胎儿先天畸形的产前超声筛查诊断价值及高危因素分析
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摘要
目的研究产前超声筛查胎儿畸形的临床意义及致畸的危险因素,为为制定有效预防及干预措施、降低出生缺陷提供理论依据。方法选取2014年8月-2018年7月在我院进行产前胎儿畸形筛查的孕妇3286例,年龄20～42y作为研究对象,对其进行产前超声筛查,并回顾性分析其临床资料,采用卡方检验和Logicstics回归筛选胎儿畸形发病的危险因素。结果 3286例孕妇引产和分娩后随访证实胎儿畸形共72例,发生率2.19%,产前超声检出68例,检出率94.44%,漏诊4例,漏诊率5.55%。72例胎儿畸形中畸形发生率的前三位为:神经系统畸形(18/72),发生率为25%,颜面部畸形(14/72),发生率为19.44%,心脏畸形(12/72),发生率为16.67%。单因素和进一步Logicstics回归多因素分析显示,年龄≥35、不良妊娠史、孕期感冒史、孕期用药史、孕期毒物接触史和孕妇血清TORCH检查IgM阳性史是胎儿畸形发生的独立的危险因素。结论产前超声是筛查胎儿畸形的有效方法,对具有高危因素的孕妇,预防为主,规范进行产前筛查及产前诊断,减少胎儿畸形的发生。
Objective:To study the clinical significance of prenatal ultrasound screening for fetal malformations and the risk factors of teratogenicity,and to provide a theoretical basis for the development of effective prevention and intervention measures to reduce birth defects. Methods:A total of 3286 pregnant women who were screened for prenatal fetal malformation from August2014 to July 1818,aged 20-42 years,were selected for prenatal ultrasound screening and clinical data were retrospectively analyzed. Cardiac test and logics regression were used to screen for risk factors for fetal malformation. Results:A total of 72 cases of fetal malformation were found in 3286 pregnant women after induction of labor and follow-up. The incidence rate was 2.19%. 68 cases were detected by prenatal ultrasound,the detection rate was 94.44%,4 cases were missed,and the rate of missed diagnosis was 5.55%. The top three malformations in 72 cases of fetal malformation were:nervous system malformation(18/72),incidence rate was 25%,facial deformity(14/72),incidence rate was 19.44%,cardiac malformation(12/72),the incidence rate is 16.67%. Univariate and further Logicstics regression multivariate analysis showed that age ≥35,history of adverse pregnancy,history of flu during pregnancy,history of medication during pregnancy,history of exposure to toxicants during pregnancy,and IgM-positive history of maternal serum TORCH were independent risk factors for fetal malformation. Conclusion:Prenatal ultrasound is an effective method for screening fetal malformations. For pregnant women with high risk factors,prevention is the main method. Prenatal screening and prenatal diagnosis are standardized to reduce the occurrence of fetal malformation.
Objective:To study the clinical significance of prenatal ultrasound screening for fetal malformations and the risk factors of teratogenicity,and to provide a theoretical basis for the development of effective prevention and intervention measures to reduce birth defects. Methods:A total of 3286 pregnant women who were screened for prenatal fetal malformation from August2014 to July 1818,aged 20-42 years,were selected for prenatal ultrasound screening and clinical data were retrospectively analyzed. Cardiac test and logics regression were used to screen for risk factors for fetal malformation. Results:A total of 72 cases of fetal malformation were found in 3286 pregnant women after induction of labor and follow-up. The incidence rate was 2.19%. 68 cases were detected by prenatal ultrasound,the detection rate was 94.44%,4 cases were missed,and the rate of missed diagnosis was 5.55%. The top three malformations in 72 cases of fetal malformation were:nervous system malformation(18/72),incidence rate was 25%,facial deformity(14/72),incidence rate was 19.44%,cardiac malformation(12/72),the incidence rate is 16.67%. Univariate and further Logicstics regression multivariate analysis showed that age ≥35,history of adverse pregnancy,history of flu during pregnancy,history of medication during pregnancy,history of exposure to toxicants during pregnancy,and IgM-positive history of maternal serum TORCH were independent risk factors for fetal malformation. Conclusion:Prenatal ultrasound is an effective method for screening fetal malformations. For pregnant women with high risk factors,prevention is the main method. Prenatal screening and prenatal diagnosis are standardized to reduce the occurrence of fetal malformation.
引文
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[3]李喜莲.胎儿先天畸形孕产妇高危因素分析[J].中国临床医学,2017,3(24):377-381
[4]刘晓辉.早孕期规范化超声检查在胎儿畸形筛查中的应用效果观察[J].河南医学研究,2016,(08):1485-1486.
[5]Robinson RL,Brooks C,Brown SL,et al. RYR1 mutations causing central core disease are associated with more severe malignant hyperthermia in vitro contracture test phenotypes[J].Hum Mutat,2002,20(2):88-97.
[6]Wozniak JR,Mueller BA,Bell CJ,et al. Global functional connectivity abnormalities in children with fetal alcohol spectrum disorders[J].Alcohol Clin Exp Res,2013,37(5):748-756.
[7]李喜莲,张斌.胎儿先天畸形孕产妇高危因素分析[J].中国临床医学,2017,(03):377-381.
[8]张学敏.胎儿致畸因素与优生策略的研究进展[J].山西医药杂志,2014,(24):2886-2889.
[9]王波,祖术球.调查分析有二胎需求孕妇胎儿畸形患病率及其影响因素[J].实用妇科内分泌杂志(电子版),2016,(19):77-78+80.