Corteville J E, Gray D L, Langer J C
Department of Obstetrics and Gynecology, Washington University, St. Louis, Missouri, USA.
Am J Obstet Gynecol. 1996 Sep;175(3 Pt 1):724-9. doi: 10.1053/ob.1996.v175.a74412.
Our purpose was to correlate ultrasonographic findings with postnatal outcome in cases of fetal bowel pathologic disorders detected by either prenatal evaluation or diagnosed in the neonatal period.
A total of 16,471 consecutive fetuses were scanned in the midtrimester or later. Fetuses were included in the study group if the prenatal ultrasonographic evaluation suggested gastrointestinal pathologic features or if gastrointestinal pathologic features were identified by postnatal evaluation. Prenatal ultrasonographic findings and postnatal outcome were collected by chart review. Prenatal ultrasonographic findings were compared with outcome. Results were compared by Fisher's exact test. Sensitivity and positive predictive values were determined.
Of the 16,471 fetuses scanned, 15,090 (91.6%) had complete postnatal follow-up. Eighty-nine fetuses had a bowel lesion suspected by prenatal ultrasonography. Twenty-two had dilated bowel distal to the duodenum, 33 had isolated hyperechoic bowel, 20 had ascites, and 14 had a cystic abdominal mass. Twenty-two fetuses (22/89 or 25%) were found at neonatal evaluation to have a gastrointestinal lesion. In those fetuses with small-bowel lesions, the sensitivity of ultrasonography was 100% and the positive predictive value was 72.7%. For large-bowel lesions the sensitivity of ultrasonography was only 7.7%, and the positive predictive value was 18%. No ultrasonographic parameter could unequivocally differentiate between the normal and abnormal outcome groups, but progressive bowel dilatation in the third trimester and hyperperistalsis with a dilated bowel loop were frequently found in the cases of small bowel obstruction. Four of the cases of dilated bowel (18.2%) were related to cystic fibrosis.
Bowel abnormalities in the fetus are manifest in diverse ultrasonographic findings, making accurate prediction of lesions difficult. The sensitivity of prenatal ultrasonography to detect large-bowel lesions was poor, although it was 100% sensitive in the detection of small-bowel lesions. Cystic fibrosis should be considered in all fetuses with bowel abnormalities suspected on prenatal ultrasonography.
我们的目的是将产前评估检测到或新生儿期诊断出的胎儿肠道病理疾病的超声检查结果与产后结局进行关联。
在孕中期或更晚阶段对总共16471例连续胎儿进行扫描。如果产前超声评估提示胃肠道病理特征或产后评估发现胃肠道病理特征，则将胎儿纳入研究组。通过查阅病历收集产前超声检查结果和产后结局。将产前超声检查结果与结局进行比较。结果通过Fisher精确检验进行比较。确定敏感性和阳性预测值。
在扫描的16471例胎儿中，15090例（91.6%）有完整的产后随访。89例胎儿产前超声怀疑有肠道病变。22例十二指肠远端肠管扩张，33例孤立性高回声肠管，20例有腹水，14例有腹部囊性肿块。新生儿评估发现22例胎儿（22/89或25%）有胃肠道病变。在那些有小肠病变的胎儿中，超声检查的敏感性为100%，阳性预测值为72.7%。对于大肠病变，超声检查的敏感性仅为7.7%，阳性预测值为18%。没有超声参数能够明确区分正常和异常结局组，但在小肠梗阻病例中，孕晚期肠管逐渐扩张以及肠管扩张伴蠕动增强较为常见。4例肠管扩张病例（18.2%）与囊性纤维化有关。
胎儿肠道异常在超声检查中有多种表现，难以准确预测病变。产前超声检查检测大肠病变的敏感性较差，尽管对小肠病变的检测敏感性为100%。对于产前超声怀疑有肠道异常的所有胎儿，均应考虑囊性纤维化。
