三维超声联合观察腭线在早孕期诊断胎儿唇腭裂中的价值

Value of three-dimensional ultrasonography combined with observation of palate line in early pregnancy diagnosis of fetal cleft lip and palate

目的分析三维超声(three-dimensional ultrasonography,3DUS)联合观察腭线对早孕期胎儿唇腭裂的诊断价值。方法选取2019年1月至2022年2月于赣州市妇幼保健院进行产前检查并分娩的8200例孕妇(8315例胎儿)为研究对象,孕妇均于早孕期接受二维超声、3DUS联合观察腭线检查,筛查唇腭裂情况,以引产或分娩后颜面部检查为金标准,分析3DUS联合观察腭线对早孕期胎儿唇腭裂的诊断价值。结果8315例胎儿经引产或分娩后颜面部检查发现12例胎儿发生唇腭裂,发生率0.14%;其中单纯腭裂7例、唇腭裂5例。3DUS联合观察腭线检出唇腭裂15例,二维超声检出唇腭裂28例。3DUS联合观察腭线筛查早孕期胎儿唇腭裂与产后颜面部检查结果具有极好的一致性(Kappa=0.815)。3DUS联合观察腭线诊断早孕期胎儿唇腭裂的特异性、准确度、阳性预测值均高于二维超声(P<0.05)。结论3DUS联合观察腭线诊断早孕期胎儿唇腭裂的价值较高,可提高诊断的特异性和准确度,且与产后颜面部检查结果的一致性极好。

Objective To analyze the value of three-dimensional ultrasonograply(3DUS)combined with observation of palate line in early pregnancy diagnosis of fetal cleft lip and palate.Methods A total of 8200 pregnant women(8315 fetuses)who underwent prenatal examination and delivered in Ganzhou Women and Children’s Health Care Hospital from January 2019 to February 2022 were selected as the study objects.In early pregnancy,all pregnant women received two-dimensional ultrasound and 3DUS combined observation of palatal line to screen for cleft lip and palate.Using facial examination after labor induction or delivery as the gold standard,the diagnostic value of 3DUS combined with observation of palatal line in early pregnancy was analyzed.Results The facial examination of 8315 fetuses after labor induction or delivery revealed that 12 fetuses had cleft lip and palate(0.14%).There were 7 cases of cleft palate alone,and 5 cases of cleft lip and palate.15 cases of cleft lip and palate were detected by 3DUS combined with observation of palatal line and 28 cases were detected by two-dimensional ultrasound.There was excellent consistency between 3DUS combined observation of palate line screening in early pregnancy and postnatal facial examination(Kappa=0.815).The specificity,accuracy and positive predictive value of 3DUS combined with observation of palatal line in the diagnosis of cleft lip and palate in early pregnancy were higher than those of two-dimensional ultrasound(P<0.05).Conclusion 3DUS combined observation of palate line in the diagnosis of early pregnancy fetal cleft lip and palate is of high value,which can improve the diagnostic specificity and accuracy,and is in good agreement with the postpartum facial examination results.