Antenatalni čimbenici rizika i mogućnosti prenatalne dijagnostike oštećenja mozga magnetskom rezonancijom

Banović, Vladimir (2012) Antenatalni čimbenici rizika i mogućnosti prenatalne dijagnostike oštećenja mozga magnetskom rezonancijom. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Study aims: To determine the incidence of fetal brain injury with fetal brain MRI in pregnancies complicated with preterm labor symptoms, preterm premature rupture of the membranes and intrauterine growth restriction. Correlate the results of conventional antenatal surveillance methods with short and long-term neurodevelopmental outcome. Pregnancies and methods: The study included 70 pregnancies with fetal brain MRI findings, complicated with preterm premature rupture of the membranes, intrauterine growth restriction or symptoms of preterm labor. Fetal brain MRI findings were compared to antenatal factors, Apgar scores, umbilical cord pH values, neonatal brain ultrasound findings and neonatal status. Research included the two year follow-up. Results: Changes in fetal brain MRI were found in 28 (40%), and normal finding in 42 (60%) pregnancies. The incidence of changed fetal brain MRI was highest in the preterm labor symptoms group (60,9%). The parameters of immediate neonatal outcome (1. minute Apgar score, pH), except 5. minute Apgar score, were independent to fetal brain MRI finding. Of total 35 children with long-term neurodevelopmental impairment 16 (46%) was proved to have antenatal brain injury on MRI. Loglinear regression proved fetal brain MRI and neonatal ultrasound in the first week as the best predictors for long term neurodevelopmental disability. Conclusions: Fetal brain MRI is effective method for fetal brain damage diagnosis and predictive for long-term neurodevelopmental disability. Fetal brain injury is most common in the preterm labor symptoms group. Conventional antenatal surveillance methods are insufficient for possible fetal brain injury diagnosis and poor predictors for short and long term neurodevelopmental outcome.

Abstract in Croatian

Ciljevi istraživanja: Istražiti pojavnost oštećenja fetalnog mozga magnetskom rezonancijom u trudnoćama sa simptomima spontanog prijevremenog poroda, prijevremenog prsnuća vodenjaka prije termina te intrauterinog zastoja rasta. Usporediti rezultate s konvencionalnim metodama nadzora fetusa te kratkoročnim i dugoročnim neurološkim ishodom djece Ispitanice i metode: Istražili smo moguća oštećenja mozga fetusa uz pomoć magnetske rezonancije u 70 trudnica s kliničkom dijagnozom intrauterinog zastoja u rastu fetusa ili simptomima prijevremenog poroda ili prijevremenim prsnućem vodenjaka prije termina. Nalazi MR pretraga uspoređeni su u sve djece s antenatalnim čimbenicima, nalazom pH iz umbilikalne krvi, vrijednostima Apgar indeksa, nalazima neonatalnog ultrazvuka mozga i neurološkog statusa djece. Dugoročni ishod djece praćen je s navršene 2 godine života. Rezultati: MR promjene nađene su u 28 trudnoća ili u 40%, a uredan nalaz u 42 ili 60 % trudnoća. Najčešće promjene MR-a fetalnog mozga nađene su u skupini sa simptomima spontanog prijevremenog poroda (60,9%). Istraživanjem obuhvaćeni parametri neposrednog neonatalnog ishoda (Apgar indeks u 1. minuti, pH) osim vrijednosti Apgar indeksa u 5. minuti nisu pokazali značajnu ovisnost o nalazu magnetske rezonancije fetalnog mozga. Od ukupno 35 djece s dugoročnim poremetnjama neurološkog razvoja njih 16 (46%) ima dokazanu antenatalnu etiologiju oštećenja mozga uz pomoć MR-a. Najbolju predikciju dugoročnih poremetnji neurološkog razvoja, dokazanu binarnim logističkim modelom ima MR fetalnog mozga i neonatalni ultrazvuk mozga u 1. tjednu života. Zaključci: Magnetska rezonancija može omogućiti dijagnozu oštećenja fetalnog mozga i predikciju dugoročnih poremetnji neurološkog razvoja djece. Oštećenja fetalnog mozga su najčešća u trudnica sa simptomima spontanog prijevremenog poroda. Konvencionalne metode nadzora stanja fetusa nisu pouzdani pokazatelji mogućih oštećenja fetalnog mozga kao ni dugoročnog neurološkog ishoda djece.

Item Type: Thesis (PhD)
Mentors:
Mentor
Škrablin-Kučić, Snježana
Departments: Katedra za ginekologiju i opstetriciju
Depositing User: dr.med. Helena Markulin
University: Sveučilište u Zagrebu
Institution: Medicinski fakultet
Number of Pages: 126
Status: Unpublished
Creators:
CreatorsEmail
Banović, VladimirUNSPECIFIED
Date: 19 September 2012
Date Deposited: 27 May 2014 09:59
Last Modified: 27 May 2014 09:59
Subjects: WQ Obstetrics > WQ 200-212 Pregnancy
Related URLs:
    URI: http://medlib.mef.hr/id/eprint/2110

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