Congenital heart disease (CC) is one of the most frequent congenital anomalies, with 6-8 cases per 1000 live births, and one of the main causes of neonatal morbidity. However, the countless scientific and technological advances in our century have allowed the development of high quality prenatal medicine and culture, which have allowed a significant reduction in perinatal morbidity and mortality. This thesis analyzes the organization of the diagnostic-assistance pathway dedicated to congenital heart disease in use in the Marche Region since 2017, the year in which Regional Resolution 855 of October 12, 2015 concerning the "Guidelines for the organization of prenatal diagnosis" came into force. Assessing the results obtained from 2017 to 2020 in the Marche Region, the objective was to establish the actual effectiveness of the care model in use and whether it represented an attractive pole for neighboring regions. Starting from a sample of 176 patients who underwent cardiac surgery within the first 6 months of life, in the period from 2017 to 2020, the study sought to identify their region of origin and whether they had received a prenatal diagnosis of CC; in the extra-regional patients, a distinction was made between who had received the diagnosis in their region of origin and who had received it in the Marche Region, continuing their subsequent care there. The study showed that there is no trend of improvement in the rate of prenatal diagnosis in the four-year period investigated, suggesting that improvements are to be made in peripheral centers that centralize patients at the second level. It was then confirmed the important influx from the neighboring regions for the II level care in pregnancy.
Le cardiopatie congenite (CC) sono le anomalie congenite più frequenti, se ne identificano infatti 6-8 casi ogni 1000 nati vivi, e sono tra le principali cause di morbilità neonatale; gli innumerevoli progressi in campo scientifico e tecnologico nel nostro secolo però hanno permesso di mettere a punto una medicina e una cultura prenatale di elevata qualità, le quali hanno consentito una riduzione notevole della morbosità e della mortalità perinatale. Tale tesi analizza l’organizzazione del percorso diagnostico-assistenziale dedicato alle cardiopatie congenite in uso nella Regione Marche a partire dal 2017, anno dell’entrata in vigore della Delibera Regionale 855 del 12 Ottobre 2015 riguardante le “Linee di indirizzo per l’organizzazione della diagnosi prenatale”. Valutando i risultati ottenuti dal 2017 al 2020 nella Regione Marche, si è posto l’obiettivo di stabilire l’effettiva efficacia del modello assistenziale in uso e se questo rappresentasse un polo attrattivo per le regioni limitrofe. Partendo da un campione costituito da 176 pazienti sottoposti ad intervento cardiochirurgico entro i primi 6 mesi di vita, nell’arco temporale che va dal 2017 al 2020, si è ricercata la loro regione di provenienza e se avessero ricevuto una diagnosi prenatale di CC; nei pazienti extraregionali si è evidenziato chi avesse ricevuto la diagnosi nella Regione di appartenenza o chi nella Regione Marche, proseguendovi anche la successiva assistenza. Dallo studio è emerso che non c’è un trend di miglioramento nel tasso di diagnosi prenatale nel quadriennio indagato, questo suggerisce che perfezionamenti sono da eseguire nei centri periferici che accentrano i pazienti al II° livello. Si è poi confermato l’importante afflusso dalle Regioni limitrofe anche per l’assistenza di II° livello in gravidanza.
Gestione delle gravide con feti cardiopatici. Il modello assistenziale nella Regione Marche
BARZOTTI, ELEONORA
2020/2021
Abstract
Congenital heart disease (CC) is one of the most frequent congenital anomalies, with 6-8 cases per 1000 live births, and one of the main causes of neonatal morbidity. However, the countless scientific and technological advances in our century have allowed the development of high quality prenatal medicine and culture, which have allowed a significant reduction in perinatal morbidity and mortality. This thesis analyzes the organization of the diagnostic-assistance pathway dedicated to congenital heart disease in use in the Marche Region since 2017, the year in which Regional Resolution 855 of October 12, 2015 concerning the "Guidelines for the organization of prenatal diagnosis" came into force. Assessing the results obtained from 2017 to 2020 in the Marche Region, the objective was to establish the actual effectiveness of the care model in use and whether it represented an attractive pole for neighboring regions. Starting from a sample of 176 patients who underwent cardiac surgery within the first 6 months of life, in the period from 2017 to 2020, the study sought to identify their region of origin and whether they had received a prenatal diagnosis of CC; in the extra-regional patients, a distinction was made between who had received the diagnosis in their region of origin and who had received it in the Marche Region, continuing their subsequent care there. The study showed that there is no trend of improvement in the rate of prenatal diagnosis in the four-year period investigated, suggesting that improvements are to be made in peripheral centers that centralize patients at the second level. It was then confirmed the important influx from the neighboring regions for the II level care in pregnancy.File | Dimensione | Formato | |
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Tesi Barzotti Eleonora.pdf
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https://hdl.handle.net/20.500.12075/874