Preoperative assessment

Many congenital defects that are of interest to the pediatric

surgeon can now be detected before birth, thus the

preoperative assessment of the newborn with a possible

congenital anomaly starts in utero. When serious malforma-

tions incompatible with postnatal life are diagnosed early

enough, the family may have the option of terminating the

pregnancy in some countries. It is extremely beneficial for

parents if the pediatric surgeon who is likely to manage the

infant postnatally is available antenatally to provide informa-

tion, be involved in management decisions, and counsel the

family before birth.1 The main goal of prenatal diagnosis is to

improve the prenatal care by maternal transport to an

appropriate center and delivering the baby in the timing

and mode that are appropriate for the specific fetal

malformation. Multidisciplinary meetings in which obstetric,

neonatal, and pediatric surgical expertise is present are

commonplace in most large pediatric institutions. They

undoubtedly improve postnatal outcome, but as always

effective communication between all disciplines is vital.

Prenatal intervention for certain congenital anomalies has

been reported extensively in recent years. The success of fetal

surgery has varied from condition to condition; for instance

antenatal closure of myelomeningocoele is associated with a

lesser requirement for subsequent ventricular shunting but

no significant improvement in neurologic deficit.2 Likewise

vesico-amniotic shunting for posterior urethral valves has not

proved to be the ‘cure-all’ it was once hoped to be,3 but it

seems clear that fetal surgical intervention is here to stay and

is likely to continue to expand its repertoire.4,5 At present,

however, almost all congenital malformations can be success-

fully managed after birth.