规范化早孕期超声筛查在双胎异常妊娠中的临床价值

Clinical value of standardized prenatal ultrasonography in diagnosis of twin abnormalities during early trimester

目的通过规范妊娠早期超声检查双胎的时间、内容和方法,探讨早孕期规范化产前超声筛查在双胎妊娠诊断中的临床应用价值。方法前瞻性分析2009年5月至2011年6月在江苏省产前诊断中心超声室受检的655例双胎妊娠孕妇,于妊娠11～13+6周行早孕期胎儿结构超声筛查,并追踪妊娠过程和临床结局。结果 655例受检双胎妊娠孕妇,早孕期发现28例孕妇的29个疑似胎儿超声异常,其中1例为两个胎儿均异常,其余为单个胎儿异常。疑似胎儿异常包括11例单纯解剖结构异常(颈部淋巴水囊瘤、无脑儿、脐膨出、腹部囊性包块和胎盘水泡样变性)以及17例早孕期超声指标异常(NT增厚、鼻骨缺失、巨膀胱和单脐动脉),其中共有17例最后经临床证实。其余早孕期正常孕妇中,共漏诊3例,失访62例,漏诊率为0.51%(3/593),实际双胎异常妊娠发生率为3.37%(20/593),早孕期超声筛查临床符合率为60.71%(17/28)。结论统一规范化进行早孕期产前超声筛查可有效地提高双胎异常检出的准确率,尽可能地检出胎儿异常、减少漏诊率以及早期干预具有重要的临床价值。

Objective To evaluate the value of prenatal ultrasonography in diagnosis of twin abnormalities during early trimester by standardized time,contents and methods of prenatal ultrasonography.Methods 655 cases of twin pregnant women during 11-13＋6 weeks of pregnancy were detected in our hospital by color Doppler ultrasound from May 2009 to June 2011.All cases were followed up for pregnancy process and clinical results.Results 28 cases of doubtful fetal abnormalities were detected from 655 cases of twin pregnant women.One case had two abnormal fetals,and others had only single abnormal fetal.Doubtful fetal abnormalities concluded 11 anatomic structure malformations,such as cystic hygroma of the neck,anencephalus,omphalocele,abdominal cystic mass and hydatidiform mole.17 cases had abnormal ultrasonic items,such as nuchal translucency thickening,absence of fetal nasal bone,megabladder and single umbilical artery.Finally,17 cases were confirmed by clinical results.But 3 cases were confirmed omission diagnose,and 62 cases were lost follow up.Therefore,its omission diagnose rate was 0.51%.The incidence rate of twin abnormal pregnancy was 3.37% in our group.The clinical coincidence rate of ultrasonography during early trimester was 60.71%.Conclusions It will effectively raise accuracy rate of twin abnormalities by standardized prenatal ultrasonography in diagnosis of twin abnormalities during early trimester.