Fetal Medicine Unit, Cairo University, Cairo, Egypt.
Ultrasound Obstet Gynecol. 2010 Mar;35(3):292-6. doi: 10.1002/uog.7444.
To assess the potential value of an early (first-trimester) ultrasound examination in depicting fetal anomalies by transabdominal (TAS) and transvaginal (TVS) sonography, to compare it with the traditional mid-trimester anomaly ultrasound examination and to evaluate the degree of patient acceptance of early sonography by the transvaginal route.
In this prospective study over a 5-year period (January 2002 to January 2007) 2876 pregnant women underwent a 13-14-week ultrasound examination. The scan was performed by TAS at first and then, if a full fetal anatomical survey was not achieved, by TVS. A mid-trimester fetal anatomy scan was then performed in patients who had not dropped out, miscarried or undergone pregnancy termination (n = 2834).
In the early scan, analyzable data for 2876 TAS and 1357 TVS examinations showed that TVS was significantly better in visualizing the cranium, spine, stomach, kidneys, bladder and upper and lower limbs (P < 0.001). Complete fetal anatomical surveys were achieved by TAS in 64% of cases versus 82% of the cases in which it was attempted by TVS (P < 0.001). Patient body mass index significantly affected the ability of the sonographer to achieve a complete anatomical survey by both TAS and TVS (P < 0.001 and P = 0.004, respectively). The duration of the scan was significantly longer using TVS. The heart and kidneys were not properly visualized in 42% and 27% of cases, respectively, at the 13-week scan compared with 1.6% and 0% at the mid-trimester scan. The total number of cases in which anomalies were detected was 31. At the first-trimester scan, anomalies were detected in 21 fetuses and in 14 of these cases the parents chose pregnancy termination. At the second-trimester scan, anomalies were detected in 17 fetuses: 10 new anomalous cases along with seven cases already detected in the first-trimester scan.
Besides its importance in screening for chromosomal abnormalities, the early scan has great potential in visualizing with precision fetal anatomy. TVS can be used to compliment difficult TAS examinations; however, patients do not always agree to undergo TVS. The mid-trimester scan remains crucial for detailed fetal anatomical survey.
通过经腹部（TAS）和经阴道（TVS）超声检查评估早孕期（第一孕期）超声检查对胎儿畸形的潜在价值，与传统的中孕期畸形超声检查进行比较，并评估经阴道早期超声检查的患者接受程度。
在这项前瞻性研究中，在 5 年期间（2002 年 1 月至 2007 年 1 月），2876 名孕妇接受了 13-14 周的超声检查。首先进行 TAS 扫描，如果未完成完整的胎儿解剖检查，则进行 TVS 扫描。在未退出、流产或终止妊娠的患者中（n=2834）进行中孕期胎儿解剖扫描。
在早期扫描中，2876 次 TAS 和 1357 次 TVS 检查中可分析的数据显示，TVS 在显示颅骨、脊柱、胃、肾脏、膀胱以及上下肢方面明显更好（P<0.001）。TAS 能够完成完整的胎儿解剖检查的比例为 64%，而 TVS 尝试完成的比例为 82%（P<0.001）。患者的体重指数显著影响了超声医师通过 TAS 和 TVS 完成完整解剖检查的能力（P<0.001 和 P=0.004）。使用 TVS 扫描的时间明显更长。与中孕期扫描相比，13 周扫描时，心脏和肾脏分别有 42%和 27%的病例无法正确显示，而中孕期扫描时则分别为 1.6%和 0%。总共发现 31 例异常病例。在早孕期扫描中，21 例胎儿发现异常，其中 14 例父母选择终止妊娠。在中孕期扫描中，发现 17 例异常：10 例新的异常病例和 7 例在早孕期扫描中已经发现的病例。
除了在筛查染色体异常方面的重要性外，早期扫描在精确显示胎儿解剖结构方面具有很大的潜力。TVS 可用于补充困难的 TAS 检查；然而，并非所有患者都同意接受 TVS 检查。中孕期扫描对于详细的胎儿解剖检查仍然至关重要。
