孕早期超聲篩查胎兒結構畸形的循證病案討論_《中國循證醫學雜志》

作者：

唐英 ¹ , 劉關鍵 ² ,  楊太珠 ¹

1. 四川大學華西第二醫院超聲科（成都?610041）；2. 四川大學華西醫院循證醫學與臨床流行病學教研室（成都?610041）;

關鍵詞：

超聲檢查胎兒畸形孕早期（孕11～14周）

DOI：

10.7507/1672-2531.20090124

視頻：

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目的　循證探討1例孕早期（孕11～14周）超聲篩查胎兒結構畸形是否有效。
方法　針對孕早期是否可進行超聲篩查胎兒結構畸形的問題，全面檢索Cochrane 圖書館（2008 年第4 期）、MEDLINE（1981 ～ 2008）、OVID ACP Journal Club（1991 ～ 2008）、BMJ Clinical Evidence（1999 ～ 2008），獲取并評價相關系統評價、隨機對照試驗、臨床對照試驗證據，并將最佳證據用于臨床實踐。
結果　從Cochrane 圖書館檢索到系統評價3篇、隨機對照試驗5篇、隊列研究9篇。結果顯示：產前各孕期的超聲檢查能夠發現不同類型的胎兒結構畸形，但不能發現所有胎兒結構畸形；在孕11～14周超聲測量胎兒頸部透明層厚度，可顯示胎兒主要的系統器官結構，從而探查部分胎兒結構畸形和篩查胎兒染色體畸形高危人群，盡早臨床決策；孕早期超聲篩查胎兒畸形不能取代孕中期篩查，兩者聯合可較好地篩查胎兒畸形。目前并無證據表明孕早期超聲篩查會影響胎兒發育及出生后生長發育。
結論　對孕11～14周孕婦進行超聲篩查胎兒結構畸形有效。

引用本文： 唐英,劉關鍵,楊太珠. 孕早期超聲篩查胎兒結構畸形的循證病案討論. 中國循證醫學雜志, 2009, 09(6): 705-708. doi: 10.7507/1672-2531.20090124 復制

1.	?7 Saltvedt S, Almstro H, Kublickas M, et al. Detection of malformations in chromosomally normal fetuses by routine ultrasound at 12 or 18 weeks of gestation——a randomised controlled trial in 39 572 pregnancies. BJOG, 2006, 113(6): 664-674.
2.	Mau H, Scharf A, Baier P, et al. Ultrasound sinulators experience with the sana trainer and exparative review of other training systems. Ultrasound Obstet Gynecol, 2004, 24(4): 581-585.
3.	Wisem CS, Kiehi EM. Pience perfect anefits and risk of fetal 3D ultrasound. Am JM Atem Child Nurs, 2007, 32(2): 102-109.
4.	李勝利. 胎兒規范化的產前超聲檢查. 中國醫療器械信息, 2007, 13(3): 11-16.
5.	Nicolaides KH. The 11-13 weeks scan. Fetal Med Foun-dation, 2004, intraduction page: 71-88.
6.	Mary EN, Linda M, Sherri PENA, et al. First-trimester combined screening Experience with an instant approach. Amn J Obs Gyn, 2007, 19(6): 601-605.
7.	Chen M, Lee CP, Lam YH, et al. Comparison of nuchal and detailed morphology ultrasound examinations in early pregnancy for fetal structural abnormality screening: a randomized controlled trial. Ultrasound Obstet Gynecol, 2008, 31: 136-146.
8.	Westin M, Saltvedt S, Bergman G, et al. Routine ultrasound examination at 12 or 18 gestational weeks for prenatal detection of major congenital heart malformations? A randomized controlled trial comprising 36 299 fetuses. BJOG, 2006, 113(6): 675-682.
9.	Souka AP, Pilalis A, Kavalkis Y, et al, Assessment of fetal anatomy at the 11–14-week ultrasound Examination. Ultrasound Obstet Gynecol, 2004, 24: 730-734.
10.	Souka AP, Pilalis A, Kavalakis I, et al. Screening for major structural abnormalities at the 11- to 14-week ultrasound scan. Am J Obs Gyn, 2006, 194: 393-396.
11.	Becker R, Wegner RD. Detailed screening for fetal anomalies and cardiac defects at the 11–13-week scan. Ultrasound Obstet Gynecol, 2006, 27: 613-618.
12.	Chen M, Lam YH, Lee CP, et al. Ultrasound screening of fetal structural abnormalities at 12 to 14 weeks in Hong Kong. Prenat Diagn, 2004, 24: 92-97.
13.	Cedergren M, Selbing AJ. Detection of fetal structural abnormalities by a 10–14-week ultrasound dating scan in an unselected Swedish population, Oral communication abstracts, August–4 September 2004, Stockholm, Sweden.
14.	Carvalho MHB, Brizot ML. Detection of fetal structural abnormalities at the 11–14 week ultrasound scan. Prenat Diagn, 2002, 22: 1-4.
15.	Srisupundit K, Theera TS, Supatra S, et al. Fetal Structural Anomaly Screening at 11-14 Weeks of Gestation at Maharaj Nakorn Chiang Mai Hospital. J Med Assoc Thai, 2006, 89 (5): 588-593.
16.	Bricker L, Neilson JP. Routine ultrasound in late pregnancy (after 24 weeks gestation) (Cochrane Review) [CD/M]. The Cochrane Library, Issue 4, 2004. Chichester, UK: John Wiely and Sons, Ltd.
17.	Newnham JP, Evans SF, Michael CA, et al. Effects of ultrasound during pregnancy: a randomized controlled trial. Lancet, 1993, 342(8876): 887-891.
18.	Neilson JP. Ultrasound for fetal assessment in early pregnancy (Cochrane Review) [CD/M]. The Cochrane Library, Issue 4, 2004. Chichester, UK: John Wiley and Sonns, Ltd.
19.	Bricker L, Neilson JP. Routine Doppler ultrasound in pregnancy (Cochrane Review) [CD/M]. The Cochrane Library, Issue4, 2004. Chichester, UK: John Wiley and Sonns, Ltd.
20.	Campbell JD. Case-control study of prenatal ultrasnography exposure in children with delayed speech. CMAJ, 1993, 149(10): 1435-1440.
21.	Salvesen KA. Routine ultrasonography in utero and school performance at age 8-9years. Lancet, 1992, 339(8785): 85-89.
22.	Kieler H. Routine ultrasound screening in pregnancy and the childrens subsequent growth, vision and hearing. Br J Obstet Gynaecol, 1997, 104(11): 1267-1272.

1. ?7 Saltvedt S, Almstro H, Kublickas M, et al. Detection of malformations in chromosomally normal fetuses by routine ultrasound at 12 or 18 weeks of gestation——a randomised controlled trial in 39 572 pregnancies. BJOG, 2006, 113(6): 664-674.
2. Mau H, Scharf A, Baier P, et al. Ultrasound sinulators experience with the sana trainer and exparative review of other training systems. Ultrasound Obstet Gynecol, 2004, 24(4): 581-585.
3. Wisem CS, Kiehi EM. Pience perfect anefits and risk of fetal 3D ultrasound. Am JM Atem Child Nurs, 2007, 32(2): 102-109.
4. 李勝利. 胎兒規范化的產前超聲檢查. 中國醫療器械信息, 2007, 13(3): 11-16.
5. Nicolaides KH. The 11-13 weeks scan. Fetal Med Foun-dation, 2004, intraduction page: 71-88.
6. Mary EN, Linda M, Sherri PENA, et al. First-trimester combined screening Experience with an instant approach. Amn J Obs Gyn, 2007, 19(6): 601-605.
7. Chen M, Lee CP, Lam YH, et al. Comparison of nuchal and detailed morphology ultrasound examinations in early pregnancy for fetal structural abnormality screening: a randomized controlled trial. Ultrasound Obstet Gynecol, 2008, 31: 136-146.
8. Westin M, Saltvedt S, Bergman G, et al. Routine ultrasound examination at 12 or 18 gestational weeks for prenatal detection of major congenital heart malformations? A randomized controlled trial comprising 36 299 fetuses. BJOG, 2006, 113(6): 675-682.
9. Souka AP, Pilalis A, Kavalkis Y, et al, Assessment of fetal anatomy at the 11–14-week ultrasound Examination. Ultrasound Obstet Gynecol, 2004, 24: 730-734.
10. Souka AP, Pilalis A, Kavalakis I, et al. Screening for major structural abnormalities at the 11- to 14-week ultrasound scan. Am J Obs Gyn, 2006, 194: 393-396.
11. Becker R, Wegner RD. Detailed screening for fetal anomalies and cardiac defects at the 11–13-week scan. Ultrasound Obstet Gynecol, 2006, 27: 613-618.
12. Chen M, Lam YH, Lee CP, et al. Ultrasound screening of fetal structural abnormalities at 12 to 14 weeks in Hong Kong. Prenat Diagn, 2004, 24: 92-97.
13. Cedergren M, Selbing AJ. Detection of fetal structural abnormalities by a 10–14-week ultrasound dating scan in an unselected Swedish population, Oral communication abstracts, August–4 September 2004, Stockholm, Sweden.
14. Carvalho MHB, Brizot ML. Detection of fetal structural abnormalities at the 11–14 week ultrasound scan. Prenat Diagn, 2002, 22: 1-4.
15. Srisupundit K, Theera TS, Supatra S, et al. Fetal Structural Anomaly Screening at 11-14 Weeks of Gestation at Maharaj Nakorn Chiang Mai Hospital. J Med Assoc Thai, 2006, 89 (5): 588-593.
16. Bricker L, Neilson JP. Routine ultrasound in late pregnancy (after 24 weeks gestation) (Cochrane Review) [CD/M]. The Cochrane Library, Issue 4, 2004. Chichester, UK: John Wiely and Sons, Ltd.
17. Newnham JP, Evans SF, Michael CA, et al. Effects of ultrasound during pregnancy: a randomized controlled trial. Lancet, 1993, 342(8876): 887-891.
18. Neilson JP. Ultrasound for fetal assessment in early pregnancy (Cochrane Review) [CD/M]. The Cochrane Library, Issue 4, 2004. Chichester, UK: John Wiley and Sonns, Ltd.
19. Bricker L, Neilson JP. Routine Doppler ultrasound in pregnancy (Cochrane Review) [CD/M]. The Cochrane Library, Issue4, 2004. Chichester, UK: John Wiley and Sonns, Ltd.
20. Campbell JD. Case-control study of prenatal ultrasnography exposure in children with delayed speech. CMAJ, 1993, 149(10): 1435-1440.
21. Salvesen KA. Routine ultrasonography in utero and school performance at age 8-9years. Lancet, 1992, 339(8785): 85-89.
22. Kieler H. Routine ultrasound screening in pregnancy and the childrens subsequent growth, vision and hearing. Br J Obstet Gynaecol, 1997, 104(11): 1267-1272.

《中國循證醫學雜志》

孕早期超聲篩查胎兒結構畸形的循證病案討論

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《中國循證醫學雜志》

孕早期超聲篩查胎兒結構畸形的循證病案討論

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