Blumenfeld Z, Zimmer E, Bronshtein M
Al-Kol Institute, Rambam Medical Center, B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa.
Obstet Gynecol. 1995 Oct;86(4 Pt 1):565-8. doi: 10.1016/0029-7844(95)00230-o.
To evaluate the combined transvaginal and transumbilical ultrasonographic approach in cases of elevated amniotic fluid (AF) alpha-fetoprotein (AFP) and/or acetylcholinesterase in the second trimester.
Nine pregnant women with normal sonographic results were referred because of elevated AF AFP and/or acetylcholinesterase and screened using a transvaginal and transumbilical 6.5-MHz ultrasound transducer. All women were at 17-21 weeks' gestation. The fetal skull and the vertebral column were scanned in both perpendicular and tangential planes for maximal exploitation of the axial resolution of the transducer, in both directions and in two to three planes.
Despite increased AF AFP and/or present acetylcholinesterase, no fetal malformation was detected in any of the nine cases. Open neural tube defects were not detected by the diagnostic technique. All nine women were delivered of term healthy neonates without malformations.
Our preliminary data suggest that targeted sonographic screening combining transvaginal and transumbilical approaches may reliably rule out an open neural tube defect larger than 0.3 mm. This may influence the decision-making process when termination of pregnancy is considered in cases of high AF AFP and/or positive acetylcholinesterase.
评估孕中期羊水（AF）甲胎蛋白（AFP）和/或乙酰胆碱酯酶升高病例中经阴道和经脐超声联合检查方法。
9例超声检查结果正常的孕妇因AF AFP和/或乙酰胆碱酯酶升高前来就诊，并使用经阴道和经脐的6.5兆赫超声探头进行筛查。所有孕妇均处于妊娠17至21周。为最大程度利用探头的轴向分辨率，在两个方向以及两到三个平面上，对胎儿颅骨和脊柱进行垂直和平行平面扫描。
尽管AF AFP升高和/或存在乙酰胆碱酯酶，但9例病例中均未检测到胎儿畸形。诊断技术未检测到开放性神经管缺陷。所有9名妇女均足月分娩健康新生儿，无畸形。
我们的初步数据表明，经阴道和经脐联合靶向超声筛查可能可靠地排除大于0.3毫米的开放性神经管缺陷。这可能会影响在AF AFP升高和/或乙酰胆碱酯酶呈阳性的情况下考虑终止妊娠时的决策过程。
