三维超声对妊娠前及早期妊娠阶段意外接触致畸物质者胎儿结局的监测

Three Dimensional Ultrasound Monitoring of the Fetal Outcome Influenced by Contacting Teratogenic Factors During Early Pregnancy

【目的】探讨现代导致胎儿畸形的因素的变化和胎儿预后的监测手段。【方法】对112例在妊娠前期、 妊娠早期意外的、非意愿性、或非认知性接触理化物质导致或可疑导致胎儿畸形的孕妇,进行首诊后的系列三 维超声检测。对确定有畸形的胎儿实施引产并验证三维超声的诊断。【结果】共计有3例肠膨出、1例多囊肾,1 例脑积水,2例唇裂,1例脑部畸形(额部肿瘤)、1例马蹄内翻足,总计胎儿畸形9例,畸形发生率8.04%。并发 胎儿宫内生长迟缓(IUGR)17例,占15.18%。9例畸形者中,分别有新近住房装修史者占4例,孕早期服用喹 诺酮类抗生素3例,孕前及早孕阶段职业接触恶性肿瘤化疗药物1例,长期使用移动电话者1例。17例IUGR 者中,孕期继续从事电脑、复印机工作者4例,妊娠合并肝炎3例。9例胎儿畸形者均由三维超声确诊并经分娩 验证,三维超声诊断胎儿畸形诊断正确率为99.11%。【结论】妊娠早期或妊娠前接触致畸物质者,可引起较高 发生率的围产儿不良结局。

ObjectiveTo explore the changes of modern teratogenic factors and the monitoring measures of fetal outcome.Using three dimensional (3D) sonographic static surface mode technique, 3D fetal anatomic structural images were reconstructed and their deliveries monitored in 112 pregnant women with 10~42 gestational weeks to exclude fetal malformation and defects. They were suspected to suffer from fetal malformation due to unexpected, undesirable and unconscious contact with physicochemical materials in early pregnant periods. Fetuses with suspected malformation was induced and their 3D ultrasound examination was identified.Nine cases of congenital malformation were detected out of 112 cases (8.04%), including 3 cases of intestinal protuberance, 1 case of polycystic kidney, 2 cases of lip cleft, 1 case of frontal tumor , 1 case of equinovarus and 1 case of hydrocephalus. There were 17 cases (15.18%) complicated with intrauterine growth retardation (IUGR). Among the 9 cases with fetal malformations,4 cases lived in new decorated house,3 cases took oral dose of quinolone antibiotics during early pregnancy, 1 cases occupationally contacted with chemotherapy drugs for malignant tumor and 1 case used cellular phone for a long time. In the 17 cases of IUGR, 4 cases continued their occupation of computer and Xerox machine, 3 cases complicated with hepatitis. These 9 cases of fetal malformation were confirmed after delivery, their 3D ultrasound diagnostic rate was 99.11%.[Conclusion]Chemical pollution through house decoration, long-term utilization of physico-radiation tools such as cellular phone, computer and Xerox machine, administration of quinolone antibiotics during early pregnancy, etc. are closely related with fetal malformation and IUGR. Contacting teratogenic factors during early pregnancy period or before pregnancy will cause high rate occurrence of unhealthy outcome in perinatal fetuses. 3D ultrasound is a routine measure of first choice for perinatal examination.