PRENATAL-DIAGNOSIS AND THE PEDIATRIC SURGEON - THE IMPACT OF PRENATALCONSULTATION ON PERINATAL MANAGEMENT

Purpose: Pediatric surgeons are increasingly called on by obstetrical colleagues to counsel parents about the implications of a prenatal ult rasound finding. Our understanding of the natural history of many pren atally diagnosed surgical conditions has grown significantly in recent years. Whether prenatal surgical consultation can influence perinatal course had not been investigated. Methods: During an 21-month period, 12,865 prenatal ultrasound studies were performed on a total of 4,551 patients, and 221 prenatal surgical consultations were obtained throu gh a newly established fetal treatment program at a tertiary care pren atal diagnostic center. To evaluate the impact of prenatal pediatric s urgical consultation on perinatal course, the authors reviewed changes in management including termination of pregnancy, in utero interventi on, and altered site, mode, or timing of delivery. Results: Two hundre d twenty-one fetuses were referred for consultation; their 234 congeni tal anomalies included genitourinary (36%), thoracic (16%), intraabdom inal (14.5%), abdominal wall (10.6%), neurological (9%), skeletal (6%) , and head and neck (2.5%) defects; 2.5% had tumors and 2.5% were twin pregnancies. Pregnancy was terminated in 9.5% of cases, because of pa tient request, chromosomal abnormality, or dismal prognosis. In 3.6%, the decision to terminate was changed as a result of consultation. Sit e of delivery was changed as a result of consultation in 37% to facili tate postnatal evaluation and initiate immediate treatment. Mode of de livery was changed in 6.8% to prevent dystocia, hemorrhage into a tumo r, as in sacrococcygeal teratoma, or to provide an emergency airway, a s in cervical teratoma. The timing of delivery was changed in 4.5% to avoid further damage to fetal organs in cases of obstructive uropathy, gastroschisis, sacrococcygeal teratoma with high-output failure, and hydrocephalus. Five percent (11) underwent treatment in utero for feta l hydrothorax, obstructive uropathy, twin-twin transfusion syndrome, o r lymphangioma. The overall perinatal mortality rate was 2.5%. Conclus ion: Prenatal pediatric surgical consultation may have a significant i mpact on the perinatal management of the fetus with a surgically corre ctable congenital anomaly. Providing obstetric colleagues and families with valuable insight into the surgical management of anomalies allow s fetal intervention when appropriate, and delivery in an appropriate setting, by the safest mode of delivery, and at the gestational age ap propriate to minimize effects of the anomaly. Copyright (C) 1996 by W. B. Saunders Company.