ABSTRACT
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.