Sohret Nurullah Cihan, Tekin Ayse Neslihan, Surmeli Onay Ozge, Suman Kamuran, Aydemir Ozge, Velipasaoglu Melih
Department of Pediatrics, Eskisehir Osmangazi University, Faculty of Medicine, Eskisehir, Turkey.
Division of Neonatology, Eskisehir Osmangazi University, Faculty of Medicine, Eskisehir, Turkey.
J Obstet Gynaecol. 2022 Oct;42(7):2999-3006. doi: 10.1080/01443615.2022.2125295. Epub 2022 Sep 23.
The aim of this study was to evaluate the early neonatal outcomes of cases with foetal ventriculomegaly (VM) and to investigate the aetiological and prognostic factors according to the degree of VM in a single tertiary referring centre. The medical records of 87 foetuses diagnosed with VM (≥10 mm) within 6 years were evaluated. Postnatal evaluation and early neonatal prognosis were determined in 39 cases divided into two groups as mild (10-15 mm, 30 cases) and severe (>15 mm, 9 cases) according to the ventricular size. The mean gestational age at which foetal VM was detected was 22 + 3 weeks. In terms of severity, severe cases of VM were more frequent in terminated pregnancies. There was no difference in gestational age, birth weight, fifth minute Apgar scores, or cord blood gases between mild and severe cases at delivery. Isolated VM was detected in 63% of mild and 22% of severe cases. In severe cases, the need for intensive care and surgery was higher than in mild cases. Antenatal VM regressed in 50% of mild cases and 22% of severe cases. Increasing knowledge about neonatal prognosis, the factors involved in aetiology, and the degree of VM will guide the management of foetal VM.IMPACT STATEMENT Some cases of foetal VM resolve spontaneously, and postnatal ultrasonography can detect normal ventricle sizes. While 74.6% of isolated VM cases show spontaneous regression, this rate is 52.1% in nonisolated cases. The gestational week at the time of diagnosis, the degree and cause of VM, intrauterine progression and the presence of any genetic, infectious, cerebral, or extracerebral disorders all influence the prognosis. Antenatal VM regressed in 50% of mild cases and 22% of severe cases. In severe cases, the need for intensive care and surgery was higher than in mild cases. The higher frequency of accompanying cerebral findings in severe cases was striking. The current study revealed that isolated VM with ventricular diameter less than 15 mm, after excluding out chromosomal abnormalities and prenatal infections, and no prior history of VM, has a favourable neonatal prognosis in terms of mortality and morbidity. In cases of foetal VM, increased knowledge of neonatal prognosis will guide pregnancy care and postnatal follow-up planning. Prospective multicentre studies on the neonatal period are required to bridge the gap between foetal VM and long-term consequences.
本研究的目的是评估胎儿脑室扩大（VM）病例的早期新生儿结局，并在单一的三级转诊中心根据VM的程度调查其病因和预后因素。对6年内诊断为VM（≥10mm）的87例胎儿的病历进行了评估。根据脑室大小将39例分为轻度（10 - 15mm，30例）和重度（>15mm，9例）两组，确定其产后评估和早期新生儿预后。检测到胎儿VM时的平均孕周为22 + 3周。就严重程度而言，重度VM病例在终止妊娠中更为常见。分娩时轻度和重度病例在孕周、出生体重、5分钟阿氏评分或脐血气方面无差异。63%的轻度病例和22%的重度病例检测到孤立性VM。在重度病例中，重症监护和手术的需求高于轻度病例。50%的轻度病例和22%的重度病例产前VM消退。增加对新生儿预后、病因相关因素和VM程度的了解将指导胎儿VM的管理。影响声明 一些胎儿VM病例可自发消退，产后超声检查可检测到脑室大小正常。虽然74.6%的孤立性VM病例显示自发消退，但在非孤立性病例中这一比例为52.1%。诊断时的孕周、VM的程度和原因、宫内进展以及是否存在任何遗传、感染、脑部或脑外疾病均会影响预后。50%的轻度病例和22%的重度病例产前VM消退。在重度病例中，重症监护和手术的需求高于轻度病例。重度病例中伴随脑部异常的频率更高，这一点很显著。当前研究表明，在排除染色体异常和产前感染且无VM既往史后，脑室直径小于15mm的孤立性VM在死亡率和发病率方面具有良好的新生儿预后。对于胎儿VM病例，增加对新生儿预后的了解将指导孕期护理和产后随访计划。需要开展关于新生儿期的前瞻性多中心研究，以弥合胎儿VM与长期后果之间的差距。
