产前超声分级检查在筛查胎儿畸形中运用价值

Application Value of Prenatal Ultrasound Grading Examination in Fetal Malformation Screening

目的探讨产前超声分级检查在筛查胎儿畸形中的应用价值。方法回顾性分析2014年1月-2017年4月于本院进行超声检查的2230例孕妇的临床资料,按照检查方法的不同分为A组(接受Ⅱ级超声检查,共1010例)与B组(接受Ⅲ级超声检查,共1220例)。以最终住院分娩或终止妊娠结果为基准计算畸形胎儿发生率、超声的胎儿畸形检出率,分析胎儿畸形情况,如畸形部位、畸形发生率等。比较Ⅱ级超声检查与Ⅲ级超声检查的胎儿畸形检出率及不同孕周孕妇的胎儿畸形检出率。结果 2230例孕妇中,202例(9.06%)确诊为畸形胎儿,其中腹腔脏器畸形91例(45.05%)、神经系统畸形57例(28.22%)、手足畸形33例(16.34%)、唇裂腭裂21例(10.40%)。超声总体检出率为91.09%(184/202)。两组的畸形发生率分别为9.81%与8.44%,差异无统计学意义(P>0.05);B组的畸形检出率为95.15%,显著高于A组86.87%(P<0.05)。两组<20周、20~30周、>30周孕妇的畸形发生率均无统计学意义(P>0.05);两组<20周、>30周孕妇中超声对畸形胎儿的检出率的差异无统计学意义(P>0.05),B组20~30周孕妇中畸形胎儿的检出率为97.14%,显著高于A组87.50%(P<0.05)。结论Ⅲ级超声检查的胎儿畸形检出率较Ⅱ级更高,且孕20周到30周为最佳检查时间。临床应鼓励孕妇极积行Ⅲ级超声检查,以降低胎儿畸形风险。

Objective To explore the application value of prenatal ultrasound grading in fetal malformation screening.Methods A retrospective analysis was made to the clinical data of 2230 pregnant women receiving ultrasound examination in our hospital during the period from Jan.,2014 to April,2017; the 2230 cases were divided into 2 groups：group A（ n = 1010,receiving grade II ultrasound examination） and group B（ n = 1220,receiving grade III ultrasound examination）; the incidence of fetal malformation and the ultrasound detection rate of fetal malformation were calculated based on the results of hospital delivery or termination of pregnancy,and the malformations of fetus,including the malformation sites and the incidence,were analyzed; a comparative study was made in the detection rate of fetal malformation and that in pregnant women of different gestational ages between the 2 groups. Results Out of the 2230 cases,202 cases were diagnozed to have malformation fetuses,including abdominal organ abnormality in 91 cases（ 45. 05%）,nervous system malformation in 57 cases（ 28. 22%）,hand-foot malformation in 33 cases（ 16. 34%） and cleft lip and palate malformation in 21 cases（ 10. 40%）; the total detection rate of ultrasound was 91. 09%（ 184/202）; the incidence of malformation in the 2 groups was 9. 81% and 8. 44%,respectively,with no statistical differnce（ P〉0. 05）; the detection rate of malformation in group B was 95. 15%,much higher than that in group A（ 86. 87%）（ P〈0. 05）; no difference of statistical significance was found in malformation incidence in cases of gestation〈 20 weeks,from 20 weeks to 30 weeks and 〉30 weeks between the 2 groups（ P〉0. 05）; the detection rate of fetal malformation in cases of gestation 〈20 weeks and 〉30 weeks in group A was of no statistical difference from that in group B（ P〉0. 05）; the detection rate of fetal malformation in cases of gestation from 20 weeks to 30 weeks in group B was97. 41%,much higher than that in group A（ 87. 50%）（ P〈0. 05）. Conclusions Grade III ultrasound examination is of higher detection rate of fetal malformation than grade II ultrasound examination and gestation from 20 weeks to 30 weeks is the best time for examnation; pregnant women should be encouraged to receive grade III ultrasound examination so as to reduce the risk of fetal malformation.