Department of Surgery, The University of Hong Kong, Hong Kong, China.
Department of Obstetrics and Gynaecology, Queen Mary Hospital, Hong Kong, China.
J Paediatr Child Health. 2021 May;57(5):710-714. doi: 10.1111/jpc.15321. Epub 2021 Jan 5.
This study reviewed the experience of a tertiary paediatric surgery and obstetric centre on prenatal counselling of congenital surgical anomalies and to explore the role of paediatric surgeons on perinatal outcomes of antenatally detected anomalies.
A retrospective analysis of all antenatal consultations and subsequent medical records after birth were performed between 2009 and 2018. Data including timing of consultations, gestations at birth, birthweight, impact on obstetrics management, neonatal mortality and need of surgery were included.
A total of 256 fetuses were diagnosed to have congenital surgical anomalies on antenatal ultrasound. The most common were urogenital (31%) and thoracic (30%) anomalies. Twelve of the 256 (4.7%) had multiple anomalies. The mean gestation at referral was 23 ± 5 weeks. The majority (85.4%) were born at term. Mode and timing of delivery was altered in 7% of patients. Four received fetal intervention after surgical consultation. Termination of pregnancy rate was 5.4% (n = 14). Neonatal death was reported in 7.8% of the cohort.
Congenital surgical anomalies had a significant impact on perinatal outcome as well as morbidity in later infancy and childhood. A multidisciplinary approach in managing pregnancy with these anomalies should be implemented. Combined-specialty consultations and counselling deliver valuable information for parents.
本研究回顾了一家三级儿科外科和产科中心在先天性外科畸形产前咨询方面的经验，并探讨了儿科外科医生在产前发现畸形的围产期结局中的作用。
对 2009 年至 2018 年间进行的所有产前咨询和随后的出生后病历进行回顾性分析。纳入的数据包括咨询时间、出生时的胎龄、出生体重、对产科管理的影响、新生儿死亡率和手术需求。
共有 256 例胎儿在产前超声检查中被诊断为先天性外科畸形。最常见的是泌尿生殖（31%）和胸（30%）部异常。256 例中有 12 例（4.7%）存在多种异常。转诊时的平均胎龄为 23±5 周。大多数（85.4%）足月出生。7%的患者分娩方式和时机发生改变。4 例在外科咨询后接受了胎儿干预。终止妊娠率为 5.4%（n=14）。该队列中有 7.8%的新生儿死亡。
先天性外科畸形对围产期结局以及婴儿期和儿童期的发病率有重大影响。应实施多学科方法来管理这些畸形的妊娠。联合专科咨询和咨询可提供有价值的信息给家长。
