连续顺序追踪超声法在早孕期胎儿严重肢体畸形中的诊断效果及对妊娠结局的影响研究

The effect of continuous sequential tracking ultrasound in the diagnosis of fetal severe limb deformities in early pregnancy and its influence on pregnancy outcome

目的分析连续顺序追踪超声法在早孕期胎儿严重肢体畸形中的诊断价值,统计妊娠结局,以期提高胎儿肢体畸形检出率,实现更佳的优生优育。方法选择2014年06月-2016年12月在我院建档进行产前保健的早孕孕妇中筛查出疑似胎儿严重肢体畸形的1128例作为研究对象,按照就诊顺序编号,采用数字随机表法将其分为对照组和观察组,每组564例。对照组采用常规超声筛查,观察组采用连续顺序追踪超声法筛查。两组孕妇均随访至引产或生产后。以引产或生产后胎儿肢体畸形情况为金标准,分析常规超声和连续顺序追踪超声法在筛查早孕期胎儿严重肢体畸形的灵敏度、特异度、准确度并比较。比较两组筛查出的肢体畸形儿的畸形部位、畸形数量、畸形分类、妊娠结局,分析连续顺序追踪超声法在胎儿肢体严重畸形中的诊断价值。结果两组孕妇在年龄、孕次、孕周、体重、体质量指数(BMI)、孕胎数量、肢体畸形家族史、合并高危妊娠种类等方面比较差异无统计学意义(P>0.05)。观察组孕妇中因肢体畸形于孕早期引产率明显高于对照组(P<0.05),因胎儿肢体畸形于孕中期引产率明显低于对照组(P<0.05),两组孕妇剖剖宫产率和阴道产率比较差异无统计学意义(P>0.05)。观察组孕妇筛查出肢体畸形58例,均经引产或者生产后证实为肢体畸形,对照组筛查出47例肢体畸形,其中1例引产后证实非肢体畸形,46例引产或生产后证实为肢体畸形。引产或生产后1128例胎儿共检出61例肢体严重畸形。观察组诊断灵敏度、特异度和准确度均高于对照组(P<0.05);观察组胎儿足内翻构成比显著高于对照组(P<0.05),其它肢体畸形构成比比较差异无统计学意义(P<0.05)。观察组胎儿肢体严重畸形数量显著多于对照组(P<0.05)。结论连续顺序追踪超声法诊断早孕期胎儿严重肢体畸形灵敏度、准确度、特异度均较高,可为孕妇及家属提供胎儿肢体可靠信息,为优生优育提供保障,具有重要临床价值。

Objective：To analyze the continuous sequence ultrasound in early pregnancy diagnosis of severe fetal limb deformity,pregnancy outcome statistics,in order to improve the detection rate of fetal limb deformity,monitoringhas. Methods：Choose 2014 06—2016 December in our hospital for prenatal care of pregnant women filing early screening of suspected severe fetal limb deformity in 1128 cases as the research object,numbered according to the order of treatment,were randomly divided into control group and observation group,564 cases in each group. The control group received conventional ultrasound screening,and the observation group was followed by sequential sequential ultrasound screening. The two groups were followed up after induction or birth. The sensitivity,specificity and accuracy of conventional ultrasound and continuous sequence tracking ultrasound in screening fetal limb deformities during early pregnancy were analyzed by comparing standard ultrasound and continuous sequence tracking ultrasound. The deformity,deformity,classification and pregnancy outcome of two groups of children with abnormal limb deformities were compared. The diagnostic value of sequential sequential ultrasound method in severe fetal limb deformities was analyzed. Results：the two groups of pregnant women in pregnancy,age,gestational age,body weight,body mass index（BMI）,fetal limb deformity,the number of family history,high-risk pregnancy type had no significant difference（P〈0.05）. Observation of limb deformity in the early stages of pregnancy induced abortion rate was significantly higher than the control group by group of pregnant women（P〈0.05）,because of fetal limb deformity in the second trimester abortion rate was significantly lower than the control group（P〈0.05）,the two groups had no statistically significant maternal cesarean section cesarean section and vaginal yield difference（P〉0.05）. The observation group screening of 58 cases of limb deformity,were treated by induction or production was confirmed after limb malformation,the control group selected 47 cases of limb malformation,1 cases confirmed by autopsy non limb malformation,46 cases were confirmed after the induction of labor or production of limb deformity. After the induction of labor or production,1128 cases of fetal abnormalities were detected in 61 cases. The observation group diagnostic sensitivity,specificity and accuracy were higher than the control group（P〈0.05）;observation group of fetal foot varus ratio was significantly higher than the control group（P〈0.05）,other than a limb deformity had no statistically significant difference（P〈0.05）. The number of fetal limb abnormalities in the observation group was significantly higher than that in the control group（P〈0.05）. Conclusion：continuous sequence ultrasound diagnosis of early pregnancy severe fetal limb deformity sensitivity,accuracy and specificity were high,can provide reliable information for fetal limb for pregnant women and their families,to provide protection for eugenics,has important clinical value.