早孕期系统超声筛查在胎儿结构畸形中的应用研究

发布时间：2018-04-29 19:07

本文选题：早孕期 + 系统超声筛查　；参考：《中南大学》2014年硕士论文

【摘要】：目的：本研究通过分析引产后确诊的胎儿结构畸形的超声图像特征,来探讨早孕期系统超声筛查在胎儿结构畸形的临床应用价值。方法：回顾性分析在2012年1月至2014年2月期间,在中南大学湘雅三医院超声科行早孕期(11～13+6周)系统超声筛查的1829例孕妇1874例胎儿(其中单胎1784例,双胎45例)。孕妇主要来自湖南省,少数来自周边省份,平均年龄28.2+3.1岁(20～42岁),平均孕龄为87.3±3.2天。检查前每位孕妇填写详细的调查问卷,包括父母基本资料及个人既往疾病史、本次妊娠记录、既往生育史等。超声提示结构畸形的胎儿,告知胎儿父母预后情况,让他们决定是否终止妊娠。征得孕妇同意的引产胎儿,行产后超声检查和(或)病理学检查。对每一入组胎儿记录孕期超声检查结果、染色体结果、出生后情况等。以引产后确诊的胎儿结构畸形患者其在早孕期的超声图像特征标准,评价早孕期胎儿结构畸形诊断的敏感性、特异性、阳性预测值、阴性预测值。结果：1829例孕妇1874例胎儿中正常单胎1698例,异常单胎86例,正常双胎42例,异常双胎3例。本组病例中共发现胎儿畸形89例,发生率为4.75%(89/1874)。其中早孕期诊断35例,早孕期胎儿结构畸形检出率为39.3%；中孕期诊断42例,早孕期联合中孕期检出率提高至86.5%。因此,以往认为中孕期才能诊断的胎儿结构畸形中45.5%(35/77)可在早孕期诊断。早孕期系统超声筛查胎儿结构畸形的敏感性、特异性、阳性预测值、阴性预测值分别为39.3%、100%、100%、97.1%。结论：早孕期系统超声筛查在胎儿结构畸形诊断中具有较高的诊断价值,以往认为中孕期才能诊断的胎儿结构畸形常可在早孕期诊断。早孕期系统超声筛查有助于孕妇早日决定妊娠结局,减少引产对孕妇心理和生理的伤害,为产前咨询和临床处理提供依据,具有十分重要的应用价值和临床意义,值得临床大力推广。图22幅,表6个,参考文献55篇
[Abstract]:Objective: to investigate the clinical application value of systematic ultrasound screening in early pregnancy by analyzing the ultrasonographic features of fetal structural malformation diagnosed after induced labor. Methods: from January 2012 to February 2014, a total of 1874 fetuses (1784 with single pregnancy and 45 with twins) in the Department of Ultrasonography, Xiangya third Hospital, Central South University, were screened by systematic ultrasound for 11136 weeks of early pregnancy. The pregnant women were mainly from Hunan Province and a few from neighboring provinces. The average age of pregnant women was 28.2 3.1 years old and 20 ~ 42 years old, and the average gestational age was 87.3 卤3.2 days. Before examination, each pregnant woman filled out detailed questionnaire, including parents' basic information and personal history of illness, pregnancy record, past birth history and so on. Ultrasound signals the fetus with structural abnormalities, informing the parents of the prognosis of the fetus and letting them decide whether to terminate the pregnancy. With the consent of the pregnant woman, the fetus shall undergo postpartum ultrasound examination and / or pathological examination. The results of ultrasound during pregnancy, chromosome and postnatal condition were recorded for every fetus in each group. The diagnostic sensitivity, specificity, positive predictive value and negative predictive value of fetal structural malformation in early pregnancy were evaluated according to the ultrasonographic characteristics of fetal structural malformation diagnosed after induced labor. Results there were 1698 cases of normal single fetus, 86 cases of abnormal single fetus, 42 cases of normal twins and 3 cases of abnormal twins. 89 cases of fetal malformation were found in this group, the incidence was 4.75% 89% 1874%. 35 cases were diagnosed in the early pregnancy, 39.3% in the early pregnancy, 42 cases in the middle pregnancy, and 86.5% in the first trimester. Therefore, 45. 5% of 35 / 77 of fetal structural malformations previously thought to be diagnosed during pregnancy can be diagnosed in early pregnancy. The sensitivity, specificity, positive predictive value and negative predictive value were 39.3% and 100% respectively. Conclusion: systematic ultrasound screening in early pregnancy has a high diagnostic value in the diagnosis of fetal structural malformation. In the past, the fetal structural malformation that can only be diagnosed during the middle pregnancy is often diagnosed in the early pregnancy. Systematic ultrasound screening during early pregnancy can help pregnant women to decide pregnancy outcome early, reduce the psychological and physiological injury of induced labor, and provide basis for prenatal counseling and clinical treatment. It has very important application value and clinical significance. It is worth popularizing in clinic. 22 figures, 6 tables, 55 references
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R714.5

【参考文献】