孕11～14周经腹部联合阴道超声筛查胎儿心脏结构畸形

SCREENING OF FATAL HEART MALFORMATION BY THE ABDOMINAL AND TRANSVAGINAL ULTRASOUND WHEN GRAVID 11-14 WEEKS

目的探讨经腹部联合阴道超声规范化筛查及软指标诊断早孕期(11~14周)胎儿心脏结构的意义。方法 2013年1月—2016年6月在该院进行妊娠早孕期(11~14周)超声检查的孕妇1 972例,经腹部超声联合阴道超声及放大技术,运用早孕期规范化超声检查方法,通过观察胎儿心脏在胸腔的位置、心尖指向、心轴、四腔切面、三血管气管及主动脉弓切面等为线索,记录颈部透明层(NT)值、三尖瓣反流(TR)及静脉导管血流a波(DVa波)倒置等软指标情况,诊断胎儿心脏异常的阳性病例进行回顾分析。结果本组1 972例共发现胎儿心脏结构异常23例,其中早孕期发现胎儿心脏结构异常15例,其中位置异常5例:2例为异位心、1例右位心、2例右移心;心轴异常3例;心脏位置、心轴正常,仅心内结构异常3例;NT增厚胎儿109例(5.52%,109/1 972),7例为心脏结构畸形,其中4例在孕早期诊断,3例在孕中期诊断。TR33例,DVa波倒置71例,而在23例产前诊断心脏畸形胎儿中,有9例合并TR,诊断敏感度为39.13%(9/23);7例合并DV a波倒置,诊断敏感度为30.43%(7/23)。结论经腹部超声联合阴道超声及放大技术进行早孕期规范化超声筛查及软指标检查对早期发现胎儿心脏结构异常具有重要的意义。

Objective To explore the significance of screening and diagnosing soft index of early pregnancy （11- 14 weeks） for researching cardiac structure and function using abdominal and transvaginal ultrasound. Methods There were about 1972 cases woman who early using Prenatal Electrocardiograph Screening in author＇s hospital. By the transnational or combined vaginal testing,and using standardization of Prenatal Electrocardiograph Screening in the early, and the cardiac position, apex cord, orientation and heart mandrel and apical four chamber view and three vessel trachea section as the clue, recording NT and TR and DV a convert soft index were observed. Reviewing analysis on the diagnosis of fetal heart abnormality position cases was performed.Results It is found that had total 23 women from 1972 cases were fetal heart abnormality. Fifteen of them were founding fatal heart abnormality in the early. Five of them were cardiac position. Including two patients with ectocardia and one dexiocardia, and two case right shift hearts, abnormal spindle （3 cases ）. Spindle was normal in cardiac position,and only 3 inner structures were abnormality. Having 109 cases were NT incrassation （109/1972）. Seven of them were diagnosed malformation of heart, four of them were diagnosing in the first trimester and four of them or diagnosing in seconding trimester. Having 23 cases were TR,77 of them were DV a convert. However,23 cases were malformation of heart in the prenatal examination. TR diag- nosis sensitivity was the sensitivity of the percentage of 39.13 { 9/23 ）. Seven of them sensitivity of the percentage was 30.43 （7/23）. ConcLusion Abdominal sonography of joint early pregnancy with vagina ultrasound and amplification technology standardized ultrasound screening and soft data check for early detection of fetal cardiac structural abnormalities has the vital significance.