Objective To evaluate the clinical value of systematic ultrasound screening for fetal abnormality in second trimester, and to analyze the causes of misdiagnosis and medical malpractice. Methods By checking up 12 682 cases of 20-24 weeks pregnant women with using systematic ultrasound screening, storied the information in the workstation, and then did the evaluate, following-up interviews and statistics. Results Six hundred sixteen cases had been diagnosed out with abnormal structure or fetal abnormality. Detection rate 4. 86％( 616/12 682 ) and 18 cases with abnormal structure were failed. Failed rate 0. 14％ ( 18/12 682 ), which were confirmed after birth. Including 2 cases with hand abnormality, 1 case with 1 degree cleft lip, 6 cases with ventricular septum defect( ≤4 mm ),1 case with tetralogy of fallot, 1 case with congenital defect of external ear, 1 case with abnormalities of the genitalia, 2 cases with cleft palate only, 1 case with strephenopodia,l case with caudal regression syndrome,l case with sacral spinal bifida with tethered cord fat, 1case with sacrococcygeal cystic spina bifida. 3 of above cases ( 1 case in caudal regression syndrome, 1 case in sacral spinal bifida with tethered cord fat, 1 case of sacrococcygeal cystic spina bifida ) caused medical malpractice after birth. There were 239 cases of the above 616 cases with fetal abnormality had abortions in our hospital,( 1 ) Necropsy 23 cases among the abortions were conformed to the ultrasound diagnosis. ( 2 ) Appearance of the abnormality 142( cleft lip 43 )cases among the abortions were conformed to the ultrasound diagnosis. ( 3 ) 61 cases had been diagnosed out with fetal visceral abnormality, without necropsy 13 cases among them were polyhydramnios or oligohydramnios. Three hundred seventy-seven exceptional cases were primary abortions, which also confirmed our diagnosis after the hospital' stelephone interview. Conclusion The systematic ultrasound screening can improve the detection rate and reduce the failed rate of the fetal abnormality.%目的 探讨中孕期系统超声筛查对检出异常胎儿的临床价值并分析漏诊和医疗纠纷原因,总结经验教训.方法 采用系统超声筛查平面对孕20～24周12 682例孕妇行中孕期超声筛查,每个胎儿资料均存放于工作站中进行系统评估及随访统计.结果 产前系统超声筛查检出结构异常胎儿616例(4.86%,616/12 682),漏诊18例(0.14%,18/12 682),均为出生后证实,包括胎手异常2例,Ⅰ度唇裂1例,室间隔缺损6例(≤4 mm),法洛四联症1例,先天性无外耳及耳道1例,外生殖器异常1例,单纯腭裂2例,足内翻1例,尾椎退化综合征1例,骶尾部脊髓脂肪膨出伴脊髓栓系1例,骶尾部囊性脊膜膨出1例.其中3例(1例尾椎退化综合征,1例骶尾部脊髓脂肪膨出伴脊髓栓系,1例骶尾部囊性脊膜膨出)胎儿出生后引发医疗纠纷.616例异常胎儿在我院引产239例,引产儿检查情况:(1)尸检23例,超声与病理检查结果均符合.(2)外观畸形142例(唇裂43例),产前超声诊断与引产后检查均符合.(3)产前超声检出胎儿内脏畸形61例,超声显示羊水过多或过少13例,引产后均未进行尸检.外院引产377例,电话随访对我院产前诊断无疑义.结论 中孕期系统超声筛查可提高胎儿结构异常或畸形检出率,减少漏诊率.
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