Maternal Ultrasonography for the Antenatal Diagnosis of Surgically Significant Neonatal Anomalies

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Abstract
The increased use of ultrasonography in the management and evaluation of [human] pregnancy provides a unique opportunity to observe the anatomy of the developing fetus from 12 wk gestation until term. Surgically important anatomic abnormalities (38) were diagnosed in utero by sonographic examinations. These include ascites (5 cases), gastroschisis (4 cases), omphalocele (3 cases), sacrococcygeal teratoma, cystic hygroma, hydrocele, duodenal atresia, multicystic kidney (2 cases each) and 1 each of jejunal atresia, conjoined twins, ureteropelvic junction obstruction, urethral valves, urethral agenesis and hydronephrosis secondary to reflux. Prenatal diagnosis by ultrasonographic examination significantly improved perinatal management. Elective cesarean section benefited infants with lesions causing dystocia, such as sacrococcygeal teratoma, omphalocele and conjoined twins. Advance notification of surgeons and neonatalogists reduced the delays of postnatal evaluation and treatment that contribute significantly to complications and death. Transfer of the pregnant mother carrying an infant with a significant surgical anomaly to a center with facilities for neonatal surgery and specialized postoperative care can be properly planned for in advance. In the near future, intrauterine fetal surgery or palliative intervention may provide increased salvage of patients with obstructive uropathy and diaphragmatic hernia, both of which carry high mortality rates secondary to in utero damage. Sonography was useful in following the dilatation of intestinal or urinary tract structures in utero. Maternal sonography improved the surgical care of the newborn and may open a new frontier of intrauterine fetal surgery in the future.