超声诊断羊水过多与胎儿畸形的探讨

目的分析超声诊断羊水过多与胎儿畸形的关系。方法回顾性分析2004年8月~2005年7月在我院作超声产前常规检查的16~40周的3292例孕妇资料。发现羊水最大深度≥8cm时,为羊水过多。结果检出羊水过多的19例,检出率为0.58%。其胎儿未见明显异常的12例,占63%,胎儿畸形7例,占37%。结论羊水最深平面≥11cm时,致死性畸形发生率明显增高。     

应用三维超声诊断胎儿半椎体畸形

目的 探讨三维超声在胎儿半椎体畸形中的诊断价值.方法 对7例经二维超声检查疑有胎儿椎体畸形病例,再行三维超声成像,与产后的结果进行对照分析.结果 7例胎儿脊柱异常三维超声冠状面可清晰显示脊柱椎体形态,部分脊柱呈现侧弯,病变处显示椎体排列不整齐,呈现楔形或三角形.结论 三维超声在胎儿脊柱半椎体畸形诊断中有一定的优势,并能发挥其重要的临床应用价值,提高对胎儿脊柱畸形的诊断率.     

二维超声与实时三维超声在胎儿体表畸形诊断中的价值比较

目的比较二维超声与实时三维超声在胎儿体表畸形诊断中的价值。方法应用Voluson730容积探头先后对孕16～40周的2556例胎儿进行二维和实时三维超声检查，观察胎儿体表畸形，分别统计胎儿体表畸形阳性率。经妇科手术或产出后验证（随访），比较二维超声和实时三维超声在胎儿畸形诊断中的价值。结果2556例胎儿中，二维超声怀疑体表畸形胎儿19例，阳性率0．7％（19／2556）；阳性符合率81．0％（17／21），假阳性2例（2／21），假阴性3例。实时三维超声发现体表畸形胎儿20例，阳性率0．78％（20／2556），阳性符合率95．2％（20／21），假阳性0例，假阴性1例。结论在胎儿体表畸形超声诊断中，实时三维超声相比二维超声，具有阳性率高、诊断明确的优点。这为产妇及产科医生在对体表畸形胎儿的保留与否方面提供了重要依据。     

胎儿畸形与羊水过多的超声相关性研究

目的探讨胎儿畸形与羊水过多之间的相关性,并对造成羊水过多的常见胎儿畸形进行排序。方法分析13351例16～40孕周的胎儿资料,比较羊水正常组胎儿畸形发生率与羊水过多组中畸形发生率,并对羊水过多组中胎儿畸形种类进行统计排序。结果超声检出羊水过多103例,发现胎儿畸形26例,畸形发生率约25.2%;正常羊水量组13248例,其中胎儿畸形31例,胎儿畸形发生率约2.3%。羊水过多组中最常见胎儿畸形依次为:中枢神经系统畸形(26.9%)、骨骼畸形(23.1%)、消化系统畸形(15.4%)。结论超声检查是判断羊水过多的首选方法,羊水过多合并胎儿畸形的发生率明显高于正常羊水量组。其常见的畸形种类依次为中枢神经系统畸形、骨骼畸形和消化系统畸形。     

二维超声诊断胎儿消化系统畸形的价值

目的　探讨二维超声对胎儿消化系统畸形的诊断价值 ,为正确诊断胎儿消化系统畸形提供参考。方法　通过总结和分析胎儿各种肠道畸形的二维超声声像图特征 ,对 163 48例胎儿除常规检查外 ,着重观测胎儿肠道液性暗区的形态、位置及最大横径 ,对其横径 >3 .2cm并形成恒定形态者诊断为肠道畸形。结果　在 164 3 8例患者中有 2 0例产前B超诊断为肠道畸形 ,后来经引产、手术或X线检查最后诊断为十二指肠闭锁者 8例、回盲部闭锁 3例、巨结肠 5例、直肠闭锁和肛门闭锁各 2例。结论　二维超声可作为诊断胎儿消化系统畸型的首选方法。     

胎儿肾脏畸形与异常的超声诊断价值

目的探讨超声对肾脏畸形和异常的诊断价值。方法对我院2002年7月～2004年7月产科患的B超检查结果进行分析。结果肾脏畸形和异常患共37例，分析肾脏各种畸形与异常的超声图像特点及诊断要点。结论二维超声在诊断胎儿肾脏畸形及对其进行分类上有着重要的价值。     

胎儿消化道畸形的二维超声诊断价值

目的:探讨二维超声诊断胎儿消化道畸形的价值。方法:回顾性分析2001-2005年我院超声检查“胎儿消化道异常”55例患者的超声影像特征。结果:55例患者中,胎儿腹腔内未见胃泡3例,小胃泡2例,胃泡呈“双泡征”7例,肝脏及脾脏近包膜处强回声1例,肝脏囊性占位1例,肝内实性占位2例,肝脏大1例,小肠扩张2例,结肠扩张11例,先天性无肛门1例,腹腔内囊性占位18例,腹腔内强回声6例。结论:二维超声能客观、动态观察胎儿消化道生理性变化及异常,强调“胎儿消化道异常”的动态及多次超声复查。     

二维及三维超声评价胎儿畸形的对比研究

目的：探讨二维及三维超声评价儿畸形的优劣，方法：二维及三维超声检查40例合并胎儿畸形的孕妇，比较两者对胎儿畸形的诊断水平，并评估两者提供的诊断信息有无差别。结果：（1）40例孕妇41个胎儿中，经引产和随访共发现胎儿畸形62处。二维超声能肯定诊断并与引产及追踪随访结果相符的有49处（79．0％），三维超声则为58处（93．5％），两者比较差异有显著性意义（P＜0．05）。（2）三维超声检出的58处胎儿畸形中，35例（60．3％）三维超声可提供更丰富诊断信息，特别在评价胎儿颅面部、脊柱四肢及体表的畸形时优于二维超声的比例，分别达到69．2％、100％、83．3％。结论：三维超声在评价胎儿畸形时诊断水平较二维超声明显提高，可提供更多的诊断信息，具有临床实用价值。     

二维超声与四维超声诊断产前胎儿畸形的应用效果

目的:探讨二维超声与四维超声诊断产前胎儿畸形的应用效果。方法:选择2017年4月-2019年5月于本院进行产检筛查的200例孕妇作为观察对象,对其分别给予二维超声、四维超声检查,以分娩或引产后胎儿畸形情况为畸形诊断金标准。统计和比较二维超声与四维超声的诊断准确性、特异性和灵敏度。结果:四维超声诊断阳性检出率、准确率、特异性以及灵敏度高于二维超声,差异具有统计学意义(P<0.05)。结论:采用四维超声诊断产前胎儿畸形具有更高的应用价值。     

羊水过多与胎儿畸形

目的：探讨羊水过多与胎儿畸形的关系。方法：对医院1997—2006年153例羊水过多患者的临床资料进行回顾性分析及产后新生儿随访。结果：153例羊水过多中有149例分娩,胎儿畸形23例,其中消化道畸形8例、肢体畸形7例、神经系统畸形5例;剖宫产11例,利凡诺引产9例,自然流产3例。结论：早期诊断羊水过多是否存在胎儿畸形是处理母儿疾病及预后的关键。     

Correlation between fetal gastric size and amniotic fluid volume

PURPOSE: Since abnormal conditions of the fetal digestive tract may alter both amniotic fluid volume and fetal gastric volume, we sought to determine whether amniotic fluid volume is correlated with fetal gastric volume in normal pregnancy. METHODS: A total of 280 fetal gastric size measurements were made prospectively from routine sonographic examinations of women with normal singleton pregnancies between 16 and 42 weeks of gestation. The fetal stomach was defined as the largest area including the pyloric site on transverse or oblique real-time sonographic scans. Gastric volume was calculated according to the formula for a prolate ellipsoid. The amniotic fluid index (AFI) was used for the evaluation of amniotic fluid volume. RESULTS: Both fetal gastric volume and AFI were significantly correlated with gestational age (R2= 0.422 and R2= 0.128, respectively). Only a weak correlation was found between gastric volume and AFI (R2= 0.036, p <0.001). On multivariate linear regression analysis adjusting for gestational age and fetal biometric measurements, gastric volume was not an independent and significant predictor of AFI. CONCLUSIONS: Although sonographically determined fetal gastric volume measurements appear to be useful in the assessment of fetal digestive tract anomalies, fetal gastric volume has no clinically significant effect on the amniotic fluid volume in normal pregnancy.     

Effect of fetal movement on the amniotic fluid index in diamniotic twin gestations

Fetal movement changes the size and location of amniotic fluid pockets during measurement of the amniotic fluid index. In singleton gestations, the effect of redistributing the fixed intrauterine fluid volume on the amniotic fluid index is clinically insignificant. In this study, we tested the hypothesis that the index in twin pregnancies is unaffected by fetal movement. A single examiner prospectively determined the amniotic fluid index before and after three discrete episodes of movement by both fetuses of 82 diamniotic twin pregnancies referred for obstetric sonograms between 20 and 38 weeks' menstrual age. A reliable blinded examiner provided a second post-movement measurement as a control. Data were analyzed by the paired t-test. The mean change in the amniotic fluid index after fetal movement was 2.1 ± 0.2 cm and 3.7 ± 0.3 cm for post-movement determinations by the same and blinded examiners, respectively (p < .001). Interobserver variation was 3.5 cm. Intraobserver variation was 1.8 cm for the first examiner and 2.2 cm for the second examiner. Therefore, interobserved and intraobserver variation can account for the observed change in the amniotic fluid index following movement of both diamniotic twins. © 1997 John Wiley & Sons, Inc. J Clin Ultrasound 25:255–257, 1997     

Association of amniotic fluid index with estimated fetal weight.

OBJECTIVE: The relationship between amniotic fluid volume and gestational age has been described previously. The association of body weight and urine output has been observed in human neonates. Our goal was to assess the correlation of the amniotic fluid index (AFI) with estimated fetal weight (EFW) in the third trimester. METHODS: We conducted a retrospective observational study on 426 pregnant women with singleton gestations who were referred to our unit for sonographic evaluation in the third trimester. The AFI, EFW, and EFW percentile corrected for gestational age were evaluated. The sonographic examinations were stratified into 3 gestational age categories: 28 through 33.9 weeks, 34 through 37.9 weeks, and 38 weeks and later. Maternal and fetal outcome variables were collected from medical records. Linear regression, Mann-Whitney U, and Kruskal-Wallis tests were used for statistical analysis. RESULTS: There was no significant relationship between the AFI and EFW in the entire group of patients (R = 0.08; P = .096). There was a significant relationship between the AFI and EFW after 38 weeks' gestation (R = 0.30; P = .003). In addition, in female fetuses the EFW percentile correlated with higher AFI values at all gestational ages (R = 0.31; P < .001); this, however, was not observed in male fetuses. CONCLUSIONS: There is no relationship between the AFI and EFW during the third trimester, although a positive relationship between the AFI and EFW was noted late in gestation. In pregnancies with female fetuses, the AFI was positively associated with EFW percentile before 38 weeks' gestation.     

The accuracy of ultrasound evaluation of amniotic fluid volume in singleton pregnancies: The effect of operator experience and ultrasound interpretative technique

The objective of this study was to evaluate the effect of operator experience and ultrasound interpretation technique on the accuracy of ultrasound estimates of amniotic fluid volume. Ultrasound evaluation was carried out by an obstetric resident, a nurse sonographer, a maternal-fetal medicine fellow, and a maternal-fetal medicine staff member to subjectively estimate (visual interpretation without sonographic measurements) amniotic fluid volume in 63 pregnancies. Amniotic fluid volume was also evaluated using ultrasound measurements based on the largest vertical pocket technique, the amniotic fluid index, and the two-diameter pocket method. The accuracy of these ultrasound estimates was assessed by comparing the ultrasound results to actual amniotic fluid volume as determined by a dye-dilution technique. For analysis, amniotic fluid volumes were classified as oligohydramnios, normal, or hydramnios using established volumetric criteria for singleton pregnancies. Subjective estimates ranged from 65% to 70% correct and did not differ by operator experience except for the more accurate diagnosis of hydramnios by the maternal-fetal medicine staff. The three sonographic measurements were similar in overall accuracy (59–67%). The two-diameter pocket method was, however, significantly more accurate in identifying oligohydramnios. It appears that neither operator experience nor sonographic technique greatly affects the accuracy of ultrasound estimates of amniotic fluid volume. © 1997 John Wiley & Sons, Inc. J Clin Ultrasound 25:249–253, 1997     

产前超声在单脐动脉及合并胎儿畸形中的诊断价值

目的研究产前超声在单脐动脉及合并胎儿畸形中的诊断价值。方法纳入单脐动脉病例113例,根据是否合并胎儿畸形将其分为对照组(67例,单纯性单脐动脉)和观察组(46例,单脐动脉合并胎儿畸形)。统计观察组胎儿的畸形类型分布、两组胎儿的染色体异常情况及围产资料。结果观察组胎儿中,以心血管系统、肢体和泌尿系统畸形为主要的畸形类型。观察组染色体异常11例(23.91%),8例18-三体,1例13-三体,2例染色体结构异常;观察组的染色体异常率显著高于对照组(P<0.05)。两组的妊娠结局、早产率、胎龄、新生儿体质量比较,差异具有统计学意义(P<0.05)。结论产前超声有助于提高单脐动脉胎儿的临床诊断率,对于单脐动脉合并胎儿畸形,建议进一步开展染色体检查。单纯性单脐动脉胎儿大多妊娠结局较好,然而单脐动脉合并畸形胎儿的早产、低出生体重发生率有所增加,应加强孕期监测。     

Amniotic fluid and the clinical relevance of the sonographically estimated amniotic fluid volume: oligohydramnios

The amniotic fluid volume (AFV) is regulated by several systems, including the in-tramembranous pathway, fetal production (fetal urine and lung fluid) and uptake (fetal swallowing), and the balance of fluid movement via osmotic gradients. The normal AFV across gestation has not been clearly defined; consequently, abnormal volumes are also poorly defined. Actual AFVs can be measured by dye dilution techniques and directly measured at cesarean delivery; however, these techniques are time-consuming, are invasive, and require laboratory support, and direct measurement can only be done at cesarean delivery. As a result of these limitations, the AFV is estimated by the amniotic fluid index (AFI), the single deepest pocket, and subjective assessment of the AFV. Unfortunately, sonographic estimates of the AFV correlate poorly with dye-determined or directly measured amniotic fluid. The recent use of color Doppler sonography has not improved the diagnostic accuracy of sonographic estimates of the AFV but instead has led to overdiagnosis of oligohydramnios. The relationship between the fixed cutoffs of an AFI of 5 cm or less and a single deepest pocket of 2 cm or less for identifying adverse pregnancy outcomes is uncertain. The use of the single deepest pocket compared to the AFI to identify oligohydramnios in at-risk pregnancies seems to be a better choice because the use of the AFI leads to an increase in the diagnosis of oligohydramnios, resulting in more labor inductions and cesarean deliveries without any improvement in peripartum outcomes.     

The fetal gastrointestinal tract is exposed to melatonin and superoxide dismutase rich amniotic fluid throughout prenatal development

Amniotic fluid (AF) is the first fluid to enter the gastrointestinal tract. Preterm birth is leading to a sudden interruption of AF swallowing. Understanding the composition of amniotic fluid is crucial to implement strategies preventing intestinal injury in preterm infants. We hypothesized that the fetal gastrointestinal tract (GIT) is exposed to melatonin and antioxidant enzymes via amniotic fluid throughout prenatal development. Amniotic fluid samples from 76 pregnant women with a median (range) gestational age of 38.0 (14.3–40.1) weeks have been collected. Immediately after birth blood samples were collected from the umbilical vein (n = 53). Median (Interquartile range) melatonin concentration was 30.5 pg/ml (12.7–118.3) and superoxide dismutase 1 (SOD1) concentration was 84 ng/ml (59–123). Extracellular glutathione peroxidase concentration was either not detectable or exceptionally low. We found a positive correlation between melatonin concentration in amniotic fluid and gestational age (Spearman’s correlation coefficient, r = 0.570, p<0.001), while SOD1 concentration in amniotic fluid was inversely correlated with gestational age (r = −0.246, p = 0.032). Compared to serum samples, melatonin concentration was statistically significantly higher in amniotic fluid (p<0.001). Our results indicate that the fetal gastrointestinal system is continuously exposed to melatonin and SOD1 via the amniotic fluid throughout prenatal development.     

Use of the amniotic fluid index combined with estimated fetal weight within 10 days of delivery for prediction of macrosomia at birth.

OBJECTIVE: The purpose of this study was to assess the value of combining the sonographically estimated fetal weight (EFW) and amniotic fluid index (AFI) measured within 10 days of term delivery for prediction of macrosomia at birth. METHODS: Prospective sonographic fetal biometric measurements and delivery ward data of a single center, uploaded separately over a 4-year period, were retrospectively linked to yield an unselected sample of nondiabetic pregnancies with live-born term neonates. RESULTS: Of the 1925 pregnancies evaluated, 140 (7.2%) were macrosomic (birth weight > or =4000 g). The AFI was significantly higher in the macrosomic group (P < .001). On receiver operating characteristic curve analysis, the area under the curve was larger for predictions based on the EFW alone than on the AFI. An EFW of 4000 g or higher had a positive predictive value of 46.6% for macrosomia at birth. Use of the previously suggested combined EFW and AFI cutoffs of 3689 g and 119 mm, respectively, yielded a positive predictive value of 30.3%. CONCLUSIONS: Combined use of the EFW and AFI rather than the EFW alone does not improve prediction of macrosomia at birth.     

四维彩超在诊断胎儿畸形中的应用价值

目的探讨四维彩色容积超声在诊断胎儿畸形中的应用价值。方法应用实时四维彩色容积超声及二维彩色多普勒超声对1 084例胎儿进行产前检查,分析二维及四维彩超在诊断胎儿畸形部位和形态改变等方面的准确性及直观性,分析比较2者的诊断符合率。结果经临床最终证实,发现胎儿畸形41例43处,二维彩超诊断符合34处,符合率79.1%,四维彩超诊断符合41处,符合率95.3%,2者比较有显著差异。结论四维彩超图像立体、直观,为胎儿体表畸形的诊断提供了更丰富的信息,优于单纯使用二维彩超,有广阔的发展前景和应用价值。