Vial Y, Tran C, Addor M C, Hohlfeld P
Département de Gynécologie-Obstétrique, maternité du CHUV, Lausanne, Switzerland.
Swiss Med Wkly. 2001 Aug 25;131(33-34):490-4. doi: 10.4414/smw.2001.09789.
To determine the sensitivity of ultrasonography in screening for foetal malformations in the pregnant women of the Swiss Canton of Vaud.
Retrospective study over a period of five years.
We focused our study on 512 major or minor clinically relevant malformations detectable by ultrasonography. We analysed the global sensitivity of the screening and compared the performance of the tertiary centre with that of practitioners working in private practice or regional hospitals.
Among the 512 malformations, 181 (35%) involved the renal and urinary tract system, 137 (27%) the heart, 71 (14%) the central nervous system, 50 (10%) the digestive system, 42 (8%) the face and 31 (6%) the limbs. Global sensitivity was 54.5%. The lowest detection rate was observed for cardiac anomalies, with only 23% correct diagnoses. The tertiary centre achieved a 75% detection rate in its outpatient clinic and 83% in referred patients. Outside the referral centre, the diagnostic rate attained 47%.
Routine foetal examination by ultrasonography in a low-risk population can detect foetal structural abnormalities. Apart from the diagnosis of cardiac abnormalities, the results in the Canton of Vaud are satisfactory and justify routine screening for malformations in a low-risk population. A prerequisite is continuing improvement in the skills of ultrasonographers through medical education.
确定超声检查在瑞士沃州孕妇胎儿畸形筛查中的敏感性。
为期五年的回顾性研究。
我们的研究聚焦于512例可通过超声检查发现的、临床相关的主要或次要畸形。我们分析了筛查的总体敏感性，并比较了三级中心与私人执业医生或地区医院医生的表现。
在512例畸形中，181例（35%）涉及肾脏和泌尿系统，137例（27%）涉及心脏，71例（14%）涉及中枢神经系统，50例（10%）涉及消化系统，42例（8%）涉及面部，31例（6%）涉及四肢。总体敏感性为54.5%。心脏异常的检出率最低，正确诊断仅为23%。三级中心在其门诊的检出率为75%，在转诊患者中的检出率为83%。在转诊中心之外，诊断率为47%。
在低风险人群中进行超声常规胎儿检查可检测出胎儿结构异常。除心脏异常的诊断外，沃州的结果令人满意，证明在低风险人群中进行畸形常规筛查是合理的。一个前提条件是通过医学教育持续提高超声检查人员的技能。
