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先天性胎儿颈部异常——资源匮乏地区的诊断与治疗困境:病例报告

Congenital fetal neck anomaly-diagnostic and therapeutic dilemma in low-resource setting: case report.

作者信息

Yotamu Noel, Chiweza Chikondi, Barbour Kelli D

机构信息

Area 25 Health Center, Maternal Health Project, Baylor Malawi Foundation, Lilongwe, Malawi (Drs Yotamu and Chiweza).

Texas Children's Hospital, Baylor College of Medicine, Houston, TX (Dr Barbour).

出版信息

AJOG Glob Rep. 2023 Jun 11;3(3):100242. doi: 10.1016/j.xagr.2023.100242. eCollection 2023 Aug.

Abstract

Fetal neck masses are uncommon but challenging to manage, particularly in limited-resource settings. We prenatally diagnosed a large fetal neck mass after consultative referral for polyhydramnios at 30 weeks' gestation. The pregnant patient was counseled on the findings, differential diagnoses, and the prenatal and postnatal management options. She delivered at 38 weeks' gestation through emergent cesarean delivery after presenting in labor owing to concern for labor dystocia with the large mass. The diagnosis of lymphangioma was made postnatally through imaging. Good prognosis has been reported in several cases with surgery and/or sclerotherapy, even in low-resource settings. Despite the availability of a pediatric surgeon to perform a resection, the family declined treatment because of a belief that the mass was of supernatural etiology. Patient-centered, multidisciplinary services focusing on maternal and fetal complications should assess and account for cultural beliefs to better understand and counsel families who have a fetus or neonate with a congenital anomaly.

摘要

胎儿颈部肿块并不常见,但处理起来具有挑战性,尤其是在资源有限的环境中。我们在孕30周因羊水过多经会诊转诊后产前诊断出一个巨大的胎儿颈部肿块。就检查结果、鉴别诊断以及产前和产后管理方案向该孕妇进行了咨询。由于担心巨大肿块导致产程难产,她在临产时紧急剖宫产,于孕38周分娩。产后通过影像学检查确诊为淋巴管瘤。即使在资源匮乏的环境中,也有几例报告显示手术和/或硬化治疗预后良好。尽管有小儿外科医生可进行切除手术,但家属因认为肿块是超自然病因而拒绝治疗。以患者为中心、关注母婴并发症的多学科服务应评估并考虑文化信仰,以便更好地理解并为有先天性异常胎儿或新生儿的家庭提供咨询。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1ac2/10331835/a62e2f426329/gr1.jpg

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