- Pregnancy and labor in women with prenately diagnostic congenital malformatioms of lungs and thorax in the fetus
Pregnancy and labor in women with prenately diagnostic congenital malformatioms of lungs and thorax in the fetus
HEALTH OF WOMAN. 2018.9(135):54–58; doi 10.15574/HW.2018.135.54
Nidelchuk O. V. , Avramenko T. V. , Gordienko I. Y. , Grebinichenko G. O.
SI «Institute of Pediatrics, Obstetrics and Gynecology named after Acad. O.M. Lukyanovaya NAMS of Ukraine», Kyiv Women's consultationof CNE «KDC» of Shevchenkivskyi district of Kyiv
The objective: to analyze the course of pregnancy and labor in women with prenatally diagnosed congenital malformations of the lungs, thorax and diaphragm in the fetus, the condition of the fetuses and newborns with this pathology.
Materials and methods. In-patient and out-patient medical records of pregnant women, the medical records of the newborns of 30 patients who gave birth to children with congenital malformations of the lung, diaphragm and thorax in the obstetric clinics of «I PAG named by O.M. Lukyanova of NAMSU» (main group) and of 250 women with normal fetal development, which were followed at the women’s consultation clinic №5 of Shevchenkivskyi district of Kiev during the period of 2011–2013 (control group).
Results. A significantly higher rate of pregnant women younger than 19 years of age, pregnant women with burdened obstetric and gynecological anamnesis, as well as a high incidence of infectious gynecological and extragenital diseases, other extragenital pathology was found among the patients in the main group compared to controls. The rate of threatened abortion in the 1 trimester of pregnancy was significantly higher in the main group (30%) compared with the control (9.2%). Polyhydramnios was registered significantly more often in the main group (33.3%) than in the control group (1.6%), Oligohydramnios was found group in a small part of the patients from the main group (6.7%). In main group delivery was more often performed by cesarean section (53.3% vs. 12,4% in the control group, p<0.01), partly as a consequence of the standard delivery plan for the congenital diaphragmatic hernia in the fetus. Despite the more gentle way of delivery, children from the main group after birth were in most cases in severe condition: 46.6% after birth had an Apgar score of 4–6 points, 46.6% – less than 4 points, and only 6,6% newborns received score of more than 6 points. In the control group, a score of <7 points after birth hada significantly lower number of children – 4.4% (p<0.01).
Conclusions. The high incidence of infectious diseases in pregnant women from the main group gives grounds to suggest the influence of the factors associated with the infection and/or systems of inflammatory reactions, on the formation of congenital malformations of the lungs, diaphragm and thorax in the fetus; The influence of these factors may also be the cause of the risk threatened abortion in the I trimester. In the overwhelming majority of cases children with congenital malformations of the lungs, diaphragm and thorax were in a severe condition immediately after birth, which should be taken into account when planning specialized care for the newborn.
Key words: congenital malformations, lungs, congenital diaphragmatic hernia, extragenital diseases, TORCH-infections, pregnancy, labor.
1. Antypkin YuH, Sliepov OK, Veselskyi VL ta spivavt. (2014). Suchasni orhanizatsiino-metodychni pidkhody do perynatalnoi diahnostyky ta khirurhichnoho likuvannia pryrodzhenykh vitalnykh vad rozvytku u novonarodzhenykh ditei v umovakh perynatalnoho tsentru. Zhurnal Natsionalnoi akademii medychnykh nauk Ukrainy 20(2):189-199.
2. Gordienko I.Yu., Tarapurova E.N., Grebinichenko A.A. et al. (2013). Analysis of the frequency and structure of congenital pathology of the lungs, chest and diaphragm development in fetus, identified in pregnant of the high-risk groups. Perinatologiya i pediatriya. 3(55):5-8; doi 10.15574/PP.2013.55.5
3. Grebinichenko G.O., Gordienko I.Yu., Tarapurova O.M. et al. (2014). An assessment of the degree of fetal lung hypoplasia with two1dimensional ultrasound. Perinatologiya i pediatriya. 3(59):21-25. https://doi.org/10.15574/PP.2014.59.21
4. Coughlin MA, Werner NL, Gajarski R et al. (2016). Prenatally diagnosed severe CDH: mortality and morbidity remain high. J Pediatr Surg. 51(7):1091-1095. https://doi.org/10.1016/j.jpedsurg.2015.10.082.
5. Jani J, Nicolaides KH, Keller RL et al. (2007). Observed to expected lung area to head circumference ratio in the prediction of survival in fetuses with isolated diaphragmatic hernia. Ultrasound Obstet. Gynecol. 30:67-71. https://doi.org/10.1002/uog.4377; https://doi.org/10.1002/uog.4376; https://doi.org/10.1002/uog.4052; https://doi.org/10.1002/uog.5167
6. Laudy JA, Wladimiroff JW. (2000). The fetal lung. 1: Developmental aspects. Ultrasound Obstet Gynecol. 16(3):284-290. https://doi.org/10.1046/j.1469-0705.2000.00228.x; PMid:11169299
7. Laudy JA, Wladimiroff JW. (2000). The fetal lung. 2: Pulmonary hypoplasia. Ultrasound. Obstet. Gynecol. 16(5):482-494. https://doi.org/10.1046/j.1469-0705.2000.00252.x; PMid:11169336
8. Sananes N, Britto I, Akinkuotu AC. (2016). Improving the Prediction of Neonatal Outcomes in Isolated Left-Sided Congenital Diaphragmatic Hernia by Direct and Indirect Sonographic Assessment of Liver Herniation. J Ultrasound Med. 35(7):1437-1443. https://doi.org/10.7863/ultra.15.07020; PMid:27208195