Nazan TARHAN, Bülent TANDOĞAN, Vedat DAYICIOĞLU

Fetal ventrikülomegalili olgularda prognoz ve etkileyen faktörlerin değerlendirilmesi

Amaç: Ventrikülomegali tespit edilen fetuslarda gebelik sonuçlarının ve bunları etkileyen faktörlerin değerlendirilmesi. Materyal ve Metod: Bu prospektif çalışmada, ventrikülomegali tespit edilen 54 olguda gebelik sonuçlan ve izole ventrikülomegali ile eşlik eden anomali varlığında prognozdaki farklılık ortaya kon-maya çalışıldı. Bulgular: Olguların 24'ü (%44.4) izole ventrikülomegali, 12'si (%22.2) ventrikülomegali + spina bifidalı, 18'i (%33.4) ventrikülomegali + diğer anomalili (kombine) olgulardı. 14 olgu ailenin isteğiyle elektif olarak sonlandırıldı. Olguların l'i (%1.8) antepartum, 20'si (%37) intrapartum, 15'i (%28) neonatal dönemde kaybedildi. İzole olguların 14'ü (%26), kombine olguların 4'ü (%7.4) olmak üzere toplam 18 (%33.2) olgu çalışma bittiğinde yaşıyordu. Üç olguya (%5.5) ventriküloperitoneal şant uygulandı. Dört olguda (%7.4) nörolojik muayenede bulgu saptandı. Nörolojik bozukluk çıkan olguların hepsi kombine olgulardı. Sonuç: Ventrikülomegaliye diğer anomalilerin eşlik etmesi prognozu kötüleştirir.

Anahtar Kelimeler:

İleriye dönük çalışma, Gebelik, Seyir, Anomaliler

Evaluation of pregnancy outconme and affecting factors in cases with ventriculomegaly

Objective: Evaluation of pregnancy outcome and affecting factors in cases with ventriculomegaly. Materials and Methods: In this prospective study, we investigated 54 fetuses with ventriculomegaly. We evaluated the difference in prognosis between isolated ventriculomegaly and ventriculomegaly with associated anomalies. Results: Twenty-four (44.4%) among 54 fetuses had isolated ventriculomegaly, rest of the cases (n=12 22.2%) had ventriculomegaly + spina bifida without other anomalies and 18 cases (33.4%) had ventriculomegaly with other anomalies. Termination of pregnancy was applied in 14 patients (26%) electively by the approval of family. There was only 1 (1.8%) antepartum death, and were 20 (37%) intra partum deaths, 15 (28%) neonatal deaths. Isolated ventriculomegaly number were 14 (26%) and ventriculomegaly with associated anomalies were 4 (7.4%) among alive 18 (33.2%) cases at the end of the study. In 3 cases (5.5%) ventriculo-peritoneal shunts were inserted. Clinically significant neurological deficit were found in 4 cases (7.4%). All cases that surgically intervened had ventriculomegaly with associated anomalies. Conclusion: Accompanying other anomalies worsen the outcome in patients with ventriculomegaly.

Keywords:

Prospective Studies, Pregnancy, Prognosis, Abnormalities,

___

1. Hertzberg BS, Lile R, Foosaner DE et al: Choroid plexus -ventricular wall separation in fetuses with normal-sized cerebral ventricles et sonography
Postnatal outcome. AJR Am J Roentgenol 63:405,1994
2. Cardoza JD, Goldstein RB, Filly RA Exclusion of fetal ventriculomegaly with a single measure-ment:The width of lateral ventricular atrium.AJR Am J Roentgenol 151:767,1988 3. Schwanitz G, Schuler H, Gembruch U ,Zerres KC: Chromosomal findings in fetuses with ultrasonographically diagnosed ventriculomegaly
Ann Genet 1993;36:150-153
4. Bronsteen RA, Comstock HC: Central Nervous system anomalies. Clin Perinat 2000;4:791-812
5. Chervenak FA, Duncan C, Ment LR et al: Outcome of fetal ventriculomegaly. Lancet 1984;2:179-181
6. Hudgins RJ, Michael SBE, Goldstein R et al: Natural history of Fetal Ventriculomegaly
Pediatrics 1988;5:692-697
7. Chervenak FA, Berkowitz RL, Tortora M, Hobbins JC: The Management of fetal hydrocephalus. Am J Obstet Gynecol 1985;151:933-942
8. Gupta JK, Bryce FC, Lilford RJ: Management of apparently isolated fetal ventriculomegaly. Obstet Gynecol Surv 1994;49:716-721
9. Oi S, Matsumoto S, Katayama K, Mochizuki M: Pathophysiology and postnatal outcome of fetal hydrocephalus. Childs Nerv Syst 1990 ;6:338-345
10. Hoppe-Hirsch E, Laroussinie F, Brunet L, Sainte-Rose C, Renier D, Cinalli G,. Late outcome of the surgical treatment of hydrocephalus. Childs Nerv Syst 1998 ;14:97-99
11. Jamjoom AB, Kahlaf NF, Mohammed AA, Jamjoom ZA: Factors affecting the outcome of foetal hydrocephaly. Acta Neurochir 1998;140:l 121-1125
12. Futagi Y, Suzuki Y, Toribe Y, Morimoto K.Neurodevelopmental outcome in children with fetal hydrocephalus.Pediatr Neurol 2002 ;27:111-116
13. Tomlinson MW, Treadwell MC, Bottoms SF isolated mild ventriculomegaly associated karyotypic abnormalities and in utero observationj Mater Fetal Med 1997,6:241-244
14. Mori K, Shimada J, Kurisaka M, Sato K, Watanabe K. Classification of hydrocepjialus and outcome of treatment 1995;17:338-348