Implications of antenatal ultrasound screening in the incidence of major genitourinary malformations.

Over the past 3 decades, infant mortality has decreased nearly 50%. Although neonatal intensive care deserves much of the credit, the recent increase in prenatal ultrasonography use, from 33% of pregnancies in 1980 to 78% in 1987, has improved early detection. The authors wished to evaluate the impact on major genitourinary malformations. Data obtained from the Malformations Surveillance Program at Brigham and Women's Hospital between 1974 and 1994, tracked 163,431 pregnancies and termination rates of fetuses with spina bifida, bladder exstrophy, prune belly syndrome, and posterior urethral valves. Hospital data showed 65% of fetuses with spina bifida, 46% with posterior urethral valves, 31% with prune belly syndrome, and 25% with exstrophy, were terminated electively. Clearly, surveillance programs and improved accuracy of antenatal ultrasound has allowed early diagnosis of major genitourinary malformations. Many factors influence decision making in these affected fetuses, including the financial and emotional impact of these major anomalies over a lifetime. Future societal decisions, and the reduction in these anomalies may influence our training programs, manpower needs, medical facility requirements, and the character of our practices. These findings may have significant implications in the field of pediatric urology.