A PERINATAL APPROACH TO THE DIAGNOSIS AND MANAGEMENT OF GASTROINTESTINAL MALFORMATIONS

Abstract

Ultrasonography now offers the opportunity to evaluate selected high-risk pregnancies for the presence of fetal malformations that are amenable to corrective measures and those that remain incompatible with life. Major fetal malformations were observed in 1% of 6050 [human] cases that underwent antenatal ultrasonographic evaluation. A series of 9 prenatally diagnosed gastrointestinal tract anomalies, including the 1st documented instances of esophageal atresia diagnosed in utero, is presented. Abdominal wall defects were those most commonly encountered in this series and were diagnosed as early as 16 wk gestation. The gastrointestinal system is not only one of the most common sites of birth defects but it is also the one wherein lies the greatest hope for a successful neonatal outcome. The value of prenatal diagnosis in a comprehensive perinatal approach to congenital gastrointestinal lesions is emphasized. Forewarning the obstetrician and alerting the pediatric surgical team for resuscitation, immediate postnatal evaluation and timely intervention decrease neonatal mortality and increase the chance of long-term infant survival.