Implications of prenatal ultrasound screening in the incidence of major genitourinary malformations

Purpose: During the last 3 decades infant mortality has decreased nearly 50 %. While neonatal intensive care deserves much of the credit, the recent in crease in prenatal ultrasound from 33% of pregnancies in 1950 to 78% in 198 7 has improved early detection. We evaluate the impact of prenatal ultrasou nd on major genitourinary malformations. Materials and Methods: Data obtained from the Malformations Surveillance Pr ogram at Brigham and Women's Hospital between 1974 and 1994 tracked 163,431 pregnancies and termination rates of fetuses with spina bifida, bladder ex strophy, the prune belly syndrome and posterior urethral valves. Results: Hospital data revealed that pregnancy was electively terminated du e to spina bifida in 65% of cases, posterior urethral valves in 46%, the pr une belly syndrome in 31% and exstrophy in 25%. Conclusions: Clearly, surveillance programs and improved accuracy of prenat al ultrasound have allowed early diagnosis of major genitourinary malformat ions. Many factors influence decision making in these affected fetal cases, including the financial and emotional impact of these major anomalies duri ng lifetime. Future societal decisions and reduction in these anomalies may influence our training programs: manpower needs, medical facility requirem ents and character of our practices. These findings may have significant im plications in the field of pediatric urology.