NEW SEL_127.pdf

∞ÏÏËÏÔÁÚ·Ê›·: µ·Û›ÏÂÈÔ˜ ∆Û¿·ÓÔ˜ ∞Ó·ÏËÚˆÙ‹˜ ∫·ıËÁËÙ‹˜ ª·È¢ÙÈ΋˜-°˘Ó·ÈÎÔÏÔÁ›·˜ - ∂Ì‚Ú˘ÔÌËÙÚÈ-΋˜ π·ÙÚÈ∂Ì‚Ú˘ÔÌËÙÚÈ-΋˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ¶·ÙÚÒÓ ¶.°.¡.ƒ›Ô˘, 26 500 ƒ›Ô-¶¿ÙÚ· e-mail: [email protected] [email protected] ∫·Ù·Ù¤ıËΠ3.5.2006 ŒÁÈÓ ‰ÂÎÙ‹ 15.5.2006 µ. ™. ∆Û¿·ÓÔ˜ ª·È¢ÙÈ΋-°˘Ó·ÈÎÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ¶·ÙÚÒÓ ∂Ì‚Ú˘ÔÌËÙÚÈ΋ π·ÙÚÈ΋

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Á›-ÓÂÙ·È ·Ú·ÎÔÏÔ‡ıËÛË ÁÈ· ˘ÔÏÂÈfiÌÂÓË ·Ó¿-Ù˘ÍË (IUGR). ∏ ·ÓÙÈÌÂÙÒÈÛË ÂÍ·ÚÙ¿Ù·È ·fi ÙË Û˘Ó˘¿Ú¯Ô˘Û· ·ÓˆÌ·Ï›·. §¤ÍÂȘ - ÎÏÂȉȿ: ÌÔÓ‹Ú˘ ÔÌÊ·ÏÈ΋ ·ÚÙËÚ›·, ÔÌÊ¿ÏÈÔ˜ ÏÒ-ÚÔ˜, ÔÌÊ·ÏÈο ·ÁÁ›· ∂ÈÛ·ÁˆÁ‹ ∏ ·ÁÁÂÈÔÁ¤ÓÂÛË Î·È ·Ó¿Ù˘ÍË ÙÔ˘ ·Ú¯¤ÁÔÓÔ˘ ·ÁÁÂÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ·Ú¯›˙ÂÈ ÛÙÔ Â͈ÂÌ-‚Ú˘ÔÓÈÎfi ÌÂÛfi‰ÂÚÌ· ÙÔ˘ ¯ÔÚ›Ô˘ ·fi ÙȘ ·Ú-¯¤˜ Ù˘ 3˘ ‚‰ÔÌ¿‰·˜ ·ËÛ˘. ™ÙÔ ÙÔ›¯ˆÌ· ÙÔ˘ §ÂÎÈıÈÎÔ‡ ·ÛÎÔ‡ (∂ÈÎfiÓ· 1) Ô˘ ‰È·ÎÚ›-ÓÂÙ·È ˘ÂÚ˯ÔÁÚ·ÊÈο ÛÙÔ Û¿ÎÎÔ Î‡ËÛ˘ ·fi ÙËÓ 5Ë Â‚‰ÔÌ¿‰· (∂ÈÎfiÓ· 2), ‰ËÌÈÔ˘Ú-ÁÔ‡ÓÙ·È Ì¿˙˜ ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ·fi ÙȘ Ôԛ˜ Û¯ËÌ·Ù›˙ÔÓÙ·È Ó‹ÛÔÈ ·›Ì·ÙÔ˜ ·ÔÙÂÏÔ‡ÌÂÓ˜ ΢ڛˆ˜ ·fi ·Ú¯¤ÁÔÓ· Ì·ÎÚÔ-Ê¿Á· Î·È ÂÚ˘ıÚÔ·ÙÙ·Ú·. ∞ÎÔÏÔ˘ı› ÔÏÏ·-Ï·ÛÈ·ÛÌfi˜ ÙˆÓ ÂÚÈÊÂÚÈÎÒÓ ÌÂÛÂÁ¯˘Ì·ÙÈ-ÎÒÓ Î˘ÙÙ¿ÚˆÓ Ô˘ ·ÚÁfiÙÂÚ· ı· ηıÔÚ›ÛÔ˘Ó ÙÔ ÂÓ‰ÔıËÏÈ·Îfi fiÚÈÔ ÙˆÓ ·ÁÁ›ˆÓ. ªÂٷ͇ ·˘ÙÒÓ ·Ú·ÙËÚÂ›Ù·È ÛÙ·‰È·Î‹ ÂÌÊ¿ÓÈÛË ÌÂ-ÛÔ΢ÙÙ·ÚÈÎÒÓ ÎÂÓÒÓ ·fi Ù· ÔÔ›· ı· Û¯ËÌ·-ÙÈÛı› Ô ·˘Ïfi˜ ÙˆÓ ·ÁÁ›ˆÓ. ∞fi ÙËÓ ·fi-Û·ÛË ÙˆÓ ÎÂÓÙÚÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ÚÔ·ÙÔ˘Ó Ù· ‚Ï·ÛÙÈο ·ÙÙ·Ú· ÙÔ˘ ·›Ì·ÙÔ˜. ªÂٷ͇ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÂÌÊ·Ó›˙ÂÙ·È Û˘ÏÏÔÁ‹ ˘ÁÚÔ‡ ·fi ÙËÓ ÔÔ›· ı· ÚÔ·„ÂÈ ÙÔ Ï¿ÛÌ· ·›Ì·-ÙÔ˜. ∞fi ÙÔ ÌÂÛ¤Á¯˘Ì· Á‡Úˆ ·fi ÙÔ ÂÓ‰Ôı‹-ÏÈÔ Û¯ËÌ·Ù›˙ÔÓÙ·È ÔÈ ÙÚ›˜ ¯ÈÙÒÓ˜ ÙˆÓ ·ÁÁ›-ˆÓ. ŒÙÛÈ, ¿Óˆ ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙÔ˘ §ÂÎÈıÈ-ÎÔ‡ ·Û§ÂÎÈıÈ-ÎÔ‡ ‰ËÌÈÔ˘ÚÁÂ›Ù·È Ô Û¯ËÌ·ÙÈÛÌfi˜ ÂÓfi˜ ÛÙÚÒÌ·ÙÔ˜ ÙÚȯÔÂȉÒÓ ·ÁÁ›ˆÓ Ù· ÔÔ›· ÂÎÙÂÏÔ‡Ó ÙËÓ ·ÔÚÚfiÊËÛË Ô͢ÁfiÓÔ˘, ‡‰·ÙÔ˜ Î·È ÙÚÔÊÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ ·fi ÙËÓ §¤ÎÈıÔ, Î·È ÙËÓ ÚÔÒıËÛ‹ ÙÔ˘˜ Î·È ÌÂÙ·ÊÔÚ¿ ÙÔ˘˜ ÛÙÔ ¤Ì‚Ú˘Ô (∂ÈÎfiÓ· 3). ∆Ô ÙÚȯÔÂȉÈÎfi ‰›-ÎÙ˘Ô Î·Ù·Ï‹ÁÂÈ ÛÙȘ ·ÚȘ ·ÚÙËڛ˜ ÙÔ˘ §Â-ÎÈıÈÎÔ‡ ·ÛÎÔ‡, ÙȘ §ÂÎÈıÈΤ˜ ·ÚÙËڛ˜. ¶·-Ú¿ÏÏËÏ·, ·fi ÙÔ Ô˘Ú·›Ô ¿ÎÚÔ Ù˘ ηډȿ˜ ·Ú¯›˙Ô˘Ó Ó· ·Ó·Ù‡ÛÛÔÓÙ·È ÔÈ √ÌÊ·ÏÔÌÂÛÂ-ÓÙÂÚÈΤ˜ ÊϤ‚˜ ÂÓÒ ·fi ÙËÓ ÂÌ‚Ú˘ÔÓÈ΋ ·ÔÚÙ‹ ·Ú¯›˙Ô˘Ó Ó· ·Ó·Ù‡ÛÛÔÓÙ·È ÔÈ √ÌÊ·-ÏÔÌÂÛÂÓÙÂÚÈΤ˜ ·ÚÙËڛ˜. ∆· §ÂÎÈıÈο ·Á-Á›· Î·È Ù· √ÌÊ·ÏÔÌÂÛÂÓÙÂÚÈο ·Á·Á-Á›· ·Ó·-Ù‡ÛÛÔÓÙ·È Ù· ÌÂÓ ÚÔ˜ Ù· ‰Â Î·È ÙÂÏÈο Û˘-ÓÂÓÒÓÔÓÙ·È. ∏ ·Ó·Ù˘ÛÛfiÌÂÓË Ì ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ Î˘ÎÏÔÊÔÚ›· ÙÔ˘ §ÂÎÈıÈÎÔ‡ ∞ÛÎÔ‡ ·ÔÙÂÏ› ÙËÓ ¶ÚÒÙË ∂͈ÂÌ‚Ú˘˚΋ ∫˘ÎÏÔÊÔ-Ú›·. ¶·Ú¿ÏÏËϘ ‰ÈÂÚÁ·Û›Â˜ ·Ó·Ù‡ÛÛÔÓÙ·È Î·È ÛÙËÓ ∞ÏÏ·ÓÙÔ˚‰·. ∏ ∞ÏÏ·ÓÙÔ˚˜ Ô˘ ÌÔÈ¿˙ÂÈ Ì ۿÎÔ ‰È·ÎÚ›ÓÂÙ·È ‹‰Ë ·fi ÙÔ ÛÙ¿‰ÈÔ Ù˘ ÂÌ‚Ú˘Ô‚Ï¿ÛÙ˘. ∆Ô ÙÔ›¯ˆÌ¿ Ù˘ ÂÓÈÛ¯‡ÂÙ·È ·fi ·ÁÁ›· ·›Ì·ÙÔ˜ Î·È ¤¯ÂÈ ÛÎÔfi Ó· ‰È·-¯ÂÈÚ›˙ÂÙ·È Ù· ·fi‚ÏËÙ· ÙÔ˘ ÂÌ‚Ú‡Ô˘. ™˘ÌÌÂ-Ù¤¯ÂÈ ÛÙȘ ÏÂÈÙÔ˘ÚÁ›Â˜ Ù˘ ‰È·ÓÔ‹˜ Î·È ¤Î-ÎÚÈÛ˘. ™ÙÔ˘˜ Â›Ì˘˜ Â›Ó·È Ô ÌÂÛÔ‰ÂÚÌÈÎfi˜ Úfi‰ÚÔÌÔ˜ ÙÔ˘ ÔÌÊ¿ÏÈÔ˘ ÏÒÚÔ˘. ÀfiÎÂÈÙ·È Û ·ÁÁÂÈÔÁ¤ÓÂÛË ÁÈ· Ó· Û¯ËÌ·Ù›ÛÂÈ ÙȘ ÒÚÈ-̘ √ÌÊ·ÏÈΤ˜ ·ÚÙËڛ˜ Î·È ÊϤ‚˜. ∏ ∞ÏÏ·ÓÙÔ˚΋ ∫˘ÎÏÔÊÔÚ›· ·ÔÙÂÏ› ÙËÓ ¢Â‡ÙÂ-ÚË ∂͈ÂÌ‚Ú˘˚΋ ∫˘ÎÏÔÊÔÚ›·. ∏ ∞ÏÏ·ÓÙÔ˚˜ ÙÚÔÊÔ‰ÔÙÂ›Ù·È Ì ·›Ì· ·fi ÙËÓ ∞ÏÏ·ÓÙÔ˚΋ ∂ÈÎfiÓ· 1: §ÂÎÈıÈÎfi˜ ∞ÛÎfi˜ - ¶ÚÒÙË ∂͈ÂÌ‚Ú˘˚΋ ∫˘ÎÏÔÊÔÚ›·.

·ÚÙËÚ›· Ô˘ ÚÔ¤Ú¯ÂÙ·È ·fi ÙËÓ ·ÔÚÙ‹ ÎÔ-ÓÙ¿ ÛÙÔ ·ÏÏ·ÓÙÔ˚Îfi Û٤ϯԘ.∆Ô ·›Ì· Ô͢ÁÔ-ÓÒÓÂÙ·È ÛÙËÓ ∞Ï·ÓÙÔ˚‰· Î·È ÂÈÛÙÚ¤ÊÂÈ ÛÙËÓ Î·Ú‰È¿ Ì ÙËÓ ∞ÏÏ·ÓÙÔ˚΋ ÊϤ‚· Ô˘ Â΂¿Ï-ÏÂÈ ÛÙÔÓ ·Ú¯¤ÁÔÓÔ ÊÏ‚fiÎÔÏÔ (∂ÈÎfiÓ· 4). ∏ √ÌÊ·ÏÈ΋ ∫˘ÎÏÔÊÔÚ›· ·ÔÙÂÏ› ÙËÓ ÙÚ›ÙË Â͈ÂÌ‚Ú˘˚΋ ΢ÎÏÔÊÔÚ›·. √È §ÂÎÈıÈΤ˜ ÊϤ-‚˜ ÂÈÛÙÚ¤ÊÔ˘Ó ·›Ì· ·fi ÙÔÓ §ÂÎÈıÈÎfi ·ÛÎfi Î·È Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ Ë·ÙÈÎÔ‡ ¶˘Ï·›Ô˘ Û˘ÛÙ‹Ì·ÙÔ˜. ∆ËÓ 4Ë Â‚‰Ô-Ì¿‰· ÔÈ ‰‡Ô √ÌÊ·ÏÈΤ˜ ÊϤ‚˜ ÂÈÛÙÚ¤ÊÔ˘Ó ·›Ì· ·fi ÙÔÓ Ï·ÎÔ‡ÓÙ· ÛÙÔ ÙÚȯÔÂȉÈÎfi ‰›-ÎÙ˘Ô ÙÔ˘ ‹·ÙÔ˜. ∆ËÓ 5Ë Â‚‰ÔÌ¿‰· Ë ‰ÂÍÈ¿ Î·È ÙÔ ÂÁÁ‡˜ ÙÌ‹Ì· Ù˘ ·ÚÈÛÙÂÚ‹˜ √ÌÊ·ÏÈ΋˜ ÊϤ‚·˜ ÂÎÊ˘Ï›˙ÔÓÙ·È Ô‡Ùˆ˜ ÒÛÙ ÙÔ ·›Ì· ·fi ÙÔÓ Ï·ÎÔ‡ÓÙ· ÌÂٷʤÚÂÙ·È Ì¤Ûˆ ÌÈ·˜ ÌÔÓ·-‰È΋˜ √ÌÊ·ÏÈ΋˜ ÊϤ‚·˜. ∆ËÓ ›‰È· ÂÚ›Ô‰Ô Ë ·ÚÈÛÙÂÚ‹ √ÌÊ·ÏÈ΋ ÊϤ‚· Û¯ËÌ·Ù›˙ÂÈ ·Ó·-ÛÙÔÌÒÛÂȘ Ì ÙÔ˘˜ Ë·ÙÈÎÔ‡˜ ÎfiÏÔ˘˜ Î·È ÙÔÓ ÚfiÛÊ·Ù· Û¯ËÌ·ÙÈÛı¤ÓÙ· ºÏÂ‚Ò‰Ë ¶fiÚÔ. √ ºÏ‚҉˘ ¶fiÚÔ˜ ÂÈÙÚ¤ÂÈ ÛÙÔ ·›Ì· ·fi ÙËÓ √ÌÊ·ÏÈ΋ ÊϤ‚· Î·È ÙËÓ ¶˘Ï·›· ÊϤ‚· Ó· ·Ú·Î¿ÌÙÂÈ ÙÔ ‹·Ú Î·È Ó· Ú¤ÂÈ ÛÙËÓ ∫¿Ùˆ ∫Ô›ÏË ºÏ¤‚· Î·È ÙÔÓ ·Ú¯¤ÁÔÓÔ ÊÏ‚fiÎÔÏÔ. √È √ÌÊ·ÏÈΤ˜ ·ÚÙËڛ˜ ÚÈÓ ÙÔÓ ÙÔÎÂÙfi ›-Ó·È Û˘Ó¤¯ÂÈ· ÙˆÓ ¤Ûˆ Ï·ÁÔÓ›ˆÓ. ªÂÙ¿ ÙÔÓ ÙÔÎÂÙfi, ÙÔ ÙÌ‹Ì· ÌÂٷ͇ Ô˘ÚÔ‰fi¯Ô˘ ·ÛÙ˘ Î·È ÔÌÊ·ÏÔ‡ ·ÙÚÔÊ› Î·È Û¯ËÌ·Ù›˙ÂÈ ÙÔÓ ª¤-ÛÔ √ÌÊ·ÏÈÎfi Û‡Ó‰ÂÛÌÔ. ∆Ô ÙÌ‹Ì· ÌÂٷ͇ Ô˘-ÚÔ‰fi¯Ô˘ ·ÛÙ˘ Î·È ¤Ûˆ Ï·ÁÔÓ›Ô˘ ·ÚÙËÚ›·˜ ÌÂÈÒÓÂÙ·È Û ̤ÁÂıÔ˜ Î·È ‰›‰ÂÈ ÙȘ ∞ÓÒÙÂÚ˜ ∫˘ÛÙÈΤ˜ ·ÚÙËڛ˜. ™ÙÔÓ ÂÓ‹ÏÈη, ÙÔ ˘fiÏÂÈÌ-Ì· Ù˘ ·ÚÈÛÙÂÚ‹˜ √ÌÊ·ÏÈ΋˜ ÊϤ‚·˜ ·Ú·-̤ÓÂÈ ˆ˜ ™ÙÚÔÁÁ‡ÏÔ˜ Û‡Ó‰ÂÛÌÔ˜ ÙÔ˘ ‹·ÙÔ˜ ÂÓÒ ÙÔ ˘fiÏÂÈÌÌ· ÙÔ˘ ºÏÂ‚Ò‰Ô˘˜ ¶fiÚÔ˘ ·-ڷ̤ÓÂÈ ˆ˜ ºÏ‚҉˘ ™‡Ó‰ÂÛÌÔ˜ (∂ÈÎfiÓ˜ 5 & 6). °È· ÙËÓ ¶·ıÔÁ¤ÓÂÛË Ù˘ ªÔÓ‹ÚÔ˘˜ √ÌÊ·ÏÈ-΋˜ ∞ÚÙËÚ›·˜ ¤¯Ô˘Ó ·Ó·Ù˘¯ı› ÙÚ›˜ ıˆ-ڛ˜. ™‡Ìʈӷ Ì ÙËÓ ÚÒÙË ıˆڛ·, ÚfiÎÂÈ-Ù·È ÁÈ· ·ÁÂÓÂÛ›· Ù˘ ÌÈ¿˜ ÔÌÊ·ÏÈ΋˜ ·ÚÙË-Ú›·˜. ™‡Ìʈӷ Ì ÙË ‰Â‡ÙÂÚË ıˆڛ·, Ë ÌÔ-Ó‹Ú˘ ÔÌÊ·ÏÈ΋ ·ÚÙËÚ›· ÔÊ›ÏÂÙ·È Û ·Ú·-ÌÔÓ‹ (·ÔÙ˘¯›· ‰È·›ÚÂÛ˘) Ù˘ ÚÔÛˆÚÈÓ‹˜ ·Ú¯¤ÁÔÓ˘ ÔÌÊ·ÏÈ΋˜ ·ÚÙËÚ›·˜ Ô˘ ÚÔ¤Ú-¯ÂÙ·È ·fi ÙËÓ ÌÔÓ‹ÚË ∞ÏÏ·ÓÙÔ˚΋ ·ÚÙËÚ›· (ÛÙÔ ™Ù¤Ï¯Ԙ). ™‡Ìʈӷ, Ù¤ÏÔ˜, Ì ÙËÓ ÙÚ›ÙË ıˆڛ·, Â¤Ú¯ÂÙ·È ·ÙÚÔÊ›· ÌÈ¿˜ ÚÒËÓ Ê˘-ÛÈÔÏÔÁÈ΋˜ ·ÚÙËÚ›·˜. ∞Ó¿ÏÔÁ· Ì ÙÔ ·ÁÁÂ›Ô Ô˘ ·ÓÙÈÚÔÛˆ‡ÂÈ ÙËÓ √ÌÊ·ÏÈ΋ ∞ÚÙËÚ›·, ‰È·ÎÚ›ÓÔÓÙ·È ‰È¿ÊÔ-Ú˜ ηÙËÁÔڛ˜, fiˆ˜ §ÂÎÈıÈ΋, ∞ÏÏ·ÓÙÔ˚΋, ∞ÚÈÛÙÂÚ‹ ÔÌÊ·ÏÈ΋, ¢ÂÍÈ¿ ÔÌÊ·ÏÈ΋. ÕÏϘ ηÙËÁÔڛ˜ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·Ó¿ÏÔÁ· Ì ÙȘ Û˘Ó˘¿Ú¯Ô˘Û˜ ·ÓˆÌ·Ï›Â˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ·Ô˘Û›· ‹ ÙËÓ ·Ú·ÌÔÓ‹ ÙÔ˘ ·ÚÈÛÙÂ-ÚÔ‡ ‹ ÙÔ˘ ‰ÂÍÈÔ‡ ·ÁÁ›Ԣ. ∂› ϤÔÓ, ‰È·ÎÚ›-ÓÔÓÙ·È Î·È ‰È¿ÊÔÚ˜ ÌÔÚʤ˜, fiˆ˜ ∂ÏÈÎÔÂÈ-∂ÈÎfiÓ· 2. §ÂÎÈıÈÎfi˜ ∞ÛÎfi˜ ÛÙÔÓ Â͈ÂÌ‚Ú˘ÔÓÈÎfi ¯ÒÚÔ. ∂ÈÎfiÓ· 3. øfi Ì ÙË Ï¤ÎÈıÔ ÂÓÙfi˜ ÙÔ˘ ÏÂÎÈıÈÎÔ‡ ·ÛÎÔ‡, ÙËÓ ·ÏÏ·ÓÙÔ˚‰· Î·È ÙÔ˘˜ ÂÌ‚Ú˘˚ÎÔ‡˜ ˘Ì¤-Ó˜. ¢È·ÎÚ›ÓÂÙ·È Ô Û¯ËÌ·ÙÈÛÌfi˜ ·Ú¯¤ÁÔÓˆÓ ÙÚȯÔ-ÂȉÒÓ ¿Óˆ ÛÙÔÓ ÏÂÎÈıÈÎfi ·ÛÎfi.

‰‹˜ Î·È ∂˘ı›·. ™Â ¤Ì‚Ú˘· Ì ª√∞ ÔÏfiÎÏËÚË Ë ·ÈÌ·ÙÈ΋ ÚÔ‹ ÚÔ˜ ÙÔÓ Ï·ÎÔ‡ÓÙ· ‰ÈÂÓÂÚÁÂ›Ù·È Ì¤Ûˆ ÙˆÓ ÎÔÈÓÒÓ Î·È ¤Ûˆ Ï·ÁÔÓ›ˆÓ ·ÚÙËÚÈÒÓ ·fi ÙËÓ ÏÂ˘Ú¿ Ù˘ ÌÔÓ‹ÚÔ˘˜ ·ÚÙËÚ›·˜, ÂÓÒ Ù· ˘ÂÏÈο ·ÁÁ›· ·fi ÙËÓ ÏÂ˘Ú¿ Ù˘ ÂÏÏ›Ô˘-Û·˜ ·ÚÙËÚ›·˜ ‰ÂÓ Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ ÂÌ‚Ú˘Ô-Ï·ÎÔ˘ÓÙȷ΋ ΢ÎÏÔÊÔÚ›·. ∏ ·Û˘ÌÌÂÙÚ›· ·˘Ù‹ Ù˘ ˘ÂÏÈ΋˜ ·ÚÙËÚȷ΋˜ ·ÈÌ·ÙÈ΋˜ ÚÔ‹˜ ·˘Í¿ÓÂÈ Ì ÙËÓ ËÏÈΛ· ·ËÛ˘ Î·È ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· Ì›ˆÛË ÙˆÓ ·ÁÁÂÈ·ÎÒÓ ·ÓÙÈ-ÛÙ¿ÛÂˆÓ ÛÙÔÓ Ï·ÎÔ‡ÓÙ· Î·È ·‡ÍËÛË ÙˆÓ ·ÓÙÈÛÙ¿ÛÂˆÓ ÛÙ· οو ¿ÎÚ·.1 ∏ Û˘¯ÓfiÙËÙ· Ù˘ ª√∞ Â›Ó·È Ë˘ÍË̤ÓË Û ‰È¿ÊÔÚ˜ ηٷÛÙ¿ÛÂȘ ·ËÛ˘, fiˆ˜ ÛÙȘ ‰›-‰˘Ì˜ Î·È Ôχ‰›-‰˘Ì˜ ΢‹ÛÂȘ (5%), ÛÙȘ ·˘-ÙfiÌ·Ù˜ ÂÎÙÚÒÛÂȘ (2.5-20%), Û ·ÓˆÌ·Ï›Â˜ ÚfiÛÊ˘Û˘ ÙÔ˘ ÔÌÊ¿ÏÈÔ˘ ÏÒÚÔ˘, Û ̷ÎÚ‡ ÔÌÊ¿ÏÈÔ ÏÒÚÔ, Û ÌÈÎÚÔ‡˜ Ï·ÎÔ‡ÓÙ˜, ÛÙȘ ÔÏ˘ÙfiΘ (>3), Û ÌËÙ¤Ú˜ ÌÂÁ¿Ï˘ ËÏÈΛ·˜ (>40) Î·È Â› ı‹ÏÂÔ˜ ÂÌ‚Ú‡Ô˘ (¿ÚÚÂÓ· 1.0: ı‹Ï· 0.85). ™˘ÓËı¤ÛÙÂÚ· Ï›ÂÈ Ë ·ÚÈÛÙÂÚ‹ ÔÌÊ·ÏÈ΋ ·ÚÙËÚ›·. ∂›Û˘ Ë Û˘¯ÓfiÙËÙ· Â›Ó·È Ë˘ÍË̤ÓË ÛÙË Ï¢΋ Ê˘Ï‹ (Û ۯ¤ÛË Ì ÙËÓ ·ÊÚÔ·ÌÂÚÈηÓÈ΋ Î·È ÙËÓ È·ˆÓÈ΋) Î·È Û ÌËÙ¤Ú˜ Ì ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË. ™ÙȘ ∏¶∞ Ë ª√∞ ··ÓÙ¿Ù·È ÛÙÔ 1% ÙˆÓ Î˘‹ÛˆÓ, ÂÓÒ ÁÂÓÈÎÒ˜ Ë Û˘¯ÓfiÙËÙ¿ Ù˘ Î˘Ì·›ÓÂÙ·È Ì ٷ͇ 0.5-7%. ™˘Ó‰˘¿˙ÂÙ·È Ì ‰È¿ÊÔÚ˜ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·-ϛ˜ Û ÔÛÔÛÙfi Ô˘ Î˘Ì·›ÓÂÙ·È ÌÂٷ͇ 21.6-32.2 %. √È ·ÓˆÌ·Ï›Â˜ ·ÊÔÚÔ‡Ó Î˘Ú›ˆ˜ ÛÙÔ Ì˘ÔÛÎÂÏÂÙÈÎfi Û‡ÛÙËÌ·, Î·È Ì Êı›ÓÔ˘Û· Û˘-¯ÓfiÙËÙ· ·ÎÔÏÔ˘ıÔ‡Ó ÙÔ Ô˘ÚÔÁÂÓÓËÙÈÎfi, ÙÔ Î·Ú‰È·ÁÁÂÈ·Îfi, ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi, ÙÔ ÎÂÓÙÚÈ-Îfi Ó¢ÚÈÎÂÓÙÚÈ-Îfi Û‡ÛÙËÌ· Î·È ÙÔ ·Ó·Ó¢ÛÙÈÎÂÓÙÚÈ-Îfi2,3 (¶›Ó·Î·˜ 1). ÃÚˆÌÔÛˆÌÈΤ˜ ·ÓˆÌ·Ï›Â˜ ·Ó¢ڛÛÎÔÓÙ·È ÛÙÔ 10-15% Î·È ·ÊÔÚÔ‡Ó ÙËÓ ∆ÚÈۈ̛·18, ÙËÓ ∆ÚÈۈ̛· 13, ÙÔ Û‡Ó‰ÚÔÌÔ Turner’s, ∆ÚÈ-ÏÔÂȉÈÛÌfi, Î·È Û·Ó›ˆ˜ ÙËÓ ∆ÚÈۈ̛· 21. ∂› ·Ó¢ڤÛˆ˜ ª√∞, Ô Î›Ó‰˘ÓÔ˜ ·ÓÒÌ·ÏÔ˘ ÂÌ‚Ú‡Ô˘ Â›Ó·È Ë˘ÍË̤ÓÔ˜ Ù¤ÛÛ·Ú˜ ÊÔÚ¤˜ (¶›Ó·Î˜ 1,2,3,4). ∂› ª√∞ ·Ú·ÙËÚÂ›Ù·È ¶ÚfiˆÚÔ˜ ÙÔÎÂÙfi˜ (<37‚‰.) Û ÔÛÔÛÙfi 20% Î·È ÀÔÏÂÈfiÌÂ-ÓË ∂Ó‰ÔÌ‹ÙÚÈ· ∞Ó¿Ù˘ÍË-IUGR (<2500ÁÚ) Û ÔÛÔÛÙfi 15-20%.4 ∏ ¶ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙ˘ Â›Ó·È 20% Î·È ∂ÈÎfiÓ· 4. ∞ÏÏ·ÓÙÔ˚΋ ∫˘ÎÏÔÊÔÚ›· -¢Â‡ÙÂÚË ∂͈ÂÌ‚Ú˘˚΋ ∫˘ÎÏÔÊÔÚ›·. ∂ÈÎfiÓ· 5. √ÌÊ·ÏÈ΋ ∫˘ÎÏÔÊÔÚ›·.

·fi ·˘Ù‹Ó, Ù· 2/3 ·ÊÔÚÔ‡Ó ÂÓ‰ÔÌ‹ÙÚÈÔ˘˜ ı·-Ó¿ÙÔ˘˜ ÂÓÒ ÙÔ 1/3 ÔÊ›ÏÂÙ·È Û ‰È·Ì·Úٛ˜, ÚÔˆÚfiÙËÙ·, Î·È IUGR. ∏ ÂÈÏÔÁ‹ Ù˘ ı¤Û˘ ÙÔ˘ ˘¿Ú¯ÔÓÙÔ˜ (‹ ÂÏ-Ï›ÔÓÙÔ˜) ·ÁÁ›Ԣ Â›Ó·È Ù˘¯·›· ·ÏÏ¿ ÂÏ·-ÊÚÒ˜ Û˘¯ÓfiÙÂÚË Â›Ó·È Ë ‰ÂÍÈ¿ ÌÔÓ‹Ú˘ ÔÌÊ·-ÏÈ΋ ·ÚÙËÚ›· (Ë ·ÎÚÈ‚‹˜ ı¤ÛË Ù˘ ÌÔÓ‹ÚÔ˘˜ ÔÌÊ·ÏÈ΋˜ ·ÚÙËÚ›·˜ ÌÔÚ› Ó· ÚÔÛ‰ÈÔÚÈ-Ûı› ˘ÂÚ˯ÔÁÚ·ÊÈο Ì ·ÎÚ›‚ÂÈ·, ·fi ÙȘ ·Ú¯¤˜ ÙÔ˘ ‚’ ÙÚÈÌ‹ÓÔ˘). ¢ÂÓ ¤¯ÂÈ ‰Âȯı› Û˘-Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ ÏÂ˘Ú¿˜ ÙÔ˘ ˘¿Ú¯ÔÓÙÔ˜ (‹ ÂÏÏ›ÔÓÙÔ˜) ·ÁÁ›Ԣ Ì ¯ÚˆÌÔÛˆÌÈΤ˜ ‹ Û˘ÁÁÂÓ›˜ ‰È·Ì·Úٛ˜, Ì ÙÔ Â›‰Ô˜ ÙˆÓ ¿ÏÏˆÓ ·ÓˆÌ·ÏÈÒÓ, Ì ÙËÓ ‚·Ú‡ÙËÙ· ÙˆÓ ·ÓˆÌ·ÏÈÒÓ, ÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ¿ÏÏˆÓ ·ÓˆÌ·ÏÈÒÓ Î·È ÙËÓ ¤Î‚·ÛË Ù˘ ˘Á›·˜ ÙÔ˘ ÓÂÔÁÓÔ‡.5,6 ∏ ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË Â›Ó·È ÂÊÈÎÙ‹ Ì ÙË ‚Ô‹ıÂÈ· ÙˆÓ ˘ÂÚ‹¯ˆÓ. ÃÚËÛÈÌÔÔÈÔ‡ÓÙ·È fiϘ ÔÈ ‰È·ı¤ÛÈ̘ Ù¯ÓÔÏÔÁ›Â˜ (B-Mode-Gray Scale, Color Flow Doppler, Power

Doppler, ∂ȉÈΤ˜ Ú˘ıÌ›ÛÂȘ). ∏ ‰È¿ÁÓˆÛË Ù˘ ª√∞ Á›ÓÂÙ·È Û ‰‡Ô ·ÚȘ ˘ÂÚ˯ÔÁÚ·ÊÈ-Τ˜ ÙÔ̤˜, Û ÂÁοÚÛÈ· ÙÔÌ‹ ÙÔ˘ ÔÌÊ·Ï›Ô˘ ÏÒÚÔ˘ Î·È Û ̛· ·ÍÔÓÈ΋ (ÂÈÌ‹ÎË) ÙÔÌ‹ Á‡-Úˆ ·fi ÙËÓ Ô˘ÚÔ‰fi¯Ô ·ÛÙË ÙÔ˘ ÂÌ‚Ú‡Ô˘. ™·ÓÈfiÙÂÚ· ‚ÔËı¿ Ì›· ÙÚ›ÙË, ÛÙÂÊ·ÓÈ·›· ÙÔ-Ì‹ ÛÙÔÓ ‰È¯·ÛÌfi Ù˘ ·ÔÚÙ‹˜. ∏ ˘ÂÚ˯ÔηÚ-‰ÈÔÁÚ·Ê›· ÙÔ˘ ÂÌ‚Ú‡Ô˘ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÚÔ-ÛʤÚÂÈ Î¿ÙÈ È‰È·›ÙÂÚÔ ÛÙËÓ ÚÔÁÂÓÓËÙÈ΋ ‰È¿-ÁÓˆÛË Ù˘ ª√∞ ÂÊfiÛÔÓ ¤¯ÂÈ ÏËÊı› Ë ÙÔÌ‹ ÙˆÓ ÙÂÛÛ¿ÚˆÓ ÎÔÈÏÔÙ‹ÙˆÓ Î·È ¤¯Ô˘Ó ÂÏÂÁ¯ı› ÔÈ Ô‰Ô› ·ÈÌ·ÙÈ΋˜ ÂÎÚÔ‹˜ (¯ÒÚÔÈ ÂÍÒıËÛ˘) Ù˘ ηډȿ˜.7 _{∏ ‰È¿ÁÓˆÛË ÙÂÎÌËÚÈÒÓÂÙ·È} ÈÛÙÔÏÔÁÈο, ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi (∂ÈÎfiÓ· 7). ™Â ÂÁοÚÛÈ· ÙÔÌ‹ ÙÔ˘ ÔÌÊ·Ï›Ô˘ ÏÒÚÔ˘ (B-Mode Scan/Grey Scale) ‰È·ÎÚ›ÓÔÓÙ·È ÌfiÓÔ ‰‡Ô ·ÁÁ›·, ¤Ó· ÌÂÁ·Ï‡ÙÂÚ˘ ‰È·Ì¤ÙÚÔ˘ Ô˘ ·ÓÙÈÚÔÛˆ‡ÂÈ ÙËÓ ÔÌÊ·ÏÈ΋ ÊϤ‚· Î·È ¤Ó· ÌÈÎÚfiÙÂÚ˘ ‰È·Ì¤ÙÚÔ˘ Ô˘ ·ÓÙÈÚÔÛˆ‡ÂÈ ÙËÓ ÔÌÊ·ÏÈ΋ ·ÚÙËÚ›·. ™ÙËÓ ›‰È· ÙÔÌ‹ Ë ‰È¿-¶›Ó·Î·˜ 1. ñ ™˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜=21.6-32.2% (ª™, √À°, ∫∞, °∂, ∫¡™, ∞¡) ñ ÃÚˆÌÔÛˆÌÈΤ˜ ·ÓˆÌ·Ï›Â˜=10-15% (∆ÚÈÛ.18, ∆ÚÈÛ.13, Turner’s, ∆ÚÈÏÔÂȉÈÛÌfi˜, Û·Ó›ˆ˜ ÙÚÈÛ.21) ñ ∫›Ó‰˘ÓÔ˜ ·ÓÒÌ·ÏÔ˘ ÂÌ‚Ú‡Ô˘ ˢÍË̤ÓÔ˜ ¯4.10 ∂ÈÎfiÓ· 6. ∏ ÂÌ‚Ú˘˚΋ ΢ÎÏÔÊÔÚ›·

ÌÂÙÚÔ˜ Ù˘ ÔÌÊ·ÏÈ΋˜ ·ÚÙËÚ›·˜ Â›Ó·È ÌÂÁ·Ï‡-ÙÂÚË ·fi ÙË Ê˘ÛÈÔÏÔÁÈ΋ ÙÈÌ‹ Ù˘ οı ·ÚÙË-Ú›·˜ Û ÏÒÚÔ ÙÚÈÒÓ ·ÁÁ›ˆÓ (> 4 mm Û ·Ë-ÛË 20-36 ‚‰.). ∏ ÛÎfi¢·Ë-ÛË Ú¤ÂÈ Ó· Á›ÓÂÙ·È Ì·ÎÚ˘¿ ·fi ÙÔÓ Ï·ÎÔ‡ÓÙ·, ‰ÈfiÙÈ ÎÔÓÙ¿ Û’·˘-ÙfiÓ ÔÈ ·ÚÙËڛ˜ Û˘¯Ó¿ Û˘Á¯ˆÓ‡ÔÓÙ·È Î·È Î·-ı›ÛÙ·Ù·È ‰˘Û¯ÂÚ‹˜ Ë ·ÎÚÈ‚‹˜ ̤ÙÚËÛ‹ ÙÔ˘˜8 (∂ÈÎfiÓ˜ 8 & 9). ™ÙÔÓ ¶›Ó·Î· 5 ·Ú·Ù›ıÂÓÙ·È ÔÈ Ê˘ÛÈÔÏÔÁÈΤ˜ ÂÁοÚÛȘ ‰È¿ÌÂÙÚÔÈ ÙˆÓ ÔÌ-Ê·ÏÈÎÒÓ ·ÁÁ›ˆÓ.9 ™ÙËÓ ·ÍÔÓÈ΋ ÙÔÌ‹ Á‡Úˆ ·fi ÙËÓ Ô˘ÚÔ‰fi¯Ô ·ÛÙË Ê·›ÓÂÙ·È ÌfiÓÔ Ì›· ·ÚÙËÚ›· Û οÔÈ· ·fi ÙȘ ‰‡Ô Ï¢ڤ˜ Ù˘ Ô˘ÚÔ‰fi¯Ô˘ ·ÛÙˆ˜ ÂÓÒ Ê˘ÛÈÔÏÔÁÈο ¤ÚÂ ӷ ˘¿Ú¯ÂÈ ·fi ÌÈ· ·ÚÙËÚ›· Âη٤ڈıÂÓ (∂ÈÎfiÓ· 10). ª›· ÛÙÂÊ·ÓÈ·›· ÙÔÌ‹ ÛÙÔÓ ‰È¯·ÛÌfi Ù˘ ·ÔÚ-Ù‹˜ ÌÔÚ› Ó· Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ ·ÛÊ·Ï‹ ‰È¿-ÁÓˆÛË Ù˘ ª√∞. ∏ ηÙÈÔ‡Û· ·ÔÚÙ‹ Ê˘ÛÈÔÏÔ-ÁÈο ‰È¯¿˙ÂÙ·È ÛÙȘ ‰‡Ô ÎÔÈÓ¤˜ Ï·ÁfiÓȘ ·Ú-ÙËڛ˜ Ô˘ ¤¯Ô˘Ó ›‰È· ‰È¿ÌÂÙÚÔ. ∏ ·ÔÚÙ‹ ÛÙ· ¤Ì‚Ú˘· Ì ª√∞ ¤¯ÂÈ ÌÈ· ÂÏ·ÊÚ¿ ·ÚÙˆÛË ÚÔ˜ ¤Ó· ÎÔÈÓfi Ï·ÁfiÓÈÔ ·ÁÁÂ›Ô Ì ‰È¿ÌÂÙÚÔ ¶›Ó·Î·˜ 2. ∞Ó¢ÏÔÂȉÈÛÌÔ› Ô˘ ¤¯Ô˘Ó Û˘Ó‰˘·Ûı› Ì ÔÌÊ¿ÏÈÔ ÏÒÚÔ ‰‡Ô ·ÁÁ›ˆÓ.

Table 2. Aneuploidy in association with two-vessel umbilical cords.

Gestational age at Karyotype Associated malformations Malformations not

diagnosis (weeks) seen on scan seen on scan

18 trisomy 13 Dandy Walker malformation,

bilateral hydronephrosis, postaxial Polydactyly

18 trisomy 18 choroid plexus cysts, tracheoesophageal fistula

ventricular septal defect, clenched hands

20+ _{46,XY; Dandy Walker malformation,}

-14, +H13; 14 cleft lip and palate, ventricular septal defect, overriding aorta,

pleural effusion, small pulmonary artery

20++ _{46,XY del(4) (pl3) symmetric IUGR at 20 weeks,}

oligohydramnios at 32 weeks

20+ _{trisomy 18 choroid plexus cysts, cleft lip,}

atrial septal defect, ventricular septal defect, clenched hands*

25* triploidy Hydrocephaly, atrioventricular canal,

truncus arteriosus, IUGR

29 trisomy 21 hydronephrosis, polyhydramnios

34 trisomy 18 holoprosencephaly. ventricular

septal defect, diaphragmatic hernia, umbilical cord cyst, clenched

fists*, polyhydramnios

35 trisomy 18 diaphragmatic hernia. ? ventricular

septal defect, clenched fists, polyhydramnios*

35 monosomy X enlarged right atrium pulmonic stenosis,

and ventricle, left multicystic endocardial fibroelastosis dysplastic kidney

Gestational age Gestational age Weight Anomalies Anomalies not seen a diagnosis (weeks) at delivery (weeks) seen on scan on scan

16 aborted Dandy Walker malformation,

meningomyelocele

17.5 40 2887 choroid plexus cyst

(resolved at 22 weeks)

18 aborted cystic hygroma,

diaphragmatic hernia

20 aborted polysplenia, single ventricle, double outlet

hypoplastic left ventricle, right ventricle non-immune hydrops, transposition

right-sided stomach

20 39 3872 right multicystic

dysplastic kidney

20 37 2319 Hydronephrosis, IUGR

21 aborted anencephaly. Heart deviated

right. No autopsy*

21 aborted IUGR. cystic adenomatoid

lung malformation, hypoplastic left heart and aortic arch, right multicystic dysplastic kidney,

echogenic bowel

23 38 4900 bladder outlet obstruction, ascites club feet

23 39 2325 ventricular septal defect, double

outlet right ventricle, polyhydramnios

24 35 IUGR hydrocephaly. IUGR.

meningomyelocele, in utero fetal demise, normal co-twin

24 37 2255 omphalocele, right renal agenesis, bladder

imperforate anus. IUGR. exstrophy oligohydramnios

26 41 2948 CHARGE association; cleft lip, micro penis,

polyhydramnios, atrial septal defect, hypospadias, ventricular septal defect cleft palate 27 31 1191 VATER association, enlarged right ventricular septal

ventricle, abnormal umbilical vein defect, course in liver, polyhydramnios tracheoesophageal

fistula

29 38 3130 aqueductul stenosis, ventricular septal defect,

hydrocephaly transposition, pulmonic atresia

29 37 2832 omphalocele, neonatal death

29 40 4200 suprasellar arachnoid cyst hemangioma left calf

30 41 2778 subarachnoid cyst, atrioventricular tracheoesophageal septal defect fistula, imperforate

anus, missing one finger left hand

31 38 2070 Hypoplastic left heart, double outlet

right ventricle, neonatal death

¶›Ó·Î·˜ 3. ¢ÔÌÈΤ˜ ·ÓˆÌ·Ï›Â˜ Ô˘ ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛı› Ì ª√∞ Î·È Â›Ù ‰È·ÎÚ›ÓÔÓÙ·È Â›Ù ‰ÂÓ

‰È·ÎÚ›ÓÔ-ÓÙ·È Ì ÙÔ˘˜ ˘¤ÚË¯Ô˘˜. º˘ÛÈÔÏÔÁÈÎfi˜ ηڢfiÙ˘Ô˜ ‹ ÎÏÈÓÈο ¯ˆÚ›˜ ˘Ô„›· ·Ó¢ÏÔÂȉ›·˜.

Table 3. Associated structural defects on scan; normal chromosomes or no suspicion of aneuploidy on

›‰ÈÔ Ì Ù˘ ·ÔÚÙ‹˜ ÛÙËÓ ÏÂ˘Ú¿ Ô˘ ˘¿Ú¯ÂÈ Ë ÔÌÊ·ÏÈ΋ ·ÚÙËÚ›· ÂÓÒ ÛÙËÓ ÏÂ˘Ú¿ Ô˘ Ï›ÂÈ Ë ÔÌÊ·ÏÈ΋ ·ÚÙËÚ›· ÙÔ Ï·ÁfiÓÈÔ ·ÁÁÂ›Ô Â›Ó·È ÌÈÎÚfi ‹ Î·È ‰˘Û‰È¿ÎÚÈÙÔ. ∏ ·ÛÊ·Ï‹˜ fï˜ ‰È¿ÁÓˆÛË Ù˘ ª√∞ ‰ÂÓ Â›-Ó·È ¿ÓÙ· ÂÊÈÎÙ‹. ∏ ‰˘Ó·ÙfiÙËÙ· ˘ÂÚ˯Ô-ÁÚ·ÊÈ΋˜ ‰È¿ÁÓˆÛ˘ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ ¿¯Ô˜ ÙˆÓ ÎÔÈÏÈ·ÎÒÓ ÙÔȯˆÌ¿ÙˆÓ Ù˘ ÌËÙ¤Ú·˜, ·fi ÙËÓ ‡·ÚÍË ¯·ÌËÏ‹˜ ÂÁηÚÛ›·˜ ÙÔÌ‹˜, ·fi ÙËÓ ËÏÈΛ· ·ËÛ˘, ·fi ÙË ı¤ÛË Î·È ÚÔ‚ÔÏ‹ ÙÔ˘ ÂÌ‚Ú‡Ô˘, ·fi ÙË ÔÛfiÙËÙ· ÙÔ˘ ·ÌÓÈ·ÎÔ‡ ˘ÁÚÔ‡, ·fi ÙÔ ‚·ıÌfi ÂÚȤÏÈ͢ ÙˆÓ ·ÁÁ›ˆÓ, ·fi ÙË Ï¢ÚÈ΋ ·Ó¿Ï˘ÛË ÙÔ˘ Ì˯·Ó‹Ì·ÙÔ˜, ·fi ÙÔ ‚·ıÌfi Û‡ÓÙË͢ ÙˆÓ ·ÁÁ›ˆÓ ÎÔÓÙ¿ ÛÙÔÓ Ï·ÎÔ‡ÓÙ· Î·È ·fi ÙËÓ ÂÌÂÈÚ›· ÙÔ˘ ÂÍÂÙ·ÛÙ‹. ∏ ‰ÂÈÓfiÙËÙ· ÙÔ˘ ˘ÂÚ˯ÔÁÚ·ÊÈÛÙ‹ ÁÈ· Â›Ù¢ÍË ÈηÓÔÔÈËÙÈ΋˜ ·ÂÈÎfiÓÈÛ˘ (Ì gray scale) Ù˘ ·Ó·ÙÔÌ›·˜ ÙˆÓ ·ÁÁ›ˆÓ ÙÔ˘ ÔÌÊ¿ÏÈÔ˘ ÏÒÚÔ˘ ÂϤÁ¯ıËΠÁÈ· ÙÔ ‰È¿ÛÙËÌ· ÌÂٷ͇ Ù˘ 15˘-20˘ ‚‰. ·ËÛ˘ Î·È ˘ÔÏÔ-Á›ÛıËΠfiÙÈ ÌÔÚ› Ó· ÂÈÙ¢¯ı› ÔÚı‹ ÚÔ-ÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË ÛÙÔ 89% ÙˆÓ ÂÚÈÙÒÛÂ-ˆÓ ·ÏÏ¿ ı· Ì›ÓÂÈ Î·È ¤Ó· ÔÛÔÛÙfi 11% „¢-‰Ò˜ ıÂÙÈÎÒÓ ‰È·ÁÓÒÛÂˆÓ ·ÎfiÌË Î·È ·fi ¤ÌÂÈÚÔ˘˜ ÂÍÂÙ·ÛÙ¤˜. ¶ÂÚ›Ô˘ ÙÔ 66% ÙˆÓ ÂÌ‚Ú‡ˆÓ ÛÙȘ 16-17 ‚‰ÔÌ¿‰Â˜ Î·È ÙÔ 97% ¶›Ó·Î·˜ 5. º˘ÛÈÔÏÔÁÈΤ˜ ÂÁοÚÛȘ ‰È¿ÌÂÙÚÔÈ ÙÔ˘ ÔÌÊ¿ÏÈÔ˘ ÏÒÚÔ˘ Î·È ÙˆÓ ·ÁÁ›ˆÓ ÙÔ˘.9

31 31 1615 hvdranencephalv. cleft lip palate

32 37 1840 VATER: heart in right chest, abnormal tracheal duplication umbilical vein course in liver, tracheoesophageal renal cyst, absent radii and thumbs, fistula, imperforate polyhydramnios anus, hemivertehrae

34 38 3090 VATER: polyhydramnios tracheoesophageal

hydronephrosis fistula, imperforate anus

35 38 2950 meningomyelocele, club feet

35 18 3445 truncus arteriosus

36 39 bilateral hydronephrosis,

bicuspid aortic valve

37 37.5 AGA oligohydramnios, hydrocephaly, sacral agenesia

dextrocardia. renal agenesis 38.5 38.5 2280 anencephaly. bilateral cleft lip palate

*, failed chromosome culture; IUGR, intrauterine growth retardation; AGA, appropriate for gestational age

Gestational age Gestational age Weight Anomalies Anomalies not seen a diagnosis (weeks) at delivery (weeks) seen on scan on scan

Û˘Ó¤¯ÂÈ· ›Ó·Î·˜ 3 ¶›Ó·Î·˜ 6.¢ÂÈÓfiÙËÙ· ÙÔ˘ ˘ÂÚ˯ÔÁÚ·ÊÈÛÙ‹ ÁÈ· Â›Ù¢ÍË ÈηÓÔÔÈËÙÈ΋˜ ·ÂÈÎfiÓÈÛ˘ (gray scale) Ù˘ ·Ó·ÙÔÌ›·˜ ÙˆÓ ·ÁÁ›ˆÓ ÙÔ˘ ÔÌÊ¿ÏÈÔ˘ ÏÒÚÔ˘ ÌÂٷ͇ Ù˘ 15˘-20˘ ‚‰ÔÌ¿‰·˜ ·ËÛ˘. ñ ™ˆÛÙ‹ ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË = 89% ñ 梉Ҙ ıÂÙÈ΋ ‰È¿ÁÓˆÛË = 11% ñ ¶Ú¿ÛÈÓ˜ ÛًϘ (·¯Ó¤˜) = ÏÒÚÔÈ Ô˘ ·ÂÈÎÔ-Ó›ÛÙËÎ·Ó ñ ∫fiÎÎÈÓ˜ ÛًϘ (ÛÎÔ‡Ú˜) = ÏÒÚÔÈ Ô˘ ‰ÂÓ ·ÂÈÎÔÓ›ÛÙËηÓ.10

¶›Ó·Î·˜ 4. ¢ÔÌÈΤ˜ ·ÓˆÌ·Ï›Â˜ Ô˘ ‰ÂÓ ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛı› Ì ª√∞. Table 4. No associated fetal anomalies on scan.

Gestational age Gestational age Comments Anomalies not seen

at diagnosis (weeks) at delivery (weeks) on scan

17 23 discordant twins,

demise both twins, velamentous cord insertions

both twins

18 31 concordant twins, preterm labor, velamentous cord insertion

18 40

19 36 abruptio placentae

19 39

19 40 marginal cord insertion; LGA

19.5 37

20 39

20 40

21 33 Abruption placentae

22 35 IUGR; oligohydramnios

22 35 early onset IUGR Goltz syndrome, syndactyly. microphthalmia

22 38

22 42

22 31 abruptio placentae, IUGR, In utero felal demise

23 40

23 38 velamentous cord insertion

23 41 24 39 25 38 IUGR 26 26 premature rupture of membranes 26 37 26 40 27 39

29 31 IUGR. oligohydrammos mild

hydronephrosis 29 36 Polyhydramnios, preterm labor

29 40

30 31 concordant twins, premature rupture of membranes, velamentous

cord insertion

30 38 tracheoesophageal fistula

and esophageal atresia

30 38

30 34 severe preeclampsia

31 39

31 40 IUGR

ÛÙȘ 18-19 ‚‰ÔÌ¿‰Â˜ ·ËÛ˘ ¤¯Ô˘Ó ÔÌÊ¿ÏÈ-Ô˘˜ ÏÒÚÔÌÊ¿ÏÈ-Ô˘˜ Ô˘ ÂϤÁ¯ÔÓÙ·È ÈηÓÔÔÈËÙÈο Ì ÙËÓ Ù¯ÓÔÏÔÁ›· ‰È·‚·ıÌ›ÛÂˆÓ ÙÔ˘ ÁÎÚÈ (gray scale)10 _{(¶›Ó·Î·˜ 6). ∏ ÚÔÁÂÓÓËÙÈ΋} ‰È¿-ÁÓˆÛË Ù˘ ª√∞ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ˘˜ ÚÔ·-Ó·ÊÂÚı¤ÓÙ˜ ·Ú¿ÁÔÓÙ˜ Î·È ‰˘Û¯ÂÚ·›ÓÂÙ·È ·fi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÎÔÓÙ¿ ÛÙÔÓ Ï·ÎÔ‡ÓÙ· ÌÔÚ› Ó· Û˘Ì‚Â› ‰È·ÊfiÚÔ˘ ‚·ıÌÔ‡ Û˘Ó¤Óˆ-ÛË ÙˆÓ ·ÁÁ›ˆÓ.8_{∂›Û˘ Ô Nyberg Î·È Û˘Ó.}11 ·Ó·ÛÎfiËÛ·Ó 107 ¤Ì‚Ú˘· Ì ÁÓˆÛÙ¤˜ ·Óˆ-̷ϛ˜ ÙÔ˘ ∫¡™ Î·È ÛËÌ›ˆÛ·Ó fiÙÈ ÙÔ 18% (20 ¤Ì‚Ú˘·) ›¯·Ó ÔÌÊ¿ÏÈÔ ÏÒÚÔ ‰‡Ô ·ÁÁ›-ˆÓ. ∞fi Ù· ›ÎÔÛÈ ·˘Ù¿ ¤Ì‚Ú˘·, ÌfiÓÔ Ù· ÂÍ Â›¯·Ó ·ÓȯÓ¢ı› ÚÔÔÙÈο Ì ÚÔÁÂÓÓËÙÈ΋ ˘ÂÚ˯ÔÁÚ·Ê›·. ÕÏÏ· ÂÍ ¤Ì‚Ú˘· ›¯·Ó ·ÓÈ-¯Ó¢ı› Ì ·Ó·‰ÚÔÌÈÎfi ¤ÏÂÁ¯Ô ÂÓÒ Ù· ˘fi-ÏÔÈ· ÔÎÙÒ ‰ÂÓ ‰È·ÁÓÒÛıËÎ·Ó ÏfiÁˆ ÔÏÈÁ¿-ÌÓÈÔ˘ ‹ ¿ÏÏˆÓ Ù¯ÓÈÎÒÓ ‰˘Û¯ÂÚÂÈÒÓ. ™Â Ì›· ¿ÏÏË ÚÔÔÙÈ΋ ÌÂϤÙË 450 ·ÛıÂÓÒÓ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ·ÓȯÓ‡ıËÎ·Ó ÂÓÓ¤· ¤Ì‚Ú˘· Ì ª√∞.12 _{∏ ϤÔÓ ÚÒÈÌË ‰È¿ÁÓˆÛË ª√∞} ¤ÁÈÓ ÛÙËÓ 23Ë Â‚‰ÔÌ¿‰· ·ËÛ˘. ¢‡Ô ¤Ì-‚Ú˘· ›¯·Ó ˘Ô„›· ª√∞ ÂÓÒ ÙÚ›· ¤Ì¤Ì-‚Ú˘· ÌÂ

Gestational age Gestational age Comments Anomalies not seen

at diagnosis (weeks) at delivery (weeks)

32 33 Discordanttwins, symmetric IUGR, oligohydramnios, velamentous cord insertion

32 35 Placenta previa

32 37 Concordant twins, AGA

32 38 IUGR, twins, co-twin AGA

33 36 preeclampsia

34 37 twins hydrocephaly. mild

left hydronephrosis

36 40

38 38

39 40

41 41

IUGR, intrauterine growth retardation; LGA, large for gestational age; AGA. appropriate for gestational age; Û˘Ó¤¯ÂÈ· ›Ó·Î·˜ 4

∂ÈÎfiÓ· 7. πÛÙÔÏÔÁÈ΋ ÙÂÎÌËÚ›ˆÛË Ù˘ ÌÔÓ‹ÚÔ˘˜

ÔÌÊ·ÏÈ΋˜ ·ÚÙËÚ›·˜.3

∂ÈÎfiÓ· 8. ∂ÁηÚÛ›· ÙÔÌ‹ ÙÔ˘ ÔÌÊ·Ï›Ô˘ ÏÒÚÔ˘

(B-Mode Scan / Grey Scale). ∏ ‰È¿ÌÂÙÚÔ˜ Ù˘ ÔÌ-Ê·ÏÈ΋˜ ·ÚÙËÚ›·˜ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË ·fi ÙË Ê˘ÛÈÔ-ÏÔÁÈ΋ ÙÈÌ‹ οı ·ÚÙËÚ›·˜ Û ÏÒÚÔ ÙÚÈÒÓ ·ÁÁ›ˆÓ (> 4 mm Û ·ËÛË 20-36 ‚‰.). ∏ ÛÎfi¢ÛË Ú¤-ÂÈ Ó· Á›ÓÂÙ·È Ì·ÎÚ˘¿ ·fi ÙÔÓ Ï·ÎÔ‡ÓÙ·, ‰ÈfiÙÈ ÎÔÓÙ¿ Û’·˘ÙfiÓ ÔÈ ·ÚÙËڛ˜ Û˘¯Ó¿ Û˘Á¯ˆÓ‡ÔÓÙ·È.

ª√∞ ‰ÂÓ Â›¯·Ó ‰È·ÁÓˆÛı› ηıfiÏÔ˘. ∂Ù¿ ·fi Ù· ÂÓÓ¤· ¤Ì‚Ú˘· Ì ª√∞ ›¯·Ó ‰ÔÌÈΤ˜ ·ÓˆÌ·Ï›Â˜. √È ·ÓˆÙ¤Úˆ ·˘Ù¤˜ ÌÂϤÙ˜ ÙÔÓ›˙Ô˘Ó ÙËÓ ·Ó¿-ÁÎË ÁÈ· ηχÙÂÚ˜ ·ÂÈÎÔÓÈÛÙÈΤ˜ Ù¯ÓÈΤ˜ Ô˘ ı· ÌÔÚÔ‡Û·Ó Ó· ‚ÂÏÙÈÒÛÔ˘Ó ÙȘ Èı·Ófi-ÙËÙ˜ ·ÔÙÂÏÂÛÌ·ÙÈ΋˜ ‰È¿ÁÓˆÛ˘ ÙÔ˘ ÔÌÊ·-Ï›Ô˘ ÏÒÚÔ˘ Ì ‰‡Ô ·ÁÁ›·, ÂȉÈο ηٿ ÙËÓ ÚÒÈÌË Î‡ËÛË ‹ οو ·fi ÌË È‰·ÓÈΤ˜ Û˘Óı‹-Θ ˘ÂÚ˯ÔÁÚ¿ÊËÛ˘. °È’·˘Ùfi, ÁÈ· ÙË ‰È¿-ÁÓˆÛË ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È fiϘ ÔÈ ‰È·ÙÈı¤ÌÂ-Ó˜ Ù¯ÓÔÏÔÁ›Â˜ ˘ÂÚ‹¯ˆÓ Î·È Ï·Ì‚¿ÓÔÓÙ·È fiϘ ÔÈ ‰˘Ó·Ù¤˜ ÙÔ̤˜. √˘ÛÈ·ÛÙÈ΋ ‚Ô‹ıÂÈ· ÚÔÛʤÚÂÈ Ë ¤Á¯ÚˆÌË ·ÂÈÎfiÓÈÛË Ù˘ ÚÔ‹˜ ÙˆÓ ÔÌÊ·ÏÈÎÒÓ ·ÚÙËÚÈÒÓ Ì ·Ú¿ÏÏËÏË Âͤ-Ù·ÛË Doppler (Colour Flow Doppler Imaging). √È Ù·¯‡ÙËÙ˜ Ì ÙÔ Doppler ·ÓÈ-¯Ó‡ÔÓÙ·È Î·Ï‡ÙÂÚ· fiÙ·Ó Ë ÁˆÓ›· ˯ԂfiÏË-Û˘ Â›Ó·È ·Ú¿ÏÏËÏË ÛÙË ÚÔ‹ ÙÔ˘ ·›Ì·ÙÔ˜. ™ÙËÓ ÂÁοÚÛÈ· ÙÔÌ‹ ÙÔ˘ ÔÌÊ¿ÏÈÔ˘ ÏÒÚÔ˘ Ë ˘ÂÚ˯È΋ ‰¤ÛÌË ÛÙÚ¤ÊÂÙ·È Î¿ıÂÙ· ÚÔ˜ ÙËÓ ·ÈÌ·ÙÈ΋ ÚÔ‹ Î·È ıˆÚËÙÈο ‰ÂÓ ·Ú¿ÁÂÈ Î·-Ó¤Ó· Û‹Ì· Doppler (∂ÈÎfiÓ˜ 11,12,13). ∂ȉÈ-Τ˜ Ù¯ÓÈ∂ȉÈ-Τ˜ Color Doppler ÌÔÚÔ‡Ó Ó· ¯ÚË-ÛÈÌÔÔÈËıÔ‡Ó ÁÈ· ÙËÓ ·ÂÈÎfiÓÈÛË ÙˆÓ ÔÌÊ·-ÏÈÎÒÓ ·ÚÙËÚÈÒÓ Û ·ÍÔÓÈ΋ ÙÔÌ‹ Á‡Úˆ ·fi ÙËÓ Ô˘ÚÔ‰fi¯Ô ·ÛÙË. ∂Ê·ÚÌfi˙ÂÙ·È Ì›· Îϛ̷-η ¯·ÌËÏÒÓ Ù·¯˘Ù‹ÙˆÓ Doppler (ÂÚ›Ô˘ 20-40 cm/sec) ÒÛÙ ӷ ˘¿Ú¯ÂÈ Ë Î·Ù¿ÏÏËÏË Â˘-·ÈÛıËÛ›·. ∏ ÈÔ ¯Ú‹ÛÈÌË ·ÂÈÎfiÓÈÛË Ï·Ì‚¿-ÓÂÙ·È ÛÙÔ Â›Â‰Ô Ù˘ Ô˘ÚÔ‰fi¯Ô˘ ·ÛÙ˘ Ì ÙȘ ‰‡Ô ÈۯȷΤ˜ ¿Î·Óı˜ Ó· Ê·›ÓÔÓÙ·È ÚÔ˜ Ù· ›Ûˆ (ÌÚÔÛÙ¿ Ô ÔÌÊ·Ïfi˜). ∆Ô ·ÎÔ˘ÛÙÈÎfi ·Ú¿ı˘ÚÔ Ô˘ ‰ËÌÈÔ˘ÚÁ›ٷÈ, ÂÈÙÚ¤ÂÈ ÛÙË ÁˆÓ›· ˯ԂfiÏËÛ˘ Ó· Â›Ó·È ·Ú¿ÏÏËÏË Ì ÙË ÚÔ‹ ÙÔ˘ ·›Ì·ÙÔ˜ Î·È Ó· ·Ú¿ÁÂÈ ¤Ó· Û‹Ì· Doppler Ô˘ Û˘ÏÏ·Ì‚¿ÓÂÙ·È Â‡ÎÔÏ· (∂ÈÎfiÓ· 14). ∏ Ù¯ÓÈ΋ ‚·Û›˙ÂÙ·È ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ‰‡Ô ÔÌÊ·ÏÈΤ˜ ·ÚÙËڛ˜ ÚÔ·ÙÔ˘Ó Û·Ó ÚÔ¤ÎÙ·ÛË ÙˆÓ ‰‡Ô Ï·ÁfiÓÈˆÓ ·ÚÙËÚÈÒÓ Î·È ÂÚÈ‚¿ÏÏÔ˘Ó ÙËÓ Ô˘ÚÔ‰fi¯Ô ·ÛÙË. √È ‰‡Ô ÎÏ¿‰ÔÈ ÂͤگÔÓÙ·È ‰È· ÙÔ˘ ÂÌ‚Ú˘˚ÎÔ‡ ÔÌÊ·-ÏÔ‡ Î·È ÂÚÈÂÏ›ÛÛÔÓÙ·È Ì ÙËÓ ÔÌÊ·ÏÈ΋ ÊϤ-‚· ÁÈ· Ó· Û¯ËÌ·Ù›ÛÔ˘Ó ÙÔÓ ÏÒÚÔ ÙˆÓ ÙÚÈÒÓ ·ÁÁ›ˆÓ. ∏ Ù¯ÓÈ΋ ÂÊ·ÚÌfi˙ÂÙ·È ·fi ÙËÓ 14.5-16 ‚‰. ·ËÛ˘ fiÔ˘ Î·È ¤¯ÂÈ È‰È·›ÙÂÚË ·Í›· ‰ÈfiÙÈ Û ·˘Ù¤˜ ÙȘ ‹ÏÈ˘ ·ËÛ˘ Ù· Ô-ÛÔÛÙ¿ ÈηÓÔÔÈËÙÈ΋˜ ·ÂÈÎfiÓÈÛ˘ (gray scale) Ù˘ ·Ó·ÙÔÌ›·˜ ÙˆÓ ·ÁÁ›ˆÓ ÙÔ˘ ÔÌÊ¿-ÏÈÔ˘ ÏÒÚÔ˘ Â›Ó·È ÂÓȯڿ. £¤Ì· ¢È·ÊÔÚÈ΋˜ ¢È¿ÁÓˆÛ˘ Ù˘ ª√∞ ‰ÂÓ Ù›ıÂÙ·È, ηıfiÙÈ Ë Î·Ù¿ÛÙ·ÛË Â›Ó·È È‰È·›ÙÂÚË Î·È ÌÔÓ·‰È΋. ª›· ·ËÛË Ì ª√∞ ÌÔÚ› Ó· ÂÍÂÏȯı› ¯ˆ-Ú›˜ η̛· ÂÈÏÔ΋13_{, ÁÂÓÈο fï˜ ˘¿Ú¯ÂÈ} ˢÍË̤ÓÔ˜ ΛӉ˘ÓÔ˜ ÁÈ· η΋ ÂÚÈÁÂÓÓËÙÈ΋ ¤Î‚·ÛË. √ ΛӉ˘ÓÔ˜ ·˘Ùfi˜ Â›Ó·È ·ÎfiÌË ÌÂÁ·-χÙÂÚÔ˜ Â¿Ó Û˘Ó˘¿Ú¯Ô˘Ó Î·È ‰ÔÌÈΤ˜ ·Óˆ-̷ϛ˜ ÙÔ˘ ÂÌ‚Ú‡Ô˘.14 ∂¿Ó ‰È·ÈÛÙˆı› ÌÔÓ‹Ú˘ ÔÌÊ·ÏÈ΋ ·ÚÙËÚ›· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·ËÛ˘, Á›ÓÂÙ·È ¤Ó·˜ ÏÂ-∂ÈÎfiÓ· 9. ∂ÁηÚÛ›· ÙÔÌ‹ ÙÔ˘ ÔÌÊ·Ï›Ô˘ ÏÒÚÔ˘

(B-Mode Scan / Grey Scale).

∂ÈÎfiÓ· 10. AÍÔÓÈ΋ (ÂÈÌ‹Î˘) ÙÔÌ‹ Á‡Úˆ ·fi

ÙËÓ Ô˘ÚÔ‰fi¯Ô ·ÛÙË. º·›ÓÂÙ·È ÌfiÓÔ Ì›· ·ÚÙËÚ›· ÛÙË Ì›· ÏÂ˘Ú¿ Ù˘ Ô˘ÚÔ‰fi¯Ô˘ ·ÛÙˆ˜ ÂÓÒ Ê˘-ÛÈÔÏÔÁÈο ¤ÚÂ ӷ ˘¿Ú¯ÂÈ ·fi ÌÈ· ·ÚÙËÚ›· Âη٤ڈıÂÓ.

ÙÔÌÂÚ‹˜ ˘ÂÚ˯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙˆÓ ÈÛÙÒÓ Î·È ÔÚÁ¿ÓˆÓ ÁÈ· Èı·Ó‹ ·Ó‡ÚÂÛË ¿Ï-ÏˆÓ ‰ÔÌÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ, ȉ›ˆ˜ Ù˘ ηډȿ˜. ∂›Û˘ Á›ÓÂÙ·È ·ÌÓÈÔ·Ú·Î¤ÓÙËÛË ÁÈ· ÙË ‰È¿-ÁÓˆÛË Èı·ÓÒÓ ¯ÚˆÌÔÛˆÌÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ Ì ηڢfiÙ˘Ô, ȉ›ˆ˜ Â¿Ó ¤¯ÂÈ ‚ÚÂı› οÔÈ· ·ÓˆÌ·Ï›·. ∆Ô ¤Ì‚Ú˘Ô ·Ú·ÎÔÏÔ˘ıÂ›Ù·È ˘Â-Ú˯ÔÁÚ·ÊÈο Û ٷÎÙÈ΋ ‚¿ÛË Î·Ù¿ ÙÔ Á’ ÙÚ›-ÌËÓÔ, ΢ڛˆ˜ ÁÈ· ˘ÔÏÂÈfiÌÂÓË ·Ó¿Ù˘ÍË (IUGR). ∏ ·ÓÙÈÌÂÙÒÈÛË ÂÍ·ÚÙ¿Ù·È ·fi ÙË Û˘Ó˘¿Ú¯Ô˘Û· ·ÓˆÌ·Ï›·. ªÂÙ¿ ÙÔÓ ÙÔÎÂÙfi ·ÎÔÏÔ˘ı› ÂͤٷÛË ÙÔ˘ ÓÂÔ-ÁÓÔ‡ ÁÈ· ‰˘ÛÌÔÚʛ˜, ÎÔÈÏȷΤ˜ Ì¿˙˜ Î·È Î·Ú‰È·Î¿ ÓÔÛ‹Ì·Ù·. ∂› ˘Ô„›·˜ ¿ÏÏˆÓ ·ÓˆÌ·ÏÈÒÓ ÂÎÙÂÏÂ›Ù·È ÂÚ·ÈÙ¤Úˆ ηٿÏÏËÏÔ˜ ¤ÏÂÁ¯Ô˜ (·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÍÂÙ¿ÛÂȘ, ηڢfiÙ˘-Ô˜ ÎÙÏ.) ÂÓÒ Â¿Ó ‰ÂÓ ¤¯ÂÈ ÙÂı› ˘Ô„›· ¿Ï-ÏˆÓ ·ÓˆÌ·ÏÈÒÓ ‰ÂÓ ÂÎÙÂÏÂ›Ù·È Ù›ÔÙ ¿ÏÏÔ.2 ∂ÈÎfiÓ· 14. ÃÚ‹ÛÈÌË ·ÂÈÎfiÓÈÛË Ô˘ Ï·Ì‚¿ÓÂÙ·È ÛÙÔ Â›Â‰Ô Ù˘ Ô˘ÚÔ‰fi¯Ô˘ ·ÛÙ˘ Ì ÙȘ ‰‡Ô ÈۯȷΤ˜ ¿Î·Óı˜ Ó· Ê·›ÓÔÓÙ·È ÚÔ˜ Ù· ›Ûˆ (ÌÚÔÛÙ¿ Ô ÔÌÊ·Ïfi˜). ∆Ô ·ÎÔ˘ÛÙÈÎfi ·Ú¿ı˘ÚÔ Ô˘ ‰ËÌÈÔ˘ÚÁÂ›Ù·È ÂÈÙÚ¤ÂÈ ÛÙË ÁˆÓ›· ˯ԂfiÏË-Û˘ Ó· Â›Ó·È ·Ú¿ÏÏËÏË Ì ÙË ÚÔ‹ ÙÔ˘ ·›Ì·ÙÔ˜ Î·È Ó· ·Ú¿ÁÂÈ ¤Ó· Û‹Ì· Doppler Ô˘ Û˘ÏÏ·Ì‚¿ÓÂÙ·È Â‡ÎÔÏ·.10 ∂ÈÎfiÓ· 13. ∞ÂÈÎfiÓÈÛË ÙˆÓ ÔÌÊ·ÏÈÎÒÓ ·ÚÙËÚÈÒÓ Á‡Úˆ ·fi ÙËÓ Ô˘ÚÔ‰fi¯Ô ·ÛÙË Û ·ÍÔÓÈ΋ (ÂÈÌ‹-ÎË) ÙÔÌ‹ Á‡Úˆ ·fi ÙËÓ Ô˘ÚÔ‰fi¯Ô ·ÛÙË Ì Color Flow Doppler. ∂ÈÎfiÓ· 12. ∞ÂÈÎfiÓÈÛË ÙˆÓ ÔÌÊ·ÏÈÎÒÓ ·ÁÁ›ˆÓ Û ·ÍÔÓÈ΋ (ÂÈÌ‹ÎË) ÙÔÌ‹ Á‡Úˆ ·fi ÙËÓ Ô˘ÚÔ‰fi¯Ô ·ÛÙË Ì Color Flow Doppler. ¢È·ÎÚ›ÓÂÙ·È ÌÔÓ‹-Ú˘ ·ÚÙËÚ›·. √ ·ÛÙÂÚ›ÛÎÔ˜ ‰Â›¯ÓÂÈ ÙË ı¤ÛË Ô˘ ı· ¤ÚÂ ӷ ‚Ú›ÛÎÂÙ·È Ë ¿ÏÏË ÔÌÊ·ÏÈ΋ ·ÚÙËÚ›·.

∂ÈÎfiÓ· 11. ∂ÁηÚÛ›· ÙÔÌ‹ ÙÔ˘ ÔÌÊ·Ï›Ô˘ ÏÒÚÔ˘

Single Umbilical Artery

B. S. Tsapanos

Department of Obstetrics and Gynecology, Medical School, University of Patras-Greece

Correspondence: University of Patra, P.G. N. Rio 26500 Rio-Patra

E-mail: [email protected], [email protected]

Summary

Single umbilical artery occurs in fewer than 1% of cords in singletons and is found more frequently in certain populations, obstetric complications and fetal disorders. It is be-lieved to be caused by atrophy of a previously normal artery, presence of the original artery of the body stalk, or agenesis of one of the umbilical arteries.

Single umbilical arteries are associated more commonly with fetal anomalies than normal cords. Thirty percent have congenital anom-alies, which may include trisomy 13, trisomy 18, and triploidy; trisomy 21 is uncommon. A 20% perinatal mortality rate exists.

The vessels in the cord are clearly identifiable with ultrasound. The vein usually is larger than the arteries. The presence of only 2 ves-sels on an ultrasound cross section is highly suggestive of a single umbilical artery. Using the colour flow doppler imaging in an axial section alongside the bladder, there is only one vessel on either side of it.

Conduct a detailed anatomy survey, especially fetal echocardiograms, whenever a 2-vessel cord is discovered. If anomalies are found, consider fetal karyotyping. Because growth is retarded in 30% of affected fetuses, consider a third trimester ultrasound for fetal growth. Twenty percent are delivered prematurely. Use neonatal ultrasound liberally to examine for anomalies.

Key words: single umbilical artery, two-vessel cord

µÈ‚ÏÈÔÁÚ·Ê›·

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∞ÓÙÛ·-ÎÏ‹˜ ∞.: ªÔÓ‹Ú˘ ÔÌÊ·ÏÈ΋ ·ÚÙËÚ›·: ¶·ÚÔ˘Û›·ÛË ÂÓfi˜ ÂÚÈÛÙ·ÙÈÎÔ‡ Î·È ·Ó·ÛÎfiËÛ˘ Ù˘ ‰ÈÂıÓÔ‡˜ ‚È-‚ÏÈÔÁÚ·Ê›·˜. À¶∂ƒ∏Ã√°ƒ∞ºπ∞ 2005; ∆ÔÌ.2,

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