3 ; 1 ; in Month : January (2021) Article No : sjnp-v3-1014
Hideaki S, Jyoji Y, Tomokazu N, Katsufumi O, Motoi

Purpose: Prenatal diagnostic accuracy has improved; however, the pediatric surgeon’s role remains unclear. This paper aimed to determine the prenatal diagnoses made and the role of pediatric surgeons. Methods: A 6-year retrospective review of 904 pregnancies managed at our institute was conducted. They were classified as a normal pregnancy (NP, n=194), abnormal pregnancy maternal factor (MF, n=449), or abnormal pregnancy fetal factor (FF, n=261). Results: In the FF group, the identified conditions were twin pregnancies (n=75), intrauterine growth restriction (IUGR) (n=49), breech presentation (n=26), arrested development (n=19), hypoamnion (n=42), fetal distress (n=16), hydramnios (n=10), abnormal heart sounds (n=5), meconium staining (n=5), surface anomaly (n=4), calcification (n=2), fetal hydrops (n=2), fetal death (n=2), bowel dilatation (n=2), abdominal mass (n=1) and diaphragmatic hernia (n=1). Case of twin pregnancies, breech presentation, arrested development, IUGR, hypoamnion, abnormal heart sounds, meconium staining and fetal hydrops did not require surgery. Of the 16 cases of fetal distress, 1 had biliary atresia. Of the 10 cases of hydramnios, 1 had meconium peritonitis. Of the 4 with surface anomalies, 3 had gastroschisis. Of the 2 with calcification, 1 had meconium peritonitis. Of the two fetal deaths, 1 had anal atresia suggesting a chromosomal abnormality. Of the 2 cases of bowel dilatation, 1 had bowel atresia. The abnormal mass was caused by adrenal bleeding. These diagnoses were made at an average of 27.4 gestational weeks; however, 2 cases of gastroschisis, suggesting a body stalk anomaly; diaphragmatic hernia; and brain cysts were diagnosed before 20 weeks and were aborted. After delivery, the mortality rate was 0% in neonates treated by pediatric surgeons and neonatologists. Conclusion: Fetal abnormalities are rare; however, early aggressive management with the cooperation of obstetricians and parents is crucial for pediatric surgeons to minimize the effects of anomalies.

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