NGHIÊN CỨU CHẨN ĐOÁN TRƯỚC SINH VÀ XỬ TRÍ THAI NGHÉN THOÁT VỊ HOÀNH TRÁI TẠI BỆNH VIỆN PHỤ-SẢN TRUNG ƯƠNG

Abstract

Objectives: (1) Describe some prenatal diagnosis methods of left diaphragmatic hernia at the National Obstetrics and Gynecology Hospital from 2020 - 2022, (2) Comment on the management and pregnancy results of the above cases. Methods: Retrospective study describing patients prenatally diagnosed with isolated left diaphragmatic hernia followed at the Prenatal Diagnosis Center from 2020-2022. Results: Pregnant women had an average age of 28.38 + 5.43 (years old). The average gestational age of detecting TVHBS (T) is 25.3 + 6.4 (weeks). The rate of pregnancy termination is 41.37%. 58.63% of diaphragmatic hernias were kept pregnant, of which 4.07% were stillborn; 48.39% died after giving birth; 47.54% lived after surgery. The infant mortality rate in the oLHR>1.3 group (39%) is lower than the oLHR 1-1.3 group (66.7%) and the oLHR <1 group (88.9%) Mortality in the o/eLHR >45% group was the lowest, accounting for 36.7%, followed by the o/eLHR group 26-45% (55%), and the highest was the o/eLHR <25% group (88.9%). The rate of infant mortality in the level 1 group is the lowest, accounting for 20% compared to level 2 (38.5%), level 3 (53.8%) and level 4 (69.6%) The rate of children needing support Postnatal respiratory support lasting >14 days among stable infants gradually increased from grade 1 (12.5%) to grade 2 (37.5%), grade 3 (66.7%), and the highest was grade 4. (85.7%). Conclusion: Congenital left diaphragmatic hernia is a serious abnormality with a high neonatal mortality rate. Termination of pregnancy can be considered when the diagnosis and prognosis are severe. Diagnosed gestational age, cephalic lung index and classification of gastric position on ultrasound should be used as one of the criteria for termination of pregnancy. It is possible to predict whether newborns will live based on oLHR, o/eLHR and classification of stomach position on ultrasound.