Fetal Medicine Research Institute, King's College Hospital, London, UK.
Fetal Medicine Unit, Medway Maritime Hospital, Gillingham, UK.
Ultrasound Obstet Gynecol. 2020 Jan;55(1):75-80. doi: 10.1002/uog.20857. Epub 2019 Oct 8.
To investigate the potential value of routine ultrasound examination at 35-37 weeks' gestation in the diagnosis of previously unknown fetal abnormalities.
This was a prospective study of 52 400 singleton pregnancies attending for a routine ultrasound examination at 35 + 0 to 36 + 6 weeks' gestation; all pregnancies had a previous scan at 18-24 weeks and 47 214 also had a scan at 11-13 weeks. We included pregnancies resulting in live birth or stillbirth but excluded those with known chromosomal abnormality. Abnormalities were classified according to the affected major organ system, and the type and incidence of new abnormalities were determined.
In the study population, the incidence of fetal abnormality was 1.9% (995/52 400), including 674 (67.7%) that had been diagnosed previously during the first and/or second trimester, 247 (24.8%) that were detected for the first time at 35-37 weeks and 74 (7.4%) that were detected for the first time postnatally. The most common abnormalities that were diagnosed during the first and/or second trimester and that were also observed at 35-37 weeks included ventricular septal defect, talipes, unilateral renal agenesis and/or pelvic kidney, hydronephrosis, duplex kidney, unilateral multicystic kidney, congenital pulmonary airway malformation, ventriculomegaly, cleft lip and palate, polydactyly and abdominal cyst or gastroschisis. The most common abnormalities first seen at 35-37 weeks were hydronephrosis, mild ventriculomegaly, ventricular septal defect, duplex kidney, ovarian cyst and arachnoid cyst. The incidence of abnormalities first seen at 35-37 weeks was 0.5% and those that were detected exclusively for the first time at this examination were ovarian cyst, microcephaly, achondroplasia, dacryocystocele and hematocolpos. The incidence of abnormalities first seen postnatally was 0.1% and the most common were isolated cleft palate, polydactyly or syndactyly and ambiguous genitalia or hypospadias; prenatal examination of the genitalia was not a compulsory part of the protocol.
A high proportion of fetal abnormalities are detected for the first time during a routine ultrasound examination at 35-37 weeks' gestation. Such diagnosis and subsequent management, including selection of timing and place for delivery and postnatal investigations, could potentially improve postnatal outcome. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
探讨在 35-37 孕周常规超声检查诊断先前未知胎儿异常的潜在价值。
这是一项前瞻性研究，纳入了 52400 例单胎妊娠，这些孕妇均在 35+0 至 36+6 孕周时接受常规超声检查，所有妊娠均在 18-24 孕周时进行过一次超声检查，47214 例还在 11-13 孕周时进行过一次超声检查。我们纳入了活产或死产的妊娠，但排除了已知染色体异常的妊娠。异常根据受影响的主要器官系统进行分类，并确定新异常的类型和发生率。
在研究人群中，胎儿异常的发生率为 1.9%（995/52400），其中 674 例（67.7%）在第一和/或第二孕期已被诊断，247 例（24.8%）在 35-37 孕周首次检出，74 例（7.4%）在产后首次检出。在第一和/或第二孕期诊断并在 35-37 孕周观察到的最常见异常包括室间隔缺损、马蹄内翻足、单侧肾发育不全和/或盆腔肾、肾盂积水、重复肾、单侧多囊肾、先天性肺气道畸形、脑室扩张、唇腭裂、多指和腹部囊肿或腹裂。在 35-37 孕周首次检出的最常见异常包括肾盂积水、轻度脑室扩张、室间隔缺损、重复肾、卵巢囊肿和蛛网膜囊肿。在 35-37 孕周首次检出的异常发生率为 0.5%，而仅在此次检查首次检出的异常为卵巢囊肿、小头畸形、软骨发育不全、鼻泪管囊肿和阴道积血。产后首次检出的异常发生率为 0.1%，最常见的是孤立性腭裂、多指或并指、生殖器模糊或尿道下裂；产前生殖器检查不是方案的强制性部分。
很大一部分胎儿异常在 35-37 孕周的常规超声检查中首次被检出。这种诊断和随后的管理，包括分娩时间和地点的选择以及产后检查，可能会改善产后结局。版权所有 © 2019 ISUOG。由 John Wiley & Sons Ltd 出版。
