Fetal counselling for congenital malformations

Congenital anomalies of the kidney and urinary tract: antenatal diagnosis, management and counselling of families

Congenital anomalies of the kidney and urinary tract are collectively one of the most commonly diagnosed antenatal conditions. Clinicians have several tools available to diagnose anomalies, including imaging, biomarkers, family history and genetic studies. In certain cases, antenatal interventions such as vesico-amniotic shunting may be considered to improve postnatal outcomes.Congenital kidney anomalies detected antenatally can vary in clinical significance from almost no impact postnatally to significant morbidity and perinatal mortality. Prognosis broadly depends on kidney size, structure and amount of amniotic fluid, alongside genetics and family history, and progression on subsequent scans. It is important to counsel parents appropriately using a parent-focused and personalised approach. The use of a multidisciplinary team should always be considered.

Feasibility Analysis of 3D Printing With Prenatal Ultrasound for the Diagnosis of Fetal Abnormalities

OBJECTIVE

To assess the feasibility and accuracy of 3D printing with prenatal three-dimensional ultrasound (3DUS) in the diagnosis of fetal abnormalities.

METHODS

Fetuses initially diagnosed with various abnormalities were included in this retrospective study. The fetuses were examined by 3DUS, modeled, and 3D printed, and the dimensional accuracy of the 3D prints was analyzed. The effectiveness, demand, necessity of 3D printing, and the diagnostic accuracy of different methods were analyzed based on questionnaire responses from 40 senior ultrasound doctors and 40 postgraduate students.

RESULTS

A total of 12 fetuses with cleft lip and palate, spinal, heart, or brain abnormalities were included for detailed assessment. All deviations (mean deviation: 0.1 mm) between the original images and the final 3D prints lay within the consistency boundary (-1.12, 1.31 mm) (P > .05). In the subsequent analyses, 90.8% of the doctors and 94.2% of the students strongly agreed that 3D printing could precisely represent and depict fetal abnormalities. The average misdiagnosis rate of the doctors decreased from 5% to 0.4% after the application of 3D printing combined with 3DUS in comparison with 3DUS alone, and the corresponding value for the students dropped from 17.9% to 5.2%.

CONCLUSIONS

The errors in modeling and 3D printing based on 3DUS were within acceptable limits, and 3D printing improved the diagnosis of various fetal abnormalities.

Management of fetal teratomas

Fetal teratomas are the most common tumors diagnosed prenatally. The majority of these tumors are benign and cured by complete resection of the mass during the neonatal period. Prenatal diagnosis has improved the perinatal management of these lesions and especially for the teratomas that might benefit from fetal intervention. A comprehensive prenatal evaluation including conventional ultrasounds, Doppler, echocardiography and fetal MRI, is essential for an effective counseling and perinatal management. Antenatal counseling helps the parents to better understand the natural history, fetal intervention, and perinatal management of these tumors, which differ dramatically depending on their size and location. Fetal surgical debulking improves survival in cases of sacrococcygeal teratoma with cardiac decompensation. Additionally, the use of an EXIT procedure reduces the morbidity and mortality if a complicated delivery in cases of cervical and mediastinal teratomas. Here, we offer an overview of all fetal teratomas and their recommended management, with emphasis on in utero treatment options.

Neonatal teratomas

Teratomas are composed of multiple tissues foreign to the organ or site in which they arise. Their origin is postulated by 3 theories one of which is the origin from totipotent primodial germ cells. Anatomically, teratomas are divided into gonadal or extragonadal lesions and histologically they are classified as mature or immature tumors. Teratomas are mainy isolated lesions and may occur anywhere in the body. In the neonatal age group most of these tumors are benign and occur mainly in the sacrococcygeal area followed by the anterior mediastinum. Diagnosis is usually established prenatally and may require intervention in compromised fetuses. Postnatal imaging with ultrasound, CT scan or MRI provides useful information for surgical intervention. Complete surgical excision is the treatment of choice for neonatal teratomas. Alpha feto protein is the tumor marker of choice and is particularly useful for assessing the presence of residual or recurrent disease.

Evaluation of a fetomaternal-surgical clinic for prenatal counselling of surgical anomalies

With increasing ability to diagnose fetal anomalies, it is imperative that parents receive appropriate counselling to reach their decision. The aim of this study was to evaluate the fetomaternal-surgical clinic held jointly by an obstetrician and a paediatric surgeon. At this monthly clinic the patients are first scanned by the consultant fetomaternal specialist in the presence of a consultant paediatric surgeon and subsequently counselled jointly in an adjacent quiet room. Other specialists such as geneticist and neonatologists provided further counselling where needed. All 43 parents who attended this clinic in the year 2005 were included in this study and were counselled by the same paediatric surgeon. A questionnaire was designed to assess the different aspects of service provided by this clinic. In this study the diagnosis was changed in 3 (7%) babies, 2 (4.6%) parents miscarried and 1 (2.3%) neonatal death occurred, unrelated to the surgical anomaly. The site of delivery was changed in 20 (48%) patients and the mode of delivery in 7 (10%). All 43 (100%) parents were satisfied with the fetal counselling, eight patients (18.6%) felt increased anxiety post-counselling and 95% had a better understanding of their unborn babies condition after counselling. Two (4.6%) parents decided to terminate the pregnancy due to complex fetal abnormalities, and 31 (72%) felt they understood the future pregnancy risks. Fifty-six per cent of parents felt that further counselling from religious person should be offered.