孕11～13^(+6)周胎儿NT≥6.0 mm孕妇妊娠结局的随访研究

Pregnancy outcomes of pregnant women with fetal NT≥6. 0 mm at 11-13^(+6) weeks of gestation: a follow-up study

目的评价孕早期胎儿颈后透明层(NT)显著增厚(≥6 mm)与妊娠结局的关联性,为临床医生的决策提供依据。方法选取2012年1月-2015年12月在甘肃省妇幼保健院产前诊断中心进行孕早期单胎NT测量的12 352例孕妇,选择其中NT≥6.0 mm的62例进行妊娠结局追踪随访,随访内容主要包括胎儿宫内发育情况及新生儿出生后健康状况。结果12 352例NT测量病例中,NT值≥3.0 mm者522例,其中NT≥6.0 mm者62例。NT≥6.0 mm者中有42例于20周前终止妊娠,27例(43.5%)行产前诊断提示为染色体病。20例继续妊娠病例中,6例(30%)胎儿中孕期彩超复查未见明显结构异常,且增厚的NT完全消失颈后皮肤厚度(NF)<6.0 mm。出生后随访(6～24个月)发现6例新生儿均健康存活,未发现智力问题或精神运动发育迟缓症状。3例(15%)胎儿20周前发现胎死宫内;2例(10%)胎儿于孕中期系统彩超诊断为胎儿颈后淋巴水囊瘤;2例(10%)胎儿中期结构筛查NF>6.0 mm;5例(25%)超声诊断为先天性心脏病;1例(5%)诊断为膈疝,1例(5%)失访。结论胎儿孕早期NT显著增厚与染色体病及胎儿先天性心脏病等结构异常有明显相关性,但不应作为孕妇终止妊娠的唯一指征。当排除了胎儿染色体异常及中孕期结构筛查未见异常时,胎儿预后较好。

Objective To evaluate the correlation between marked thickening of fetal nuchal translucency（ NT）（ ≥6 mm） and pregnancy outcomes,provide a basis for clinical decision-making. Methods A total of 12 352 pregnant women receiving NT measurement of single fetus during the first trimester of prengancy in Center for Prenatal Diagnosis,Gansu Provincial Maternity and Child-care Hospital from January 2012 to December 2015 were selected,and 62 pregnant women of them were found with NT≥6. 0 mm,their pregnancy outcomes were followed up,the follow-up content mainly included fetal intrauterine development situation and neonatal health condition. Results Among 12 352 cases,522 cases were found with NT≥3. 0 mm,and 62 cases were found with NT≥6. 0 mm. Among 62 cases with NT≥6. 0 mm,42 cases terminated pregnancy before the 20 th gestational week,27 cases（ 43. 5%） were indicated as chromosomal diseases by prenatal diagnosis. Among 20 cases continuing pregnancy,6 cases（ 30%） were not found with obviously structural abnormalities in reexamination by color ultrasonography during the second trimester of pregnancy,the thickness of nuchal skin-fold（ NF） was less than 6. 0 mm when the thickened NT disappeared completely. Six neonates were healthy and alive during follow-up for 6-24 months,no intelligent problem or psychomotor retardation symptom was found. Three fetuses（ 15%） were found with intrauterine death before the 20 gestational week,two fetuses（ 10%） were diagnosed as nuchal cystic hygroma by systematical color ultrasonography during the second trimester of pregnancy,two fetuses（ 10%） were found with NF6. 0 mm during the second trimester of pregnancy,5 fetuses（ 25%） were diagnosed as congenital heart diseases,one fetus（ 5%） was diagnosed as diaphragmatic hernia,one fetus（ 5%） was lost to follow up. Conclusion Significant thicking of fetal NT during the first trimester of pregnancy is significantly correlated with chromosomal diseases and fetal structural abnormalities,such as congenital heart diseases,but it can not be used as the only indicator of pregnancy termination,the prognosis of fetuses is good when fetal chromosomal abnormalities are excluded and no structural abnormality is found in screening during the second trimester of pregnancy.