Consequences of antenatal diagnosis for pediatric surgery

Based on an increase from 6000 ultrasound examinations done at the First University Gynecological Hospital of Munich in 1969 to more than 13,000 in 1982, and on an increased rate of antenatally diagnosed malformation, the accuracy of antenatal ultrasound diagnosis was investigated. It turned out that correct diagnosis could be made in over 80% of cases. However, this was incomplete in approximately 40% of the cases, since associated malformations of the gastrico-intestinal tract, congenital heart disease, myelomeningocele in correctly diagnosed hydrocephalus, and others were not recognized. False-positive results were found in 17.5% of cases, false-negative ones in 12.7%. Because of the uncertainty of antenatal diagnosis and ignorance of many physiological parameters, intrauterine surgical treatment cannot be advocated at present. Intrauterine measures are still confined to punctures, administration of drugs, and diagnostic procedures. Further consequences such as termination of pregnancy, psychological aspects, and possible development of intrauterine therapy are discussed.