Reichler A, Sherer D M, Divon M Y
Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
Obstet Gynecol. 1997 Jun;89(6):949-52. doi: 10.1016/s0029-7844(97)00153-1.
To assess the advantage of applying uterine fundal pressure to assist transvaginal sonographic imaging of early second-trimester fetal anatomy.
One hundred consecutive patients with singleton fetuses underwent routine transvaginal sonographic assessment of fetal anatomy between 13 and 17 weeks' gestation. If the entire fetal anatomy including cardiac outflow tracts was not depicted, uterine fundal pressure was applied with the operator's nonscanning hand in a bimanual fashion, to facilitate transvaginal imaging. Transabdominal sonography was performed when visualization of the entire fetal anatomy was not obtainable with transvaginal or uterine fundal pressure-assisted transvaginal sonography. Observed fetal structures with and without fundal pressure were compared. Factors assessed that may have modified the value of fundal pressure included patient weight, gestational age, fetal presentation, previous abdominal surgery, and the presence of uterine fibroids. Statistical analysis included McNemar test, chi 2, Fisher exact test, and t test, with P < .05 considered significant.
Visualization of lower limbs, head (including intracranial structures), upper limbs, kidneys, spine, gender, feet, hands (digits), face, four-chamber view, and cardiac outflow tracts was significantly enhanced by uterine fundal pressure-assisted versus nonassisted transvaginal sonography. Uterine fundal pressure improved transvaginal sonographic imaging in 91% of subjects, and in 51% of all subjects, a complete examination was thus obtained. In 20% of all subjects, transabdominal sonography was required to complete the examination. Complete fetal anatomic scanning was unobtainable despite uterine fundal pressure supplemented by transabdominal sonography in 29% of cases. Completion of the transvaginal sonographic fetal anatomic survey with uterine fundal pressure was related to gestational age (P < .02) and maternal weight (P < .05) yet not related to fetal presentation (P = .13), previous abdominal surgery (P = .06), or uterine fibroids (P = .26).
Uterine fundal pressure applied during early second-trimester transvaginal sonographic evaluation of fetal anatomy significantly improves visualization of fetal structures otherwise located beyond the effective range of the transvaginal transducer.
评估在孕中期早期经阴道超声检查胎儿解剖结构时施加子宫底压力的优势。
100例单胎妊娠患者在妊娠13至17周期间接受了常规经阴道超声胎儿解剖结构评估。如果未显示包括心脏流出道在内的整个胎儿解剖结构，则由操作者用非扫描手以双手操作方式施加子宫底压力，以利于经阴道成像。当经阴道或子宫底压力辅助经阴道超声无法显示整个胎儿解剖结构时，则进行经腹超声检查。比较施加和未施加子宫底压力时观察到的胎儿结构。评估的可能影响子宫底压力价值的因素包括患者体重、孕周、胎儿先露、既往腹部手术史以及子宫肌瘤的存在。统计分析包括McNemar检验、卡方检验、Fisher精确检验和t检验，P <.05被认为具有统计学意义。
与未施加子宫底压力的经阴道超声相比，子宫底压力辅助经阴道超声对下肢、头部（包括颅内结构）、上肢、肾脏、脊柱、性别、足部、手部（手指）、面部、四腔心切面和心脏流出道的显示明显增强。子宫底压力使91%的受试者经阴道超声成像得到改善，51%的受试者因此获得了完整的检查。20%的受试者需要经腹超声检查以完成检查。在29%的病例中，尽管采用经腹超声补充子宫底压力，但仍无法获得完整的胎儿解剖扫描。施加子宫底压力完成经阴道超声胎儿解剖学检查与孕周（P <.02）和孕妇体重（P <.05）有关，但与胎儿先露（P =.13）、既往腹部手术史（P =.06）或子宫肌瘤（P =.26）无关。
在孕中期早期经阴道超声评估胎儿解剖结构时施加子宫底压力，可显著改善对原本位于经阴道换能器有效范围之外的胎儿结构的显示。
