A Study On The Diagnosis Of Facial Deformity With Early Pregnancy Fetal Craniofacial Combined With Cranial Ultrasound

1.Objective: Improve the quality of the population is a basic national policy of our country,and the birth of a healthy baby is the mother’s desire to reduce the birth of deformed children and mentally retarded children is conducive to improving the quality of the nation.Studies have shown that the majority of fetal structural abnormalities occurred 12 weeks ago,at this stage,if you carefully observe the structure of the fetus,the fetus can effectively diagnose the malformation.Therefore,if you can part of the structure of the pregnancy screening in advance to early pregnancy,it is helpful for the clinical early to determine the response plan to minimize the psychological and physical harm caused by induced labor for pregnant women.2.Methods: 2.1.Research object: 2014-2015 in 360 cases of singleton fetus in our hospital underwent routine prenatal screening,respectively ~13+6 in pregnancy 11 weeks and 22 weeks of pregnancy ~24 weeks were measured,pregnant women aged 19~40(25.6±3.2)years old,early pregnancy fetal crown rump length of 45~84mm was(62.8±8.1)mm.2.2.Instruments: select GE Voluson E8,Medison A30 color Doppler ultrasound diagnostic apparatus,convex array probe,frequency of 3MHz~5MHz,the use of routine obstetric conditions for screening.2.3.Section choice: Early pregnancy section: postnasal triangle coronal and lateral ventricle horizontal cross section,NT section,the upper lip level of coronary section;the pregnancy section: the cross section,the level of the thalamus section of mandible. o observe the S shape curve of the lower lip and chin in the median sagittal section.2.4.Measurement methods: Head and facial measurements: Yan beam by fetal forehead to enter and gradually to the caudal and ventral tilt,can be in order to show the cross section,the level of the lateral ventricles cerebellar horizontal cross section,postnasal triangle coronal and coronal nasal lip.Mandibular clearance measurement: instructing pregnant women supine,conventional transabdominal ultrasonography in coronal observation of the fetal postnasal triangle 11 weeks of pregnancy ~13+6 weeks of development,and in the fetal postnasal triangle section enlarged image,using two-dimensional ultrasound clearly showed hypoechoic gap between mandibular mandibular condyle,measure the width(Figure 1 in the fetal axis);median sagittal section,measure the natural buckling state of fetal crown rump length(CRL,crown-rump,length);22 ~24 weeks of pregnancy through the thalamus level cross section measurement of the biparietal diameter(BPD,Biparietal,diameter)in the long axis view of mandible complete display mandibular maximum diameter of the probe beam.Slightly to the side of the deflection,the local image display and the gap between the mandibular ossification point enlarged mandibular width(Figure 2),the measurements were repeated for three times.Average value.NT measurement standards: the sagittal flexion natural image magnification;fetal head and chest to occupy the instrument screen of 2/3 to 3/4,or on the top of the chest measurement of fetal skin and subcutaneous tissue layer inner outer layer with the width of the echo free distance,3 times the maximum value measurement report.Nasal bone: With the surface length in the midsagittal plane measurement of nasal hyperecho,try to make the beam direction and perpendicular to the long axis of each measurement of fetal nasal bone,3 times and report the average values.2.5.Sectional analysis: Section NT: front probe in the fetal face,amplifying fetal head and upper chest to occupy the entire screen,clearly show the facial contour,strong echo with the upper nasal long axis parallel to the skin,nose,maxilla,mandible,thalamus,dot like rhombencephali,banded neck edge clear transparent layer.Lateral horizontal plane: rotating probe of the sound beam plane enters from the fetal fetal forehead,bilateral lateral horizontal plane,hyperechoic oval skull ring,separate the left brain midline and stone cerebral hemisphere,lateral ventricle was echogenic choroid plexus filling bilateral choroid plexus,a "butterfly".The horizontal section of the cerebellum: the transverse side of the brain level of acoustic beam to the tail plane slightly skewed Skull Ring hyperechoic oval,brainstem and cerebellum,shows the posterior fossa pool is three hypoecho band parallel to each other.Postnasal triangle section: get the cerebellum plane,the sound beam to fetal caudal oblique,nasal rear triangle area showed low internal echo,namely postnasal triangle,maxillary protrusion,mandible or palate in the same plane,respectively.A blue triangle edge vertex of a triangle is about nasal section strong echo.The ball shaped strong echo is a symmetrical located below the display on the palate mandibular plane visible hypoechoic mandibular gap between the two.The level of nasolabial coronary section: obtain posterior nasal triangle plane,the beam to deflect towards the tail side,showing fetal lip coronal section,about nasal hyperechoic,below the visible network parallel echogenic lines and Bu Shangchun respectively,lips closed line,the lower lip,mandible,lip echo below the lips closed line.When the fetus appears mouth movement,can clearly show the lips.The cross section of the thalamus level: lateral ventricle plane downward translation the largest brain midline plane,coherence,1/3 visible pseudocele,thalamus in 1/3 visible on both sides of the symmetrical plane,the measurement of the biparietal diameter section of standard section. orizontal transverse view of the thalamus: the first 3 shows a transparent septum,one in the middle of the thalamus,the central line is not coherent.Mandible: showing the mandible and its space.3.results: There was no significant correlation between the craniofacial display in early pregnancy and gestational age,and the positive rate of craniofacial combined with cranial scan in the early diagnosis of craniofacial deformity was higher than that of simple facial scanning.Early pregnancy found 40 cases of fetal malformation,including 5 cases of exencephaly,holoprosencephaly in 7 cases,6 cases of 1 cases of anencephaly,encephalocele,cystic hygroma in 13 cases,4 cases of cleft lip and palate,15 cases of fetal edema,3 cases of scoliosis,4 case of cardiac abnormalities,6 cases of omphalocele,single umbilical artery 4,2 cases of echogenic bowel,4 cases of giant bladder.All the abnormal fetuses were confirmed by mid pregnancy and induced labor.In the observation of the fetal face,in the posterior part of the nose of the fetus,there was a certain regularity in the change of the mandibular space with the gestational age.11 weeks of pregnancy ~13+6 weeks fetal linear regression equation was =0.034x+0.157(r=0.532)(Figure 3),the hypothesis test of the regression coefficient(t test)results: t=10.293,P value is less than 0.001.There was a significant correlation between the fetal mandibular space and CRL at 11 weeks of gestation at ~13+6 weeks.The relationship between BPD and the mandibular gap scatter found,22 weeks of pregnancy-24 weeks fetal mandibular clearance values is not obvious change;gestational age was 22 weeks ~24 weeks fetal mandibular clearance data with normal distribution,which is maintained in a stable range,the reference value of 95% range(2.59,5.99)4.Conclusions:4.1.Early pregnancy combined with facial brain scan chubby facial deformity screening value more simple.4.2.There was a significant correlation between the fetal mandibular space and CRL at 11 weeks of gestation,and the value of ~13+6 was valuable in predicting the mandibular deformity.