妊娠晚期超声检出胎儿结构异常的回顾性分析

Characteristics of fetal anomalies detected on the third trimester ultrasound scan

目的 评价超声于妊娠晚期检出胎儿结构异常的重要性.方法 2012年1月1日至2013年12月31日在北京大学第一医院妇产科定期产前检查并分娩的单胎妊娠孕妇中,共检出胎儿结构异常492例.其中442例于妊娠早期和/或妊娠中期超声筛查时检出,其余50例（10.2％）妊娠早、中期超声筛查正常,仅于妊娠晚期（≥28周）检出结构异常,纳入研究.分析妊娠晚期超声检出胎儿结构异常的种类. 结果 50例孕妇的平均年龄为（35.7±5 2）岁（26～43岁）,检出胎儿结构异常的孕周平均为（32.4±2.8）周（28.6～36.8周）.妊娠晚期检出的胎儿结构异常依次是中枢神经系统（42％,21/50）、消化系统（28％,14/50）、泌尿系统（16％,8/50）、心血管系统（8％,4/50）、呼吸系统（4％,2/50）和面部异常（2％,1/50）.除1例胎死宫内外,其余49例均活产分娩.49例新生儿中,14例正常;5例生后异常表现加重而行手术治疗;3例生后发现合并其他异常;4例失访;23例产后诊断与产前相符,未发现明显功能障碍,仍在密切随访中.30％（6/20）的中枢神经系统异常胎儿预后不良,2/4的心血管系统异常胎儿预后不良.消化和泌尿系统异常胎儿中分别只有1/12和2/7预后不良. 结论 妊娠晚期超声应重点扫查胎儿中枢神经系统和心血管系统.

Objective To investigate the categories of fetal anomalies detected by ultrasound scan in the third trimester.Methods From January 1,2012 to December 31,2013,492 singleton fetuses were found to have structural abnormalities on the first,second or third trimester ultrasound scan in the Peking University First Hospital,only 50 （10.2％） fetuses were detected on the third trimester （≥ 28 weeks of gestation） with no abnormalities detected on the first and second trimester scan,were enrolled.The categories of the fetal structural abnormalities were analyzed.Results The age of the mothers of the 50 fetuses with structural abnormalities was （35.7± 5.2） years （26-43 years） with an average gestation of （32.4±2.8） weeks （28.6-36.8 weeks）.These abnormalities were seen in the central nervous system （42％,21/50）,digestive system （28％,14/50）,urinary system （16％,8/50）,cardiovascular system （8％,4/50）,respiratory system （4％,2/50） and facial structures （2％,1/50）.Intrauterine death occurred in one case and 49 mothers had a live birth.After birth,14 neonates were normal,five needed further treatment,three cases were complicated by other abnormalities,23 had no dysfunction but need follow-up and four were lost to follow-up.Six of the 20 （30％） fetuses with central nervous system abnormalities and 2/4 fetuses with cardiovascular system abnormalities had an adverse prognosis,while 1/12 and 2/7 fetuses with digestive and urinary system abnormalities had an adverse prognosis.Conclusions The central nervous system and cardiovascular system should be examined in priority during the third trimester ultrasound scan.