产前超声筛查胎儿解剖结构异常的回顾性分析

发布时间：2018-02-28 12:47

本文关键词： 产前超声胎儿畸形解剖结构高危因素　出处：《江苏大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探究系统性产前超声筛查胎儿解剖结构异常的价值分析及产前超声筛查胎儿畸形漏误诊原因的分析。方法:1.对2014年3月至2017年3月在我院超声科进行系统性产前超声检查并在我院生产的孕妇7160例作为研究资料,通过不同孕周的超声检查,记录正确诊断胎儿畸形时的孕周、类别和例数,并按照系统解剖分类。分析畸形胎儿在不同孕周的比例关系。计算超声筛查胎儿结构畸形的灵敏度、特异性、阳性预测值、阴性预测值、阳性似然比、阴性似然比。2.在7160例畸形中,分析超声准确诊断胎儿畸形的孕妇相关高危因素,高危因素与无高危因素的孕妇其胎儿畸形运用卡方检验对比分析得出结果。3.在7160例孕妇中,通过超声诊断结果与引产后及临床分娩结果进行对比统计,运用卡方检验得出结果,随访漏误诊病理,对其原因进行详细分析。结果:1.本组研究显示精确检出胎儿畸形264例,检出率为3.69%。按器官系统不同排前5名:心血管系统、中枢神经系统、泌尿系统、颜面部及颈部、骨骼肌肉系统及前腹壁畸形并列第5名。按详细畸形病种区分前5名:唇腭裂、无脑儿/露脑儿、多囊肾、脑积水、心内膜垫缺失及肾积水并列第五。2.孕早期及中孕早期筛查检出畸形以神经管缺陷(无脑儿、露脑儿)为主;孕中期结构畸形筛查覆盖各个脏器器官,以心血管发育异常最多见,其次是泌尿系统及神经管缺陷常见;晚孕期胎儿心血管发育异常为主,其次是颜面部及颈部畸形和泌尿系统畸形并列第二。3.产前超声诊断的符合率99.59%,灵敏度91.35%,特异性99.94%,阳性预测值97.78%,阴性预测值99.67%,阳性似然比1522.5,阴性似然比0.0865。4.胎儿畸形的发生率与孕妇的病毒感染、高龄、孕期接触有害物质及服用可致畸的药物具有明显相关性。5.通过随访超声漏误诊结果:23例漏诊病例,6例误诊病例,其中2例心脏畸形诊断错误,4例正常胎儿诊断为轻微畸形。超声诊断结果与引产后或临床分娩结果进行对比分析,P0.05,说明虽然超声诊断出现漏误诊情况,但是超声在诊断胎儿畸形应用上依旧具有重要的意义。结论:产前系统性超声筛查胎儿解剖结构异常具有非常重要的价值,虽然超声不能筛查出所有的疾病,但是它的安全性能、可重复性、无创性等都使得产前超声已成为一种绝不能缺失的检查方式。
[Abstract]:Objective: to explore the value of systematic prenatal ultrasound screening fetal anatomical structural abnormalities and the causes of misdiagnosis of fetal malformation by prenatal ultrasound screening. Methods: 1. Systematic analysis of ultrasound department of our hospital from March 2014 to March 2017. A total of 7160 pregnant women born in our hospital were examined by prenatal ultrasound as the data of the study. By ultrasonic examination of different gestational weeks, the gestational weeks, types and cases of fetal malformations were recorded, and the proportion of malformed fetuses in different gestational weeks was analyzed according to systematic anatomical classification. The sensitivity of ultrasonic screening of fetal structural deformities was calculated. Specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio. In 7160 cases of pregnant women, the results of ultrasound diagnosis were compared with the results of induced labor and clinical delivery, and the results were obtained by chi-square test. The causes of misdiagnosis were analyzed in detail. Results: in this study, 264 cases of fetal malformation were accurately detected, and the detection rate was 3.69. According to the organ system, the top 5 were: cardiovascular system, central nervous system, urinary system, and so on. Facial and cervical, musculoskeletal and anterior abdominal wall deformities were ranked 5th. According to detailed deformities, the top 5 were cleft lip and palate, anencephaly / exposed brain, polycystic kidney, hydrocephalus, Absence of endocardial cushion and hydronephrosis were 5th. 2. Neural tube defects (anencephaly, exposed brain) were mainly detected in early pregnancy and early pregnancy, the second trimester of pregnancy covered various organs and organs, and cardiovascular abnormalities were the most common. Secondly, urinary system and neural tube defects were common, and abnormal cardiovascular development of fetus during late pregnancy was the most common. The conformance rate of prenatal ultrasound diagnosis was 99.59, sensitivity 91.35, specificity 99.94, positive predictive value 97.78 and negative predictive value 99.677.The positive likelihood ratio was 1522.5, the negative likelihood ratio was 0.0865.4. The incidence of viral infection in pregnant women, In old age, exposure to harmful substances during pregnancy and teratogenic drugs were significantly correlated. 5. The misdiagnosis of 23 missed cases was found in 6 cases. Two cases of cardiac malformation were diagnosed as mild malformations in 4 cases of normal fetuses. The results of ultrasound diagnosis were compared with the results of induced labor or clinical delivery (P 0.05). However, ultrasound is still of great significance in the diagnosis of fetal malformations. Conclusion: prenatal systematic ultrasound screening of fetal anatomical abnormalities is of great value, although ultrasound can not screen all diseases. However, its safety, repeatability, noninvasive, etc., make prenatal ultrasound an indispensable examination method.
【学位授予单位】：江苏大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R714.5

【参考文献】