Orgul Gokcen, Soyer Tutku, Yurdakok Murat, Beksac Mehmet Sinan
a Department of Obstetrics and Gynecology, Division of Perinatalogy , Hacettepe University, Faculty of Medicine , Ankara , Turkey.
b Department of Pediatric Surgery , Hacettepe University, Faculty of Medicine , Ankara , Turkey.
J Matern Fetal Neonatal Med. 2019 Oct;32(19):3215-3220. doi: 10.1080/14767058.2018.1460350. Epub 2018 Apr 12.
Signs of congenital obstruction of the gastrointestinal tract (GIT) organs may present on prenatal ultrasonography. Prenatal detection is influenced by several factors, including obstruction site, lesion degree (partial or complete), the occurrence of associated malformations, and gestational week at screening. Here, we aimed to evaluate the success of prenatal diagnosis of GIT obstructions in a tertiary center in Turkey. The study included 34 prenatally and 22 postnatally diagnosed babies with different GIT malformations. GIT obstructions were divided into five groups according to the level of obstruction (A. esophagus, B. stomach and proximal duodenum, C. small intestine, D. large intestine, E. multiple obstructions). The prenatal detection rate among all cases was 60.7%. The associated structural malformation and aneuploidy rates were 21.4 and 5.4%, respectively. Twelve neonates died within the first day after birth due to various reasons. The remaining 43 babies underwent surgery at different times according to their clinical conditions. The mean time between birth and surgery was 4.5 days (range, 1-56 days). There were 12 postoperative deaths due to various complications, and one case died at 2 years of age. Overall, 31 of the 56 (55.4%) babies were alive during the follow-up period. The successful prenatal diagnosis rates were 57.2, 85.8, 75, 25, and 80% in groups A, B, C, D, and E, respectively. The median birth weight increased significantly in groups A through D ( = .04). However, there were no intergroup differences in the Apgar scores, associated abnormality rates, time to surgery, and number of babies operated. These findings demonstrate the importance of prenatal ultrasonography and success of prenatal detection especially for upper GIT abnormalities. Although there are some prenatal signs of GIT obstructions, such as double bubble, polyhydramnios, enlarged bowel, and failure to visualize the stomach, early prenatal diagnosis is difficult and can be delayed, resulting in the detection of GIT obstruction after birth. When suspecting GIT obstruction, clinicians should evaluate the fetal anatomy carefully and be aware of associated chromosomal abnormalities.
胃肠道（GIT）器官先天性梗阻的体征可能在产前超声检查中出现。产前检测受多种因素影响，包括梗阻部位、病变程度（部分或完全）、相关畸形的发生情况以及筛查时的孕周。在此，我们旨在评估土耳其一家三级中心对GIT梗阻进行产前诊断的成功率。该研究纳入了34例产前诊断和22例产后诊断的患有不同GIT畸形的婴儿。GIT梗阻根据梗阻水平分为五组（A.食管，B.胃和十二指肠近端，C.小肠，D.大肠，E.多处梗阻）。所有病例中的产前检出率为60.7%。相关结构畸形和非整倍体率分别为21.4%和5.4%。12例新生儿在出生后第一天因各种原因死亡。其余43例婴儿根据其临床情况在不同时间接受了手术。出生至手术的平均时间为4.5天（范围1 - 56天）。有12例因各种并发症术后死亡，1例在2岁时死亡。总体而言，56例婴儿中有31例（55.4%）在随访期间存活。A、B、C、D和E组的产前诊断成功率分别为57.2%、85.8%、75%、25%和80%。A组至D组的出生体重中位数显著增加（P = 0.04）。然而，在阿氏评分、相关异常率、手术时间和接受手术的婴儿数量方面，各组之间没有差异。这些发现表明了产前超声检查的重要性以及产前检测尤其是对上消化道GIT异常的成功率。尽管存在一些GIT梗阻的产前体征，如双泡征、羊水过多、肠管扩张以及胃显示不清，但早期产前诊断困难且可能延迟，导致在出生后才检测到GIT梗阻。当怀疑GIT梗阻时，临床医生应仔细评估胎儿解剖结构并注意相关染色体异常。
