Congenital defects. 2.

Sophisticated imaging and fetal sampling techniques have defined the natural history and pathophysiologic characteristics of many previously mysterious conditions of newborn. Although most prenatally diagnosed malformations are best managed by appropriate medical and surgical therapy after delivery, an increasing number of simple anatomic abnormalities with predictably devastating developmental consequences have been successfully corrected before birth. Many of the technical intricacies of open fetal surgery have been solved, but preterm labor remains an omnipresent risk to the mother and fetus. The recent development of minimally invasive techniques to treat the fetus prenatally has significantly lessened preterm labor. Minimally invasive surgical techniques, in combination with new tocolytic strategies, promise to extend the indications for fetal surgical intervention.

Congenital Abnormalities↗

PubMed1998

Routine ultrasound screening of congenital anomalies. An overview of the European experience.

Results from ultrasound in low-risk pregnant women are significant when routine screening is performed on a large population because the anomalies are rare. Professionals expect from routine ultrasound objective information that cannot usually be obtained by clinical procedures. Parents seek reassurance about the absence of fetal congenital anomalies and overall fetal health. Therefore, Europeans view routine ultrasound as a part of obstetrical care, capable of filling important gaps by delivering much key information for improving obstetrical practice. Fetal anomalies screening (FAS) requires higher education and qualifications than obstetrical ultrasound. The health insurance systems support ultrasound screening and allow its spread in most European countries; approximately 98% of pregnant women are examined by ultrasound and, frequently, two to three times (usually once per trimester). Detection rate of congenital anomalies is about 28% in geographical areas (private practice and hospitals), 60 to 80% in Ob/Gyn's ultrasound labs. Routine ultrasound screening policy has not proved to result in an immoderate use of ultrasound; on the contrary, chaotic use of routine ultrasound can lead to an unproductive and excessive number of scans. New trends in FAS, such as the early detection of fetal defects and chromosomal anomalies, bring more arguments for routine screening. Effectiveness should increase by enhancing education and training and the systematic referral for FAS to accredited laboratories.

Congenital Abnormalities↗