The Study Of The Relationship Between The Abnormalities Of Fetal Sonographic Markers And The Outcomes Of The Fetus And Neonate

ObjectiveIn this study,we collected 49 cases of different types and different numbers of fetal abnormal ultrasound markers,including ultrasound soft markers,fetal structural abnormalities and other abnormal markers which can not be classified into the former two groups,such as liver echogenic foci and simple pleural and peritoneal effusion.Establish electronic medical records of these patients,to trace,follow-up and evaluate,and to take prenatal diagnosis if necessary.Record the outcomes of pregnancy and visit the condition of neonates.This study is aiming to analyze the relationship between these common abnormal ultrasound markers and the outcomes of fetus and neonates,especially the prognosis of the abnormal narkers with unknown clinical meanings.And finally to give scientific and well-founded clinical instructions for the patients with similar pregnant risk during prenatal consultation.Content49 cases were collected from May 2016 to December 2016 of the women who come to the General Hospital of Tianjin Medical University for their fetal ultrasound abnormalities.To establish the electronic medical records,recording the basic information,history of pregnancy,condition of the body,the result of Down's screening or noninvasive DNA screening,the results of ultrasound re-exams and the following changes.According to the risk of evaluation to take prenatal diagnosis if necessary.Cases with evident structural abnormalities and with abnormal fetal chromosome,were advised to terminate pregnancy.The formers were advised to take genetic tests of fetus after induced labor.When abnormal markers of the other cases is no deteriorating even became better,the patients can continue the pregnancy under close monitoring.To follow up and get the final outcomes of their pregnancy.The neonates are also suggested to take related genetic tests.Record the outcomes of the pregnancy and related genetic tests,including gestational age,method of labor,gender of the newborn,birth weight,the postnatal results of relevant genetic tests if they have examined,images of neonatal postnatal ultrasound reexamination and the corresponding treatments of the abnormalities if their babies have.To use Word,Excel and other softwares to input information,establishing patients' electronic medical records.To import to SPSS statistics software and take analyze.Learning the changes of these abnormal ultrasound markers,and the relationship with outcomes of fetus and neonates.Result :In this study,49 cases of fetal ultrasound abnormalities were collected.1.There are 14 cases with pure abnormal ultrasound soft markers:(1).With one abnormal soft marker and ?2 markers are both 7 cases.(2).6 out of 14 cases terminated pregnancy.3 cases are of high-risk outcomes of NIPT and their abnormal markers become deteriorated in the following weeks.2cases are of short long bones and both appeared a syndromes of fetal growth restriction and with normal fetal chromosome after induced labor.1 case is with lateral ventriculomegaly and intestine echogenic bowel which become hydrocephalus and dilated intestines.(3).8 out of 14 cases continued pregnancy till to delivery after prenatal screening and diagnosis.The prognosis of neonates is fine.2.There are 32 cases with structural abnormalities.(1).15 cases are with single structural abnormality,11 case are also with abnormal soft markers,6 cases are with ? 2 structural abnormalities or with other abnormal ultrasound markers.(2).7 out of 32 cases,which are with non-fatal structural abnormalities,continued pregnancy and with good prognosis after prenatal screening and diagnosis.(3).25 out of 32 cases terminated the pregnancy.18 cases took related genetic tests and 14 out of 18 cases with abnormal fetal chromosome.3.There are 3 cases with other abnormal ultrasound markers.(1).1 case terminated pregnancy for deterioration of abnormal markers.(2).2 cases continued pregnancy till delivery and with good prognosis.1 of them with simple mild pleural effusion and transient ventriculomegaly found mild ventricular septal defect after postnatal re-examination.4.28 out of 49 cases took related genetic tests.(1).11 of 28 cases are with normal fetal chromosomes.5 cases continued pregnancy and appeared good prognosis.6 cases terminated pregnancy for lymphatic hydrocele,acromphalus,fetal hydrops,thickened NT and severe fetal growth restriction.(2).17 cases of 28 appeared abnormal fetal chromosomes,including 21-trisomy syndrome of 4 cases,18-trisomy syndrome of 5 cases,Turner syndrome of 2cases,1 case of Klinfner syndrome,chromosome 3 aneuploidy of 1 case,chromosome microdeletion and microduplication of 3 cases,PKHD gene mutation of 1 case.5.There are 39 cases measured the NT value.29 of 39 are among the normal range(average 1.44 mm,0.7~2.9mm).10 of 39 are with thickened NT(average4.94 mm,3.1~9mm).6.8 women are older than 35 years old and all with abnormal ultrasound markers.7 cases took related genetic tests and 5 cases showed abnormal fetal chromosome.Conclusion1.In the cases of abnormal ultrasound soft markers,increased NT value and abnormal development of fetal nasal bone may be closely related with poor prognosis of fetus or neonates;echogenic bowel mostly appears accompanying with other ultrasound soft markers or structural malformations.It does not usually appear alone and has less value of diagnosis;simple shortness of long bone should be valued carefully,and be distinguished with fetal growth restriction.2.In the cases of structural malformations,lymphatic hydrocele is much common,which indicates the poor prognosis of fetus when accompanying with increased NT and fetal hydrops.In this group,there exists higher occurrence rate of fetal abnormal chromosome.Simple agenesis of kidney,simple talipes varus and axillary lymphatic hydrocele can be cured and have a good prognosis without other abnormal ultrasound markers.3.Other abnormal soft markers may indicate some minimal lesions of fetus which should be observe closely during the pregnancy and should be examined after delivery.4.For the cases of older pregnant women,with valued abnormal ultrasound soft markers,with nonlethal structural malformations,or other abnormal and equivocal markers,obstetric doctors should evaluate the pregnant risk carefully based on the prenatal lab tests,images scan and monitor the process of pregnancy.