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目的回顾性分析2009-2011年宁波地区孕妇产前筛查结果及其妊娠结局情况。方法应用时间分辨荧光免疫方法检测孕15～19+6周孕妇血清中甲胎蛋白(AFP)、游离绒毛膜促性腺激素(Freeβ-hCG)、未结合雌三醇(uE3)水平,用风险评估软件Lifecycle 3.0计算胎儿可能患唐氏综合征(DS)、爱德华综合征(ES)、神经管畸形(NTD)的风险值;胎儿先天畸形由染色体核型分析、超声检查确诊,或经引产证实;依托妇幼保健三级网络对筛查孕妇的妊娠结局进行随访。结果 137 515例孕妇中检出各类高风险人群共4895例,筛查阳性率3.56%。其中DS高风险4121例,占筛查总数的3.00%;ES高风险429例,占筛查总数的0.31%;NTD高风险345例,占筛查总数的0.25%。高风险孕妇妊娠结局随访率99.53%,出生缺陷发生率16.65%;低风险孕妇妊娠结局随访率94.70%,发现DS 9例,NTD 15例,其他畸形1617例。产前确诊的所有DS、ES、NTD及部分严重胎儿结构畸形予以终止妊娠。结论孕中期产前筛查是预测异常胎儿和不良妊娠结局的重要指标,产前诊断是防止出生缺陷发生的重要手段之一,准确的随访结果有利于筛查方案效果的客观评价。
Objective To retrospectively analyze the prenatal screening results and pregnancy outcomes of pregnant women in Ningbo during 2009-2011. Methods The serum levels of AFP, Freeβ-hCG and uE3 in pregnant women with gestational age from 15 to 19 + 6 weeks were detected by time-resolved fluorescence immunoassay. The risk factors The software Lifecycle 3.0 calculates the risk of fetus with Down Syndrome (DS), Edward’s syndrome (ES) and neural tube defects (NTD). Fetal congenital malformations are confirmed by chromosomal karyotyping, ultrasonography or induced by labor. Relying on three levels of maternal and child health care network screening pregnant women’s pregnancy outcomes were followed up. Results A total of 4895 cases were detected in 137 515 pregnant women with high risk population and the positive rate of screening was 3.56%. Among them, 4121 patients were at high risk of DS, accounting for 3.00% of the total number of screening; 429 patients were at high risk of ES, accounting for 0.31% of the total number of screening; 345 patients were at high risk of NTD accounting for 0.25% of the total number of screening. High-risk pregnant women follow-up rate of pregnancy was 99.53%, the incidence of birth defects was 16.65%; low-risk pregnant women follow-up rate of 94.70%, found in 9 cases of DS, NTD 15 cases, 1617 other deformities. Prenatal diagnosis of all DS, ES, NTD and some serious fetal structural abnormalities to terminate the pregnancy. Conclusion Prenatal screening in the second trimester is an important index for predicting abnormal fetuses and adverse pregnancy outcomes. Prenatal diagnosis is one of the important measures to prevent birth defects. Accurate follow-up results are helpful for the objective evaluation of screening results.