Management of prenatally diagnosed congenital malformations--actual problems and the importance of an interdisciplinary team approach.
Today's methods of prenatal diagnosis, i.e., ultrasound, amniocentesis, and fetoscopy, allow for early recognition of abnormalities in the fetus. Trials of surgery on human fetuses are widely discussed in scientific as well as lay journals; they are accepted with enthusiasm by some and severely criticized as unethical by others. This report deals with the modern concepts of prenatal diagnosis and possible therapy in the light of current general social context. Some of the arising controversies and ethical problems are shown. The consequences of prenatal diagnosis of congenital malformations of the fetus are separately discussed with reference to the mother, the family, and society on one side and to the fetus itself on the other. The practical question of whether the fetus is already a person or not is seen against its historical, religious, and philosophical background. The necessity for an interdisciplinary team approach in dealing with mothers bearing malformed children--i.e., cooperation of obstetricians, pediatric surgeons, neonatologists, geneticians, neurologists, etc.--is stressed, and the contribution of the pediatric surgeon within this team is discussed in detail, with practical examples given. The present status of intrauterine therapy is summarized and critically evaluated. Finally, an example is given of the ideal team approach in a case of prenatally diagnosed congenital cystic adenomatoid malformation with a successful outcome and long-term survival.