中孕期胎儿先天畸形116例临床分析

Fetal anomalies in second trimester in recent ten years： clinical analysis of 116 cases

目的评价胎儿畸形的发生情况以及早期诊断和处理方法。方法回顾性分析1998至2007年间因胎儿畸形行中期引产或胎死宫内，难免流产等原因引产后发现为胎儿畸形的患者的临床病理资料。结果10年间共有中孕胎儿畸形引产者116例，占同期住院分娩者的比例有明显上升趋势（P〈0．01）。2003至2007年较之1998至2002年，胎儿畸形的确诊方法无明显改变，检出孕周无明显提前。116例胎儿畸形中，发生比例前5位依次为21三体、无脑儿、唇／腭裂、胎儿颈部淋巴管囊肿、心脏畸形。高龄孕妇30例，染色体异常发生比例最高（60．0％）。结论胎儿畸形的发生有升高趋势。高龄孕妇仍是发生胎儿畸形的高危人群。如何早期诊断胎儿畸形，仍是临床亟待解决的问题。

Objective To evaluate the prevalence of fetal anomalies in recent 10 years and explore the effective methods of early diagnosis and treatment. Methods The clinical and pathological data of 116 pregnant women who underwent induced abortion in the second trimester due to fetal anomalies 1998 -2007 were analyzed retrospectively. Results The fetal anomaly rate in the period 2003 - 2997 was 8. 7%, significantly higher than that in the period 1998 - 2002 （ 3. 1%0, P 〈 0. 001 ）. The diagnostic methods of fetal anomalies used during the period 2003 -2007 did not show significant differences compared with those used during the period 1998 -2002. The gestational week when the fetal anomalies were detected in 2002 -2007 was 19. 3 weeks, not significantly preceded compared with that during 1998 -2002 （22. 4 weeks, P 〉 0. 05 ）. The top 5 fetal anomalies with high incidence rates were Down＇ syndrome, anencephalus, lip/ palate cleft, fatal cystic hygroma of the neck, and cardiac anomalies. There were 30 cases of advanced maternal age over 35 years, 60. 0% of whose fetuses showed chromosome abnormality. Conclusion The incidence of fetal anomalies increases in recent years. The risk of fetal anomalies is high in the pregnant women in elder age. Pregnancy in advanced maternal age show high risk to occur fetal anomaly. Better approaches to diagnose fetal anomaly earlier are still to be found.