胎儿主动脉弓离断的产前超声诊断

目的探讨胎儿主动脉弓离断的超声诊断特点。方法回顾性分析产前超声诊断为胎儿主动脉弓离断的35胎胎儿资料,同时纳入180胎正常胎儿。二维超声判断胎儿内脏及心脏位置,获取四腔心切面、左右心室流出道切面、三血管切面及三血管-气管切面等横断面,并扫查腔静脉长轴切面、主动脉弓切面及动脉导管弓切面等矢状切面。测量主动脉弓离断胎儿左右心室内径比值及主动脉与肺动脉内径比值,并与相应孕周的正常胎儿进行比较。结果产前二维超声诊断A型、B型及C型主动脉弓离断分别为16、18及1胎,均伴室间隔缺损,共27胎经尸体检查或产后检查证实产前诊断,3胎诊断错误,余5例新生儿失访。四腔心切面及三血管切面发现主动脉弓离断胎儿左右心室内径比值和主动脉与肺动脉内径比值显著小于相应孕周正常胎儿,差异有统计学意义(P均0.01)。矢状切面对主动脉追踪连续扫查可确定主动脉的分支及走行,可明确诊断及分型。A型、B型及C型离断升主动脉走行及分支分别呈现典型的"W型"、"Y型"及"I型"。矢状面扫查及横断面扫查对胎儿主动脉弓离断的诊断率分别为90.00%(27/30)及56.67%(17/30),差异有统计学意义(P0.01)。结论产前二维超声可诊断胎儿主动脉弓离断,横断面扫查可发现某些线索,矢状面连续扫查对诊断胎儿主动脉弓离断具有重要意义。     

超声心动图诊断胎儿冠状静脉窦扩张

目的探讨胎儿冠状静脉窦(CS)扩张的超声诊断思路。方法回顾性分析145胎正常冠状静脉窦胎儿(正常组)和72胎CS扩张胎儿(CS组)的资料,于非标准四腔心切面下显示CS长轴,测量CS的矢状切面面积。采用二维超声结合彩色多普勒超声对所有胎儿分别进行胎儿四腔心切面、左右心室流出道切面、三血管切面、大动脉短轴切面、主动脉弓切面、动脉导管弓切面及腔静脉长轴切面扫查,观察CS的特点。结果胎儿CS矢状切面面积与孕周呈正相关(正常组:r=0.954,P0.05;CS组:r=0.904,P0.05),同孕周正常组胎儿CS矢状切面面积小于CS组(P均0.01)。产前超声诊断72胎CS扩张的胎儿中,52胎为永存左上腔静脉,15胎为完全型肺静脉异位引流,5胎右心压力负荷增大。结论胎儿CS矢状切面的面积与孕周呈正相关;胎儿心脏超声检查发现CS扩张时应同时考虑其他心内畸形;临床应通过多切面、多角度扫查,分析和诊断引起CS扩张的病因。     

超声在诊断胎儿颜面畸形中的应用价值及颜面部畸形与染色体异常的关系研究

目的:探究超声在诊断胎儿颜面畸形中的临床价值,进一步分析颜面部畸形与染色体异常的关系。方法:回顾性分析2018年12月-2019年7月在笔者医院超声科行产前筛查的1533例孕妇的资料,以超声筛查胎儿颜面部异常者(超声异常组,n=30)和超声筛查胎儿颜面部正常但具有高危因素者(超声正常高危组,n=66)作为研究对象。记录超声及染色体检查结果,分析颜面部畸形与染色体异常的关系。结果:30例超声筛查颜面部异常胎儿中,8例单纯颜面部异常,22例颜面部异常合并其他异常。超声异常合并其他异常组NT厚度显著高于超声单纯异常组和超声正常高危组,差异有统计学意义(P<0.05)。超声异常组胎儿染色体异变率为20.00%,显著高于超声正常高危组的4.55%,差异有统计学意义(P<0.05)。结论:产前筛查中应用超声诊断可以明显提高染色体异常胎儿的检出率,值得临床推广应用。     

孕早期胎儿NT及鼻骨超声检查在胎儿畸形诊断中的应用价值分析

目的探究孕早期胎儿颈项透明层(NT)及鼻骨超声检查在胎儿畸形诊断中的应用价值。方法选择2015年1月至2017年12月在本院进行孕早期产检的8012例单次妊娠的孕妇,采用多普勒彩超进行NT及鼻骨检测,观察胎儿鼻骨缺失及颈项透明层增厚的情况,此外,孕早期检测结果与孕晚期胎儿畸形筛查结果进行对比分析。结果 8012例孕妇中,孕早期检查检出40例胎儿畸形,阳性率为0.499%,40例孕妇均选择终止妊娠。孕早期检查中,鼻骨正常7921例,其中包括7例染色体异常和4例染色体结构异常,异常率为0.14%;鼻骨缺失例,其中包括8例染色体异常和7例染色体结构异常,异常率为16.49%,显著高于鼻骨正常患者,具体统计学意义(P0.05)。孕早期检查中,鼻骨正常7921例,其中包括7例染色体异常和4例染色体结构异常,异常率为0.14%;鼻骨缺失例,其中包括8例染色体异常和7例染色体结构异常,异常率为16.49%,显著高于鼻骨正常患者,具体统计学意义(P0.05)。结论孕早期胎儿NT及鼻骨超声具有较高的胎儿畸形检出率,值得在临床上广泛推广。     

磁共振评价正常胎儿后颅窝结构

目的通过MRI测量正常胎儿后颅窝各指标值,推算正常值参考范围。方法对242胎胎龄28～40周胎儿以1.5T MR仪行头部成像。用Image J Basics(Version 1.38)软件分别于正中矢状面T2WI测量小脑前后径、上下径、正中矢状面小脑面积及脑外间隙,并进行统计学分析。结果正中矢状面胎儿小脑上下径、前后径及小脑面积的95%可信区间分别为19.87～20.72mm、15.50～16.50mm、316.25～338.87mm2。小脑前后径、上下径,正中矢状面小脑面积与胎龄呈正相关(r2=0.846、0.826、0.865,P均<0.05);胎儿正中矢状面后颅窝脑外间隙95%可信区间为5.48～6.01mm,与胎龄无明显相关(r2=0.032,P>0.05)。结论 MRI可评价胎儿后颅窝结构,为围产期评估后颅窝发育状况提供重要参考依据。     

孕早期胎儿心脏结构的超声筛查

目的探讨孕11~13~(+6)周经腹部超声筛查胎儿心脏畸形的可行性及临床价值。方法于孕11~13~(+6)周对3360胎行心脏四切面扫查,包括胎儿四腔心切面、三血管切面、左心室流出道切面及右心室流出道切面。根据孕周分为A(11~11~(+6)周)、B(12~12~(+6)周)、C(13~13~(+6)周)3组,比较3组胎儿心脏切面满意显示率。并于该时期筛查胎儿严重心脏畸形并随访至中孕期。结果 C组心脏各切面显示率明显高于A、B组,差异有统计学意义(P0.05)。3360胎中于早孕期筛查出心脏异常12胎,并于中孕期得以证实。结论孕早期经腹部超声筛查胎儿严重心脏畸形是可行的。     

实时三维超声双平面技术评价胎儿卵圆孔处血流的应用

目的探讨实时三维超声双平面(Bi-plane)技术在评价胎儿卵圆孔处血流中的应用价值。方法纳入186胎无心内外畸形的正常胎儿,获得下腔静脉右心房入口冠状切面。于该切面测量卵圆孔内径(DFO)及下腔静脉右心房入口处内径(DIVC),计算两者的比值(DFO/DIVC),并分析该比值与孕周的相关性。结果 DFO/DIVC与孕周无明显相关性(r=-0.228,P0.05)。中孕期(21~28周)胎儿共155胎,DFO为(4.46±0.57)mm,DIVC为(4.55±1.22)mm,DFO/DIVC为1.03±0.22;晚孕期(29~36周)胎儿共31胎,DFO为(5.20±0.43)mm,DIVC为(5.90±1.33)mm,DFO/DIVC为0.92±0.17。DFO/DIVC均值95%可信区间为(0.98,1.04),个体值95%正常参考值范围为(0.80,1.44)。结论采用实时三维超声Biplane技术可获得胎儿心脏下腔静脉右心房入口冠状切面,可观察到下腔静脉血流在进入右心房后正对房间隔上缘,并被房间隔上缘分为两部分的血流走行全程,在评价房间隔卵圆孔处血流方面具有重要意义。     

中晚孕期胎儿静脉导管A波倒置与胎儿心脏畸形

目的探讨中晚孕期胎儿静脉导管A波倒置的临床诊断价值。方法选取资料完整的静脉导管A波倒置胎儿27胎,分析胎儿先天性心脏畸形特点,并与尸体检查及新生儿随访结果相对照。结果 27胎静脉导管A波倒置胎儿中,右心系统发育异常20胎(20/27,74.07%),其中右心发育不良综合征13胎,肺动脉瓣狭窄并三尖瓣重度反流3胎,Ebstein畸形并三尖瓣重度反流2胎,三尖瓣黏液样变性并重度反流1胎,单纯肺动脉瓣轻度狭窄1胎;锥干畸形5胎(5/27,18.52%),其中右心室双出口2胎,永存动脉干1胎,法洛四联症1胎,功能矫正型大动脉转位1胎;扩张型心肌病1例;卵圆孔血流受限1例。结论静脉导管A波倒置高度提示胎儿右心系统发育不良或胎儿锥干畸形。     

产前超声测量肺头比值评价先天性肺隔离症胎儿预后

目的通过中孕期超声测量并计算先天性隔离肺(PS)胎儿肺头比(CVR)值,探讨CVR评估PS胎儿预后风险的价值。方法收集88例中孕期超声诊断为PS胎儿的超声及临床资料,根据产前测算的胎儿CVR值,分为CVR≥1.6组和CVR1.6组,对比两组胎儿胎儿水肿发生率、产后呼吸窘迫症状及存活率。结果 88例PS胎儿中,中孕期超声诊断叶内型(ILS)62胎(62/88,70.45%),叶外型(ELS)I型19胎(19/88,21.59%),ELSⅡ型7胎(7/88,7.95%)。活产81胎(81/88,92.05%),引产5胎(51/88,5.68%),死胎2胎(2/88,2.27%)。CVR≥1.6组44胎,呼吸窘迫发生率为81.82%(36/44),胎儿水肿发生率为88.64%(39/44),活产率为84.09%(37/44);CVR1.6组44胎,3胎(3/44,6.82%)产后发生呼吸窘迫,3胎(3/44,6.82%)发生胎儿水肿,活产率为100%(44/44)。两组胎儿水肿发生率、产后呼吸窘迫发生率及存活率的差异均有统计学意义(P均0.05)。结论 CVR是产前中孕期超声筛查评价PS胎儿预后的有效指标。     

超声诊断双臀联体双胎1例

<正>孕妇29岁,孕1产0,孕17周。无双胎家族史,未服用促排卵药。常规产前超声:双胎儿胎头融合,可见2个小脑影(图1A),单一颜面;脊柱矢状切面上2条脊柱从臀部至颈部逐渐靠拢(图1B),头部、颈部、胸部及脐以上腹部均融合,可探及4条上肢及4条下肢回声;胸腔内可见2个胎儿心脏,形态异常;腹腔内可见2个胃泡、4个肾脏、2个膀胱,双胎儿腹壁共用1个脐带入口(图1C)。超声诊断:中期妊娠,联体双胎(头、颈、胸、腹部相连)。引产娩出双臀联体双胎男婴,单头、单一颜面、4只     

Meconium peritonitis: A 22-year review in a tertiary referral center

BackgroundMeconium peritonitis (MP) is a sterile, chemical peritonitis resulting from in-utero fetal bowel perforation. Severe cases may lead to serious morbidities and mortalities.ObjectiveTo review the common antenatal ultrasound abnormalities associated with MP, and identify radiological and clinical prognostic factors.Materials and methodsRetrospective review of all neonates with MP from January 1997 to December 2019 treated in our hospital was performed. Antenatal ultrasound findings, clinical presentations and outcomes were analyzed.ResultsThirty-five neonates (17 males, 18 females) were included in the study. Thirty-two (91.4%) attended antenatal screening, and 27 (84.4%) of them had abnormalities identified on antenatal ultrasound. The most common abnormality was polyhydramnios (43.8%). Nineteen (54.3%) patients were inborn. Twenty (57.1%) patients were born prematurely. Laparotomy was required in 85.7% of patients. The median time to laparotomy was shorter in the inborn group [1 day (0–9 days) vs 4 days (2–34 days), p = 0.001], but the duration of post-operative hospital stay was comparable [71 days (16–423 days) vs 73.5 days (23–231 days)]. However, such duration was found to be significantly longer in the pre-term group when compared to full-term [58.5 days (16–89 days) vs 85 (21–423 days), p = 0.01]. The most common pathology was small bowel atresia and there were two mortalities.ConclusionDue to the advancement in prenatal detection, pediatric anesthesia, intensive care and surgical techniques, the morbidity and mortality of MP has much decreased. Effective multi-disciplinary antenatal counseling facilitated the perinatal management of MP and resulted in comparable prognosis and outcome in inborn and outborn neonates.Level of evidence3     

Hemodynamic changes in children with Down syndrome during and following inhalation induction of anesthesia with sevoflurane

Study ObjectiveTo evaluate whether children with Down Syndrome are at increased risk of bradycardia and hypotension during and following sevoflurane induction.DesignRetrospective study.SettingUniversity-affiliated children's hospital.MeasurementsThe records of children with Down syndrome and a sample matched by age, congenital heart defect, and ASA physical status, were searched. Demographics, history of Down syndrome or congenital heart anomaly, heart rate (HR), mean arterial pressure (MAP), and end-tidal concentration of sevoflurane (EtSevo) at baseline and following induction were recorded.Main Results96 children with Down syndrome were identified from 11,201 pediatric anesthetics (< 1%). Demographics were similar in the matched sample. The Down syndrome group was more likely to experience bradycardia and had greater decreases in HR from baseline. These findings were similar for children with or without congenital heart defects. There were no differences between groups in the number who were treated with a pharmacologic agent.ConclusionA significantly higher prevalence and degree of bradycardia occurred in children with Down syndrome during and following sevoflurane induction, which was corrected by decreasing the concentration of sevoflurane and airway manipulation.     

Hirschsprung disease with Edward syndrome: A rare association: A case report

Introduction and importanceEdward's syndrome (ES) occurs as a result of trisomy of chromosome 18 and is associated with multisystem congenital anomalies. The association of ES with various gastrointestinal malformations but Hirschsprung disease (HD) is well documented.Case presentationA female infant on her 5th day of life presented with episodes of bilious vomiting along with abdominal distension and no passage of stool. The child had a small head and prominent occiput, low set abnormal ears, small jaw, upturned nose, widely spaced eyes, small neck with widely spaced nipples, clenched hands with overlapping fingers, flexed big toe, and prominent heels.Clinical discussionEdward syndrome is associated with multisystem congenital abnormalities of which gastrointestinal abnormalities make up the most part. The condition can be identified by fetal ultrasound screening. Surgical correction of associated congenital anomalies at different times along with lifelong supportive management is important.ConclusionsEdward syndrome can present as Hirschsprung disease as a part of associated gastrointestinal Malformation. Often, early identification and termination of the pregnancy in antenatal life can reduce the suffering. Surgical correction of associated anomalies along with supportive care forms the cornerstone of management. However, the prognosis remains poor.     

The outcome of antenatally diagnosed urological abnormalities

Twenty-eight patients undergoing routine antenatal screening by ultrasound were found to have a fetus with a major urological abnormality. In addition, two babies suspected of having an enlarged bladder were found post-natally to be normal. Seven of the 28 pregnancies were terminated before 26 weeks' gestation as a result of the ultrasound findings and all these fetuses had lethal renal abnormalities. Of the remaining 21 babies, four died of renal failure following delivery. Fifteen of the 17 babies who are alive and well had an ultrasound scan before 24 weeks' gestation. Only one of these scans revealed the abnormality. In the remaining patients the abnormality was first detected after 28 weeks. No patient had surgery in utero. Our data suggest that renal abnormalities detected prior to 24 weeks' gestation are associated with severe renal impairment. It appears that the role of antenatal drainage procedures may be of limited value.     

The addition of a brief ultrasound examination to clinical assessment increases the ability to confirm placement of double-lumen endotracheal tubes

Study ObjectiveTo evaluate the role of a brief ultrasound examination (US) in detecting the correct position of the left double-lumen endotracheal tube (LDLT).DesignProspective, randomized clinical study.SettingOperating room of a university hospital.Patients50 elective adult thoracic surgery patients who required a LDLT during anesthesia.Intervention and MeasurementsPatients were randomized to two groups: Group A, who underwent clinical assessment of the LDLT position, and Group B, who were examined clinically and by ultrasound. All 50 patients underwent the same conventional procedure of LDLT placement. In all patients, clinical assessment of LDLT positioning was made by observing chest wall expansion and checking lung compliance by manual ventilation and by auscultation of both lungs. In Group B, a very brief ultrasound (15-30 sec) examination was added. Ultrasound examination included visualization of the pleural movements (“lung sliding”) and motion of the diaphragm from both sides before and after selective clamping of the bronchial and tracheal limbs. In both groups, a second anesthesiologist performed bronchoscopy to estimate actual LDLT position.Main ResultsSensitivity and negative predictive values in detecting proper LDLT positioning for both methods were 100%. For the clinical assessment alone (Group A), specificity was 22%, accuracy was 72%, and positive predictive value, 70%; for the clinical and ultrasound assessment (Group B), specificity was 50%, accuracy was 88%, and positive predictive value, 86%.ConclusionA brief ultrasound examination added to clinical assessment ensured more precise placement of LDLT than did clinical assessment alone.     

Contribution of the foetal uro-MRI in the prenatal diagnosis of uronephropathies

PurposeTo study the complementary diagnostic value and role in the perinatal management of foetal MRI in the prenatal diagnosis of abnormalities of the urinary tract.Patients and methodsRetrospective monocentric study from November 2002 to June 2011 of foetuses benefiting from an MRI after ultrasound diagnosis of uronephropathy abnormalities. Ultrasound and MRI data were compared with postnatal radiological and/or surgical data or with the foetopathology. The MRI analysis focused on the diagnostic concordance with the ultrasound, the complementary diagnostic contribution and/or a change in perinatal care.ResultsOf the 154 MRI examined, a follow-up was obtained for 108 cases. The indications for MRI were classified into six groups: suspected renal agenesis (n = 20, 18.5%), posterior urethral valve (n = 20, 18.5%), reflux or megaureter (n = 14, 13%), uretropelvic junction syndrome (n = 24, 22.5%), enlarged kidneys (n = 7, 6.5%) and others (n = 23, 21%). The information supplied by ultrasound was confirmed by MRI in 72 patients (67%). MRI provided additional data for 36 patients (33%) and changed the perinatal care for 16 patients (15%).ConclusionFoetal uro-MRI is a useful complementary tool in the prenatal diagnosis of some uropathy abnormalities.     

Morgagni hernia mimicking pneumonia in Down syndrome

Down syndrome patients are immunodeficient and commonly suffer from respiratory infections. Two children with Down syndrome were referred for evaluation of recurrent pneumonia accompanied by persistent infiltrate on chest radiographs. In both cases the radiographic abnormalities were actually found to be Morgagni hernia. When a child with Down syndrome has a persistent lower lobe infiltrate on chest radiograph, the possibility of a diaphragmatic defect should be entertained.     

对比不同影像学方法对胰腺神经内分泌肿瘤的检出率

目的探讨不同影像学检查方法对检出胰腺神经内分泌肿瘤(P-NEN)的价值。方法回顾性分析40例(共43个病灶)经手术后病理证实的P-NEN患者的影像学资料,包括CT、MRI、超声内镜(EUS)、PET/CT,与手术结果相对照,分析各种影像学方法对P-NEN的检出率。结果 CT、MRI、EUS及PET/CT对P-NEN病灶的检出率分别为76.74%(33/43)、94.87%(37/39)、94.59%(35/37)和51.52%(17/33)。MRI与EUS病灶检出率差异无统计学意义(P均0.05),余两两比较差异均有统计学意义(P均0.05)。结论 MRI可作为P-NEN的首选影像学检查方法。     

Diagnosis of congenital abnormalities with post-mortem ultrasound in perinatal death

Purpose

To determine the sensitivity and specificity of post-mortem ultrasound in the diagnosis of major congenital abnormalities of fetuses using conventional autopsy as the standard of reference.

Pregnancy-Related Change in pQCT and Bone Biochemistry in a Population With a Habitually Low Calcium Intake

In pregnancy, changes in maternal calcium (Ca) economy occur to satisfy fetal Ca demand. It is unclear whether maternal mineral reserves facilitate these requirements and no data exist from sub-Saharan Africa. The aim was to determine skeletal changes with peripheral quantitative computed tomography (pQCT) and bone biochemistry between early second and third trimesters. Pregnant rural Gambians aged 18 to 45 years (n = 467) participating in a trial of antenatal nutritional supplements (ISRCTN49285450) had pQCT scans and blood collections at mean (SD) 14 (3) and 31 (1) weeks’ gestation. Outcomes were pQCT: radius/tibia 4% total volumetric bone mineral density (vBMD), trabecular vBMD, total cross-sectional area (CSA), 33%/38% radius/tibia cortical vBMD, bone mineral content (BMC), total CSA; biochemistry: collagen type 1 cross-linked β-C-telopeptide (β-CTX), type 1 procollagen N-terminal (P1NP), parathyroid hormone (PTH), and 1,25(OH)₂D. Independent t tests tested whether pooled or within-group changes differed from 0. Multiple regression was performed adjusting for age. Data for change are expressed as mean (confidence interval [CI] 2.5, 97.5%). Radius trabecular vBMD, cortical vBMD, and BMC increased by 1.15 (0.55, 1.75)%, 0.41 (0.24, 0.58)%, and 0.47 (0.25, 0.69)%. Tibia total and trabecular vBMD increased by 0.34 (0.15, 0.54)% and 0.46 (0.17, 0.74)%, while tibia cortical vBMD, BMC, and cortical CSA increased by 0.35 (0.26, 0.44)%, 0.55 (0.41, 0.68)% and 0.20 (0.09, 0.31)%, respectively. CTX, PTH, and 1,25(OH)₂D increased by 23.0 (15.09, 29.29)%, 13.2 (8.44, 19.34)%, and 21.0 (17.67, 24.29)%, while P1NP decreased by 32.4 (−37.19, −28.17)%. No evidence of mobilization was observed in the peripheral skeleton. Resorption, although higher in late versus early gestation, was lower throughout pregnancy compared with non-pregnant non-lactating (NPNL) in the same community. Formation was lower in late pregnancy than in early, and below NPNL levels. This suggests a shift in the ratio of resorption to formation. Despite some evidence of change in bone metabolism, in this population, with habitually low Ca intakes, the peripheral skeleton was not mobilized as a Ca source for the fetus. © 2021 crown copyright . Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR). The article published with the permission of the Controller of HMSO and the Queen's Printer of Scotland..