孕期第二和第三阶段脐带的三维超声评估

Hata T, Aoki S, Hata K, Miyazaki K

Department of Obstetrics and Gynecology, Shimane Medical University, Izumo, Japan.

Gynecol Obstet Invest. 1998;45(3):159-64. doi: 10.1159/000009947.

OBJECTIVE

To evaluate the umbilical cord and its abnormalities by use of three-dimensional ultrasonography with a specially developed abdominal three-dimensional transducer.

PATIENTS AND METHODS

Ninety-five pregnancies (92 normal, 2 with hydrops fetalis, and 1 with omphalocele) from 14 to 40 weeks of gestation were studied with a specially developed abdominal three-dimensional transducer (3.5 MHz). This system can provide conventional two-dimensional ultrasonography images and can also generate within seconds high-quality three-dimensional images in the surface and transparent mode with no need for an external workstation. A proportion of the umbilical cords (coiled or noncoiled free loop, abdominal insertion, and placental insertion) visualized at each gestational age interval is presented.

RESULTS

The proportion of the umbilical cords visualized during pregnancy except for between 24 and 27 weeks of gestation was about 70% (range 64-83%). Optimal visualization of the umbilical cord was achieved between 24 and 27 weeks of gestation. During this period it was possible to adequately depict the umbilical cord in 93% of the cases. The proportions of the noncoiled umbilical cord depicted during pregnancy ranged from 8 to 45%. The detection rate of abdominal insertion of the umbilical cord visualized at 14-19 weeks was 44%; the detection rate decreased thereafter. Placental insertion of the umbilical cord could not be identified after 28 weeks of gestation. In 2 cases with hydrops fetalis, edematous umbilical cord was evident. In 1 fetus, omphalocele was clearly depicted.

CONCLUSIONS

The new three-dimensional ultrasound technology generates within seconds high-quality three-dimensional images of the umbilical cord, although limitation of viewing direction exists. These results suggest that the new three-dimensional ultrasonography has the potential to be a supplement to two-dimensional ultrasonography and might be useful in identifying abnormal umbilical cords in utero.

目的

使用专门研发的腹部三维探头，通过三维超声评估脐带及其异常情况。

患者与方法

采用专门研发的腹部三维探头（3.5兆赫）对95例孕周为14至40周的孕妇进行研究（92例正常妊娠、2例胎儿水肿、1例脐膨出）。该系统可提供传统二维超声图像，还能在数秒内生成表面模式和透明模式下的高质量三维图像，无需外部工作站。呈现了各孕周区间内可视化的部分脐带情况（盘绕或非盘绕游离环、腹壁附着及胎盘附着）。

结果

除孕24至27周外，孕期脐带可视化比例约为70%（范围64% - 83%）。孕24至27周时可实现脐带的最佳可视化。在此期间，93%的病例能够充分显示脐带。孕期非盘绕脐带的显示比例在8%至45%之间。孕14至19周时脐带腹壁附着的检出率为44%；此后检出率下降。孕28周后无法识别脐带胎盘附着情况。2例胎儿水肿病例中，可见水肿的脐带。1例胎儿中，脐膨出清晰显示。