**9. Management of prenatally diagnosed congenital anomalies in Africa**

Management/Treatment of any clinical condition including congenital anomalies is hinged on accurate and reliable diagnosis. Accurate diagnosis requires well trained personnel and appropriate equipment. A comprehensive management will also require the services of different specialists [Obstetricians, Neonatologists, Pediatric surgeons**,** special care nurses trained in care of infants with congenital anomalies]. These are all hard to come by in Africa. People generally recognize gross physical anomalies, hidden anomalies are not appreciated before birth [e.g. Cardiac anomalies]. It is only when the child is born and start manifesting with clinical symptoms that the parents will appreciate the problem. When a child is born with gross anomalies such anomalies may be associated with some syndrome. When the gross anomaly is corrected the genetic syndrome problem will remain and will manifest itself. Parents will attribute the manifestations of the genetic syndrome to metaphysical causes. It is thus difficult to make them understand the real cause and the possible remedy. As facilities for genetic/chromosomal analysis are few and in most cases non-existent it becomes difficult to make

comprehensive evaluation and diagnosis. This makes final decision on management extremely difficult for the physician in Africa. Such is the environment perinatologists practice in Africa.

In this circumstance management of congenital anomalies cannot comprehensive and will be provided in a scattered manner. Often times when an anomaly is diagnosed treatment is limited to pregnancy termination where the laws allow. In one hospital 65% of pregnant women request for pregnancy termination when an anomaly is found in their fetus. In those with distressing polyhydramnius intermittent aspiration of the amniotic fluid is done to relieve the distress. Women who present with obstructed labor and a dead congenitally malformed fetus with hydrocephalus, delivery can be effected by craniotomy. For those that present with ruptured uterus, laparotomy is done and further management will depend on the extent of the rent and the clinical state of the fetus. Few countries [e.g. Egypt and South Africa] have centers that offer prenatal screening, diagnosis, treatment and follow up services, however such centers are not within the reach of the poor who carry most of the burden of congenital anomaly.
