CHẨN ĐOÁN TRƯỚC SINH VÀ KẾT QUẢ ĐIỀU TRỊ SỚM THOÁT VỊ CUỐNG RỐN BẨM SINH

Abstract

Background: Umbilical cord hernia (UCH) is a congenital midline abdominal defect, in which the abdominal organs protrude through the incomplete umbilical ring. Object: Describe the prenatal diagnosis and clinical symptoms of UCH at National hospital of obstetrics and gynecology, and evaluate the results of early treatment for UCH. Subjects - Methods: A descriptive study of 40 cases of UCH born at National hospital of obstetrics and gynecology from January 1, 2017 to August 31, 2023. Results: The male-to-female ratio was 2.1/1, 85% of the children were full-term. 90% of UCH cases were detected via prenatal ultrasound, the average gestational age at detection was 15.9 ± 6.6 weeks. The hernia mass primarily contained the intestine (97.5%) and liver (52.5%), 77.5% of the hernia masses measuring ≥ 5 cm. 12.5% of the children had associated congenital anomalies, mainly congenital heart defects. The study showed a higher rate of conservative treatment in the group with hernia masses ≥ 5 cm compared to those with masses < 5 cm (89.5% vs 10.5). Treatment depended on the size of the hernia mass, gestational age, birth weight, and associated anomalies. The group receiving conservative treatment had a significantly higher rate of hernias containing the stomach compared to the surgical group. Children treated with one-stage surgery had a survival rate of 90.9%, two-stage surgery had a survival rate of 37.5%, while the conservative treatment group had a survival rate of 68.4%. Treatment outcomes were influenced by factors such as hernia size, associated anomalies, and the child's health status. The mortality rate was 40%. Survival rates were associated with birth weight, the need for resuscitation, and respiratory support after birth. Conclusions: In this study, most UCH were detected early and had large hernia masses, primarily consisting of the small intestine and liver. The survival rate after treatment was high, but the risk of mortality increased in newborn who has low-birth-weight, required resuscitation and respiratory support after birth.