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。     

中晚孕胎儿颅后窝结构的超声检测及其临床意义

目的测量中晚孕期胎儿的颅后窝结构，并分析其与孕龄的相关性和临床应用价值。方法测量450例孕14～40周胎儿的小脑横径（TCD）、小脑蚓部的前后径（VMap）和上下径（VMcc）、颅后窝池的前后径（CMap）、第四脑室的宽径（4Vwd）和前后径（4Yap），计算TCD／AC及4Vwd／4Vap。用多元回归的统计学方法分析这些测量指标与胎儿孕龄的相关性，P〈0．05有显著的统计学意义。结果TCD／AC、4Vwd／4Vap与胎儿孕龄无明显相关性（P〉0．05）。TCD、VMcc、VMap、CMap、4Vwd、4Yap与孕龄有显著的相关性（P〈0．05）。结论超声测量胎儿小脑、蚓部、第四脑室、颅后窝池可以帮助我们更准确地估算胎儿的孕龄，并在筛选胎儿颅后窝畸形中提供重要的诊断线索。     

正常胎儿肾脏长径、横截面积及肾腹横截面积比值的超声研究与临床价值

目的 以超声方法确立不同孕周胎儿肾脏长径(KL)、横截面积(KA)及胎儿肾腹横截面积比值(KA/AA)的正常参考值,并研究其与孕周的相关性. 方法 以3家三级医院为依托,从接受常规产前超声检查的18～40周孕妇中选取符合条件的2446例进入样本库,对其胎儿进行KL、KA、AA的测量,最后按孕龄分组,并进行相关统计学处理. 结果 KL、KA在18周后的整个妊娠期中随孕龄增加呈线性增长,而KA/AA的变化则很小,特别是在22～35周及36～40周2个孕龄段内,其KA/AA值在各孕周间无明显统计学差异. 结论 KL、KA随孕龄增加呈线性增长,而KA/AA可作为一种新的且更为简便、实用的肾脏发育评估指标.     

11~14周正常胎儿心脏超声检查

目的对妊娠11^＋0～14^＋6周正常胎儿心脏结构进行观察，获得该孕周内正常胎儿心脏的生理参数。方法对100位孕妇在妊娠11^＋0～14^＋6周进行常规经腹超声检查，同时观察胎儿心脏各切面结构并进行测量。结果胎儿心脏各切面显示率不同，四腔心显示率最高，其次是动脉交叉，而动脉导管的显示率最低。妊娠13周以后胎儿心脏结构超声可清晰显示。胎儿心脏周长、面积及各心室内径的增加与孕周有相关性，而心脏周长与胸廓周长比值，心脏面积与胸廓面积比值，左右心房比值以及房室率均相对衡定，与孕周之间无明显相关性。结论由于在妊娠13周以后胎儿心脏结构能够清晰显示，因此，可以将胎儿超声心动图检查时间提前至妊娠中期的早期。主要筛查与四腔心切面相关的严重的胎儿先天性心脏畸形，有利于胎儿严重先天性心脏畸形的早期诊断。     

超声测量胎儿子宫前后径及横径与孕周关系的研究

目的通过超声测量不同孕周胎儿子宫前后径和横径,探讨胎儿子宫前后径、横径与孕周的关系。方法选择行超声检查的24~37孕周的261名孕妇,行横切面超声扫查,测量胎儿子宫前后径、横径,比较不同孕周胎儿子宫前后径和横径值,采用Pearson相关性分析方法探讨子宫前后径、横径与孕周的相关性。结果随着孕周的增长,胎儿子宫前后径、横径逐渐增加,差异均有统计学意义(F分别=21.85、23.66,P均<0.05);胎儿子宫前后径、横径与孕周成正相关(r分别=0.95、0.95,P均<0.05);经线性回归分析建立胎儿子宫前后径、横径与孕周的线性回归方程为:子宫前后径(mm)=孕周(周)×0.45-4.82,子宫横径(mm)=孕周(周)×0.47-2.75。结论超声测量胎儿子宫前后径、横径与孕周呈正相关,并且成功建立了24~37周胎儿子宫前后径、横径的线性回归方程,对产前胎儿子宫发育异常的诊断具有指导意义。     

高频超声检测早孕期胎儿颈项透明层的临床价值

目的：探讨高频超声在早孕期检测胎儿颈项透明层的应用价值。方法：选取我院妊娠期在10～12周进行超声检查且胎儿距母体皮下距离<70 mm的孕妇,共600名,分为3组,每组200名,第1组：孕龄≥10周且<11周,第2组：孕龄≥11周且<12周,第3组：孕龄≥12周且<13周,分别用高频超声和常规超声测量胎儿颈项透明层厚度,比较两种方法的成功率。结果：高频超声和常规超声测量胎儿颈项透明层成功率分别为：第1组：184例和149例,χ2=12.64,P<0.001;第2组：196例和171例,χ2=6.35,P<0.05;两组差异均有统计学意义,第3组：196例和182例,χ2=1.97,P>0.05。结论：早孕期高频超声测量胎儿颈项透明层比常规超声有显著优越性,可以更早、更精确测量胎儿颈项透明层。     

胎儿皮下软组织厚度及肝脏长度与体质量的相关性?

【目的】探讨胎儿皮下软组织厚度及肝脏长度(LL)与胎儿体质量(EFW)的相关性。【方法】将孕龄为13~40周的1713例正常胎儿按照孕龄分为六组：A组(13~16周)；B组(17~20周)；C组(21~24周)；D组(25~28周)；E组(29~32周)；F组(33~36周)；G组(37~40周)。采用四维超声测量各组胎儿双顶径、头围、腹围、股骨长度、肱骨长度并估测 EFW,同时测量胎儿颈项皮肤厚度(NF)、面颊(CCD)、腹部(ASTT)、肱骨(HSTT)、股骨(FSTT)皮下软组织厚度及 LL,分析各指标与 EFW的相关性。【结果】NF、CCD、ASTT、HSTT、FSTT皮下软组织厚度及 LL与 EFW 呈显著性正相关(r =0.53、0.66、0.60、0.68、0.71、0.88,P <0.05),且 NF、CCD、ASTT、HSTT、FSTT、LL均与孕周呈正相关(r =0.72、0.71、0.68、0.78、0.81、0.82,P <0.05)。【结论】胎儿 NF、CCD、ASTT、HSTT、FSTT皮下软组织厚度及 LL与 EFW相关性,采用四维彩超测量 NF、CCD、ASTT、HSTT、FSTT皮下软组织厚度及 LL 预测 EFW 相对准确,方法简便,值得临床推广应用。     

胎儿泌尿系统畸形的超声筛查分析

我们对 14 80 5例孕妇进行常规超声检查 ,发现其中 13例胎儿泌尿系统畸形。为了解胎儿泌尿系统畸形发病情况 ,经分娩后超声检查、手术或引产后尸体解剖确诊 ,现报告如下。资料与方法一、临床资料1997年 1月至 2 0 0 2年 3月在我院进行产前检查及住院分娩的孕妇共计 14 80 5例 ,孕龄 16～ 42周。孕妇年龄 2 1～ 43岁(平均 2 6.3岁 )。常规进行超声检查。二、仪器与方法使用SiemensSI 2 5 0及ToshibaSSA 2 40A超声诊断仪 ,探头频率 3 .5MHz。孕妇取仰卧位 ,对胎儿各系统器官进行全面检查及测量。观察胎儿肾脏时取胎儿脊柱长轴切面 ,对脊柱…     

超声观察正常胎儿肾动脉的血流动力学参数及其临床价值

目的以彩色多普勒超声观察不同孕周胎儿肾动脉(RA)收缩期峰值血流速度(Vmax)、舒张期最低血流速度(Vmin)及搏动指数(PI)、阻力指数(RI),确定其正常参考值,分析其与孕龄的相关性。方法从接受常规产前超声检查的18～40周孕妇中选取符合条件的2627名进入样本库,测量胎儿肾动脉Vmax、Vmin和PI、RI,最后按孕龄分组,并进行统计学处理。结果胎儿左、右侧肾动脉血流Vmax(r=0.75,0.75)、Vmin(r=0.62,0.60)与孕龄呈正相关(P均<0.05),RI、PI随孕龄增长而呈缓慢下降趋势,仅在妊娠末期略有回升;胎儿左、右肾各血流参数测值间差异无统计学意义(P>0.05)。结论胎儿肾动脉血流速度与孕龄呈正相关,而肾动脉RI、PI随孕龄变化幅度很小。胎儿肾动脉血流监测可作为预测和评估胎儿有无宫内缺氧的方法之一。     

Fetal transverse cerebellar diameter measurements in normal and reduced fetal growth.

OBJECTIVES: To establish the increase in fetal transverse cerebellar diameter (TCD) relative to gestational age during normal and restricted fetal growth; to determine the significance of TCD and TCD/AC relationship in predicting fetal outcome as expressed by perinatal mortality. DESIGN: A retrospective cross-sectional study. SUBJECTS: Three hundred and sixty normally developing fetuses between 17 and 34 weeks of gestation and 73 growth-restricted fetuses between 24 and 34 weeks of gestation. METHODS: Ultrasonographic measurements included head circumference (mm), abdominal circumference (mm) and transverse cerebellar diameter (mm). A gestational age-related normal reference chart was produced for TCD. RESULTS: Statistically significant relationships between transverse cerebellar diameter and gestational age, abdominal circumference and head circumference were found. The normal fetal TCD exhibited a more than twofold increase in size during the second half of pregnancy. Twenty-six per cent of the small-for-gestational age (SGA) fetuses displayed a reduced TCD and 82% of the SGA fetuses demonstrated raised TCD/AC values. No statistically significant difference in perinatal mortality or birth weight was found between the subsets of growth-restricted fetuses with reduced or normal TCD; or between the subsets with normal or raised TCD/AC values. CONCLUSIONS: In the normally developing fetus the TCD increases with advancing gestational age. Increased TCD/AC values are suspicious of fetal growth restriction. The perinatal mortality in growth-restricted fetuses with a small cerebellum is increased twofold over that of other fetuses.     

正常胎儿心脏发育与孕周增长关系的初步探讨

目的 初步探讨二维超声心动图在研究胎儿心脏发育与孕周增长关系中的应用价值.方法 回顾分析386例正常胎儿超声心动图测值,统计胎儿心脏横径、左右房室横径、主动脉内径、主动脉及肺动脉流速、动脉导管舒张期和收缩期流速,以及心率随孕周变化增长的关系,分析正常胎儿心脏发育趋势;比较胎儿左右房室大小.结果 ①胎儿心脏横径、左右房室横径、主动脉内径、主动脉及肺动脉流速、动脉导管舒张期和收缩期流速与孕周之间均呈线性相关关系,随孕周增长而增长,心脏横径与孕周间的线性相关性最大,动脉导管舒张期流速受孕周影响最小;胎心率与孕周无明显线性相关;②右心系统横径大于左心系统横径,右心房横径与左心房横径,右心室横径与左心室横径间比较差异有统计学意义;③心脏横径/孕周比值及心脏横径/胸廓横径比值均呈正态分布,前者均数为0.95,接近1.0;后者均数0.44,小于0.5.结论 二维超声心动图可作为评估胎儿心脏发育的检测方法.     

正常胎儿胸腹纵径比、总肺面积和肺纵径与肺发育的相关性研究

目的 应用二维超声观察不同孕周正常胎儿胸腹纵径比、总肺面积及肺纵径的参数值,探讨胎儿胸腹纵径比等参数对评估肺发育的应用价值.方法 对592例正常单胎妊娠18～40周胎儿进行肺二维超声扫查,采用标准四腔心观及胎儿躯干冠状切面,分别测定心脏面积、胸廓面积,肺尖至相应膈肌穹窿顶部的直线距离与膈肌穹窿顶部至胎儿膀胱底部的距离之比(胸腹纵径比),应用相关回归分析拟合总肺面积及肺纵径随孕周增长的回归方程.结果 正常妊娠胎儿总肺面积及肺纵径随着孕龄的增加而增大,总肺面积、肺纵径随着孕周增长的最适回归方程分别为:总肺:y =0.83X +13.894,R2 =0.914;肺纵径:y=0.669 X+3.124,R2=0.892.不同孕周胎儿胸腹纵径比在恒定范围内(0.44～0.59).结论 18～40周胎儿胸腹纵径比在恒定范围内,总肺面积与肺纵径值随孕周增长,上述参数可为产前评估胎肺发育提供有价值的参考指标.     

产前超声于左无名静脉切面测量孕20~38周胎儿胸腺参数

目的 观察产前超声于左无名静脉切面测量孕20~38周胎儿胸腺参数的价值。方法 前瞻性纳入661名孕20~38周健康单胎妊娠孕妇,采用超声分别于三血管切面和左无名静脉切面测量胎儿胸腺参数,包括胸腺横径、前后径、周长及横断面积,分析各参数与孕周的相关性,观察并对比于两切面测量胸腺参数的价值。结果 超声于三血管切面所测孕35~38周胎儿胸腺横径及孕20~38周胎儿胸腺前后径、周长和横断面积均小于左无名静脉切面（P均<0.05）;且相同切面所测胎儿胸腺参数均随孕周增长而增高（P均<0.05）。三血管切面（r=0.873、0.793、0.839、0.858,P均<0.001）和左无名静脉切面（r=0.901、0.796、0.866、0.904,P均<0.001）胸腺横径、前后径、周长及横断面积测值均与孕周呈正相关。观察者间及观察者内测量胸腺参数的一致性均好（ICC均>0.75,P均<0.001）,于左无名静脉切面测量的ICC略高。结论 产前超声于左无名静脉切面测量孕20~38周胎儿胸腺各参数可减小测量误差,在一定程度上弥补三血管切面测量的不足。     

Fetal gallbladder growth and development during gestation.

This study sought to establish normal dimensions of the fetal gallbladder throughout pregnancy. The gallbladders in 300 normal fetuses between 15 and 40 weeks of gestation were measured prospectively for length, anteroposterior dimension, and transverse dimension. The gallbladder length, anteroposterior diameter, and transverse diameter have a linear relationship with gestational age between 15 weeks and 30 weeks of gestation, after which a plateau is observed. Calculated gallbladder area, volume, and sagittal perimeter have similar rates of growth in utero. The normative dimensions we have established for the fetal gallbladder throughout pregnancy can be expected to serve as a basis against which aberrant growth can be evaluated prenatally.     

Intrauterine growth restriction and Doppler ultrasonography.

To clarify the difference between the fetus that is small for gestational age and the fetus with true intrauterine growth restriction, we undertook a retrospective study of singleton fetuses who had fetal weight estimation and umbilical artery Doppler velocity studies within 2 weeks of their delivery. Fetuses were divided into four categories on the basis of sonographic results from their last examination. Statistical comparisons of neonatal outcome were made for the four groups, which totaled 578 fetuses. Increased cesarean section for fetal distress, stays in the neonatal intensive care unit, and increased neonatal morbidity were seen in both small for gestational age and average for gestational age neonates with abnormal Doppler blood flow. The small for gestational age fetuses with normal Doppler studies showed no increased morbidity when compared with their average for gestational age cohorts. Umbilical artery Doppler blood flow studies were a better predictor of neonatal outcome than estimated fetal weight. Small for gestational age fetuses with normal Doppler studies most likely represent constitutionally small, not pathologically growth restricted, fetuses.     

Fetal gastric size in normal and abnormal pregnancies.

OBJECTIVE: The aim of this observational study was to construct an ultrasound index of fetal gastric size for the prenatal detection of congenital digestive tract obstruction. SUBJECTS: A total of 386 fetal measurements were performed in routine ultrasonographic examinations of women with normal singleton pregnancies between 18 and 39 weeks of gestation. Gastric measurements were also performed in 13 fetuses with digestive tract obstruction. METHODS: The ultrasound plane which included the pylorus and which provided the largest stomach area was used for definition and measurement of gastric area and maximal longitudinal dimension. The transverse section at the center of the gastric corpus was used for transverse and anteroposterior dimensions. Gastric volumes were calculated as a prolate ellipsoid. The gastric area ratio was defined as the gastric area divided by the transverse abdominal area. Biparietal diameter (BPD) and abdominal transverse area were also measured. RESULTS: The fetal gastric area was significantly correlated with fetal gastric volume (r = 0.91) and gestational age (r = 0.74). However, the correlation coefficient for gastric area with gestational age was smaller than those of the BPD (r = 0.97) with gestational age and abdominal transverse area with gestational age (r = 0.97). Gastric area ratio decreased slightly towards term. The gastric area ratio was below the 95% confidence intervals for the predicted values in all five fetuses with esophageal atresia, and exceeded the 95% confidence intervals in seven of the eight fetuses with duodenal atresia or intestinal tract obstruction. CONCLUSION: Fetal gastric area correlates with ultrasound-determined gastric volume measurements and appears to be useful in the assessment of digestive tract anomalies.     

不同孕周胎儿心脏结构及其心功能的相关参数的分析

[目的]探讨不同孕周胎儿心脏结构及其心功能的相关参数.[方法]应用彩色多普勒超声心动图检测不同孕周孕妇216例,比较不同孕周胎儿心腔径线、瓣膜口峰值血流速度、射血分数和Tei指数.[结果]胎儿时期心脏各腔室大小随着孕周的增长而增大,右室大于左室,结构上右室占优势;各瓣口峰值血流速度随胎龄增加而升高,二尖瓣小于三尖瓣,主...     

脊柱裂胎儿小脑延髓池改变的超声研究

目的探讨超声检测胎儿小脑延髓池（CM）前后径对提示脊柱裂诊断的价值。方法胎儿脊柱裂36例,对照组为相应孕周的108例正常胎儿。经小脑横切面观察胎儿小脑形态、结构,并测量CM前后径。结果36例脊柱裂胎儿,囊性脊柱裂33例,隐性脊柱裂3例。21～36孕周胎儿34例,声像图表现为CM消失;16～20孕周胎儿2例,声像图表现为CM缩小。对照组108例胎儿,6例CM缩小,无CM消失。脊柱裂胎儿CM消失的发生率高于对照组（P〈0．05）。结论孕21周以后胎儿,CM消失是胎儿脊柱裂超声检查重要的间接征象。     

胎儿第四脑室发育在产前超声鉴别颅后窝异常的临床应用

目的研究中孕期胎儿第四脑室形态与大小在鉴别颅后窝异常诊断中的临床应用价值。 方法根据笔者既往建立并报道的第四脑室正常值测量数据作为第四脑室大小的评价指标,结合胎儿颅脑异常的超声图像、第四脑室形态与大小测值,对2013年1月至2017年12月四川省妇幼保健院产前超声诊断为颅后窝异常58例单胎胎儿的临床资料进行分组研究。第1组,第四脑室增大24例;第2组,第四脑室缩小或消失7例;第3组,第四脑室形态与测值正常27例。总结3组颅后窝异常胎儿临床结局。 结果第1组24例胎儿中Dandy-Walker畸形15例,超声形态与测值：以第4脑室横径增大为主,横径测值均位于同孕周两倍标准差之上;交通性脑积水9例;超声形态与测值：第四脑室横径、前后径、周长及面积均位于同孕周胎儿两倍标准差之上。第2组7例胎儿中Arnold-ChiariⅡ畸形3例,菱脑融合3例,Joubert综合征1例;超声形态与测值：第四脑室横径、前后径、周长、面积均位于同孕周两倍标准差之下。第3组27例胎儿中后颅窝池增宽10例,颅后窝蛛网膜囊肿3例,第四脑室以上部位梗阻导致脑积水8例,永存Blake陷窝囊肿6例;超声形态与测值：第四脑室横径、前后径、周长及面积均在正常范围内。临床结局：3组58例产前诊断颅后窝异常的胎儿超声或（和）磁共振检查后29例孕妇选择终止妊娠在外院引产,19例孕妇继续妊娠至胎儿正常出生。产后磁共振成像,引产后尸检证实产前超声诊断与产后检查结果均符合。 结论第四脑室形态与大小测值在产前超声评价颅后窝异常中有重要价值。第四脑室增大、减小甚至消失是颅后窝严重畸形的线索,是预后不良的指标之一。更大样本量,更广孕周范围的研究有可能进一步证实本研究得出的结论。