Vimercati Antonella, Grasso Silvana, Abruzzese Marinella, Chincoli Annarosa, de Gennaro Alessandra, Miccolis Angela, Serio Gabriella, Selvaggi Luigi, Fascilla Fabiana Divina
Department of Obstetric and Gynecology, University of Bari, Italy.
J Prenat Med. 2012 Apr;6(2):13-7.
to compare ultrasound (US) and autopsy findings of fetal malformations in second trimester terminations of pregnancy to evaluate the degree of agreement between US and fetal autopsy.
in this study, all second trimester termination of pregnancy between 2003-2010 were considered. US and autopsy findings were compared and all cases were classified into five categories according to the degree of agreement between US and pathology (A1: full agreement between US and autopsy; A2: autopsy confirmed all US findings but revealed additional anomalies 'rarely detectable' prenatally; B: autopsy demonstrated all US findings but revealed additional anomalies 'detectable' prenatally; C: US findings were only partially demonstrated at fetal autopsy; D: total disagreement between US and autopsy).
144 cases were selected. In 49% of cases there was total agreement between US and autopsy diagnosis (A1). In 22% of cases additional information were about anomalies 'not detectable' by US (A2). In 12% of cases autopsy provided additional information about anomalies not observed but 'detectable' by US (B). In 13% of cases some anomalies revealed at US, such as valve insufficiencies, pericardial and pleural effusions, were not verified at autopsy (C). Total lack of agreement was noted only in 4% of cases (D). Main areas of disagreement concerned cardiovascular, CNS and complex malformations. The degree of agreement was higher if malformations were diagnosed in a tertiary center.
this study shows an overall high degree of agreement between definitive US and autopsy findings in second trimester termination of pregnancy for fetal malformations. Autopsy reveals to be the best tool to diagnose malformations and often showed other abnormalities of clinical importance not detected by US, but sometimes also US could provide additional information about functional anomalies because US is a dynamic examination.
比较妊娠中期终止妊娠时胎儿畸形的超声（US）检查结果与尸检结果，以评估US与胎儿尸检之间的一致性程度。
本研究纳入了2003年至2010年间所有妊娠中期终止妊娠的病例。比较US和尸检结果，并根据US与病理学之间的一致性程度将所有病例分为五类（A1：US与尸检完全一致；A2：尸检证实了所有US检查结果，但发现了产前“很少能检测到”的其他异常；B：尸检显示了所有US检查结果，但发现了产前“可检测到”的其他异常；C：胎儿尸检仅部分显示了US检查结果；D：US与尸检完全不一致）。
共选取144例病例。49%的病例中US与尸检诊断完全一致（A1）。22%的病例中，额外信息是关于US“无法检测到”的异常（A2）。12%的病例中，尸检提供了关于未观察到但US“可检测到”的异常的额外信息（B）。13%的病例中，US显示的一些异常，如瓣膜关闭不全、心包和胸腔积液，在尸检中未得到证实（C）。仅4%的病例中完全不一致（D）。主要不一致的领域涉及心血管、中枢神经系统和复杂畸形。如果在三级中心诊断畸形，一致性程度更高。
本研究表明，在妊娠中期终止妊娠以诊断胎儿畸形时，最终的US检查结果与尸检结果总体上具有高度一致性。尸检是诊断畸形的最佳工具，且常显示出US未检测到的其他具有临床重要性的异常，但有时US也能提供关于功能异常的额外信息，因为US是一种动态检查。
