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Antenatal and postnatal diagnoses of visible congenital malformations in a sub-Saharan African setting: a prospective
Igor Kamla1, Nelly Kamgaing2,3, Serge Billong4
1Department of Surgery and sub-Specialties, Faculty of Medicine and Biomedical Science of University of Yaoundé I, Yaoundé, Cameroon. kamlaigor@yahoo.fr.
Insights
Visible congenital malformations (VCMs) are a significant cause of disability. This study found low antenatal diagnosis rates for VCMs in a low-resource setting, highlighting the need for improved prenatal screening to reduce fetal and maternal morbidity.
Area of Science:
- Medical Science
- Obstetrics and Gynecology
- Public Health
Background:
- Visible congenital malformations (VCMs) are a leading global cause of disability.
- Prenatal diagnosis of VCMs is standard in high-income countries but often lacking in low-resource settings.
- Cameroon, a low-resource setting, has no established policy for antenatal diagnosis of VCMs.
Purpose of the Study:
- To determine the incidence of prenatal diagnosis of VCMs in a low-resource setting.
- To assess the prevalence of antenatal diagnosis of VCMs.
- To evaluate the concordance between clinical and sonographic diagnoses of VCMs.
Main Methods:
- Prospective cohort multicenter study conducted in 10 maternity units in Yaoundé, Cameroon (July 2015 - June 2016).
- Inclusion of all newborns with detectable VCMs at birth.
- Analysis of obstetrical ultrasound scan findings from the 1st, 2nd, and 3rd trimesters.
Main Results:
- The incidence of VCMs was 9 per 1000 births, with skeletal, neurological, and gastrointestinal malformations being most common.
- The prevalence of sonographic antenatal diagnosis of VCMs was 21%, with hydrocephalus being the most frequently diagnosed.
- Among malformed newborns, 37% were premature, and 18.5% had a VCM diagnosis confirmed after therapeutic termination of pregnancy.
Conclusions:
- The incidence of VCMs in this resource-limited setting is high, but antenatal diagnosis rates are very low.
- The study underscores the critical importance of antenatal diagnosis of VCMs, which is frequently overlooked in such settings.
- Improving antenatal diagnosis of VCMs is essential to reduce maternal and fetal morbidity in areas with high maternal and neonatal mortality rates.
Background:
Visible congenital malformations (VCMs) are one of the principal causes of disability in the world. Prenatal diagnosis is a paramount mandatory integral part of the follow up of pregnancies with VCM of the foetus in high-income setting. We aimed to determine the incidence of prenatal diagnosis of VCMs in a low-resource setting with no policy on antenatal diagnosis of VCMs.
Methods:
We carried out a prospective cohort multicenter study from July 2015 to June 2016 in 10 randomly selected maternity units of Yaoundé, Cameroon. We enrolled all newborns with one or more detectable VCMs at birth. Variables studied were findings of the 1st, 2nd and 3rd trimesters' obstetrical ultrasound scans, in order to establish a concordance between the clinical and sonographic diagnoses of the VCMs and determine the frequency of antenatal diagnosis as well as the rate of medical abortion.
Results:
The incidence of VCMs was 9 per 1000 births. The main VCMs were malformations of the skeletal (4.3%), neurological (2.2%), and gastrointestinal (2.1%) systems. The sex ratio was 1.1. Among the malformed newborns, 37% were premature and in 18.5% the diagnosis of a VCM was confirmed after a therapeutic termination of pregnancy (following suggestive findings of a malformation on antenatal ultrasound scan). The prevalence of sonographic antenatal diagnosis of VCMs was 21%. Hydrocephalus was the most diagnosed VCM antenatally. The mean gestational age at which antenatal clinics were initiated was 15 ± 5 weeks. The mean number of obstetrical ultrasound scans performed was two.
Conclusion:
The incidence of VCMs in our resource-limited setting is high and antenatal diagnosis rates are very low. Overall, our study emphasizes on the importance antenatal diagnosis of VCMs, often overlooked in our setting. The goal being to reduce maternal and foetal morbidity in a setting already burdened by a high maternal and neonatal mortality.
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