Evaluation of routine ultrasound examination for the prenatal diagnosis of malformation.

In 1986, a retrospective survey was undertaken in the southern part of the province of Hainaut, Belgium, in order to measure the frequency of ultrasound examinations during pregnancy and to evaluate the effectiveness of the routine practice of echography screening for the detection of congenital malformations in an unselected population. The reference populations comprised 8316 pregnancies covered by the EUROCAT Registry of Hainaut. In 1986, 190 congenital malformations cases were registered. For each of the 190 cases, one control ending in the birth of a non-malformed infant was retrospectively selected. The analysis showed that an average of four ultrasound examinations were performed during pregnancy. When all malformations are considered, the sensitivity of the screening is 14% (27/190). Sensitivity of detection varied from 100% for gross malformations such as anencephaly to 0% for defects of a minor size such as facial clefts. In these 27 cases, obstetrical interventions following prenatal diagnosis were termination of pregnancy in 14 cases and induction of labor in 3 cases. Antenatal care was planned in 8 cases, 5 of which had early surgical repair. In the control group, a malformation was suspected in 3 of the 144 pregnancies (specificity of detection, 98%).

[Frequency and value of autopsy in perinatal death]. / Fréquence et intérêt de l'autopsie lors du décès périnatal.

In the province of Hainaut (Belgium), a study was undertaken in order to assess a pediatric pathology department, organized at the regional level. The study concerned 182 perinatal deaths, occurring among the 16,071 births in 9 maternity hospitals, in 1982 and 1983. The frequency of autopsies was 51%, both for stillbirths and for early neonatal deaths. It was 76% in the group of deaths related to congenital malformations and 48% in the group of deaths of unknown cause. The lack of an autopsy was explained in 20% of cases by the parents' refusal, in 8% of cases by the state of maceration of the fetus and by the obviousness of the diagnosis in 24%. In 46% of cases, no etiology was found and it appeared that the degree of physician interest was an important factor in the frequency of autopsies. Dissection alone revealed the cause of death in 13 of the 94 autopsies. In children presenting with congenital malformations, the performance of a complete pathologic study almost always led to genetic counseling for the parents. This counseling was almost never given when autopsy was not performed.

[Definition and classification of perinatal mortality]. / Problèmes de définition et de classification des décès périnatals.

Analysis of problems related to the classification of perinatal mortality was made possible through the evaluation of data collected from the medical records of nine maternity hospitals in South-Hainaut. Medical records of 135 fetal and early neonatal deaths were investigated. Perinatal mortality statistics were compiled on the basis of five different definitions of perinatal mortality. Depending on which definition was used, perinatal mortality varied between 10.2% and 15.1%. This study shows that reporting of perinatal mortality in hospital registries according to the legal requirement is incomplete. Standard data should be collected for each pregnancy product, on the basis of clearly defined, national and international accepted definitions. It is suggested that the 1975 recommendations of the World Health Organization (International Classification of Diseases, 9th edition), be used for definition and classification of perinatal mortality.