Fetal Medicine, National Maternity Hospital, Dublin 2, Ireland.
UCD Perinatal Research Centre, University College Dublin, National Maternity Hospital, Dublin, Ireland.
Ir J Med Sci. 2022 Feb;191(1):407-412. doi: 10.1007/s11845-021-02544-z. Epub 2021 Feb 27.
A specialist fetal neurosurgical clinic was set up in order to improve patient care in a tertiary referral fetal medicine centre. The clinic provides a targeted clinical service for women diagnosed with fetal neurological abnormalities. The service consists of fetal MRI, fetal ultrasound and joint assessment and counselling from neurosurgery and fetal medicine teams.
We aimed to review this service that provides MDT expertise directly to parents and record the cases and pregnancy outcomes involved.
This is a prospective study of clinic data from Jan 2013 to Dec 2017. Information includes ultrasound scan findings, MRI results, karyotype results and pregnancy outcome data including post mortem results and data from the paediatric neurosurgery service at the affiliated children's hospital.
From 2013 to 2017, there were 1852 major fetal anomalies diagnosed antenatally at the tertiary referral fetal medicine service and n = 306/1852 [16%] were primarily neurological in origin. The neurosurgical clinic reviewed 125 patients since 2013. The most common reasons for referral were spina bifida, n = 60 [48%] and isolated ventriculomegaly n = 43 [34%]. Other reasons for referral include agenesis of the corpus callosum n = 4 [3%], encephalocoele n = 5 [4%] and intracranial mass lesions n = 3 [2.4%]. Cases with borderline ventriculomegaly and cases with known chromosomal or genetic abnormalities were not typically referred to the clinic. Full outcome data were available on 110 of 125 women seen. Thirty-two women [29%] underwent invasive testing and 14 women [12.7%] had a termination of pregnancy.
Multidisciplinary antenatal counselling supported with in utero MRI provides families with optimum information to inform them of likely neonatal outcome.
为了改善三级转诊胎儿医学中心的患者护理，成立了专门的胎儿神经外科诊所。该诊所为诊断为胎儿神经发育异常的妇女提供有针对性的临床服务。该服务包括胎儿 MRI、胎儿超声以及神经外科和胎儿医学团队的联合评估和咨询。
我们旨在回顾该为父母提供多学科专家意见的服务，并记录相关病例和妊娠结局。
这是一项对 2013 年 1 月至 2017 年 12 月期间诊所数据的前瞻性研究。信息包括超声扫描结果、MRI 结果、核型结果以及妊娠结局数据，包括尸检结果和附属儿童医院小儿神经外科服务的数据。
在三级转诊胎儿医学服务中，2013 年至 2017 年间共诊断出 1852 例主要胎儿畸形，其中 n=306/1852 [16%] 主要为神经起源。自 2013 年以来，神经外科诊所共对 125 名患者进行了评估。转诊的最常见原因是脊柱裂，n=60 [48%] 和孤立性脑室扩大，n=43 [34%]。其他转诊原因包括胼胝体发育不全，n=4 [3%]、脑膨出，n=5 [4%] 和颅内肿块病变，n=3 [2.4%]。轻度脑室扩大的病例和已知染色体或遗传异常的病例通常不转介到诊所。在接受评估的 125 名妇女中，有 110 名的完整结局数据可用。32 名妇女 [29%] 接受了有创性检测，14 名妇女 [12.7%] 终止了妊娠。
多学科产前咨询并结合宫内 MRI 为家庭提供了最佳信息，使他们能够了解新生儿的可能结局。
