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 malformations 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 information, 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 a 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 myelomeningocele is associated with a lesser requirement for subsequent ventricular shunting and improved motor outcomes at 30 months.2 However, vesicoamniotic 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 successfully managed after birth.
