Results:
The number of obstetric patients seen at RH in the Ultrasound and Fetal
Medicine Units were 147563 patients. Of which, 1502 cases found to have
major congenital anomalies, among them 947 (63.05 %) fetuses with
isolated major anomalies and 555 cases (36.95%) with complex or
multiple congenital anomalies, during the period of 10 year. Figure 1
shows the progressive rise of number of major congenital anomalies over
the years in Oman. The average antenatal prevalence of congenital
anomalies for 10 years was 10.1 per 1000 pregnancies.
The mean (SD) of age of study population was 30.22 (SD 6.00) and ranged
from (17-50). Most common identified medical history were as follow:
diabetes, chronic hypertension, cardiac disease, connective tissue
disease, hypothyroidism, epilepsy, iron deficiency anemia, asthma and
subfertility.
Table 1 shows the distribution of cases according to regions,
frequencies and most frequent organ system identified from each area.
Most (42.9%) of referrals were from Muscat and 19.4% from Al Batinah
(North) and (17.6%) cases from South Al Batinah, more details
illustrated in figure 2. Among the 11 governorates, cases were mostly
referred from Muscat and ALBatinah. From ALWusta region least number of
cases were referred with the smallest mean maternal age. AlWusta became
a governorate in October 2011, its capital is Hima. It occupies a large
area in the middle of Oman and the population density is one of the
least comparing to other governorates (5). Many referrals were at 27
weeks (mean 27.47, SD5.5) which was almost consistent across all the
governorates.
Coexisting maternal factors were observed in 481 (32%) of patients
including diabetes in pregnancy (10.15%), advanced maternal age
(6.59%) and recurrent early pregnancy loss (7.12%). The consanguinity
rate of first cousins was 22%. Two hundred and sixty-two cases (18%)
had a previous family history of similar anomalies.
Of all the major congenital anomalies, the nervous system was the most
common (29%) abnormalities observed and cardiothoracic system (24.9%)
was the second most common. 92 cases presented with Hydrops (6.17%),
out of which 15.2% cases with Immune Hydrops.
Perinatal outcomes showed that 9.6 % had early neonatal death, 19% had
still births and 4 % had neonatal death. The perinatal mortality rate
was 32.6% among fetuses with major congenital anomalies.