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Objective To review the clinical treatment and outcome of ultrasonographic soft markers in prenatal diagnostics. Methods This study recruited 268 pregnant women who underwent prenatal diagnostics in our hospital between Jun 2005 to Mar 2009. Fetuses were followed up postnatally. The outcome and chromosomal abnormalities of ultrasonographic soft markers were assessed. Results Of 268 cases consulted, 29 cases were missed (10.8%), 34 cases (12.7%) chose abortion, and 205 cases (76.5%) delivered. The top four most common delivered isolated markers were thickened nuchal fold, mild pyelectasis, echogenic bowel and rhizomelic limb shortening. Mild ventriculomegals had the highest aborted rate (17.2%). Six chromosomal structural abnormalities and one 21-trisome were detected in 59 fetuses who received chromosomal examination. Conclusions Ultrasonographic soft markers are risks to both fetal trisome and chromosomal structural abnormalities. Owing to extinction in most cases, consultant should be strengthed to avoid unnecessary invasive examination and abortion.
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Objective To assess prenatal heart disease screening program by ultrasound. Methods A total of 11 544 second-trimester screening scans were performed before 24 weeks′ gestation on 11 410 women between February 2004 and May 2007 in Obstetrics and Gynecology Hospital of Fudan University. Fetal heart screening was based on four-chamber and outflow tract views( left ventricular outflow + three vessel view). The sensitivity and specificity of different views were evaluated. Follow-up data of newborns was obstained. Results (1) Among 11 544 cases, 48 cases of congenital heart disease (CHD) were diagnosed in utero. Six cases were false negative, and 2 cases were false positive. The incidence of CHD was 0.47% (54/11 544). (2) Thirty-three CHDs were detected based on the four-chamber view, including 18 ventricular septal defect (9 with conotroncal anomalies),6 anomalous atrioventricle valve, 9 disproportion of left/right ventricle. The sensitivity of the four-chamber view alone was 61.11% (33/54), and the specificity was 99. 98% ( 11 488/11 490). Fifteen CHDs were detected based on the left ventricular outflow and three vessel views, including 1 pulmonary atresia, 3 pulmonary valve stenosis, 2 transposition of the great arteries ( TGA ), 1 pulmonary stanosis with TGA, 6 tetralogy of Fallot, and 2 pulmonary stenosis. The sensitivity of the combination of the four-chamber and outflow tract views was 88. 89% (48/54), and the specificity was 99. 98% (11 488/11 490). (3)Of 48 CHDs,11 cases were eceompanied by other malformations. Eleven cases were performed amniocentesis, amony whom 5 cases were trisemy 21. Conclusion The screening program based on four-chamber and outflow tract views shows good sensitivity and excellent specificity. Our prenatal heart screening program is clinically feasible.
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Objective To assess the efficacy of ultrasound contrast agent Levovist in evaluating vascularization of ovarian tumors.Methods Nineteen ovarian lesions (seven benign ovarian tumors,twelve malignant ovarian tumors) were submitted to color Doppler flow imaging (CDFI) before and after i.v.Levovist for examining their vascularization,including the number of blood vessel,vessel torsion and Doppler signal enhancement. And then receiver operator characteristic(ROC) curves were established.Results Compared to benign tumors',after contrast color Doppler signals in malignant tumors enhanced obviously and character characteristic vessel morphologies were observed.Vessel numbers and tortuosity increased obviously.Doppler signal enhancement appeared earlier,arrival to peak enhancement was quicker,and duration longer.ROC showed time to commencement for the enhancement ≤50 s,time to peak ≤100 s and enhancement duration ≥400 s,at which the sensitivity and specificity were the highest.Conclusions Levovist,as a contrast agent, increases the intensity of color Doppler signals obviously,and allows a more complete display of the vascular patterns of ovarian tumor.It improves markedly the role of CDFI in the diagnosis and differentiation of ovarian tumors.
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Objective To assess fetal cardiac hypertrophy and ventricular function in fetuses of diabetic mothers. Methods Study group was consist of 23 fetuses of diabetic pregnancies. Control group was consist of 108 fetuses of normal pregnancies. Cardiac size was measured by ultrasound as inter-ventricular septal (IVS) thickness and ventricular diastolic and systolic (VD and VS) dimensions and perimeter. Cardiac function was expressed as ventricular shortening fraction 1 (VSF1) (ventricular diastolic perimeter -ventricular systolic perimeter/ventricular diastolic perimeter)and ventricular shortening fraction 2 (VSF2) (ventricular diastolic dimension-Ventricular systolic dimension/ventricular diastolic dimension).Fetal birth weight was recorded. Results IVS of study group （6.1±0.7） mm, which was significantly thicker than IVS of control group （4.4±0.7） mm. Left ventricular diastolic dimension (LVDD) and Left ventricular systolic dimension (LVSD) of study group were （3.3±0.8）cm2 and （2.2±0.6） cm2, which were greater than those of control group （2.6±0.6） cm2 and （2.0±0.5） cm2. Right ventricular diastolic dimension (RVDD) and Right ventricular systolic dimension (RVSD) of study group were （3.9±0.7） cm2 and （2.6±0.7） cm2, which were also greater than those of control group （3.5±0.5） cm2 and （2.4±0.7） cm2. Left ventricular shortening fraction 1 of left ventricular (LVSF1) of study group was 0.20±0.07, which was greater than that of control group （0.12±0.04）. LVSF2 of study group was 0.35±0.11，which was greater than that of control group too （0.23±0.10）. Right ventricular shortening fraction 1 of left ventricular (RVSF1) of study group was 0.19±0.05，which was greater than that of control group （0.13±0.11）. RVSF2 of study group was 0.33±0.09，which was greater than that of control group （0.23±0.14）. Estimated fetal birth weight of study group was （4 076±608） g, which was greater than that of control group （3 440±377） g. Conclusion These findings showed that fetal hyperinsulinemia result in fetal weight increasing, global cardiac enlarger inter-ventricular septal thickness larger and revealed hypercontractillty of ventricle in fetuses of diabetas mothers.
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Objective To investigate the characteristics of fetal growth in uterus. Methods A total of 695 term singleton infant were studied. Various ultrasound measurements (including Biparietal diameter BPD, Transverse abdomen-diameter AD, femur length FL) obtained from 26 weeks' gestation to term. 147 cases were macrosomia. 48 cases were intra-uterine growth retardation (IUGR). 500 cases were normal weight. We assessed the tendency of BPD/AD and AD/FL of fetal. Results BPD/AD ratio of macrosomia was lowest, and BPD/AD ratio of IUGR was highest of them. The tendency of BPD/AD ratio were declined in gestation. AD/FL ratio of macrosomia were highest, and AD/FL ratio of IUGR was lowest of them. The tendency of AD/FL ratios were smooth in gestation. Conclusion The tendency of fetal growth in uterus showed that the add of abdominal diameter contributed to gain in weight.
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Objective To study the echo and flow dynamic change of fetal lung during pregnancy. Methods Take advantage of ultrasound attenuation and Doppler effect to observe the echo and dynamic change of fetal lung.Results ① The echo of lung and the pulsatile index of intrapulmonary artery increased according to gestational ages.② Pathological pregnancy had no effect on the echo of lung,and diabetes had no effect on the flow indexes of intrapulmonary artery,either.Conclusions The echo and flow indexes of fetal lung have dose relation with gestational ages.
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Objective To evaluate the value of Doppler indices of intrarenal artery (IRA) in clinicobservation in pregnancy induced hypertension(PIH).MethodsForty-six cases of PIH underwent Doppler measurment of PI,RI in IRA,and 186 normotensive pregnant women were measured as control.Results ①There was a larger increase of IRAPI and IRARI in PIH than in normal prgnant(P<0.001),and IRAPI is significantly higher in moderate and severe PIHs than in mild PIH(P<0.001),②IRAPI,IRARI correlate positively with classification of PIH(P<0.001),proteinuria(P<0.001)and MAP(P<0.05),and IRAPI is the best one.Conclusions It is of a certain significance to the clinical observation and treatment of PIH by using color Doppler to examine the indices of IRA in the pregnant women with PIH.