Saari-Kemppainen A, Karjalainen O, Ylöstalo P, Heinonen O P
First Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Finland.
Lancet. 1990 Aug 18;336(8712):387-91. doi: 10.1016/0140-6736(90)91941-3.
During a 19-month period, 95% of all pregnant women in the greater Helsinki area, Finland, entered a study to compare one-stage ultrasonography screening with selective screening according to antenatal hospital use, obstetric procedures, and fetal outcomes. Of 9310 women who entered the trial, 4691 were randomly allocated to ultrasound screening between the 16th and 20th gestational weeks and 4619 to follow-up only. Screened and control groups otherwise had the same antenatal care, which included ultrasonography according to usual practice. Screened women made fewer visits to the antenatal outpatient clinic than did women in the control group (2.3 vs 2.6). There were no differences in the number of labour inductions or mean birthweights in the two groups. Perinatal mortality was significantly lower in the screened than in the control group (4.6/1000 vs 9.0/1000); this 49.2% reduction was mainly due to improved early detection of major malformations which led to induced abortion. All twin pregnancies were detected before the 21st gestational week in the screening group compared with 76.3% in the control group; perinatal mortality in the small series of twins was 27.8/1000 vs 65.8/1000, respectively.
在19个月的时间里，芬兰大赫尔辛基地区95%的孕妇参与了一项研究，该研究旨在比较单阶段超声筛查与根据产前医院使用情况、产科程序和胎儿结局进行的选择性筛查。在9310名参与试验的女性中，4691名被随机分配在孕16至20周期间接受超声筛查，4619名仅接受随访。筛查组和对照组在其他方面接受相同的产前护理，其中包括按照常规做法进行超声检查。接受筛查的女性到产前门诊就诊的次数少于对照组女性（2.3次对2.6次）。两组的引产次数或平均出生体重没有差异。筛查组的围产期死亡率显著低于对照组（4.6‰对9.0‰）；这49.2%的降低主要归因于对严重畸形的早期检测得到改善，从而导致了人工流产。筛查组所有双胎妊娠均在孕21周前被检测出，而对照组这一比例为76.3%；在少量双胎妊娠中，围产期死亡率分别为27.8‰和65.8‰。
