The role of perinatal center on neonatal surgery for GIS

The fetus with an anomaly requires a team of specialists working together. A multiclisciplinary team includes perinatologists experienced in fetal diagnosis and intrauterine interventions, geneticists, obstetrical sonologists experienced in the diagnosis o! fetal anomalies and a pediatric surgeon and neonatologist who will manage the infant after birth. Fetal therapy is a team effort needing varying amounts of input from all team members.
The options for perinatal management of a fetus with gastrointestinal malformation cover a wide spectrum, depending on the type and the severity of the lesion and on the probability of associated malformations. Most correctable defects are best managed by maternal transport to an appropriate center and delivery near term. Some may benefit from change in timing or mode of delivery to minimize postnatal morbidity and mortality.
Esophageal duodenal or jejunoileal atresias, anorectal malformations, enteric ovarian mesenteric or choledochal cysts, uncomplicated meconium ileus and small intact omphalocele are best corrected after delivery.
Gastrochisis or ruptured omphalocele, intestinal ischemia-necrosis secondary to volvulus, meconium ileus etc. may benefit from induced preterm delivery for early correction ex utero.
Giant omphalocele, large sacrococcygeal teratoma or a cervical cystic hygroma may benefit from cesarean delivery.
Congenital gastrointestinal malformations comprise a relatively small proportion of all fetal anomalies (less than 10%) and prenatal ultrasound is commonly used to detect them. Duodenal and high intestinal obstructions are more readily diagnosed. The ability of prenatal ultrasound to detect esophageal atresia depends on the presence of a trachea esophageal fistula. The diagnosis of pure esophageal atresia is relatively easy. However miclgut abnormalities and hindgut abnormalities are difficult to diagnose. The commonly reported sonographic appearance of "echogenic" bowel is usually nonspecific. Those involved in prenatal scanning must be aware of limitations of ultrasonography. It is important to ensure that the level of diagnostic uncertainty is communicated to parents and those responsible for the postnatal care of the infant.