title: Delivery in a tertiary Center with co-located surgical facilities makes the difference among neonates with prenatally diagnosed major abnormalities.
abstract: OBJECTIVE
  Impact of prenatal diagnosis (PD) of major abnormalities on neonatal outcome is matter of debate. Unfortunately cases with and without PD may sometimes not be comparable. This is generally related to a lower maturity (GA) and weight (BW) secondary to a high rate of preterm cesarean sections (CSs) for clinical convenience. Present study tried to find out if in utero transfer to a Center with co-located surgical facilities reduces these potential risk factors.
  
  
  METHODS
  152 cases with prenatally detectable conditions were studied and divided according to PD; the following data were compared: GA, BW, obstetrical complications, associated malformations, mode and site of delivery, outcome. Cases with PD delivered in our Center (Inborn, IB) or transferred after birth (Outborn, OB) were compared.
  
  
  RESULTS
  61 cases had a PD (IB/OB ratio 34/27); GA and BW were lower respect to no-PD cases and a higher CS rate was found among OB cases, not justified by complicated pregnancies. No differences in outcome were observed.
  
  
  CONCLUSIONS
  Elective preterm CS is still largely practiced for fetuses with PD of a major congenital anomaly in Centers without co-located surgical facilities either in the presumption of safer delivery or to facilitate postnatal transfer. This leads to a lower GA and BW and may spoil potential impact of PD on outcome. This may be avoided promoting prenatal transfer to a Center with co-located surgical facilities.
authors.affiliation: Pediatric Surgery and Urology, San Camillo Hospital, Rome Italy. a.calisti@tiscali.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Calisti
authors.forename: Lucia
authors.initials: L
authors.lastname: Oriolo
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Giannino
authors.forename: Lorna
authors.initials: L
authors.lastname: Spagnol
authors.forename: Philippe
authors.initials: P
authors.lastname: Molle
authors.forename: Elsa Laura
authors.initials: EL
authors.lastname: Buffone
authors.forename: Claudio
authors.initials: C
authors.lastname: Donadio
mesh_terms: D000015:Abnormalities, Multiple / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D000328:Adult; D000013:Congenital Abnormalities / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D036861:Delivery, Obstetric / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D005865:Gestational Age; D006268:Health Facilities; D006771:Hospitals, Maternity / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D011296:Prenatal Diagnosis; D011787:Quality of Health Care; D013503:Surgery Department, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D062606:Tertiary Care Centers / Q000458:organization & administration* / Q000706:statistics & numerical data