孕11~14周羊膜带综合征早期超声诊断

Early sonographic diagnosis of amniotic band syndrome at 11-14 weeks′gestation

目的探讨孕11~14周胎儿羊膜带综合征的产前超声诊断特点。方法回顾性分析总结在北京协和医院首诊的孕11~14周超声检查羊水中未测及飘带样回声,经病理证实为羊膜带综合征的4例胎儿的超声表现。结果4例胎儿中,胎儿1、2表现为胎头位置固定伴颅骨光环缺失、颅脑结构紊乱,胎儿3、4表现为一侧上肢与脐带粘连、活动受限。4例胎儿首诊时均未测及羊水中多发游离飘带样回声,其中1例可见羊膜绒毛膜分离明显。3例胎儿进行了中孕复查,可见与肢体粘连的飘带样回声。胎儿1、2因颅脑畸形明显经产前咨询进行引产,胎儿3、4分别于17+3周和19+4周胎死宫内后引产。4例胎儿引产后均证实为羊膜带综合征。结论孕11~14周产前超声检查发现胎儿头颅位置固定、颅内结构紊乱或胎儿手与脐带粘连、活动受限时,应注意寻找飘带样回声,密切随诊,防止漏诊羊膜带综合征。

Objective To investigate the prenatal sonographic feature in the early diagnosis of amniotic band syndrome at 11-14 weeks′gestation.Methods A retrospective study was conducted to analysis and summarize the ultrasonographic features of 4 fetuses without band-like echoes in amniotic cavity at 11-14 weeks′gestation,but verified as amniotic band syndrome in Peking Union Medical College Hospital.Results Two cases(cases 1,2)showed the fixed head position with skull defect and intracranial structure disorders.Cases 3 and 4 showed one upper limb in a fixed position,and the hand seemed to adhere to the umbilical cord isolatedly.In addition,case 1 showed complete chorioamniotic membrane separation.There were multiple band-like echoes adhered to body of 3 fetals during the follow-up scan at 14-18 weeks.The parents of cases 1 and 2 chose to terminate the pregnancy after counseling,the other 2 cases also induced labor due to intrauterine fetal death at 15+2 weeks and 19+2 weeks respectively.All 4 cases were confirmed as amniotic band syndrome by pathology.Conclusions When the fetal sonographic images showed fixed head position,disordered intracranial structure,or adhesion between umbilical cord and hand with limited movement at 11-14 weeks′gestation,it should be paid attention to observing the band-like echoes and followed up closely to prevent missed diagnosis of amniotic band syndrome.