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The importance of pre-natal diagnosis of facial congenital malformations
Journal of Plastic, Reconstructive & Aesthetic Surgery (2013) 66, e236ee237
CORRESPONDENCE AND COMMUNICATION The importance of pre-natal diagnosis of facial congenital malformations Dear Sir, Obstetrics is one of the areas that most clearly benefits from technology for monitoring pregnancy and fetal health, while also revealing the gender of the unborn child. A valuable function of ultrasound technology during pregnancy is fetal malformations diagnosis. This leads into the extremely complex field of bio-ethics, involving healthcare practitioners, families and concepts.1 Some parents present psychic reactions for the stages of mourning. There is a time of denial during which, despite a diagnosis confirmed through trustworthy methods, parents think that there might have been a mistake, or simply refuse to believe it.2 All these aspects vary, depending on the family and the social and economic contexts surrounding the child, and also whether this is the first occurrence in the family, whether the child is the first-born or not, and the severity of the malformation. Acceptance is much easier when one of the parents or a close relative suffers from the same type of malformation. As it is not a surprise, the problem is not as frightening. A range of reactions occur when one of several siblings is affected, becoming either more protected or rejected. Various types of congenital malformations treated by Plastic Surgery, such as amniotic bands, deformities of the hands and feet, and facial clefts, may be diagnosed through pre-natal ultrasound examinations. Particularly useful is the pre-natal diagnosis for cleft lips and palates, not only because this type of malformation is relatively frequent, but also because treatment must begin immediately after birth. Before the advent of diagnostic methods that allowed fetal malformations to be detected, their abrupt appearance at the time of birth required immediate adaptation to this shocking and unexpected situation. The immediate needs of the new-born, the physicians to be consulted, what measures to take, the funds to find, the family structure to be organized and many other steps increase the feeling of helplessness among these families, hampering the progress of mourning through to acceptance. Pre-natal diagnoses of malformations ease the transition
through the various stages of mourning, and the presence of a multidisciplinary team is vital. We have conducted a study among our Cleft Lip and Palate Treatment Center patients’ regarding pre-natal diagnosis of the deformity. In spite of all the patients received an ultrasound study during pregnancy, just 40% had confirmed diagnoses. Among these families, 75% felt it was positive receiving pre-natal diagnoses, and 25% did not offer an opinion. Psychological support is always indicated, although some patients refuse it. A massive effort is required in mental and emotional terms, not only during the initial moments after the diagnosis, but throughout the remaining months of pregnancy and after the birth. Malformations of internal organs, even when more serious, are usually better accepted than those that adversely affect the external appearance of the body, harming the narcissistic structure of the parents. Among our patients, we noted that the presence of relatives with malformations helped ensure better acceptance of these babies, as they do not introduce any dramatic novelty to their families. Coordinated by the obstetrician and later by the pediatrician, caring for these families requires the participation of a wide variety of specialists, depending on where the deformity is located. This is one of the major advantages of pre-birth knowledge of fetal problems: there is time for the family to adapt, and pre-natal ultrasound examinations are the preferred method for tracking congenital defects all over the world. Detecting a congenital defect during the pre-natal stage introduces technical and emotional demands as well as significant costs that require an interdisciplinary team of practitioners specializing in this type of condition. Thus, the care offered to pregnant women with diagnoses of congenital defects should ideally take place at tertiary centers. Although pre-natal monitoring has expanded significantly in Brazil, the situation is still far from ideal. When facial malformations are diagnosed, the families either do not know or are not told about the advantages of pre-natal consultations with a plastic surgeon. It would be highly beneficial to stress these advantages.
Conflict of interest/funding None.
1748-6815/$ - see front matter ª 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.bjps.2013.04.018
Correspondence and communication
References 1. Clotet J, Goldim JR. Selec¸a˜o de Sexo e Bioe´tica. Porto Alegre: EDIPUCRS; 2004. 2. Ku ¨bler-Ross E. Sobre a morte e o morrer: o que os doentes terminais teˆm para ensinar a me´dicos, enfermeiras, religiosos e aos seus pro´prios. 8a ed. Sa ˜o Paulo: Martins Fontes; 2005.
Diogo Franco Talita Franco, Marcella Iani Plastic Surgery Division, Federal University of Rio de Janeiro (UFRJ), Brazil E-mail address: [email protected]
e237 Fernando Peixoto-Filho Obstetrics Department, Fernandes Figueira Institute (Rio de Janeiro), Brazil Jorge Rezende-Filho Obstetrics Department, Federal University of Rio de Janeiro (UFRJ), Brazil
15 November 2012
CORRESPONDENCE AND COMMUNICATION The importance of pre-natal diagnosis of facial congenital malformations Dear Sir, Obstetrics is one of the areas that most clearly benefits from technology for monitoring pregnancy and fetal health, while also revealing the gender of the unborn child. A valuable function of ultrasound technology during pregnancy is fetal malformations diagnosis. This leads into the extremely complex field of bio-ethics, involving healthcare practitioners, families and concepts.1 Some parents present psychic reactions for the stages of mourning. There is a time of denial during which, despite a diagnosis confirmed through trustworthy methods, parents think that there might have been a mistake, or simply refuse to believe it.2 All these aspects vary, depending on the family and the social and economic contexts surrounding the child, and also whether this is the first occurrence in the family, whether the child is the first-born or not, and the severity of the malformation. Acceptance is much easier when one of the parents or a close relative suffers from the same type of malformation. As it is not a surprise, the problem is not as frightening. A range of reactions occur when one of several siblings is affected, becoming either more protected or rejected. Various types of congenital malformations treated by Plastic Surgery, such as amniotic bands, deformities of the hands and feet, and facial clefts, may be diagnosed through pre-natal ultrasound examinations. Particularly useful is the pre-natal diagnosis for cleft lips and palates, not only because this type of malformation is relatively frequent, but also because treatment must begin immediately after birth. Before the advent of diagnostic methods that allowed fetal malformations to be detected, their abrupt appearance at the time of birth required immediate adaptation to this shocking and unexpected situation. The immediate needs of the new-born, the physicians to be consulted, what measures to take, the funds to find, the family structure to be organized and many other steps increase the feeling of helplessness among these families, hampering the progress of mourning through to acceptance. Pre-natal diagnoses of malformations ease the transition
through the various stages of mourning, and the presence of a multidisciplinary team is vital. We have conducted a study among our Cleft Lip and Palate Treatment Center patients’ regarding pre-natal diagnosis of the deformity. In spite of all the patients received an ultrasound study during pregnancy, just 40% had confirmed diagnoses. Among these families, 75% felt it was positive receiving pre-natal diagnoses, and 25% did not offer an opinion. Psychological support is always indicated, although some patients refuse it. A massive effort is required in mental and emotional terms, not only during the initial moments after the diagnosis, but throughout the remaining months of pregnancy and after the birth. Malformations of internal organs, even when more serious, are usually better accepted than those that adversely affect the external appearance of the body, harming the narcissistic structure of the parents. Among our patients, we noted that the presence of relatives with malformations helped ensure better acceptance of these babies, as they do not introduce any dramatic novelty to their families. Coordinated by the obstetrician and later by the pediatrician, caring for these families requires the participation of a wide variety of specialists, depending on where the deformity is located. This is one of the major advantages of pre-birth knowledge of fetal problems: there is time for the family to adapt, and pre-natal ultrasound examinations are the preferred method for tracking congenital defects all over the world. Detecting a congenital defect during the pre-natal stage introduces technical and emotional demands as well as significant costs that require an interdisciplinary team of practitioners specializing in this type of condition. Thus, the care offered to pregnant women with diagnoses of congenital defects should ideally take place at tertiary centers. Although pre-natal monitoring has expanded significantly in Brazil, the situation is still far from ideal. When facial malformations are diagnosed, the families either do not know or are not told about the advantages of pre-natal consultations with a plastic surgeon. It would be highly beneficial to stress these advantages.
Conflict of interest/funding None.
1748-6815/$ - see front matter ª 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.bjps.2013.04.018
Correspondence and communication
References 1. Clotet J, Goldim JR. Selec¸a˜o de Sexo e Bioe´tica. Porto Alegre: EDIPUCRS; 2004. 2. Ku ¨bler-Ross E. Sobre a morte e o morrer: o que os doentes terminais teˆm para ensinar a me´dicos, enfermeiras, religiosos e aos seus pro´prios. 8a ed. Sa ˜o Paulo: Martins Fontes; 2005.
Diogo Franco Talita Franco, Marcella Iani Plastic Surgery Division, Federal University of Rio de Janeiro (UFRJ), Brazil E-mail address: [email protected]
e237 Fernando Peixoto-Filho Obstetrics Department, Fernandes Figueira Institute (Rio de Janeiro), Brazil Jorge Rezende-Filho Obstetrics Department, Federal University of Rio de Janeiro (UFRJ), Brazil
15 November 2012