Wax Joseph R, Watson William J, Miller Richard C, Ingardia Charles J, Pinette Michael G, Cartin Angelina, Grimes Charles K, Blackstone Jacquelyn
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine, USA.
J Ultrasound Med. 2008 Jul;27(7):1023-7. doi: 10.7863/jum.2008.27.7.1023.
The purpose of this study was to evaluate associated anomalies and outcomes of fetuses with prenatally diagnosed hemivertebrae.
Fetuses with prenatally diagnosed hemivertebrae, excluding those associated with spina bifida, were identified by searching the prospectively maintained ultrasound databases of 4 institutions from 1997 to August 2007. Associated birth defects were tabulated by organ system and hemivertebra location. Outcomes included karyotypes, gestational ages, and routes and outcomes of deliveries.
Nineteen fetuses had a diagnosis of hemivertebrae at a mean gestational age +/- SD of 20.5 +/- 5.4 weeks. Fourteen (73.7%) fetuses had additional anomalies, of which 5 (35.7%) were syndromic (4 with cloacal exstrophy and omphaloceles and 1 with Jarcho-Levin syndrome). Karyotypes were normal in all 11 available cases, each of which had additional anomalies. Fourteen (73.7%) neonates were live born at a mean gestational age of 34.9 +/- 4.3 weeks, of which 7 (50%) were born by cesarean delivery. Ten neonates (71.4%) were delivered before term, and 4 (28.6%) were growth restricted (<10th percentile). Two (14.3%) of these neonates died; both had cloacal exstrophy and large omphaloceles. The remaining pregnancies were terminated (4 [21.1%]) or had a fetal death (1 [5.3%]).
Most fetuses with prenatally diagnosed hemivertebrae have additional anomalies, often syndromic, which affect the prognosis. Affected pregnancies have high rates of cesarean delivery and growth restriction. Neonates with nonisolated hemivertebrae are more often delivered before term and have higher mortality rates.
本研究旨在评估产前诊断为半椎体胎儿的相关异常情况及结局。
通过检索4家机构1997年至2007年8月前瞻性维护的超声数据库，确定产前诊断为半椎体的胎儿，但不包括与脊柱裂相关的胎儿。按器官系统和半椎体位置将相关出生缺陷列表。结局包括核型、孕周、分娩途径及分娩结局。
19例胎儿在平均孕周±标准差为20.5±5.4周时被诊断为半椎体。14例（73.7%）胎儿有其他异常，其中5例（35.7%）为综合征性异常（4例合并泄殖腔外翻和脐膨出，1例合并贾科-列文综合征）。11例可获得核型结果的病例核型均正常，且均有其他异常。14例（73.7%）新生儿存活，平均孕周为34.9±4.3周，其中7例（50%）通过剖宫产分娩。10例新生儿（71.4%）早产，4例（28.6%）生长受限（<第10百分位数）。这些新生儿中有2例（14.3%）死亡；均有泄殖腔外翻和巨大脐膨出。其余妊娠被终止（4例[21.1%]）或发生胎儿死亡（1例[5.3%]）。
大多数产前诊断为半椎体的胎儿有其他异常，常为综合征性异常，影响预后。受影响的妊娠剖宫产率和生长受限率较高。非孤立性半椎体的新生儿更常早产且死亡率较高。
