Johnson N, Bishop K, Trotman H, Reid M
Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University of the West Indies, Mona, Kingston, Jamaica.
J Matern Fetal Neonatal Med. 2012 Jun;25(6):687-91. doi: 10.3109/14767058.2011.594921. Epub 2011 Jul 20.
The objective of this study was to compare outcomes of patients with prenatally versus postnatally diagnosed congenital abnormalities seen during the first 18 months of a recently established MFM unit.
Hospital charts of all congenital abnormalities diagnosed between July 2008 and December 2009 were reviewed. Data collected included: maternal demographics, perinatal outcome, neonatal mortality and morbidity as defined in the Radius trial.
Fifty-five pregnancies with 57 anomalous fetuses were identified: 13 (23%) postnatally and 44 (77%) prenatally. Most frequent postnatally diagnosed anomalies were gastrointestinal (33%), central nervous system (CNS) (16%) and cardiac (16%); whereas prenatally diagnosed were CNS (29%) and genitourinary (23%). Mothers postnatally diagnosed had a 12 kg (17%) greater mean weight; 12 (92%) had anomaly scans reported as normal; birth weight and moderate neonatal morbidity were statistically greater (2.8 vs. 2.13 kg, p < 0.02) and (9/12 vs. 11/29, p < 0.03), respectively. Neonatal morbidity was 6.2 times more likely in the postnatally diagnosed group adjusting for birth weight, gestational age and route of delivery [OR (95% CI) 6.2, (1.2-32.4), p = 0.03].
Most abnormalities were diagnosed prenatally; however, the majority of postnatally diagnosed had false negative anomaly scans and experienced significantly more moderate neonatal morbidity.
本研究的目的是比较在一个新成立的母胎医学科最初18个月内产前与产后诊断先天性异常的患者的结局。
回顾了2008年7月至2009年12月期间所有诊断为先天性异常的医院病历。收集的数据包括：产妇人口统计学资料、围产期结局、如在Radius试验中所定义的新生儿死亡率和发病率。
共识别出55例妊娠中的57例异常胎儿：产后诊断出13例（23%），产前诊断出44例（77%）。产后最常诊断出的异常是胃肠道（33%）、中枢神经系统（CNS）（16%）和心脏（16%）；而产前诊断出的是CNS（29%）和泌尿生殖系统（23%）。产后诊断出异常的母亲平均体重高12千克（17%）；12例（92%）的异常扫描报告为正常；出生体重和中度新生儿发病率在统计学上分别更高（2.8千克对2.13千克，p<0.02）和（9/12对11/29，p<0.03）。在根据出生体重、孕周和分娩方式进行调整后，产后诊断组的新生儿发病率高6.2倍[比值比（95%可信区间）6.2，（1.2 - 32.4），p = 0.03]。
大多数异常是产前诊断出的；然而，大多数产后诊断出的病例存在异常扫描假阴性情况，且中度新生儿发病率明显更高。
