早孕期规范化超声检查在胎儿出生缺陷中的应用效果及妊娠结局研究

Effect of standardized ultrasound examination in early pregnancy on the birth defects of fetus and pregnancy outcome

目的观察早孕期规范化超声检查降低胎儿出生缺陷率的临床效果及妊娠结局,探讨早孕期规范化超声检查提升优生优育水平的价值。方法选取2015年1月~2016年12月期间在我院建档行孕期保健并分娩的孕妇500例作为研究对象,设为观察组。另选择同期500例于孕中期在我院建档行孕期保健的孕妇作为研究对象设为对照组。观察组孕妇行首次超声检查(孕11^(+0)周~13^(+6)周),根据胎儿头臀长和NT厚度结果,初步判定胎儿NT值是否正常,对NT值异常胎儿孕妇增加检测指标如无创DNA,进一步明确胎儿是否有唐氏综合征、其它三体综合征等遗传疾病。两组孕中期保健均按照指南规定频次、内容进行。统计观察组孕早期超声规范化诊断结果,比较两组孕妇孕中晚期保健筛查结果,妊娠结局、流产或引产胎儿病理学诊断结果、胎儿出生后缺陷情况。结果观察组500位早孕期规范化超声检查结果:17例胎儿检查结果异常。其中11例胎儿NT增厚,6例胎儿出现器官结构异常。NT异常的11例均行无创DNA检查,确诊8例胎儿为三体综合征均引产,其余3例继续观察妊娠。6例器官结构异常胎儿均行引产。对照组孕妇孕中晚期保健筛查出三体综合征5例,均引产,胎儿器官结构异常共计13例,其中11例行引产,2例继续观察妊娠。观察组孕中晚期筛查出胎儿器官结构异常10例,7例引产,3例继续妊娠观察。观察组引产率高于对照组,引产病理结果与引产前筛查结果符合率高于对照组,出生缺陷率低于对照组,上述指标组间比较差异有统计学意义(P<0.05),出生缺陷存在的差异主要是三体综合征,对照组有3例三体综合征未检出,而观察组无三体综合征出生缺陷。观察组妊娠结局不良率明显低于对照组(P<0.05)。结论早孕期规范化超声检查对胎儿三体综合征的筛查具有重要价值,可有效降低出生缺陷率,提升孕妇妊娠结局。

Objective：To observe the effect of standardized ultrasound in early pregnancy to reduce the rate of fetal birth defects and pregnancy outcomes,and to explore the value of standardized ultrasound in early pregnancy to improve the level of prenatal and postnatal care. Methods：From January 2015 to December 2016,500 pregnant women who took part in health care and delivered during pregnancy in our hospital were selected as the study group and were selected as the observation group. Another 500 cases during the same period choose the second trimester in our hospital building line pregnant women during pregnancy as a research object as the control group. According to the results of fetal head-hip length and NT thickness,the fetal NT value of the observation group was initially determined whether the NT value was normal or not,and the detection indexes such as noninvasive DNA were added to pregnant women with abnormal NT value,Further clarify whether the fetus has Down syndrome,other trisomy syndrome and other genetic diseases. Two groups of second-trimester health care are in accordance with the provisions of the guidelines frequency,content. Statistics observation group early normal ultrasound diagnostic results,comparison of two groups of pregnant women in the second trimester health screening results,pregnancy outcomes,miscarriage or induced abortion fetal pathology diagnosis,fetal defects after birth. Results：The observation group 500 normal early pregnancy ultrasound results：17 cases of abnormal fetal examination results. Among them,11 cases of fetal NT thickening,6 cases of fetal organ structure abnormalities. NT abnormalities in 11 cases were noninvasive DNA examination,diagnosed 8 cases of fetuses as trisomy syndrome were induced,the remaining 3 cases continue to observe the pregnancy. Six cases of abnormal fetal organ abortion induced labor. Pregnant women in the control group in the second trimester of health screening of trisomy 5 cases,both induced abortion,fetal organ abnormalities in a total of 13 cases,of which 11 cases of induced labor,2 cases continue to observe pregnancy. In the second trimester of pregnancy,10 cases of structural abnormalities of the fetus were screened out,7 cases were induced abortion and 3 cases were observed the pregnancy. The abortion rate in the observation group was higher than that in the control group. The coincidence rate of the pathological results of induced abortion and prenatal screening results was higher than that of the control group,and the birth defect rate was lower than that of the control group. There was significant difference between the above groups（P〈0.05）The main difference is the existence of defects trisomy syndrome,control group,three cases of trisomy was not detected,while the observation group without trisomy syndrome birth defects. The rate of adverse pregnancy in observation group was significantly lower than that in control group（P〈0.05）. Conclusion：Normalized ultrasound in early pregnancy has important value in the screening of fetus trisomy. It can effectively reduce the birth defect rate and improve the pregnancy outcome of pregnant women.