Letters

Congenital anterior abdominal wall defects

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7077.371a (Published 01 February 1997) Cite this as: BMJ 1997;314:371

A national congenital malformations register is needed

  1. Carole Luck, Consultant radiologista,
  2. Jacqui Scrutton, Ultrasonographera
  1. a Heatherwood Hospital, Ascot SL5 8AA
  2. b Information and Statistics Division, NHS in Scotland, Edinburgh EH5 3SQ
  3. c Darlington Memorial Hospital, Darlington DL3 6HX
  4. d Northern Congenital Abnormality Survey, Newcastle upon Tyne NE2 4AA
  5. e Department of Epidemiology and Public Health, University of Newcastle, Newcastle upon Tyne NE2 4HH
  6. f Departments of Fetal Medicine and Paediatric Surgery, Leeds General Infirmary, Leeds LS2 9NS

    Editor–Kelvin H Tan and colleagues' paper analysing the incidence of congenital abdominal wall defects highlights the need for adequate antenatal and postnatal data collection nationwide.1 The authors retrospectively analysed abdominal wall defects coded according to the ninth revision of the International Classification of Diseases, using data from the Office of Population Censuses and Surveys (now the Office for National Statistics). It is not possible to differentiate between gastroschisis and exomphalos with these codes, and reanalysis of the original forms was therefore necessary. Records of the incidence of such defects may be influenced by differing regional uptakes of abortion services and variations in methods and skill in antenatal diagnosis and postnatal management. There are too many variables in the study to draw firm conclusions.

    In our unit, with 17 000 deliveries over the past seven years, there were seven cases of exomphalos and four of gastroschisis. Six fetuses with exomphalos and one with gastroschisis were terminated after detailed counselling and karyotyping. These diagnoses are now made at between 11 and 14 weeks' gestation as part of the nuchal thickening programme. Earlier diagnosis tends to influence the decision to terminate and emphasises the need for meticulous record keeping.

    Data from the Office for National Statistics are unsuitable for epidemiological research because of underreporting, but such research is vital to support current trends in primary health care. In the same issue of the BMJ a news item reports on the Gulf war syndrome2; the possibility of associated fetal anomalies cannot be analysed because of inadequate data. A further news article reports a possible connection between fluoxetine and minor birth defects.3 Do we have to have another disaster of thalidomide proportions before a …

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