Objectives: To investigate the characteristics of cervical elastosonography in pregnancies and establish an ultrasound-based combing predictor for improving the prediction in pregnant women with prior-preterm birth who might ultimately undergo preterm birth (PTB). Materials and Methods: 169 singleton pregnancies with prior-preterm birth were examined by cervical elas-tography from January to November of 2021. According to the ultrasound image and result of the following-up, the patients were separated into preterm groups and full-term groups with or without cerclage. There were five elastographic parameters: Elasticity Contrast Index (ECI), Cervical hard tissue Elasticity Ratio (CHR), External Cervical os Strain rate (ES), Closed Internal Cervical os Strain rate (CIS), CIS/ES ratio and CLmin. Multivariable logistic regression was used to screen out the most significant predictors. The area under the receiver operating characteristic curve (AUC) was calculated to evaluate the ability of prediction. Results: The PTB group without cerclage showed significantly softer cervix stiffness, while those with cerclage showed significantly harder. CHRmin with P < 0.05 in the univariate logistic regression analysis was screened as a more valuable cervical elastosonography parameter than other ones. The combination of CLmin and CHRmin in un-cerclage and integrating CHRmin, maternal age and pre-pregnancy BMI in cerclage presented good predictive value. The results of AUC were higher than CLmin, respectively (0.775 vs 0.734, 0.729 vs 0.548). Conclusions: The addition of cervical elastography parameters (such as CHRmin) might improve the ability to predict preterm birth in pregnant women with previous preterm delivery, which was better than using CL alone.& COPY; 2023 Elsevier Masson SAS. All rights reserved.

肝脏肿瘤约占围产期胎儿肿瘤的 5％;肝血管瘤约占 60％,是最常见先天性良性肿瘤,而肝母细胞瘤则为最常见先天性恶性肿瘤[1].本研究主要观察胎儿肝脏肿瘤超声表现.

This study set out to investigate a novel ultrasound parameter using cervical elastosonography for improving the prediction of spontaneous preterm birth (sPTB) in twin pregnancies. The study was comprised of 106 twin pregnancies from October 2020 to January 2022 in Beijing Obstetrics and Gynecology Hospital. They were divided into two groups according to gestational age (GA) at delivery (delivery < 35 weeks and delivery ≥ 35 weeks). There were five elastographic parameters: Elasticity Contrast Index (ECI), Cervical Hardness Ratio (CHR), Closed Internal cervical ostium Strain rate (CIS); External cervical ostium strain rate (ES), CIS/ES ratio and Cervical Length (CL). All of the clinical and ultrasonic indicators with P < 0.1 were considered candidate indicators via univariate logistic regression. Based on the extracted unified combination of clinical indicators, the combinations of permutation with the candidate ultrasound indicators were performed step by step in multivariable logistic regression. The best ultrasound indicator with the lowest Akaike Information Criterion (AIC) and the highest Areas Under the receiver operating characteristic Curve (AUC) was chosen for establishing the prediction score. Over 30% (36/106) of those who delivered before 35 weeks gestation. There were distinct differences in the clinical characteristics and cervical elastography parameters between the two groups. Seven major clinical variables were identified as a unified clinical indicator. CISmin as the best ultrasound elastography predictor indicated the lowest AIC and the highest AUC and outperformed alternative indicators significantly in the prediction of delivery before 35 weeks of gestation. Unfortunately, CLmin which was commonly used in clinical practice ranked far from all of the cervical elastography parameters and presented the highest AIC and the lowest AUC. A preliminary scoring rule was established and the ability to predict the risk of sPTB in twin pregnancies was improved (Accuracy: 0.896 vs 0.877; AIC: 81.494 vs 91.698; AUC: 0.923 vs 0.906). The cervical elastosonography predictor such as CISmin might be a more useful indicator applied for enhancing the ability in predicting twin pregnancies preterm birth than CL. Furthermore, there would be more benefits for advancing clinical decision-making in actual clinical practice by using cervical elastosonography in the near future.

目的 探讨产前超声在诊断胎儿第一二鳃弓综合征中的临床应用.资料与方法 回顾性选取2017年1月—2020年12月首都医科大学附属北京妇产医院10例产前超声诊断和出生后诊断为第一二鳃弓综合征胎儿,回顾性分析其产前超声检查中,口唇、下颌及双耳等部位的结构异常,与引产后或足月出生后的结果 相比较,并总结其超声特点.结果 典型的第一二鳃弓综合征以面横裂、小下颌、耳部结构异常为特征,其中以面横裂最常见,其次为耳部结构异常.本组所有胎儿均经引产后大体标本或出生后证实,10例确诊为第一二鳃弓综合征,其中9例产前发现异常,1例出生后发现口角裂和同侧耳屏前肉赘组织.8例产前超声显示面横裂,其中4例单侧面横裂均合并耳部结构异常,3例双侧面横裂且其中1例合并小下颌和眼异常,1例为口角裂合并同侧耳屏前肉赘组织.产前发现异常的9例病例中,1例足月出生,8例引产,结果 均与超声结果 相符合.结论 产前超声对口唇、耳部及下颌的观察,以及三维超声在颜面部的应用,为第一二鳃弓综合征的诊断提供了重要依据,并对指导孕妇做出正确决策有重要意义.

Objective To discuss prenatal ultrasonographic characteristics of placental lake-like lesions and the significance of prenatal diagnosis of these lesions. Methods Six patients with prenatal placental lake-like lesions (maximal diameter>5 cm) detected by ultrasound were selected from Beijing Obstetrics and Gynecology Hospital, Capital Medical University from February 2016 to December 2021. Their demographic data, ultrasound features, clinical diagnoses and pregnancy outcomes were retrospectively analyzed. Results All the patients had a singleton pregnancy, aged 27-33 years at diagnosis, and were initially found with placental lake-like lesions at 18 weeks and two days of pregnancy to 31 weeks and 6 days of pregnancy. Lake-like lesions with clear margins with placenta were detected by ultrasound in cases 1, 2 and 3, all of them were clinically diagnosed with massive subchorionic hematoma (MSH) , then underwent ceserean section at less than 34 weeks but greater than 33 weeks of pregnancy, less than 30 weeks but greater than 29 weeks of pregnancy, and 32 weeks of pregnancy, respectively, and all of 3 neonates had hypospadias. In case 4, a lake-like lesion with definite border protruding into amniotic cavity was found, which spontaneously disappeared in minutes. Fetal growth was unremarkable during pregnancy. In follow-up, the lesion was decreased significantly. Final diagnosis was real large placental lake. In cases 5 and 6, lake-like lesions diffusely involved most part of placenta, with decreased normal placental tissues. Both cases were complicated by early-onset fetal growth restriction (all biometric parameters<1%, abdominal circumference 2.3%) . Absence of diastolic flow in umbilical artery and notches in uterine arteries (bilateral, unilateral) were found in ultrasound examinations in both cases. Case 5 chose to terminate pregnancy at 23 weeks of pregnancy, and case 6, who was also complicated by preeclampsia, terminated pregnancy at less than 28 weeks but greater than 27 weeks of pregnancy. Clinical diagnosis for both of them was maternal vascular malperfusion (MVM) with early-onset FGR. Conclusion Placental lake-like lesions can be caused by different etiologies. Each type can be differentiated according to ultrasound characteristics. Timely prenatal diagnosis by ultrasound will benefit close monitoring of fetal status in MSH and MVM cases to prevent negative pregnancy outcomes.

目的 对比经产妇与初产妇妊娠中晚期宫颈超声弹性参数差异.方法 选取96名产妇,其中初产妇48名(初产组)、经产妇48名(经产组),追踪妊娠结局均为足月自然分娩.采用经阴道超声宫颈弹性成像获取宫颈长度(CL)、闭合段宫颈内口应变率(CIS)、宫颈外口应变率(ES)、CIS/ES、超声弹性对比指数(ECI)及宫颈硬组织弹性占比(CHR),比较组间各指标差异.结果 初产组孕晚期CL较孕中期缩短(P＜0.05),CIS和CIS/ES升高(P均＜0.05);经产组孕晚期CHR较孕中期降低(P＜0.05);孕晚期经产期CIS和CIS/ES均较初产组降低(P均＜0.05).结论 经产妇与初产妇孕期宫颈组织超声弹性参数存在一定差异,CIS、CIS/ES、CL和CHR伴随孕周增长具有不同变化特点.

目的 探讨经阴道宫颈弹性超声成像评估体外受精-胚胎移植(IVF-ET)术后双胎自发性早产的价值.资料与方法 选取IVF-ET术后双绒毛膜性双胎初产孕妇20例,其中7例分娩孕周<35周纳入早产组,13例分娩孕周>35周纳入对照组.采用经阴道超声宫颈组织弹性成像(E-Cervix模式4point测量法)同时获取并比较组间宫颈长度、闭合段宫颈内口应变率(CIS)、宫颈外口应变率(ES)、CIS/ES比值、超声弹性对比指数(ECI)及宫颈硬组织弹性占比(CHR).结果 早产组孕妇宫颈长度较对照组缩短[(1.73±0.86)cm比(2.63±0.97)cm],ECI(4.05±0.60比3.70±1.0)、ES[(0.37±0.09)％比(0.34±0.07)％]和CIS/ES比值(0.99±0.16比0.82±0.25)均升高,但差异均无统计学意义(P>0.05);早产组孕妇CIS较对照组显著升高[(0.34±0.06)％比(0.18±0.08)％],CHR显著下降[(40.3±14.63)％比(59.7±14.07)％],差异均有统计学意义(P<0.05).结论 宫颈组织超声弹性指标在评估IVF-ET术后双胎自发性早产中优于宫颈长度,其中CIS与CHR更具临床意义.

孕妇36岁,孕5产1 ,自然流产2次,中期引产2次.于10年前停经29周因胎儿肢体短小等多发畸形引产,未行胎儿尸解及遗传学检测; 6年前停经24周因胎儿肢体短小等结构异常引产,未行胎儿尸解及遗传学检测.在本次怀孕中,胎儿颈项透明层正常,唐氏筛查结果显示低风险,孕19周行羊水穿刺染色体核型分析及微阵列分析结果未见异常,夫妻双方染色体核型分析结果未见异常.于孕23周常规行胎儿系统超声检查显示:胎儿面部扁平,下颌短小(图1) ,双侧嘴角闭合欠佳(图2);左耳长1 .3cm ,右耳长1.7cm;胎儿脊柱偏短,长10 .7 cm ,胸腰段椎体排列紊乱,部分椎体融合,左侧侧弯(图3);四肢长骨明显小于孕周,肱骨长 3.1cm,股骨长3.4cm,胫骨长2.8cm,足长4.0cm;左肾大小3.0 cm×1.8cm,肾盂分离宽 1.1cm,肾盏分离宽 0.4cm,右肾大小2.5cm ×1.6cm,肾盂分离宽 1.0cm,肾盏分离宽0.4cm;未显示正常外生殖器形态.超声提示:胎儿多发结构异常:面部异常－下颌短小,面横裂?耳异常?四肢短小;脊柱异常;双肾积水;外生殖器异常;建议遗传学分析.患者及家属在知情同意后,选择终止妊娠.胎儿尸检显示:前额部膨隆,眼距宽;鼻短小,鼻梁低平,鼻根部宽大,鼻孔朝天,嘴宽而扩大呈三角形,上下唇发育不良,口唇闭合欠佳,下颌短小(图4);双侧耳位低;X线片显示胸椎9、12半椎体,胸2～5 、 7及11椎体发育不良,胸10椎体缺失,脊柱侧弯畸形(图5) ;双侧多囊肾;躯干、四肢短小,上臂长4.2cm,前臂长3.2cm,手长2.9cm,双下肢大腿长4.9 cm,小腿长5.0cm,足长 4.2cm,手指脚趾短小明显;外生殖器形态异常,未见明显阴茎,仅见一突起,体积 1 .5 cm×1.5cm×0.9cm,扪及阴茎状物,上见一小孔,挤压有

例1 孕妇,36岁,孕1产0,因原发不孕行体外授精-胚胎移植(in vitro fertilization-embryo transfer,IVF-ET)术,移植胚胎2枚,成活2枚,常规大剂量应用雌、孕激素,孕期定期产前检查.孕34周因胎儿生长受限入院治疗,37周入院剖宫产分娩一女一男双胎.早孕期超声检查提示双绒毛膜性双胎,两胎儿大小符合孕周;孕11～13+6周超声提示双胎颈项透明层(nuchal translucency,NT)测值均在正常范围内,两胎儿大小符合孕周.孕期行无创DNA检查提示低风险.孕22周超声检查提示胎儿外生殖器外观均呈现女性特征,两胎儿大小符合孕周.