孕中期规范化产科超声检查用于准确发现胎儿先天性畸形的临床分析

Clinical analysis of fetal congenital malformation by standardized obstetric ultrasound in the middle of pregnancy

目的探讨孕中期规范化产科超声检查胎儿先天性畸形的检出率、漏诊率及准确性。方法选取2015年6月-2017年10月到我院妇产科接受产前检查的孕15~28周孕妇74例作为研究对象,均予以规范化产科超声检查,仪器选用美国GE-E8彩色多普勒超声诊断仪,观察胎儿脐带、胎盘及羊水等情况是否正常,并监测检查时发现的胎儿头面部、脊柱、胸腔、腹腔及四肢结构畸形病例,持续跟踪检测直至分娩结束。结果本次研究对象为2000例,胎儿先天性畸形74例,经规范化产科超声检测出71例,有3例漏诊,诊断准确率为95.95%,漏诊率为4.05%;检测出的先天性畸形类型包括脑积水11例(0.55%)、无脑儿3例(0.15%)、唇腭裂12例(0.60%)、心血管畸形22例(1.1%)、泌尿系统畸形8例(0.4%)、腹腔畸形3例(0.15%)、囊性淋巴管瘤3例(0.15%)、消化系统畸形4例(0.20%)及四肢发育畸形8例(0.40%)等,其中以心血管畸形、唇腭裂及脑积水最为常见。结论规范化产科超声检查胎儿先天性畸形的诊断准确率高,可有效减少先天性畸形儿出生率,尤以孕中期检查效果为佳,具有临床推广应用价值。

Objective：To investigate the detection rate,missed diagnosis rate and accuracy of fetal congenital malformation by standardized obstetric ultrasound in the mid-term pregnancy. Methods：From June 2015 to October-2017 in our hospital obstetrics and Gynecology prenatal examination for pregnant women during 15~28 weeks of gestation in 74 cases as the research object,are to be standardized obstetric ultrasound examination,selection of instruments made by SIEMENS of Germany ACUSON X600 color Doppler ultrasound observation of fetal umbilical cord,placenta and amniotic fluid is normal,check and monitoring when the fetal head,spine,chest,abdomen and limbs deformity cases,continuous tracking until the delivery end. Results：The object of this research is 2000 cases,74 cases of fetal congenital malformations,the standardization of obstetric ultrasound detected 71 cases,3 cases of misdiagnosis,the diagnostic accuracy was 95.95%,the misdiagnosis rate was 4.05%;the type of congenital malformation detected including 11 cases of hydrocephalus（0.55%）,3 cases of anencephaly（0.15%）,12 cases of cleft lip and palate（0.60%）,22 cases of cardiovascular malformations（1.1%）,urinary system malformation in 8 cases（0.4%）,3 cases of abdominal malformation（0.15%）,3 cases of cystic lymphangioma（0.15%）,digestive system abnormalities in 4 cases（0.20%）and four limbs malformation in 8 patients（0.40%）so,the cardiovascular malformation,cleft lip and palate and hydrocephalus is most common. Conclusion：Standardized obstetric ultrasound for fetal congenital malformation has a high accuracy rate,which can effectively reduce the birth rate of congenital malformed children,especially in the second trimester. It has the value of clinical popularization and application.