Prenatal Diagnosis and Foetal Therapy

Introduction Prenatal diagnosis and foetal therapy are rare in Africa except for the presentation of polyhydraminios in foetal bowel obstruction. This chapter therefore covers prenatal diagnosis and therapy as practised in resourced countries. Expertise in surgical correction of congenital malformations may favourably influence the perinatal management of prenatally diagnosed anomalies, by changing the site of delivery for immediate postnatal treatment; altering the mode of delivery to prevent obstructed labour or haemorrhage; early delivery to prevent ongoing foetal organ damage; or treatment in utero to prevent, minimise or reverse foetal organ injury as a result of a structural defect. The referral base for a paediatric surgeon now includes the perinatal period. The diagnosis and management of complex foetal anomalies require a team effort by obstetricians, neonatologists, genetecists, paediatricians, and paediatric surgeons to deal with all the maternal and foetal complexities involved in diagnosis of a structural defect. This team should be able to provide information to prospective parents on foetal outcomes; possible interventions; appropriate setting, time, and route of delivery; and expected postnatal outcomes. The role of the surgical consultant in this team is to present information regarding the prenatal and postnatal natural history of an anomaly, its surgical management, and the expected long-term outcome.