广州地区早孕期超声测量胎儿颈项透明层图像质量分析

目的探讨提高超声医师早孕期胎儿超声筛查能力的方法。方法对广州地区232例孕11~13+6周妇女超声测量胎儿颈项透明层(nuchal translucency,NT)的图像质量进行回顾性分析,对照英国胎儿医学基金会超声测量早孕期胎儿NT图像标准,记录所有胎儿超声报告中头臀径(CRL)以及胎儿头胸部占超声显像图面比例、胎儿姿势、胎儿皮肤与羊膜区分是否清晰、游标尺放置位置等情况,并分析该地区不同等级医院上述胎儿超声图像质量达标情况。结果 232例超声报告中228例(98.28%)CRL测值符合标准;203例(87.50%)可显示胎儿轮廓,其中127例(62.56%)图像放大倍数未达要求,76例(37.44%)胎儿头胸部占超声显像图面比例≥75%,19例(9.36%)显示胎儿正中矢状面,107例(52.71%)胎儿自然平躺,67例(33.00%)可以清楚区分胎儿皮肤与羊膜,33例(45.83%)游标尺度量位置正确。除CRL达标、游标尺放置位置正确外,上述余早孕期超声NT图像质量指标,二、三级甲等医院比较差异均有统计学意义(P0.05或P0.01)。结论对操作者的培训、足够的实践经验、建立一套定期审核及持续评定影像质量的机制是提高超声医师早孕期胎儿超声筛查能力的有效措施。     

超声检测早孕期颈项透明层增厚的临床价值

目的应用超声检测胎儿颈项透明层(NT)厚度,探讨其增厚与胎儿异常妊娠的关系。方法选取我院早孕期筛查的584例NT增厚的单胎胎儿病例,按照不同NT值分为3.0~3.9 mm组(313例)、4.0~4.9 mm组(169例)及≥5.0 mm组(102例),比较各组胎儿结构异常、染色体异常检出率及不良预后情况,分析NT增厚与异常妊娠的关系。结果超声检查发现584例NT增厚者,其中单纯NT增厚者330例(56.51%),合并其他结构异常者254例(43.49%)。419例胎儿行染色体核型分析,结果显示核型正常364例,核型异常55例。正常分娩存活283例,自然流产或胚胎宫内停止生长15例,引产282例,失访4例。胎儿结构异常、染色体异常、不良妊娠结局均随NT增厚而升高,各组NT增厚胎儿结构异常检出率、不良妊娠结局比较差异均有统计学意义(χ~2=3.464、37.312,P=0.019、<0.01);染色体异常检出率比较差异无统计学意义(χ~2=2.523,P=0.178)。结论胎儿NT厚度与胎儿异常妊娠密切相关,且胎儿异常妊娠检出率随NT增厚明显升高,早孕期超声监测NT厚度可以较早发现胎儿严重结构畸形,有效筛查染色体核型异常的高危胎儿,为临床评价胎儿的预后提供了重要的参考价值。     

应用三维超声检测孕11+2～14+2周胎儿颈部透明层厚度的可行性分析

目的：探讨利用三维超声技术获得标准正中矢状切面测量颈部透明层厚度的可行性,评价三维超声技术在此方面是否有优越性。方法：对198例孕11+2～14+2周的胎儿应用二维超声及三维超声分别测量胎儿颈部透明层厚度,对比二者测量值是否有统计学差异。结果：对198例检测结果进行统计学分析,结果显示三维超声测量NT值与二维超声测量NT值统计学上无显著性差异（t=0.488,P=0.626＞0.05）,二者之间具有可比性,二者测得的颈部透明层厚度均与孕周呈正相关,三维超声及二维超声测得颈部透明层厚度与孕周相关系数分别为r=0.536,P<0.05;r=0.543,P<0.05。结论：应用三维超声重建功能及三维扩展成像技术能够获得测量胎儿颈部透明层厚度所需的标准正中矢状切面,因此三维超声在检测胎儿颈部透明层厚度方面是可行的。     

产前超声检测颈部透明带厚度在胎儿染色体异常筛查中的价值

目的 评价超声检测颈部透明带厚度在胎儿染色体异常筛查中的作用,从而提高染色体异常胎儿的诊断率.方法 于胎体正中矢状切面测量颈部透明带厚度,妊娠10 ～14 周的孕妇测量胎儿颈部透明带厚度,妊娠14 ～16 周孕妇测量胎儿颈项部皮肤厚度,共计610 例.对妊娠10 ～13 周颈部透明带厚度≥3.0 mm 的胎儿或妊娠14 ～16 周颈项部皮肤厚度≥6.0 mm 的胎儿进行染色体核型分析,并收集其父母行为的相关资料.结果 17 例因颈部透明带或颈项部皮肤增厚进行了染色体核型分析检查,显示8 例胎儿为正常染色体核型,9 例胎儿为非整倍体染色体核型.本组资料中,染色体核型正常胎儿平均颈部透明带厚度(3.7 mm)明显小于异常组(6.0 mm).大多数染色体核型正常的胎儿妊娠早期显示的颈部透明带增厚在妊娠14 周后会自行消退.染色体核型异常的胎儿大多数于妊娠中期进展为颈项部皮肤水肿或虽未进展为颈项部皮肤水肿但合并其他畸形.父母的行为与其胎儿染色体核型正常或异常关系不大.结论 在妊娠早中期检测胎儿的颈部透明带厚度并密切随诊观察其变化,对染色体核型异常胎儿及高危胎儿的检出有重大意义,同时对胎儿畸形的鉴别诊断及判断胎儿预后等也有重要作用.     

探讨胎儿颈项透明层超声检查在早孕期胎儿筛查中的临床价值

目的：分析早孕期胎儿筛查中胎儿颈项透明层（nuchal translucency,NT）超声检查的临床价值。方法：回顾性选取2020年3月—2021年2月在苏州市第九人民医院分娩产检的2 700例孕妇作为研究对象,均行NT超声检查,以分娩或引产结果作为金标准,分析超声检查结果。结果：以分娩、引产结果作为金标准发现,2 700例孕妇中有21例（0.78%）胎儿为畸形阳性者,经NT超声检测显示有73例为胎儿畸形,超声诊断准确度为97.33%(2 628/2 700),敏感度为52.38%(11/21),特异度为97.69%(2 617/2 679),漏诊率为47.62%(10/21),误诊率为2.31%(62/2 679);NT超声检查异常且经染色体核型分析异常胎儿有9例,对其染色体核型进行分析显示,畸形胎儿主要染色体核型为13-三体综合征（2例,占比22.22%）、18-三体综合征（2例,占比22.22%）、21-三体综合征（5例,占比55.56%）3种类型,21-三体综合征孕周时间最短,NT超声检查最厚,组间比较差异显著（P <0.05）;超声随访检查出早孕期胎儿畸形主要为颜面部...     

经阴道超声对颈项透明层增厚胎儿心脏异常的诊断价值

目的：探讨经阴道超声诊断11~14孕周NT增厚胎儿心脏异常的方法和价值。材料和方法：对66例11~14周胎儿NT增厚的孕妇进行了经阴道超声检查,并与胎儿引产结果及出生后超声心动图对照。结果：66例中发现胎儿心脏异常4例。随访均与阴道超声心动图检查结果符合。结论：经阴道超声心动图对早期诊断NT增厚胎儿心脏结构异常有重要的临床应用价值。     

三维超声测量胎儿颈部透明层的研究

胎儿颈部透明层是指胎儿颈后部皮下组织内液体积聚的厚度，即超声观察到的胎儿颈后皮下组织内的无回声层。近来在产前超声检查中，孕10～14周的厚度已被作为早期发现胎儿异常尤其是染色体异常的重要指标。三维超声是一种较新的超声检查方法，它利用三维容积探头扫查，具有同时观察3个相互垂直切面，并在扫查结束后可以对图像进行重建及储存等优点。本研究的目的是探讨三维超声在胎儿颈部透明层测量上是否具有优越性。     

超声探测颈部透明带检出胎儿染色体异常

目的：评价超声探测颈部透明带或颈部水肿在检出胎儿染色体异常方面的作用。方法：于孕10－14周测量胎儿颈部透明带厚度，或孕14周后测量胎儿颈部皮肤厚度，并随诊观察，结果：通过超声探测共检出12例非整倍体型染色体异常的胎儿，5例正常染色体但随诊发现严重并发症的胎儿，与颈部透明带增厚但染色体及颈后正常的胎儿相比，上述异常胎儿在孕10－14周时的颈部透明带显著增厚（平均厚度6．1mm对3．6mm)，且大多数进展为妊娠中期时的颈部水肿，并合并其他超声异常。结论：超声测量颈部透明带厚度能早期有效地检出染色体异常及合并其他严重并发症的胎儿，且超声随诊观察颈部透明带厚度的变化对于鉴别诊断及评价预后有很大帮助。     

超声探测颈项透明层检测早期胎儿异常

目的评价超声探测颈项透明层在检出早期胎儿异常方面的作用。方法于孕11～14周测量胎儿颈项透明层厚度，并随诊观察。结果通过超声探测共检出52例颈项透明层增厚的胎儿，其中6例非整倍体染色体异常的胎儿，7例正常染色体但随诊发现严重并发症的胎儿，与颈项透明层增厚但染色体及预后正常的胎儿相比，上述异常胎儿在于孕11～14周时的颈项透明层显增厚(平均厚度6．8mm对3．5mm)，且大多数进展为妊娠中期时的颈部水肿，并合并其他超声异常。结论超声测量颈项透明层厚度能早期有效地检出异常胎儿及合并其他严重并发症的胎儿，且超声随诊观察颈项透明层厚度的变化对于鉴别诊断及评价预后有很大帮助。     

早孕期胎儿颈部透明层厚度及静脉导管波形与先天性心脏畸形的关系

目的：探讨早孕期胎儿颈部透明层厚度（Nuchal translucency, NT）及胎儿静脉导管（Ductus venosus, DV）频谱波型与胎儿心脏畸形之间的关系。方法：对2010年6月—2011年6月就诊于我院的孕妇3 112例,于孕11~13+6周测量NT值及DV频谱,并对胎儿进行追踪观察,筛查出心脏畸形的胎儿。结果：NT值和DV血流频谱单独及联合筛查胎儿心脏异常的敏感性、特异性、阳性预测值、阴性预测值及准确性分别为84.6%、95.2%、13.9%、99.9%,95.1%;88.5%,95.6%,15.6%,99.9%,95.5%;81.8%,97.7%,29.5%,99.1%,97.4%。结论：NT值及DV血流频谱异常可作为孕早期胎儿先天性心脏畸形的筛查指标,两者联合应用能够进一步提高筛查的特异性及准确性。     

孕早期超声检测胎儿颈项透明层增厚的临床价值

目的探讨孕早期超声检测胎儿颈项透明层(NT)厚度的临床价值并分析妊娠结局,为产前咨询和临床处理提供一定的依据。方法选取2015年3月至2018年2月在我院产前门诊进行孕早期产检的280例NT测量厚度≥2.5 mm的孕妇为研究对象,观察不同NT厚度胎儿畸形检出情况及妊娠结局;分析NT增厚孕妇年龄与染色体异常、结构畸形检出率的关系;探讨NT增厚与TORCH宫内感染的关系。结果随着NT增厚,胎儿染色体异常、结构异常及四肢畸形检出率呈上升趋势,但差异无统计学意义(P>0.05);随着NT增厚,胎儿不良妊娠结局发生率随之增加(P<0.05)。NT增厚孕妇随着年龄的增长,染色体异常、结构畸形检出率逐渐升高(P<0.05)。伴TORCH宫内感染孕妇NT值显著高于未感染者(P<0.05)。结论孕早期进行胎儿NT厚度检测,能较为准确的反应胎儿畸形情况,可作为基层医院早期胎儿畸形的筛查指标。临床工作中需根据孕妇情况及NT不同厚度给予个性化咨询及指导。     

孕早期胎儿颈项透明层厚度的超声测量价值及与不良妊娠结局的关系

目的探讨孕早期胎儿颈项透明层厚度(NT)的超声测量价值及其与不良妊娠结局的关系。方法选取在超声医学科接受孕早期NT测量且保留完整妊娠随访资料的300例单胎妊娠孕妇作为研究对象,依据NT测量值将其分为对照组(NT2.50 mm,n=254)和研究组(NT≥2.50 mm,n=46),比较2组胎儿染色体异常、结构畸形、水囊状淋巴管瘤和胚胎停止发育等不良妊娠结局。结果对照组孕期出现胚胎停止发育2例(含染色体异常1例),孕中期超声检查提示水囊状淋巴管瘤1例(合并染色体异常),不良妊娠结局发生率为1.18%(3/254)。研究组孕早期引产3例(含染色体异常1例),胚胎停止发育4例(含染色体异常2例),孕中期引产17例,其中严重结构畸形12例(合并染色体异常6例)、水囊状淋巴瘤5例(合并染色体异常2例),出生后水囊状淋巴瘤1例,不良妊娠结局发生率为54.35%(25/46),染色体异常率23.91%(11/46)。研究组不良妊娠结局发生率高于对照组,差异有统计学意义(P0.05)。将研究组孕妇按NT中位数分为2组,4.02 mm组的不良妊娠结局发生率为69.57%,高于2.50～4.02 mm组的39.13%,差异有统计学意义(P0.05)。结论孕早期NT超声测量值与孕妇妊娠结局关系密切,对孕期产前诊断、产前咨询服务以及指导科学妊娠具有重要价值。     

超声测量胎儿颈项皮肤厚度的初步研究

目的 通过超声检查寻找合适的胎儿颈项皮肤厚度（NT）临界值。方法 对67例早期妊娠（孕10-14周）病例进行超声检查测量颈项皮肤透明层厚度。结果 4例发现异常。1例NT4.0mm因心血管畸形而终止妊娠;1例VT3.6mm为21-三体;2例难免流产 其NT分别为2.7mm 1.9mm.结论 早期妊娠对作超声检查测量NT,对异常者作超声随访或染色检查，可提高胎儿畸形的早期诊断率。早期妊娠时作超声检查测量 NT已成为筛胎儿畸形的一个新指标。     

Do early pregnancy ultrasound measurements correlate with fetal nuchal translucency at 11-14 weeks?

OBJECTIVE: To assess whether extremes in nuchal translucency (NT) thickness measurements at 11-14 weeks of gestation are preceded by departures from normal in early ultrasound biometry or embryonic heart rate in euploid fetuses. METHODS: This was a retrospective analysis of data from women with singleton pregnancies examined in early pregnancy between June 2002 and January 2003, who subsequently had a nuchal translucency (NT) scan. The early pregnancy scan was performed transvaginally, and the crown-rump length (CRL), mean gestational sac diameter (GS), mean yolk sac diameter (YS) and embryonic heart rate (HR) were measured where possible. At the second scan CRL and NT were measured. RESULTS: A total of 534 singleton pregnancies were included in the analysis. The mean maternal age was 30 (range, 14-45) years, and 59.4% of the patients were nulliparous. The mean CRL was 11.5 (range, 1.4-30.0) mm at the first scan and 62.8 (range, 42.0-88.0) mm at the second scan. GS, YS and HR measurements were obtained in 87.6%, 72.5% and 72.5% of cases, respectively. No statistically significant correlation was observed between NT and Z-scores of early pregnancy: GS (r = 0.013, P = 0.77), YS (r = 0.039, P = 0.44) or HR (r = 0.016, P = 0.76). GS, YS and HR were not significantly different in fetuses with NT measurements below the 10th percentile or above the 90th percentile (P = 0.24, 0.84 and 0.60, respectively). CONCLUSION: Ultrasound biometry and heart rate measured in early pregnancy are not related to nuchal translucency measurements at 11-14 weeks of gestation in chromosomally normal fetuses.     

Measurement of fetal nuchal translucency thickness by three-dimensional ultrasound.

OBJECTIVE: To investigate the feasibility and repeatability of nuchal translucency thickness measurement using three-dimensional ultrasound. METHODS: Forty consecutive women with uncomplicated singleton pregnancies attending for Down syndrome screening at 11-14 weeks' gestation were included in this prospective crossover trial. Nuchal translucency thickness was measured using both two-dimensional and three-dimensional ultrasound. In each case two three-dimensional volumes were recorded and then examined by using the technique of planar reformatted sections. The initial plane of the first volume always contained a clear image of the nuchal region ('sagittal volume'), whilst the initial plane of the second volume was selected randomly regardless of fetal position ('random volume'). The repeatability of nuchal translucency measurement was examined by constructing a scatter diagram of the difference between the measurements plotted against the mean of two readings. RESULTS: Nuchal translucency measurements could be repeated in 38/40 (95%) sagittal volumes and 24/40 (60%) random volumes. The mean difference between two-dimensional measurements and those obtained by reslicing of sagittal three-dimensional volumes was -0.097 mm (95% limits of agreement from -0.481 to 0.675) and 0.225 mm (95% limits of agreement from -0.369 to 0.819) when random volumes were examined. CONCLUSIONS: Reslicing of stored three-dimensional volumes can be used to replicate nuchal translucency measurements only when nuchal skin can also be clearly seen on two-dimensional ultrasound.     

Optimal crown-rump length for measuring the nuchal translucency

PURPOSE: To determine the optimal crown-rump length (CRL) for obtaining nuchal translucency (NT) measurements. METHODS: Women undergoing NT measurements by NT-certified sonographers within a combined screening program over an 18-month period were included in the study if they had a living fetus with a CRL of 45-84 mm. NT measurement success and screen-positive rates, transvaginal sonography (TVUS) use, and reasons for failed NT measurements were compared in 3 groups by CRL corresponding to 11-0/7 to 11-6/7 weeks (45-54 mm), 12-0/7 to 12-6/7 weeks (55-66 mm), and 13-0/7 to 13-6/7 weeks (67-84 mm). RESULTS: Eight hundred thirty-seven women aged 34.9 +/- 4.9 years underwent 1 to 3 NT measurements at a mean CRL of 59.8 +/- 25.0 mm. NT measurements were more successful at 11 and 12 weeks (81.8% and 84.4%) than at 13 weeks (66.9%) (p < 0.001). Screen-positive and TVUS rates, and reasons for failed NT measurements did not vary by CRL. CONCLUSION: NT measurements are most successful at CRL 45-66 mm corresponding to sonographically determined gestational ages of 11-0/7 to 12-6/7 weeks.     

Impact of nuchal cord on measurement of fetal nuchal translucency thickness.

OBJECTIVE: To define the impact of nuchal cord on the measurement of fetal nuchal translucency thickness (NT). METHODS: Between December 2004 and June 2006, we examined prospectively 53 fetuses that were observed on routine first-trimester ultrasound examination between 11 + 3 and 13 + 6 weeks of gestation to have nuchal cord causing an indentation in the skin in the nuchal region. The fetuses were re-examined after a median interval of 132 min, when the cord was no longer around the neck and indentation of the skin had resolved. Various NT measurements (highest, lowest, mean) with the cord located around the neck (nuchal cord) were compared with NT measurements in the absence of nuchal cord ('true' NT) in the same fetuses. Measurements were considered to be equal when they were within mean +/- 1.96 SD, defined by our own intraobserver repeatability according to the method of Bland and Altman. RESULTS: The mean of the largest and the smallest of six measurements in the presence of nuchal cord fell within the mean +/- 1.96 SD of our own intraobserver repeatability, i.e. gave a correct estimate of the true NT, in 80% of fetuses, while the NT was overestimated in 10% and underestimated in 10% of fetuses. The largest and the smallest of six measurements in the presence of nuchal cord gave an underestimate of the true NT in 2% of fetuses and an overestimate in 4% of fetuses, respectively. CONCLUSION: There is a wide scattering of measurements in fetuses with nuchal cord in comparison to the same fetuses in the absence of nuchal cord. This prevents accurate prediction of the true NT, although the largest and smallest of repeat measurements with nuchal cord can allow calculation of the highest and lowest possible risks, respectively. These facts must be taken into consideration in counseling patients.     

NT与NF筛查染色体异常的意义

目的：探讨早孕期测量颈项透明层（NT）值及中孕期测量颈后皮肤皱褶（NF）值对筛查染色体异常的意义及其相互关系。方法：对3 963名单胎孕妇分别于孕早期（11～14周）测量NT值,在孕中期（16～22周）测量NF值,并对孕妇随诊观察。结果：3 963名孕妇中共发现染色体异常胎儿39胎,13胎表现为孕早期NT增厚（33.3%）,12胎表现为NF增厚（30.8%）,其中NT及NF均增厚5胎。超声检查共发现44胎NT增厚病例及55胎NF增厚病例,其中包括14胎NT及NF均增厚病例。NT增厚对染色体异常的检出率为29.5%, NF增厚对染色体异常的检出率为21.8%,NT及NF均增厚对染色体异常的检出率为35.7%。结论：NT及NF是筛查染色体异常的两个独立、有效的软指标,NT及NF均增厚的胎儿出现染色体异常的风险性明显增加。     

早孕期超声法判断双胎绒毛膜性的临床研究

目的:探讨早孕期采用2次超声法判断双胎绒毛膜性的临床价值。方法:选取33例在我院产科检查及分娩的双胎妊娠孕妇的临床资料。孕5~10周(早孕早期)进行第1次超声检查,判断双胎绒毛膜囊、羊膜囊数目;孕11~13周(早孕晚期)进行第2次超声检查,并参考第1次超声结果判断双胎绒毛膜囊、羊膜囊数目。比较早孕早期单次超声法和早孕期2次超声法判断双胎绒毛膜性的准确率。结果:33例双胎妊娠孕妇分娩后经胎盘病理检查,证实双绒毛膜囊双羊膜囊双胎者为20例,单绒毛膜囊双羊膜囊双胎者为11例,单绒毛膜囊单羊膜囊双胎者为2例。早孕早期单次超声法判断双胎绒毛膜性的准确率为78.78%(26/33),早孕期2次超声法判断双胎绒毛膜性准确率为93.93%(31/33)(P<0.05)。结论:早孕期2次超声法可弥补早孕早期单次超声法判断双胎绒毛膜性的不足,且具有更高的判断准确率。