Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba, Brazil.
Department of Radiology and Imaging Diagnostic, Faculty of Medicine of Ribeirão Preto - University of São Paulo (FMRP-USP), Ribeirão Preto, Brazil.
J Clin Ultrasound. 2023 Jun;51(5):803-811. doi: 10.1002/jcu.23341. Epub 2022 Sep 24.
To describe the ultrasonographic characteristics of congenital porto-systemic venous shunts (CPSS) diagnosed during pregnancy, their outcomes, and their evolution.
Two independent researchers selected 493 review articles and case reports through the analysis of titles, abstracts, and full text. The PubMed and LILACS databases were searched. Through the application of filters according to the PRISMA protocol, only six articles were used in the research. The following information was collected, when available: gestational age at diagnosis, gender, birth weight, type of shunt, associated anomalies/complications and treatment/progression.
The data were obtained from 27 cases, with 22 (82%) fetuses diagnosed with intra-hepatic CPSS and 5 (18%) with extra-hepatic CPSS. The median time of intrauterine diagnosis was 33 weeks. In 12 (57.1%) of the 21 pregnancies evaluated, delivery was preterm. The estimated fetal weight ranged from 1150 to 3760 g, with 4 (25%) cases at <3rd, 3 (18.75%) cases at <10th, 8 (50%) cases at <50th, and 1 (6.25%) case at >97th percentile for gestational age. The most frequent obstetric complication was fetal growth restriction, which occurred in nine (60%) cases. As for postnatal treatment, 19 (70.4%) cases were conservatively treated, and 8 (29.6%) cases required surgical intervention.
The diagnosis of CPSS still represents a challenge during prenatal care. Its early identification aims to provide guidance to pregnant women and their families, as well as follow-up and anticipation of possible complications, in addition to the evaluation of the mode of delivery and postnatal follow-up, directing the short- and long-term prognosis.
描述妊娠期诊断的先天性门体静脉分流（CPSS）的超声特征、结局及其演变。
通过标题、摘要和全文分析，两名独立研究人员选择了 493 篇综述文章和病例报告。检索了 PubMed 和 LILACS 数据库。通过应用 PRISMA 方案的过滤器，仅使用了 6 篇文章进行研究。收集了以下信息：诊断时的胎龄、性别、出生体重、分流类型、相关异常/并发症以及治疗/进展。
数据来自 27 例病例，其中 22 例（82%）胎儿诊断为肝内 CPSS，5 例（18%）为肝外 CPSS。宫内诊断的中位时间为 33 周。在 21 例评估的妊娠中，有 12 例（57.1%）早产。估计胎儿体重范围为 1150 至 3760g，4 例（25%）低于第 3 百分位，3 例（18.75%）低于第 10 百分位，8 例（50%）低于第 50 百分位，1 例（6.25%）高于第 97 百分位。最常见的产科并发症是胎儿生长受限，发生在 9 例（60%）中。至于产后治疗，19 例（70.4%）采用保守治疗，8 例（29.6%）需要手术干预。
CPSS 的诊断在产前护理中仍然具有挑战性。早期识别旨在为孕妇及其家属提供指导，以及对可能的并发症进行随访和预期，此外还评估分娩方式和产后随访，指导短期和长期预后。
