超声检查早发现胎儿宫内脑积水临床研究

A clinical study on the early diagnosis and intervention of the intrauterine fetal intrauterine hydrocephalus

目的通过超声检查早发现、早干预宫内脑积水胎儿,减少出生缺陷,提高出生人口素质。方法对怀孕>15周的孕妇,在孕16、24、32周进行超声检查观察胎儿脑发育情况,对于重度脑积水并脑发育典型异常者早期干预及时终止妊娠;对于轻度脑积水进一步经MRI检查确诊继续妊娠。结果从2368例围产保健孕妇中筛选出1118例符合条件的观察对象,共检出胎儿脑积水者34例。超声检出脑积水并脑发育畸形23例,其中15例终止妊娠,8例失去联系;11例轻度异常者生后7例发育正常,另4例中2例智力+运动发育稍落后,2例运动落后者经康复治疗达正常水平。结论孕早期发现胎儿脑积水以及脑发育异常,超声检查是最方便、适时、快捷、廉价、准确、无创的首选方法;MRI是进一步明确诊断的无创检查,典型的胎儿脑发育畸形可及时终止妊娠;仅有轻度脑积水不合并脑发育畸形者可以在严密观察中继续妊娠;出生婴儿可以正常发育,部分会有发育落后经康复治疗可达正常儿发育水平。

Objective Though the early discovery and early intervention of fetal intrauterine hydrocephalus by ultrasound examination, in order to reduce the birth defect rate and improve the quality of the newborn population. Methods Ultrasonic examinations were conducted to observe the fetal brain development, on gravidas with more than 15 weeks pregnancy （16, 24, 32 weeks）, so that dysplasia can be detected in time. For typical intrauterine hydrocephalus, early intervention or termination of pregnancy should be adopted; for mild hydrocephalus without typical malformation, further MRI examination and consultation were employed to decide the necessity of the termination of the pregnancy. Results Among the 2368 gravidas with the perinatal health care, 1118 cases met the criteria were selected, and 34 cases of intrauterine hydrocephalus were detected. Specifically, 23 cases of typical intrauterine hydrocephalus were detected by ultrasonic examinations, among which 15 cases ended with termi- nations of pregnancy and 8 cases could not be contacted. Moreover, 11 mild abnormal cases were under guidance and monitored, according to the results, 7 infants grew healthily, 2 cases of mental and motor development slightly backward, 2 cases of sports backward up to normal level after the rehabilitation therapy. Conclusion Ultrasonic examination has proved to be one of the most effective, convenient, inexpensive and noninvasive methods for early diagnosis of fetal intrauterine hydrocephalus. Mean-while, MRI can serve as a complementary approach of ultrasonic examination for the further clarification of the diagnosis. The termination of pregnancy is suggested for typical intrauterine hydrocephalus. For mild hydrocephalus without brain malformation, gestation can continue under close observations, newborn babies can develop properly, part of newborns with development retardation up to the normal level by the rehabilitation therapy.