胎儿泌尿系统异常产前超声特征与妊娠结局

目的探讨胎儿泌尿系统异常产前超声特征与妊娠结局。方法采用胎儿系统超声检查法对14120例孕15～39周孕妇中的58例泌尿系统异常胎儿产前超声特点及产后结果进行对照分析。结果胎儿泌尿系统异常发生率为0.41%(58/14120),引产后尸检或分娩后新生儿超声随访证实51例,失随访4例,产前超声诊断准确率为87.9%,漏误诊3例(5.2%,1例重复肾漏诊、2例盆腔异位肾产前误诊为单侧肾缺如)。58例胎儿泌尿系统异常产前超声表现及妊娠结局:(1)胎儿肾脏形态结构的改变,泌尿系统梗阻表现为肾盂积水或伴发输尿管扩张及膀胱形态改变。(2)单侧泌尿系统异常34例,羊水量正常。(3)双侧泌尿系统异常与下尿路梗阻23例,无羊水或羊水过少。(4)非梗阻性原因所致巨膀胱1例,表现为膀胱增大而羊水量正常。(5)随诊54例(失随访4例):保留分娩28例,均为单侧泌尿系统异常无伴发畸形,其中15例手术治疗预后良好;引产26例,尸检证实双侧泌尿系统异常17例(9例伴发其他系统异常)、单侧泌尿系统异常4例(3例伴发其他系统异常)、巨膀胱5例(4例下尿路梗阻)。结论胎儿单侧泌尿系统异常无伴发畸形者预后良好,可继续妊娠;双侧泌尿系统异常与下尿路梗阻或多发畸形者产后出生儿多不能存活或预后差。     

胎儿泌尿系畸形的产前超声诊断及预后评估

目的 探讨超声诊断胎儿泌尿系畸形的声像图特征及其临床实用价值。 方法 按产科超声常规检查胎儿，发现胎儿泌尿系统异常者，根据声像图特征评估处理。 结果 52例产前超声可疑为泌尿系畸形患者中，13例考虑到泌尿系畸形可能为致命性病变而终止妊娠，10例因一侧肾病变而自愿引产，12例胎儿出生后随访肾盂积水消失，7例胎儿肾盂扩张大于1．5cm，考虑输尿管狭窄出生后经手术治疗，1例胎儿单侧肾囊肿因合并心脏严重畸形出生后死亡，8例胎儿一侧肾脏异常、另一侧形态及结构未发现异常后均自然分娩，1例胎儿于孕24周可疑婴儿型多囊肾后经复查排除。 结论 产前超声诊断胎儿泌尿系畸形，依靠特有的声像图改变及合并其他畸形，对胎儿预后判断、临床及早采取措施提供依据，这对优生优育及新生儿早期治疗有重要临床实用价值。     

超声诊断胎儿肾脏畸形的临床价值

目的 探讨超声诊断胎儿肾脏畸形的临床价值.方法 在产前超声检查中发现胎儿肾脏畸形,产后婴儿行超声复查,引产者进行尸检,然后将产前超声结果和产后结果进行对照.结果 胎儿肾脏畸形29例,其中肾积水15例,单侧12例,双侧4例,多囊肾4例,重复肾3例,马蹄肾2例,双肾发育不全3例,单肾发育不全1例.结论 超声对胎儿肾脏畸形的诊断有较高的价值,并且根据不同类型,判断其病因及预后,对临床采取措施提供依据.     

先天性肺囊腺瘤畸形的产前超声诊断与临床预后

目的 探讨先天性肺囊腺瘤畸形(CCAM)的产前超声表现,评价疾病预后及发展过程. 方法 回顾性分析29例产前怀疑诊断先天性肺囊腺瘤胎儿的超声表现,并与产后结果进行对照分析. 结果 29例孕妇中,19例选择中止妊娠,其中16例接受尸检,14例病理证实为CCAM,2例病理诊断为隔离肺合并CCAM; 10例孕妇选择继续妊娠,其中1例胎儿出生后1个月因呼吸衰竭而死亡,余9例胎儿出生后至今均未出现呼吸系统症状. 结论 产前超声对CCAM的诊断是可靠的,在发现该病灶后,可应用超声观察病灶变化,单纯CCAM不合并胎儿水肿的患儿出生后预后较好.     

迷走右侧锁骨下动脉的产前超声诊断技巧及意义

目的:提高迷走右锁骨下动脉(ARSA)产前超声检出率以及评估ARSA对染色体异常的影响。方法:回顾性分析与随访我科产前超声诊断为ARSA的46例胎儿产前产后超声心动图与染色体核型结果及临床结局。结果:40例单纯性ARSA,2例21-三体,1例18-三体,3例合并复杂结构畸形;40例单纯性ARSA胎儿足月活产,随访至年龄1-12个月身体发育良好,未出现异常症状。结论:ARSA多为单纯性,当不合并其他异常时其合并染色体异常的风险性较小,预后好;当合并结构畸形或多发异常的超声软指标时,应进行染色体核型检查排除染色体异常;产前超声能够准确诊断ARSA及其合并的心内、外畸形,为孕妇的产前咨询及胎儿预后评估提供较可信的科学依据。     

胎儿迷走右锁骨下动脉的产前超声诊断及预后

目的探讨胎儿迷走右锁骨下动脉(ARSA)的产前超声诊断及预后。方法本研究为回顾性研究, 选取2015年3月至2020年12月北部战区总医院妇产科收治的102例胎儿ARSA孕妇, 年龄(29.4±3.8)岁, 年龄范围为21～45岁。讨论胎儿ARSA的产前超声诊断特征及其临床预后。结果胎儿ARSA孕妇102例, 产前超声显示单纯胎儿ARSA者92例, 未合并心内及心外畸形, 其中1例合并染色体异常, 终止妊娠;产前超声显示合并心内或心外畸形者10例, 其中合并染色体异常者3例, 选择终止妊娠者5例。其余91例生产患儿随访6—12个月, 均未出现右锁骨下动脉压迫食管或气管的临床症状。结论产前超声诊断胎儿ARSA准确性高, 对于指导围产期孕妇及患儿成年后的临床处置具有重要意义。     

产前超声诊断胎儿异位肾的价值

目的探讨产前超声诊断胎儿异位肾的价值。方法应用二维超声对78450例胎儿进行系统检查,分析产前超声诊断为胎儿异位肾的声像图特征与临床资料。结果产前超声诊断胎儿异位肾60例,共同声像图特征为:一侧或双侧肾区未见肾脏回声,肾上腺呈"平卧"征,盆腹腔内见肾脏图像或异常包块。左侧22例,右侧35例,双侧3例;其中27例合并其他畸形,发生率为45%(27/60),18例合并肾脏畸形(多囊性肾发育不良10例,肾发育不良4例,对侧肾缺如2例,肾囊肿及肾积水并输尿管扩张各1例),8例合并肾外畸形(5例为复杂畸形,3例为单脐动脉),1例同时合并肾脏及肾外畸形。分娩后新生儿超声随访或引产后尸体解剖证实产前超声正确诊断51例,失访9例。结论产前超声能准确地显示胎儿异位肾的位置、形态、大小、回声以及合并的畸形,在胎儿异位肾的诊断方面有重要的作用。     

胎儿异常泌尿道扩张产前超声诊断

胎儿泌尿系畸形是常见的一种先天性畸形，发生率为1／600～1／800，而胎儿泌尿道扩张占胎儿泌尿系畸形相当比率，有的出生后需手术治疗，有的影响双肾功能愈后极差。正确认识胎儿泌尿道扩张声像表现，对临床产前咨询、愈后评估、是否终止妊娠将提供有力依据。本文总结了14例胎儿异常泌尿道扩张产前超声表现，现报道如下。     

胎儿泌尿系统畸形的超声诊断

目的:进一步探讨胎儿泌尿系统畸形的超声表现及超声诊断价值,提高超声诊断符合率。方法:回顾性地分析了95例产前超声诊断为泌尿系统畸形的胎儿超声图像,并与产后结果进行对照。结果:95例产前超声诊断泌尿系异常的胎儿随访80例,随访率为84.2%;产前超声诊断与产后随访结果基本一致。结论:产前超声检查对胎儿泌尿系统畸形有重要的诊断价值,并有利于估计预后。     

产前彩色多普勒超声对胎儿静脉导管异常连接的诊断价值及预后评估分析

目的：分析产前彩色多普勒超声对胎儿静脉导管异常连接的诊断价值及预后评估。方法：选取2019年4月—2022年4月于鄂尔多斯市中心医院超声科进行检查的120例孕妇为研究对象,于产前对所有孕妇进行彩色多普勒超声诊断,然后进行随访。分析典型病例的超声结果,总结静脉导管异常连接胎儿的临床资料以及超声图像表现,记录随访结果中静脉导管异常连接胎儿的结局。结果：典型病例中1例二尖瓣及三尖瓣启闭运动可见静脉导管汇入肝左静脉诊断为胎儿静脉导管走行异常,1例静脉导管汇入肝中静脉属支诊断为胎儿静脉导管走行异常。所有孕妇中共诊断出3例为静脉导管异常连接,连接途径分别为静脉导管-肝中静脉、静脉导管-冠状静脉窦-右房以及静脉导管-肝左静脉,其染色体均为低危;静脉导管-冠状静脉窦-右房患儿妊娠结局为死亡,产后行尸检表明合并主动脉狭窄,终止妊娠;1例静脉导管异常连接肝中静脉的胎儿妊娠结局良好,产后行新生儿常规检查未合并任何心内外畸形,静脉导管结局生后闭锁;另1例静脉导管汇入肝左静脉胎儿妊娠结局为引产,合并脊柱裂畸形,静脉导管生后闭锁,其余各项检查正常,随访暂未见异常。结论：产前彩色多普勒超声对于静脉导管异常连接的诊断...     

Prenatal sonographic diagnosis of VATER association.

PURPOSE: We examined the potential role of sonography in the prenatal diagnosis of the VATER association, a spectrum of fetal anomalies that includes vertebral defects, imperforate anus, tracheoesophageal fistula, and radial and renal dysplasia. METHODS: The sonographic findings in 4 fetuses with prenatal diagnoses of VATER association were prospectively recorded, along with information on outcome and postnatal radiographic findings. RESULTS: VATER association was diagnosed in 4 fetuses at 20, 17, 21, and 29 weeks' menstrual age. All showed bilateral radial atresia and tracheoesophageal fistula, visible sonographically as a collapsed or absent stomach with polyhydramnios. Two fetuses had vertebral defects. Postnatal radiographic and macroscopic findings confirmed the prenatal diagnosis in all cases. Other associated anomalies detected prenatally included single umbilical arteries (2 cases), ventricular septal defect (1 case), and renal abnormalities (2 cases). Anal atresia, present in 3 of the 4 fetuses, was not detected prenatally. CONCLUSIONS: This small series suggests that the VATER association can be readily diagnosed in utero. Important clues include radial atresia, absent or collapsed stomach, and polyhydramnios. Prenatal diagnosis can contribute to clinical decisions regarding pregnancy and neonatal management.     

羊水量正常时胎儿肾发育不良的超声诊断及临床意义

目的 探讨产前超声检查对于羊水量正常时胎儿肾发育不良的诊断价值和临床意义.方法 于孕中晚期对羊水量正常胎儿中发现的单侧或双侧肾超声表现异常(包括大小、回声、形态异常,出现囊肿等)病例进行系统二维超声检查、孕期及生后随访观察、病理学检查等,并进行总结分析.仅有肾盂增宽的胎儿不包括在本组研究中.结果 发现羊水量正常但单侧或双侧肾发育不良的胎儿11例.其中单侧多囊性肾发育不良5例,4例不合并其他异常,1例合并同侧手缺如;单侧肾缺如2例,其中1例不合并其他畸形,另1例合并多发畸形包括脑积水、骶尾部脊柱裂、同侧桡骨缺失及单脐动脉,符合VACTERL综合征;盆腔.肾1例,马蹄肾1例,生后超声证实;常染色体显性遗传多囊肾1例,胎儿一侧肾可见多发囊肿,合并心脏横纹肌瘤,孕妇为双侧多囊肾;双侧肾发育不良1例,产前超声表现为双侧肾回声增强.结论 单侧多囊性肾发育不良是羊水量正常时产前超声最常检出的胎儿肾发育不良性疾病.根据产前超声表现并结合家族史,能在大多数胎儿肾发育不良病例中进行病因学诊断并帮助判断预后.     

Postnatal outcome of fetuses with the prenatal diagnosis of asymmetric hydrocephalus.

We sought to assess the sonographic findings and postnatal outcome in fetuses with the prenatal diagnosis of asymmetric hydrocephalus. The sonograms from cases of asymmetric hydrocephalus diagnosed prenatally at our institution were reviewed. Postnatal outcome was obtained from maternal, neonatal, and pediatric records. Fourteen fetuses at 17.3 to 38.9 weeks' gestational age on prenatal sonography had a maximum ventricular measurement of 10.2 to 48.8 mm, with the degree of asymmetry ranging from 2.2 to 27.3 mm. Thirteen of 14 had a normal-sized contralateral ventricle. Other fetal anomalies identified at sonography included Dandy-Walker malformation, intraventricular hemorrhage, porencephalic cyst, hydronephrosis, pleural effusion, and mild dilatation of a renal pelvis. Eleven fetuses had follow-up prenatal sonography. Among these, ventricular dilatation resolved in 5, remained the same in 3, increased in 2, and decreased in 1. Postnatal outcome was normal in 6 cases (43%) and abnormal in 8 (57%), including 2 cases of in utero intracranial hemorrhage, 2 with congenital syndromes, 1 with an imperforate foramen of Monro, 1 with tuberous sclerosis, 1 with developmental delays, and 1 with cerebral palsy. Asymmetric unilateral hydrocephalus appears to represent an entity different from bilateral hydrocephalus in that there is less risk of perinatal death, there are fewer associated anomalies, and the overall prognosis is better. Outcome may be normal, but fetuses with increasing unilateral ventriculomegaly and cases associated with other brain abnormalities tend to have a poor neurologic outcome.     

Severe uropathy and normal amniotic fluid volume in a male fetus: sonographic surveillance leading to the diagnosis of megacystis-microcolon-intestinal hypoperistalsis syndrome

The widespread use of sonography as a screening tool for fetal anomalies has facilitated prenatal detection of several fetal conditions characterized by urinary tract dilatation. These conditions are more common in male fetuses and are generally a result of an anatomic defect causing obstruction along the urinary tract system. Although the prognosis of these conditions largely depends on the specific anomaly, several poor prognostic factors have been described. These factors include detection at an early gestational age, bilateral marked dilatation, a persistently obstructed bladder, oligohydramnios causing pulmonary hypoplasia, and the presence of associated fetal or chromosomal anomalies. We report a case in which a male fetus at 14 weeks' gestation had a diagnosis of rapidly progressing bilateral hydronephrosis, massive bladder dilatation, hydroureter, and a surprisingly normal amniotic fluid volume. Serial sonographic surveillance assisted us in obtaining the correct diagnosis, which was important for adequately consulting the patient regarding the fetal prognosis in the affected index pregnancy as well as the likelihood of recurrence in future gestations.     

Fetuses and infants with congenital urinary system anomalies: correlation between prenatal ultrasound and postmortem findings.

OBJECTIVE: Detection of congenital urinary system anomalies is an important part of the prenatal ultrasound examination. The present study compares prenatal ultrasonographic findings and postmortem examinations of fetuses and infants with renal and urinary tract anomalies. DESIGN: Criteria for inclusion were an ultrasound examination at the National Center for Fetal Medicine (Trondheim, Norway) and autopsy performed during the period 1985-94. Results from the ultrasound examination and autopsy regarding urinary system anomalies were categorized according to the degree of concordance. RESULTS: Urinary system anomalies were found in 112 (27%) of 408 fetuses with congenital anomalies. The renal and/or urinary tract anomaly was the principal reason for induced abortion or cause of death in 50 cases (45%). In 97 (87%) of the 112 cases there was full agreement between the ultrasound observations and the autopsy findings. In five cases the autopsy revealed minor findings not mentioned in the ultrasound report. The main diagnosis was thus correct in 102 cases (91%). In four cases major autopsy findings had not been found by ultrasound examination; in another four, none of the autopsy findings were suspected by ultrasound, and in two, minor ultrasound findings were not confirmed at autopsy. CONCLUSIONS: The accordance between ultrasound diagnoses and postmortem examinations proved to be satisfactory. The close co-operation between ultrasonographers and perinatal pathologists is mutually beneficial. In addition to complementing prenatal diagnosis, postmortem examination is of vital importance for the quality control of ultrasonography in fetal diagnosis and plays an important role in genetic counseling.     

Frequency and nature of structural anomalies in fetuses with single umbilical arteries.

Published studies differ concerning the rate of anomalies occurring in the presence of a single umbilical artery and the significance of the single umbilical artery as an isolated sonographic finding. We assessed the frequency, nature, and sonographic detection of structural anomalies in fetuses with a single umbilical artery. We identified all cases in which prenatal sonography diagnosed a single umbilical artery. Cases were excluded if postnatal physical or pathologic examination demonstrated a three-vessel cord, yielding a study population of 167 cases. For each case, we recorded the gestational age at diagnosis of single umbilical artery and the findings of the sonographic fetal anatomic survey. We recorded postnatal clinical and pathologic information when available. Gestational age at time of diagnosis ranged from 16.8 to 41.1 weeks (mean, 29.2 +/- 6.5 weeks). Twenty of the 167 fetuses (12%) were twins, and the remainder were singletons. Among 118 cases with postnatal information, 37 (31%) had structural abnormalities, often involving multiple organs. The most common organ systems involved were the heart (19 cases) and the gastrointestinal (14 cases) and central nervous systems (nine cases). Five of the anomalous fetuses had abnormal karyotypes. The sonographic survey was abnormal in 31 of the 37 anomalous fetuses (84%). Among 85 cases with apparently isolated single umbilical artery at sonography and known fetal outcome, six (7%) proved to be anomalous at birth. We had two sonographic false-positive results (mild hydronephrosis, suspected skeletal dysplasia). In summary, approximately one third of fetuses with single umbilical artery have structural anomalies, most often cardiac. Even when the single umbilical artery is an apparently isolated sonographic finding, the likelihood that the neonate will prove to have structural anomalies is considerable (7% in our series).     

胎儿泌尿生殖系统异常的磁共振诊断

目的 探讨磁共振成像(MRI)在胎儿泌尿生殖系统异常诊断中的价值。方法 回顾性分析72例随访证实为泌尿生殖系统异常胎儿的产前MRI, 其中泌尿系统61例、生殖系统11例,孕龄21~39周,平均29周, 以胎儿出生后或引产后随访结果为参考标准,与产前MRI、US诊断结果对比分析。通过MRI采用感兴趣区工具(ROI)测量胎儿肺肝信号强度比(LLSIR),采用t检验进行统计学分析。结果 61例泌尿系异常其中肾不发育9例(同时伴肺发育不良2例),盆腔异位肾2例,多囊性发育不良肾15例(同时伴肺发育不良5例),梗阻性尿路疾病23例(其中重复畸形或输尿管异位开口3例、同时伴肺发育不良1例),肾发育不良9例(同时伴肺发育不良3例),脐尿管囊肿2例(1例合并睾丸鞘膜积液),左肾上腺神经母细胞瘤1例;11例生殖系统异常其中卵巢囊肿8例,睾丸鞘膜积液2例,右卵巢畸胎瘤1例,其中1例睾丸鞘膜积液存在全身水肿,1例卵巢囊肿还存在脑发育不良及右心房增大。MRI诊断准确率为95.8％。11例羊水过少肺发育不良胎儿LLSIR为1.06~1.29,平均值为1.20±0.08,较正常明显减低(P=0.000<0.05)。结论 MRI是胎儿泌尿生殖系统异常较有价值的产前影像诊断方法。能提供超声以外的信息,发挥超声的重要补充作用,尤其是超声显示不清时。     

Congenital renal tract anomalies: outcome and follow-up of 402 cases detected antenatally between 1986 and 2001.

OBJECTIVE: To determine the long-term prognosis of antenatally detected renal tract anomalies in order to optimize parental counseling. METHODS: This was a follow-up study of all renal tract abnormalities detected antenatally in a Level 3 ultrasound department between 1986 and 2001. Follow-up data (median age, 8 years) were retrieved from the records of the Paediatric Urology Department or the attending pediatrician. RESULTS: A urinary tract anomaly was detected in 408 fetuses. There were four false-positive diagnoses. From two children follow-up data were incomplete, leaving 402 cases for analysis. A chromosomal abnormality was present in 7/81 (8.6%) fetuses that had karyotyping. Termination of pregnancy was performed in 55 (13.7%) cases and a further 66 (16.4%) children died during the perinatal period and up to 1 year of age. In 106/121 (26.4% of all fetuses) deceased children the cause of death was directly related to the renal tract anomaly. In the 281 surviving children a total of 545 renal tract anomalies were diagnosed postnatally, requiring a total of 381 surgical interventions in 156 infants. Outcome in survivors was generally good, with impaired renal function in nine infants and hypertension in three (4% of the survivors). CONCLUSIONS: Congenital renal tract anomalies are associated with a high mortality rate, especially when they are structural developmental anomalies of the kidneys. Survivors require multiple operations, but the outcome is generally favorable. Ultrasound diagnosis, especially when made early, of non-lethal urinary tract anomalies may prevent additional renal damage by timing of delivery and early postnatal treatment.     

胎儿主动脉弓异常的产前超声声像图特征

目的 探讨主动脉弓异常的产前超声声像图特征,以提高其产前超声诊断率.方法 回顾性分析73例先天性主动脉弓异常胎儿的产前超声声像图、引产后胎儿尸检结果或新生儿超声心动图结果,并与正常胎儿产前超声图像进行对比,研究主动脉弓异常的产前超声图像特征.结果 73例先天性主动脉弓异常胎儿中,主动脉弓位置异常33例,正常左位主动脉弓伴右锁骨下动脉迷走9例,主动脉弓离断5例,主动脉弓缩窄26例.本组66例经产后证实的病例资料显示主动脉弓异常产前超声诊断准确率为86.36%.最有效的扫查切面是三血管切面和三血管气管切面.结论 先天性主动脉弓异常各类型均有特征性的超声表现,掌握其产前超声诊断的主要切面及产前超声声像图特征,其产前超声诊断准确率较高.但是主动脉弓严重缩窄与主动脉弓离断产前超声鉴别诊断有一定难度.