Who needs prenatal counselling with a pediatric surgeon? Experience from a large tertiary care university hospital

Alizée Froeliger; Luke Harper; Sara Tunon de Lara; Frédéric Lavrand; Maya Loot; Yan Lefevre; Loïc Sentilhes; Frédéric Coatleven; Éric Dobremez

doi:10.1515/jpm-2021-0130

Article

Who needs prenatal counselling with a pediatric surgeon? Experience from a large tertiary care university hospital

Alizée Froeliger , Luke Harper , Sara Tunon de Lara , Frédéric Lavrand , Maya Loot , Yan Lefevre , Loïc Sentilhes , Frédéric Coatleven and Éric Dobremez

Published/Copyright: January 17, 2022

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From the journal Journal of Perinatal Medicine Volume 50 Issue 4

Abstract

Objectives

To describe our experience with prenatal counselling for surgical anomalies in a large volume center. The secondary aim is to suggest a list of prenatal abnormalities warranting counselling by a pediatric surgeon.

Methods

We reviewed all prenatal counselling consultations performed by the pediatric surgery team between January 1st, 2015 and December 31st, 2016.

Results

A total of 169 patients or couples had a prenatal consultation with a pediatric surgeon. Prenatal work-up included a fetal MRI in 26% of cases, mainly for digestive and thoracic pathologies (56.1% of cases). Consultation with the pediatric surgeon led mainly to recommendations concerning the place of delivery. Induction for reasons related to the fetal anomaly occurred in 22.2% of cases. Most children were surgically treated within the first year of life (63.5%). Correlation between predicted prognosis and actual status at four years of life was 96.9%. Correlation between prenatal and postnatal diagnosis was 87.4%.

Conclusions

Prenatal counselling by a pediatric surgeon allows couples to obtain clear information on the pathology of their unborn child, giving them greater autonomy in their decision to continue the pregnancy.

Keywords: antenatal consultation; fetal malformation; fetal medicine; pediatric surgery; prenatal counseling; prenatal diagnosis

Corresponding author: Alizée Froeliger, Department of Gynecology and Obstetrics, Bordeaux University Hospital, place Amélie Raba-Léon, 33076 Bordeaux, France, Phone: +0033 5 56 79 55 79, E-mail: alizee.froeliger@hotmail.fr

Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: The local Institutional Review Board deemed the study exempt from review.

References

1. Blondel, B, Coulm, B, Bonnet, C, Goffinet, F, Le Ray, C. National Coordination Group of the National Perinatal Surveys. Trends in perinatal health in metropolitan France from 1995 to 2016: results from the French National Perinatal Surveys. J Gynecol Obstet Hum Reprod 2017;46:701–13. https://doi.org/10.1016/j.jogoh.2017.09.002.Search in Google Scholar

2. Code de la Santé Publique, Article L2131-1. Diagnostics anténataux: diagnostic prénatal et diagnostic préimplantatoire. 2016. Available from: https://www.legifrance.gouv.fr.Search in Google Scholar

3. Raboei, E. The role of the pediatric surgeon in the perinatal multidisciplinary team. Eur J Pediatr Surg 2008;18:313–7. https://doi.org/10.1055/s-2008-1038641.Search in Google Scholar

4. Aite, L, Zaccara, A, Cuttini, M, Mirante, N, Nahom, A, Bagolan, P. Lack of institutional pathways for referral: results of a survey among pediatric surgeons on prenatal consultation for congenital anomalies: referral to pediatric surgeon after prenatal diagnosis. Prenat Diagn 2013;33:904–7. https://doi.org/10.1002/pd.4165.Search in Google Scholar

5. Cordier, A-G, Russo, FM, Deprest, J, Benachi, A. Prenatal diagnosis, imaging, and prognosis in Congenital Diaphragmatic Hernia. Semin Perinatol 2019;44:51163. https://doi.org/10.1053/j.semperi.2019.07.002.Search in Google Scholar

6. Benachi, A, Sarnacki, S. Prenatal counselling and the role of the paediatric surgeon. Semin Pediatr Surg 2014;23:240–3. https://doi.org/10.1053/j.sempedsurg.2014.09.002.Search in Google Scholar

7. Crombleholme, TM, D’Alton, M, Cendron, M, Alman, B, Goldberg, M, Klauber, G, et al.. Prenatal diagnosis and the pediatric surgeon: the impact of prenatal consultation on perinatal management. J Pediatr Surg 1996;31:156–63. https://doi.org/10.1016/s0022-3468(96)90340-1.Search in Google Scholar

8. Delgove, A, Harper, L, Savidan, P, Paygambar, A, Dobremez, E, Lefevre, Y. How can we decrease preoperative anxiety in parents of children undergoing surgery? Arch Dis Child 2018;103:1001–2. https://doi.org/10.1136/archdischild-2017-314579.Search in Google Scholar

9. Marokakis, S, Kasparian, NA, Kennedy, SE. Prenatal counselling for congenital anomalies: a systematic review: prenatal counselling for congenital anomalies. Prenat Diagn 2016;36:662–71. https://doi.org/10.1002/pd.4836.Search in Google Scholar

10. Aite, L, Zaccara, A, Nahom, A, Trucchi, A, Iacobelli, B, Bagolan, P. Mothers’ adaptation to antenatal diagnosis of surgically correctable anomalies. Early Hum Dev 2006;82:649–53. https://doi.org/10.1016/j.earlhumdev.2005.12.010.Search in Google Scholar

11. Alshammari, DM, Dobremez, E, Froeliger, A, Coatleven, F, Harper, L. Mothers’ perception of prenatal counseling following diagnosis of congenital anomalies of the urinary tract. Arch Pediatr 2021;28:533–6. https://doi.org/10.1016/j.arcped.2021.08.003.Search in Google Scholar

12. Aite, L, Trucchi, A, Nahom, A, Zaccara, A, La Sala, E, Bagolan, P. Antenatal diagnosis of surgically correctable anomalies: effects of repeated consultations on parental anxiety. J Perinatol 2003;23:652–4. https://doi.org/10.1038/sj.jp.7210992.Search in Google Scholar

13. Skreden, M, Skari, H, Malt, UF, Haugen, G, Pripp, AH. Long-term parental psychological distress among parents of children with a malformation – a prospective longitudinal study. Am J Med Genet A 2010;152A:2193–202. https://doi.org/10.1002/ajmg.a.33605.Search in Google Scholar

14. Berman, L, Kabre, R, Kazak, A, Hicks, B, Luks, F. Exposure to prenatal consultation during pediatric surgery residency: implications for training. J Pediatr Surg 2016;51:131–6. https://doi.org/10.1016/j.jpedsurg.2015.10.030.Search in Google Scholar

15. Deeney, S, Somme, S. Prenatal consultation for foetal anomalies requiring surgery. Women Birth 2016;29:e1–7. https://doi.org/10.1016/j.wombi.2015.08.004.Search in Google Scholar

16. van Stralen, KJ, Borzych-Dużalka, D, Hataya, H, Kennedy, SE, Jager, K, Verrina, E, et al.. Survival and clinical outcomes of children starting renal replacement therapy in the neonatal period. Kidney Int 2014;86:168–74. https://doi.org/10.1038/ki.2013.561.Search in Google Scholar

17. Gagnon, A, Wilson, RD, Allen, VM, Audibert, F, Blight, C, Brock, JA, et al.. Evaluation of prenatally diagnosed structural congenital anomalies. J Obstet Gynaecol Can 2009;31:875–81. https://doi.org/10.1016/s1701-2163(16)34307-9.Search in Google Scholar

18. Berman, L, Jackson, J, Miller, K, Kowalski, R, Kolm, P, Luks, F. Expert surgical consensus for prenatal counseling using the Delphi method. J Pediatr Surg 2018;53:1592–9. https://doi.org/10.1016/j.jpedsurg.2017.11.056.Search in Google Scholar

Received: 2021-03-16

Accepted: 2021-12-18

Published Online: 2022-01-17

Published in Print: 2022-05-25

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Articles in the same Issue

https://doi.org/10.1515/jpm-2021-0130

Keywords for this article

antenatal consultation; fetal malformation; fetal medicine; pediatric surgery; prenatal counseling; prenatal diagnosis