1. Figure 1: Classification of CNS abnormality (%)
PRENATAL DIAGNOSIS OF CENTRAL NERVOUS SYSTEM
ABNORMALITY IN TERENGGANU: HOW DID WE FARE?
PRENATAL DIAGNOSIS OF CENTRAL NERVOUS SYSTEM ABNORMALITY IN TERENGGANU: HOW DID WE FARE?
PRENATAL DIAGNOSIS OF CENTRAL NERVOUS SYSTEM
ABNORMALITY IN TERENGGANU: HOW DID WE FARE?
PRENATAL DIAGNOSIS OF CENTRAL NERVOUS SYSTEM
ABNORMALITY IN TERENGGANU: HOW DID WE FARE?
PRENATAL DIAGNOSIS OF CENTRAL NERVOUS SYSTEM ABNORMALITY IN TERENGGANU: HOW DID WE FARE?
PRENATAL DIAGNOSIS OF CENTRAL NERVOUS SYSTEM ABNORMALITY IN TERENGGANU:
HOW DID WE FARE?
Idayu AM a, Maheran AR a, Zahar AZ b
a Maternal Fetal Medicine Unit, Obstetrics & Gynaecology Department, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Terengganu.
b Obstetrics & Gynaecology Department, Hospital Kemaman, Terengganu
INTRODUCTION
RESULTS
RESULTS
In the state of Terengganu, lethal congenital malformations were the cause of death for 28.7% neonatal mortality in 2014 (source: State of Terengganu Health Department)
Congenital central nervous system (CNS) malformations are relatively common and account for a substantial proportion of miscarriages, stillbirths and infant deaths 1. Early detection of congenital anomalies would allow proper counselling of the parents and appropriate antenatal and neonatal care, possibility of discussing termination of pregnancy, in-utero treatment or planned delivery at the tertiary centre.
A total of 2344 women were referred for various indications. There were 258 cases with fetal structural abnormality and 96 (37.8%) of them had some forms of CNS abnormalities.
Fifty nine cases had the primary malformation within the central nervous system. Holoprosencephaly and anencephaly made up of more than 50% of the cases (Figure 1).
Figure 3: Agreement between referral and final prenatal diagnosis
ABSTRACT
Introduction
Congenital malformations are one of the main causes of perinatal and neonatal mortality. Early detection and timely referral to the tertiary centre would allow proper counselling, in-utero treatment delivery plan.
Methods
This is a retrospective review in Maternal Fetal Medicine Unit, Obstetrics & Gynaecology Department, Hospital Sultanah Nur Zahirah, of prenatally detected fetal central nervous system abnormality. All cases seen between January 2011 and December 2015 were analysed for gestational age at referral and agreement between indication of referral and final prenatal and/ or postnatal diagnosis
Results
There were a total of 59 cases of fetal primary central nervous system abnormalities detected. The mean gestational age at diagnosis was 26.8 weeks (range 19-36) with 28.8% were referred before 24 weeks. In total, 57.6% of the referral findings were in agreement with the final diagnosis but most of spina bifida and holoprosencephaly were not detected in the referring centres.
Conclusion
The results highlighted the opportunity for improvement in our antenatal service. Routine 2nd trimester ultrasound screening should be considered with implementation of a standardised training for the ultrasonographers in the primary and secondary health care settings.
Key words: prenatal diagnosis, central nervous system abnormality, ultrasound screening
Figure 1: Classification of CNS abnormality (%)
DISCUSSION
Our finding on prevalence of prenatally detected fetal malformation is similar to a study in The Netherlands (11.0% vs 12.9%), a country which is not offering routine ultrasound screening for fetal anomalies, similar to Malaysia 2.
Data showed, only a quarter of the CNS anomalies were detected before 24 weeks, lower than countries offering routine screening programme 3,4.
Although our study was not designed to calculate the detection rate at the primary and secondary level health services but we were able to show that slightly more than half of the CNS abnormalities were correctly identified before being referred to the tertiary centre.
METHODS AND MATERIALS
To determine
Prevalance of prenatally diagnosed fetal CNS anomalies
Gestational age at diagnosis
Correct diagnosis at referral
Mean gestation at diagnosis was 26.8 weeks (range 19 – 36 weeks).
Only 28.8% of the CNS abnormalities were referred before gestation age of 24 weeks while large majority of them was seen later in the pregnancy ( Figure 2)
Design
Retrospective review
Duration
January 2011—December 2015
Site
Maternal-Fetal Unit, Obstetrics & Gynaecology Department, HSNZ
Inclusion
All prenatally detected major fetal CNS anomalies
Exlusion
Minor CNS anomalies
Data source
“Fetal Anomaly Scan” format
Data analysis
IBM SPSS Statistic version 22
CONCLUSIONS
Figure 2: CNS abnormality detected before or after 24 weeks of gestation (%)
It seems that “routine” rather than “indicated” ultrasound screening may be necessary to ensure earlier diagnosis of the fetal anomalies and timely referral to a tertiary centre as majority of the cases had no antecedent risk factor.
REFERENCES
Rosano A, Botto LD, Botting B, Mastroiacovo P. Infant mortality and congenital anomalies from 1950 to 1994: an international perspective. J Epidemiol Community Health 2000; 54: 660–666..
Adama van Scheltema PN, Nagel HTC, Brouwer OF, Vandenbussche PHA. Outcome of children with prenatally diagnosed central nervous system malformations. Ultrasound Obstet Gynecol 2003; 21:41–47
Grandjean H, Larroque D, Levi S. The performance of routine ultrasonographic screening of pregnancies in the Eurofetus Study. Am J Obstet Gynecol. 1999;181(2):446–54
Rosendahl H, Kivinen S. Antenatal detection of congenital malformations by routine ultrasonography. Obstet Gynecol 1989; 73: 947–951
RESULTS
Dermographic Highlights
Mean age
29 (range years).
Mean parity
1.5 (range 0 – 7)
No of fetus(es)
56 = singleton; 3 = twin
In our series, 89.8% (53/59) of the referrals were due to detectable structural abnormality. Analysis showed that 34 cases (57.6%) were identified correctly in the referring centres while the rest of were referred for non CNS abnormalities (Figure 3).