Drysdale Karen, Ridley D, Walker Karry, Higgins B, Dean Taraneh
Antenatal Ultrasound Department, St Mary's Hospital, I.W. Healthcare NHS Trust, Newport, Isle of Wight PO30 5TG, UK.
J Obstet Gynaecol. 2002 Mar;22(2):159-65. doi: 10.1080/01443610120113300.
This study set out to evaluate the feasibility and acceptability of routine early ultrasound (12-14 weeks) within a district general hospital (DGH) for identifying high-risk and abnormal pregnancies. This was a pilot study for screening by ultrasound examination all women who presented to their community midwife before 12 weeks' gestation. The study involved 991 women who presented clinically pregnant before 12 weeks' gestation between May 1998 and May 1999. Women were offered routinely two ultrasound examinations during their pregnancy, the first at 12-14 weeks' gestation and the second at 20-21 weeks' gestation. The main outcome measures were: range and number of abnormal/high-risk pregnancies identified during an ultrasound scan at 12-14 weeks' gestation; range and number of abnormalities diagnosed during scans at later gestations; outcomes of the pregnancies; questionnaires assessing how the women viewed early pregnancy ultrasound as a method of screening. Nine hundred and eighty-four (99%) women accepted the offer of an early ultrasound scan at 12-14 weeks' gestation; of these 840(85%) women accepted screening for trisomy 21 (T21) by fetal nuchal translucency thickness (NT) and maternal age (fetal medicine foundation risk assessment programme) and this was completed successfully in 797(80%) of cases. Twenty-four women (2%) had a failed pregnancy and where necessary an ERPC was performed following a planned admission. Thirty pregnancies (3%) were diagnosed as abnormal or having high risk of abnormality at the early scan. A major abnormality was confirmed before the expected anomaly scan at 20 weeks in five (17%) pregnancies; all of these patients opted for an elective termination. Twenty-six (3%) pregnancies had a diagnosis of abnormality at their anomaly scan. Of these, three pregnancies were diagnosed as major abnormalities with two resulting in termination of the affected pregnancy before 24 weeks' gestation. Eight hundred and thirty-seven women (85%) completed questionnaires, 833 women (84.5%) were satisfied with the counselling they received before the ultrasound scan and 827 women (84%) answered that they would accept an early pregnancy scan if offered during their next pregnancy. Early pregnancy ultrasound at 12-14 weeks' gestation can be used as an effective method of identifying and screening for major abnormalities of pregnancy within a DGH setting, but it is appropriate to use this in conjunction with an anomaly scan at around 20 weeks' gestation. Women found this method of screening acceptable.
本研究旨在评估在地区综合医院（DGH）进行常规早期超声检查（12 - 14周）以识别高危和异常妊娠的可行性和可接受性。这是一项针对所有在妊娠12周前就诊于社区助产士的妇女进行超声检查筛查的试点研究。该研究纳入了1998年5月至1999年5月期间临床诊断为妊娠12周前怀孕的991名妇女。妇女在孕期常规接受两次超声检查，第一次在妊娠12 - 14周，第二次在妊娠20 - 21周。主要观察指标包括：在妊娠12 - 14周超声扫描时识别出的异常/高危妊娠的范围和数量；在孕晚期扫描时诊断出的异常范围和数量；妊娠结局；评估妇女如何看待早期妊娠超声作为一种筛查方法的问卷。984名（99%）妇女接受了妊娠12 - 14周的早期超声扫描；其中840名（85%）妇女接受了通过胎儿颈部半透明厚度（NT）和孕妇年龄进行的21三体（T21）筛查（胎儿医学基金会风险评估项目），797例（80%）成功完成。24名妇女（2%）妊娠失败，必要时在计划入院后进行了清宫术。30例妊娠（3%）在早期扫描时被诊断为异常或有异常高风险。5例（17%）妊娠在预期的20周异常扫描前确诊为重大异常；所有这些患者均选择了选择性终止妊娠。26例（3%）妊娠在异常扫描时被诊断为异常。其中，3例妊娠被诊断为重大异常，2例在妊娠24周前终止了受影响的妊娠。837名妇女（85%）完成了问卷，833名妇女（84.5%）对超声扫描前接受的咨询感到满意，827名妇女（84%）回答如果下次怀孕时提供早期妊娠扫描，她们会接受。妊娠12 - 14周的早期妊娠超声可作为在DGH环境中识别和筛查妊娠重大异常的有效方法，但应与妊娠20周左右的异常扫描联合使用。妇女认为这种筛查方法是可接受的。
