3000例孕中期系统产前超声筛查妊娠结局分析

发布时间：2018-03-08 18:41

  本文选题：胎儿畸形　切入点：超声软指标　出处：《天津医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的分析3 000例妊娠妇女(单胎)系统产前超声筛查胎儿结构畸形及超声软指标的灵敏度、特异度,分析超声软指标与胎儿结构畸形的相关性。加强规范性系统产前超声筛查质量控制,规范应用超声软指标,提高对系统产前超声筛查及超声软指标的临床正确认识。方法选取2013年7月1日至2014年12月31日来天津市塘沽妇产医院进行孕中期系统产前超声筛查的3 000例妊娠妇女(单胎),收集妊娠妇女临床资料,与拟进行系统产前超声筛查的妊娠妇女签署知情同意书。按规范要求进行系统产前超声筛查,存储标准切面及异常切面图像并测量所需数据,出具报告。所有相关图像及数据均保存三年以上。对所有病例进行妊娠结局追踪及随访至产后6个月。应用灵敏度、特异度分析系统产前超声筛查及超声软指标临床意义。所有资料均采用SPSS17.0软件进行X~2检验分析数据,期望值1用确切概率法;1≤期望值5用连续校正法,均以P0.05表示差异具有统计学意义。结果3 000例妊娠妇女(单胎)通过产后随访证实胎儿结构畸形50例,胎儿结构畸形发生率为1.67%(50/3 000)。胎儿结构畸形50例中有42例通过系统产前超声筛查确定,并经新生儿手术或引产胎儿组织病理学证实。系统产前超声筛查胎儿结构畸形灵敏度为84%(42/50),特异度为100%(2950/2950)。假阴性8例均为胎儿单发畸形且无致死性畸形,分别为单纯性室间隔缺损2例、肺动脉瓣狭窄1例、肛门闭锁1例、单纯腭裂1例、多指2例和并指1例。3 000例妊娠妇女(单胎)通过系统产前超声筛查共检出超声软指标胎儿425例,其中证实胎儿结构畸形30例,超声软指标发生率14.16%(425/3000),灵敏度60%(30/50),特异度86.6%(2555/2950),其中心内点状强回声特异度最低93.9%(2771/2950),脉络丛囊肿灵敏度最低4%(2/50)。具有≥2个超声软指标的胎儿比单个超声软指标胎儿发生结构畸形相关性高。胎儿颈部皮肤增厚、鼻骨发育异常、心内点状强回声、侧脑室增宽、肾盂扩张、肠管回声增强、单脐动脉均与胎儿结构畸形有相关性,脉络丛囊肿与胎儿结构畸形无相关性。结论1.规范性系统产前超声筛查能够有效的筛查出胎儿结构畸形,避免严重致死、致畸结构异常儿出生,客观评价系统产前超声筛查是非常必要的。2.超声软指标与胎儿结构畸形有一定的相关性,具有多个超声软指标胎儿结构畸形明显高于单一超声软指标。加强对超声软指标的正确认识,合理应用超声软指标,能够提高胎儿结构畸形检出率。3.加强系统产前超声筛查质量控制,规范系统产前超声筛查,既能最大程度筛查胎儿结构畸形同时也可规避医疗风险。
[Abstract]:Objective to analyze the sensitivity and specificity of prenatal ultrasound screening in 3 000 pregnant women (single fetus) for fetal structural abnormalities and soft indexes of ultrasound. To analyze the correlation between ultrasonic soft index and fetal structural malformation, to strengthen the quality control of prenatal ultrasound screening in standard system, and to standardize the application of ultrasonic soft index. Methods from July 1st 2013 to December 31st 2014, 3 000 cases of pregnancy were selected from Tianjin Tanggu Obstetrics and Gynaecology Hospital for systematic prenatal ultrasound screening. Pregnant women (single pregnancy, collect clinical data of pregnant women, Sign an informed consent form with a pregnant woman who intends to undergo systematic prenatal ultrasound screening. Perform systematic prenatal ultrasound screening in accordance with the specifications, store standard section and abnormal section images, and measure the required data. All relevant images and data were kept for more than three years. Pregnancy outcome was tracked and followed up to 6 months after delivery. Sensitivity was applied. The clinical significance of prenatal ultrasound screening and ultrasonic soft index in specificity analysis system. All the data were analyzed by X2 test using SPSS17.0 software, and the expected value 1 was determined by the exact probability method and 1 鈮，

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