Missed Opportunities for Prenatal Ultrasound Diagnosis of Major Congenital Anomalies in Infants Presenting Postnataly With Major Congenital Anomalies at Kenyatta National Hospital

Abstract

Background: Congenital anomalies also known as birth defects are functional or structural abnormalities that occur during foetal development and are present at birth. They occur in approximately 3% of all pregnancies and contribute to 300,000 neonatal deaths annually. Early detection is possible through direct foetal visualisation using ultrasound or Magnetic Resonance Imaging, foetal tissue sampling, amniocentesis and genetic studies. Objective: To determine the proportion of missed opportunities for antenatal diagnosis of major congenital anomalies using ultrasound among neonatal admissions in Kenyatta National Hospital. Methodology: This was a prospective cross-sectional study in which 64 infants with major congenital anomalies were recruited consecutively at Kenyatta National hospital surgical and medical paediatric wards, the new-born unit, paediatric emergency unit, labour ward and post-natal ward. Data collection was done using a structured questionnaire. Descriptive analysis was done while logistic regression was performed to investigate factors influencing missed opportunities for in utero diagnosis of major congenital anomalies using ultrasound. Results: A total of 55 infants with congenital anomalies were enrolled in the study. The median age for infants was two weeks (IQR: 1.0 to 3.0 weeks). The majority 32/55 (58.2%) of the babies were males. The proportion of babies with major congenital anomalies whose mothers did not have an obstetric ultrasound done was 31% (95% CI 22%, 41%). The most affected region of the body was the abdomen accounting for 50% of all the major congenital malformation in the study population; gastroschisis 9/27 (34.6%), omphalocele 8/27 (26.9%) and intestinal atresia 9/27 (34.6%) were the most common anomalies encountered. Bivariate analysis showed that no factors influenced the non-detection of major congenital anomlaies. Conclusion and recommendations: The findings have shown that missed opportunities for diagnosis of congenital anomalies is high with around one out of three infants having the diagnosis missed on antenatal ultrasound. Despite a majority of the mothers having had an antenatal ultrasound, many major anomalies that should have been identified were missed which points to a need for proper training of ultrasound operators especially on the anomaly scan (18-20 weeks) to improve detection rates. Most of the mothers to infants with major anomalies were from rural areas with majority of ultrasounds being done in public facilities. This should be addressed on a larger 10 scale and to more detail on the quality and effectiveness of antenatal ultrasounds done in public facilities All expectant mothers should be referred for two appropriately timed antenatal ultrasounds and they should be educated on the importance of antenatal ultrasonography