Objective To investigate the clinical value in the diagnosis of intrauterine device with three dimensional ultrasound shadow image and surface rendering technique comparatively.Methods 200 cases were scanned with shadow image and surface rendering technique separately.The quality of images obtained was compared with shadow image and surface rendering image.Results Compared to surface rendering image,shadow image had higher visibility of mirena,TCu220C and gynefix;Compared to shadow image,surface rendering mode had higher visibility of O-type IUD and uterus-type IUD.Conclusion Shadow image is an important addition of three dimensional ultrasound,especially for mirena.

Objective:To assess and to compare fetal left ventricular morphology and left ventricular diastolic function in pregnancies with diabetes and in normal pregnancies using fetal echocardiography.Methods:34 cases of fetal hearts in pregnancies with diabetes and 54 cases of fetal hearts in normal pregnancies were prospectively studied by the detailed fetal echocardiography for two times(fetus gestational age from 20 weeks to 28 weeks and 32 to 38 weeks).The parameters of mitral valve were measured and E/A ratio were calculated.Isovolumetric relaxation time,E wave deceleration time,interventricular septum thickness,left ventricular post wall thickness,left ventricular diastolic dimentions,left ventricular fractional shortening,left ventricular ejection fraction,left ventricular mass were obtained. These variables were then analyzed using an unpaired 2-tailed Student t test.Results:Fetal septal thickness and left ventricular mass in diabetic pregnancies were different from those of control group(P<0.05).The parameters of mitral valve,isovolumetric relaxation time,E wave deceleration time,left ventricular contract function had no evident difference between two groups(P>0.05).Conclusion:The fetuses of diabetic pregnancies demonstrate signs of altered left ventricular morphology and left ventricular diastolic function.Fetal septal thickness and left ventricular mass are more sensitive than other parameters to reflect the variation of fetal left ventricular morphology and diastolic function.

Objective To assess the value of transvaginal three-dimensional ultrasonography in diagnosis of distortion and malposition intrauterine contraceptive device(IUD).Methods Three-dimensional ultrasonography examinations were con- ducted in 32 patients suspected with IUD based on transvaginal two-dimensional ultrasonography scan.Through reconstruc- tion of transvaginal three-dimensional ultrasonography,the type and location of each IUD was detected,and the findings of hysteroscopy,laparoscopy or laparotomy was compared with the result of three-dimensional ultrasonography.Results Sat- isfactory three-dimensional ultrasonography images were obtained in 31 cases(96.9%)in which the type and location of IUD and the relationship between IUD and uterine cavity were distinctly shown.IUDs were removed by hysteroscopy,laparosco- py,or laparotomy successfully in 29 of the 31 cases with IUD.The findings of operation were consistent with the results of three-dimensional ultrasonography.Conclusion Transvaginal three-dimensional ultrasonography is of great value in diagno- sis the distortion and malposition of IUD.

目的应用组织多普勒成像(TDI)技术对糖尿病孕妇胎儿二尖瓣环的运动速度进行动态观察,并与正常胎儿比较,探讨其评价糖尿病孕妇胎儿左室舒张功能变化的可行性。方法分别在妊娠20～28周、32～38周,应用TDI技术测量31例妊娠糖尿病孕妇和45例正常孕妇胎儿二尖瓣环的运动速度。用传统多普勒技术测量舒张期胎儿二尖瓣血流速度,并与舒张期二尖瓣环的运动测值进行比较。结果无论在中孕期或晚孕期,应用TDI技术测量的糖尿病组胎儿Ea/Aa与正常对照组比较差异有统计学意义(P<0.05),而传统采用的二尖瓣血流E/A值两组之间差别无统计学意义(P>0.05)。结论糖尿病孕妇胎儿左室舒张功能在中孕期及晚孕期均已发生改变;TDI技术较传统多普勒技术更能敏感反映胎儿左室舒张功能的微小变化。

Objective To assess fetal left ventricular diastolic function in diabetic pregnancies by echocardiography. Methods Changes of left ventricular diastolic function in 34 fetuses of diabetic mother and 54 normal fetuses were prospectively studied by detailed fetal echocardiography for two times,respectively at fetus gestational age 20-28 weeks and 32-38 weeks. The parameters of pulmonary venous flow and mitral valve were measured and S/D, E/A were calculated. These variables were then analyzed using an unpaired 2-tailed Student t test. Results Fetal pulmonary venous flow S/D, presystolic velocity in diabetic pregnancies were different from those of control group(P(0.05)). The E/A of mitral valve had no evident difference between two groups(P(0.05)). Conclusions The fetuses of diabetic pregnancies demonstrated signs of altered left ventricular diastolic function at both medium and late periods of pregnancy. Fetal pulmonary venous flow S/D, presystolic velocity were more sensitive than mitral valve (E/A) to reflect the variation of fetal left ventricular diastolic function.

Objective To explore the operating skills and diagnostic standard of echocardiography in detecting fetal cardiac malposition. Methods The position of fetal heart was determined by observing fetal posture, location of fetal abdominal organs and the three fractions analysis method of heart. Results Eleven cases (11/12) of fetal cardiac malposition were detected by fetal echocardiography, including dextrocardia, sinistrocardia, extrathorax heart and common heart of conjoined twins. One case (1/12) of dextroversion was missed by fetal echocardiography, but found by autopsy after delivery. Conclusion Operating skill of fetal echocardiography is very important in detecting fetal cardiac malposition.

目的了解不同胎龄期正常胎儿肺静脉血流频谱的特点.方法分别在妊娠20～24周、30～34周,应用胎儿超声心动图观察100例正常胎儿心脏形态结构,系统探测了肺静脉血流,测量S波(收缩期峰值速度)、D波(舒张期峰值速度)、A谷(心房收缩期峰值速度),并计算S/D比值.部分胎儿出生后1周内随访,获得了相应肺静脉血流参数.结果肺静脉S波、D波速度随着胎龄增加而增加,S/D比值始终大于1.多数胎儿A波在多普勒波形上表现为前向较深的切迹(A谷),有2例胎儿肺静脉血流频谱未见A波显示.48例胎儿出生后复查,肺静脉血流S波、D波速度值均明显高于胎儿期.结论正常胎儿肺静脉血流频谱形态与成人明显不同.

目的探讨超声检查及判断胎儿心脏位置的方法与操作技巧.方法胎心位置异常组12例和正常对照组30名,应用胎儿腹部和心脏超声,按照胎方位、腹腔脏器位置和心脏三节段分析法判断心脏的方位.结果超声检出胎儿心脏位置异常11例,包括右位心、左旋心、胸外心脏、连体双胎共同心脏等类型,其中4例经尸检证实,1例出生后手术证实.超声漏诊右旋心1例,后经尸检发现.结论掌握正确的超声操作技巧有助于早期发现胎儿心脏位置异常,对优生优育有重要意义.

先天性心脏病在活产新生儿中的发病率为8‰,在胎儿期的发生率更高于这个数字,约在4～10%[1,2].我科自2000年初起,开展了对每一位产前超声检查的孕妇进行胎儿心脏的筛选性检查,至今已发现胎儿心脏异常近百例,严重者及时终止了妊娠,非致死型者出生后经超声心动图再次确诊并给予相应治疗,其中3例在新生儿期即进行了手术治疗.从这项工作的进程中,我们深刻体会到其重要临床意义,同时也摸索出一些经验与教训,现总结如下.

Objective: To investigate the efficacy and clinical value of prenatal echocardiographic screening for fetal congenital heart diseases. Methods: All fetuses had been scanned in four-chamber plane and two ventricular outflow tract planes. In case cardiac anomalies were detected, more detailed planes visualizing the heart and great vessels from different directions were acquired and analyzed. Results: Cardiac anomalies were detected in 25 fetuses, among whom 9 cases were confirmed by autopsy after induced labor, 8 cases by echocardiography after birth and 2 cases by operation. Conclusions: Four-chamber plane and two ventricular outflow tract planes is a simple and effective technique of prenatal echocardiolgraphic screening for fetal congenital heart diseases. It car detect most fetal cardiac anomalies (including great vessels anomalies), and should be performed as a routine means of prenatal echocardiographie screening for fetal congenital heart diseases.

在胎儿时期准确诊断和监护先天性心脏病已经成为国内外超声工作者研究的重要课题.先天性心脏病活产婴儿的发病率约8/万[1],如能在产前尽早检出胎儿严重心脏畸形并终止妊娠,对于优生优育和降低围生期死亡率具有重要意义.