Fetal counselling for surgical congenital malformations

Abstract

Paediatric surgeons are often called to counsel parents once a surgical abnormality is diagnosed on a prenatal scan. The referral base for a paediatric surgeon now includes the perinatal period. Expertise in surgical correction of congenital malformations may favourably infl uence the perinatal management of prenatally diagnosed anomalies by changing the site of delivery for immediate postnatal treatment; altering the mode of delivery to prevent obstructed labour or haemorrhage; early delivery to prevent ongoing fetal organ damage; or treatment in utero to prevent, minimise or reverse fetal organ injury as a result of a structural defect. Favourable impact of prenatal counselling has been confi rmed to infl uence the site of delivery in 37% of cases, change the mode of delivery in 6.8%, reverse the decision to terminate a pregnancy in 3.6% and infl uence the early delivery of babies in 4.5%. Counselling parents about prenatally suspected surgically correctable anomalies should not be solely performed by obstetricians or paediatricians. Similarly the paediatric surgeon performing these prenatal consultations must be aware of differences between the prenatal and postnatal natural history of the anomaly. There is often a lack of understanding of the natural history and prognosis of a condition presenting in the newborn and the same condition diagnosed prenatally. The diagnosis and management of complex fetal anomalies require a team effort by obstetricians, neonatologists, genetecists, paediatricians and paediatric surgeons to deal with all the maternal and fetal complexities of a diagnosis of a structural defect. This team should be able to provide information to prospective parents on fetal outcomes, possible interventions, appropriate setting, time and route of delivery and expected postnatal outcomes. The role of the surgical consultant in this team is to present information regarding the prenatal and postnatal natural history of an anomaly, its surgical management and the longterm outcome. © 2009 Springer Berlin Heidelberg.