二维及三维超声检测正常胎儿颅缝及前囟

目的 观察二维和三维超声对胎儿颅缝和前囟的显像价值.方法 对80名16～35孕周的孕妇进行二维和三维超声检测,观察胎儿颅缝和前囟,比较两种方法的显示率.结果 二维与三维超声对胎儿额缝、人字缝、冠状缝、前囟显示率差异无统计学意义, 三维超声对矢状缝的显示率明显高于二维超声.三维超声对颅缝和前囟的完全显示率在孕30周之前与二维超声显示率差异有统计学意义,30孕周之后显像率随孕期增加而下降.结论 三维超声能直观、形象地显示胎儿颅缝和前囟的立体形态,对矢状缝的显示率优于二维超声,在30孕周前对胎儿颅缝和前囟的完全显像优于二维超声.     

三维超声观察正常胎儿额骨和额缝的变化规律

目的 运用三维超声观察9至32孕周正常胎儿的额骨和额缝的变化规律.方法 观察150例9至32孕周胎儿的额骨和额缝,分9～13孕周、14～16孕周、17～24孕周、25～28孕周和29～32孕周5个时段,每一时段各30例.运用经腹或经阴道二维扫查胎儿头面部全貌,用经腹或经阴道三维超声获取胎儿整个颅骨的容积数据,处理容积数据直至获得清晰胎儿面部的图像,观察分析不同孕周胎儿的额骨高度和额缝角度、宽度的变化规律.结果 在第9孕周,胎儿两侧额骨眶上部位的中点分别出现一个小骨化中心,至第11孕周时额骨像两道稠密的眉毛,从第13孕周至24孕周,双侧额骨高度随孕周逐渐增高,额缝的宽度随孕周逐渐缩小,双侧额骨逐步向中线汇合勾绘出额缝.额骨之间的缝隙在第16孕周左右从鼻骨区开始闭合,在28孕周向前囟门延伸,到第32孕周从鼻骨区至前囟门额缝明显闭合.结论 胎儿额骨的骨化和额缝的形成及闭合是有规律的,运用三维超声可以直观观察胎儿额骨和额缝的形成和发展过程,从而为临床早期诊断胎儿颅骨异常提供重要信息.     

实时三维超声STIC-TUI在正常单胎孕11+0～14+6周胎儿心脏扫查中的应用

目的 探讨实时三维超声时空关联成像-断层超声显像(STIC-TUI)早期检测胎儿心脏主要结构的应用价值.方法 应用实时三维超声STIC-TUI技术采集130例孕11+0～14+6周的正常胎儿心脏容积数据,进行离线分析.设定重现12项心脏主要结构指标,分析各项指标显示情况.另选择30例18+0～18+6孕周(为胎儿心脏结构显示最佳时期的最初期)的正常胎儿作为对照组.结果 130例孕11+0～14+6周和30例孕18+0～18+6周胎儿均获得容积数据.对于孕11+0～14+6周胎儿,其四腔心切面显示较为理想的有92例(70.77％).相同孕周胎儿的心脏主要结构指标的显示率不同,不同孕周胎儿的同一心脏结构指标的显示率亦不同,其中显示率最高的是降主动脉切面,为91.53％.不同孕周心脏主要结构总显示率分别为48.08％、69.89％、94.74％、96.32％,心脏结构的显示率随孕周增大而提高,但孕13+0～13+6周与孕14+0～14+6周其显示率差别无显著性意义(x2 =1.38,P＞0.10).孕13+0～13+6周、孕14+0～14+6周与孕18+0～18+6周比较其心脏主要结构总显示率差别亦无显著性意义(x2分别为3.81、0.02,P均＞0.05).结论 实时三维超声STIC-TUI技术可用于显示早孕晚期及中孕早期胎儿心脏结构的扫查,为早期筛查胎儿严重先天性心脏病(FCHD)提供技术支持.     

产程中区分胎儿前囟与后囟的护理方法

总结产程中区分胎儿前囟与后囟的护理方法,以准确识别胎方位。区分胎儿前囟与后囟的方法有:根据囟门形状区分;根据颅缝数目区分;根据矢状缝指引法区分;根据颅缝形成角度区分;根据颅骨软硬度和胎儿头发区分。另外,介绍了辨别囟门时的特殊情况处理方法,包括假囟门、回头位、囟门闭合。在助产工作中,有时用上述方法中的一种即可迅速判断囟门,有时要根据情况同时参考几种方法来确定胎方位。     

孕11周～14周胎儿颈部透明层厚度及鼻骨应用三维超声检测分析

目的:分析应用三维超声检测孕11周~14周胎儿颈部透明层(NT)厚度及鼻骨的临床价值。方法:选取孕周为11周~14周的单胎妊娠孕妇120例,分别应用二维和三维超声对胎儿NT厚度及鼻骨进行检测。结果:三维超声与二维超声检测的NT厚度及鼻骨显示率无明显差异,P0.05,差异无统计学意义。三维超声获得胎儿标准正中矢状切面的时间明显短于二维超声,P0.05,差异具有统计学意义。结论:应用三维超声可在较短时间内获得标准正中矢状切面,缩短胎儿超声检查的时间;孕11周~14周的胎儿NT厚度、鼻骨长度与孕周呈正相关,三维超声检测孕11周~14周胎儿的NT厚度及鼻骨对早期判断胎儿异常情况具有重要价值。     

二维及三维超声在观察胎儿面部结构中的比较分析

目的探讨应用二维和三维超声观察胎儿面部正常或异常结构的临床价值。方法应用Voluson730三维容积探头表面成像模式及二维探头对孕18~40周,1288例胎儿进行超声检查,重点观察胎儿颜面部结构。结果1288例中,孕23周后应用二维及三维超声观察胎儿颜面部结构,显示率分别为84.6%、87.2%,两者无明显差异;孕23周前三维高于二维。诊断唇裂11例,两者均能作出判断。漏诊单鼻孔畸形1例,腭裂1例。结论只要掌握好最佳检查时机和操作技巧,孕23周后二维和三维超声观察胎儿颜面部结构在显示率上无明显差异,但各有其临床价值,两者可作为信息互补来进行综合评价。     

超声观察胎儿外耳标准切面及观察时机

目的 探讨超声观察胎儿外耳的标准切面及观察时机.方法 2212名17～40周、发育正常的胎儿按胎龄分成6组,对各组胎儿分别进行颈后横斜切面(A切面)、下颌横斜切面(B切面)、外耳旁矢状切面(C切面)及外耳冠状切面(D切面)的超声观察,记录不同孕周各切面胎儿外耳的获取数,并进行统计学分析.结果 2212例胎儿中,A切面共获取3454个外耳(获取率78.07%),B切面共获取1694个外耳(获取率38.29%),C切面共获取3454个外耳(获取率78.07%),D切面共获取2304个外耳(获取率52.08%).同组A切面与C切面外耳获取率相同,但二者与B切面及D切面的外耳获取率差异有统计学意义(P<0.05);B切面与D切面外耳获取率在25～40周差异有统计学意义(P<0.01).各切面胎儿外耳的获取率与孕周均呈负相关(P<0.01),即随着孕周的增加各切面胎儿外耳的获取率降低.结论 超声观察胎儿外耳方法简单易掌握,可应用于产前胎儿外耳畸形的筛查.A切面和C切面可作为超声观察胎儿外耳的标准切面,B切面和D切面可作为A切面和C切面的补充.观察胎儿外耳的最佳时期为孕17～24+6周.     

NT检测期间孕11~13+6周经腹部超声筛查胎儿先天性心脏病的可行性

目的:探究NT检测期间孕11~13+6周经腹部超声筛查胎儿先天性心脏病的可行性。方法:选取2018年2月至2019年11月时间段在我院进行检查的250例胎儿,均为NT检测期间行腹部超声筛查的单胎妊娠胎儿,主要记录三血管切面、四腔心切面、右心室流出道切面以及左心室流出道切面,计算各个切面的显示率。结果:250例胎儿平均头臂长为(6.45±1.15)c m,颈项透明带平均厚度(1.38±0.41)m m。孕11~13+6周胎儿三血管切面显示率为42.40%,四腔心切面显示率为83.60%,右心室流出道切面为48.80%,左心室流出道切面为50.80%,孕周越大,各个切面的显示率也随之增加。差异具有统计学意义(P<0.05)。结论:NT检测期间孕11~13+6周采取经腹部超声筛查可有效观察胎儿心脏结构,有利于胎儿先天性心脏病诊断,具有一定临床价值。     

孕11～14周正常胎儿心脏经阴道与腹部超声检查的对比研究

目的探讨经阴道超声检查观察孕11～14周胎儿心脏的方法及其诊断价值。方法对158例有高危妊娠病史及胎儿颈项透明层增厚且胎儿心脏正常的孕妇,于孕11～14周采用经阴道超声检查及腹部超声检查进行胎儿心脏检查。结果经阴道超声检查对孕12+0～12+6周、孕13+0～13+6周、孕14+0～14+3周胎儿心脏四腔心、左心室流出道及右心室流出道切面的显示明显优于腹部超声检查,两者相比差异有统计学意义(P0.01,P0.05)。而经阴道超声检查对孕11+0～11+6周胎儿心脏各切面的显示与腹部超声检查相比差异无统计学意义(P0.05)。结论对早孕晚期及中孕早期的高危孕妇行经阴道超声检查有临床应用价值。     

三维超声在胎儿手部成像中的应用

目的应用三维超声研究胎儿手部成像,探求三维超声显示胎儿手部的最佳切面和检查时间。方法选取100名孕20～38周无明显产科合并症孕妇,按孕龄20周～、24周～、28周～、32周～、36～38周分为五组,每组20名（40只手）。对胎儿手部分别进行二维、三维超声检查,并进行对比分析。结果二维、三维超声对各孕龄组胎儿手部成像按完全显示、部分显示、不能显示三种结果比较,x^2值在6．179～12．094之间,各孕龄组两种成像比较有明显差异（P〈0．05）,三维超声优于二维超声;其中孕28周～组胎儿手部显示率最高为50．0％,孕36～38周组最低为37．5％。结论三维超声对胎儿手部有较清晰的显示,可为染色体异常提供超声软标记。     

The role of three-dimensional ultrasound in visualizing the fetal cranial sutures and fontanels during the second half of pregnancy.

OBJECTIVES: The aim of this study was to evaluate the significance of three-dimensional (3D) ultrasound in visualizing fetal cranial sutures and fontanels and to determine factors that could influence visualization and image quality. METHODS: Serial 3D ultrasound examinations were evaluated for visibility of fetal cranial sutures and fontanels, image quality and possible influencing parameters in the second half of pregnancy. Thirty fetuses were scanned at four different gestational ages providing a data set of 120 cases. RESULTS: Most (82-100%) cranial sutures and fontanels could be visualized with 3D ultrasound. However, the sagittal suture and posterior fontanel were visualized in only 47% and 42%, respectively. Gestational age significantly influenced the visibility of the sutures and fontanels, image quality decreasing with advancing gestational age. CONCLUSIONS: 3D ultrasound can be a reliable technique for visualizing most fetal cranial sutures and fontanels. By performing a sagittal and a transverse scan, most of the sutures and fontanels can be made visible during the second half of pregnancy. Visualization depends on gestational age.     

超声经后脑横断面观察11~13+6孕周胎儿颅内后脑结构的研究

目的 探讨超声经后脑横断面观察11~13+6孕周胎儿颅内后脑结构的可行性，以期在开展对早中孕胎儿颅内结构进行有效筛查的同时缩短检查时间。方法 随机选择2695例11~13+6孕周正常胎儿进行颅脑正中矢状面及经后脑横断面切面的获取，观察后脑结构并分别测量颅内透明层的厚度进行统计比较两者一致性。结果 2695例胎儿中，2402例获得颅脑正中矢状切面及经后脑横断面，另有239例仅获得经后脑横断面，未获得颅脑正中矢状切面。颅脑正中矢状切面及经后脑横断面均可观察到胎儿后脑“二高三低回声带”结构，2402例胎儿两种切面所测IT值使用MedCalc医学统计软件进行Bland-Altman绘图分析。两种切面所测IT值具有较高的一致性。结论 经后脑横断面与颅脑正中矢状切面同样可以有效观察胎儿后脑结构，但经后脑横断面的获取较少受到胎儿体位限制，该切面的运用可提高超声医师的工作效率，同时对于体位不佳的胎儿，经后颅窝横断面为观察其颅脑结构提供一个有效的途径。     

不同孕周的胎儿泌尿系统畸形的三维超声产前诊断及预后评估

目的:探讨不同孕周的胎儿泌尿系统畸形的三维超声产前诊断及预后评估.方法:以2016年1 月-2018年12月在我院行产前检查的1 288例孕妇作为研究对象.均进行二维、三维超声检查,分娩或引产后进行确诊.结果:1 288例孕妇共分娩或引产1 307例胎儿,根据引产尸检或分娩后确诊检查以及随访结果,发现泌尿系统畸形共35...     

颅面部五切面法在11~13+6周胎儿颅面部畸形诊断中的应用价值

目的探讨颅面部五切面法在早孕期胎儿颅面部畸形诊断中的应用价值。 方法回顾性选取2020年1月至2021年1月在四川省妇幼保健院行早孕期超声检查的孕妇9183例,所有孕妇均于孕11~13⁺⁶周行超声检查,应用颅面部五切面法观察胎儿颅面部形态、结构等,并对分娩后新生儿及引产后胎儿进行随访。 结果9183例孕妇均可获得满意的颅面部五切面,最终诊断颅面部异常52例,孕11~13⁺⁶周检出42例（80.7%,42/52）,其中无叶全前脑15例（喙鼻9例,独眼4例）,唇腭裂畸形5例,露脑畸形12例,无脑儿4例,脑膜脑膨出3例,开放性脊柱裂3例,42例均经引产后尸解或临床随访证实胎儿颅面部异常。10例早孕期未检出,于孕中期超声检查检出,包括小眼畸形2例,小耳畸形3例,单纯唇裂畸形3例,面裂畸形1例,鼻翼部分缺损1例。 结论胎儿颅面部五切面法能较全面评价胎儿颅脑及颜面部,是早孕期筛查胎儿颅面部畸形的有效方法。     

孕11~13+6周超声筛查胎儿结构畸形的临床价值

目的总结孕11~13⁺⁶周胎儿结构畸形超声声像图特征,探讨孕11~13⁺⁶周胎儿超声规范化筛查的临床价值。 方法对2011年9月至2014年5月在深圳市宝安区妇幼保健院产前检查的4853例孕妇的孕早期（11~13⁺⁶周）胎儿行颈项透明层（NT）厚度测量,同时行胎儿主要结构超声筛查,显示胎儿正中矢状切面、颈项矢状切面、颅脑横切面、心脏四腔心切面及三血管气管切面、腹部横切面、膀胱切面、上肢切面、下肢切面,并保存图像。对超声检查后继续妊娠的孕妇均行中孕期Ⅲ级和晚孕期Ⅱ级超声检查,所检病例均追踪随访至出生后6周,引产胎儿均行病理检查,超声与病理检查结果进行对照分析。 结果孕11~13⁺⁶周超声筛查的4853例孕妇中单胎4500例,双胎353例,共5206例胎儿,发现胎儿结构异常85例,检出率为（1.6%,85/5206）,包括中枢神经系统异常28例,前腹壁异常9例,心脏异常6例,泌尿系畸形3例,骨骼系统畸形2例,多房性水囊瘤及水肿胎35例,双胎之一结构异常2例。85例结构异常胎儿中6例在孕14周后复查无异常,正常出生;79例结构异常胎儿超声诊断后孕妇均选择引产;其中孕14周前选择引产73例,孕14周后超声复查及染色体检查证实胎儿畸形后孕妇选择引产6例;仅9例孕妇选择绒毛膜穿刺或羊水穿刺,胎儿核型分析3例正常,3例为18-三体综合征,3例为45X综合征。产后检查证实胎儿结构异常110例,与产后检查结果对照,早孕期超声漏诊胎儿结构异常25例（22.7%,25/110）,中晚孕期补充检出胎儿结构异常22例,产前超声共诊断胎儿结构异常107例,仅漏诊3例,出生后检查新生儿室间隔缺损2例、小耳畸形1例。 结论孕11~13⁺⁶周超声结构筛查可使胎儿畸形筛查时间提前,为致死性胎儿畸形的孕妇提供较早终止妊娠的机会,有效减少结构异常胎儿出生,具有重要临床意义。     

Fetal gender assignment by first-trimester ultrasound.

OBJECTIVE: Ultrasound determination of fetal sex can benefit decision-making regarding invasive prenatal testing in pregnancies at risk of sex-linked genetic abnormalities. The aim of this study was to assess the accuracy of fetal sex determination by ultrasound at 12-14 weeks of gestation in a large cohort. METHODS: Fetal gender assessment by transabdominal ultrasound was performed in 656 singleton pregnancies at 12-14 weeks of gestation. The genital region was examined in the mid-sagittal plane. The angle of the genital tubercle to a horizontal line through the lumbosacral skin surface was measured. The fetus was assigned male gender if the angle was > 30 degrees , and female gender if the genital tubercle was parallel or convergent (<10 degrees ) to the horizontal line. At an intermediate angle of 10-30 degrees the gender was not determined. Crown-rump length (CRL) was measured in all cases. RESULTS: Gender assignment was possible in 613 of the 656 (93%) fetuses. Gender identification according to CRL was feasible in 85%, 96% and 97% of the fetuses at gestational ages of 12 to 12 + 3, 12 + 4 to 12 + 6 and 13 to 13 + 6 weeks, respectively. Phenotypic sex was confirmed in 555 newborns. The accuracy of male gender assignment in this group was 99-100% at all ages, and that of female gender assignment was 91.5% at 12 to 12 + 3 weeks, 99% at 12 + 4 to 12 + 6 weeks and 100% at 13 to 13 + 6 weeks. CONCLUSION: Prenatal gender assignment by ultrasound has a high accuracy rate at 12-14 weeks. These results indicate that invasive testing can probably be carried out in fetuses identified as males at this gestational age. However, in fetuses identified as female at a CRL of <62.6 mm, despite the relatively high 91.5% accuracy rate, the decision regarding invasive testing should be postponed until a higher CRL is achieved.     

产前超声三血管多切面和主动脉冠状及矢状切面诊断胎儿先天性血管环

目的 观察产前超声三血管多切面和主动脉冠状及矢状切面诊断胎儿先天性血管环的价值。方法 回顾性分析42胎经产前超声诊断的先天性血管环胎儿,于超声三血管多切面、主动脉冠状及矢状切面观察上腔静脉、主动脉弓、肺动脉及动脉导管与气管的位置关系等,并结合产后随访结果分析各切面用于诊断胎儿先天性血管环的价值。结果 42胎中,19胎为右位主动脉弓,其中16胎为右位主动脉弓+迷走左锁骨下动脉+左侧动脉导管,3胎为右位主动脉弓伴镜像分支+左侧动脉导管;17胎为左位主动脉弓伴迷走右锁骨下动脉;3胎为双主动脉弓,其中2胎为右弓优势型、1胎为均衡型;3胎为肺动脉吊带。15胎合并心内畸形。8名孕妇因胎儿染色体异常终止妊娠,9名孕妇于外院分娩而失访;25例新生儿超声心动图或CTA所见均与产前检查结果相符。结论 产前超声三血管多切面结合主动脉冠状及矢状切面有助于检出胎儿先天性血管环。     

Umbilical artery Doppler velocimetry in pregnancies of less than 21 weeks' duration

Most Doppler ultrasound investigations of the umbilical artery circulation have been confined to beyond 16 weeks' gestation. The purpose of this study is to explore the evolution of this circulation in human pregnancies of less than 21 weeks' gestation. We studied 169 low-risk pregnant women (125 longitudinally and 44 cross-sectionally) with a pulsed Doppler system on 357 separate occasions between 9 and 20 weeks of gestation. Systolic/diastolic (S/D) ratios were used for waveform analysis. We obtained umbilical waveforms as early as 9 weeks. Before 13 weeks, all fetuses had absent end-diastolic velocity (AEDV), then progressive development of end-diastolic velocity (EDV) appeared from 13 to 18 weeks. At 18 weeks, all fetuses had developed EDV. S/D ratios progressively declined from 13 to 20 weeks (y = 17.67 - 1.26x + 0.3x2; r2 = .95). A cross-sectional evaluation of fetal heart rate in 136 fetuses revealed a significant negative second-order polynomial relationship with gestational age between 9 and 20 weeks y = 245.84 - 10.33x + 0.27x2; r2 = .93). In 136 fetuses, 185 measurements of S/D ratios and their corresponding fetal heart rate revealed no relationship (weighted linear regression, r2 = .005). Mean fetal heart rate was significantly higher when EDV was absent (164.6 +/- 10.8 standard deviation [SD], n = 74) than when EDV was present (150.1 +/- 5.8 SD; n = 62; P = .000). Thus, upstream factors may be of little importance in the generation of umbilical artery velocity waveforms in early pregnancy. Umbilical Doppler velocimetry in the first half of pregnancy gives a functional assessment of the vascular development of the umbilical-placental circulation.(ABSTRACT TRUNCATED AT 250 WORDS)     

Metopic suture in fetuses with Apert syndrome at 22-27 weeks of gestation.

OBJECTIVES: To examine the possible association of skull deformity and the development of the cranial sutures in fetuses with Apert syndrome. METHODS: Three-dimensional (3D) ultrasound was used to examine the metopic and coronal sutures in seven fetuses with Apert syndrome at 22-27 weeks of gestation. The gap between the frontal bones in the transverse plane of the head at the level of the cavum septi pellucidi was measured and compared to findings in 120 anatomically normal fetuses undergoing routine ultrasound examination at 16-32 weeks. RESULTS: In the normal group, the gap between the frontal bones in the metopic suture at the level of the cavum septi pellucidi, decreased significantly with gestation from a mean of 2.2 mm (5th and 95th centiles: 1.5 mm and 2.9 mm) at 16 weeks to 0.9 mm (5th and 95th centiles: 0.3 mm and 1.6 mm) at 32 weeks. In the seven cases with Apert syndrome, two-dimensional ultrasound examination demonstrated the characteristic features of frontal bossing, depressed nasal bridge and bilateral syndactyly. On 3D examination there was complete closure of the coronal suture and a wide gap in the metopic suture (15-23 mm). CONCLUSION: In normal fetuses, cranial bones are believed to grow in response to the centrifugal pressure from the expanding brain and proximity of the dura to the suture is critical in maintaining its patency. In Apert syndrome, the frontal bossing may be a mere consequence of a genetically predetermined premature closure of the coronal suture. Alternatively, there is a genetically predetermined deformation of the brain, which in turn, through differential stretch of the dura in the temporal and frontal regions, causes premature closure of the coronal suture and impaired closure of the metopic suture.