Anteby Eyal Y, Yagel Simcha
Department of Obstetrics and Gynecology, Hadassah University Hospital, P.O. Box 24035, Mt. Scopus, Jerusalem, Israel.
Eur J Obstet Gynecol Reprod Biol. 2003 Jan 10;106(1):5-9. doi: 10.1016/s0301-2115(02)00033-7.
Our ability to diagnose fetuses with congenital anomalies has dramatically increased over the past two decades and with improved surgical treatment for some defects, more women may choose to continue their pregnancies. Antenatal management is thus of increasing relevance. The literature on route of delivery suggests the following conclusions. Babies with neural tube defects presenting by the breech benefit from caesarean section but there is no clear evidence that cesarean improves outcome in those with a vertex presentation. When the size of the sac exceeds 6 cm, cesarean section may be justified to decrease the risk of disruption. Vaginal delivery is desirable in all other cases to reduce maternal morbidity. Cystic hygroma: cesarean section offers optimal conditions for management of large anterior lymphangiomas that can obstruct the airway. Sacrococcygeal teratoma: the current approach is based on the size of the tumor. In a fetus with a tumor of less than 5 cm, vaginal delivery may be attempted. Ventral wall defects: there is no conclusive evidence that cesarean section is beneficial for fetuses with omphalocele. Gastroschisis: because of the heterogeneity of the studies, it is difficult to assess the net impact of mode of delivery. There is no evidence of significant differences in outcome among fetuses delivered by the vaginal versus the abdominal route. Trauma to the abdominal viscera can occur during either route, and careful delivery is thus mandated.
在过去二十年中，我们诊断先天性异常胎儿的能力显著提高，并且随着一些缺陷的外科治疗方法得到改进，更多的女性可能会选择继续妊娠。因此，产前管理的相关性日益增加。关于分娩方式的文献表明了以下结论。臀位分娩的神经管缺陷婴儿可从剖宫产中获益，但没有明确证据表明剖宫产能改善头位分娩婴儿的结局。当囊肿大小超过6厘米时，剖宫产可能是合理的，以降低破裂风险。在所有其他情况下，阴道分娩是可取的，以降低产妇发病率。颈部水囊瘤：剖宫产为处理可能阻塞气道的大型前淋巴管瘤提供了最佳条件。骶尾部畸胎瘤：目前的方法是基于肿瘤的大小。对于肿瘤小于5厘米的胎儿，可尝试阴道分娩。腹壁缺损：没有确凿证据表明剖宫产对脐膨出胎儿有益。腹裂：由于研究的异质性，很难评估分娩方式的净影响。没有证据表明经阴道分娩与经腹分娩的胎儿结局存在显著差异。两种分娩途径都可能发生腹部脏器损伤，因此必须谨慎分娩。
