目的   探讨孕中晚期口腔二维轴向切面超声在产前诊断胎儿唇腭裂中的应用价值，评估其对唇裂、唇腭裂及继发腭裂的检出率和准确性。方法   本研究为前瞻性研究，共纳入2020年3月—2023年12月在我院超声科行产前超声诊断的3 666例孕中晚期胎儿，其中经超声检查诊断出111例唇腭裂，这些病例归为唇腭裂组，其余3 555例归入正常对照组。所有受试者均通过口腔二维轴向切面超声进行评估，诊断结果经产后随访确认。结果   在正常对照组中，上唇及上牙槽突的评估成功率为100%，软硬腭分界线显示率为99%，软腭显示率为85%。在唇腭裂组中，超声对唇裂、唇腭裂及继发腭裂的检出率分别为45%、48%和7%，且超声诊断的灵敏度、特异度和预测值均超过98%。结论   孕中晚期口腔二维轴向切面超声在产前诊断胎儿唇腭裂中具有较高的准确性和可靠性，为早期干预和临床管理提供了重要的影像学依据。

       Objective  To explore the application value of two-dimensional axial section ultrasound in prenatal diagnosis of fetal cleft lip and palate in the second and third trimesters of pregnancy，and to evaluate its detection rate and accuracy for cleft lip，cleft lip and palate，and secondary cleft palate．Methods  This study is a prospective study that included 3 666 fetuses in the second and third trimesters of pregnancy．Among them，111 cases of cleft lip and palate were diagnosed by ultrasound examination．These cases were classified as the cleft lip and palate group，and the remaining 3 555 cases were classified as the normal control group．All subjects were evaluated by oral two-dimensional axial section ultrasound，and the diagnostic  results were confirmed by postpartum follow-up．Results  In the normal control group，the success rates of evaluating the upper lip and upper alveolar process were 100%．The present rate of the soft hard palate boundary was 99%，and the present rate of the soft palate was 85%．In the cleft lip and palate group，the detection rates of cleft lip，cleft lip and palate，and secondary cleft palate by ultrasound were 45%，48% and 7% respectively，and the sensitivity，specificity，and predictive value of ultrasound diagnosis exceeded 98%．Conclusions  Two dimensional axial section ultrasound of the oral cavity in second and third trimesters of pregnancy has high accuracy and reliability in prenatal diagnosis of fetal cleft lip and palate，providing strong imaging evidence for early intervention and clinical management．

目的 探讨宫腔积血对于中晚期妊娠结局的影响以及影响的因素。方法 结合477例中晚期宫腔积血孕妇的临床资料分析,根据妊娠结局分为正常妊娠结局组(NP)及不良妊娠结局组(AP)。结果 AP的平均孕周(23.22±6.87周)明显大于NP(16.11±4.76周),两组有明显差异性(P<0.001)。两组首次B超宫腔积血平均体积分别为8.01(2.22~28.67)(NP),13.05(3.54~26.34)mL(AP)(P=0.001),但相邻第二次测量结果两组相差不大(P=0.230)。AP组中胎盘下血肿的比率(53.4%)明显大于NP组(24.2%),而绒毛膜下血肿比率(44.0%)明显小于NP(73.8%),两组有明显差异性(P<0.001)。宫缩也是影响因素之一,在AP组可扪及宫缩的病例(88例55.3%)明显高于NP(38例11.9%),两组有明显差异性(P<0.001)。但在阴道流血率方面两组没有明显差异(P=0.407)。结论 妊娠中晚期宫腔积血可能会导致不良妊娠结局,而首次出现的孕周,急性大量宫腔出血、宫腔积血位置以及是否伴有宫缩都是影响妊娠结局的重要因素。

Objective To study the poor pregnancy outcomes of patients with intrauterine hematoma in the second and third trimesters, and discuss the risk factors. Methods We analyzed the clinical data of 477 patients who underwent routine examination in our hospital from January 2010 to June 2016 and classified them into normal pregnancy (NP) group and adverse pregnancy (AP) group according to their pregnancy outcomes. Results Gestational age at first detection of hematoma of AP group(23.22±6.87 weeks) was more than NP group (16.11±4.76 weeks)(P<0.001). The volumes of hematoma during the first detection were significantly different between the two groups (P=0.001).The average hematoma volume were 8.01(2.22-28.67)(NP),13.05(3.54-26.34)mL(AP)respectively. However, the hematoma volumes recorded in the second B-ultrasound examination were not significantly different between the two groups (P=0.230). In the AP group, the incidence of retroplacental hematoma (53.4%) was significantly higher than in the NP group (24.2%), while the incidence of subchorionic hematoma (44.0%) was significantly lower than in the NP group (73.8%)(P<0.001). The incidence of palpable contractions in the AP group (62.8%) was significantly higher than in the NP group (12.1%), P<0.001. However, the incidence of vaginal bleeding was similar (P=0.407). Conclusion Intrauterine hematoma in the second and third trimester may lead to adverse pregnancy outcomes. Risk factors for poor pregnancy outcomes are included gestational age at first diagnosis, acute and large intrauterine bleeding, location of hematoma and accompanying contraction.