Prof. Dr. Mahmoud Emad Salem,
Assistant Professor of Obstetrics & Gynecology – Cairo University.

Subject: Congenital anomalies … Causes, early diagnosis & prevention.

First of all we would like to welcome Prof. Dr. Mohmoud Salem assistant professor of obstetrics & gynecology in Cairo University as a dear guest at the Arabian medical network.

We’d like to ask you professor about the types of congenital anomalies that may affect the fetus?

Congenital anomalies may affect any system of the body; there may be one or more type of the anomalies, so when the physician discovers any abnormality he should look for other anomalies.
There are many types of the congenital anomalies, if we started with the head, congenital anomalies may affect the skull in the forms of unusual sizes or shapes of the skull. Also we may find “The Hydrocephalus “ in which there is a fluid collection in the head due to obstruction of the circulation concerned with CSF “ Cerebro Spinal Fluid ” drainage.

The face also may be affected in the form of cleft palate or cleft lip.
In the neck we may find a cyst of lymphatic fluid. Mental retardation & Mongolism are other types of congenital anomalies.
Congenital anomalies of the heart are very common starting with a defect in the wall of the heart up to transposition of the great vessels.

When we talk about digestive system, we may find atrophy of stomach or duodenum or even obstruction of the anus.

Urinary system may be affected in many forms like polycystic kidney, congenital obstruction of the ureter, or complete absence of the kidneys.

Genital organs of the fetus may also be affected. We may find the un-descended testis or undifferentiated sex due to certain hormones intake during pregnancy.

Penile opening may be present above or below the penis (epispedius or hypospedius respectively) instead of its normal site. There’s a close relation between urinary and genital system in the presence of congenital anomalies.

When we talk about abdominal wall, we have to talk about abdominal hernia, which may be minor or major. Minor hernia entails the baby caesarian section for delivery. Baby with major abdominal wall defect is not compatible with life due to the presence of abdominal organs out side the abdomen. Diaphragmatic hernia and the presence of congenital track between esophagus and trachea are another types of congenital anomalies.

As regards the limbs, we may find abnormally extra finger or toe or absence of one or more fingers of the hands or the feet.
Vertebral column may be affected with what’s called “Spina bifida “in which there is defect in the spines leading to prolepses of the nerves and atrophy of lower limbs and pelvic muscles.

What about the causes of congenital anomalies?

There are many causes of congenital anomalies; we will discuss the most important of them …
Congenital anomalies may be hereditary, which means a defect in a certain chromosome that causes a certain disease. For example the polycystic kidney; which is transmitted from the parents to the baby.

Also chromosome 21 that is responsible for Mongol baby. Here we have to mention that normal chromosome may undergo what’s called mutation due to abnormal influences leading to appearance of congenital anomalies.

Congenital anomalies may be also caused by maternal infection with certain organism during pregnancy or activation of certain organism that affected the mother before pregnancy, such as the CMV “ Cyto-megalo Virus “ which gives influenza like symptoms on infection then the virus remains dormant until woman becomes pregnant & it may cause abortion or fetal anomalies. Syphilis also is one of the causes.

Drug abuse during pregnancy is one of these causes; here we have to speak in details about drug abuse. It’s a must for every married woman at the age of pregnancy (15-45) unless she uses an effective mean of contraception to put in mind the possibility of pregnancy in the second half of menstrual cycle.

We have to mention here that the effect of drugs on the baby depends on the duration of exposure to the drug, the age of the fetus on exposure and the type of the drug itself.

By the way we don’t say that the usage of drugs during pregnancy is totally contraindicated, but it must be limited and under strict medical supervision and we have to consider the coast-benefit relation in using drugs. For example epilepsy patient cannot stop medication during pregnancy in spite of the risk of 5-10% of causing congenital anomalies.

Diabetes is the cause of 70% of the congenital anomalies. Diabetic woman should control diabetes during pregnancy to minimize the risk on her baby.

I’d like also to focus on an important point … some pregnant are using chemical product that may affect the baby without knowing, I mean the cosmetics and hair stains. Some of these products contains retinoic acid which is highly harmful for the fetus, so I advice the pregnant to consult her physician before using such products.

I also advice pregnant not to use what’s called medical herbs, many of them are harmful to the pregnant and the fetus.

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