B超诊断胎儿畸形的临床应用

目的探讨B超在产前诊断胎儿畸形中的价值。方法回顾性分析本院2001年1月～2003年2月住院分娩的6978例产妇中77例畸形儿产前B超检查情况。结果严重畸形儿产前诊断率为82.2 %。指、趾、口、耳等小畸形的产前诊断率仅7.4 % ,二者差异显著。胎儿各系统畸形中以神经系统畸形最多见 ,占62% ;其B超产前诊断率也最高 ,达93.5 %。无脑儿、脊柱裂诊断最早 ,多数在孕16～20周便能确诊。肾缺如、胸腹水、短肢畸形、脐膨出等异常图像明显的畸形都能在产前作出诊断。食道、肛门、十二指肠闭锁等消化道畸形产前诊断率仅16.7 %。复杂先心、先天愚型的产前诊断比较困难。羊水量异常及孕妇合并癫痫、梅毒 ,胎儿致畸率高。结论B超是一种安全有效的产前诊断胎儿畸形方法。从孕中后期开始 ,特别在剖宫产前 ,B超检查时须顺序观察胎儿各个器官以提高畸形检出率。对高危孕妇的胎儿更要注意畸形检查。B超产前诊断率与B超医生的工作态度、业务技能密切相关。

Objective To investigate the diagnostic value of B ultrasound(BUS)in fetal abnormity prenatally. Methods 77fetal abnormity in6978parturien diagnosed prenatally by BUS from2001.1to2003.2in our hospital were analyzed retrospectively. Results The diagnosis rate of prenatal severe abnormity was82.2%.but that of minor abnormity in fingers,toes,mouth and ears was only7.4%.There are significant difference between them.Fetal abnormity in nervous system(62%)had the highest diagnosis rate(93.5%)in various systems abnormity.Anencephaly and spinal fissure could be diagnosed earliestly,most of them were diagnosed during16-20weeks of gestation.The abnormal images of anephrogenesis、ascites and pleural fluid、shortened lower limb and omphalocele were very obvious and could be diagnosed prenatally.The prenatal diagnosis rate of digestive tract abnormities such as esophagal,anal and duodenal atresia was only16.7%.Complicated congenital heart disease(CHD)and Down's syndrome were more difficult to diˉagnose before birth.Abnormal amniotic fluid and pregnancy with epilepsy,syphilis were easy to cause fetal abnormity. Conclusion BUS was a safe way to diagnose fetal abnormity before birth.Fetal organs should be checked by BUS in certain order since the middle and late pregnant period especially before cesarean and in high risk pregnant women to increase diagnostic rate of fetal abnormity.The diagnostic rate of fetal abnormity is closely related to the doctor's working attitude and practical skill.