异常多胎妊娠的超声诊断与鉴别诊断

目的探讨异常多胎妊娠的超声表现,提高超声诊断的准确性和诊断效果。方法回顾性分析江西省妇幼保健院2008年1月至2010年1月期间33例异常多胎妊娠超声资料与随访结果,总结其声像图特点。结果对273例多胎妊娠进行了产前超声检查,其中双胎261例,28例异常;3胎12例,异常5例。所有的异常单胎妊娠类型均可发生于多胎妊娠,但多胎妊娠也有其特有的异常类型。大部分异常多胎妊娠可在妊娠中期超声检查时被发现。结论超声检查是产前诊断与评估的重要手段。     

多胎妊娠中胎儿畸形的超声诊断

目的与方法：报告1994年－2000年间共计8516例孕妇多胎妊娠发生率,多胎妊娠中胎儿畸形发病率及超声诊断。结果：多胎妊娠的发生率为1．3％,单胎妊娠胎儿畸形发病率1．4％,多胎妊娠中胎儿畸形的发病率5．4％。结论：多胎妊娠胎儿畸形发病率明显高于单胎妊娠,超声检查是产前诊断的主要手段。     

异常双胎妊娠的超声诊断

目的探讨超声在双胎妊娠中胎儿发育异常的诊断价值.方法对2002年1月～2005年6月在我院检查的双胎妊娠孕妇的超声检查结果进行分析.结果在331例双胎妊娠中,胎儿异常的48例,并对其声像图特点及诊断要点进行分析.结论二维超声在异常双胎妊娠中有重要的价值.     

ISUOG临床应用指南:双胎妊娠超声诊断规范解读

正近十年超声检查已广泛应用于产前胎儿生长评估、畸形筛查及多胎妊娠管理。2016年国际妇产超声学会(International Society of Ultrasound in Obstetrics Gynecology,ISUOG)临床标准委员会(Clinical Standards Committee,CSC)发表了双胎妊娠超声应用指南,为产科和超声医学科工作者提供了统一的双胎妊娠超声检查诊断规范,是目前     

超声在多胎妊娠筛查和选择性减胎中的临床应用

目的评估超声在多胎妊娠筛查和选择性减胎中的临床应用价值。 方法选择2011年7月至2015年4月在南京大学医学院附属鼓楼医院妇产科产前诊断中心接受超声筛查及减胎术的46例多胎妊娠孕妇,分析其超声检出的多胎类型、绒毛膜性、胎儿异常及减胎手术指征,追踪减胎术后的妊娠过程和临床结局。 结果46例多胎妊娠孕妇中,双胎妊娠28例（60.87%,28/46）,均是双绒毛膜双羊膜囊,5例妊娠无异常,孕妇要求减去其中一胎。21例因超声检出双胎之一发育异常减胎,2例因孕妇合并症减胎。三胎妊娠15例（32.61%,15/46）,其中三绒毛膜三羊膜囊8例,胎儿均无异常,孕妇要求减去其中一胎;双绒毛膜三羊膜囊5例,3例胎儿无异常,均减去其中单绒毛膜双羊膜囊两胎,2例因单绒毛膜双羊膜囊两胎之一异常,分别减去单绒毛膜双羊膜囊中两胎及一胎;双绒毛膜双羊膜囊2例,其中1例单绒毛膜单羊膜囊两胎之一异常,均减去单绒毛膜单羊膜囊两胎。四胎妊娠3例（6.52%,3/46）,胎儿发育均正常,均减去其中两胎,保留两胎。随访：双胎妊娠减胎术后保留28胎,1胎中孕超声检出左侧多囊性肾发育不良,2胎流产,其余25胎正常。三胎、四胎减胎术后保留胎儿均正常。 结论早期超声可以检出多胎妊娠的类型及异常胎儿,重视多胎妊娠的早期产前诊断并及时干预可以改善其妊娠结局。     

研究妊娠晚期超声诊断帆状胎盘在产科中的应用

目的:探究超声检查在产科妊娠晚期帆状胎盘中诊断价值。方法:将2015年10月-2018年10月,我院妊娠晚期分娩产妇72例随机分组,其中非帆状胎盘产妇纳入对照组36例,帆状胎盘产妇纳入研究组36例,两组均接受超声检查后,分析超声图像特征。结果:相比对照组,研究组产前阴道出血率、出血量、胎心监护异常、剖宫产率、新生儿预后不良均较高,P<0.05,;研究组产前超声检查诊断帆状胎盘36例,经产后诊断确诊,检出率为100%。结论:超声检查对产科妊娠晚期超声诊断帆状胎盘患者具有显著的诊断价值,提高了帆状胎盘诊断准确率,从而有效改善新生儿预后。     

经阴道超声诊断早期异位妊娠86例分析

目的:探讨经阴道超声在早期异位妊娠诊断中的价值。方法:对临床疑诊为异位妊娠而经腹超声不能确诊的86例患者进行经阴道超声检查,仔细观察异常包块的形态、血流特点。结果:结合尿及血HCG检查,86例附件区异常包块,经阴道超声诊断确诊为异位妊娠85例,诊断正确率为98.8%,误诊1例。结论:经阴道超声检查对早期异位妊娠的诊断具有重要价值。     

腹部超声与阴道超声诊断异位妊娠的效果评价

选取2012年1月~2014年8月我院收治的100例异位妊娠患者作为观察对象,随机分为对照组和试验组各50例。对照组采用腹部超声检查,试验组采用阴道超声检查,对比两种检查方式诊断异位妊娠的准确率。结果对照组腹部超声检查诊断准确率为72%,试验组阴道超声检查诊断准确率为96%。两种超声检查诊断异位妊娠的准确率存在明显差异(P<0.05),差异具有统计学意义。阴道超声诊断异位妊娠的效果更为显著,是检查异位妊娠的首选方式,值得临床推广。     

超声在筛选胎儿心血管异常中的应用价值分析

目的:讨论研究超声检查对筛选胎儿心血管异常的临床意义与价值.方法:选择于我院进行产前检查的500例孕妇作为研究对象并对其进行产前超声检查.以病理检查结果作为诊断金标准与产后超声结果或胎儿尸检结果进行比较,探讨超声检查的诊断符合率及诊断效能.结果:500例孕妇中共发现40例心血管异常,异常率8%,37例在分娩后超声检查或尸检后获得确诊.年龄超过35岁孕妇及存在异常妊娠史的孕妇其胎儿发生心血管异常概率较年龄低于35岁、无异常妊娠史的孕妇更高(P<0.05).结论:超声检查作为一项对孕妇无创、重复性好且安全性高的检查方式,可显著提高孕妇分娩质量并提升新生儿生存质量,对降低新生儿缺陷发生风险具有积极重要的意义,可作为产前诊断胎儿心血管异常的首选方式.     

阴道超声联合超声造影在剖宫产后疤痕妊娠中的应用分析

目的:分析经阴道超声检查联合超声造影在剖宫产术后疤痕妊娠患者中的运用。方法:选择我院收治的42例剖宫产术后疤痕妊娠患者为研究对象。给予患者经阴道超声检查及超声造影。结果:经阴道超声检查联合超声造影诊断疤痕妊娠的准确率高于单纯经阴道超声检查(P0.05)。结论:剖宫产术后疤痕妊娠诊断中,经阴道超声联合超声造影诊断的优势明显,可有效检出疤痕妊娠。     

A potential pitfall in the ultrasonographic diagnosis of fetal encephalocele

Abnormalities of the fetal neural axis may be diagnosed prenatally utilizing ultrasonography. Attempts to increase the sensitivity of ultrasonography in the detection of these anomalies run the risk of increasing the false-positive diagnoses. Since the prenatal diagnosis of neural tube defects significantly affects the clinical management of the pregnancy, a false-positive diagnosis of neural tube anomaly must be avoided. The authors describe several cases of patients with polyhydramnios in which the fetal ear protruded into the amniotic fluid, simulating the appearance of an encephalocele on ultrasonography.     

The ultrasonographic spectrum of fetal omphalocele

Four cases of fetal omphalocele diagnosed in utero by ultrasonography represent variations in the sonographic appearance of this rare anomaly. A possible pathogenesis of omphalocele is presented, with a discussion of the associated complications and the effect of diagnosing omphalocele prenatally on the management of the pregnancy itself. The association between fetal omphalocele and elevated alpha-fetoprotein is significant, and may prompt a search for a small omphalocele that would otherwise be missed on a routine obstetric sonogram. The differentiation of omphalocele from gastroschisis is difficult, yet the two anomalies can be reliably differentiated sonographically.     

The sonographic approach to the detection of fetal cardiac anomalies in early pregnancy.

BACKGROUND: Transvaginal sonography enables imaging of the fetal heart in various planes and directions in early pregnancy. This study summarizes our experience in early detection of fetal cardiac anomalies. METHODS: Transvaginal sonographic examination was performed in 36 323 consecutive fetuses in both high- and low-risk pregnancies. More than 99% of cases were evaluated at 14-16 weeks' gestation. Examination of the cardiovascular system did not rely on still images of the classic views but instead was performed in a dynamic mode visualizing the heart and great vessels from different directions and in various scanning planes. RESULTS: Cardiac anomalies were detected in 173 fetuses, giving an overall incidence of 1 in 210 pregnancies. In 44% of these, the cardiac anomaly was isolated. An abnormal karyotype was detected in 27 of the 72 cases that underwent chromosomal analysis. An abnormal nuchal translucency finding was observed in 59 fetuses. The sonographic diagnosis was confirmed after delivery or at postmortem in 90 cases. Ten fetuses had a cardiac anomaly which differed from the anomaly suggested by sonography. In the remaining cases, a postmortem examination was not possible because termination of pregnancy was performed by dilatation and curettage. In four cases we did not detect the cardiac anomaly in early pregnancy. Two of them were detected at rescanning in mid-pregnancy. CONCLUSION: Early detection of fetal cardiac anomalies is now possible. Most anomalies occur in low-risk pregnancies. We suggest performing a detailed early multidirectional dynamic continuous sweep ultrasound examination of the fetal cardiovascular system in all pregnancies.     

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。     

超声检查对诊断胎儿畸形的临床价值

目的:探讨超声在产前诊断胎儿缺陷的临床价值。方法:对9089例18～40周的孕妇采用实时彩色多普勒超声波进行系统检查,对胎儿畸形进行筛查和诊断。结果:在9089例孕妇中,经引产或出生后证实的各种畸形133例,彩超筛查诊断胎儿畸形115例,漏诊18例。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。     

Ultrasound diagnosis of bilateral cataracts in a fetus with possible cerebro-ocular congential muscular dystrophy during the routine second trimester anomaly scan

The finding of bilateral congenital cataracts in the fetus is rare. We report bilateral congenital cataracts detected during the routine second trimester anomaly scan, which subsequently were found to be associated with other congenital anomalies and the parents opted for a termination of pregnancy. At post-mortem, Muscle–Eye Brain disease or Walker–Warburg Syndrome was considered likely, which are autosomal recessive congenital muscular dystrophy disorders associated with cerebral, cerebellar, muscle and eye anomalies. On ultrasound, bilateral cataracts appear as echogenic, solid areas within the fetal orbits. The examination of the fetal face and orbits plays an important role in confirming fetal well-being antenatally. We propose that it should become a routine part of the structural survey of fetal anatomy during the obstetric anomaly scan. This is especially important in pregnancies previously affected by fetal cataracts or pregnancies at risk of rare genetic syndromes.     

Prenatal diagnosis of fetal hydrometrocolpos secondary to a cloacal anomaly by magnetic resonance imaging.

Fetal female urogenital anomalies are often difficult to evaluate by ultrasonography, especially in late gestation. We report a case of fetal hydrometrocolpos detected at 35 weeks of gestation. Ultrasonography revealed a large retrovesical septate hypoechogenic mass in the fetal abdomen, however the sonographic findings were inconclusive. Magnetic resonance imaging (MRI) confirmed that the abdominal mass was fluid-filled with a mid-plane septum in the midline posterior to the bladder, and showed a connection to the dilated uterus that was duplicated. These findings were consistent with a diagnosis of hydrometrocolpos with septate vagina and uterus didelphys. The neonate showed abdominal distension, ambiguous genitalia and anal atresia with a single perineal opening. Hydrometrocolpos was secondary to a urethral type of cloacal anomaly. Aspiration of the mass and a colostomy were performed on the first postnatal day, followed by anorectoplasty at 19 months of age. MRI is a useful complementary tool for assessing fetal urogenital anomalies when ultrasonography is inconclusive.     

早孕期诊断胎儿体蒂异常超声与病理对照研究

目的探讨早孕期胎儿体蒂异常超声诊断的临床价值。 方法对2009年1月至2014年7月早孕期在湖北省妇幼保健院超声筛查诊断体蒂异常的17例胎儿超声声像图特征及引产胎儿病理尸检（15例）结果进行对照研究。 结果早孕期诊断体蒂异常的17例胎儿超声表现与中晚孕期相同：腹壁大的缺损及肿块回声,严重脊柱侧弯,肢体异常,颅面缺损,神经管缺陷和脐带极短或缺失。其中多数胎儿（10例）合并心脏,泌尿系统等畸形。17例体蒂异常胎儿早孕期特有的超声表现：头臀径（CRL）测值评估孕周均小于临床孕周;颈项透明层（NT）增厚11例,胚外体腔持续存在13例。妊娠结局：17例体蒂异常胎儿超声检查后胎儿母亲均选择终止妊娠,15例引产胎儿标本尸检证实与产前超声诊断相符合;畸形分类：Ⅰ型3例,以颅面缺陷为主要特征;Ⅱ型12例,无颅面畸形,腹部-胎盘附着为主要特征,8例伴肢体畸形;2例未行病理尸检。17例体蒂异常胎儿产前超声漏误诊心脏及肢体异常9例。 结论早孕期系统超声筛查对检出胎儿体蒂异常有重要临床价值,胎儿体蒂异常合并心脏及肢体异常产前超声易漏诊或误诊。     

Early fetal anomaly scanning in a population at increased risk of abnormalities.

OBJECTIVES: To determine the effectiveness of early fetal anomaly scanning in a population at risk of fetal anomalies. DESIGN: A prospective study in a tertiary center of 101 consecutive fetuses at risk of congenital anomalies at 11-14 weeks of gestation. RESULTS: The principal (93/101 = 92%) reason for referral was having a previously affected infant. Nine (9/101 = 9%) fetuses were shown to have structural anomalies at the 11-14-week scan. In five of nine structurally affected fetuses, the nature of the anomalies was similar to that established in a previously affected pregnancy, four of which had a recurrence of an autosomal recessive syndrome. In two fetuses with a normal 11-14-week scan, anomalies were detected at the 18-21-week (arthrogryposis) or 30-week (cardiomyopathy) scans. CONCLUSIONS: The majority of fetal anomalies can be diagnosed in the late first/early second trimesters of pregnancy. This will be of particular advantage to those women who are at high risk of having affected offspring. However, as fetal anomalies may present at varying gestational ages, the standard 18-21-week scan cannot be abandoned. The effectiveness of the early pregnancy scan depends on the natural history of anomalies (gestational age at onset) and the variable phenotypic expression of anomalies/syndromes.     

Clinical impact of fetal MRI in addition to ultrasonography in brain anomalies--three case reports

Fetal magnetic resonance imaging (MRI) is a reliable method to further evaluate brain anomalies detected on ultrasonography. MRI can reveal additional brain abnormalities which are consequential for counselling parents about the fetal prognosis and subsequently influence the decision about continuing the pregnancy. In case of fatal malformations, MRI can confirm a diagnosis established on ultrasonography, supplying more reliability.