Nakling Jakob, Backe Bjørn
Department of Obstetrics and Gynecology, Oppland Central Hospital, Lillehammer, Norway.
Acta Obstet Gynecol Scand. 2005 Nov;84(11):1042-8. doi: 10.1111/j.0001-6349.2005.00785.x.
To assess the sensitivity for detecting fetal congenital anomalies by a routine ultrasound examination program at midtrimester performed in an unselected population by midwives and specialists in obstetrics and gynecology.
Six hundred seventy-six of the pregnancies had the midtrimester ultrasound examinations performed outside the county. Three hundred seventeen of the women had midtrimester ultrasound examinations performed in the county, but delivered outside the county. A total of 18 181 pregnancies were eligible for the study.
Altogether there were 267 fetuses and newborns with anomalies, which gives a prevalence of 1.5%. One hundred three of the 267 anomalies were detected at the midtrimester ultrasound examination, yielding a sensitivity of 39.0%. There were 11 false positives and 163 remained undiagnosed (false negatives), which gives a specificity of 99.9% and a positive predictive value of 90.4%. The sensitivity for detecting anomalies ranged from 74.4 to 8.3% according to the organ system of the fetus.
Our study shows that midtrimester routine ultrasound examination in district hospitals can achieve a detection rate of congenital anomalies comparable with tertiary centers. One-stage ultrasound examination at midtrimester gives acceptable results concerning congenital anomalies with few false-positive results.
评估由助产士以及妇产科专家在未经过筛选的人群中进行的孕中期常规超声检查程序检测胎儿先天性异常的敏感性。
676例妊娠在县外进行了孕中期超声检查。317名女性在本县进行了孕中期超声检查，但在县外分娩。共有18181例妊娠符合研究条件。
共有267例胎儿和新生儿存在异常，患病率为1.5%。在孕中期超声检查中检测出267例异常中的103例，敏感性为39.0%。有11例假阳性，163例仍未诊断出来（假阴性），特异性为99.9%，阳性预测值为90.4%。根据胎儿的器官系统，检测异常的敏感性范围为74.4%至8.3%。
我们的研究表明，地区医院的孕中期常规超声检查能够实现与三级中心相当的先天性异常检测率。孕中期的一次性超声检查在先天性异常方面给出了可接受的结果，假阳性结果很少。
