Application of Management, Outcome, Risk, and Expectation Classification for Antenatally Suspected Structural Anomalies: A Multidisciplinary Experience

A BSTRACT Introduction: The study aimed to assess the outcome of antenatally suspected structural congenital anomalies (ASSCAs) using a Management, Outcome, Risk, and Expectation (MORE) framework. Methods: A total of 426 ASSCAs were studied from records of a multidisciplinary clinic from August 2016 to August 2024. After excluding cases requiring initial genetic evaluation, 261 pregnancies underwent MORE analysis. Results: Maternal age ranged from 25 to 45 years (mean: 35 ± 3). Structural anomalies were first suspected between 12 and 33 weeks; 52.8% were identified before 20 weeks. The M-1, M-2, M-3, M-4, and M-5 groups accounted for 55/261 (21.1%), 159/261 (60.9%), 28/261 (10.7%), 2/261 (0.8%), and 17/261 (6.5%), respectively. Outcomes were O-1, O-2, O-3, O-4, and O-5 in 63/261 (24.1%), 92/261 (35.2%), 83/261 (31.8%), 4/261 (1.5%), and 19/261 (7.3%), respectively. Referral for karyotyping was needed in 83/261 (31.8%) pregnancies (R-2), while R-1 and R-3 accounted for 160/261 (61.3%) and 18/261 (6.9%), respectively. R-2 cases incorporated the presence of more than two soft markers of aneuploidy, multiple anomalies, abdominal wall defects, and facial anomalies, etc., Parental expectations were categorized as E-1, E-2, and E-3 in 7/261 (2.7%), 220/261 (84.3%), and 34/261 (13.0%), respectively. Neonatal surgery was required in 68/261 (24.5%), while eight neonatal deaths occurred due to severe anomalies. Conclusion: MORE thereby optimizing prognostication, supporting evidence-based parental decision-making, and strengthening neonatal care delivery. Despite these benefits, its implementation was not uniform across healthcare settings, as attrition, limited availability of advanced diagnostic infrastructure, and sociocultural as well as economic constraints substantially influenced its feasibility and sustainability.