产前经腹超声前后囟联合声窗获得胎儿颅脑正中矢状切面的可行性

Feasibility of combining anterior and posterior fontanelle acoustic windows for median sagittal plane in fetal cranial ultrasound scanning

目的探讨产前经腹超声联合前后囱声窗获得胎儿颅脑正中矢状切面的可行性。方法2012年4月2日至8月10日，10例因胎儿畸形或母亲因素引产或流产的死亡胎儿进行颅脑超声检查，以前肉、矢状缝、后囟及枕骨大孔为声窗。2012年7月5日到8月25日间，共有200例孕妇在妊娠22～24周接受系统产前超声筛查。采用经腹超声，以前囟、矢状缝及后囟为声窗采集胎儿颅脑正中矢状切面。计算各声窗获得颅脑正中矢状切面的成功率，数据比较采用X^2检验。结果（1）10例引产或流产出的胎儿经前囟、矢状缝、后囱声窗均成功获得颅脑正中矢状切面。（2）产前超声胎儿颅脑正中矢状切面的获得情况：200例胎儿单独经后囟声窗获得颅脑正中矢状切面的成功率为76．0％（152／200），高于单独经前囟声窗的成功率[59．5％（119／200）]，差异有统计学意义（X^2=12．5，P〈0．01）。联合采用前后囟声窗获得胎儿颅脑正中矢状切面的成功率为95．5％（191／200），高于单独经前囟或单独经后肉的成功率，差异均有统计学意义（X^2分别为74．3和31．1，P均〈0．01）。头位胎儿单独经后肉声窗获得颅脑正中矢状切面的成功率为63．7％（65／102），高于单独经前囟声窗的成功率[37．3％（38／102）]，差异有统计学意义（X^2=14．3，P〈0．01）。非头位胎儿单独经后囱声窗获得颅脑正中矢状切面的成功率为88．8％（87／98），与单独经前囟声窗的成功率282．7％（81／98）]差异无统计学意义（X^2=1．5，P〉0．05）。头位胎儿经前后囟声窗皆获得颅脑正中矢状切面的成功率为9．8％（10／102），低于非头位胎儿[71．4％（70／98）]，差异有统计学意义（X^2=79．1，P〈0．01）。结论后囟声窗获得胎儿颅脑正中矢状切面的成功率高于前肉，联合采用前、后囟声窗可以提高获得该切面的成功率。

Objective To explore the feasibility of combining anterior and posterior fontanelle acoustic windows for fetal median sagittal plane cranial scanning in prenatal ultrasound. Methods From July 5 to August 25 in 2012, 200 pregnant women in Huai＇an First Hospital at 22 to 24 gestational weeks accepted transabdominal ultrasonography, with anterior fontanelle, longitudinal suture and posterior fontanelle as acoustic windows to obtain the median sagittal plane. In the mean time, ten aborted or induced fetuses （with malformations or maternal complications） underwent cranial ultrasound with the same acoustic windows. The successful rates of obtaining median sagittal plane were calculated. Data were analyzed by Chi-square test. Results （1） Among the ten aborted or induced fetuses, all median sagittal planes were successfully obtained through anterior, posterior fontanelle, or longitudinal suture alone. （2） Among the 200 cases of prenatal ultrasonography, the successful rate of obtaining median sagittal plane through posterior fontanelle alone was 76.0% （152/200）, which was higher than that through anterior fontanelle alone [59.50%（119/200）,X^2=12.5, P〈0.01]. The successful rate was 95.5% （191/200） when combining the anterior and posterior fontanelle, which was higher than that through anterior fontanelle or posterior fontanelle alone （X^2=74.3 and 31.1, both P〈0.01）. The successful rate of obtaining median sagittal plane through posterior fontanelle was 67.3% （65/102） in cephalic presentation, which was also higher than that through anterior fontanelle [37.3%（38/102）, X^2=14.3, P〈0.012. The successful rate was 88.8% （87/98） through posterior fontanelle in non-cephalic presentation, which was similar to that through anterior fontanelle [82.7% （81/98）,X^2 = 1.5, P〉0.05]. When both anterior and posterior fontanelle applied, the successful rate in cephalic presentation was 9.8%（10/102）, lower than that in non cephalic presentation fetuses [71.4%（70/98）, X^2=79.1, P〈0.01]. Cenelusions The successful rate in obtaining median sagittal plane through posterior fontanelle is higher than that through anterior {ontanelle, and might be increased when both anterior and posterior fontanelle were used.