Biggio Joseph R, Wenstrom Katharine D, Owen John
University of Alabama at Birmingham, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine and Reproductive Genetics, Birmingham, Alabama 35249-7333, USA.
Prenat Diagn. 2004 Apr;24(4):287-9. doi: 10.1002/pd.853.
To determine the natural history of the prenatal development of ventriculomegaly and talipes in fetuses with open spina bifida.
All fetuses with isolated open spina bifida and managed at our center between January 1996 and March 2000 were retrospectively evaluated. Ultrasonographic images and reports were reviewed from examinations performed every 3 to 4 weeks from the time of diagnosis to delivery for lesion level and type, ventriculomegaly (defined as an atrial width of > or =10 mm), and lower extremity appearance.
Of the 53 pregnancies identified, 20 (38%) were electively terminated. In the 33 ongoing gestations, the lesions ranged from lower thoracic to sacral; 79% were characterized as meningomyeloceles and 21% as myeloschises. Fifty-five percent (n = 18) had ventriculomegaly at diagnosis (early onset, mean gestational age at diagnosis 22 +/- 5 weeks), 33% (n = 11) subsequently developed ventriculomegaly (late onset, mean 29 +/- 6 weeks), and 12% (n = 4) had normal ventricle size at the last sonogram before birth (mean 38 +/- 1 weeks). The ventricular size prior to delivery was significantly smaller with late-onset ventriculomegaly than with early-onset: 15 +/- 4 mm versus 28 +/- 10 mm, (p = 0.001). Only 6% (n = 2) had talipes at the initial sonogram, and 18% (n = 6) were subsequently determined to have talipes (mean 30 +/- 6 weeks).
Most fetuses with open spina bifida develop ventriculomegaly, and the majority do so by 21 weeks' gestation. Fetuses that develop ventriculomegaly later in gestation have less severe ventricular dilation at birth. In contrast, a minority of fetuses have congenital talipes, and because most cases develop after 20 weeks, they are not predicted by early midtrimester sonographic evaluation.
确定脊柱裂胎儿脑室扩大和畸形足的产前发育自然史。
对1996年1月至2000年3月在本中心接受治疗的所有孤立性开放性脊柱裂胎儿进行回顾性评估。从诊断到分娩，每3至4周进行一次超声检查，复查超声图像和报告，以了解病变水平和类型、脑室扩大（定义为心房宽度≥10毫米）以及下肢外观。
在确定的53例妊娠中，20例（38%）选择性终止妊娠。在33例持续妊娠中，病变范围从下胸部到骶部；79%为脊髓脊膜膨出，21%为脊髓裂。55%（n = 18）在诊断时出现脑室扩大（早发型，诊断时平均孕周22±5周），33%（n = 11）随后出现脑室扩大（晚发型，平均29±6周），12%（n = 4）在出生前最后一次超声检查时脑室大小正常（平均38±1周）。分娩前晚发型脑室扩大的脑室大小明显小于早发型：15±4毫米对28±10毫米，（p = 0.001）。初始超声检查时只有6%（n = 2）有畸形足，随后18%（n = 6）被确定有畸形足（平均30±6周）。
大多数开放性脊柱裂胎儿会出现脑室扩大，且大多数在妊娠21周前出现。妊娠后期出现脑室扩大的胎儿出生时脑室扩张程度较轻。相比之下，少数胎儿有先天性畸形足，且由于大多数病例在20周后出现，孕中期早期超声评估无法预测。
