经阴道彩超诊断宫内早早孕73例分析

目的　探讨宫内早早孕阴道彩色多普勒超声特点。方法　分析 73例宫内早早孕的子宫大小、内膜厚度、子宫动脉和内膜血流的阻力指数 (RI)值 ,并与 4 5例育龄非妊娠妇女作对照。结果　子宫动脉平均RI值 0 .82± 0 .0 6 ,与对照组比较无差异 ;子宫增大 2 5例 ,平均值 15 .6 0± 1.70cm ;子宫内膜增厚达 1.1～ 2 .1cm ,≥ 1.2cm者 6 9例 (占94 .5 % ) ;内膜血流显示率 10 0 % ,呈低阻力型 ,平均RI值 0 .4 4± 0 .0 7,三项与对照组比较有差异。结论　子宫大小、内膜厚度及血流特征 ,结合停经史和血HCG阳性 ,对诊断宫内早早孕具有重要的价值     

阴道彩色多普勒超声对早期异位妊娠和妊娠黄体的鉴别诊断

目的：探讨早期异位妊娠与妊娠黄体的经阴道彩色多普勒超声声像图特点,以提高诊断符合率。方法：回顾性分析48例异位妊娠与50例早孕卵巢黄体的二维声像图及彩色多普勒超声表现。结果：异位妊娠声像图表现为宫旁不均质包块,周围均无小卵泡样回声,妊娠黄体中31例（62.00%）周围可见小卵泡回声;45例（93.75%）异位妊娠患者血流呈点状血流及带状血流,2例（4.17%）呈环状血流,1例（2.08%）无明显血流信号,48例（96.00%）妊娠黄体呈环状及半环状血流,2例（4.00%）呈点线状血流;异位妊娠患者较宫内早孕妊娠黄体收缩期峰值流速（PVS）低,而RI、搏动指数（PI）、收缩期与舒张期比值（S/D）高。结论：经阴道超声在早期异位妊娠与妊娠黄体的鉴别诊断中有较高的价值。     

经阴道彩色多普勒超声对早期异位妊娠和妊娠黄体的鉴别诊断

目的 :探讨早期异位妊娠与妊娠黄体的经阴道彩色多普勒超声声像图特点,以提高诊断符合率。方法 :回顾性分析48例异位妊娠与50例早孕卵巢黄体的二维声像图及彩色多普勒超声表现。结果 :异位妊娠声像图表现为宫旁不均质包块,周围均无小卵泡样回声,妊娠黄体中31例(62.00%)周围可见小卵泡回声;45例(93.75%)异位妊娠患者血流呈点状血流及带状血流,2例(4.17%)呈环状血流,1例(2.08%)无明显血流信号,48例(96.00%)妊娠黄体呈环状及半环状血流,2例(4.00%)呈点线状血流;异位妊娠患者较宫内早孕妊娠黄体收缩期峰值流速(PVS)低,而RI、搏动指数(PI)、收缩期与舒张期比值(S/D)高。结论:经阴道超声在早期异位妊娠与妊娠黄体的鉴别诊断中有较高的价值。     

经阴道超声检查在异位妊娠诊断中的临床应用

目的 探讨异位妊娠患者行经阴道超声检查诊断临床价值。方法 选取疑似异位妊娠的80例患者，分析异位妊娠经阴道超声检查特点。结果 80例经阴道超声检查确诊异位妊娠72例，诊断准确率、灵敏度、特异度分别为90.00%、93.42%、75.00%。阳性预测值和阴性预测值分别为75.00%、37.50%,异位妊娠的肿块体积平均为(36.12±4.35) mm。结论 经阴道超声检查异位妊娠诊断中具有较高的灵敏度、特异度及准确率，通过检测孕囊及子宫内膜的厚度、血流等指标对异位妊娠发挥良好的诊断效能。     

血清β-HCG、孕酮联合阴道超声检测对早期异位妊娠的诊断价值

目的探讨血清绒毛膜促性腺激素(β-HCG)、孕酮(P)联合阴道超声检测对早期异位妊娠的临床诊断价值。方法对51例异位妊娠患者(异位妊娠组),48例正常早孕者(正常妊娠组),56例健康体检者(健康对照组)分别检测其血清β-HCG、P水平和子宫内膜厚度;比较血清β-HCG、P检测、阴道超声检测及三项联合检测的敏感性、特异性、准确性。结果血清β-HCG、P水平及子宫内膜厚度正常妊娠组均明显高于异位妊娠组(P<0.01),健康对照组又明显低于异位妊娠组(P<0.01)。而三项联合检测的敏感性、特异性和准确性分别提高至94.1%、95.7%和74.2%,高于各项的单独检测(P<0.05)。结论联合检测血清β-HCG、P和阴道超声有利于提高异位妊娠诊断的敏感性、特异性和准确性,对异位妊娠的早期诊断有重要意义。     

经阴道超声检查子宫内膜厚度联合血清β-HCG、孕酮检测评估异位妊娠价值

目的 探讨经阴道超声检查子宫内膜厚度(ET)、联合血清β-HCG、孕酮(P)对发生异位妊娠(EP)的辅助诊断价值。方法 选取本院收治的40例EP患者为EP组,另选同期体检健康的宫内妊娠30例为对照组,比较两组收缩期最大血流速度(VS)、月经周期、孕次、舒张末期流速(VD)、停经天数、BMI、孕周、阻力指数(RI)等一般资料差异;比较两组血清β-HCG、P水平以及ET值差异。ROC曲线分析血清β-HCG、P水平以及ET值对EP的诊断价值。结果 EP组与对照组间年龄、月经周期、孕次、停经天数、BMI、孕周比较差异无统计学意义(P> 0.05); EP组VD、VS、RI值显著高于对照组(P <0.05)。EP组血清β-HCG(3793.78±959.46) m IU/ml、P水平(18.25±3.82) nmol/L以及ET值(8.50±1.17) mm显著低于对照组(8226.15±1573.88) m IU/ml、(35.86±9.45) nmol/L、(11.47±2.07) mm(P <0.05); β-HCG、P水平、ET值均是影响EP的独立危险因素;血清β-HC...     

子宫内膜容积和内膜下血流对子宫内膜容受性影响的比较

目的探讨子宫内膜容积和子宫内膜下血流情况对子宫内膜容受性的影响。方法应用经阴道二维彩色多普勒及三维容积成像,对138例拟行体外受精一胚胎移植技术(IVF-ET)的不孕症患者于控制性超促排卵周期中移植日进行子宫内膜容积及子宫内膜下螺旋动脉血流搏动指数(PI)、血流阻力指数(RI)进行测量。根据妊娠结果将138例患者分为妊娠组(55例)和非妊娠组(83例),比较两组间相关参数的差异。结果妊娠组子宫内膜容积与非妊娠组比较,无统计学差异(P>0.05);妊娠组子宫内膜下螺旋动脉的PI及RI均低于非妊娠组,两组比较,差异均有显著统计学意义(P<0.01)。子宫内膜容积及内膜下螺旋动脉PI、RI预测妊娠的ROC曲线下面积分别为0.569、0.729、0.717。结论子宫内膜下血流情况在子宫内膜容受性方面起重要的作用,对IVF-ET的妊娠率影响更大。     

子宫内膜厚度联合β-HCG对异位妊娠的鉴别诊断价值

目的探讨阴道超声检测子宫内膜厚度联合血清人绒毛膜促性腺激素β亚单位(β-HCG)检测对异位妊娠的诊断价值。方法将2012年9月~2014年10月收治的130例疑似异位妊娠患者,按照确诊结果分为宫内正常妊娠组(A组)35例、宫内妊娠自然流产组(B组)30例、异位妊娠组(C组)65例,对3组的子宫内膜厚度、血清β-HCG等指标水平进行比较分析。结果 A组的子宫内膜厚度和β-HCG水平,均显著高于B组和C组(P<0.05);而B组与C组比较,差异均无统计学意义(P>0.05);3组的子宫内膜厚度与β-HCG的联合检测符合率,均显著高于各组单项检测的符合率(P<0.05)。结论采用阴道超声检测子宫内膜厚度联合β-HCG检测,可显著提高对异位妊娠的诊断正确率,降低误诊的风险,临床应用价值价高。     

胚胎移植日经阴道三维超声评估子宫内膜容受性对体外受精/卵泡质内单精子显微注射-胚胎移植患者妊娠结局预测价值研究

目的探讨胚胎移植日经阴道三维超声评估子宫内膜容受性对体外受精/卵泡质内单精子显微注射-胚胎移植患者妊娠结局的预测价值。方法选取北部战区总医院和平院区自2016年11月至2018年10月收治的1 048例体外受精/卵泡质内单精子显微注射-胚胎移植患者为研究对象。根据是否妊娠,将患者分入妊娠组(n=712)和非妊娠组(n=336)。所有患者均在胚胎移植日接受经阴道三维超声检查,比较两组患者的子宫内膜厚度、子宫内膜血流分支及血流参数、子宫动脉血流参数。结果非妊娠组子宫内膜厚度为(0.78±0.23)cm,小于妊娠组的(0.96±0.21)cm,差异有统计学意义(P<0.05)。非妊娠组子宫内膜血流分支为(7.09±1.68)支,少于妊娠组的(8.62±1.65)支,差异有统计学意义(P<0.05)。妊娠组、非妊娠组子宫内膜阻力指数分别为(0.53±0.12)、(0.51±0.08),搏动指数分别为(0.78±0.27)、(0.79±0.21),收缩峰速度与舒张末期速度比值(S/D)分别为(2.15±0.52)、(2.13±0.45),差异无统计学意义(P>0.05)。妊娠组、非妊娠组子宫动脉阻力指数分别为(0.78±0.04)、(0.81±0.06),搏动指数分别为(1.96±0.36)、(1.94±0.41),S/D分别为(5.26±1.25)、(5.17±1.31),差异无统计学意义(P>0.05)。结论胚胎移植日经阴道三维超声可用于评估子宫内膜容受性,对预测体外受精/卵泡质内单精子显微注射-胚胎移植患者妊娠结局具有一定意义。     

剖宫产切口瘢痕妊娠的超声诊断及误诊分析

目的探讨剖宫产切口瘢痕妊娠(CSP)的超声影像学特征。方法对22例经手术证实的CSP病例的超声影像学特征进行分析。结果 22例CSP患者子宫前位者18例,子宫后位者4例,宫腔内可见息肉者2例,宫内有节育环者2例,子宫内膜厚度不足4.0 mm者4例。2例患者伴发有子宫肌瘤。CSP患者的孕囊超声表现征象分为4类特征:无回声者2例(18.2%);混合回声者8例(36.4%);妊娠囊回声者10例(45.5%);不均质回声者2例(18.2%)。多普勒超声可见病灶周围有丰富的血流信号,大多表现为低速低阻型。超声诊断符合者20例,符合率为90.9%,有2例误诊,误诊率为9.1%。结论彩色多普勒超声对CSP的临床诊断具有较大价值。     

Ectopic pregnancy: evaluation with endovaginal color flow imaging.

Endovaginal sonography and endovaginal color flow imaging were compared in 155 patients with clinical suspicion of ectopic pregnancy. Sixty-five patients (42%) had surgically confirmed ectopic pregnancies. Thirty-six of the pregnancies were diagnosed with endovaginal sonography alone, the criteria being an extrauterine sac or ectopic fetus (sensitivity, 54%). Sixty-two ectopic pregnancies were diagnosed with endovaginal color flow imaging (sensitivity, 95%) when an ectopic fetus or sac was seen or placental flow was identified in an adnexal mass separate from the ovary and uterus. The diagnosis of ectopic pregnancy was excluded with endovaginal sonography (specificity, 98%) and endovaginal color flow imaging (specificity, 98%) by finding an intrauterine gestation, nonvisualization of an adnexal mass, and absence of placental flow. Three false-positive and three false-negative diagnoses were made with endovaginal color flow imaging (positive predictive value, 97%). The addition of color Doppler flow imaging to endovaginal sonography allows increased sensitivity in the detection of ectopic pregnancy.     

Endovaginal color Doppler sonographic evaluation of ectopic pregnancy in women after in vitro fertilization and embryo transfer

The aim of this study was to evaluate the value of endovaginal color Doppler ultrasonography in the early diagnosis of ectopic pregnancy in women after in vitro fertilization and embryo transfer, and to correlate the sonographic findings with ?-hCG serum levels. Thirty-five patients had proven ectopic pregnancies and 4 other patients had heterotopic pregnancies. The diagnosis was disclosed correctly in all cases by endovaginal color Doppler US by identifying an adnexal mass with placental flow and a nongravid uterus called a “cold uterus”. An intrauterine sac with “double ring sign” was found in all normal intrauterine pregnancies when the hCG levels exceeded 1000 IU/l but in none of the patients with ectopic pregnancy (EP). These findings suggest the efficacy of the discriminatory hCG serum level of 1000 IU/l in the investigation of EP. In conclusion, this study describes the diagnostic importance of transvaginal color Doppler US in correlation with hCG serum levels in the early detection of EP avoiding life-threatening complications and improving patient outcome. Received: 4 May 1998; Revision received: 10 August 1998; Accepted: 10 September 1998     

Diagnosis of ectopic pregnancy: endovaginal vs transabdominal sonography

During a 25-month period, 193 women with the clinical diagnosis of suspected ectopic pregnancy had transabdominal and endovaginal sonograms. Most had quantitative determinations of serum human chorionic gonadotropin (HCG). Endovaginal sonography was diagnostic of ectopic pregnancy in 23 (38%) of the 60 patients with surgically proved ectopic pregnancies: transabdominal sonography was diagnostic in 13 patients (22%). All 83 intrauterine pregnancies were identified with endovaginal sonography, compared with 34 identified with transabdominal sonography. Endovaginal sonography was somewhat more helpful in the diagnosis of missed abortion and blighted ovum. Eighty endovaginal sonograms were classified as indeterminate as compared with 141 transabdominal studies. This indeterminate group included patients with complete abortions, ectopic pregnancies without sonographic evidence of an extrauterine gestation, incomplete abortions, and patients with subsequent negative serum levels. As in prior reports, endovaginal sonography was superior to transabdominal sonography in the evaluation of suspected ectopic pregnancies. Overall, endovaginal sonography was diagnostic in 113 patients, whereas transabdominal sonography was diagnostic in 52 patients. The finding of an extrauterine fetal pole or embryo was diagnostic for an ectopic pregnancy. Pelvic fluid, the appearance of the endometrium, and a single positive serum HCG determination were not helpful in making the diagnosis of ectopic pregnancy.     

Early pregnancy complications: endovaginal sonographic findings correlated with human chorionic gonadotropin levels

Endovaginal sonography results were compared with quantitatively determined human chorionic gonadotropin (hCG) levels in 84 women referred for early pregnancy complications. Of the 27 with normal intrauterine pregnancies, an intrauterine gestational sac was prospectively identified in one of five cases (20%) in which hCG levels were below 500 IU/L (Second International Standard), four of five (80%) with hCG levels of 500-1,000 IU/L, and all 17 with hCG levels above 1,000 IU/L. In comparison, 17 of the 26 women with ectopic pregnancies (65%) had hCG levels greater than 1,000 IU/L, and none of the 26 had an intrauterine gestational sac. Endovaginal sonography demonstrated an adnexal mass and/or a gestational sac-like structure in 16 of the 17 cases (94%) in which hCG levels were above 1,000 IU/L, compared with only three of the nine (33%) with lower hCG levels (P less than .01). These findings indicate that an intrauterine gestational sac should be normally visualized with endovaginal sonography when the hCG level exceeds 1,000 IU/L, and that visualization of an extrauterine gestational sac and/or adnexal mass is significantly more likely in ectopic pregnancies when the hCG level exceeds 1,000 IU/L.     

Ectopic pregnancy: duplex Doppler evaluation

Of 398 patients in whom there was a clinical suspicion of ectopic pregnancy, 96 (24%) were found to have the condition. Of the 96, 70 underwent duplex Doppler imaging. A viable ectopic fetus was seen in 10 of 70 (14%), and an extrauterine sac without an identifiable fetus was seen in an additional 27, giving a sensitivity for imaging alone of 53%. Fetal heart activity was detected with Doppler in 13 (19%). High-velocity flow, which suggested the presence of an ectopic pregnancy, was detected in 38 of 70 (54%) patients (total preoperative sensitivity, 73%). In the 91 patients who did not have an ectopic pregnancy, duplex Doppler imaging of the intrauterine contents alone allowed an ectopic pregnancy to be excluded in 29 (32%) on the first examination and in a further 21 on the second scan (specificity, 55%). Nine vascular adnexal masses were falsely considered to be ectopic pregnancies (specificity, 90%). The positive predictive values were 47% for imaging alone and 85% for Doppler. The negative predictive values were 60% for imaging alone and 81% for Doppler.     

A model of the expected occurrence of adverse pregnancy outcomes aboard U.S. Navy ships

The goal of this study was to model the incidence of ectopic pregnancy and spontaneous abortion if pregnant women in the first 20 weeks of gestation were to remain aboard ship while at sea during deployments. Ectopic pregnancies and other pregnancy complications at sea can be life-threatening events. Data sources included shipboard medical departments, an Enlisted Personnel Survey, and the Naval Health Research Center Hospitalized Pregnancy and Women Aboard Ship studies. The overall pregnancy rate was 19 per 100 woman-years (95% confidence interval, 18-20), based on the complement of women assigned to participating ships. If pregnant women routinely were to remain aboard ships at sea during deployments through their first 20 weeks of pregnancy, it is expected that approximately 9 ectopic pregnancies and 40 spontaneous abortions would occur aboard ships at sea.     

脑胎盘率联合无应激胎心监护对高危妊娠结局的诊断意义

 目的 探讨胎儿脑胎盘率(cerebroplacental ratio,CPR)联合无应激胎心监护(non stress test,NST)对高危妊娠结局的诊断意义。方法 选取2018-12至2020-02在石家庄市第六医院产检并分娩的单胎高危妊娠患者120例为研究对象。平均孕周28-41周,进行超声检测胎儿脐动脉(umbilical artery,UA)和大脑中动脉(middle cerebral artery,MCA)血流,测得CPR,同时行产前NST。对母儿分娩结局:羊水污染、胎儿窘迫、剖宫产、助产(产钳/胎吸);新生儿结局:1 min Apgar评分＜7分、血气 pH＜7.25、入住NICU进行比较。比较不同方法对高危妊娠不良妊娠结局评估的效能,主要包括灵敏度、特异度、阳性预测值及阴性预测值。结果 根据NST与CPR结果分为4组:A组(NST与CPR均正常),B组(NST异常),C组(CPR异常),D组(NST与CPR均异常)。D组中胎儿窘迫 21例(80.77%)、羊水污染23例(88.46%)、剖宫产24例(92.31%)、助产(产钳/胎吸)3例(11.54%)、1 min Apger评分＜7分17例(65.38%)、血气pH＜7.25 16例(61.54%)、入住NICU 18例(69.23%),明显高于其他3个组,且差异有统计学意义(P<0.05)。CPR联合胎心监护对不良妊娠结局预测的灵敏度为97.01%、特异度为93.78%、阳性预测值为91.06%、阴性预测值为97.27%,均高于单纯使用CPR及胎心监护。结论 CPR与NST联合应用对高危妊娠中异常情况诊断及时、准确、安全、有效,可有效避免不良妊娠结局的发生,在高危妊娠管理中具有重要意义,值得临床推广。     

Endometrial abnormalities: evaluation with transvaginal sonography

The value of transvaginal sonography in detecting gynecologic disease currently is being defined. To evaluate transvaginal depiction of the endometrium, transvaginal sonograms were compared with conventional transabdominal scans in 29 patients whose sonograms revealed endometrial abnormalities. The two techniques were compared for image quality and ability to provide unique diagnostic information. Sonographic findings included fluid collections (16), thickened and/or echogenic endometria (10), endometrial irregularities (two), and echogenic foci (two). Clinical diagnoses included early intrauterine pregnancies (five), pseudogestational sacs of ectopic pregnancy (one), intrauterine contraceptive devices (two), endometrial carcinoma (one), and intrauterine synechiae with amenorrhea (Asherman syndrome) (two). In most cases (77%), diagnostic information was obtainable by either transabdominal or transvaginal sonograms, although in 23% transvaginal scanning provided unique diagnostic information not available with the transabdominal technique. In no case did transabdominal sonography contribute diagnostic information not provided transvaginally. The quality of the transvaginal image was judged to be better than that of the transabdominal image in 63% of cases; image quality was the same in 33% of cases and worse in 3% of cases. The results show that transvaginal sonography is often superior to transabdominal scanning in the evaluation of endometrial abnormalities. Transvaginal sonography may be the preferred technique in these cases.     

Suspected ectopic pregnancy: endovaginal and transvesical US

Until the advent of endovaginal ultrasonography (US), transvesical US was the only US technique availab le for evaluation of patients with suspected ectopic gestation. A study was undertaken to assess the predictive ability of transvesical and endovaginal US and determine whether endovaginal US could be used alone. Fifty-three patients who had a positive pregnancy test finding and who were at risk for ectopic pregnancy were examined with both endovaginal and transvesical US. Twenty-nine were examined retrospectively and 24 were examined prospectively. Standard sonographic criteria were used to differentiate between intrauterine pregnancy and ectopic gestation. The clinical or pathologic diagnosis was ectopic pregnancy in 18 patients (34%), normal intrauterine pregnancy in 19 (36%), and abnormal intrauterine pregnancy in 16 (30%). Endovaginal US increased the sensitivity of detecting a live ectopic pregnancy (from 6% to 17%). Endovaginal US, by allowing early diagnosis of intrauterine pregnancy, significantly increased the diagnostic accuracy for ectopic pregnancy (from 60% to 83%). Endovaginal US provided significant additional information in women referred for sonography with a suspected ectopic gestation. On the basis of these findings it is concluded that endovaginal US can be used alone in the majority of women with suspected ectopic gestation.     

Comparison of transvaginal and transabdominal sonography in the detection of early pregnancy and its complications

Ninety women with a positive pregnancy test and signs and symptoms of threatened abortion or ectopic pregnancy had endovaginal and abdominal sonography in order to compare the value of the two techniques for the detection of gestational abnormalities. Either a normal delivery occurred or surgical and/or pathologic confirmation of the diagnosis was available in all cases. Fifty-five women had normal intrauterine pregnancies, 22 had ectopic pregnancies, seven had blighted ova, and six had missed abortions. All 55 normal intrauterine pregnancies were detected by endovaginal sonography, while only 11 (20%) were diagnosed by transabdominal sonography. The yolk sac, fetal pole, and fetal heart motion were seen as early as 34 days from the last menstrual period with endovaginal sonography, compared with 42 days with transabdominal sonography. Fetal heart motion was detected with endovaginal sonography in fetal poles with a crown-rump length of 3 mm or greater, whereas the fetal pole had to be at least 6 mm before fetal heart motion could be detected with the transabdominal technique. In the 22 ectopic pregnancies, a specific diagnosis of an extrauterine sac containing a fetal pole with heart motion or yolk sac was possible in three cases with the endovaginal technique, but it was not possible in any case with transabdominal sonography. Both techniques showed that each of the seven patients with final diagnosis of blighted ova had a gestational sac that was 1.7 cm or larger without visualization of the fetal pole or yolk sac. All six missed abortions were detected by endovaginal sonography, but only three were diagnosed on transabdominal sonograms. Our findings show that endovaginal sonography is more sensitive than transabdominal sonography in the detection of early pregnancy and its complications.