产前超声检查诊断胎儿结构畸形的临床价值

目的探讨产前超声检查在胎儿畸形诊断中的临床价值。方法回顾性分析2013年黄石市中心医院行产前超声检查的2 200例孕妇的胎儿畸形筛查资料,将孕期超声筛查分为3个阶段:11~13+6周、20~24周、28~32周。并与产后或尸体解剖结果进行对照。结果 2 200例孕妇中,产前超声筛查检出胎儿畸形共49例,经分娩或引产证实的畸形儿53例,畸形率2.41%,漏诊4例,漏诊率7.55%。结论产前超声检查可为产前胎儿畸形的临床诊断提供可靠的参考。     

胎儿先天性心脏病孕早期超声筛查的临床价值

目的 探讨在诊断胎儿先天性心脏病(CHD)中应用孕早期规范化超声筛查的临床意义.方法 回顾性分析2018年7月—2020年12月在温州市中心医院产前诊断中心检查的7 945例孕妇的临床资料,在孕11～13+6周期间对其行孕早期规范化超声筛查.对怀疑有胎儿CHD的孕妇,2～4周后复查胎儿心脏超声,密切追踪可疑胎儿CHD病...     

Randomized comparison of the quality of realtime fetal ultrasound images transmitted by ISDN and by IP videoconferencing

We compared the quality of realtime fetal ultrasound images transmitted using ISDN and IP networks. Four experienced obstetric ultrasound specialists viewed standard recordings in a randomized trial and rated the appearance of 30 fetal anatomical landmarks, each on a seven-point scale. A total of 12 evaluations were performed for various combinations of bandwidths (128, 384 or 768 kbit/s) and networks (ISDN or IP). The intraobserver coefficient of variation was 2.9%, 5.0%, 12.7% and 14.7% for the four observers. The mean overall ratings by each of the four observers were 4.6, 4.8, 5.0 and 5.3, respectively (a rating of 4 indicated satisfactory visualization and 7 indicated as good as the original recording). Analysis of variance showed that there were no significant interobserver variations nor significant differences in the mean scores for the different types of videoconferencing machines used. The most significant variable affecting the mean score was the bandwidth used. For ISDN, the mean score was 3.7 at 128 kbit/s, which was significantly worse than the mean score of 4.9 at 384 kbit/s, which was in turn significantly worse than the mean score of 5.9 at 768 kbit/s. The mean score for transmission using IP was about 0.5 points lower than that using ISDN across all the different bandwidths, but the differences were not significant. It appears that IP transmission in a private (non-shared) network is an acceptable alternative to ISDN for fetal tele-ultrasound and one deserving further study.     

产前不同时期三维超声筛查胎儿唇裂的效果比较

目的 探讨产前不同时期三维超声筛查胎儿唇裂畸形的效果。方法 选择2007年8月至2014年6月在衡阳市第一人民医院进行产前检查并确诊胎儿为唇裂的孕妇31例,对其二维图像及三维成像进行对比,研究三维成像对胎儿唇裂的显示率及最佳显示时间。结果 31例唇裂中,孕14～19周5例,面部三维成像满意者3例,唇部结构清晰显示者2例（唇裂的三维超声显示率40．0％）;孕20～27周17例,面部三维成像满意或基本满意者15例,唇部结构清晰显示者15例（三维超声显示率88．2％）;孕28～34周6例,面部三维成像满意或基本满意者3例,唇部结构清晰显示者2例（三维超声显示率33．3％）;孕35周～39周3例,仅1例羊水过多患者面部三维成像满意,唇部结构显示清晰（三维超声显示率33．3％）。孕20～27周胎儿唇裂三维成像显示率明显高于孕14～19周（χ^2=5．119,P＝0．024）、28～34周（χ^2=6．933,P＝0．008）和35～39周（χ^2=4．804,P＝0．028）,差异均有统计学意义。三维成像满意显示的唇裂中Ⅰ度唇裂3例（15．0％）,Ⅱ度唇裂4例（20．0％）,Ⅲ度唇裂7例（35．0％）,唇裂合并上牙槽突裂3例（15．0％）,唇裂合并腭裂3例（15．0％）。结论 三维超声诊断胎儿唇裂存在明显的时限性,最佳时间为孕20～27周。     

The feasibility of telemedicine for the training and supervision of general practitioners performing ultrasound examinations of patients with urinary tract symptoms

Ultrasound examinations were carried out by a general practitioner on patients who presented with lower urinary tract symptoms. To assist in the interpretation of ultrasound anatomy, still images were captured during the ultrasound examination and transmitted to a university expert. In total 15 telemedicine sessions were conducted, using PC-based videoconferencing equipment connected by ISDN at 128 kbit/s. Fifteen patients were randomly selected and both the transmitted and hard-copy images (printed on thermal paper) were graded for technical quality. Data were missing for 13 of the possible 105 paired comparisons, as some images could not be evaluated. Overall agreement between the technical quality scores for the transmitted and hard-copy images was poor (weighted kappa=0.04). The 105 transmitted images were also rated for their diagnostic quality: 90% were classified as diagnostic and 10% were judged to be non-diagnostic. The results show the feasibility of tele-ultrasound in primary care. The general practitioner concerned benefited from regular ultrasound training and supervision, and achieved a satisfactory level of clinical competency in scanning the prostate, bladder and kidneys.     

异位妊娠早期超声诊断371例临床分析

目的:探讨早期异位妊娠超声图像表现及误漏诊原因。方法:对本院2007～2010年诊断为异位妊娠的371例临床资料、声像图表现及超声漏误诊情况进行回顾分析。结果:371例异位妊娠经检查确诊249例,漏诊96例,误诊15例。111例超声复查显示异位妊娠未破裂型97例(87%),破裂型14例(13%)。结论:对临床疑诊病例子宫及附件进行超声扫查及分析,遇图像不典型时,详细追问病史,结合hCG检查,提出超声复查时间及检查注意事项,以减少早期异位妊娠的误漏诊率。     

早孕期超声筛查在胎儿结构畸形诊断中的应用

目的：探究早孕期系统性超声筛查在胎儿结构畸形诊断中的临床应用价值。方法选取聊城市第二人民医院于2013年5月至2015年5月期间接受孕期超声检查的11～13＋6周孕妇64例,行早期超声胎儿筛查;对妊娠至22～24＋6周孕妇行中孕期超声检查（采用连续扫查法）,并对以上最终的结果进行跟踪。结果早孕期畸形胎儿检出率与中孕期畸形胎儿检出率相比,组间无显著性差异（χ2＝1．03,P＞0．05）,早中孕期联合诊断畸形胎儿检出率与单独的早孕期检出率和中孕期检出率相比,组间均存在显著性差异（χ2＝4．53,P＜0．05;χ2＝5．39,P＜0．05）。早孕期超声筛查胎儿结构畸形共36种类型,占前3位的分别为：颈部水囊瘤及NT增厚（33．33％）、颜面部异常（25．00％）、前腹壁异常（11．11％）;中孕期超声筛查胎儿结构畸形共42种类型,占前3位的分别为：心血管异常（30．95％）、颜面部异常（21．43％）、中枢神经系统异常（11．11％）。早孕期与中孕期进行系统性超声筛查结果中,各类畸形结构分布率均存在显著性差异（χ2＝4．55～6．32,P＜0．05）。结论早孕期进行系统性超声筛查,胎儿结构畸形检出率较高,但是不能完全取代中期的超声检查,同时建议早中联合检查可以提高胎儿结构畸形的检出率。     

早孕期超声观察胎儿手部的可行性分析

目的分析早孕期超声观察胎儿手部各结构可行性。方法回顾性分析2014年10月至2015年1月南充市中心医院进行超声检查的543例孕妇的临床资料,按照不同孕周分为A组(126例)和B组(417例)。A组:孕11~13+6周(胎儿手252只),B组:孕20~24+6周(胎儿手834只),在超声检查中多切面观察胎儿手部声像,比较两组胎儿手部各超声切面的显示率及每手平均扫查切面数。结果早孕期胎儿手腕姿势和掌骨的显示率与中孕期比较差异无统计学意义(P0.05);早孕期胎儿手指的显示率高于中孕期,差异有统计学意义(P0.05);早孕期每手平均扫查切面明显少于中孕期,差异有统计学意义(P0.05)。结论早孕期对胎儿手部进行观察是可行的,有望提前胎儿手异常检出时间。     

Realtime ultrasound screening by satellite telecommunication

Realtime ultrasound screening was carried out using a medical examination vehicle equipped with a diagnostic ultrasound scanner and a satellite telecommunication system. Screening was performed on 205 residents in a rural community in Japan and consisted of 57 cardiac, 57 abdominal, 60 thyroid and 31 breast ultrasound scans. The resolution of the realtime ultrasound images sent via communications satellite at 1.5 Mbit/s was almost identical to that of the original images taken by the ultrasound scanner. A disorder was diagnosed in 11 (19%) of the cardiac examinations, 28 (49%) of the abdominal, 19 (32%) of the thyroid and 7 (23%) of the breast examinations. Although some technical problems occurred, ultrasound screening by telemedicine appears to be a promising technique for those who live in rural communities.     

Individually customised fetal weight charts derived from ultrasound measurements: the Generation R Study

Maternal and fetal characteristics are important determinants of fetal growth potential, and should ideally be taken into consideration when evaluating fetal growth variation. We developed a model for individually customised growth charts for estimated fetal weight, which takes into account physiological maternal and fetal characteristics known at the start of pregnancy. We used fetal ultrasound data of 8,162 pregnant women participating in the Generation R Study, a prospective, population-based cohort study from early pregnancy onwards. A repeated measurements regression model was constructed, using backward selection procedures for identifying relevant maternal and fetal characteristics. The final model for estimating expected fetal weight included gestational age, fetal sex, parity, ethnicity, maternal age, height and weight. Using this model, we developed individually customised growth charts, and their corresponding standard deviations, for fetal weight from 18 weeks onwards. Of the total of 495 fetuses who were classified as small size for gestational age (<10th percentile) when fetal weight was evaluated using the normal population growth chart, 80 (16%) were in the normal range when individually customised growth charts were used. 550 fetuses were classified as small size for gestational age using individually customised growth charts, and 135 of them (25%) were classified as normal if the unadjusted reference chart was used. In conclusion, this is the first study using ultrasound measurements in a large population-based study to fit a model to construct individually customised growth charts, taking into account physiological maternal and fetal characteristics. These charts might be useful for use in epidemiological studies and in clinical practice.     

产前超声筛查胎儿畸形——附80例分析

目的:探讨超声对孕期胎儿畸形的诊断价值。方法:对孕期经超声检查的胎儿畸形80例进行分析。结果:80例胎儿畸形中产前诊断与产后完全符合63例,未能在产前超声诊断胎儿畸形17例(3例漏诊、6例超声不能诊断、3例难以诊断、5例诊断不完全符合),单发畸形56例,复合畸形17例,多器官畸形7例。结论:超声可实时观察宫内胎儿各器官发育情况。在孕期能及早发现先天性畸形,对临床有重要的诊断价值。     

彩超评估孕16～40周胎儿下腔静脉血流的多普勒正常参考范围

目的 探讨彩超对孕16～40周胎儿下腔静脉（IVC）血流多普勒正常参考范围的评估价值.方法 将744例单胎妊娠孕妇（孕16 ～ 40周）根据孕周进行分组,每个孕周27 ～ 35例,利用彩超测量胎儿的IVC多普勒参数,包括前负荷指数、峰值指数、搏动指数.结果 所有胎儿IVC多普勒参数在孕16～26周呈快速下降的趋势,之后则保持相对稳定或轻微下降,直到妊娠结束.结论 建立孕16 ～ 40周每个孕周的IVC血流正常多普勒参考范围,可以成为有效的、无损伤的评估胎儿心脏功能的方法.     

超声引导下游离脐带穿刺术的应用

目的:探讨超声引导下游离脐带穿刺术的操作特点和安全性。方法:对51例孕19～35周的孕妇进行超声引导下游离脐带穿刺术。结果:51例孕妇中,穿刺成功47例,成功率为92.16%。胎血培养及染色体核型分析均获成功。术中及术后发生胎儿心动过缓3例,占0.06%。脐带穿刺点渗血16例,占31.37%。穿刺针涉及胎盘7例,退针后穿刺点有渗血,但均未超过60s。术后未出现流产、早产、死胎和宫内感染等并发症。结论:游离脐带穿刺术有较高的成功率和安全性,可用于产前诊断。     

Minimum requirements for remote realtime fetal tele-ultrasound consultation

We studied the transmission bandwidth required for accurate diagnoses when performing realtime fetal tele-ultrasound consultations. The study was divided into three phases. In phase I, three experienced clinicians evaluated the quality of ultrasound images transmitted at various bandwidths (internally looped back within Brisbane) using eight commercially available codecs at random. The two codecs that performed best proceeded to phase 2, in which a realtime video-link of up to 2 Mbit/s was set up between Brisbane and Townsville (1,500 km apart). Testing with a standard video-tape was performed at seven different bandwidths selected at random, with four clinicians (who were blinded to the equipment and bandwidths used). The optimum line rates for transmission were determined, and testing was then performed using these line rates for fetuses with various anomalies (phase 3). The results showed significant differences in performance according to bandwidths used, but not according to observers. Bandwidths were grouped into three levels. At level I (256 kbit/s) the performance was significantly worse than at level II (384, 512 or 768 kbit/s), which was in turn worse than that at level III (1, 1.5 or 2 Mbit/s). However, within each level, performance at one bandwidth was not significantly different from that at the others. The most cost-effective transmission rates therefore appeared to be 384 kbit/s and 1 Mbit/s. Further testing with fetuses affected by various anomalies confirmed that the majority could be diagnosed using a 384 kbit/s link, with slight improvement in evaluation when the bandwidth was increased to 1 Mbit/s.     

Prenatal ultrasound biometry related to subsequent blood pressure in childhood

STUDY OBJECTIVE: To relate measures of fetal growth/size other than birth weight with subsequent blood pressure measured on the same individuals within the context of the "fetal origins of adult disease". DESIGN: A prospective cohort study in which measurements of fetal dimensions obtained by serial ultrasound imaging between 18 and 38 weeks gestation were analysed with reference to systolic blood pressure measurements on the offspring at age 6 years. SETTING: Perth, Western Australia. PARTICIPANTS: A subgroup of 707 eligible mother-fetus pairs from a cohort of 2876 pregnant women and their offspring. The number of mother-fetus pairs varied at each gestational age and by measurement of fetal dimension. Subsequent blood pressure recordings were obtained on approximately 300 of the offspring at age 6 years. Main results: The findings confirmed the inverse association between birth weight and systolic blood pressure at age 6. There was, also, an inverse relation between fetal femur length and systolic blood pressure at age 6, adjusted for current height. Furthermore, an inverse association was demonstrated between a statistically derived measure of fetal growth (conditional z score) between 18 and 38 weeks gestation and later systolic blood pressure at age 6. The effect sizes for all three relations were in the order of 1-2 mm Hg per standard deviation change. CONCLUSION: The mechanisms underpinning the "fetal origins" hypothesis may be operative early in pregnancy and may be reflected in the length of the fetal femur in early to mid-pregnancy.     

三维超声诊断胎儿脊柱侧弯的临床价值研究

目的:探讨三维超声(3DUS)在诊断胎儿脊柱侧弯中的应用及其临床价值。方法:回顾性分析3例胎儿脊柱侧弯的二维超声(2DUS)、3DUS声像图表现、引产后尸体X线表现、尸体解剖结果或宫内胎儿X线表现,总结胎儿脊柱侧弯及相关畸形的声像图特点。结果:3DUS胎儿脊柱侧弯的声像图比二维超声更直观、更准确,与引产后尸体X线图像一致、与尸体解剖结果一致。1例孕18周胎儿为胸腰段椎体旋转向右侧弯曲并胼胝体未发育、腹裂、内脏外翻、马蹄内翻足;1例孕27周胎儿为胸4和胸10脊柱向右侧凸,胎儿胸10半椎体、胸6和胸7椎体融合、胸9和胸10椎体融合、腰1蝶状椎体、第6和第7、第9和第10肋骨融合、单脐动脉;1例孕32周胎儿为腰段脊柱向左侧凸并颈椎前凸、枕骨缺矢脑膜脑膨出、左侧肾缺失、心脏畸形。结论:3DUS对胎儿脊柱侧弯及其相关畸形的诊断是较准确的,具有显著的临床价值。     

孕期综合性筛查技术评估唐氏综合征风险

目的 探讨孕早期超声与孕中期母血清标记物联合筛查评估唐氏综合征(DS)的风险价值.方法 回顾性分析2011年至2015年间,在西安交通大学第一附属医院检查和其他医院转诊的具备完整妊娠结局的单胎妊娠孕妇2730例,所有孕妇均于妊娠11~13+6周完成常规超声检查和唐氏综合征相关超声软指标筛查,其中96例孕妇完成了超声胎儿鼻骨探查;2597例孕妇于妊娠15~19+6周完成孕中期DS筛查,检测甲胎蛋白(AFP),人绒毛膜促性腺激素游离β亚基(Freeβ-hCG),游离雌三醇(uE3)指标;初步筛查DS风险较高者于妊娠12周至24周,完成无创产前检测(NIPT).采用羊膜腔穿刺羊水细胞培养与染色体分析确诊的DS病例作为金标准,病例组和对照组按照1:1标准配对,各纳入12例,运用受试者特征曲线(ROC曲线)分析孕早期超声DS筛查软指标、孕中期实验室DS血清学筛查指标、无创产前检测筛查指标在诊断DS中的价值.结果 2730例孕妇行孕早期超声筛查,其中96例完成胎儿鼻骨超声检查,早期超声显示胎儿鼻骨不显影的筛查阳性率最高,达3.13%;胎儿颈项部透明层厚度(NT)高危的筛查阳性率为1.43%;胎儿颈部水囊瘤和水肿的筛查阳性率均不足1.00%.2597例孕妇行DS实验室筛查,孕期母体血清检测DS高危和临界高危的阳性率分别为2.04%和3.62%.诊断DS的各类检测筛查方法中,诊断准确性高且具有显著诊断意义的方法为无创产前检测(AUC=0.958,P<0.05);诊断准确性中等的方法包括孕早期超声胎儿鼻骨不显影(AUC=0.750,P=0.038),孕早期超声NT≥3mm(AUC=0.701,P=0.094)和孕中期血清学DS筛查(AUC=0.708,P=0.083).结论 孕早期超软指标、孕中期母血清标志物的应用对胎儿DS具有筛检意义,孕早期胎儿鼻骨不显影的超声软指标对DS筛查有显著意义.应用早期超声和中期血清标志物的联合筛检有助于提高唐氏综合征的检出率.     

2011-2018年超声在广东省出生缺陷诊断中的应用分析

目的通过分析广东省2011-2018年超声在出生缺陷确诊中运用,探讨影响超声诊断出生缺陷的灵敏度的相关因素。方法根据国家出生缺陷监测方案的方法要求,以监测医院为基础收集出生缺陷监测资料,对广东省监测医院的数据进行统计和分析,探索缺陷诊断方法的变化趋势。结果广东省57家出生缺陷监测医院2011-2018年共监测孕产妇208.85万例,检出缺陷儿到缺陷儿71099例,其中诊断依据为超声或超声联合其他诊断方法的有43908例,占61.76%,超声作为诊断依据其年度率的差异有统计学意义(χ^2=159.23,P<0.05)。超声诊断出生缺陷灵敏度较高的出生缺陷为:先天性心脏病,先天性脑积水,脑膨出,无脑畸形,先天性膈疝,脊柱裂,腹裂,联体双胎,水肿综合征,脐膨出。超声诊断灵敏度较低的10种出生缺陷为:外耳其他畸形(小耳、无耳除外),多指(趾),尿道下裂,并指(趾),小耳(含无耳),直肠肛门闭锁(含狭窄或无肛),唐氏综合征,马蹄内翻足,腭裂,唇裂。2011-2018年超声或超声联合其他诊断方法产前确诊缺陷儿23964例,产前超声确诊灵敏度最高的为13~27孕周组,为74.35%。结论超声诊断能够发现大部分胎儿结构畸形,但部分缺陷的产前超声确诊率较低,应尽可能使胎儿畸形筛查确诊提前,有助于预防严重畸形的晚期妊娠,提高出生质量。     

Comparison of asynchronous and realtime teleconsulting for orthopaedic second opinions

We studied a teleconsulting service for second opinions in orthopaedics. Three units of the national insurance organization for accidents at work were connected to a large orthopaedic hospital in Bologna. During a 20-month study, 65 consultations were provided: 51 (78%) by asynchronous (store-and-forward) consulting and 14 (22%) by realtime videoconferencing. All the consultations made use of radiology images (radiographs, computerized tomography scans, magnetic resonance imaging scans and ultrasound scans). Video-messages and still images were commonly used to support the asynchronous consultations. More data were transmitted on average for an asynchronous teleconsultation (8 MByte) than in a videoconference (5 MByte). The average time spent by orthopaedic specialists was slightly longer in videoconferences (21 min, SD 8) than in asynchronous teleconsultations (19 min, SD 8). The clinicians confidence in their diagnosis was generally good but was lower in asynchronous consultations. The main problem affecting the telemedicine service was the lack or the low quality of the information received from the referring sites. The clinical complexity of the case and the organizational requirements were declared to be the main factors affecting the choice of consulting procedure. The study showed that the asynchronous method was preferred in the majority of cases and could be easily integrated into clinical practice, although there were some concerns about the diagnostic quality of the information transmitted.     

产前胎儿系统超声筛查在减少出生缺陷中的临床应用

目的:探讨超声在产前诊断胎儿出生缺陷的临床价值及对出生缺陷率的影响。方法:按全国出生缺陷监测网要求,对武汉市第一医院2007年1月～2008年9月住院分娩的孕28周至产后7天的围生儿进行监测,同时对3 935例孕16～40周的妇女采用实时彩色多普勒超声仪进行系统检查,对胎儿畸形进行筛查和诊断。结果:2007年1月～2008年9月武汉市第一医院共分娩新生儿2 629例,出生缺陷儿11例,出生缺陷发生率为4.18‰,低于1998年～2003年出生缺陷发生率。在3 935例孕妇中,共发现先天性缺陷35例,孕28周以前检出超声诊断胎儿主要系统畸形占57.1%,孕28周至孕36周诊断超声诊断胎儿主要系统畸形占37.1%。结论:妊娠中晚期进行系统超声检查可以对胎儿形态结构方面的明显畸形进行产前诊断,可以降低出生缺陷发生率,提高严重畸形的检出率,对提高人口素质具有重要意义。