Prenatal diagnosis and the pediatric surgeon: The impact of prenatal consultation on perinatal management

Timothy M. Crombleholme, Mary D'Alton, Marc Cendron, Benjamin Alman, Michael D. Goldberg, George T. Klauber, Alan Cohen, Carl Heilman, Michael Lewis, Burton H. Harris

Research output: Contribution to journalArticle

Abstract

Purpose: Pediatric surgeons are increasingly called on by obstetrical colleagues to counsel parents about the implications of a prenatal ultrasound finding. Our understanding of the natural history of many prenatally diagnosed surgical conditions has grown significantly in recent years. Whether prenatal surgical consultation can influence perinatal course had not been investigated. Methods: During an 21-month period, 12,865 prenatal ultrasound studies were performed on a total of 4,551 patients, and 221 prenatal surgical consultations were obtained through a newly established fetal treatment program at a tertiary care prenatal diagnostic center. To evaluate the impact of prenatal pediatric surgical consultation on perinatal course, the authors reviewed changes in management including termination of pregnancy, in utero intervention, and altered site, mode, or timing of delivery. Results: Two hundred twenty-one fetuses were referred for consultation; their 234 congenital anomalies included genitourinary (36%), thoracic (16%), intraabdominal (14.5%), abdominal wall (10.6%), neurological (9%), skeletal (6%), and head and neck (2.5%) defects; 2.5% had tumors and 2.5% were twin pregnancies. Pregnancy was terminated in 9.5% of cases, because of patient request, chromosomal abnormality, or dismal prognosis. In 3.6%, the decision to terminate was changed as a result of consultation. Site of delivery was changed as a result of consultation in 37% to facilitate postnatal evaluation and initiate immediate treatment. Mode of delivery was changed in 6.8% to prevent dystocia, hemorrhage into a tumor, as in sacrococcygeal teratoma, or to provide an emergency airway, as in cervical teratoma. The timing of delivery was changed in 4.5% to avoid further damage to fetal organs in cases of obstructive uropathy, gastroschisis, sacrococcygeal teratoma with high-output failure, and hydrocephalus. Five percent (11) underwent treatment in utero for fetal hydrothorax, obstructive uropathy, twin-twin transfusion syndrome, or lymphangioma. The overall perinatal mortality rate was 2.5%. Conclusion: Prenatal pediatric surgical consultation may have a significant impact on the perinatal management of the fetus with a surgically correctable congenital anomaly. Providing obstetric colleagues and families with valuable insight into the surgical management of anomalies allows fetal intervention when appropriate, and delivery in an appropriate setting, by the safest mode of delivery, and at the gestational age appropriate to minimize effects of the anomaly.

Original languageEnglish (US)
Pages (from-to)156-163
Number of pages8
JournalJournal of Pediatric Surgery
Volume31
Issue number1
DOIs
StatePublished - Jan 1996
Externally publishedYes

Fingerprint

Prenatal Diagnosis
Referral and Consultation
Pediatrics
Teratoma
Fetus
Hydrothorax
Fetofetal Transfusion
Gastroschisis
Lymphangioma
Dystocia
Pregnancy
Twin Pregnancy
Perinatal Mortality
Abdominal Wall
Tertiary Healthcare
Hydrocephalus
Surgeons
Natural History
Chromosome Aberrations
Gestational Age

Keywords

  • fetal therapy
  • perinatal management
  • Prenatal diagnosis
  • ultrasonography

ASJC Scopus subject areas

  • Surgery

Cite this

Crombleholme, T. M., D'Alton, M., Cendron, M., Alman, B., Goldberg, M. D., Klauber, G. T., ... Harris, B. H. (1996). Prenatal diagnosis and the pediatric surgeon: The impact of prenatal consultation on perinatal management. Journal of Pediatric Surgery, 31(1), 156-163. https://doi.org/10.1016/S0022-3468(96)90340-1

Prenatal diagnosis and the pediatric surgeon : The impact of prenatal consultation on perinatal management. / Crombleholme, Timothy M.; D'Alton, Mary; Cendron, Marc; Alman, Benjamin; Goldberg, Michael D.; Klauber, George T.; Cohen, Alan; Heilman, Carl; Lewis, Michael; Harris, Burton H.

In: Journal of Pediatric Surgery, Vol. 31, No. 1, 01.1996, p. 156-163.

Research output: Contribution to journalArticle

Crombleholme, TM, D'Alton, M, Cendron, M, Alman, B, Goldberg, MD, Klauber, GT, Cohen, A, Heilman, C, Lewis, M & Harris, BH 1996, 'Prenatal diagnosis and the pediatric surgeon: The impact of prenatal consultation on perinatal management', Journal of Pediatric Surgery, vol. 31, no. 1, pp. 156-163. https://doi.org/10.1016/S0022-3468(96)90340-1
Crombleholme, Timothy M. ; D'Alton, Mary ; Cendron, Marc ; Alman, Benjamin ; Goldberg, Michael D. ; Klauber, George T. ; Cohen, Alan ; Heilman, Carl ; Lewis, Michael ; Harris, Burton H. / Prenatal diagnosis and the pediatric surgeon : The impact of prenatal consultation on perinatal management. In: Journal of Pediatric Surgery. 1996 ; Vol. 31, No. 1. pp. 156-163.
@article{cdcb214cf47d457d844689193993d343,
title = "Prenatal diagnosis and the pediatric surgeon: The impact of prenatal consultation on perinatal management",
abstract = "Purpose: Pediatric surgeons are increasingly called on by obstetrical colleagues to counsel parents about the implications of a prenatal ultrasound finding. Our understanding of the natural history of many prenatally diagnosed surgical conditions has grown significantly in recent years. Whether prenatal surgical consultation can influence perinatal course had not been investigated. Methods: During an 21-month period, 12,865 prenatal ultrasound studies were performed on a total of 4,551 patients, and 221 prenatal surgical consultations were obtained through a newly established fetal treatment program at a tertiary care prenatal diagnostic center. To evaluate the impact of prenatal pediatric surgical consultation on perinatal course, the authors reviewed changes in management including termination of pregnancy, in utero intervention, and altered site, mode, or timing of delivery. Results: Two hundred twenty-one fetuses were referred for consultation; their 234 congenital anomalies included genitourinary (36{\%}), thoracic (16{\%}), intraabdominal (14.5{\%}), abdominal wall (10.6{\%}), neurological (9{\%}), skeletal (6{\%}), and head and neck (2.5{\%}) defects; 2.5{\%} had tumors and 2.5{\%} were twin pregnancies. Pregnancy was terminated in 9.5{\%} of cases, because of patient request, chromosomal abnormality, or dismal prognosis. In 3.6{\%}, the decision to terminate was changed as a result of consultation. Site of delivery was changed as a result of consultation in 37{\%} to facilitate postnatal evaluation and initiate immediate treatment. Mode of delivery was changed in 6.8{\%} to prevent dystocia, hemorrhage into a tumor, as in sacrococcygeal teratoma, or to provide an emergency airway, as in cervical teratoma. The timing of delivery was changed in 4.5{\%} to avoid further damage to fetal organs in cases of obstructive uropathy, gastroschisis, sacrococcygeal teratoma with high-output failure, and hydrocephalus. Five percent (11) underwent treatment in utero for fetal hydrothorax, obstructive uropathy, twin-twin transfusion syndrome, or lymphangioma. The overall perinatal mortality rate was 2.5{\%}. Conclusion: Prenatal pediatric surgical consultation may have a significant impact on the perinatal management of the fetus with a surgically correctable congenital anomaly. Providing obstetric colleagues and families with valuable insight into the surgical management of anomalies allows fetal intervention when appropriate, and delivery in an appropriate setting, by the safest mode of delivery, and at the gestational age appropriate to minimize effects of the anomaly.",
keywords = "fetal therapy, perinatal management, Prenatal diagnosis, ultrasonography",
author = "Crombleholme, {Timothy M.} and Mary D'Alton and Marc Cendron and Benjamin Alman and Goldberg, {Michael D.} and Klauber, {George T.} and Alan Cohen and Carl Heilman and Michael Lewis and Harris, {Burton H.}",
year = "1996",
month = "1",
doi = "10.1016/S0022-3468(96)90340-1",
language = "English (US)",
volume = "31",
pages = "156--163",
journal = "Journal of Pediatric Surgery",
issn = "0022-3468",
publisher = "W.B. Saunders Ltd",
number = "1",

}

TY - JOUR

T1 - Prenatal diagnosis and the pediatric surgeon

T2 - The impact of prenatal consultation on perinatal management

AU - Crombleholme, Timothy M.

AU - D'Alton, Mary

AU - Cendron, Marc

AU - Alman, Benjamin

AU - Goldberg, Michael D.

AU - Klauber, George T.

AU - Cohen, Alan

AU - Heilman, Carl

AU - Lewis, Michael

AU - Harris, Burton H.

PY - 1996/1

Y1 - 1996/1

N2 - Purpose: Pediatric surgeons are increasingly called on by obstetrical colleagues to counsel parents about the implications of a prenatal ultrasound finding. Our understanding of the natural history of many prenatally diagnosed surgical conditions has grown significantly in recent years. Whether prenatal surgical consultation can influence perinatal course had not been investigated. Methods: During an 21-month period, 12,865 prenatal ultrasound studies were performed on a total of 4,551 patients, and 221 prenatal surgical consultations were obtained through a newly established fetal treatment program at a tertiary care prenatal diagnostic center. To evaluate the impact of prenatal pediatric surgical consultation on perinatal course, the authors reviewed changes in management including termination of pregnancy, in utero intervention, and altered site, mode, or timing of delivery. Results: Two hundred twenty-one fetuses were referred for consultation; their 234 congenital anomalies included genitourinary (36%), thoracic (16%), intraabdominal (14.5%), abdominal wall (10.6%), neurological (9%), skeletal (6%), and head and neck (2.5%) defects; 2.5% had tumors and 2.5% were twin pregnancies. Pregnancy was terminated in 9.5% of cases, because of patient request, chromosomal abnormality, or dismal prognosis. In 3.6%, the decision to terminate was changed as a result of consultation. Site of delivery was changed as a result of consultation in 37% to facilitate postnatal evaluation and initiate immediate treatment. Mode of delivery was changed in 6.8% to prevent dystocia, hemorrhage into a tumor, as in sacrococcygeal teratoma, or to provide an emergency airway, as in cervical teratoma. The timing of delivery was changed in 4.5% to avoid further damage to fetal organs in cases of obstructive uropathy, gastroschisis, sacrococcygeal teratoma with high-output failure, and hydrocephalus. Five percent (11) underwent treatment in utero for fetal hydrothorax, obstructive uropathy, twin-twin transfusion syndrome, or lymphangioma. The overall perinatal mortality rate was 2.5%. Conclusion: Prenatal pediatric surgical consultation may have a significant impact on the perinatal management of the fetus with a surgically correctable congenital anomaly. Providing obstetric colleagues and families with valuable insight into the surgical management of anomalies allows fetal intervention when appropriate, and delivery in an appropriate setting, by the safest mode of delivery, and at the gestational age appropriate to minimize effects of the anomaly.

AB - Purpose: Pediatric surgeons are increasingly called on by obstetrical colleagues to counsel parents about the implications of a prenatal ultrasound finding. Our understanding of the natural history of many prenatally diagnosed surgical conditions has grown significantly in recent years. Whether prenatal surgical consultation can influence perinatal course had not been investigated. Methods: During an 21-month period, 12,865 prenatal ultrasound studies were performed on a total of 4,551 patients, and 221 prenatal surgical consultations were obtained through a newly established fetal treatment program at a tertiary care prenatal diagnostic center. To evaluate the impact of prenatal pediatric surgical consultation on perinatal course, the authors reviewed changes in management including termination of pregnancy, in utero intervention, and altered site, mode, or timing of delivery. Results: Two hundred twenty-one fetuses were referred for consultation; their 234 congenital anomalies included genitourinary (36%), thoracic (16%), intraabdominal (14.5%), abdominal wall (10.6%), neurological (9%), skeletal (6%), and head and neck (2.5%) defects; 2.5% had tumors and 2.5% were twin pregnancies. Pregnancy was terminated in 9.5% of cases, because of patient request, chromosomal abnormality, or dismal prognosis. In 3.6%, the decision to terminate was changed as a result of consultation. Site of delivery was changed as a result of consultation in 37% to facilitate postnatal evaluation and initiate immediate treatment. Mode of delivery was changed in 6.8% to prevent dystocia, hemorrhage into a tumor, as in sacrococcygeal teratoma, or to provide an emergency airway, as in cervical teratoma. The timing of delivery was changed in 4.5% to avoid further damage to fetal organs in cases of obstructive uropathy, gastroschisis, sacrococcygeal teratoma with high-output failure, and hydrocephalus. Five percent (11) underwent treatment in utero for fetal hydrothorax, obstructive uropathy, twin-twin transfusion syndrome, or lymphangioma. The overall perinatal mortality rate was 2.5%. Conclusion: Prenatal pediatric surgical consultation may have a significant impact on the perinatal management of the fetus with a surgically correctable congenital anomaly. Providing obstetric colleagues and families with valuable insight into the surgical management of anomalies allows fetal intervention when appropriate, and delivery in an appropriate setting, by the safest mode of delivery, and at the gestational age appropriate to minimize effects of the anomaly.

KW - fetal therapy

KW - perinatal management

KW - Prenatal diagnosis

KW - ultrasonography

UR - http://www.scopus.com/inward/record.url?scp=9044234012&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=9044234012&partnerID=8YFLogxK

U2 - 10.1016/S0022-3468(96)90340-1

DO - 10.1016/S0022-3468(96)90340-1

M3 - Article

C2 - 8632271

AN - SCOPUS:9044234012

VL - 31

SP - 156

EP - 163

JO - Journal of Pediatric Surgery

JF - Journal of Pediatric Surgery

SN - 0022-3468

IS - 1

ER -