Fetal outcome of prenatally diagnosed congenital abnormality: A Retrospective study”

1. OPTIONALLOGO HERE Fetal outcome of prenatally diagnosed congenital abnormality: A Retrospective study” Vallikkannu Narayanan1 Archana Subramanian 2 Khong Su Yen3 1. Senior Lecturer & Clinical Consultant ; Maternal fetal medicine, 2. Medical student Phase 3b; University Malaya 3. Associate Professor and Clinical Consultant; Urogynaecology. OPTIONALLOGO HERE Methods Results Objectives Conclusions To study the prevalence of congenital anomalies detected antenatally in University Malaya Medical Centre, Kuala Lumpur (UMMC) in the year 2009. To assess the different types of fetal anomalies and the neonatal outcome of these pregnancies. This was a retrospective study conducted from 18th October till 10th December 2010 in UMMC. Data was collected from medical records of patients who were diagnosed with congenital fetal abnormalities between 1st January and 31st December 2009. Further information was gathered from records in the Antenatal Ultrasound Department.  A total of 111 cases had antenatally diagnosed congenital abnormalities. The total number of deliveries during that year in 2009 was 4883. This makes the antenatal detection of congenital anomalies as 2.3%. This is in keeping with the Belgian multicentric study1. Among the congenital anomalies that were detected antenatally, 68% were Malays, 29% were Chinese and 3% were Indians and Others. 58% of mothers presented between 21 – 30 years old and 43% were primigravida patients. 67% of the patients had no prior obstetric history while 21% had a history of previous miscarriage. Only 2% had preexisting type 2 diabetes mellitus. 22% had multiple congenital abnormalities. 20% had CNS abnormalities, 13% had cardiovascular anomalies, 9% genitourinary abnormalities, 7% hydrops fetalis and 5% had gastrointestinal abnormalities. 4% had thoracic anomalies and 4% limb defects and 3% cleft lip/ palate. 18% of the mothers underwent termination of pregnancy, 40% were live births, 14% were intrauterine deaths while 12% were neonatal deaths. Data was missing for 16% as these patients defaulted follow up at UMMC. Among the live births, the fetal anomalies detected were as follows: central nervous system(29.5%), renal (20%), cardiovascular (13.6%), thoracic (13.6%),abdominal (4.5%), limb (6.8%) facial (2%) and multiple anomalies (9%). Antenatal diagnosis of lethal congenital anomalies enables important issues such as early termination of pregnancy to be discussed with the couple. Counseling of parents and family of the affected fetus regarding antenatal or postnatal treatment as well as management during pregnancy and delivery can also occur. As these cases are usually deemed high risk pregnancies, referral to a tertiary centre where a multidisciplinary team is available is likely to improve the neonatal prognosis and survival.  The Helsinki randomised trial has shown a significantly lowered perinatal mortality, in the ultrasound screened group, of which nearly half was due to the termination of fetuses with malformation.2 References • End-result of routine ultrasound screening for congenital anomalies: The Belgian Multicentric Study 1984–92 :S. Levi,etal, Ultrasound Obstetrics and Gynaecology 5: 1995 ( 366-371) • Ultrasound screening and perinatal mortality, controlled trial of systematic one stage screening in pregnancy. The Helsinki ultrasound trial : Lancet: 1990; 336: 387 - 391 • .