Benefits and adverse effects of prenatal diagnosis in non-urological surgical disorders

The purpose of this study was to assess the accuracy of prenatal ultrasound in correctly diagnosing fetal structural abnormality requiring surgical intervention and to evaluate its effect on management and eventual outcome. Information was collected from existing departmental databases. From 1985 to 1991, 101 surgical disorders were suspected prenatally in the Yorkshire region; termination of pregnancy was requested in 6. Prenatal diagnoses were incorrect in 22/101, six being normal infants. In 28/101 cases the diagnosis was made after 30 weeks of gestation. Transfer to the tertiary referral centre was postnatal in 12/95 cases, although prenatal diagnosis should have allowed earlier referral. Mortality data for the 95 infants showed a survival of 73% overall. Definite parental anxiety resulting from either an incorrect diagnosis, inappropriate counselling, or unnecessary investigations was identified in 16 cases. Although prenatal diagnosis is helpful in the majority of cases, these findings suggest the need for improvements in diagnostic accuracy, inter-departmental communications and patient care.