复发性流产史与IVF助孕孕妇早孕末期超声筛查胎儿结构异常检出率研究

目的评价早孕末期超声筛查对复发性流产史和IVF助孕的孕妇筛查的必要性及其检查侧重点。方法 2007年1月至2010年12月在中山大学孙逸仙纪念医院行11～13＋6孕周超声检查的孕妇2 139例,对照组（无特殊病史,以下相同）、有复发性流产史和IVF助孕的孕妇各有1 500例、329例和301例,同时有该两种病史的孕妇9例。超声筛查胎儿结构异常共有97例,三组孕妇各57例、21例和19例。结果三组超声筛查胎儿结构异常检出率依次为3.80%、6.38%和6.31%。后两组分别与对照组的超声结构异常检出率比较,差异有统计学意义（PRPL=0.036,PIVF=0.048）。三组异常主要在于颈部异常。结论有复发性流产史和（或）IVF助孕的孕妇更有必要做早孕末期超声筛查,并着重检查颈部异常方面。

Research of the detection rate of fetal structural abnormalities with two special historys in the ultrasound screening

Objective: To evaluate the necessity of ultrasound screening in fetus at 11-13+6 weeks in unselected pregnant women who have the history of Recurrent Pregnancy Loss and IVF,and to evaluate the focus of screening.Methods: From January 2007 to December 2010,the Prenatal ultrasound examination were Preformed for 2 139 pregnant women who can track the history at 11 to 13 +6 gestational weeks in the Sun Yat-sen Memorial Hospital of Sun Yat-sen University,including 1 500 cases of the control group(excluding something special histories,following is the same),329 cases of a history of recurrent pregnancy loss,301 cases of a history of IVF,and 9 cases of the two histories.On the other hand,the early ultrasound screenings for fetal structural abnormalities were 97 cases,including 57 cases of the control group,21 cases of a history of recurrent pregnancy loss,and 19 cases of history of IVF,but there were no cases of the two histories.Results: In the control group,the early ultrasound screening for fetal structural abnormality detection rate was 3.80%(57/1 500),and 6.38%(21/329) in the second group with a history of recurrent pregnancy loss,and 6.31%(19/301) in the third group with a history of IVF.The top three structural abnormalities were neck abnormalities(increased nuchal translucency thickness and cystic hydroma),urinary tract abnormalities(renal pelvis expansion,urethral atresia and giant bladder),anterior abdominal wall abnormalities(omphalocele,abdominal swelling and abdominal crack) in the control group,neck abnormalities(increased nuchal translucency thickness and cystic hydroma),urinary tract abnormalities(renal Pelvis expansion,urethral atresia and giant bladder) and single umbilical artery in the second group and neck abnormalities(increased nuchal translucency thickness and cystic hydroma),central nervous system abnormalities(ventricular dilatation with hydrocephalus and spinal cysts),and urinary tract abnormalities(renal Pelvis expansion,urethral atresia and giant bladder) in the third group.The detection rate in the second group and the control group,respectively,with statistically significant difference(P= 0.036),while the same in the third group and the control group(P= 0.048).The major malformation in the three groups was neck abnormalities.Conclusions: The early ultrasound screening detection rate of fetal structural abnormalities in the second group with a history of recurrent pregnancy loss and the third group with a history of IVF could be higher than the control group.As a result,it is necessary to perform ultrasound examination in the pregnant women at 11 to 13+6 gestational weeks who have the history of recurrent pregnancy loss and(or) IVF.Additional,it should be specifically focus on the neck when performing ultrasound screening.