胎儿腹内脐静脉扩张的超声诊断及其妊娠结局

Ultrasound diagnosis and pregnancy outcome of fetal intra-abdominal umbilical vein varix

目的探讨胎儿腹内段脐静脉（FIUV）扩张的超声表现与妊娠结局之间的关系。方法回顾性分析2007年3月至2009年10月间天津市中心妇产科医院超声科检出的22例胎儿腹内脐静脉扩张的超声表现并追踪其妊娠结局。结果在43126例孕妇中诊断22例FIUV扩张,发生率为0.51‰,均为单胎妊娠。FIUV扩张最大值为（13.37±3.54）mm（9.40~22.40mm）。13例超声检查未发现合并胎儿其他结构异常,均分娩健康活婴（占59.09%）。9例胎儿合并其他结构异常（占40.91%）,其中仅1例合并单脐动脉者分娩健康活婴,其余8例均合并胎儿严重畸形,最多见的异常是胎儿先天性心脏病3例（占13.6%）。21~3体1例（占4.5%）。宫内死胎1例（占4.5%）。结论单纯FIUV扩张妊娠结局良好。FIUV扩张合并胎儿其他部位结构异常表现时是一个危险指征,大多预后不良。常规产前超声检查过程中一旦发现FIUV扩张,应系统地全方位筛查胎儿其它部位有否异常,尤其应进行胎儿超声心动图检查以及非整倍染色体异常标记的筛查。

Objective To probe the relationship between ultrasound diagnostic character of fetal intra-abdominal umbilical vein（FIUV） varix and their pregnancy outcome.Methods This was a retrospective case series study,analyzed ultrasound diagnostic character of 22 cases of FIUV varix and followed up their pregnancy outcome between March 2007 and October 2009.Results 22 cases FIUV varix were identified among a population of 43126.The incidence was 0.51‰.All were singleton gestation.Maximum FIUV varix size（mm,mean±SD（range））：13.37±3.54（9.40~22.40）.13 cases were not accompanied by other anomalies on ultrasound examination and the neonates were healthy（59.09%）.9 cases were accompanied by various anomalies（40.91%）,only one neonate which was accompanied by single umbilical artery was healthy.The other 8 fetuses were accompanied by severe malformations,and congenital heart diseases were the most common findings（3 cases,13.6%）.1 case was trisomy-21（4.5%）.1 case was intrauterine death（4.5%）.Conclusion The outcome of pregnancy with isolate FIUV varix is generally favorable.FIUV varix accompanied by other anomalies is dangerous sign,most of them have poor pregnancy outcomes.Once FIUV varix is identified during routine ultrasonograph,serial scans should be performed to exclude other abnormalities.Especially fetal ultrasonic cardiogram and scanning for markers of aneuploidy should be performed.