This study aimed to develop a new ultrasonographic dating formula to estimate gestational age (GA) based on fetal crown–rump length (CRL) in a Chinese population, evaluate model accuracy and compare its performance with established dating formulas. A prospective, multicenter study was conducted across mainland China. Participants included healthy, low-risk women with spontaneously conceived singleton pregnancies and a regular menstrual cycle in the preceding year. Ultrasonography was performed between 11 and 14 weeks of gestation, with GA determined based on the last menstrual period. Participants were randomly assigned to a development or validation cohort in a 7:3 ratio. A best-fit regression model was constructed for GA estimation based on CRL in the development cohort. For validation, mean differences between the new estimated GA and menstrual age were calculated and compared with those obtained using five established CRL-based dating formulas in the validation cohort. All participants were followed through to delivery. The study recruited 4,710 women with singleton pregnancies, with 3,297 in the development cohort and 1,413 women in the validation cohort. The mean and standard deviation values of CRL changed linearly with GA during 11–14 weeks. CRL demonstrated a linear relationship with GA between 11 and 14 weeks, yielding the regression equation GA = 59.590085 + 0.458539×CRL (R2 = 0.8042). The mean difference between estimated GA and menstrual age was 0.32 days (95

Objective To explore the diagnostic performance of prenatal ultrasound in the prediction of biliary atresia (BA). Methods We prospectively collected cases of suspected biliary abnormalities in the 2 (nd) trimester of pregnancy and performed a series (at least 3) of prenatal ultrasound examinations in the 2 (nd) and 3 (rd) trimester. The presence of the gallbladder was examined each time, and its size and shape were assessed if the gallbladder was visible. The existence of other abnormalities was carefully evaluated. Neonatal ultrasound examination was conducted within 1 month after birth, and clinical data were followed-up for 6 months after birth. Results Among the 41 895 patients, 298 were suspected to have biliary abnormalities, while 82 patients were excluded due to loss to follow-up or induced labor caused by other abnormalities. A total of 216 patients were included in this study, and 15 were diagnosed with BA. We summarized the ultrasound findings of the gallbladders and defined a high-risk gallbladder for the prenatal diagnosis of BA. This was demonstrated to have the best diagnostic performance as a single parameter, with an area under the curve of 0.914 (95 %CI: 0.869-0.948). In addition, higher incidences of biliary cysts, right hepatic artery dilation, echogenic bowel, and ascites were observed in BA fetuses. Logistic regression analysis showed that the combination of 5 parameters had better diagnostic performance, with an area under the curve of 0.995 (95 %CI: 0.973-0.999). Conclusion The fetal gallbladder was found to be a critical feature for the identification of BA. Concomitant abnormalities could be helpful to improve the accuracy of the diagnosis.

目的 探讨三维及二维超声在产前诊断胎儿唇腭裂的诊断价值.方法 回顾性分析2017年1月至2020年3月本院收治的50例产后发生胎儿唇腭裂孕产妇的临床资料,所有孕产妇均行三维及二维超声产前筛查唇腭裂,以产后胎儿颜面部结果为金标准,分析两种技术诊断结果的准确性.结果 唇腭裂50例中,单纯唇裂41例,唇腭裂并存9例.二维超声产前检出单纯唇裂34例,唇腭裂6例,准确率为80.00％;三维超声产前检出单纯唇裂39例,唇腭裂8例,准确率94.00％;三维超声检查准确率高于二维超声检查,差异有统计学意义(P<0.05).结论 三维、二维超声检查对于产前诊断唇腭裂具有重要的应用价值,三维超声获得空间信息多与二维超声,建议两者联合应用,以提高产前唇腭裂诊断准确度.

目的 研究超声连续追踪对凶险型前置胎盘伴胎盘植入的早期诊断价值.方法 选取2019年4月-2021年4月我院接诊62例凶险型前置胎盘患者为观察组,其中伴胎盘植入22例,未伴胎盘植入40例,并选取同期我院接诊的60例非凶险型前置胎盘孕妇为对照组.比较两组孕妇不同孕囊位置情况、不同孕周孕妇与胎盘距宫颈内口距离情况、孕22～26周孕妇胎盘距宫内口<50 mm中前壁胎盘与后壁胎盘发生情况、孕30～32周前壁和后壁胎盘孕妇不同胎盘类型发生情况.结果 观察组孕妇孕早期孕囊位置在宫腔下1/2发生率大于对照组,差异有统计学意义(P<0.05);观察组孕14～20周胎盘距宫内口<30 mm发生率大于对照组,孕22～26周胎盘距宫内口<50 mm发生率大于对照组,差异有统计学意义(P<0.05);伴胎盘植入孕妇前壁胎盘发生率高于未伴胎盘植入孕妇及对照组,后壁胎盘发生率低于未伴胎盘植入孕妇及对照组,差异有统计学意义(P<0.05);孕30～32周,前壁胎盘孕妇中央型胎盘发生率高于后壁胎盘,部分型、边缘型胎盘发生率均低于后壁胎盘,差异有统计学意义(P<0.05).结论 连续超声追踪可显示不同孕期孕囊位置、胎盘距宫颈内口距离、胎盘位置以及胎盘类型,为凶险型前置胎盘伴胎盘植入诊断提供可靠的参考依据,有助于临床早期防范,改善妊娠结局.

目的:研究在高危妊娠中应用胎儿脐血流以及胎心监护监测的预测效果.方法:选取2017年4月～2020年4月我院产科收治的高危妊娠孕产妇140例作为研究对象,根据脐血流S/D值检测和胎心监测结果,将这些患者分为四组,包括正常组(44例)、胎心异常组(24例)、S/D值异常组(34例)以及双异常组(38例).进行胎心检测、脐血流S/D值检测,观察分娩情况.结果:双异常组不良妊娠发生率显著高于其它三组,P<0.05;正常组新生儿Apgar评分均为8-10分,显著高于其它三组,P<0.05;双异常组新生儿Apagar评分8-10分占比为81.58％,与胎心异常组、S/D异常组比较,P>0.05;脐动脉S/D与胎心监护联合诊断的灵敏度、特异度优于单纯使用脐动脉血流S/D值测定及胎心监护,差异有统计学意义P<0.05.结论:在高危妊娠妇女中进行胎儿脐血流监测和胎心监测,具有无创、可重复性操作,有助于了解产妇可能发生的不良妊娠结局,可提前做好防治措施.

目的 应用产前超声观察不同孕周男性胎儿尿道海绵体部线样回声的形态及其长度,探索各测值与孕周的关系,以期能够辅助诊断胎儿尿道下裂.方法 收集285例孕周为19～37周的正常男性胎儿.使用二维超声生殖器矢状面测量正常男性胎儿尿道海绵体部长度,三次测量取平均值.当胎儿外生殖器形态异常,可疑尿道下裂时,观察胎儿尿道线样回声能否达到阴茎末端,同时测量尿道长度.应用SPSS 22.0软件统计分析.结果 男性胎儿尿道海绵体部长度均随孕周变化,呈线性相关(R2=0.92,P＜0.001),经线性回归分析可建立线性方程为:Y(mm)=2.0X-20.2(孕周为自变量X,胎儿尿道海绵体部长度为因变量Y).可疑尿道下裂胎儿尿道线样回声中断,未达阴茎末端,同时海绵体部尿道长度低于95％可信区间.结论 男性胎儿的海绵体部尿道长度与孕周呈线性相关.海绵体部尿道的观察和测量有助于诊断尿道下裂.

目的 利用超声测量不同孕周胎儿子宫的前后径及横径,建立胎儿期子宫前后径及横径与孕周的关系.方法 收集285例19～37孕周的女性胎儿,横切面超声扫查,于胎儿低位盆腔内、膀胱与直肠之间测量其子宫前后径及横径,三次测量取平均值,利用SPSS 22.0软件进行统计分析.结果 胎儿子宫前后径及横径均随孕周增加而增长,呈线性相关(R2=0.919,P＜0.001;R2=0.920,P＜0.001),经线性回归分析建立胎儿子宫前后径及横径与孕周的线性回归方程:子宫前后径(mm) =0.45×孕周-4.9,子宫横径(mm)=0.51×孕周-3.8;同时提供了各孕周胎儿子宫前后径及横径的均数、标准差及95％可信区间.结论 女性胎儿子宫在孕19周后产前超声扫查可显示,其前后径及横径与孕周呈线性正相关.

Background: To develop an ultrasonographic dating formula for predicting gestational age (GA) based on fetal crown–rump length (CRL) in a Chinese population, evaluate its systematic prediction error and compare it with existing formulae. Methods: This was a prospective cross-sectional study of spontaneously conceived singleton pregnancies among women with a regular menstrual cycle in the preceding year. Ultrasound examinations were performed at 11–14 weeks according to the date of the last menstrual cycle. The CRL was measured three times for each fetus, and the mean was used to derive the best-fit fractional polynomial regression model for estimation of GA in relation to CRL. For each fetus, the GA was compared with the GA calculated using six established dating formulae based on CRL measurements. The means of the differences between estimated and menstrual age were calculated for each formula. All the women were followed up routinely until the birth of the fetus. Results: Of the 4710 subjects recruited, the mean and standard deviation values of CRL changed linearly with GA. The corresponding regression equation and its correlation coefficient (R 2 ) was GA = 59.361513 + 0.461425 ´ CRL (R 2 = 0.8028). The mean difference between estimated and menstrual age was 0.22 days (95% confidence interval 0.05–0.21), lower than that of the six existing CRL dating formulae. Conclusions: We have derived a CRL-based dating formula suitable for naturally conceived pregnancies for GA between 11+0 and 13+6 weeks. The formula has no systematic prediction error, comparing favorably with the existing published dating formulae.

孕妇,27岁,孕2产1,孕24周.外院超声检查提示胎儿腹腔囊性包块.我院超声检查:胎儿双顶径6.2 cm,股骨长4.5 cm,胎儿上腹腔偏右侧腹主动脉前方见一大小2.6 cm×1.0 cm囊性包块(图1),边界清,形态略不规整,内见无回声,与胃泡未见相通,胃泡大小2.3 cm × 1.2 cm.超声提示:上腹腔囊性包块,建议进一步除外淋巴管瘤.孕32周超声检查:胎儿双顶径8.1 cm,股骨长6.3 cm,腹壁回声连续,胎儿胃泡水平,下腔静脉与腹主动脉间见一大小1.5 cm×0.6 cm囊性包块(图2),边界清,内见液性无回声.超声提示:中期妊娠,单胎;胎儿腹膜后囊性包块.患儿足月生产后36 d行经腹三维超声检查:左上腹后壁胃小弯旁见一大小3.7 cm×3.2 cm×2.8 cm囊性包块,边界清,壁略厚,内见液性无回声伴团状高回声(图3).超声提示:左上腹后壁囊性包块,建议进一步除外畸胎瘤.产后40 d行MRI检查:胰腺受压改变,胰腺后方见混杂信号包块,以长T1长T2为主,内见脂肪信号及软组织影,最大截面约2.9 cm× 2.5 cm×3.3 cm(图4);提示胰腺后方包块,畸胎瘤?实验室检查:甲胎蛋白1043 ng/ml.患儿行腹膜后肿物切除术,术中见类球形肿物,有毛发组织,肿物位于右腹膜后,包膜完整,肿物前方为胰腺,后方为脊柱并横跨脊柱,肿物根部血管丰富成网且有较大血管,术中诊断为畸胎瘤.病理诊断:腹腔实性成熟性畸胎瘤.

INTRODUCTION:Three-dimensional (3D) sonography combined with tomographic ultrasound imaging (TUI) to observe placental vascular anastomoses in monochorionic diamniotic (MCDA) twin pregnancies was evaluated. METHODS:Women with MCDA twin pregnancies at a gestational age of 16-32 weeks were enrolled in this retrospective study. Placental anastomoses were detected using two-dimensional (2D) and 3D sonography. Two-dimensional data were obtained by color and spectral Doppler and 3D data with high-definition flow within the area between twins' umbilical cord insertions. Volume post-processing using TUI mode identified anastomoses. Anastomotic findings on ultrasound were compared with fetoscopic surgery or postnatally injected placentas for diagnostic value. Anastomoses detection was compared between the two imaging modalities. RESULTS:Seventy-six twin pregnancies were analyzed: 11 selective intrauterine growth restrictions (sIUGR), 10 twin-to-twin transfusion syndrome (TTTS), and 55 without complications. Seventy-one twin pregnancies had arterio-arterial (AA) anastomoses and 75 had arterio-venous (AV) anastomoses. Three-dimensional sonography combined with TUI was more sensitive (87.3%) and accurate (88.2%) in detecting AA anastomoses than 2D sonography (74.6%, 76.3%, respectively; P < 0.05), but had comparable sensitivity for AV anastomoses. The specificity of both modalities for anastomoses was 100%. The detection rate of AA anastomoses by 3D modality was (40%) TTTS vs. (87.3%) normal (P < 0.05), but comparable (90.9%) for sIUGR. The detection rates of AV anastomoses (90%, 81.8%) in TTTS and sIUGR were comparable with (87.3%) normal (P > 0.05). DISCUSSION:Three-dimensional sonography combined with TUI highlighted placental anastomoses and may be useful for the clinical diagnosis and therapy of MCDA twin complications.

胎儿胰腺发育异常如环状胰腺(annular pancreas,AP)可影响胎儿生长.胎儿AP与宫内生长受限、妊娠糖尿病和遗传等因素有关.本研究通过产前超声观察胎儿胰腺,探究其测量胎儿胰腺周长(pancreas circumference,PC)的可行性,并构建不同胎龄胎儿PC与孕周(gestational age,GA)正常参考值范围,分析PC与GA及孕妇腹围(abdominal circumference,AC)的相关性.

目的 总结产前诊断胎儿膀胱外翻的声像图特点,提高对该疾病的认识,减少漏诊和误诊.方法 回顾性分析7例胎儿膀胱外翻的产前超声图像,并与引产结果进行对比.结果 膀胱外翻的产前超声图像特点是胎儿双肾正常,羊水量充足,但动态观察盆腔内未显示正常充盈的膀胱.有时可发现下腹壁缺损和向外膨出的包块,此时腹壁脐带入口偏低.另外,膀胱外翻常合并生殖器的异常.结论 膀胱外翻作为一种罕见的先天性畸形,产前超声对其诊断具有非常重要的价值.当胎儿双肾正常,羊水量充足时,动态观察盆腔内无正常充盈的膀胱应引起足够重视,避免漏诊和误诊.

病例1,孕妇30岁,孕1产0,孕11+2周.外院超声提示胎儿异常.超声检查:宫腔内可见1个妊娠囊,囊内见双胎儿,腹侧相对,相对位置始终不变;胎儿头臀长分别约4.0 cm、3.9 cm,颅骨光环完整,颅内及胸腹腔内结构显示不清,胸腹处分界不清(图1A),无胎心搏动,双上肢及双下肢均可见;周身皮肤呈水肿状态;宫内可见1个胎盘.三维超声示两胎儿胸腹部紧贴(图1B).超声诊断:宫内妊娠,联体双胎(胸腹联体),胎死宫内.行引产术,大体病理所见支持超声诊断.

病例 孕妇,35岁,孕1产0,妊娠17周2天.超声检查:宫腔内见一单活胎,胎头轮廓完整,脑中线居中,双顶径3.6 cm.脊柱显示至胸腰段后回声中断,前凸侧弯.胎腹空虚,腹壁回声不连续,广泛缺损,肝脏及胃、肠管外翻,均暴露于腹腔外(图1).肝与胎盘之间仅见两根脐血管相连,脐带过短,长度仅为3.3 cm,且无螺旋(图2).双侧肱骨、股骨可见,股骨长1.9 cm.胎儿双下肢并拢僵直,双足外翻,动态观察无明显变化(图3).胎盘附着于子宫后壁,成熟度0级.羊水最大深度2.1 cm.胎体表面可见条带样羊膜回声,胎儿部分结构位于羊膜与宫壁间(图4).

Objective To compare serum placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) concentrations among women with pre-eclampsia and healthy control women and to evaluate the associations of serum PlGF and sFlt-1 with fetal and uterine artery Doppler indices in pre-eclampsia. Methods A prospective cross-sectional study of 33 women with pre-eclampsia and 33 normotensive pregnant women attending a university hospital in China between January and November 2014. Serum PlGF and sFlt-1 were assayed by enzyme linked immunosorbent assays. Doppler indices of the uterine artery, umbilical artery, fetal middle cerebral artery, and ductus venosus were measured. Results The pulsatility index of the uterine artery was negatively correlated with PlGF (r, -0.487; P=0.004) and positively correlated with sFlt-1 (r, 0.420; P=0.015). Gestational age at birth was positively correlated with PlGF (r, 0.601, P<0.001) and negatively correlated with sFlt-1 (r, -0.568; P=0.001). Birth weight was positively correlated with PlGF (r, 0.555; P=0.001) and negatively correlated with sFlt-1 (r, -0.552; P=0.001). Apgar score was negatively correlated with sFlt-1 (r, -0.427; P=0.017). Conclusion Lower PlGF and higher sFlt-1 levels in maternal serum were significantly associated with increased uterine arterial impedance in pre-eclampsia.

Purpose This study was undertaken to evaluate the performance of indirect sonographic signs in detecting partial agenesis of the corpus callosum (pACC) at midgestation, focusing on the cavum septum pellucidum (CSP) ratio. Methods A retrospective case-controlled study of singleton pregnancies was conducted, examining fetuses diagnosed with isolated pACC and normal controls. At midgestational age, fetal head volumes were imaged with 3D US and stored for the evaluation of indirect sonographic findings in axial planes. Results Fifteen normal and 15 abnormal fetuses (with pACC) were analyzed. Based on a CSP ratio < 1.5, detection of pACC increased from 66.7% (10/15) to 80% (12/15). All indirect signs proved highly suspicious for pACC (risk ratios > 1). Conclusion Use of indirect sonographic signs to screen for pACC at midgestation is challenging. However, a low CSP ratio may improve the detection rate, serving as a new indirect sign.

OBJECTIVES:This retrospective study was undertaken to examine fetuses with dilated cavum septi pellucidi (CSP) as an isolated finding and to identify factors impacting postnatal outcomes. STUDY DESIGN:Fully documented cases of dilated CSP as a sole prenatal defect were selected for study. Recorded data included serial sonographic examinations, fetal MRI studies, chromosomal testing, screening for infection, and postnatal follow-up. Fetal subjects were further stratified by gender, gestational age at diagnosis (<28 w or ≥28 w), CSP width at diagnosis (<10 mm or ≥10 mm), evolution at term (persistent vs non-persistent CSP), and postnatal MRI diagnosis (presence/absence of CSP cyst). Chi-square or Fisher's exact test (as appropriate) was used to compare categorical variables and patient groups. RESULTS:A total of 48 fetuses met our inclusion criteria, none exhibiting chromosomal abnormalities. Six (12.5%) of these 48 were subsequently diagnosed with neurodevelopmental delays. However, such delays were unrelated to any categorical variable listed above (p > 0.05). CONCLUSIONS:Dilated CSP as an isolated prenatal finding by ultrasound or MRI carries a low risk of chromosomal abnormalities but a high risk of neurodevelopmental delay. These perils should be adequately conveyed to the parents of such infants.

BACKGROUND Heart defects are the most common congenital malformations in fetuses. Fetal cardiac structure and function abnormalities lead to changes in ventricular volume. As ventricular volume is an important index for evaluating fetal cardiovascular development, an effective and reliable method for measuring fetal ventricular volume and cardiac function is necessary for accurate ultrasonic diagnosis and effective clinical treatment. The new intelligent spatiotemporal image correlation (iSTIC) technology acquires high-resolution volumetric images. In this study, the iSTIC technique was used to measure right ventricular volume and to evaluate right ventricular systolic function to provide a more accurate and convenient evaluation of fetal heart function. AIM To investigate the value of iSTIC in evaluating right ventricular volume and systolic function in normal fetuses. METHODS Between October 2014 and September 2015, a total of 123 pregnant women received prenatal ultrasound examinations in our hospital. iSTIC technology was used to acquire the entire fetal cardiac volume with off-line analysis using QLAB software. Cardiac systolic and diastolic phases were defined by opening of the atrioventricular valve and the subsequent closure of the atrioventricular valve. The volumetric data of the two phases were measured by manual tracking and summation of multiple slices and recording of the right ventricular end-systolic volume and the right ventricular end-diastolic volume. The data were used to calculate the right stroke volume, the right cardiac output, and the right ejection fraction. The correlations of changes between the above-mentioned indices and gestational age were analyzed. The right ventricular volumes of 30 randomly selected cases were measured twice by the same sonographer, and the intraobserver agreement measurements were calculated. RESULTS Among the 123 normal fetuses, the mean right ventricular end-diastolic volume increased from 0.99 +/- 0.34 mL at 22 wk gestation to 3.69 +/- 0.36 mL at 35+ 6 wk gestation. The mean right ventricular end-systolic volume increased from 0.43 +/- 0.18 mL at 22 wk gestation to 1.36 +/- 0.22 mL at 35+ 6 wk gestation. The mean right stroke volume increased from 0.62 +/- 0.29 mL at 22 wk gestation to 2.33 +/- 0.18 mL at 35+ 6 wk gestation. The mean right cardiac output increased from 92.23 +/- 40.67 mL/min at 22 wk gestation to 335.83 +/- 32.75 mL/min at 35+ 6 wk gestation. Right ventricular end-diastolic volume, right ventricular end-systolic volume, right stroke volume, and right cardiac output all increased with gestational age and the correlations were linear (P < 0.01). Right ejection fraction had no apparent correlation with gestational age (P > 0.05). CONCLUSION Fetal right ventricular volume can be quantitatively measured using iSTIC technology with relative ease and high repeatability. iSTIC technology is expected to provide a new method for clinical evaluation of fetal cardiac function.

Purpose The purpose of this study was to measure the maximal width, middle width, and length of the cavum septi pellucidi (CSP) in normal fetuses, and compare these measurements obtained in the transthalamic (TT) plane with those obtained in the transventricular (TV) plane. Method A prospective study was conducted of normal singleton fetuses, ranging from 18 to 36 weeks in gestational age. In each case, a three-dimensional volume of the fetal head was obtained in the TT plane for further offline measurements, then the maximal width, middle width, and length of the CSP in both the TT and TV planes were measured. Intraobserver and interobserver reproducibility was assessed, and curve estimation was used to assess the possible relationship between these measurements of CSP and gestational age (GA). Results A total of 267 normal fetuses were studied. The CSP width and length in TT and TV planes as a function of GA were analyzed using a quadratic regression model. Intraobserver and interobserver agreement of the CSP measurements was excellent overall (ICCs >0.9), with intraobserver and interobserver differences of less than 4%. Conclusion Measurements of CSP in the TT and TV planes are equally reproducible.

BACKGROUND Muscular atrophy is the basic defect of neurogenic clubfoot. Muscle atrophy of clubfoot needs more scientific and reasonable imaging measurement parameters to evaluate. The Hippo pathway and myostatin pathway may be directly correlated in myogenesis. In this study, we will use congenital neurogenic clubfoot muscle atrophy model to verify in vivo. Further, the antagonistic mechanism of TAZ on myostatin was studied in the C2C12 cell differentiation model. AIM To identify muscle atrophy in fetal neurogenic clubfoot by ultrasound imaging and detect the expression of TAZ and myostatin in gastrocnemius muscle. To elucidate the possible mechanisms by which TAZ antagonizes myostatin-induced atrophy in an in vitro cell model. METHODS Muscle atrophy in eight cases of fetal unilateral clubfoot with nervous system abnormalities was identified by 2D and 3D ultrasound. Western blotting and immunostaining were performed to detect expression of myostatin and TAZ. TAZ overexpression in C2C12 myotubes and the expression of associated proteins were analyzed by western blotting. RESULTS The maximum cross-sectional area of the fetal clubfoot on the varus side was reduced compared to the contralateral side. Myostatin was elevated in the atrophied gastrocnemius muscle, while TAZ expression was decreased. They were negatively correlated. TAZ overexpression reversed the diameter reduction of the myotube, downregulated phosphorylated Akt, and increased the expression of forkhead box O4 induced by myostatin. CONCLUSION Ultrasound can detect muscle atrophy of fetal clubfoot. TAZ and myostatin are involved in the pathological process of neurogenic clubfoot muscle atrophy. TAZ antagonizes myostatin-induced myotube atrophy, potentially through regulation of the Akt/forkhead box O4 signaling pathway.