阴道超声观测羊膜囊形态大小在早期妊娠中的诊断价值及应用前景

目的 探讨经阴道超声观测羊膜囊形态大小在早期妊娠中的诊断价值和应用前景.方法研究对象选2012年1～12月妊娠 6～10周经阴道超声检查的孕妇607例,追踪随访至妊娠28周,以妊娠 6～28周期间超声检查胚胎停育或自然流产的孕妇为异常妊娠组共149例,按照按妊娠结局分为先兆流产组和必然流产组,余下458例经超声检查胚胎正常发育的孕妇为正常妊娠组.采用流行病学巢氏病例对照研究方法,观察孕妇各项生命指标,应用经阴道超声观测妊娠囊及囊内容物（羊膜囊、卵黄囊及心管搏动）,重点观察羊膜囊是否显示及其形态、大小,测量羊膜囊直径,分析预测妊娠结局.结果 通过羊膜囊测值结果分析其形态特征,正常妊娠组和异常妊娠组妊娠的羊膜囊大小及形态,存在显著性差异（P〈0.05）.对比先兆流产和必然流产与羊膜囊分析关系显示比较无显著差异（P〉0.05）.说明超声显像与病理分析对胚胎发育停止类型的判定无差异,可通过超声准确判断胚胎停止发育类型.结论 经阴道超声检测早孕羊膜囊形态大小,结合HCG、孕酮等检验结果,可准确预测胚胎发育及妊娠结局,为临床指导治疗、降低流产率提供了有力参考.     

早孕期孕囊容积与胎儿孕龄相关性的三维经阴道超声研究

目的探讨早孕期(5～12周)孕囊容积与胎儿孕龄的相关性。方法应用三维经阴道容积超声获取210例早孕期拟行终止妊娠治疗孕妇的孕囊容积图像,使用三维超声影像工作站4D-view软件测量孕囊的容积和直径,容积测量方法为VOCAL法,孕囊直径为长、宽和厚径的平均值。根据末次月经确定胎儿孕龄。对所测得结果进行统计学分析,确定胎儿孕龄与孕囊容积和直径相关性的密切程度。结果 210例孕妇中146例符合制定的标准,数据进行统计学分析。结果显示:孕妇年龄16～41岁,平均(26.80±5.57)岁;胎儿孕龄35～84d,平均(45.58±8.39)d;孕囊容积(GSV)0.008～89.943ml,平均(5.46±11.65)ml;孕囊直径(GSD)0.077～7.009cm,平均(1.88±1.25)cm;孕囊容积的平方根与孕龄表现很强的相关性(R2=0.806;P0.001),孕囊直径与孕龄亦有较强的相关性(R2=0.684;P0.001);孕囊容积的平方根与胎儿孕龄的相关性确定系数明显高于孕囊直径与胎儿孕龄的相关性确定系数。结论孕囊直径和孕囊容积的平方根与胎儿孕龄均有较密切相关性,但孕囊容积是早孕期预测孕龄的一个更好的指标,可更准确地预测胎儿孕龄。研究结果还需要进一步证实。     

Does gestational sac volume predict the outcome of missed miscarriage managed expectantly?

PURPOSE: The aim of this study was to investigate whether gestational sac volume (GSV) can predict the outcome of missed miscarriages that are managed expectantly. METHODS: This was a prospective observational study. Between February 1, 2000, and January 31, 2001, all patients with a confirmed first-trimester missed miscarriage who chose to undergo expectant management were recruited to participate. A single investigator performed all sonographic examinations and measurements. The main outcome measure was a complete spontaneous abortion within 4 weeks of the initial diagnosis. A complete miscarriage was defined as a maximum anteroposterior diameter of the endometrium of less than 15 mm on transvaginal sonography and no persistent heavy vaginal bleeding. The patients could opt to undergo surgery at any time, but those who had not expelled the products of conception within 4 weeks of the diagnosis were advised to have surgical uterine evacuation. RESULTS: In total, 90 patients were enrolled, and 86 patients completed the study. The mean GSV, as measured by 3-dimensional sonography, was 9.7 +/- 8.9 ml, and the mean sac diameter was 24.5 +/- 8.0 mm. A significant exponential correlation was found between the mean sac diameter and the GSV (r = 0.86; p < 0.0001). Forty-six (53.5%) of the 86 patients experienced a complete miscarriage within 4 weeks of the diagnosis (ie, expectant management was successful), but expectant management was unsuccessful in the remaining 40 (46.5%) patients (5 had an incomplete miscarriage, and 35 did not expel the products of conception). The GSV did not differ significantly between the "successful" and "unsuccessful" groups (p = 0.82). A logistic regression analysis showed no significant correlation between GSV and the outcome of missed miscarriages managed expectantly (p = 0.59). CONCLUSIONS: The GSV does not predict the outcome of expectant management of missed miscarriage within 4 weeks of the diagnosis.     

Ultrasound demonstration of the normal fetal yolk sac

Using high-resolution real-time ultrasound in the first trimester of pregnancy, we have been able to demonstrate, in addition to the fetus, the yolk sac and the amniotic membrane. Pitfalls to avoid in first-trimester pregnancies include (a) mistaking the yolk sac for a second separate fetus, (b) including the yolk sac in the crown-rump length, and (c) misinterpreting the amniotic membrane for a septum between two separate gestational sacs.     

Gestational sac volume measured by three-dimensional ultrasound at 11 to 13 + 6 weeks of gestation: relation to chromosomal defects.

OBJECTIVE: To determine the potential value of measuring the gestational sac volume (GSV) at 11 to 13 + 6 weeks of gestation in screening for chromosomal defects. METHODS: The GSV was measured using three-dimensional (3D) ultrasound in 500 consecutive singleton pregnancies immediately before chorionic villus sampling (CVS) for fetal karyotyping at 11 to 13 + 6 (median 12) weeks of gestation. RESULTS: The fetal karyotype was normal in 417 pregnancies and abnormal in 83. In the chromosomally normal group, the mean GSV increased significantly with gestational age from a mean of 69 mL at 11 weeks to 144 mL at 13 + 6 weeks (the standard deviation was 27 mL). In the chromosomally abnormal group, the mean GSV for gestational age was not significantly different from normal in fetuses with trisomy 21, trisomy 18 and Turner syndrome, but it was smaller in those with triploidy and trisomy 13. However, the mean GSV for crown-rump length (CRL) was significantly larger in trisomy 18, smaller in triploidy and trisomy 13, and not different from normal in trisomy 21 and Turner syndrome. The mean CRL for gestational age was significantly smaller than normal in trisomy 18, triploidy and trisomy 13. CONCLUSIONS: The measurement of the GSV at 11 to 13 + 6 weeks of gestation is unlikely to provide useful prediction of the major chromosomal defects. In trisomy 13 and triploidy, the small GSV may be due to early onset fetal growth restriction and reduced amniotic fluid volume. In trisomy 18, the increase in GSV is probably due to the presence of associated fetal abnormalities that interfere with fetal swallowing.     

Transvaginal sonography of the yolk sac in normal and abnormal pregnancy

A cross-sectional study comprising 117 consecutive first trimester singleton pregnancies was performed using transvaginal sonography (TVS) to evaluate size abnormalities of the secondary yolk sac (YS) vis-à-vis pregnancy outcome. In normal pregnancy outcome (NPO) the YS diameter showed an increase from the 5th to the 11th week, menstrual age, followed by a decrease and its disappearance after 12 weeks. A YS of abnormal size was statistically significant (p < 0.001) in spontaneous abortion (SA) versus NPO, with a sensitivity of 68.7%, a specificity of 99%, a positive predictive value of 91.6% and a negative predictive value of 95.2%. These preliminary results indicate that a measurement of the YS very early in gestation may be a useful marker of pregnancy outcome. © 1996 John Wiley & Sons, Inc.     

Yolk sac sign: sonographic appearance of the fetal yolk sac in missed abortion

With improving technology, the fetal yolk sac can be routinely visualized sonographically in all living gestations of six to ten weeks. The minimal growth of the yolk sac during this interval and its subsequent obscuration by the growing amniotic sac are verified in this study. An important new sign of missed abortion has been inferred by Bernard and Cooperberg (AJR 144:597, 1985), and is titled in this article the "yolk sac sign." A gestational sac of 25 mm or more in mean diameter and empty except for the yolk sac is highly suspicious for nonviable gestation. This one-year prospective study adds nine such cases. To enhance specificity of this sign, additional criteria specify a yolk sac measuring 4 mm, a free-floating position within the gestational sac, and evacuation of the yolk sac on follow-up scan. However, when a ring-like structure measures 3 mm or less and lies peripherally in the gestational sac, this must be presumed to be a potential fetal pole.     

Amniotic fluid volumetry by three-dimensional ultrasonography during the first trimester of pregnancy

In a longitudinal prospective study, we quantitated the amniotic fluid volume (AFV) of 25 normal fetuses by endovaginal 3-D ultrasonography (3D-US) from the 8th to the 11th week of pregnancy. AFV by 3D-US was obtained by subtracting the volumetric measurement of the embryo (EV) from the amniotic sac volume (ASV). EV and ASV were obtained by virtual organ computer-aided analysis (VOCAL), using 6 degrees of rotation. AFV increased from 5.75 to 42.96 cm(3) from the 8th to the 11th week (ANOVA, p < 0.05), with a correlation between gestational age and AFV (p < 0.001, r(2) = 98.1%). We conclude that there was an increase in AFV assessed by 3D-US. The AFV values for normal fetuses can be used for comparison with those detected in pregnancies with risk of fetal loss.     

Sonography of pregnancies with first-trimester bleeding and a small intrauterine gestational sac without a demonstrable embryo.

OBJECTIVE: This was a prospective observational cohort study to evaluate the outcome and prognostic criteria of pregnancies with first-trimester bleeding and a gestational sac 相似文献   

三种中期引产方法临床效果比较

目的 比较米非司酮配伍米索前列醇、利凡诺配伍米非司酮及单纯使用利凡诺在中期引产中的效果.方法 235例12～28周要求终止妊娠孕妇,随机分成3组:观察1组、观察2组和观察3组.观察1组80例,米非司酮50 mg空腹或饭后2 h口服,12 h 1次,连用3 d,第4天米索前列醇阴道上药,剂量200～1000 μg;观察2组78例,利凡诺羊膜腔注射,剂量70～100 mg,同时米非司酮75 mg空腹或饭后2 h口服,12 h 1次,共1 d;观察3组77例,仅用利凡诺羊膜腔注射,剂量70～100 mg.结果 观察1组、观察2组和观察3组完全流产率分别为88.75%(71/80)、65.38%(51/78)、38.96%(30/77),成功率分别为98.75%(79/80)、71.79%(56/78)、76.62%(59/77).开始宫缩至胎儿胎盘娩出时间分别为(6.85±3.68)、(8.87±3.58)、(14.67±3.50)h,产时至产后2 h阴道出血量分别为(80.86±40.28)、(94.70±42.35)、(120.68±43.30)ml.观察1组完全流产率、成功率高于观察2组和观察3组,而且产程短、出血少,差异有统计学意义(P均<0.01).观察2组完全流产率高于观察3组,且产程缩短,差异有统计学意义(P<0.01).结论 米非司酮配伍米索前列醇引产具有完全流产率高、成功率高、产程短、出血少等优点,特别适用于孕20周以下中期引产;利凡诺配伍米非司酮引产能够提高完全流产率,缩短产程,减少出血,适合于孕周16周以上引产;单纯利凡诺引产产程长,疼痛较重,不全流产率较高.     

Ultrasonic planimetry of the gestation sac as a biometric method in early pregnancy.

A new method for determining the area of the gestation sac by thread planimetry is described. Mean weekly values with two standard deviations were determined on a series of 237 measurements of gestation sac area, age five to 11 weeks, in normal pregnancies. The gestation sac area grows curvilinearly from 1.85 cm2 at five weeks to 15 cm2 at 11 weeks. The mean diameter was calculated from the gestation sac area by using an adequate approximation of the irregular gestation sac shape to a circle of the same area. The dependence of the mean gestation sac diameter on gestation age is defined by the regression equation y = 0.46x - 0.95 and the correlation factor r = 0.92. Practical applications of gestation sac planimetry include the determination of gestation age in early pregnancy, and the follow-up of growth or determination of delayed growth in disturbed or failed early pregnancy.     

经阴道彩超检测黄体血流对胚囊发育的研究

本文研究目的是经阴道彩超检测早期妊娠黄体血流阻力指数，做为预测胚囊正常发育的参数值。研究内容采用实验组与对照组在早孕期间（孕３６～６５天），经阴道彩超常规检测妊娠黄体血流阻力指数后，对早妊胚囊分别进行临床病理检验和影像跟踪观察，最后筛选出病检具有正常绒毛组织和超声检测发育至１８周为正常胎儿的早妊黄体血流阻力指数值，做统计学处理。研究结果表明：本文中所测得的黄体血流阻力指数（两组共计６０例），均能维持胚芽的正常发育。两组均值无显著性差异，均服从于正态分布ｔ＝０．０２６３７＜０．０５，Ｐ＞０．０５两组正态分布的总体均值是相同的。从而说明一定范围内的黄体血流阻力指数可作为判别早妊胚囊发育正常的参考值     

A Novel Technique for the Semi-Automated Measurement of Embryo Volume: An Intraobserver Reliability Study

The aim was to assess intraobserver reliability of a new semi-automated technique of embryo volumetry. Power calculations suggested 46 subjects with viable, singleton pregnancies were required for reliability analysis. Crown rump length (CRL) of each embryo was analyzed using 2-D and a 3-D dataset acquired using transvaginal ultrasound. Virtual organ computer-aided analysis (VOCAL) was used to calculate volume of gestation sac (GSV) and yolk sac (YSV) and SonoAVC (sonography-based automated volume count) was used to quantify fluid volume (FV). Embryo volume was calculated by subtracting FV and YSV from GSV. Each dataset was measured twice. Reliability was assessed using Bland-Altman plots and intraclass correlation coefficients (ICCs). Fifty-two datasets were analyzed. Median embryo volume was 1.8cm³ (0.1 to 8.1 cm³); median gestational age 7 + 4 weeks; median CRL 13 mm (2 to 29 mm). Mean difference of embryo volume measurements was 0.1cm³ (limits of agreement [LOA] –0.3 to 0.4 cm³); multiples of mean (MoM) 0.38; mean difference of CRL measurements 0.3 mm (LOA –1.4 to 2.0 mm), MoM = 0.26. ICC for embryo volume was 0.999 (95%CI 0.998 to 0.999), confirming excellent intraobserver agreement. ICC for CRL was 0.996 (95%CI 0.991 to 0.998). Regression analysis showed good correlation between embryo volume and CRL (R² = 0.60). The new semi-automated 3-D technique provides reliable measures of embryo volume. Further work is required to assess the validity of this technique. (E-mail: shyamaly@doctors.org.uk)     

Gestational sac diameter in very early pregnancy as a predictor of fetal outcome.

OBJECTIVE: To determine whether transvaginal sonographic measurement of gestational sac diameter in pregnancies 28-42 days from the last menstrual period can predict whether a pregnancy results in a normal term birth or a spontaneous miscarriage. DESIGN: Gestational sac diameter was measured during the 4th and 5th weeks of gestation from the last menstrual period in 67 women who had a total of 102 ultrasound scans. These pregnancies were followed until one of two outcomes occurred: term gestation (n = 32) or spontaneous miscarriage (n = 35). Gestational sac diameter as a function of gestational age was compared in each of the groups. RESULTS: The mean diameter of the gestational sac at 28-35 days from the last menstrual period among normal pregnancies did not differ significantly from that in those that subsequently miscarried (2.6 mm vs. 2.7 mm; P = 1.00). In pregnancies 36-42 days from the last menstrual period, the mean sac diameter was significantly different between the two groups (normal group, mean sac diameter, 8.2 mm and miscarriage group, mean sac diameter, 4.5 mm; P < 0.001). CONCLUSION: There is no difference in gestational sac diameter at 28-35 days from the last menstrual period in normal and abnormal pregnancies. However, smaller than expected sac diameter in pregnancies 36-42 days from the last menstrual period is predictive of spontaneous miscarriage.     

阴道超声检测早孕卵黄囊

为了了解继发性卵黄囊的超声特点并估价异常卵黄囊和妊娠结局的关系。使用阴道超声对１０２例早孕妇女进行检测。结果：正常妊娠结局的卵黄囊大小从孕５周至孕１１周随孕周增加而增大，随后缩小，孕１２周后消失。卵黄囊大小异常在正常妊娠结局组和异常妊娠结局组间存在明显差异（Ｐ＜０．００１），其敏感性为８１．８２％，特异性为９２．５０％。结果表明：孕早期使用阴道超声检测卵黄囊直径可以作为预测妊娠结局的一种方法     

早期先兆流产患者不同孕龄血清雌二醇水平波动对妊娠结局的影响

目的 分析不同孕龄的早期先兆流产患者雌二醇(E2)水平波动对妊娠结局的影响.方法 利用回顾性分析法,选取2015年1月至2019年1月在中国人民解放军空军军医大学第一附属医院东院妇产科就诊的250例先兆流产患者,按照妊娠结局的不同将其分为保胎成功组(n=125)和稽留流产组(n=125).检测2组患者不同孕龄的血清中E...     

超声检查习惯性流产患者早孕期胎心率在妊娠结局中的预测价值

目的探讨超声检查习惯性流产（RSA）患者早孕期胎心率变化在妊娠结局预测中的作用。方法收集行超声检查的妊娠42~69 d的孕妇，其中，有RSA病史孕妇255例，无RSA病史孕妇201例。根据妊娠42~196 d（即6~28周）期间妊娠结局分为3组:RSA异常妊娠组（有RSA病史孕妇本次妊娠期间发生自然流产）；RSA正常妊娠组（有RSA病史孕妇本次妊娠至28周以上）；非RSA正常妊娠组（无RSA病史孕妇本次妊娠至28周以上）。孕妇经腹或经阴道超声测量孕囊大小及胚芽、胎儿头臀长，启用M取样并放大模式测量胎心率，连续测量3次，取均值，记录孕囊大小、头臀长及胎心率，追踪随访至妊娠28周，比较各组间资料。结果255例RSA孕妇中，83.0%的胚胎停育发生在55 d前，胎心率越低，胚胎停育发生率越高。超声检查与胚胎停育时间相隔越短，胎心率缓慢发生率越高。RSA正常妊娠组与非RSA正常妊娠组各孕龄平均胎心率的差异无统计学意义（P > 0.05）。RSA异常妊娠组与非RSA正常妊娠组孕49~62 d平均胎心率差异有统计学意义（P < 0.05），孕42~48 d和孕63~69 d平均胎心率之间差异无统计学意义（P > 0.05）。用胎心率为检验变量，妊娠结局为金标准，预测胎心率诊断的价值，曲线面积为0.831，结果具有统计学意义（P < 0.05）。结论超声检查发现RSA患者早孕期胎心率缓慢对不良妊娠结局有一定的预测价值。      

Does the 10-MHz transvaginal transducer improve the diagnostic certainty that an intrauterine fluid collection is a true gestational sac?

PURPOSE: We studied whether a 10-MHz transvaginal transducer improves the diagnostic certainty that a small intrauterine fluid collection is a true gestational sac. METHODS: Over a 6-week period, women who presented with a positive pregnancy test and a fluid collection (devoid of any characteristics such as yolk sac or fetal pole) in the uterus seen with a standard 6-7-MHz transvaginal transducer were entered in the study. The patients were immediately rescanned with a 10-MHz transvaginal probe, and characteristics of the fluid collection using this probe were noted. Specifically, the visualization of a yolk sac or the intradecidual or double decidual sign was considered an objective improvement in the certainty that the fluid collection was a gestational sac. RESULTS: Twelve patients presented with a positive pregnancy test and a fluid collection in the uterus seen with a 6-7-MHz probe. Eight of these fluid collections were smaller than 1 cm in mean diameter, and all 8 of these patients had an objective improvement in the diagnosis of an intrauterine pregnancy using the 10-MHz probe. The other 4 patients had fluid collection 1-2 cm in mean diameter seen at 6-7 MHz. The 10-MHz probe improved the diagnostic confidence in 2 of these 4 patients. CONCLUSIONS: In patients with early pregnancies who have questionable gestational sacs on sonography with standard 6-7-MHz transducers, the 10-MHz probe improves the diagnostic confidence of the presence of an intrauterine gestational sac.     

B超检测卵黄囊在早期妊娠中的临床意义

目的：通过超声检测卵黄囊直径大小，探讨其与妊娠结果的关系。方法：使用腹部及阴道超声对262例早期妊娠妇女进行检查，观察卵黄囊正常、异常与妊娠结果的关系。结果：198例正常妊娠全部见卵黄囊，其生长与孕周相关，孕5－11周呈现一定规律性持续增长，孕12周开始缩小至13周消失。卵黄囊大小在正常及异常妊娠组间有明显差异（P＜0．05）。结论：检测早孕卵黄囊大小对预测妊娠后有重要的临床意义。     

Sonographic visualization of normal-size ovaries during pregnancy.

OBJECTIVE: To assess the ability of ultrasound to detect ovaries of normal size during pregnancy METHODS: A prospective study of 329 women with a normal pregnancy course was undertaken; 68 were excluded from analysis because of an enlarged, cystic ovary. Of the remainder, 60 pregnancies were examined in the first trimester and 201 in the second or third trimester. The first group underwent transvaginal (TVS) and transabdominal (TAS) scanning. The second group underwent TAS examination only. RESULTS: In the first-trimester group, TVS identified both ovaries in 57 patients (95%) and transabdominal ultrasound in 20 (33.3%). In the second- and third-trimester patients, TAS visualized both ovaries in 33 patients (16.4%), and neither ovary in 120 (59.7%). Both ovaries were less visible with advancing gestational age. The right ovary showed a significant change in position during pregnancy, from about 1 cm (at 15-24 weeks) to 2.5 cm (at 30-41 weeks) cranial to the iliac spine. The left ovary was found 1 cm above the iliac spine throughout pregnancy. CONCLUSIONS: Transvaginal sonography is adequate for the visualization of both ovaries in the first trimester of pregnancy. With advanced gestational age, the ovaries were significantly less visible by TAS. Sonographic scanning of the ovaries in second and third trimester should be concentrated mainly at the level of the iliac spine. Poor sonographic visualization of both ovaries in late gestation may mandate the use of other imaging modalities.