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Anencephaly: changes in prenatal detection and birth status, 1972 through 1990
1Department of Newborn Medicine, Brigham and Women's Hospital, Boston, MA 02115.
American Journal of Obstetrics and Gynecology
|May 1, 1994
Summary
Prenatal diagnosis significantly reduced live births of anencephaly infants. By the late 1980s, all cases were detected prenatally, leading to elective terminations and earlier gestational ages at termination.
Area of Science:
- Medical Genetics
- Prenatal Diagnosis
- Public Health
Background:
- Anencephaly is a severe neural tube defect with high mortality.
- Historically, management relied on postnatal identification, leading to live births.
- Limited prenatal detection impacted early intervention strategies.
Purpose of the Study:
- To evaluate the impact of prenatal diagnosis on anencephaly births.
- To assess changes in birth status and gestational age over time.
- To understand the role of parental choice in pregnancy management.
Main Methods:
- Retrospective analysis of anencephaly cases (n=175) from 1972-1990.
- Inclusion of stillborn infants and second-trimester elective terminations.
- Categorization into "nontransfers" and "transfers" based on planned delivery location.
Main Results:
- In the 1970s, half of anencephaly infants were born alive with average gestational age of 35.6 weeks.
- By 1988-1990, prenatal diagnosis (ultrasonography, alpha-fetoprotein screening) was universal.
- All affected pregnancies were terminated electively, with average gestational age of 19.6 weeks.
Conclusions:
- Prenatal detection has dramatically altered the birth status of anencephaly infants.
- Parental choice for elective termination significantly influences outcomes.
- Improved prenatal screening has led to earlier pregnancy interventions.