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腹裂——该告诉父母些什么?

Gastroschisis--what should be told to parents?

作者信息

Lepigeon Karine, Van Mieghem Tim, Vasseur Maurer Sabine, Giannoni Eric, Baud David

机构信息

Materno-fetal & Obstetrics Research Unit, Department of Obstetrics and Gynecology, University Hospital, 1011, Lausanne, Switzerland.

出版信息

Prenat Diagn. 2014 Apr;34(4):316-26. doi: 10.1002/pd.4305. Epub 2014 Jan 20.

Abstract

Gastroschisis is a common congenital abdominal wall defect. It is almost always diagnosed prenatally thanks to routine maternal serum screening and ultrasound screening programs. In the majority of cases, the condition is isolated (i.e. not associated with chromosomal or other anatomical anomalies). Prenatal diagnosis allows for planning the timing, mode and location of delivery. Controversies persist concerning the optimal antenatal monitoring strategy. Compelling evidence supports elective delivery at 37  weeks' gestation in a tertiary pediatric center. Cesarean section should be reserved for routine obstetrical indications. Prognosis of infants with gastroschisis is primarily determined by the degree of bowel injury, which is difficult to assess antenatally. Prenatal counseling usually addresses gastroschisis issues. However, parental concerns are mainly focused on long-term postnatal outcomes including gastrointestinal function and neurodevelopment. Although infants born with gastroschisis often endure a difficult neonatal course, they experience few long-term complications. This manuscript, which is structured around common parental questions and concerns, reviews the evidence pertaining to the antenatal, neonatal and long-term implications of a fetal gastroschisis diagnosis and is aimed at helping healthcare professionals counsel expecting parents.

摘要

腹裂是一种常见的先天性腹壁缺陷。由于常规的母体血清筛查和超声筛查项目,几乎总是能在产前诊断出该病。在大多数情况下,该病是孤立存在的(即不伴有染色体或其他解剖学异常)。产前诊断有助于规划分娩的时间、方式和地点。关于最佳的产前监测策略仍存在争议。有力证据支持在三级儿科中心于妊娠37周时择期分娩。剖宫产应仅用于常规产科指征。腹裂婴儿的预后主要取决于肠道损伤的程度,而这在产前很难评估。产前咨询通常会涉及腹裂问题。然而,父母主要关心的是产后长期结局,包括胃肠功能和神经发育。尽管患有腹裂的婴儿出生后往往要经历艰难的新生儿期,但他们很少出现长期并发症。本手稿围绕父母常见的问题和担忧展开,回顾了与胎儿腹裂诊断的产前、新生儿期及长期影响相关的证据,旨在帮助医疗保健专业人员为准父母提供咨询。

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