Objective: To investigate whether antenatal diagnosis of coarctation of the aorta results in reduced mortality and improved preoperative haemodynamic stability compared with postnatal diagnosis. Design: Retrospective review of all cases of coarctation of the aorta presenting to a tertiary fetal and neonatal cardiology service from January 1994 to December 1998. Methods: Prenatal, postnatal, and necropsy records were reviewed to determine survival in the two groups. Markers of preoperative illness severity were recorded, including presence of femoral pulse, collapse, left ventricular function, ductal patency on echocardiography, coagulation status, duration of intensive care unit and total hospital stay, heart rate, respiratory rate, plasma creatinine, plasma potassium, and right upper limb blood pressure. A univarate and multivariate analysis was conducted on all variables and a cumulative score was created and subjected to logistic regression analysis. Results: Both collapse and death were more common in the postnatally diagnosed group (p < 0.05). Femoral pulses were more likely to be palpable and there was echocardiographic evidence of duct patency in the antenatally diagnosed infants (p < 0.001 and p < 0.05, respectively). An increased respiratory rate was associated with postnatal presentation (p < 0.05). Infants with haemodynamic instability preoperatively were more likely to have been diagnosed postnatally (p < 0.01). Conclusions: Antenatal diagnosis of coarctation of the aorta is associated with improved survival and preoperative clinical condition. P renatal diagnosis of coarctation of the aorta has been possible for over 12 years.1 It can, however, be a difficult diagnosis to make, as evidenced by the number of false positive and false negative diagnoses, even in the best centres.2 Postnatally, coarctation often presents with cardiovascular collapse and acidosis as the arterial duct closes. Early diagnosis of coarctation should therefore improve preoperative haemodynamic stability with its associated risk of neurodisability and early neonatal death. Previous studies of coarctation 3 4 have not shown improved survival as a result of antenatal diagnosis but have suggested that the preoperative cardiovascular stability of affected infants is improved. These studies have examined coarctation as part of a group of mixed diagnoses and did not study necropsy cases. We therefore undertook a retrospective review of prenatally suspected coarctation to see whether the outcome was significantly better in this group than in infants diagnosed for the first time postnatally. METHODSWe included all cases of neonatal coarctation presenting to our cardiology department over a five year period from 1994. Prenatal, postnatal, and necropsy case records were reviewed. Outcome variables are shown in table 1. These were selected to assess the illness severity and were available in all cases. The acid-base status was not checked routinely on all neonates if they were considered to be in good or excellent condition, and these da...

One hundred consecutive cases of confirmed anterior abdominal wall defect, identified prenatally in the Oxford Prenatal Diagnosis Unit over 11 years, were studied. Fifty nine per cent of cases were suspected omphaloceles and 41% suspected gastroschisis. Fifty four per cent of omphaloceles were accompanied by other defects compared with 5% of those with gastroschisis. Overall, 29% of fetuses with omphalocele had an abnormal karyotype, and of those with another abnormality identified on scan (excluding four cases with no karyotype performed), 54% had an abnormal karyotype. Of the 27 cases with suspected isolated omphalocele, 14 were live born, all of whom have survived. If the 11 whose parents opted for termination of pregnancy are excluded, survival to birth was 88%. Six of the suspected isolated omphaloceles have Beckwith Wiedemann syndrome (BWS). Eight (57%) of the live born babies with omphaloceles had major problems up to the age of 2, but only one (7%) has long term major problems. This child has BWS and is deaf.Of the 39 cases of suspected isolated gastroschisis, 33 (85%) pregnancies resulted in live birth and one in neonatal death after surgery. Survival rate (excluding terminated pregnancies) was 97%. Gastroschisis was associated with a younger maternal age than omphalocele (p<0.001) and lower birthweight centile (p<0.01).Fifteen per cent of the gastroschisis babies had major problems up to the age of 2 years and 12% long term developmental problems. Ninety three per cent of the omphalocele babies and 88% of those who had gastroschisis have no long term problems. Over the study period there have been major changes in scanning equipment and expertise. Since 1991 no woman with a suspected isolated lesion has opted for termination of pregnancy. (Arch Dis Child Fetal Neonatal Ed 1998;78:F209-F213)

Sonographic assessment of the skeleton is a routine part of fetal anomaly scanning. We report a series of 35 cases seen during a 7‐year interval in which a skeletal dysplasia was suspected prenatally. In 7 (20 per cent) of the 35 cases, a specific diagnosis could not be made either pre‐ or postnatally. Follow‐up was incomplete in one case. In 32 (91 per cent) of the 35 cases, prenatal sonographic examination correctly predicted the prognosis, although in only 11 (31 per cent) of the 35 cases was the suggested prenatal diagnosis proven to be correct. The difficulty of making an accurate prenatal sonographic diagnosis in fetuses with suspected skeletal dysplasias throughout gestation, especially in the third trimester, and the importance of comprehensive multidisciplinary postnatal assessment in these cases are emphasized. © 1998 John Wiley & Sons, Ltd.

The incidence of structural heart disease in MC twins is increased, independent of TTTS. This justifies referral of these pregnancies for detailed fetal echocardiography as part of their assessment. If one twin is affected, the risk to the other twin is increased further.

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