彩色多普勒超声诊断脐动脉血流异常胎儿结构畸形

Color Doppler ultrasound in diagnosing abnormal flow in umbilical artery with fetal structure anomalies

目的评价彩色多普勒超声诊断脐动脉舒张期血流异常胎儿结构畸形的价值。方法回顾性分析接受产前筛查的133胎脐动脉舒张期血流异常及72胎存在先天性结构畸形胎儿的超声特点,对其羊水或脐血染色体检查结果进行分析,并与产后新生儿特殊检查或引产后尸体解剖及病理检查结果相对照。结果本组107 784胎(107 726名孕妇)中,共检出脐动脉舒张期血流异常133胎,脐动脉舒张期血流异常的发生率为0.12%(133/107 784);脐动脉舒张期血流异常胎儿中存在先天性结构畸形72胎,发生率为54.14%(72/133);脐动脉舒张期血流异常且存在先天性结构畸形儿中,染色体异常25胎,发生率为18.80%(25/133),最常见者为心血管结构畸形,其次为水肿、多发结构畸形和中枢神经系统畸形。胎龄<28周脐动脉舒张期血流异常胎儿的结构畸形及染色体异常发生率均高于≥28周者。结论脐动脉舒张期血流异常胎儿结构畸形发生率较高;彩色多普勒超声检测脐动脉舒张期血流异常有助于检出胎儿先天性结构畸形。

Objective To assess clinical value of color Doppler ultrasound for diagnosing abnormal diastolic flow in um- bilical artery with fetal congenital structure anomalies. Methods Ultrasonic findings of 133 fetuses with abnormal diastolic flow in umbilical artery, including 72 with congenital structure anomalies, were retrospectively analyzed and compared with chromosome results got through amniocentesis or fetal blood sampling and specific check-results of neonates or pathologic findings after induction. Results Totally 133 fetuses among 107 784 fetuses （107 726 pregnant women） were found with abnormal diastolic flow in umbilical artery, the accidence was 0.12 % （133/107 784）. Seventy-two fetuses were diagnosed with congenital structure anomalies, the accidence was 54.14% （72/133）, of which 25 fetuses （25/133, 18.80%） with chromosome abnormalities. The common congenital structure anomalies included cardiovascular system anomalies, fetal e- dema, multi-structure anomalies and central nervous system anomalies. The rate of both fetal congenital structure anoma- lies and abnormal chromosome were higher in diastolic flow in the umbilical artery abnormalities fetuses ~28 weeks than those ~28 weeks. Conclusion High accidence of congenital structure anomalies exist among fetuses with abnormal dias- tolic flow in umbilical artery. Color Doppler ultrasound is helpful to detecting congenital abnormality in fetuses with abnor- mal diastolic flow in umbilical artery.