PRENATAL DIAGNOSIS OF CONGENITAL ANOMALIES

这一项目的目标是改进诊断和治疗 胎儿疾病。在过去，该分支机构率先使用了 薄壁胎儿宫内窥镜及内窥镜胎儿手术 多胎妊娠障碍的治疗。今年的努力是 重点检查了怀孕日期的准确性 怀孕中期。 胎龄评估是产前护理不可或缺的一部分。 年龄分配不准确会导致错误率增加 阳性和假阴性案例、诊断错误和不必要的 侵入性手术。分配持续时间的标准方法 怀孕是月经年龄，准确性取决于可靠性。 月经史的记录。然而，多达45%的孕妇患有 月经史不佳。到目前为止，最流行的替代方案 测年的方法是胎儿生物测量和超声波。围产期医学 研究部与康奈尔大学合作进行了一项研究 大学医学中心将确定胎儿生物测量的准确性 在14至22周之间预测胎儿的胎龄 基于患者数量的单胎、双胞胎和三胎妊娠 他们是通过体外受精受孕的。这样做的结果 研究表明，胎儿的头围是最大的 所有研究参数对胎龄的准确预测。这个 添加一个参数(腹围或股骨长度)或 二(腹围和股骨长度)显著改善了 仅基于头围的预测的准确性。这个 在大多数产科单位的临床实践中， LMP的胎龄与推算的胎龄相差14天以上 从怀孕中期的胎儿生物测定来看，LMP评估是 取而代之的是胎儿生物测量。我们的研究表明，当一个差异 两者之间存在超过7天的时间，生物特征预测 如果没有先天畸形或 严重的生长延迟。 这项研究的一个主要发现是，测年公式源于 单胎妊娠可用于确定多胎妊娠的日期。一个 这两个双胞胎的胎龄预测的简单平均值是 被发现是年龄的准确预测。就三胞胎而言，一个 一天可以加到妊娠最长和最短的平均值上 三胞胎中的年龄预测。我们的观察表明，胎儿 双胞胎妊娠的增长速度与单胎妊娠的增长速度相似 怀孕中期。然而，20到22周的三胞胎数据是 暗示增长减速，这一问题需要进一步 调查。我们观察到，胎龄的差异 多胎妊娠成员的预测平均为2.2天 双胞胎(最长=7.2天)和三胞胎4.2天(最长=10.8天) 天数)。因此，当多个成员之间的差异 怀孕两周或更长时间，寻找胎儿生长障碍， 先天性异常，或测量误差是合理的。

The goal of this project is to improve the diagnosis and treatment of fetal disease. In the past, the Branch has pioneered the used of thin-gauge embryo-fetoscopy and endoscopic fetal surgery for the treatment of disorders of multiple gestation. This year the effort was focused on examining the accuracy of dating of pregnancy in the midtrimester. Gestational age assessment is an integral part of prenatal care. Inaccurate age assignment results in an increase in the rate of false positive and false negative cases, diagnostic errors, and unnecessary invasive procedures. The standard method of assigning duration of pregnancy is menstrual age and accuracy is dependent upon the reliability of menstrual history. However, as many as 45% of pregnant women had sub-optimal menstrual history. By far, the most popular alternative method of dating is fetal biometry with ultrasound. The Perinatology Research Branch conducted a study in collaboration with the Cornell University Medical Center to determine the accuracy of fetal biometry between 14 and 22 weeks in the prediction of gestational age in singleton, twin and triple gestations based upon population of patients who conceived as a result of in vitro fertilization. The results of this study demonstrated the size of the fetal head circumference was the most accurate predictor of gestational age of all parameters studied. The addition of one parameter (abdominal circumference or femur length) or two (abdominal circumference and femur length) significantly improved the accuracy of the prediction based on head circumference alone. The clinical practice in most obstetrical units is that discrepancy between gestational age by LMP disagrees by more than 14 days with that derived from fetal biometry in the second trimester, the LMP assessment is superseded by fetal biometry. Our study suggests that when a discrepancy of more than 7 days exists between the two, the biometric prediction should be given preference, provided there is no congenital anomaly or severe growth delay. A major finding of the study was that the dating formulae derived from singleton gestations can be used for dating multiple pregnancies. A simple average of the gestational age prediction of the two twins was found to be an accurate predictor of age. In the case of triplets, one day can be added to the average of the longest and shortest gestational age prediction among the triplets. Our observations imply that fetuses of twin gestations grow at a similar rate to singleton gestations during the midtrimester. However, data on triplets between 20 and 22 weeks is suggestive of a deceleration of growth, an issue which requires further investigation. We observed that the difference in the gestational age prediction among members of a multiple gestation averaged 2.2 days for twins (maximum = 7.2 days) and 4.2 days for triplets (maximum = 10.8 days). Therefore, when the difference among members of multiple gestation is two weeks or more, a search for fetal growth disorders, congenital anomalies, or a measurement error is justified.