Yoneda Satoshi, Shiozaki Arihiro, Yoneda Noriko, Sameshima Azusa, Ito Mika, Shima Tomoko, Nakashima Akitoshi, Yoshino Osamu, Kigawa Mika, Takamori Ryosuke, Shinagawa Yasuhiro, Saito Shigeru
Department of Obstetrics and Gynecology, University of Toyama, Toyama, Japan.
Kanagawa University of Human Services, Faculty of Health and Social Services, Graduate Course of Health and Social Services, Yokosuka, Japan.
J Ultrasound Med. 2018 May;37(5):1233-1241. doi: 10.1002/jum.14467. Epub 2017 Nov 1.
It is very hard to estimate an abnormal or normal fetal karyotype in miscarriage before surgery. We investigated whether the abnormal fetal karyotype in early miscarriage could be estimated by comprehensive ultrasonographic findings by a multivariate analysis.
One hundred fifty-one patients with early miscarriage (<12 weeks' gestation) were selected in our hospital. The clinical characteristics were compared between pregnant women carrying a fetus with an abnormal karyotype and those with a normal one, and the size and configuration of the gestational sac, yolk sac, and embryo at diagnosis of early miscarriage were also evaluated.
The rate of abnormal fetal karyotypes was 66.2 % (100 of 151). A maternal age older than 35 years (odds ratio, 3.2; 95% confidence interval, 1.4-7.4; P = .005), yolk sac larger than 5 mm (odds ratio, 6.2; 95% confidence interval, 2.2-22.7, P < .001), and absent embryo (odds ratio, 0.40; 95% confidence interval, 0.16-0.95; P = .038) were independent markers for predicting an abnormal fetal karyotype by multiple logistic regression analysis.
At the point of early miscarriage diagnosis, a yolk sac larger than 5 mm suggests an abnormal fetal karyotype, whereas an absent embryo indicates a normal fetal karyotype.
手术前很难估计流产胎儿的核型是异常还是正常。我们通过多变量分析研究了能否根据综合超声检查结果来估计早期流产胎儿的异常核型。
选取我院151例早期流产（妊娠<12周）患者。比较了携带核型异常胎儿的孕妇与携带核型正常胎儿的孕妇的临床特征，并评估了早期流产诊断时妊娠囊、卵黄囊和胚胎的大小及形态。
胎儿核型异常率为66.2%（151例中的100例）。多因素logistic回归分析显示，母亲年龄大于35岁（比值比，3.2；95%置信区间，1.4 - 7.4；P = 0.005）、卵黄囊大于5 mm（比值比，6.2；95%置信区间，2.2 - 22.7，P < 0.001）以及无胚胎（比值比，0.40；95%置信区间，0.16 - 0.95；P = 0.038）是预测胎儿核型异常的独立指标。
在早期流产诊断时，卵黄囊大于5 mm提示胎儿核型异常，而无胚胎则提示胎儿核型正常。
