孕早期标准化超声切面筛查胎儿结构畸形的临床分析

Clinical analysis on standardized ultrasound cross-section during early pregnancy in screening of fetal structural abnormalities

目的探讨在孕早期行标准化超声切面筛查胎儿结构畸形的临床意义。方法选取2013年3月-2015年7月在该院行产前超声检查且在该院分娩的孕妇1 129例,所有孕妇均行孕早期标准化超声切面筛查并追踪妊娠结局。结果孕早期(孕11~13+6周)标准化超声切面筛查孕妇1 129例共1 206胎;对所有孕妇妊娠结局进行追踪随访,其中正常单胎1 013例,单胎异常39例,双胎正常72例,双胎异常5例,共发现胎儿畸形44例,发生率为3.65%(44/1 206)。孕早期超声筛查诊断16例,胎儿结构畸形占36.36%,骨骼四肢和神经系统畸形检出率较高,分别占64.28%和60.00%,呼吸和消化系统畸形均占0.00%;孕早期超声筛查胎儿结构畸形具有较好的诊断价值,其灵敏度、特异度、阳性预测值和阴性预测值分别为36.36%、100.00%、100.00%和97.65%;孕中期超声筛查诊断胎儿结构畸形28例,超声诊断结果与引产后诊断相符合。结论孕早期标准化超声切面筛查可检出部分严重胎儿畸形,但不能替代孕中期超声筛查。

Objective To explore the clinical significance of standardized ultrasound cross-section during early pregnancy in screening of fetal structural abnormalities. Methods A total of 1 129 pregnant women receiving prenatal ultrasonic examination and giving birth to their babies in the hospital from March 2013 to July 2015 were selected,standardized ultrasound cross-section during early pregnancy was adopted to screen all the pregnant women,the pregnancy outcomes were tracked. Results A total of 1 129 pregnant women（ 1 206 fetuses）underwent standardized ultrasound cross-section screening during early pregnancy（ 11-13＋6gestational weeks）,the pregnancy outcomes of all the pregnant women were tracked and followed up,1 013 normal singletons,39 abnormal singletons,72 normal twins,5 abnormal twins were included,44 fetuses were diagnosed as fetal abnormalities,the incidence rate was 3. 65%（ 44/1 206）. Sixteen fetuses（ 36. 36%）were diagnosed as fetal structural abnormalities by ultrasonic screening during early pregnancy,the detection rates of bone and limbs abnormalities,nervous system abnormalities were high,which were 64. 28% and 60. 00%,respectively,no respiratory system abnormalities and digestive system abnormalities was found. The diagnostic value of ultrasonic screening during early pregnancy was good,the sensitivity,specificity,positive predictive value,and negative predictive value were 36. 36%,100. 00%,100. 00%,and 97. 65%,respectively. Twenty-eight fetuses were diagnosed as fetal structural abnormalities by ultrasonic screening during middle pregnancy,the diagnostic results were coincidence with diagnostic results after induced labor. Conclusion Standardized ultrasound cross-section screening during early pregnancy can detect partial severe fetal malformations,but it can replace ultrasonic screening during middle pregnancy.