發(fā)布時間：2018-04-29 19:07

  本文選題：早孕期 + 系統(tǒng)超聲篩查��； 參考：《中南大學》2014年碩士論文

【摘要】：目的：本研究通過分析引產(chǎn)后確診的胎兒結(jié)構(gòu)畸形的超聲圖像特征,來探討早孕期系統(tǒng)超聲篩查在胎兒結(jié)構(gòu)畸形的臨床應(yīng)用價值。 方法：回顧性分析在2012年1月至2014年2月期間,在中南大學湘雅三醫(yī)院超聲科行早孕期(11～13+6周)系統(tǒng)超聲篩查的1829例孕婦1874例胎兒(其中單胎1784例,雙胎45例)。孕婦主要來自湖南省,少數(shù)來自周邊省份,平均年齡28.2+3.1歲(20～42歲),平均孕齡為87.3±3.2天。檢查前每位孕婦填寫詳細的調(diào)查問卷,包括父母基本資料及個人既往疾病史、本次妊娠記錄、既往生育史等。 超聲提示結(jié)構(gòu)畸形的胎兒,告知胎兒父母預(yù)后情況,讓他們決定是否終止妊娠。征得孕婦同意的引產(chǎn)胎兒,行產(chǎn)后超聲檢查和(或)病理學檢查。對每一入組胎兒記錄孕期超聲檢查結(jié)果、染色體結(jié)果、出生后情況等。以引產(chǎn)后確診的胎兒結(jié)構(gòu)畸形患者其在早孕期的超聲圖像特征標準,評價早孕期胎兒結(jié)構(gòu)畸形診斷的敏感性、特異性、陽性預(yù)測值、陰性預(yù)測值。 結(jié)果：1829例孕婦1874例胎兒中正常單胎1698例,異常單胎86例,正常雙胎42例,異常雙胎3例。本組病例中共發(fā)現(xiàn)胎兒畸形89例,發(fā)生率為4.75%(89/1874)。其中早孕期診斷35例,早孕期胎兒結(jié)構(gòu)畸形檢出率為39.3%；中孕期診斷42例,早孕期聯(lián)合中孕期檢出率提高至86.5%。因此,以往認為中孕期才能診斷的胎兒結(jié)構(gòu)畸形中45.5%(35/77)可在早孕期診斷。 早孕期系統(tǒng)超聲篩查胎兒結(jié)構(gòu)畸形的敏感性、特異性、陽性預(yù)測值、陰性預(yù)測值分別為39.3%、100%、100%、97.1%。 結(jié)論：早孕期系統(tǒng)超聲篩查在胎兒結(jié)構(gòu)畸形診斷中具有較高的診斷價值,以往認為中孕期才能診斷的胎兒結(jié)構(gòu)畸形�？稍谠缭衅谠\斷。早孕期系統(tǒng)超聲篩查有助于孕婦早日決定妊娠結(jié)局,減少引產(chǎn)對孕婦心理和生理的傷害,為產(chǎn)前咨詢和臨床處理提供依據(jù),具有十分重要的應(yīng)用價值和臨床意義,值得臨床大力推廣。圖22幅,表6個,參考文獻55篇
[Abstract]:Objective: to investigate the clinical application value of systematic ultrasound screening in early pregnancy by analyzing the ultrasonographic features of fetal structural malformation diagnosed after induced labor. Methods: from January 2012 to February 2014, a total of 1874 fetuses (1784 with single pregnancy and 45 with twins) in the Department of Ultrasonography, Xiangya third Hospital, Central South University, were screened by systematic ultrasound for 11136 weeks of early pregnancy. The pregnant women were mainly from Hunan Province and a few from neighboring provinces. The average age of pregnant women was 28.2 3.1 years old and 20 ~ 42 years old, and the average gestational age was 87.3 鹵3.2 days. Before examination, each pregnant woman filled out detailed questionnaire, including parents' basic information and personal history of illness, pregnancy record, past birth history and so on. Ultrasound signals the fetus with structural abnormalities, informing the parents of the prognosis of the fetus and letting them decide whether to terminate the pregnancy. With the consent of the pregnant woman, the fetus shall undergo postpartum ultrasound examination and / or pathological examination. The results of ultrasound during pregnancy, chromosome and postnatal condition were recorded for every fetus in each group. The diagnostic sensitivity, specificity, positive predictive value and negative predictive value of fetal structural malformation in early pregnancy were evaluated according to the ultrasonographic characteristics of fetal structural malformation diagnosed after induced labor. Results there were 1698 cases of normal single fetus, 86 cases of abnormal single fetus, 42 cases of normal twins and 3 cases of abnormal twins. 89 cases of fetal malformation were found in this group, the incidence was 4.75% 89% 1874%. 35 cases were diagnosed in the early pregnancy, 39.3% in the early pregnancy, 42 cases in the middle pregnancy, and 86.5% in the first trimester. Therefore, 45. 5% of 35 / 77 of fetal structural malformations previously thought to be diagnosed during pregnancy can be diagnosed in early pregnancy. The sensitivity, specificity, positive predictive value and negative predictive value were 39.3% and 100% respectively. Conclusion: systematic ultrasound screening in early pregnancy has a high diagnostic value in the diagnosis of fetal structural malformation. In the past, the fetal structural malformation that can only be diagnosed during the middle pregnancy is often diagnosed in the early pregnancy. Systematic ultrasound screening during early pregnancy can help pregnant women to decide pregnancy outcome early, reduce the psychological and physiological injury of induced labor, and provide basis for prenatal counseling and clinical treatment. It has very important application value and clinical significance. It is worth popularizing in clinic. 22 figures, 6 tables, 55 references
【學位授予單位】：中南大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R445.1;R714.5

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