超声产前筛查漏诊胎儿畸形9例及转诊问题分析

Analysis of missed diagnosis of fetal malformation in 9 cases and referral of prenatal ultrasound screening

目的对我院自2013年8月～2014年8月胎儿畸形的超声筛查的漏诊及转诊情况进行分析。方法妊娠20～24周临产前在我院进行产前超声筛查的胎儿2460例，并进行随访，胎儿的畸形筛查内容要观察胎儿各系统的发育情况，并常规测量双顶径、头围、腹围、股骨侧脑室宽度、并观察脊柱、胃泡、双肾、膀胱、胫腓骨、尺桡骨、四腔心切面、左右室流出道切面、脐血管数目、脐动脉血流指数、胎盘位置及厚度、羊水情况等。结果2460例胎儿中，胎儿畸形漏诊9例。分别是指弯曲、室缺、肺动脉狭窄、耳小并低位耳、小下颌畸形、21-三体综合征、左手六指畸形、腭裂、帆状胎盘。结论超声可作为胎儿畸形筛查的首选工具，简便、无创，但应提高自身技术水平，对于待诊及确诊畸形儿的转诊，筛查机构应与诊断机构建立信息平台，达到诊断结果共享，从而提高技术水平，减少漏诊。

Objective To analyze fetal abnormalities of ultrasound screening in diagnosis and referral of our hospital from August 2013 to August 2014. Methods 2460 cases of fetus of the 20 weeks of gestation-24 weeks before labor in our hospital were collected for prenatal ultrasound screening, and follow-up, fetal malformation screening content to observe fetal development situation of each system, and the conventional double top diameter, head circumference, the femoral lateral ventricle width, and the spine and the stomach, double kidney, bladder, tibiofibula, foot radius, fourchamber view, left and right ventricular outflow tract aspect, umbilical cord blood tube number, umbilical artery blood flow index in location and thickness, amniotic fluid, placenta, etc were observed. Results In 2460 cases of fetus, fetal abnormalities, 9 cases of misdiagnosis. Respectively was refers to the bending, room lacks, pulmonary artery stenosis, small ears and low ear, small chin deformity, 21-three body syndrome, left hand, six deformity, cleft palate, sail the placenta. Conclusion The ultrasound can be used as a tool of choice for fetal malformation screening, is simple, noninvasive, but should improve their technical level, for referral for diagnosis and diagnose oaf, screening mechanism should be established and diagnostic information platform, achieve Shared diagnosis results, so as to improve the level of technology, reduce misdiagnosis.