妊娠不同时期胎儿畸形的超声诊断

Fetal malformations diagnosed by ultrasound during different gestational weeks

目的:探讨妊娠不同时期超声诊断胎儿畸形检出特点。方法:选择2020年1月-2022年12月本院确诊胎儿畸形的不同孕周孕产妇170例临床资料,均接受超声检查,以终止妊娠胎儿病理检查或分娩结局为畸形诊断标准。结果:170例中163例在妊娠期间B超检出胎儿畸形,7例B超漏诊为妊娠早期3例、妊娠中期3例和妊娠晚期1例;170例中66例产妇选择分娩,104例产妇接受终止妊娠,分娩的66例胎儿随访1个月均存活。163例检出神经系统畸形、胸腔腹壁畸形、心血管畸形、颜面颈部畸形、四肢、脊柱畸形、泌尿系统畸形及其他等胎儿畸形,4例为多发畸形(均在妊娠中期检出),159例为单发畸形;163例胎儿畸形中,心血管畸形35例(21.5%)、胸腔腹壁畸形32例(19.6%)、颜面颈部畸形30例(18.4%)、泌尿系统畸形25例(15.3%)和中枢神经畸形22例(13.5%)检出较多。妊娠早期48例,检出中枢神经畸形15例(31.3%)、胸腔腹壁畸形11例(22.9%)和单纯NT/NF增厚10例(20.8%)较多;妊娠中期85例,检出胎儿的心血管畸形32例(37.65%)和颜面颈部畸形17例(20.00%)较多;妊娠晚期30例,检出胎儿泌尿系统畸形12例(40.0%)较多。B超诊断灵敏度和准确度,妊娠早期分别为93.8%和93.8%,妊娠中期分别为96.5%和96.5%,妊娠晚期分别为96.7%和96.7%。结论:妊娠不同时期超声均可检出胎儿畸形,应根据其特点予以鉴别。

Objective:To explore the detection and characteristics of fetal malformations diagnosed by ultrasound during different gestational weeks.Methods:The clinical data of 170 pregnant women with diagnosed fetal malformation dur-ing different gestational weeks from January 2020 to December 2022 were selected in this study.All these women were examined by ultrasound,and the pathological examination of the fetus after termination of pregnancy or the delivery outcomes were taken as the gold standard for the diagnosis of fetal malformation.Results:Among 170 women,there were 163 cases with fetal malformation detected by B-ultrasound during pregnancy,and there were 7 cases with missed fetal malformation by B-ultrasound,including 3 cases during the first trimester of pregnancy,3 cases during the second trimester of pregnancy,and 1 case during the third trimester of pregnancy.Among 170 women,66 women had chosen to give birth,and 104 women had accepted the termination of pregnancy.66 newborns of the women who had chosen to give birth had survived in 1 month of follow-up after born.There were 163 women with fetal malformation detected,including neurological malformations,thoracic and abdominal wall malformations,cardiovascular malformations,facial and neck malformations,limbs,spine malformations,urinary system malformations,and other fetal malformations.4 fetuses with multiple malformations were detected during the second trimester of pregnancy,159 fetuses with single malformations were detected.Among 163 fetuses with malformations detected,there were 35(21.5%)cases with car-diovascular malformations,32(19.6%)cases with thoracic and abdominal wall malformations,30(18.4%)cases with facial and neck malformations,25(15.3%)cases with urinary system malformations,and 22(13.5%)cases with cen-tral nervous system malformations.48 fetuses with malformations detected during the first trimester of pregnancy,.there were 15(31.3%)cases with central nervous system malformations,11(22.9%)cases with thoracic and abdomi-nal wall malformations,and 10(20.8%)cases with NT/NF thickening alone.85 fetuses with malformations detected during the second trimester of pregnancy,there were 32(37.7%)cases with cardiovascular malformations and 17(20.0%)cases with facial and neck malformations.30 fetuses with malformations detected during the third trimester of pregnancy,there were 12(40.0%)cases with urinary system malformations,which was more than other malforma-tions.The diagnostic sensitivity and accuracy of B-ultrasound for diagnosing the fetal malformation during the first tri-mester of pregnancy were 93.8%and 93.8%,which during the second trimester of pregnancy were 96.5%and 96.5%,and which during the third trimester of pregnancy were 96.7%and 96.7%.Conclusion:The fetal abnormalities during different gestational weeks all can be found by ultrasound.