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Ultraschall Med 2022; 43(06): e105-e111
DOI: 10.1055/a-1232-1179
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Is There a Role for Cerebral Ultrasonography in Near-Term/Term Neonates Following Assisted Vaginal Delivery? A Prospective, Single-Center Study

Welche Rolle spielt die zerebrale Sonografie bei Neugeborenen nach vaginal-operativer Entbindung kurz vor oder am Termin? Eine prospektive Studie an einem Zentrum
Martin Poryo
1   Department of Pediatric Cardiology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany
,
Anika Zimmer
2   Medical School, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany
,
Amr Hamza
3   Department of Gynecology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany
,
Stefan Wagenpfeil
4   Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany
,
Michael Zemlin
5   Department of Pediatrics and Neonatology, Universitatsklinikum des Saarlandes und Medizinische Fakultat der Universitat des Saarlandes, General Pediatrics and Neonatology, Germany
,
Martina Geipel
5   Department of Pediatrics and Neonatology, Universitatsklinikum des Saarlandes und Medizinische Fakultat der Universitat des Saarlandes, General Pediatrics and Neonatology, Germany
,
Günther Löffler
5   Department of Pediatrics and Neonatology, Universitatsklinikum des Saarlandes und Medizinische Fakultat der Universitat des Saarlandes, General Pediatrics and Neonatology, Germany
,
Sascha Meyer
5   Department of Pediatrics and Neonatology, Universitatsklinikum des Saarlandes und Medizinische Fakultat der Universitat des Saarlandes, General Pediatrics and Neonatology, Germany
6   Department of Neuropediatrics, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany
,
Erol Tutdibi
5   Department of Pediatrics and Neonatology, Universitatsklinikum des Saarlandes und Medizinische Fakultat der Universitat des Saarlandes, General Pediatrics and Neonatology, Germany
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Abstract

Aim To evaluate the role of cerebral ultrasonography studies (CUSS) in detecting intracerebral and cranial pathologies (hemorrhages, ischemia, skull fractures) in near-term and term neonates following assisted vaginal delivery.

Patients and Methods Prospective single-center study (11/2017–11/2018) at the University Children’s Hospital of Saarland, Homburg, Germany including newborns with a gestational age ≥ 36 weeks born by assisted vaginal delivery. In all newborns, a standardized CUSS was performed within the first three days of life prior to discharge.

Results 200 neonates (43.0 % female, 57.0 % male; gestational age 39.6 ± 1.3 weeks) were included in this study (birth weight 3345.6 ± 450.6 g, body length 51.7 ± 2.5 cm, head circumference 35.0 ± 1.5 cm). 67 (33.5 %) neonates had minor external injuries of the scalp. 5 children showed clinical neurologic abnormalities: 4 (2.0 %) seizures and 1 facial palsy (0.5 %). In 34 (17.0 %) patients, minor incidental intracranial abnormalities unrelated to mode of delivery were detected on CUSS. No intracerebral, cranial pathologies or skull fractures were seen on routine CUSS.

Conclusion Routine CUSS in newborns after assisted vaginal delivery did not yield clinically relevant results in our cohort. Clinical observation and selective CUSS in symptomatic newborns might be more efficient than routine CUSS.

Zusammenfassung

Ziel Bewertung der Rolle von zerebralen Ultraschalluntersuchungen (cUS) bei der Erkennung von intrazerebralen und kranialen Pathologien (Blutungen, Ischämie, Schädelfrakturen) bei Neugeborenen nach vaginal-operativer Entbindung kurz vor oder am Termin.

Patienten und Methoden Prospektive Studie an einem einzigen Zentrum (11/2017–11/2018) am Universitätskinderklinikum, Homburg, Deutschland, die Neugeborene mit einem Gestationsalter von ≥ 36 Wochen nach vaginal-operativer Entbindung einschließt. Bei allen Neugeborenen wurde innerhalb der ersten drei Lebenstage vor Entlassung ein standardisierter cUS durchgeführt.

Ergebnisse 200 Neugeborene (43,0 % weiblich, 57,0 % männlich; Gestationsalter 39,6 ± 1,3 Wochen) wurden in diese Studie eingeschlossen (Geburtsgewicht 3345,6 ± 450,6 g, Körperlänge 51,7 ± 2,5 cm, Kopfumfang 35,0 ± 1,5 cm). 67 Neugeborene (33,5 %) hatten leichte, äußere Verletzungen der Kopfhaut. 5 Kinder wiesen klinische neurologische Anomalien auf: 4 Krampfanfälle (2,0 %) und 1 Faszialisparese (0,5 %). Bei 34 Patienten (17,0 %) wurden im cUS geringfügige zufällige intrakraniale Anomalien festgestellt, die nicht mit dem Entbindungsmodus zusammenhingen. Beim Routine-cUS wurden keine intrazerebralen oder kranialen Pathologien oder Schädelfrakturen festgestellt.

Schlussfolgerung Routine-cUS bei Neugeborenen nach vaginal-operativer Entbindung erbrachte in unserer Kohorte keine klinisch relevanten Ergebnisse. Klinische Beobachtung und selektiver cUS sind bei symptomatischen Neugeborenen möglicherweise effizienter als routinemäßiger cUS.

Key words

assisted vaginal delivery - vacuum extraction - cerebral ultrasonography study - hemorrhage - ischemia - skull fracture


Publication History

Received: 07 August 2019

Accepted: 28 July 2020

Article published online:
10 September 2020

© 2020. Thieme. All rights reserved.

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