title: Prenatal diagnosis of congenital malformations for the better and for the worse.
abstract: BACKGROUND
  Prenatal detection of congenital malformations gives an opportunity to positively influence prenatal and postnatal management, survival and morbidity, as well as to allow parental choice and psychological preparation.
  
  
  OBJECTIVE
  To examine the available evidence regarding the impact of detection and underdetection of fetal anomalies as well as that of fetal therapy on neonatal outcome, parental psychological wellness and neonatal care organization.
  
  
  METHODS
  Literature search of PubMed.
  
  
  CONCLUSIONS
  The impact of prenatal diagnosis on neonatal survival and morbidity is dependent upon the type and severity of the anomalies inasmuch as upon the evaluation criteria chosen. We discuss the various pitfalls in the design of trials explaining why only few studies, targeting selected anomalies, have shown improved outcomes associated with prenatal diagnosis of congenital malformations. Fetal therapy applies mainly to conditions that are lethal either in utero or at birth if untreated before birth. It has rarely been evaluated with the highest level of evidence; this may be explained by a poor acceptability of randomization between prenatal intervention and expectancy up until delivery.
authors.affiliation: a Department of Neonatology and Neonatal intensive care , AP-HP, Necker-Enfants Malades Hospital , Paris , France.|c Paris Descartes University, Sorbonne Paris-Cité , Paris , France.
authors.forename: Elsa
authors.initials: E
authors.lastname: Kermorvant-Duchemin
authors.affiliation: b Department of Obstetrics and Fetal Therapy , AP-HP, Necker-Enfants Malades Hospital , Paris , France and.|c Paris Descartes University, Sorbonne Paris-Cité , Paris , France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Ville
mesh_terms: D015331:Cohort Studies; D000013:Congenital Abnormalities / Q000175:diagnosis*; D005260:Female; D046128:Fetal Therapies / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010290:Parents / Q000523:psychology; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000523:psychology; D011296:Prenatal Diagnosis / Q000523:psychology*; D016032:Randomized Controlled Trials as Topic
keywords: Neonatal outcome; fetal therapy; parental stress and anxiety; prenatal diagnosis