Patterns and Dimensional Clustering of Major Fetal Anomalies in i Tertiary Maternal–Fetal Medicine Setting

Background: Congenital anomalies remain a leading cause of perinatal morbidity and mortality, particularly in low-resource tertiary referral settings where case severity is often concentrated.Objective: To analyse patterns, clustering, and outcomes of fetal anomalies diagnosed in a tertiary obstetric unit in the setting of Maternal–Fetal Medicine (MFM).Methods: A prospective cohort of 147 foetuses (398 anomalies; mean 2.7 per fetus) was studied at a tertiary MFM center. Anomalies were categorized by system. Outcomes included delivery mode, survival, APGAR scores, neonatal admission, and maternal complications. Dimensional reduction with principal component analysis (PCA) and hierarchical clustering was applied to map anomaly co-occurrence.Results: CNS/NTD (n = 83), skeletal (n = 62), and cardiac (n = 52) anomalies were most prevalent. PCA identified three clusters: (1) craniofacial/neuromuscular (CNS, orofacial, skeletal), (2) urogenital/digestive (renal, GUT, digestive), and (3) thoraco-abdominal (cardiac, respiratory, abdominal wall), explaining ~70% of variance. The dendrogram confirmed these groupings. Male fetuses predominated (57%), and stillbirths accounted for 44.2% (FSB 30.6%, MSB 13.6%). Neonates with multiple anomalies had the highest NICU admission (100%) and mortality (75%). Chi-square analysis confirmed outcome distributions were highly significant (χ² = 44.5, p < 0.001).Conclusion: Congenital anomalies cluster into biologically coherent groups, reflecting known syndromic associations (Trisomy 13/18, VACTERL, Noonan/CHARGE). These findings highlight the diagnostic utility of PCA and clustering in prenatal counselling and emphasize the urgent need for prevention, genetic evaluation, and neonatal preparedness in resource-limited settings. This document gives formatting instructions for authors preparing papers for publication in the Recent Science Journals. The authors must follow the instructions given in the document for the papers to be published. You can use this document as both an instruction set and as a template into which you can type your own text.