超声在筛查孕11～13+6周胎儿结构畸形中的应用价值

CLINICAL VALUE OF ULTRASOUND SCREENING IN FETAL STRUCTURAL DEFORMITYIN 11-13+6 WEEKS OF GESTATION

目的利用二维超声标准化切面筛查11~13+6周胎儿结构畸形,探讨超声在孕早期筛查胎儿结构畸形中的应用价值。方法对2015年1月—2017年12月在唐山市妇幼保健院超声科检查的12 924例(单胎11 698例,双胎613例)孕11~13+6周胎儿进行标准化检查,记录胎儿结构畸形种类和数量。对未发现异常胎儿进行孕中期和孕晚期超声筛查,随访妊娠结局,以引产后或出生后确诊的结构畸形类型为判断标准。计算孕11~13+6周产前超声诊断胎儿结构畸形的特异度、灵敏度、阳性预测值、阴性预测值。结果 12 924例胎儿中发现胎儿结构畸形528例,其中孕早期184例,检出率为34.9%(184/528),孕中晚期328例,检出率62.1%(328/528),漏诊16例,漏诊率3.0%(16/528)。其中重大结构畸形共197例,孕早期检出108例,检出率为54.8%(108/197),孕中晚期检出89例,检出率45.2%(89/197)。孕11~13+6周超声筛查胎儿重大结构畸形的灵敏度是35.2%,特异度是99.9%,阳性预测值97.9%,阴性预测值97.4%。结论产前超声在孕11~13+6周筛查胎儿结构畸形尤其是重大结构畸形中具有重要的应用价值,为孕妇提供早期准确的诊断信息,以减轻引产造成的孕妇身体和精神上的伤害。

Objective To explore the clinical value of ultrasound in screening fetal structural deformityin early pregnancy by using standardized section of two-dimensional ultrasound for 11—13+6 weeks.Methods From January 2015 to December 2017,twelve thousand nine hundred and twenty-four fetuses(11 698 singletons and 613 twins)who were examined by ultrasonography in Tangshan Maternal and Child Health Hospital at 11—13+6 weeks of gestation underwent standardexamination,and the types and numbers of fetal structural abnormalities were recorded.Ultrasound screening was carried out in the second and third trimesters of pregnancy for fetuses without abnormal findings,and pregnancy outcomes were followed up.The type of structural deformities diagnosed after induced labor or after birth was used as the criterion.The specificity,sensitivity,positive predictive value and negative predictive value of prenatal ultrasound in the diagnosis of fetal structural anomalies at 11-13+6 weeks of gestation were calculated.Results There were 528 cases with fetal structural deformity detected in 12924 fetuses,and its incidence was 4.1%,including 184 cases(34.9%,184/528)found in 11-13+6 weeks,328 cases in the mid and late pregnancy,the detection rate was 62.1%(328/528),16 cases were missed and the missed diagnosis rate was 3.0%(16/528).Among them,there were 197 cases of major structural deformities,108 cases were detected in the early pregnancy,the detection rate was 54.8%(108/197),89 cases in the mid and late pregnancy,the detection rate was 45.2%(89/197).The sensitivity,specificity,positive predictive value and negative predictive value were 35.2%,99.9%,97.9%and 97.4%respectively.Conclusion Prenatal ultrasound plays an important role in screening fetal structural deformities,especially major structural deformities,at 11-13+6 weeks of gestation.It can provide early and accurate diagnostic information for pregnant women to alleviate the physical and mental damage caused by induced labor.