The thesis solves an important problem relevant for radiological diagnostics in perinatology – there were developed methodological principles of prenatal ultrasound examination and the personalized prognistication of clinical outcome in congenital diaphragmatic hernias, omphalocele and gastroschisis in the fetus.
The data of complex prenatal examinations of 265 cases of congenital diaphragmatic hernia, 175 cases of gastroschisis and 174 cases of omphalocele in the fetus, carried out at the Department of Fetal Medicine of the SI “Institute of Pediatrics, Obstetrics and Gynecology named after acad. O.M. Luk’yanova of the National Academy of Medical Sciences of Ukraine”, as well as clinical results for children after birth in 125, 75 and 22 cases, respectively.In this study large prenatal cohorts of congenital diaphragmatic hernia, gastroschisis and omphalocele in the fetus were analyzed. Associated pathology is characterized, and detailed ultrasound semiotics is described. The principles of unified prenatal ultrasound measurements using indices for an assessment of the pathological process independent of the gestational age have been developed. Indices are proposed for assessing the degree of lung hypoplasia and the degree of liver hernia into the chest in fetuses with diaphragmatic hernia, the degree of visceroabdominal imbalance in fetuses with gastroschisis, the size of omphalocele, as well as the corresponding classifications. Variants of positions of the stomach were determined with a description of the location of other displaced organs in congenital diaphragmatic hernia. The main predictors of negative outcome in the general group of diaphragmatic hernia are multiple malformations (OR: 11.1, 95% CI 2.4-50.4), right-sided defects (OR 3.7, 95% CI 1.1-12.2), liver herniation in left-sided hernias (OR: 105, 95% CI 4.2-26.3), and polyhydramnios (OR 3.7, 95% CI 1.8-7.6). In isolated left-sided hernias - lung hypoplasia (OR: 56.0, 95% CI 15.8-199), liver herniation (OR: 12.7, 95% CI 4.3-37.6), including severe (OR: 22, 95% CI 4.2-115), and the position of the stomach. Predictors of mortality in gastroschisis are dilatation of eventrated bowel ≥ 20 mm (OR 17.14, 95% CI 3.36-87.6), changes in the eventrated intestinal wall (OR 7.9, 95% CI 1.6-39.3 ), polyhydramnios (OR 5.7, 95% CI 1.3-25.8), fetal growth retardation (OR 5.7, 95% CI 1.2-28.1), gastromegaly (OR 4.9, 95% CI 1.3-18.3), severe visceral abdominal disproportion (OR 4.2, 95% CI 1.1-16.2). In omphalocele, negative outcomes were associated with multiple anomalies, (OR: 59.4, 95% CI 2.4-1472.4), as well as large + giant size (OR 15.0, CI 1.1-198.0).
The developed algorithm and mathematical models made it possible to increase the accuracy of predicting negative results up to 90.8% and 82.4% in diaphragmatic hernia and gastroschisis, respectively. The use of the proposed algorithm within the framework of the prenatal clinical examination system allows optimal planning of pregnancy, childbirth and the neonatal period, including the prevention of surgical interventions in patients with a poor prognosis, and leads to a decrease in postoperative mortality.
