胎儿畸形超声筛查应用于产前诊断中的临床价值探讨

Clinical Value of Ultrasound Screening for Fetal Malformations in Prenatal Diagnosis

目的在产前诊断中应用胎儿畸形二维+三维超声超声筛查,观察其对胎儿畸形的检出情况及临床应用价值。方法方便选取2021年1月—2022年12月邹城市人民医院1500名产前诊断孕妇作为研究对象,所有孕妇均行胎儿畸形二维+三维超声筛查,记录胎儿畸形检出情况,将引产或分娩后胎儿畸形检查结果作为金标准,分析胎儿畸形二维超声及二维+三维超声筛查的敏感性、特异性、准确性、阳性与阴性预测值,并对比不同孕周产前超声畸形诊断准确率。结果金标准诊断结果显示,1500名产妇分娩后,55名存在胎儿畸形,占3.67%;腹部畸形8例、颅面部畸形9例、胸部畸形7例、脊柱四肢畸形15例、体表畸形10例、其他6例;二维超声筛查结果显示阳性56例,阴性1444例,二维+三维超声阳性55例,阴性1445例;二维+三维超声诊断敏感性、准确率、阴性预测值分别为94.55%、99.60%、99.79%,高于二维超声诊断,差异有统计学意义(P<0.05),诊断特异性、阳性预测值比较,差异无统计学意义(P>0.05);不同孕周产前超声畸形诊断准确率比较,差异有统计学意义(P<0.05),其中18~24周、25~32周诊断准确率高于12~17周、33周~足月。结论超声筛查对胎儿畸形诊断敏感性、准确性高,且以孕18~24周、25~32周准确率高,能够有效检出胎儿畸形情况,有利于降低畸形胎儿出生率。

Objective To apply two-dimensional and three-dimensional ultrasound screening for fetal malformations in prenatal diagnosis,and observe its detection status and clinical application value for fetal malformations.Method 1500 prenatal diagnosed pregnant women from Zoucheng People's Hospital from January 2021 to December 2022 were conveniently selected as the research subjects.All pregnant women underwent two-dimensional and threedimensional ultrasound screening for fetal malformations,and the detection status of fetal malformations was recorded.The results of fetal malformation examination after induction or delivery were used as the gold standard to analyze the sensitivity,specificity,accuracy,positive and negative predictive values of two-dimensional ultrasound and twodimensional and three-dimensional ultrasound screening for fetal malformations,and compare the diagnotic accuracy of prenatal ultrasound abnormalities at different gestational weeks.Result The gold standard diagnostic results showed that 55 out of 1500 postpartum women had fetal abnormalities,accounting for 3.67%.There were 8 abdominal deformities,9 craniofacial deformities,7 chest deformities,15 spinal and limb deformities,10 surface deformities,and 6 other deformities,the results of two-dimensional ultrasound screening showed that 56 cases were positive,1444 cases were negative,and 55 cases were positive and 1445 cases were negative with two-dimensional and three-dimensional ultrasound.The sensitivity,accuracy,and negative predictive value of two-dimensional and three-dimensional ultrasound diagnosis were 94.55%,99.60%,and 99.79%,respectively,which were higher than those of two-dimensional ultrasound diagnosis,the difference was statistically significant(P<0.05).The difference in diagnostic specificity and positive predictive value was not statistically significant(P>0.05).There was a statistically significant difference in the accuracy of prenatal ultrasound abnormalities among different gestational weeks(P<0.05),with higher diagnostic accuracy rates at 18-24 weeks and 25-32 weeks compared to 12-17 weeks and 33 weeks to term.Conclusion Ultrasound screening has high sensitivity and accuracy in diagnosing fetal malformations,with high accuracy at 18-24 weeks and 25-32 weeks of pregnancy.It can effectively detect fetal malformations and help reduce the birth rate of deformed fetuses.