四维超声成像技术诊断孕中期胎儿心脏畸形的价值

目的探讨四维超声成像技术诊断孕中期胎儿心脏畸形的临床价值。方法选取济源市人民医院2017年3月至2020年3月接待的高危孕中期产检孕妇300例进行研究,均接受胎儿心脏畸形筛查,包括常规二维超声检查与四维超声成像技术检查。将产后超声心动图或心脏病理解剖结果作为标准,比较常规二维超声与四维超声成像技术检查采集时间、孕妇满意度、胎儿心脏畸形检出率,以及心脏结构异常检出率。结果产后超声心动图或心脏病理解剖结果证实有胎儿心脏畸形54例,其中四维超声成像技术检查孕妇时,采集时间更短,孕妇满意度评分更高,组间差异有统计学意义(P<0.05)。四维超声成像技术胎儿心脏畸形检出率更高,组间差异有统计学意义(χ^(2)=5.698,P<0.05)。产后超声心动图或心脏病理解剖结果证实有胎儿心脏畸形54例,共计心脏结构异常97处,其中四维超声成像技术检出心脏结构异常95处,检出率为97.94%,常规二维超声检查检出心脏结构异常80处,检出率为82.47%,四维超声成像技术检出率明显高于常规二维超声检查(χ^(2)=6.557,P<0.05)。结论孕中期胎儿心脏畸形检查中应用四维超声成像技术诊断,可减少影像采集时间,从而减少了不必要的损害,同时可以提高胎儿畸形检出率与心脏结构异常检查率,促使孕妇对检查更满意,值得在胎儿心脏畸形筛查中应用。     

孕早期颈项透明层超声联合孕中期彩色多普勒超声可提高产前胎儿畸形检出率

目的探究孕早期颈项透明层（NT）超声联合孕中期彩色多普勒超声在产前胎儿畸形筛查中的应用价值。方法选择2017年8月~2019年12月在我院行胎儿畸形筛查的2417例孕妇作为研究对象,所有孕妇于孕11~14周行NT超声检查,并于孕22~28周行二维、四维彩超检查。以引产或分娩结果为“金标准”,比较畸形胎儿、正常胎儿的NT值及NT异常率,对比NT超声检查、二维联合四维彩超检查结果,并就NT超声、二维及四维彩超及二者联合在诊断胎儿畸形中的诊断率进行比较。结果2417例孕妇最终确诊异常胎儿88例,发病率为3.64%。畸形胎儿的NT值明显高于正常胎儿,NT异常率（93.18%）明显高于正常胎儿（1.33%）,差异比较有统计学意义（P < 0.05）。NT超声检查共检出异常胎儿82例,诊断准确率为93.18%;二维联合四维彩超共检出异常胎儿85例,诊断准确率为96.59%。二维联合四维彩超的诊断准确率略高于NT超声检查,差异无统计学意义（P>0.05）。NT超声联合二维、四维彩超在诊断胎儿畸形中的敏感度、特异度和准确度分别为100.00%、99.57%、99.59%,高于NT超声、二维和四维彩超（分别为93.18%、98.67%、98.47%和96.59%、99.06%、98.97%）,组间比较差异有统计学意义（P < 0.05）。结论孕早期NT超声及孕中期彩色多普勒超声在产前筛查胎儿畸形上各具有优势,均具有较好的诊断价值。二者联合应用能够进一步提升胎儿畸形的检出率,对尽早终止胎儿畸形孕妇继续妊娠,减少畸形胎儿出生具有重要意义。      

超声心动图诊断胎儿心脏Ebstein畸形1例

超声心动图诊断胎儿心脏Ｅｂｓｔｅｉｎ畸形１例李伟钢①孕妇，３０岁，初产妇，末次月经为１９９５年９月２５日，孕３２周时产前Ｂ超检查发现胎儿心脏增大，故采用ＨＰ－１０００型彩色多普勒超声心动图仪检查胎儿心脏，发现如下改变：①胎儿心脏增大，主要为右房室腔明...     

产前超声诊断胎儿畸形165例（附8例报告）

目的探讨超声检查在产前筛查胎儿畸形中的临床应用价值。方法应用二维及彩色多普勒超声对4182例孕妇行产前常规检查。结果胎儿畸形发生率3．94％，多数经引产、手术或追踪随访证实。先天性心脏病近期诊断率在不断提高。结论先天畸形儿的产前诊断率呈上升趋势，超声检查是产前诊断的主要方法，畸形检出率与孕周、超声医师技术水平、仪器的灵敏度密切相关。     

超声诊断胎儿韦尔加腔的价值

目的 探讨妊娠中晚期胎儿韦尔加腔的存在与胎儿神经系统结构异常的关系.方法 对29 244例20～42孕周产前检查的孕妇行彩色多普勒超声检查,分析胎儿韦尔加腔与神经系统畸形的相关性.结果 胎儿畸形总检出率为1.3%,其中神经系统畸形的检出率为0.4%;合并韦尔加腔的胎儿畸形检出率为17.2%,其中神经系统畸形的检出率为14.7%.伴有韦尔加腔的胎儿畸形超声检出率尤其是神经系统畸形的检出率高于未伴有韦尔加腔的胎儿.结论 了解中晚期孕周胎儿韦尔加腔的超声表现有助于胎儿中枢神经系统结构异常的检出.     

超声心动图检测高危妊娠对胎儿心脏影响的临床研究

目的 探讨超声心动图检测高危妊娠对胎儿心脏影响的临床研究.方法 应用Philips Sonos-7500型彩色多普勒超声诊断仪对580例孕龄在20～40周的高危妊娠孕妇行胎儿超声心动图检查,并将产前超声检查与胎儿尸检或分娩后超声心动图检查结果 进行对照.同时检测孕龄在20～40周无明显高危妊娠因素的孕妇760例,作为平行对照组.结果 检出88例心脏异常,先天性心脏畸形52例,先心病检出率为3.8% ,其中高危组45例,先心病检出率为7.8% ;对照组7例,检出率为0.9% .另外发现左室腔内强回声6例,心包积液7例,产后复查均消失;三尖瓣反流23例.结论 超声心动图在检测胎儿心脏畸形中有着十分重要的临床应用价值;单纯性先天性心脏病或单纯性心包积液或单纯性少量三尖瓣反流或单纯心脏内有点状强回声,不能作为终止妊娠的指标;对高危妊娠孕妇应及早行常规胎儿心脏超声心动图检查.     

胎儿畸形182例超声诊断分析

目的：了解超声检查对胎儿畸形的检出情况、漏诊情况及胎儿畸形与孕周和羊水异常的关系。方法：回顾性分析9328例孕妇孕期超声检查时的胎儿发育情况并与临床结果进行对比。结果：9328例胎儿中，最后临床确诊胎儿畸形182例，胎儿畸形的发生率为1．95％。182例畸形儿中，超声检出胎儿畸形152例，检出率为83．5％；漏诊30例，漏诊率为16．5％。检出胎儿畸形的孕妇42．8％伴随羊水异常．40．8％在孕21～28周之间被检出。结论：与其他研究结果相比，来本院孕检的孕妇胎儿畸形的发生率较高，对孕检孕妇，尤其是羊水异常孕妇。在行常规超声检查的同时，尽量在孕21～28周之间对胎儿进行一次全面系统的超声检查，以早期发现胎儿畸形，减少畸形儿的出生．达到优生的目的     

彩色多普勒超声检查在孕中晚期胎儿心脏畸形筛查中的应用

目的分析彩色多普勒超声检查在孕中晚期胎儿心脏畸形筛查中的应用价值。方法对6850例中晚期孕妇进行超声筛查,观察胎儿心脏不同切面的超声表现,分析胎儿心脏畸形确诊率和漏诊率。结果 6850例孕产妇中,产后检出29例心脏畸形胎儿,畸形率0.42%。其中超声检出26例,24例经心脏检查证实,2例经尸检证实;漏诊3例(室间隔缺损2例,房间隔缺损1例)。超声诊断准确率89.66%(26/29),漏诊率10.34%(3/29)。结论彩色多普勒超声能发现大多数胎儿心脏结构异常,在孕中晚期胎儿心脏畸形筛查中具有十分重要的价值。     

三血管气管切面超声诊断胎儿心脏大血管畸形的价值

【目的】探讨胎儿三血管气管切面超声诊断胎儿心脏大血管畸形的价值。【方法】回顾分析2006年1月至2007年3月12028例接受产前胎儿筛查的孕妇资料,采用彩色多普勒超声按顺序法扫查胎儿后检查胎儿心脏,在四腔心切面的基础上平行向胎儿头侧移头即可显示三血管气管切面,然后叠加彩色多普勒血流显像,观察大动脉血流分布和血流方向。【结果】12028例胎儿超声心动图检出胎儿心脏结构异常326例,其中大血管病变47例。36例胎儿抽脐带血或羊水检查染色体,15例染色体异常。16例在本院引产,14例尸检,其畸形结果与产前诊断相符。【结论】三血管气管切面超声检查对筛查及诊断胎儿心脏大血管畸形的先天性心脏病有重要的价值。     

二维联合四维超声对妊娠期畸形胎儿的诊断价值

目的探讨应用二维联合四维超声诊断妊娠期畸形胎儿的临床价值。方法选取2014年2月至2017年2月产前超声筛查中晚期孕妇2 132例,所有孕妇均采用二维超声检查,二维超声检查高度怀疑畸形的胎儿采用二维联合四维超声检查,与随访引产或分娩后证实为畸形胎儿进行比较,分析二维超声与二维联合四维超声对畸形胎儿的畸形部位检出率。结果 2 132例孕妇中随访引产和分娩畸形胎儿证实为畸形部位85处,二维彩超检出畸形部位67处,误诊3处,检出率为75.29%,误诊率为3.53%,漏诊率为24.71%,二维联合四维超声检出畸形部位79处,未出现误诊,检出率为92.94%,漏诊率为7.06%,二维超声检查与二维联合四维超声检查对畸形胎儿的畸形部位检出率比较,差异有统计学意义(P0.05)。结论与二维超声比较,二维联合四维超声检查能提高畸形胎儿畸形部位的检出率,有效降低漏诊率及误诊率。     

实时三维超声在胎儿畸形筛查和诊断中的临床应用价值

目的 探讨实时三维超声在胎儿畸形的筛查和诊断中的临床应用价值.方法 采用实时三维超声对3 758例孕14～41周胎儿进行二维及三维超声检查,并与出生后及引产结果相比较.结果 在3 758例孕14～41周的胎儿中,经引产或出生后证实的各种畸形266例,二维超声产前检出256例,漏诊10例,二维超声诊断符合率96.2％(255/266);二维超声诊断胎儿畸形的敏感度96.2％,特异度100％,准确度99.7％,阳性预测值100％,阴性预测值99.7％,实时三维超声产前检出263例,漏诊3例,诊断符合率为98.9％(263/266),实时三维超声诊断胎儿畸形的敏感度98.9％,特异度100％,准确度99.9％,阳性预测值100％,阴性预测值99.9％.结论 实时三维超声对胎儿畸形的筛查和诊断具有较高敏感度和特异度,在胎儿畸形的产前诊断方面具有较高的应用价值.     

四腔心切面联合三血管气管切面彩色多普勒超声在孕11~13+6周胎儿严重先天性心脏畸形筛查中的应用价值

目的探讨四腔心切面联合三血管气管切面彩色多普勒超声在孕11~13⁺⁶周胎儿严重先天性心脏畸形筛查中的应用价值。 方法选择2018年1月至12月在四川省妇幼保健院行孕期检查的9756例孕妇,分别于孕 11~13⁺⁶周及孕16~24周进行胎儿心脏超声检查。采用四腔心切面联合三血管气管切面彩色多普勒超声对孕11~13⁺⁶周胎儿筛查心脏畸形,采用标准化胎儿超声心动图筛查孕16~24周胎儿心脏畸形,并对分娩后所有新生儿及引产胎儿进行随访。 结果9756例胎儿孕11~13⁺⁶周超声筛查发现心脏畸形38例（51.4%,38/74）,其中非严重心脏畸形5例（14.2%,5/35）,严重心脏畸形33例（84.6%,33/39）。出生或引产后诊断先天性心脏畸形74例,其中严重先天性心脏畸形39例,非严重心脏畸形35例。 结论运用四腔心切面联合三血管气管切面彩色多普勒超声能筛查出大部分严重胎儿心脏畸形,可为临床咨询、预后提供及时有力的证据。     

Fetus acardius: two- and three-dimensional ultrasonographic diagnoses.

OBJECTIVE: To determine whether ultrasonographic detection of acardiac fetuses and diagnostic accuracy of related malformations improve with complementary use of two-dimensional ultrasonography, three-dimensional ultrasonography, and Doppler scanning. METHODS: Three pregnant women with multifetal gestations who were found to have discordant fetuses on initial two-dimensional ultrasonographic scanning were subsequently scanned with three-dimensional ultrasonography and color Doppler ultrasonography. RESULTS: Although the possibility of acardiac fetuses was entertained in all cases after two-dimensional ultrasonographic scanning, the diagnosis was confirmed, and the accuracy and extent of fetal malformations were established with three-dimensional ultrasonography and color Doppler scanning. Two of the women had twin gestations, and the third woman had a triplet gestation. Among the women with twin gestations, 1 donor twin had no abnormalities, and the other donor twin had a diagnosis of arthrogryposis and gastroschisis. The woman with triplets had 1 acardiac fetus; the donor fetus was anencephalic; and the third fetus had alobar holoprosencephaly. CONCLUSIONS: Complementary use of two-dimensional ultrasonography, three-dimensional ultrasonography, and color Doppler scanning improves diagnostic accuracy and the ability to evaluate the extent and severity of organ compromise in pregnancies complicated by acardiac fetuses.     

2D and 3D Ultrasound in the evaluation of normal and abnormal fetal anatomy in the second and third trimesters in a level III center

Between July 2000 and December 2003, a total number of 3,472 fetuses was evaluated by two-dimensional (2D) and three-dimensional (3D) ultrasonography. All examinations were carried out as part of a detailed level III ultrasound examination for fetal anomalies. The gestational age was between 11 and 35 weeks. A 3D endovaginal probe (5 - 7 MHz) was used for examinations between 11 and 13 weeks, and an abdominal 3D probe (5 MHz) after 13 weeks. Four different 3D image display modes were employed in visualizing fetal malformations: triplanar orthogonal display; surface display; transparent display; and the combined transparent and color display (= glass body-rendering). In 906 of the 3,472 high-risk pregnancies, fetuses with one to five fetal defects were found (mean 1.17). The total number of detected defects was 1,012, exclusive of 48 fetal heart defects. Fetal heart defects were excluded from this study since a reliable demonstration of these defects was not possible by 3D ultrasound. Comparing the 2D and 3D techniques, 3D sonography proved advantageous in 60.8 % of the defects, with the benefit derived from the exact tomographic survey using the multiplanar view in 69.9 % of these cases, from a more precise demonstration of the defect in the surface view in 25.2 %, from a distinct demonstration in the transparent view in 3.9 %, and from a precise demonstration in the combined transparent and color view in 1.0 %. In 42 of the 1,012 malformations (4.2 %), a defect was accurately identified or verified with 3D ultrasound only. 3D ultrasound proves not only a useful tool in appreciating the severity of a fetal defect, but also provides more convincing evidence of a normal fetus than conventional two-dimensional sonograms in cases with increased risk of a recurrent surface malformation.     

不同孕周的胎儿泌尿系统畸形的三维超声产前诊断及预后评估

目的:探讨不同孕周的胎儿泌尿系统畸形的三维超声产前诊断及预后评估.方法:以2016年1 月-2018年12月在我院行产前检查的1 288例孕妇作为研究对象.均进行二维、三维超声检查,分娩或引产后进行确诊.结果:1 288例孕妇共分娩或引产1 307例胎儿,根据引产尸检或分娩后确诊检查以及随访结果,发现泌尿系统畸形共35...     

单脐动脉与伴发畸形的关系及胎儿围生期预后

目的 探讨单脐动脉(SUA)与其伴发畸形的关系及单纯SUA对胎儿生长发育的影响。 方法 回顾性分析产前超声筛查的12 542胎,将其中92胎SUA分为2组:单纯SUA组(A组,n=46)及SUA合并畸形组(B组,n=46)。正常组(C组)为与SUA胎儿同期出生、经随访追踪无异常的46胎。观察SUA合并畸形的种类和比例,对比A、B组SUA胎儿围生期死亡率,并分析SUA胎儿与正常胎儿出生时的体质量、体长及孕龄等。 结果 B组围生期死亡率(78.26%, 36/46)显著高于A组(2.17%, 1/46, P<0.01)。SUA伴发畸形几乎涵盖所有系统,与多种严重复杂畸形相关联。与正常胎儿相比,SUA胎儿出生体质量、体长及孕龄较正常胎儿偏小,但胎儿宫内生长受限(FGR)及小于胎龄儿(SGR)发生率的差异无统计学意义。 结论 SUA可伴发多种畸形;SUA伴发畸形胎儿的围生期死亡率显著高于单纯SUA,后者因脐带动脉的代偿功能而相对预后良好。     

二维超声"三切面"法筛查胎儿先天性心脏畸形

目的 探讨应用二维超声"三切面"法筛查胎儿先天性心脏畸形的可行性及局限性. 方法 以四腔心、左心室、右心室流出道为筛查切面,筛查胎儿先天性心脏畸形.疑有异常者送上级医院行系统超声心动图检查,并追踪随访,与引产后尸检或出生后超声心动图对照. 结果 本法筛查获得较清晰的胎儿心脏二维结构图像.12 046例受检胎儿中,正确诊断胎儿心脏异常19例,误诊1例,漏诊2例,产前诊断符合率86.36%. 结论 应用二维超声采用四腔心加左右心室流出道切面法检查可清楚直观地观察胎儿心脏解剖结构,方法 简便可靠.     

超声在出生缺陷产前诊断中的临床价值

目的探讨超声在产前诊断胎儿缺陷的临床价值。方法对8089例孕13～40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，随访至产后7d。结果在8089例孕妇中，共发现先天性缺陷164例，超声诊断胎儿畸形104例，与产后诊断符合率为100％。超声检查漏诊60例，漏诊病例主要表现为较小畸形和缺陷。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，对于降低出生缺陷发生率，提高人口素质具有重要意义。     

Perinatal three-dimensional color power Doppler ultrasonography of vein of Galen aneurysms.

OBJECTIVE: To present the prenatal and postnatal three-dimensional color power Doppler ultrasonographic features in cases of vein of Galen aneurysmal malformation. METHODS: Prenatal three-dimensional color power Doppler ultrasonography was used to image the neurovascular malformations in 3 fetuses with vein of Galen aneurysms and in unaffected control fetuses at the same gestational age. Postnatal transfontanel three-dimensional power Doppler ultrasonography was also performed in the third affected case and in an unaffected control neonate. The feeding and drainage vessels were analyzed in the three-dimensional rendering mode. RESULTS: The first case was complicated by porencephaly and fetal heart failure, and the pregnancy was terminated. The other 2 cases were uncomplicated prenatally, but 1 of the infants died after aneurysmal embolization due to acute cerebral ischemia. The angioarchitecture of the arteriovenous fistula was characterized in greater detail by three-dimensional color power Doppler ultrasonography than by two-dimensional ultrasonography, especially regarding the anatomic features of the feeding and drainage vessels and their connections with the dilated vein of Galen. CONCLUSIONS: Three-dimensional color power Doppler ultrasonography provided detailed images of the aneurysmal malformation and its vascular connections. Further studies are needed to correlate three-dimensional vascular imaging patterns with outcome.