妊娠23-24周三维容积超声部分肢体体积预测胎儿晚发型生长受限的应用价值

目的 测量妊娠23-24周胎儿三维容积超声部分肢体体积,和常规二维超声参数比较,探讨对预测晚发型生长受限(fetal growth restriction,FGR)的应用价值。方法 选取2018年1月至2019年12月在我院行产前检查并最终确诊为晚发型FGR的74例孕妇,定义为病例组,另选取同期正常孕妇200例为对照组。在超声诊断仪规范化测量妊娠23-24周胎儿二维超声参数：双顶径、头围、腹围、股骨长度,记录二维超声参数生成的胎儿体重(estimated fetal weight,EFW)。三维容积超声测量部分肢体体积：上臂中段50%的体积(fractional arm volume, AVol)和大腿中段50%的体积(fractional thigh volume,TVol)。比较二组各个数值差异,应用ROC曲线下面积AUC比较各个参数预测晚发型FGR的价值。结果 病例组和对照组的双顶径、头围、腹围、股骨长度及EFW无统计学差异。两组间的AVol和TVol比较差异有统计学意义。ROC曲线分析显示,AVol和TVol预测晚发型FGR的曲线下面积(AUC)为0.70和0.74,二者差异无统计学意义,最佳截断值分别为4.5 mL和9.4 mL,,预测晚发型FGR的敏感性、特异性、准确性分别为63.5%和69.4%、89.4%和88.1%、81.4%和83.2%。二者联合预测晚发型FGR敏感性、特异性和准确率分别为79.0%、94.8%和90.1%。     

超声预测晚发型胎儿宫内生长受限的临床价值

目的 探讨超声对晚发型胎儿宫内生长受限的预测价值。方法 选取在我院行产前超声检查的孕妇99例,依据不同妊娠结局分为正常组66例（胎儿宫内发育正常）和迟发组33例（晚发型胎儿宫内生长受限）,获取两组心肌做功指数（MPI）、脑胎盘率（CPR）、肝静脉血流阻力指数（HVI）、静脉脉搏传递时间（VPTT）及心输出量（CO）,比较两组上述参数的差异。相关性分析采用Spearman相关分析法;绘制受试者工作特征（ROC）曲线分析各参数预测晚发型胎儿宫内生长受限的效能。结果 正常组CPR、VPTT、CO均高于迟发组,MPI、HVI均低于迟发组,差异均有统计学意义（均P<0.05）。CO与VPTT呈正相关（r=0.783,P<0.001）,CPR与HVI呈负相关（r=-0.374,P=0.037）,MPI与HVI呈正相关（r=0.639,P<0.001）。ROC曲线分析显示,MPI、CPR、HVI、VPTT、CO预测晚发型胎儿宫内生长受限的曲线下面积分别为0.809、0.836、0.987、0.897、0.989,敏感性分别为0.886、0.545、0.894、0.894、0.924...     

子宫动脉和脐动脉血流动力学参数对晚发型胎儿宫内生长受限的预测价值

目的 探讨子宫动脉和脐动脉彩超血流动力学检测指标对晚发型胎儿宫内生长受限(FGR)的预测价值.方法 选取198例孕晚期孕妇,其中晚发型FGR 60例(观察组),正常138例(对照组).FGR患者根据子宫动脉及脐动脉血流动力学检测结果分为4个亚组:Ⅰ组(子宫动脉、脐动脉均异常)、Ⅱ组(子宫动脉正常、脐动脉异常)、Ⅲ组(子...     

超声对晚发型胎儿生长受限不良围产期结局的预测价值

目的探讨超声对晚发型胎儿生长受限（FGR）不良围产期结局的预测因素,并分析其诊断效能。 方法回顾性分析2015年12月至2021年5月郑州大学第三附属医院收治的149例产前诊断为晚发型FGR患者的超声声像图及临床资料,按照是否出现不良围产期结局分为不良围产期结局组（72例）和对照组（77例）。记录一般临床资料及分娩前1周内经超声测量的大脑中动脉搏动指数（MCA-PI）、脐动脉搏动指数（UA-PI）、脑胎盘比（CPR）、羊水-脐脑比（AUCR）及估计胎儿体质量（EFW）。采用两独立样本t检验、Mann-Whitney U检验、χ²检验比较组间上述指标的差异,采用单因素和多因素Logistic逐步回归分析确定晚发型FGR不良围产期结局的预测因素,构建受试者操作特征（ROC）曲线分析各超声参数对不良围产期结局的预测效能。 结果与对照组相比,不良围产期结局组AUCR、EFW百分位数、CPR、MCA-PI、最大羊水暗区垂直深度均明显降低［30.63±10.33 vs 39.70±11.15;3.2（2.1,6.4）vs 5.7（3.5,8.9）;1.18±0.28 vs 1.37±0.21;1.22±0.26 vs 1.34±0.23;27.50（22.00,31.00）mm vs 29.00（23.50,34.50）mm］,UA-PI明显增高（1.05±0.20 vs 0.98±0.16）,差异具有统计学意义（t=5.138,P＜0.001;Z=-4.618,P＜0.001;t=4.464,P＜0.001;t=3.129,P=0.002;Z=-2.292,P=0.022;t=-2.504,P=0.013）。多因素Logistic逐步回归分析显示AUCR、EFW百分位数、CPR为晚发型FGR不良围产期结局的独立预测因素（OR=0.951、0.753、0.154,P=0.024、＜0.001、=0.044）。经过ROC曲线分析,AUCR、EFW百分位数、CPR预测晚发型FGR不良围产期结局的界值、敏感度、特异度分别为39.64、53.2%、81.9%;4.85、66.2%、66.7%;1.19、81.8%、51.4%。AUCR、EFW百分位数、CPR 3个变量联合的多参数模型对不良围产期结局的诊断效能提升,弥补了单项参数预测晚发型FGR不良围产期结局敏感度与特异度失衡的问题,ROC曲线下面积为0.795,敏感度、特异度分别为76.6%、70.8%。 结论超声检查在预测晚发型FGR不良围产期结局中具有重要价值,AUCR、EFW百分位数及CPR是晚发型FGR不良围产期结局的独立预测因素,可为产前咨询和临床处理提供依据。     

彩色多普勒超声对晚发型胎儿宫内生长受限血流动力学变化及妊娠结局的评估价值探讨

目的:探讨彩色多普勒超声对晚发型胎儿宫内生长受限血流动力学变化及妊娠结局的评估价值.方法:选取2019年7月—2020年7月在我院产检并生产的孕晚期孕妇114例为研究对象.经临床及常规超声确诊为胎儿生长受限(fetal growth restriction,FGR)的54例孕妇作为病例组,60例宫内胎儿正常发育孕妇作为...     

胎儿静脉导管超声检查在预测宫内生长受限胎儿出生结局中的应用价值

目的探讨胎儿静脉导管超声检查在预测宫内生长受限胎儿不良出生结局中的应用价值。方法选取我院确诊存在宫内生长受限胎儿的孕妇53例,依据新生儿出生不同结局分为正常组23例、轻微异常组15例和明显异常组15例。检测比较各组胎儿静脉导管多普勒血流参数变化情况。结果胎儿静脉导管的心室收缩期峰值流速/最大心房期回流速度(DVS/A)、静脉导管的阻力指数(DVRI)及静脉导管血流量/脐静脉血流量(QDV/QUV)均可以对FGR胎儿的明显异常出生结局作出预测,其中DVS/A曲线下面积最大,为91%,其次为DVRI,曲线下面积为90%,QDV/QUV曲线下面积为74%。结论 DVS/A、DVRI及QDV/QUV均可以作为预测宫内生长受限胎儿明显异常出生结局的指标,其中DVS/A、DVRI预测价值较高。     

小于胎龄儿与晚发型宫内生长受限胎儿右室心肌做功指数的研究

目的 比较小于胎龄儿(SGA)与晚发型宫内生长受限(LO-IUGR)胎儿右室心肌做功指数的差异性.方法 选取我院产检发现的晚发型宫内生长受限胎儿50例(孕32～37周)及同孕龄的小于胎龄儿50例,并选取孕龄相匹配的50例正常胎儿作为对照组,运用组织多普勒分别检测三组胎儿的右室心肌做功指数(MPI).结果 与对照组相比,...     

彩色多普勒超声在诊断宫内胎儿生长受限中的临床意义表达

目的:探究多普勒超声在诊断宫内胎儿生长受限(FGR)中的价值.方法:选取我院2015年5月至2018年12月疑似FGR孕妇60例为研究对象,行彩色多普勒超声检查,以分娩结果为金标准,分析比较脐动脉搏动指数(PIUA)、子宫动脉搏动指数(PIUTA)、大脑中动脉收缩期峰值速度(MCA-PSV)与分娩结果及FGR的关系.结...     

彩色多普勒超声检测子宫动脉及脐动脉在晚发型宫内生长受限中的价值

目的：彩色多普勒超声检测母体子宫动脉和胎儿脐动脉在晚发型宫内生长受限的血流动力学价值及预测不良围产儿结局。 方法：分析晚发型宫内生长受限的孕妇169例和58例同期分娩正常孕妇,于妊娠期产前超声多普勒分别检测子宫动脉和脐动脉的搏动指数(PI),比较各组动脉血流异常及妊娠结局不良发生率。 结果：晚发型FGR孕妇中胎儿宫内窘迫所致急诊剖宫产、早产、新生儿1min Apgar评分评分、转入NICU、子宫动脉血流异常及脐动脉血流异常例数发生率分别为48.5%、39.6%、31.4%、35.5%、31.4%和21.9%,均高于对照组(P <0.05);在晚发型宫内生长受限孕妇中妊娠结局不良发生率,D组(子宫动脉和脐动脉血流均异常)明显高于A组(子宫动脉和脐动脉血流均正常),而除了胎儿宫内窘迫所致急诊剖宫产外,B组(子宫动脉异常,脐动脉正常)妊娠结局不良发生率高于C组(子宫动脉正常,脐动脉异常)。 结论：超声多普勒检测检测晚发型胎儿生长受限孕妇的子宫动脉和脐动脉的血流动力学,是了解围产儿预后的有效监护手段,在晚发型胎儿生长受限孕妇中,子宫动脉和脐动脉均异常,提示妊娠合并症增加和围产儿结局不良。     

胎儿心脏参数对胎儿宫内生长受限的预测价值

目的初步探讨胎儿心脏参数对胎儿生长受限（FGR）的预测价值。 方法选取2018年1月至2022年4月妊娠晚期在温州医科大学附属第二医院进行胎儿超声心动图检查的临床可疑FGR的孕妇50例（观察组）,选取同时间段胎儿心脏检查孕周、年龄匹配的正常孕妇56例（对照组）。可疑FGR孕妇根据出生后新生儿体质量分为2个亚组：FGR确认组和FGR改善组。收集胎儿的生长情况及脐动脉血流、大脑中动脉血流、主动脉峡部血流情况;获得胎儿的心脏参数,包括右心房横径、左心房横径、左心室横径、右心室横径、肺动脉内径、主动脉内径、主动脉峡部内径、动脉导管弓内径、右心房横径/左心房横径、右心室横径/左心室横径、左心室球形指数、右心室球形指数、左心室球形指数/右心室球形指数、主动脉内径/肺动脉内径、主动脉峡部内径/动脉导管弓内径;并获取孕妇基本临床资料、分娩情况和妊娠结局。采用方差分析或Kruskal-Wallis秩检验比较FGR确认组、FGR改善组和对照组三组间上述参数的差异,进一步组间两两比较采用LSD-t检验或Bonferroni法校正;各参数与FGR确认组、FGR改善组分组的相关性分析采用Spearman相关分析,采用受试者工作特征（ROC）曲线评估各参数诊断FGR的效能。 结果FGR确认组与FGR改善组相比,右心房横径/左心房横径值较高[1.27（1.10,1.44）vs 1.09（1.00,1.20）],差异具有统计学意义（Z=2.581,P=0.030）,主动脉峡部内径、主动脉峡部内径/动脉导管弓内径、左心室球形指数/右心室球形指数值较低[2.80（2.50,3.25）mm vs 3.50（3.03,3.78）mm;0.73±0.18 vs 0.96±0.19;0.72±0.11 vs 0.80±0.11],差异具有统计学意义（Z=-3.673,P=0.001;t=-5.043,P<0.001;t=-2.255,P=0.026）。FGR确认组与对照组相比,主动脉峡部内径[2.80（2.50,3.25）mm vs 3.30（3.00,3.80）mm]、主动脉峡部内径/动脉导管弓内径（0.73±0.18 vs 1.00±0.12）、左心室球形指数/右心室球形指数（0.72±0.11 vs 0.83±0.14）、左心房横径[11.0（10.0,12.0）mm vs 12.0（11.0,13.0）mm]较低,右心房横径/左心房横径[1.27（1.10,1.44）vs 1.00（1.00,1.10）]、右心房横径[14.0（12.5,16.0）mm vs 12.0（11.0,14.0）mm]、右心室横径/左心室横径[1.12（1.04,1.32）vs 1.00（0.93,1.10）]、右心室球形指数[0.62（0.58,0.71）vs 0.58（0.52,0.65）]、动脉导管弓内径[3.90（3.45,4.70）mm vs 3.35（3.08,3.75）mm]较高,差异均具有统计学意义（Z=-3.991,P<0.001;t=-7.143,P<0.001;t=-3.904,P<0.001;Z=-2.624,P=0.026;Z=4.959,P<0.001;Z=2.599,P=0.028;Z=3.591;P=0.001;Z=2.530,P=0.034;Z=3.722,P=0.001）。FGR改善组与对照组相比,各参数差异均无统计学意义（P均>0.05）。FGR确认组、FGR改善组分组的相关性分析显示,体质量指数、主动脉峡部舒张期可见逆向血流、脐动脉血流和（或）大脑中动脉血流是否异常、是否早产、是否急诊剖宫产、是否胎盘或脐带异常与FGR确认组、FGR改善组分组相关（r=0.306,P=0.036;r=0.587,P<0.001;r=0.450,P=0.001;r=0.542,P<0.001;r=0.421,P=0.002;r=0.365,P=0.010）,是否合并妊娠糖尿病、是否合并妊娠高血压、是否合并羊水少、是否在32周前怀疑FGR与FGR确认组、FGR改善组分组无统计学相关性（P均>0.05）。在观察组中,主动脉峡部内径/动脉导管弓内径、主动脉峡部内径诊断FGR的敏感度分别为75%、83%,特异度分别为72%、68%,ROC曲线下面积分别为0.81、0.77。 结论胎儿心脏右心增大、主动脉峡部内径缩小与FGR密切相关,可用于协助诊断FGR,主动脉峡部内径/动脉导管弓内径具有较高诊断效能。胎儿心脏检查可为临床预测FGR提供有效依据。     

Prenatal detection of fetal growth restriction by fetal femur volume: efficacy assessment using three-dimensional ultrasound

As fetal growth restriction (FGR) may have increased risks with perinatal morbidity and mortality, it is very important to detect FGR prenatally. Fetal femur dysplasia is associated with a variety of congenital syndromes and FGR as well. To date, no prenatal assessment of fetal FV in predicting FGR using three-dimensional (3D) ultrasound (US) has been reported. In this study, we used 3D US to test the efficacy of fetal femur volume (FV) measurement in predicting FGR. We calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and efficacy of fetal FV assessed by 3D US in detecting FGR according to the Bayes' theorem. All the fetuses were singletons and were followed up to delivery to determine whether they were complicated with FGR or not. In total, 304 fetuses without FGR and 42 fetuses with FGR were included for FV assessment in utero by 3D US. Our results showed fetal FV assessed by 3D US can differentiate fetuses with FGR from fetuses without FGR well. The best predicting threshold for FGR is at the 10th percentile of FV. Using the 10th percentile as the cutoff, the sensitivity of fetal FV in predicting FGR was 71.4%, specificity 94.1%, positive predictive value 62.5%, negative predictive value 96.0% and accuracy 91.3%. In addition, fetal FV is superior to fetal biparietal diameter and fetal abdominal circumference in predicting FGR. In conclusion, fetal FV assessed by 3D US can be applied to detect FGR well prenatally. We believe fetal FV assessment by 3D US would be a useful test in detecting fetuses with FGR.     

彩色多普勒超声检测12～14孕周胎儿三尖瓣反流的应用价值

目的探讨彩色多普勒超声检测孕12—14周胎儿三尖瓣反流的临床价值。方法52例孕12-14周发现三尖瓣反流的胎儿为反流组,根据反流程度分为轻度反流和中重度反流;50例孕12-14周未见三尖瓣反流的胎儿为对照组。两组均于孕中晚期行彩色多普勒系统畸形筛查。结果反流组胎儿轻度反流46例,中重度反流6例;检出胎儿异常10例,检出率为19．2％。对照组检出胎儿异常2例,检出率为4．0％;反流组胎儿异常检出率高于对照组（P〈0．05）。结论孕12-14周三尖瓣反流的胎儿发生异常的风险高于正常胎儿,彩色多普勒超声检测孕早期胎儿三尖瓣反流有重要的临床价值。     

The efficacy assessment of thigh volume in predicting intrauterine fetal growth restriction by three-dimensional ultrasound

Intrauterine growth restriction (IUGR) is an important issue in perinatology. To assess the efficacy of fetal thigh volume (ThVol) in predicting IUGR, we undertook a prospective cross-sectional study using quantitative 3-D ultrasound (US). During the study period, 30 fetuses with IUGR and 282 fetuses with non-IUGR were included for the ThVol assessment in utero by 3-D US. All the fetuses were singletons and had follow-up to the delivery to determine whether they were complicated with IUGR or not. Our results showed fetal ThVol assessed by 3-D US can differentiate fetuses with IUGR from fetuses with non-IUGR well. Using the 10th percentile as the screening threshold, the sensitivity of fetal ThVol in predicting IUGR was 86.6%, with specificity 91.1%, predictive value of positive test 51.0%, predictive value of negative test 98.5% and accuracy 90.7%. In conclusion, fetal ThVol assessed by quantitative 3-D US can be used to predict fetuses with IUGR antenatally. We believe fetal ThVol assessment by 3-D US would be a useful test in detecting fetuses with IUGR.     

孕早期胎盘体积的三维超声测量研究

目的 利用三维彩色超声容积技术测量早孕胎盘体积,初步探讨胎盘体积与孕龄和胎儿生长发育指标——头臀长的关系.方法 对2011年6月至2012年7月我院超声诊断科就诊的孕11～13+6周孕妇的胎盘留取容积数据,应用4Dview软件进行离线分析,采用VOCAL法得出胎盘体积(PV),最大胎盘截面的直径(MPD)及厚度(MPT).结果 ①胎盘体积范围33.2～171.3 cma,平均(84.9±26.5)cm3;孕龄79～100 d,平均(87.6±3.9)d;头臀长4.6～8.3 cm,平均(6.2±0.8)cm.②胎盘体积与孕龄及胎儿头臀长呈线性正相关,回归方程为:胎盘体积=-190.6+3.1×孕龄(r=0.511,P＜0.01)及胎盘体积=-17.5+16.5×头臀长(r=0.513,P＜0.01).③胎盘体积可以由MPD及MPT估计,方程为:胎盘体积=-30.7+12.6×MPD+ 11.7×MPT(r=0.622,P＜0.01).结论 早孕期胎盘体积与孕龄及头臀长具有相关性,并可以由最大胎盘截面直径及厚度进行估测.     

动态三维超声对胎儿体表畸形的诊断价值

目的 探讨动态三维超声在胎儿体表畸形诊断中的应用价值.方法 二维和动态三维超声对150例中晚期妊娠胎儿进行产前筛查,并比较二者超声诊断与产后诊断符合率.结果 150例胎儿共发现胎儿畸形26例31处.二维超声诊断与产后诊断相符19处,符合率61.3%;动态三维超声诊断28处,符合率90.0%,二者比较差异有统计学意义(P...     

Screening for pre-eclampsia and fetal growth restriction in twin pregnancies at 23 weeks of gestation by transvaginal uterine artery Doppler.

OBJECTIVE: To assess the value of transvaginal uterine artery Doppler at 23 weeks of gestation in predicting the development of adverse perinatal outcomes in twin pregnancies. PATIENTS AND METHODS: Women with twin pregnancies attending for routine ultrasound examination at 23 weeks in any one of seven hospitals underwent Doppler assessment of the uterine arteries. The right and left uterine arteries were identified using color flow mapping and velocity waveforms were obtained using pulsed Doppler. The mean pulsatility index (PI) of the two arteries was determined and the presence of uterine artery notching noted. Results were compared between monochorionic and dichorionic twins, and with our previously reported data from singleton pregnancies. Screening characteristics in the prediction of pre-eclampsia, fetal growth restriction (FGR), placental abruption, fetal death and early preterm delivery were calculated. RESULTS: Uterine artery Doppler at 22-24 weeks of gestation was performed in 360 twin pregnancies, including 324 dichorionic and 36 monochorionic diamniotic twins. Complete outcome data were available in 351 (97.5%). The mean uterine artery PI did not change significantly with gestation and there was no significant difference in mean PI between the dichorionic and monochorionic groups. However, the mean PI was significantly lower in twin pregnancies than in singletons. The pregnancy was complicated by pre-eclampsia in 6.0% of cases, FGR below the 5th centile of both twins in 8.8%, abruption in 0.9%, intrauterine fetal death in 1.7% and early preterm delivery at less than 32 completed weeks of gestation in 5.7% of cases. The respective sensitivities of uterine artery mean PI above the 95th centile for these complications were 33.3%, 9.7%, 66.6%, 33.3% and 18.6%. CONCLUSIONS: In twin pregnancies PI in the uterine arteries is lower than that in singleton pregnancies, but there is no significant difference between dichorionic and monochorionic twins. Doppler assessment of the uterine arteries at 23 weeks identifies a large proportion of twin pregnancies destined to develop adverse outcomes related to uteroplacental insufficiency.     

产前超声诊断妊娠11~13+6周胎儿体蒂异常的应用价值

目的探讨产前超声对妊娠11~13+6周胎儿体蒂异常的诊断价值。方法回顾性分析我院产前超声诊断的19例妊娠11~13+6周胎儿体蒂异常的超声图像特征及其随访结果。结果19例体蒂异常的胎儿中,单胎16例、双胎3例,均有不同程度的胸腹壁缺损、内脏外翻和脊柱发育异常,其中脐带异常18例,肢体发育异常9例,露脑畸形2例,静脉导管异常9例,颈部透明层增厚2例,颈部水囊瘤3例,腹腔囊性占位2例,泄殖腔发育异常1例,巨膀胱1例,门体分流1例。结论产前超声检查对胎儿体蒂异常的早期诊断和确定临床处理决策具有重要的应用价值。