IN THE CASE OF DETERMINATION OF DISTORTION IN THE SUPREMOGRAPHY
When we detect a malformation during the ultrasound check or the presence of indicators that are beyond normal, we take a series of steps before making any decision. We do this to avoid mistakes and unnecessary termination of pregnancy
So before any decision is made:

CONFIRMATION
It is important to confirm the existence and nature of dysplasia. Our center cooperates with distinguished centers in Greece and abroad that specialize in specific malformations of the central nervous system, the kidneys or the heart in order to be consulted in case of malformations

COORDINATES DIFFICULTIES
We consider it necessary to look ultrasonographically if more than one malformation coexists. This research may be difficult if there is an oligoamnio, or anamnio

CHROMOSOMATIC ANOMALIA
We also need to look for a chromosomal abnormality.
The karyotype is, in the torboplast on 11th to 13th weeks, in amniotic fluid or amniocentesis, in the second part of pregnancy from 17th to 18th week, or with embryonic blood taken by umbilical cord blood by ultrasonography in the third trimester of pregnancy. With the method of umbilical cord blood collection, the results are obtained in 48 hours.

OPINION PEDIATRIC AND PEDIATRIC SURGERY

In our center for each case we have the advice of a pediatrician and a pediatric surgeon who will better appreciate the possibilities of treatment or intervention at birth.

INFORMATION FOR PARENTS

Our main concern is to inform future parents. In our center, parents are informed based on the data they collect. The information we give them is trying to be as complete and clear as possible. If a post-natal intervention is envisaged, the child surgeon will see the couple as soon as the dysplasia is recognized.

DECISIONS AFTER CONFIRMATION OF FINDINGS

Various decisions can be made.

FIRST DECISION

INTERRUPTION OF PREGNANCY

Indications:

It is possible to propose or accept the interruption of pregnancy without ever imposing it, where it exists:

- fatal malformations of the fetus in the uterus, at birth or shortly after,

- malformations associated with chromosomal abnormality,

- polymorphisms,

- very serious malformations that could be addressed but with the cost of serious consequences

Benefits of stopping pregnancy

Stopping pregnancy allows:

- shorten a pregnancy that has become irrelevant and end a difficult psychological condition

- to avoid an unreasonable cesarean incision that creates a scar in the uterus and limits the number of subsequent pregnancies,

- be able to examine the embryo by a specific pathologist to ensure qualitative genetic counseling.

Here we point out two things:

First, we know the technical termination of pregnancy in advanced weeks so that we can avoid serious complications such as: cervical insufficiency, uterine rupture and adhesions in the uterus.

In the case of childbirth we do not intervene and we expect its development again to avoid complications.

SECOND DECISION

Continuation of pregnancy

Indications

1. INDIVIDUAL MALFORMATIONS AND CAPABLE SURGERY INTERVENTION
   In most cases, couples after detailed information from the experts we work with accept the continuation of pregnancy when it can be confirmed that dysplasia is unique, functional and that the child will not have serious consequences.This is the case in a number of cases such as atherosclerosis, mesenteric bladder, some cases of elevated meson in the intestine, some cases of gastric ulceration, umbilical hernia and some cases of diaphragmacillus which are capable of managing endometrially, monocytic polycystic kidney, renal bladder or hydronephrosis, certain congenital heart disease and pulmonary cysts, some serious external malformations, such as sacrocyclic teratoma, ovarian cyst. In other cases, a pregnancy monitoring is required to grow the fetus so that when the surgeon sends a child to be mature, as long as you get older, do not break through and have a good balance of surgeons. Such cases are some hydration, some cases of single ventricular dilatation with stable amber diameters.
   
   
2. EXTERNAL MALFORMATIONS
   In these cases the parental agreement is more difficult to achieve. Discussion is difficult when it comes to facial abnormalities, torn lip and palate even when post-natal function is good. This is all the more true in the case of limb abnormalities, because the results of the surgery, which are often satisfactorily functional, are less aesthetically pleasing.

It is often difficult for the obstetrician, surgeon or midwife to resist family pressure.

TECHNICAL CHILDBIRTH

Causing premature birth

This is not a good solution, because prematurity can frustrate the surgeon's efforts and complicate the post-operative course of the child. Premature labor can be triggered when there is an increase in amniotic fluid that is not tolerable by the mother when fetal dysplasia is complicated and when the fetus is disturbed.

CAESAREAN

It can occur when: there is a mechanical dystocia from a fetal tumor

Fetal discomfort, which can be very serious.

PUNCTURE

It can be done before the onset of labor to facilitate the progression of normal labor when the tumor bearing the embryo is fluid eg ascites, large sputum, large ovarian cyst

THIRD DECISION

Endometrial therapy

It may be pharmaceutical or surgical

Indications

The embryo can be treated endometriously:

1. with the administration of drugs to the mother, which penetrate the placenta: for example, antibiotics, digoxin,
2. by pouring into the umbilical cord of certain substances, for example: blood, platelets, antiarrhythmics, 
3. by draining peritoneal or pleural effusions of the fetus, 
4. by decompression of certain organs of the fetus: urinary bladder, renal pelvis, stomach in the case of diaphragmacillus.
   
   

DECISIONS WHICH SHOULD BE AVOIDED

1. Sometimes decisions are made which do not take into account the mother or the embryo as an entity. This is often the case when you have to diagnose wrongly
   - malformations not observed,
   - "ghost" malformation, i.e., malformations described while not present. This is sometimes due to the location of the fetus, due to the poor visibility of the fetus on the basis of the pregnant body, the reason for the fetal hyperactivity, etc.

The description of these malformations may be the cause of a psychological burden on parents, even if the diagnosis is subsequently corrected but can also lead to abusive abortion

2. Decisions resulting from:
   a) incomplete diagnosis due to the ignorance of a malformation or a polydysmorphic syndrome, b) reason of ignorance of a chromosomal variant that gives false hopes to parents, and puts surgeons in very sensitive situations
   
   
3. It may be due to a correct diagnosis but to irrational instructions 
   a) recommendations for stopping pregnancy while a post-natal operation could fully improve the condition of the newborn, b) a pregnancy interruption because the parents after diagnosis are very convinced of the problem of the embryo and do not accept to visit another center for malformations c) do not interrupt pregnancy endangering the mother when dysplasia is severe and interference with the child has no chance of success. For example, the bifurcated spine finding at 17 weeks, if follow up until 20-22 weeks, then the increase in fetal volume makes it harder to get out and end up with cesarean to end the pregnancy.

End

Whatever the progression of pregnancy, genetic counseling is fundamental to preparing for the future