Management of Prenatally Diagnosed Congenital Malformations — Actual Problems and the Importance of an Interdisciplinary Team Approach

Abstract

Modern methods of prenatal diagnosis — especially ultrasonography, amniocentesis, and fetoscopy — provide us with early information concerning the clinical state of the fetus. Reports in the lay press of sensational intrauterine surgery have made the public aware of these possibilities and have led to considerable, sometimes very controversial discussions. Intrauterine therapy has been both hailed as a great advance and condemned in various articles in the lay press as well as in scientific journals. This highlights the fact that there is a considerable amount of uncertainty about the actual value of these new methods and their practical consequences today. Early recognition of congenital malformations in utero may be the basis for many important decisions regarding the future of mother and child. The same prenatal diagnostic methods not only help the future child but also allow the physician to consider selective termination of pregnancy. Termination of pregnancy is certainly justified, for instance, in cases of antenatally diagnosed anencephaly. In the great majority of cases, however, the situation is less clear cut and may lead to serious ethical, moral, religious, and even legal disputes. The complex problems of prenatal diagnosis and their consequences can therefore not be discussed in isolation in an ivory tower of modern medicine. They have to be put within the social, socioeconomic, ethical, and religious conditions of the western society of today.