中孕期胎儿超声筛查切面的规范化探讨

Clinical significance of standardized ultrasonographic views in fetal screening of second trimester pregnancy

目的探讨在中孕期胎儿筛查中规范超声检查的重要性及操作程序。方法根据临床工作中的体会,应用9个标准切面进行中孕期胎儿筛查,即小脑横径切面,唇面部冠状切面,脊柱纵切面,心脏四腔心切面,左右室流出道长轴切面,双肾横切面,左右侧脐动脉起始段彩色血流,双上肢及双下肢切面。结果对2111例中孕期妇女进行超声筛查,检出211例胎儿异常,其中严重畸形胎儿83例,包括颅脑、中枢神经系统畸形22例,心脏畸形14例,唇腭裂13例,消化系统畸形8例,胎儿水肿综合征6例,单脐动脉13例,肢体畸形2例,泌尿系统畸形1例,膈疝1例,肺分离征1例,骶尾部肿块1例,右下腹肿块1例。超声检查结果与病理解剖相符。结论中孕期胎儿超声筛查切面的规范化是早期发现异常胎儿,减少漏诊的重要措施,对减少围产期死亡率,提高出生人口质量具有重要意义。

Objective To explore clinical significance of standardized ultrasonographic views and operational procedure in the fetal screening in the second trimester of pregnancy. Methods Nine standard ultrasonographic views, which consisted of cerebelli transverse view, lip-face coronal view, spine longitudinal view, cardiac 4-chamber view, left and right ventricular outlet tract views, two-renal transverse view, color flow view of original segment of left and right umbilical arteries, upper and lower extremities views, were developed according to our clinical experience. Results The prenatal ultrasonographic screening was conducted in 2111 pregnant women with the second trimester pregnancy. Among them, 211 of abnormal fetus were found and 83 cases of them belonged to severe abnormalities, consisted of 22 cases of skull or central nervous system abnormalities, 14 cases of cardiac abnormalities, 13 cases of cleft lip and/or cleft palate, 8 cases of digestion system abnormalities, 6 cases of fetal edema syndrome, 13 cases of single umbilical artery, 2 cases of extremities abnormalities, 1 case of urinary system abnormalities, 1 case of diaphragmatic hernia, 1 case of lung sequestration, 1 case of sacrococcygeal tumor and 1 case of right lower abdomen, which were in coincidence with pathologic autopsy after induced labor. Conclusions Standardized ultrasonographic views in the fetal screening in the second trimester pregnancy is an important procedure in the early identification of fetal abnormalities and reduction of missed diagnosis. This procedure plays an important role in the decrease of perinatal mortality and improvement of newborn population quality.