11～13＋6孕周与14～17＋6孕周胎儿超声筛查的对比

Comparation of ultrasound screening for 11-13＋6 versus 14-17＋6 week fetus

目的 评价非选择孕妇11～13＋6孕周和14～17＋6孕周胎儿超声筛查的作用.方法 2002年1月至2008年4月在中山大学附属第一医院行11～17＋6孕周胎儿首次产前常规超声检查共3645例患者,其中11～13＋6孕周组1556例,14～17＋6孕周组2089例.比较两组胎儿结构异常的检出率及畸形类型构成比.结果 11～13＋6孕周组和14～17＋6孕周组胎儿结构异常首次检出率分别为2.3%（36/1556）和3.3%（68/2089）,差异无统计学意义.两组胎儿结构异常类型构成比差异有统计学意义（P=0.03）.11～13＋6孕周组胎儿畸形前3位为颈部异常（项颈透明层增厚及颈部淋巴水囊瘤）占31.6%（18/57）,胎儿水肿占15.8%（9/57）,前腹壁异常占12.3%（7/57）.14～17＋6孕周组胎儿畸形前3位为心血管系统异常占16.7%（18/108）,中枢神经系统异常占14.8%（16/108）,前腹壁异常占12.0%（13/108）.结论 11～13＋6孕周胎儿超声检查能诊断多种致死性胎儿畸形及检测各种染色体异常超声标记;14～17＋6孕周胎儿超声检查可观察相对细微的胎儿结构异常.11～13＋6孕周是早期胎儿超声筛查的理想时间.

Objective To evaluate the role of ultrasound screening in fetus at 11-13＋6 weeks and 14-17＋6 weeks in unselected pregnant women. Methods From January 2002 to April 2008,first-time prenatal ultrasound routine examinations were performed for 3645 pregnant women at 11-17＋6 gestationalweeks in the First Affiliated Hospital of Sun Yat-sen University,including 1556 cases of 11-13＋6 and 2089 of 14-17＋6 gestational weeks. Detection and types of structural anomalies were compared between these two groups. Results Primary detection identified fetal structural abnormalities in 2.3% （36/1556） and 3.3%（68/2089） of women at 11-13＋6 and14-17＋6 gestational weeks,respectively,with no statistically significant difference. However,constituents of structural anomalies varied （P=0.03）,with the first three leading types being nuchal abnormalities[31.6% （18/57）]（increased nuchal translucency thickness and cystic hydroma）,fetal hydrops[15.8%（9/57）]and abdominal wall defects[12.3%（7/57）]in the 11-13＋6 weeks group,and cardiovascular defects[16.7% （18/108）],central nervous system malformations[14.8% （16/108）]and abdominal wall defects[12.0%（13/108）]in the 14-17＋6 weeks group. Conclusions The ultrasound examinations performed at 11-13＋6 weeks can be useful in screening the soft markers for chromosomal abnormalities and certain fatal malformations,while those performed at 14-17＋6 weeks may identify more details of fetal structure. The 11-13＋6 weeks of gestation may be an optimal window for early ultrasound screening of the fetus.