiological study of congenital malformations in rural children. Indian Pediatr 31:909–914

    CAS  PubMed  Google Scholar 

  17. Bhat BV, Babu L (1998) Congenital malformations at birth–a prospective study from south India. Indian J Pediatr 65:873–881

    Article  CAS  PubMed  Google Scholar 

  18. Grover N (2000) Congenital malformations in Shimla. Indian J Pediatr 67:249–251

    Article  CAS  PubMed  Google Scholar 

  19. Datta V, Chaturvedi P (2000) Congenital malformations in rural Maharashtra. Indian Pediatr 37:998–1001

    Google Scholar 

  20. Dutta HK, Bhattacharyya NC, Sarma JN, Giriraj K (2010) Congenital malformations in Assam. J Indian Assoc Pediatr Surg 15:53–55

    Article  PubMed  PubMed Central  Google Scholar 

  21. Gupta DK, Sharma S, Gupta M (2010) Outcome of antenatally referred congenital surgical anomalies—a pediatric surgeon’s perspective. J Pediatr Surg Spec 4:1–9

    CAS  Google Scholar 

  22. Pineda-Del Villar L, Martínez-Basalo MC, Delgado W, Prieto-Carrasquero M, Villasmil Y (1994) Epidemiology of congenital malformations at the Hospital Pedro García Clara, Ciudad Ojeda. Venezuela. Invest Clin 35:19–34

    CAS  PubMed  Google Scholar 

  23. Tayebi N, Yazdani K, Naghshin N (2010) The prevalence of congenital malformations and its correlation with consanguineous marriages. OMJ 25:37–40

    Article  Google Scholar 

  24. Penchaszadeh VB (2002) Preventing congenital anomalies in developing countries. Community Genet 5:61–69

    Article  PubMed  Google Scholar 

  25. Romero R (1993) Routine obstetric ultrasound. Ultrasound Obstet Gynecol 3:303–307

    Article  CAS  PubMed  Google Scholar 

  26. Crane JP, LeFevre ML, Winborn RC, Evans JK, Ewingman BG, Bain RP et al (1994) RADIUS Study Group. A randomised trial of prenatal ultrasonographic screening: impact on the detection, management, and outcome of anomalous fetuses. Am J Obstet Gynecol 171:392–399

    Article  CAS  PubMed  Google Scholar 

  27. Levine D, Barnes PD, Madsen JR, Abbot J, Tejas Meta T, Edelman R (1999) Central nervous system abnormalities assessed with magnetic resonance. Obstet Gynecol 94:1011–1019

    CAS  PubMed  Google Scholar 

  28. Todros T, Capuzzo E, Gaglioti P (2001) Prenatal diagnosis of congenital anomalies. Images Paediatr Cardiol 3:3–18

    CAS  PubMed  PubMed Central  Google Scholar 

  29. Grandjean H, Larroque D, Levi S (1999) Eurofetus Study Group. The performance of routine ultrasonographic screening of pregnancies in the Eurofetus Study. Am J Obstet Gynecol 181:446–454

    Article  CAS  PubMed  Google Scholar 

  30. Johnson P, Sebire NJ, Snijders RJM, Tunkel S, Nicolaides KH (1997) Ultrasound screening for anencephaly at 10–14 weeks of gestation. Ultrasound Obstet Gynecol 9:14–16

    Article  CAS  PubMed  Google Scholar 

  31. Chitty LS, Pandya PP (1997) Ultrasound screening for fetal abnormalities in the first trimester. Prenat Diagn 17:1269–1281

    Article  CAS  PubMed  Google Scholar 

  32. Pilu G, Perolo A, Falco P, Visentin A, Gabrielli G, Bovicelli L (2000) Ultrasound of the central nervous system. Curr Opin Obstet Gynecol 12:93–103

    Article  CAS  PubMed  Google Scholar 

  33. Sebire NJ, Noble PL, Thorpe-Beeston JG, Snijders RJ, Nicolaides K (1997) Presence of the ‘lemon’ sign in fetuses with spina bifida at the 10-14-week scan. Ultrasound Obstet Gynecol 10:403–407

    Article  CAS  PubMed  Google Scholar 

  34. Gembruch U (1997) Prenatal diagnosis of congenital heart disease. Prenat Diagn 17:1283–1297

    Article  CAS  PubMed  Google Scholar 

  35. Todros T, Faggiano F, Chiappa E, Gaglioti P, Mitola B, Sciarrone A (1997) Gruppo piemontese for prenatal screening of congenital heart disease. Accuracy of routine ultrasonography in screening heart disease prenatally. Prenat Diagn 17:901–906

    Article  CAS  PubMed  Google Scholar 

  36. Fesslova V, Nava S, Villa L (1999) Fetal Cardiology Study Group of the Italian Society of Pediatric Cardiology. Evolution and long term outcome in cases with fetal diagnosis of congenital heart disease: Italian multicentre study. Heart 82:549–599

    Article  Google Scholar 

  37. Allan LD, Sharland GK, Milburn A, Lockhart SM, Groves AMM, Anderson RH et al (1994) Prospective diagnosis of 1,006 consecutive cases of congenital heart disease in the fetus. J Am Coll Cardiol 23:1452–1458

    Article  CAS  PubMed  Google Scholar 

  38. Raymond FL, Simpson JM, Sharland GK, Mackie Ogilvie CM (1997) Fetal echocardiography as a predictor of chromosomal abnormality. Lancet 350:930

    Article  CAS  PubMed  Google Scholar 

  39. Yates R (1999) Fetal cardiac abnormalities and their association with aneuploidy. Prenat Diagn 19:563–566

    Article  CAS  PubMed  Google Scholar 

  40. Lynema S, Fifer CG, Laventhal NT (2016) Perinatal decision making for preterm infants with congenital heart disease: determinable risk factors for mortality. Pediatr Cardiol 37:938–945

    Article  PubMed  Google Scholar 

  41. Todros T (2000) Prenatal diagnosis and management of fetal cardiovascular malformations. Curr Opin Obstet Gynecol 12:87–92

    Article  Google Scholar 

  42. Kalter H, Warkany J (1983) Congenital malformations (first of two parts). N Engl J Med 308:424–431

    Article  CAS  PubMed  Google Scholar 

  43. Kalter H, Warkany J (1983) Congenital malformations (second of two parts). N Engl J Med 308:491–497

    Article  CAS  PubMed  Google Scholar 

  44. Neilson JP (2000). Ultrasound for fetal assessment in early pregnancy. The cochrane database of systematic reviews. 2

  45. Zimmer EZ, Avraham Z, Sujoy P, Goldstein I, Bronshtein M (1997) The influence of prenatal ultrasound on the prevalence of congenital anomalies at birth. Prenat Diagn 17:623–628

    Article  CAS  PubMed  Google Scholar 

  46. Bull C (1999) Current and potential impact of fetal diagnosis on prevalence and spectrum of serious congenital heart disease at term in the UK. Lancet 354:1242–1247

    Article  CAS  PubMed  Google Scholar 

  47. Parilla BV, Leeth EA, Kambich MP, Chilis P, MacGregor SN (2003) Antenatal detection of skeletal dysplasias. J Ultrasound Med. 22:255–258 (quiz 259–261)

    Article  PubMed  Google Scholar 

  48. Tonni G, Granese R, Martins Santana EF, Parise Filho JP, Bottura I, Borges Peixoto A et al (2016) Prenatally diagnosed fetal tumors of the head and neck: a systematic review with antenatal and postnatal outcomes over the past 20 years. J Perinat Med. doi:10.1515/jpm-2016-0074

  49. Shalaby H, Hemida R, Nabil H, Ibrahim M (2016) Types and outcome of fetal urinary anomalies in low resource setting countries: a retrospective study. J Obstet Gynaecol India 66:316–320

    Article  PubMed  Google Scholar 

  50. Bondagji NS (2014) Antenatal diagnosis, prevalence and outcome of congenital anomalies of the kidney and urinary tract in Saudi Arabia. Urol Ann. 6:36–40

    Article  PubMed  PubMed Central  Google Scholar 

  51. Andrés-Jensen L, Jørgensen FS, Thorup J, Flachs J, Madsen JL, Maroun LL et al (2016) The outcome of antenatal ultrasound diagnosed anomalies of the kidney and urinary tract in a large Danish birth cohort. Arch Dis Child 101:819–824

    Article  PubMed  Google Scholar 

  52. Policiano C, Djokovic D, Carvalho R, Monteiro C, Melo MA, Graça LM (2015) Ultrasound antenatal detection of urinary tract anomalies in the last decade: outcome and prognosis. J Matern Fetal Neonatal Med 28:959–963

    Article  PubMed  Google Scholar 

  53. Altokhais T, Soomro MA, Gado A, Albassam A (2016) Bedside neonatal intensive care unit correction of congenital diaphragmatic hernia: is repair without compromise? Am J Perinatol 33:861–865

    Article  PubMed  Google Scholar 

  54. Fievet L, Natale C, D’Journo XB, Coze S, Dubus JC, Guys JM et al (2015) Congenital pulmonary airway malformation and sequestration: two standpoints for a single condition. J Minim Access Surg. 11:129–133

    Article  PubMed  PubMed Central  Google Scholar 

  55. Lamquami S, Mamouni N, Errarhay S, Bouchikhi C, Banani A (2015) Antenatal diagnosis of isolated omphalocele. Pan Afr Med J. 21:233

    PubMed  PubMed Central  Google Scholar 

  56. Tarcă E, Aprodu S (2014) Past and present in omphalocele treatment in Romania. Chir (Bucur) 109:507–513

    Google Scholar 

  57. Ţarcă E, Ciongradi I, Aprodu SG (2015) Birth weight, compromised bowel and sepsis are the main variables significantly influencing outcome in gastroschisis. Chir (Bucur) 110:151–156

    Google Scholar 

  58. Lepigeon K, Van Mieghem T, Vasseur Maurer S, Giannoni E, Baud D (2014) Gastroschisis—what should be told to parents? Prenat Diagn 34:316–326

    Article  PubMed  Google Scholar 

  59. Okur MH, Arslan MS, Arslan S, Aydogdu B, Türkçü G, Goya C et al (2014) Gastrointestinal tract duplications in children. Eur Rev Med Pharmacol Sci 18:1507–1512

    CAS  PubMed  Google Scholar 

  60. Ballehaninna UK, Nguyen T, Burjonrappa SC (2013) Laparoscopic resection of antenatally identified duodenal duplication cyst. JSLS 17:454–458

    Article  PubMed  PubMed Central  Google Scholar 

  61. Agrawal A, Sampley S (2014) Spinal dysraphism: a challenge continued to be faced by neurosurgeons in developing countries. Asian J Neurosurg 9:68–71

    Article  PubMed  PubMed Central  Google Scholar 

  62. McClure EM, Saleem S, Goudar SS, Moore JL, Garces A, Esamai F et al (2015) Stillbirth rates in low-middle income countries 2010–2013: a population-based, multi-country study from the Global Network. Reprod Health 12(Suppl 2):S7

    Article  PubMed  PubMed Central  Google Scholar 

  63. Nayak SS, Shukla A, Girisha KM (2015) Anomalies associated with single umbilical artery at perinatal autopsy. Indian Pediatr 52:73–74

    Article  PubMed  Google Scholar 

  64. Morris JK, Garne E, Wellesley D, Addor MC, Arriola L, Barisic I et al (2014) Major congenital anomalies in babies born with Down syndrome: a EUROCAT population-based registry study. Am J Med Genet A 164A:2979–2986

    Article  PubMed  Google Scholar 

  65. Lakhoo K (2012) Fetal counselling for surgical conditions. Early Hum Dev. 88:9–13

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This work is done under a project sponsored by the Department of Biotechnology, Government of India. Reference BT/PR9572/MED/97/210/2013. Website: http://birthdefect.in/.

Author information

Authors and Affiliations

  1. Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India

    Shilpa Sharma, Ranjana Bhanot, Minu Bajpai & Devendra K. Gupta

  2. Department of Gynaecology, All India Institute of Medical Sciences, New Delhi, India

    Dipika Deka

Authors
  1. Shilpa Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ranjana Bhanot
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dipika Deka
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Minu Bajpai
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Devendra K. Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shilpa Sharma.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sharma, S., Bhanot, R., Deka, D. et al. Impact of fetal counseling on outcome of antenatal congenital surgical anomalies. Pediatr Surg Int 33, 203–212 (2017). https://doi.org/10.1007/s00383-016-4015-x

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-016-4015-x

Keywords

Search

Navigation