新生児外科的疾患における出生前診断と周産期管理の現況

抄録

Recently, cases of antenatal diagnosis in neonatal surgical patients have been rapidly increased by progress in perinatal medicine and fetal ultrasonography in our country. The data in this paper were obtained from 15 pediatric surgical institutions and 8 obstetrial insutitutions during the past 5 years. Two handred and seventy-seven cases (18.9%) out of total neonatal surgical patients were antenatally detected their anomalies. Intestinal atresia, meconium peritonitis, ovarian cyst and disorders of urinary tract including kidney were detected frequently by fetal ultrasonography. On the other hand, it was very difficult to detect intestinal malrotation, aganglionosis and imperforate anus. Antenatal diagnosis for neonatal surgical diseases offer many benefits as follows : improvement of perinatal care for fetus with congenital defects, maternal transport, change of the timing or mode of delivery, cooperative medical team for treatment and the appropriate family councering before birth. Out of 185 patients with antenatal diagnosis whose perinatal managements were clearly investigated by question-naries, 138 cases (74.6%) were delivered and treated at the same hospital. Fourty-six cases (24.8%) were changed timing of delivery and 74 cases (40%) were delivered by elective cesarean section. Many cases with abdominal wall defect or diaphragma-tic hernia were selected timing or mode of delivery and were performed surgical treatment immediately after birth.