早孕期系统性超声筛查在胎儿结构畸形诊断中的临床应用价值
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摘要
目的探讨早孕期系统性筛查在胎儿结构畸形诊断中的应用价值。方法选取2252例来我社康中心进行早孕期(11-13+6w)、中孕期(22-24+6w)检查的孕妇,检查时间为2016年5月至2018年5月期间,采用SIEMENSS2000彩色多普勒超声诊断仪(百胜Mylab90)经腹超声检查,3.5-5.0MHz腹部超声探头,进行胎儿正中矢状切面、颅脑横切面、NT切面、侧脑室切面、双耳切面、静脉导管频谱图、腹围切面、双眼冠状切面、四腔心切面、脐带入口切面、双下肢切面、膀胱切面、双上肢切面扫查,观察检查结果。结果 2252例胎儿异常病例总数为103例(4.57%),其中神经系统异常胎儿17例(16.50%),心血管异常胎儿23例(22.33%),泌尿系统异常8例(7.77%),骨骼四肢异常12例(11.65%),消化系统异常2例(1.94%),前腹壁畸形7例(6.80%),呼吸系统异常胎儿1例(0.97%),颜面部畸形5例(4.85%),颈部水囊瘤15例(14.56%),其他异常13例(12.62%)。早孕期超声检查共检出45例,检出率为43.69%,其中前腹壁畸形7例(15.22%),骨骼、四肢异常胎儿8例(17.39%);颈部水囊瘤15例(32.61%);神经系统异常胎儿7例(15.22%);颜面部畸形1例(2.17%);心血管异常胎儿2例(4.35%);其他异常6例(13.04%),未发现消化系统、泌尿系统及呼吸系统异常,上述结果均经引产后证实;早孕期畸形胎儿检出率与中孕期比较无明显差异性(P>0.05),而早中孕期联合诊断胎儿畸形检出率与中孕期及早孕期检出率比较均有明显差异性(P<0.05)。结论早孕期系统性超声筛查在筛查胎儿畸形中的临床价值较高,能发现多种严重结构异常,而早孕期和中孕期联合超声筛查,可使胎儿结构畸形的检出率提高,减少出生缺陷。
Objective:To explore the value of systematic screening in early pregnancy in the diagnosis of fetal structural abnormalities.Methods:2252 cases of pregnant women who came to Our community center for early pregnancy(11-13+6weeks)and middle pregnancy(22-24+6 weeks)were examined during the period from May 2016 to May 2018.Transabdominal ultrasonography was performed by SIEMENS S2000 color Doppler ultrasound diagnostic system(Yum Mylab 90)and 3.5-5.0MHz abdominal ultrasonic probe to carry out the median sagittal section of the fetus,the craniocerebral transverse section,the NT section,the lateral ventricle section,the double ears cutting surface,the venous catheter spectrum,the abdominal circumference,the coronal section of the binocular,the four cavities,the entrance of the umbilical cord,the cut of the lower extremities,the cut of the bladder,the tangent face of the upper limb,and the double upper limb of the upper limb to scan.Observed the inspection results.Results:Among the 2252 fetuses,the total number of abnormal cases was 103(4.57%),of which 17 cases were abnormal in the nervous system(16.50%),23 cases in the fetus with abnormal cardiovascular disease(22.33%),8 cases in the urinary system(7.77%),12 cases(11.65%)in the extremities of the bones,2 cases(1.94%)in the digestive system,and the respiration of the anterior abdominal wall,and respiration.There were 1 case of abnormal fetus(0.97%),facial deformity in 5 cases(4.85%),cervical NT thickening and neck water cystoma in 15 cases(14.56%),and other abnormalities in 13 cases(12.62%).A total of 45 cases were detected by ultrasonography in early pregnancy,the detection rate was 43.69%,of which 7 cases were anterior wall deformity(15.22%),and 8 cases were abnormal bone and limb(17.39%).Cervical NT thickening and neck sac were found in 15 cases(32.61%).7 cases of abnormal fetal nerve system(15.22%);1 case of facial deformity(2.17%);2 cases of fetal cardiovascular abnormalities(4.35%);Other abnormalities were found in 6 cases(13.04%),and no digestive system,urinary system and respiratory system were found,all of the above results were confirmed after induction of labor.There was no significant difference between the detection rate of fetal malformation during the early pregnancy and the middle pregnancy(P>0.05),but the detection rate of fetal malformation in the early and middle pregnancy was significantly different from that in the middle pregnancy and the early pregnancy(P<0.05).Conclusion:Systemic ultrasound screening in early pregnancy is of high clinical value in screening fetal malformation,and a variety of severe structural abnormalities can be found.Early pregnancy and mid pregnancy combined ultrasound screening can improve the detection rate of fetal structural malformation and reduce birth defects.
Objective:To explore the value of systematic screening in early pregnancy in the diagnosis of fetal structural abnormalities.Methods:2252 cases of pregnant women who came to Our community center for early pregnancy(11-13+6weeks)and middle pregnancy(22-24+6 weeks)were examined during the period from May 2016 to May 2018.Transabdominal ultrasonography was performed by SIEMENS S2000 color Doppler ultrasound diagnostic system(Yum Mylab 90)and 3.5-5.0MHz abdominal ultrasonic probe to carry out the median sagittal section of the fetus,the craniocerebral transverse section,the NT section,the lateral ventricle section,the double ears cutting surface,the venous catheter spectrum,the abdominal circumference,the coronal section of the binocular,the four cavities,the entrance of the umbilical cord,the cut of the lower extremities,the cut of the bladder,the tangent face of the upper limb,and the double upper limb of the upper limb to scan.Observed the inspection results.Results:Among the 2252 fetuses,the total number of abnormal cases was 103(4.57%),of which 17 cases were abnormal in the nervous system(16.50%),23 cases in the fetus with abnormal cardiovascular disease(22.33%),8 cases in the urinary system(7.77%),12 cases(11.65%)in the extremities of the bones,2 cases(1.94%)in the digestive system,and the respiration of the anterior abdominal wall,and respiration.There were 1 case of abnormal fetus(0.97%),facial deformity in 5 cases(4.85%),cervical NT thickening and neck water cystoma in 15 cases(14.56%),and other abnormalities in 13 cases(12.62%).A total of 45 cases were detected by ultrasonography in early pregnancy,the detection rate was 43.69%,of which 7 cases were anterior wall deformity(15.22%),and 8 cases were abnormal bone and limb(17.39%).Cervical NT thickening and neck sac were found in 15 cases(32.61%).7 cases of abnormal fetal nerve system(15.22%);1 case of facial deformity(2.17%);2 cases of fetal cardiovascular abnormalities(4.35%);Other abnormalities were found in 6 cases(13.04%),and no digestive system,urinary system and respiratory system were found,all of the above results were confirmed after induction of labor.There was no significant difference between the detection rate of fetal malformation during the early pregnancy and the middle pregnancy(P>0.05),but the detection rate of fetal malformation in the early and middle pregnancy was significantly different from that in the middle pregnancy and the early pregnancy(P<0.05).Conclusion:Systemic ultrasound screening in early pregnancy is of high clinical value in screening fetal malformation,and a variety of severe structural abnormalities can be found.Early pregnancy and mid pregnancy combined ultrasound screening can improve the detection rate of fetal structural malformation and reduce birth defects.
引文
[1]霍晓恺,刘泰石,解耀锃,等.早孕期超声筛查在胎儿结构畸形诊断中的应用[J].中国妇幼健康研究,2016,27(9):1071-1073.
[2]王海玉.二维超声联合四维超声对不同孕周胎儿畸形诊断的价值分析[J].中国计划生育学杂志,2015,23(1):38-40,45.
[3]何冠南,罗红,杨家翔,等.孕11~13+6w产前超声筛查胎儿肢体畸形的价值[J].中国医学影像学杂志,2014,22(8):634-637.
[4]汪云,孟卓,徐英,等.标准化超声切面筛查孕11~13+6w胎儿结构畸形的临床价值及效果分析[J].山西医药杂志,2016,45(5):507-509.
[5]郑明明,唐慧荣,张燕,等.早孕期系统胎儿超声结构筛查诊断胎儿异常的价值[J].中华围产医学杂志,2017,20(3):183-189.
[6]孙丽娟,王欣,吴青青,等.超声检查胎儿颈项透明层厚度在筛查胎儿染色体异常中的价值[J].中华妇产科杂志,2013,48(11):819-823.
[7]易艳,熊奕,林琪,等.胎儿颅脑正中矢状面智能三维超声成像系统的初步应用研究[J].中华超声影像学杂志,2015,24(3):246-248.
[8]侯莉,张冬梅,杨懿,等.胎儿超声软标记或结构畸形与染色体异常的关系探讨[J].实用妇产科杂志,2015,31(7):552-555.
[9]张茂春,张红薇,周洪贵,等.胎儿结构畸形的产前超声筛查价值及相关危险因素分析[J].中国妇幼保健,2016,31(11):2402-2404.
[10]Espinoza,J.,Lee,W.,Vials,F.et al.Collaborative study of4-dimensional fetal echocardiography in the first trimester of pregnancy[J].Journal of Ultrasound in Medicine[J].Official Journal of the American Institute of Ultrasound in Medicine,2014,33(6):1079-1084.
[11]丁海耀,周文蓉.二维联合四维超声检查在先天性心脏畸形胎儿产前诊断中的应用[J].山东医药,2016,56(20):63-64.
[12]邓凤莲,郭燕丽,段灵敏,等.产前超声检查对胎儿前脑无裂畸形的诊断价值[J].中国临床医学影像杂志,2014,25(4):256-259.
[2]王海玉.二维超声联合四维超声对不同孕周胎儿畸形诊断的价值分析[J].中国计划生育学杂志,2015,23(1):38-40,45.
[3]何冠南,罗红,杨家翔,等.孕11~13+6w产前超声筛查胎儿肢体畸形的价值[J].中国医学影像学杂志,2014,22(8):634-637.
[4]汪云,孟卓,徐英,等.标准化超声切面筛查孕11~13+6w胎儿结构畸形的临床价值及效果分析[J].山西医药杂志,2016,45(5):507-509.
[5]郑明明,唐慧荣,张燕,等.早孕期系统胎儿超声结构筛查诊断胎儿异常的价值[J].中华围产医学杂志,2017,20(3):183-189.
[6]孙丽娟,王欣,吴青青,等.超声检查胎儿颈项透明层厚度在筛查胎儿染色体异常中的价值[J].中华妇产科杂志,2013,48(11):819-823.
[7]易艳,熊奕,林琪,等.胎儿颅脑正中矢状面智能三维超声成像系统的初步应用研究[J].中华超声影像学杂志,2015,24(3):246-248.
[8]侯莉,张冬梅,杨懿,等.胎儿超声软标记或结构畸形与染色体异常的关系探讨[J].实用妇产科杂志,2015,31(7):552-555.
[9]张茂春,张红薇,周洪贵,等.胎儿结构畸形的产前超声筛查价值及相关危险因素分析[J].中国妇幼保健,2016,31(11):2402-2404.
[10]Espinoza,J.,Lee,W.,Vials,F.et al.Collaborative study of4-dimensional fetal echocardiography in the first trimester of pregnancy[J].Journal of Ultrasound in Medicine[J].Official Journal of the American Institute of Ultrasound in Medicine,2014,33(6):1079-1084.
[11]丁海耀,周文蓉.二维联合四维超声检查在先天性心脏畸形胎儿产前诊断中的应用[J].山东医药,2016,56(20):63-64.
[12]邓凤莲,郭燕丽,段灵敏,等.产前超声检查对胎儿前脑无裂畸形的诊断价值[J].中国临床医学影像杂志,2014,25(4):256-259.