van Gelder-Hasker M R, van Wezel-Meijler G, de Groot L, van Geijn H P, de Vries J I P
Department of Obstetrics and Gynecology, VU University Medical Centre, Amsterdam, The Netherlands.
Ultrasound Obstet Gynecol. 2003 Aug;22(2):110-20. doi: 10.1002/uog.179.
To determine whether periventricular leukomalacia (PVL) and peri- and intraventricular hemorrhages can be detected in fetuses at risk for preterm birth and to establish the clinical significance of this finding.
Prenatal cerebral sonography was performed in 26 fetuses at risk for uteroplacental insufficiency on the day of inclusion into the study and weekly until delivery. Neonatal cerebral ultrasound examination was performed within 24 h of birth and biweekly until discharge. The infants underwent standardized neurological examinations.
During 30 observations, 21/26 fetuses presented in a cephalic position. Successful visualization in the coronal and sagittal planes was significantly correlated with that of a control population (r = 0.615; 95% CI, 0.390-0.771). In 20/21 fetuses at least one observation was adequate for analysis. Eleven cerebral abnormalities were found in nine fetuses, periventricular echodensities in four, intraventricular hemorrhage in two, and localized thalamic densities in five. In six of these infants ultrasound abnormalities persisted after birth. Neurological follow-up at 24 months demonstrated abnormalities in three infants, two infants were normal and one was lost to follow-up. The three infants with normal ultrasound results after birth had a normal follow-up. Five infants with normal antenatal ultrasound results showed ultrasound abnormalities during the neonatal period; four of them developed PVL Grade 1 and one developed PVL Grade 2. The follow-up of two of these infants was normal, two died and one developed spastic tetraplegia. Abnormal antenatal brain sonography was significantly correlated with gestational age at birth (r = 0.487; P = 0.029).
Peri- and intraventricular echodensities can be detected reliably before birth in fetuses at high risk for uteroplacental insufficiency. When abnormalities persist, there is a high risk for an adverse outcome.
确定在有早产风险的胎儿中能否检测到脑室周围白质软化（PVL）以及脑室周围和脑室内出血，并确定这一发现的临床意义。
对26例有子宫胎盘功能不全风险的胎儿在纳入研究当天进行产前脑部超声检查，之后每周检查一次直至分娩。新生儿在出生后24小时内进行脑部超声检查，之后每两周检查一次直至出院。婴儿接受标准化的神经学检查。
在30次观察中，21/26例胎儿为头位。冠状面和矢状面的成功可视化与对照组显著相关（r = 0.615；95%CI，0.390 - 0.771）。在21例胎儿中的20例，至少有一次观察结果可用于分析。在9例胎儿中发现了11处脑部异常，4例有脑室周围回声增强，2例有脑室内出血，5例有局限性丘脑密度改变。其中6例婴儿出生后超声异常持续存在。24个月时的神经学随访显示3例婴儿有异常，2例婴儿正常，1例失访。出生后超声结果正常的3例婴儿随访正常。5例产前超声结果正常的婴儿在新生儿期出现超声异常；其中4例发展为1级PVL，1例发展为2级PVL。这些婴儿中的2例随访正常，2例死亡，1例发展为痉挛性四肢瘫。产前脑部超声异常与出生时的孕周显著相关（r = 0.487；P = 0.029）。
在有子宫胎盘功能不全高风险的胎儿中，产前可可靠检测到脑室周围和脑室内回声增强。当异常持续存在时，不良结局风险很高。
