Lipa Michal, Kosinski Przemyslaw, Wojcieszak Kamila, Wesolowska-Tomczyk Aleksandra, Szyjka Adrianna, Rozek Martyna, Wielgos Miroslaw
1st Chair and Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland.
Ginekol Pol. 2019;90(3):148-153. doi: 10.5603/GP.2019.0026.
To estimate the prevalence, associated anomalies, and postnatal outcomes in infants prenatally diagnosed with ventriculomegaly.
All cases of ventriculomegaly that were examined and treated by the 1st Department of Obstet- rics and Gynecology, at the Medical University of Warsaw, from August 2007 until November 2017 were included in this study. Ultrasound data, and information on perinatal outcomes and long-term postnatal follow up were retrospectively collected by a standardised telephone survey. Ventriculomegaly was diagnosed when the atrial width of the lateral ventri- cles was ≥ 10 mm. The cases analyzed were divided into two subgroups: isolated ventriculomegaly (IVM) and non-isolated ventriculomegaly (NIVM). Neurodevelopmental complications were differentiated as either moderate or severe and were compared within each group and between groups.
There were 118 cases of prenatally diagnosed ventriculomegaly. Complete follow up records were collected for 54 cases (45.8%). IVM was diagnosed in 29/54 (53.7%) cases, while NIVM was diagnosed in the remaining 25 (46.3%). The mean ventricular width for IVM was 16.93 mm (range 10.0 mm-73.0 mm) and 14.08 mm (range 9.0 mm-27.1 mm) for NIVM (p = 0.28). The mean gestational age at delivery for the IVM cases was 36 + 4 weeks and in the NIVM group 33 + 4 weeks (p = 0.022). Mild VM (10-12 mm) was diagnosed in 22/54 cases (40.7%), moderate VM (13-15 mm) in 12/54 (22.3%) and severe (≥ 15 mm) in 20/54 (37%). Among the infants with IVM the rate of severe medical complications was 29.6% (8/28) and for NIVM 667% (8/12) (p = 0.041). Less severe medical conditions affected 6/28 of the infants with IVM (21.4%) vs 9/12 NIVM cases (75%) (p = 0.012).
In terms of prenatal diagnosis, treatment of ventriculomegaly remains challenging due to a lack of specific prognostic factors and the significant risk of neurodevelopmental disorders. Nevertheless, isolated ventriculomegaly has significantly better long-term outcomes compared with non-isolated ventriculomegaly. In our material, the rate of severe neurodevelopmental disorders in the non-isolated ventriculomegaly cases was associated with a 52% rate of adverse perinatal outcomes. On the other hand, less severe medical conditions occurred in 21.4% of the infants with IVM and in 75% of the NIVM cases. Furthermore, obstetrical data suggest that the risks of premature delivery and caesarean section are significantly higher in cases of non-isolated ventriculomegaly.
评估产前诊断为脑室扩大的婴儿的患病率、相关异常情况及产后结局。
本研究纳入了2007年8月至2017年11月期间在华沙医科大学第一妇产科接受检查和治疗的所有脑室扩大病例。通过标准化电话调查回顾性收集超声数据、围产期结局及产后长期随访信息。当侧脑室房部宽度≥10mm时诊断为脑室扩大。分析的病例分为两个亚组：孤立性脑室扩大（IVM）和非孤立性脑室扩大（NIVM）。神经发育并发症分为中度或重度，并在每组内及组间进行比较。
共有118例产前诊断为脑室扩大的病例。收集到54例（45.8%）的完整随访记录。54例中29例（53.7%）诊断为IVM，其余25例（46.3%）诊断为NIVM。IVM的平均脑室宽度为16.93mm（范围10.0mm - 73.0mm），NIVM为14.08mm（范围9.0mm - 27.1mm）（p = 0.28）。IVM病例的平均分娩孕周为36 + 4周，NIVM组为33 + 4周（p = 0.022）。54例中22例（40.7%）诊断为轻度脑室扩大（10 - 12mm），12例（22.3%）为中度脑室扩大（13 - 15mm），20例（37%）为重度（≥15mm）。IVM婴儿中严重医疗并发症发生率为29.6%（8/28），NIVM为66.7%（8/12）（p = 0.041）。IVM婴儿中较轻医疗状况影响6/28例（21.4%），NIVM为9/12例（75%）（p = 0.012）。
在产前诊断方面，由于缺乏特定的预后因素以及神经发育障碍的显著风险，脑室扩大的治疗仍然具有挑战性。然而，与非孤立性脑室扩大相比，孤立性脑室扩大的长期结局明显更好。在我们的研究资料中，非孤立性脑室扩大病例中严重神经发育障碍的发生率与52%的不良围产期结局发生率相关。另一方面，IVM婴儿中21.4%出现较轻医疗状况，NIVM病例中这一比例为75%。此外，产科数据表明，非孤立性脑室扩大病例中早产和剖宫产的风险显著更高。
