产前超声筛查对中晚孕期胎儿异常结构筛查的临床价值

The clinical value of prenatal ultrasound screening in screening abnormal fetal structure in mid late pregnancy

目的分析产前超声在中晚孕期胎儿异常结构筛查方面作用。方法选择在本院进行产前超声检查的400例孕妇为研究样本,其研究时间均在2017年11月至2019年12月之间。分别在妊娠中期以及妊娠晚期对孕妇实施产前超声检查,重点筛查胎儿有无异常结构情况。将超声筛查结果与分娩结果实施比较,探究产前超声在筛查中晚孕期胎儿异常结构方面作用。结果 400例孕妇分娩后显示有10例新生儿出现异常结构,异常结构率是2.50%;其中1例颜面畸形(唇裂合并腭裂)、1例中枢神经畸形(脑膨出)、1例腹壁畸形(脐膨出)以及1例心脏畸形,有2例泌尿系统畸形(1例肾缺如以及1例左肾异位并多囊性发育不良)、3例骨骼系统畸形(1例半椎体畸形、1例多趾、1例多指)及1例颜面畸形(小耳畸形)。中孕期超声筛查提示8例胎儿纯在结构异常,异常结构率2.00%,其中有4例因中孕期筛查严重结构缺陷而引产结束妊娠,超声检查提示与引产结果相符合,准确率100%;足月分娩的396例新生儿中6例胎儿纯在结构异常,余胎儿正常,中孕期超声筛查提示有3例胎儿存在结构异常,余胎儿正常,晚孕期超声提示有4例存在胎儿异常结构,余胎儿正常。中孕期与晚孕期超声检查准确率分别是99.24%、99.49%(P>0.05)。结论在产前实施超声筛查可有效诊断胎儿异常结构,在中晚孕期进行胎儿异常结构筛查,晚孕期筛查漏诊率低于中孕期,虽然耳朵、手指,脚趾不是我们必须筛查的部位,但因为出现异常结构的几率相对较多,耳朵及某些手指、脚趾异常结构也与某些染色体异常相关,因此在中孕期筛查时需尽可能对胎儿肢体以及颜面部等进行全面观察,尽可能提升筛查准确性,减少漏诊率。

Objective:To analyze the role of prenatal ultrasound in the screening of fetal abnormal structure in the middle and late pregnancy.Methods:400 pregnant women who underwent prenatal ultrasound examination in our hospital were selected as the research samples,and the study time was between November 2017 to December 2019.Prenatal ultrasound examination was carried out in the second and third trimester of pregnancy,focusing on screening for fetal abnormalities.Compared the results of ultrasound screening with the results of childbirth,and explored the role of prenatal ultrasound in screening abnormal fetal structure during the second and third trimester.Results:After delivery of 400 pregnant women,10 newborns showed abnormal structure,the abnormal structure rate was 2.50%;There were 1 case of facial malformation(cleft lip and cleft palate),1 case of central nervous malformation(encephalocele),1 case of abdominal wall malformation(omphalocele)and 1 case of cardiac malformation.There were 2 cases of urinary system malformation(1 case of renal agenesis and 1 case of left kidney ectopic polycystic dysplasia),3 cases of skeletal system malformation(1 case of hemivertebra malformation,1 case of polydactyly,1 case of polydactyly)and 1 case of facial malformation(microtia).During the second trimester of pregnancy,ultrasound screening showed that 8 fetuses were pure structural abnormalities,the abnormal structure rate was 2.00%.Among them,4 cases were induced to end pregnancy because of serious structural defects during the second trimester screening;Among 396 full-term newborns,6 fetuses were found to have structural abnormalities,and the rest were normal.Ultrasound screening during the second trimester showed that 3 fetuses had structural abnormalities and the rest were normal.Ultrasound in late pregnancy showed that 4 fetuses had abnormal structures and the rest were normal.The accuracy rate of ultrasonography in the second and late pregnancy was 99.24% and 99.49%(P>0.05).Conclusion:Prenatal ultrasound screening can effectively diagnose fetal abnormal structures.Screening for fetal abnormal structures in the middle and late pregnancy period shows that the missed diagnosis rate in late pregnancy is lower than that in the second trimester.Although ears,fingers and toes are not the parts that we must screen,because the probability of abnormal structures is relatively high,the abnormal structures of ears and some fingers and toes are also related to some chromosome abnormalities.Therefore,in the second trimester screening,it is necessary to observe the fetal limbs and face as much as possible to improve the accuracy of screening and reduce the rate of missed diagnosis.