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目的探讨腹部彩超、阴道彩超及联合应用在妊娠早期胎儿畸形诊断中的价值。方法选择2014年1月-2016年12月于咸水沽医院进行胎儿畸形筛查的妊娠早期孕妇为研究对象,采用腹部彩超、阴道彩超及联合应用对胎儿进行畸形筛查,对超声提示胎儿结构畸形的孕妇进行遗传咨询,详细记录每位孕妇妊娠期间所做的检查结果和胎儿出生或引产后情况。结果共发现胎儿畸形15例,发生率为5.21%。腹部彩超和阴道彩超联合诊断妊娠早期胎儿畸形的敏感度(93.33%)及特异度(99.27%)高于腹部、阴道彩超单独诊断敏感度(66.67%、80.00%)及特异度(98.53%、97.80%),腹部彩超、阴道彩超单独及联合应用诊断妊娠早期胎儿畸形的ROC下面积(AUC)分别为0.765、0.808、0.873,联合应用两种检测方式的AUC大于单独腹部彩超(P=0.032)和阴道彩超(P=0.048),单独使用阴道彩超的AUC大于单独腹部彩超(P=0.652)。结论腹部彩超和阴道彩超联合应用、综合判断可以提高妊娠早期胎儿畸形诊断水平。
Objective To investigate the value of abdominal ultrasound, vaginal ultrasound and combined application in the diagnosis of fetal malformations in early pregnancy. Methods From January 2014 to December 2016, the pregnant women with fetal malformations who were screened in Xianshuigu Hospital for pregnant women were enrolled in this study. Abnormal fetus was screened by abdominal ultrasonography, vaginal ultrasound and combined application. Deformity of pregnant women for genetic counseling, a detailed record of each pregnant woman during pregnancy and the results of the test and the fetus after birth or induced abortion. Results Fetal malformations were found in 15 cases, the incidence was 5.21%. Sensitivity (93.33%) and specificity (99.27%) of abdominal ultrasonography combined with vaginal ultrasonography in the diagnosis of fetal malformation in early pregnancy were higher than those in abdominal and vaginal ultrasound alone (66.67%, 80.00%) and specificity (98.53%, 97.80 %). The area under the ROC (AUC) of abdominal ultrasound and vaginal ultrasound in the diagnosis of fetal malformations in early pregnancy were 0.765, 0.808 and 0.873, respectively. The AUC of the two detection methods was higher than that of abdominal ultrasonography alone (P = 0.032) and Vaginal color Doppler ultrasound (P = 0.048), single use of vaginal ultrasound AUC greater than single abdominal ultrasound (P = 0.652). Conclusion The combined application of abdominal ultrasound and vaginal ultrasound, comprehensive judgment can improve the diagnosis of fetal malformations in early pregnancy.