1、妇儿超声检查手册超声正常值妇儿超声检查手册(超声正常值)来源: 点击:221发布时间:2014-10-27 14:54:21核心提示:美中宜和妇儿医院超声检查手册一、正常早孕期1 孕龄计算公式 孕天数=胎囊平均内径(长+宽+厚) 3(mm) +303天2 孕龄计算公美中宜和妇儿医院超声检查手册一、正常早孕期1. 孕龄计算公式 孕天数=胎囊平均内径(长+宽+厚)/3(mm) +303天2. 孕龄计算公式 孕天数=孕囊最大经线+3天此两个测量公式适用于孕7周之内,但有一定误差。3. 孕龄(天)=CRL+424. 孕龄(周)=CRL+6.5此两公式适用于孕7-12周。测量时不包括卵黄囊及肢体,取胚胎
2、躯体最长最直的正中矢面图,测量最长经线,最好取三次测量平均值。5. 胎囊每日生长速度:1-1.5mm/d6. 正常早中期超声孕周可见孕周胚胎大小mm正常超声所见5可见小胎囊及卵黄囊,胎囊约占宫腔1/463.2胎囊清晰可见,可见卵黄囊、胎芽及胎心79.3清楚可见胎芽、胎心,胎囊约占宫腔1/3815.7可区分胎头、胎体,胎囊约占宫腔1/2,可见蠕动922.6胎囊几乎占满宫腔,胚胎轮廓清晰,胎头、脑泡及肢芽可见1030.7胚胎肢芽清晰可见,活跃于羊水中,胎盘开始形成1140.6胎囊完全消失,胎盘清晰可见,四肢骨,指趾清晰可见1252.8胎儿颅骨光环清晰,脊柱及四腔心可见 简单记忆:5囊6芽7心8动9
3、胎盘7. 胎儿停止发育胎囊平均内径2.5cm,未见胎芽或胎芽长0.6cm,未见胎心搏动。注意:观察胎心搏动要在2分钟以上8. 胎儿妊娠结局不良(1)孕囊平均内径-CRL5mm(2)孕早期胎心率80bpm9. 胎儿NT增厚测量范围:头臀长44mm-85mm 相当于孕11周2天-14周3天 正常NT3.0mm 50%的21三体,25%的18三体及10%的turner综合症NT或NF增厚 对于高龄孕妇(年龄大于35岁),唐氏高危者,孕11-12周,NT2.5mm,考虑增宽。二、产前筛查(孕11-14周)要求 测量胎儿头臀长并估计孕周 胎儿矢状面测量NT厚度和鼻骨的显示 胎儿侧脑室显示显示胎儿心脏、胃
4、泡显示胎儿四肢 此期可筛查出的畸形:无脑儿、全前脑、脑膨出、四肢异常、NT增厚 如果检查胎儿NT增厚,注意胎儿鼻骨有无缺失或过短,有无三尖瓣反流。NT增厚应建议做羊穿检查。三、孕中期胎儿筛查要求1、 头部(1)颅骨大小:双顶径平面测量形态:正常为椭圆形,无局部突出或缺失,无柠檬头或草莓头完整性:无骨质缺损骨密度:回声过弱或过强应考虑颅骨质矿化问题,如成骨不全、低磷酸酯酶症等。(2)脑结构侧脑室水平横断面:观察脑中线、脉络丛、侧脑室、透明隔丘脑水平横断面:丘脑、透明隔、经小脑横切面:小脑横径、小脑蚓部、大脑延髓池颅底横切面:大脑脚 Wellis环颅脑正中矢状切面:丘脑、胼胝体2、 脊柱 显示整个
5、脊柱颈椎、胸椎、腰椎、尾椎(矢状、冠状切面)膀胱水平横切面显示三个骨化中心的排列3、 面部上唇的完整性、双眼眶、面部轮廓、口唇、鼻孔矢状面显示鼻骨4、 颈部观察颈部有无肿物,如颈部水囊瘤或畸胎瘤5、 胸部胸廓形态规则,肋骨自然弯曲,无短肋;双肺回声均匀,无纵膈或肿物;膈肌呈线状回声,分隔胸腹部脏器。6、 心脏正常四腔心,对称,左右室流出道,无膈疝证据,心率7、 腹部胃泡位置正常,肠管无扩张,双肾、膀胱均显示;脐带腹壁入口处可见8、 肢体显示双上肢、双下肢、双手、双足及其连接关系9、 其他胎盘:位置,有无肿物及副胎盘 宫颈内口长度、形态脐带:三根血管外生殖器、宫颈、子宫形态及附件(斜体部分为产前
6、诊断要求)四、胎儿生物测量正常值1、胎儿头臀长与孕周孕周CRL孕周CRL孕周CRL孕周CRL孕周CRL10周0天3.0511周0天4.0512周0天5.2513周0天6.6514周0天7.9510周1天3.1511周1天4.1512周1天5.4513周1天6.7514周1天8.0510周2天3.3511周2天4.4512周2天5.6513周2天7.0514周2天8.3510周3天3.4511周3天4.5512周3天5.8513周3天7.1514周3天8.4510周4天3.5511周4天4.6512周4天5.9513周4天7.3514周4天8.5510周5天3.7511周5天4.8512周5天6
7、.2513周5天7.5514周5天8.7510周6天3.8511周6天5.0512周6天6.3513周6天7.6514周6天8.852、正常胎儿双顶径、头围、腹围、股骨长(medison)孕周双顶径头围腹围股骨长131.90-2.347.2-8.86.3-7.41.00-1.33142.35-2.748.9-10.407.5-8.61.34-1.66152.78-3.1710.45-11.958.7-9.81.67-1.99163.18-3.5511.96-13.49.9-11.02.00-2.30173.56-3.9113.45-14.7911.1-12.22.31-2.59183.92-4
8、.2614.8-16.1912.3-13.42.61-2.90194.27-4.6016.2-17.3913.5-14.62.91-3.19204.61-4.9317.40-18.5914.7-15.73.20-3.46214.95-5.2418.60-19.7515.8-16.93.47-3.74225.25-5.5419.76-20.8417.0-18.03.75-4.00235.55-5.8420.85-21.8918.1-19.14.01-4.26245.85-6.1421.90-22.8919.2-20.34.27-4.49256.15-6.4122.90-23.8920.4-21.
9、44.50-4.74266.42-6.6823.90-24.8021.5-22.54.75-4.99276.69-6.9424.81-25.6922.6-23.65.00-5.25286.95-7.2025.70-26.5923.7-24.75.26-5.47297.21-7.4626.60-27.4024.8-25.75.48-5.69307.47-7.6927.40-28.1925.8-26.85.70-5.94317.70-7.9528.20-28.9026.9-27.85.95-6.15327.96-8.1929.00-29.7027.9-28.96.16-6.36-338.20-8.
10、4229.80-30.4929.0-30.06.37-6.59348.43-8.6530.60-31.2030.1-30.96.60-6.79358.66-8.8831.30-31.8031.0-32.06.80-7.00368.89-9.1031.90-32.5932.1-33.07.01-7.20379.11-9.3232.60-33.2033.1-34.07.21-7.40389.33-9.5333.30-33.8934.1-35.07.41-7.60399.54-9.7533.90-34.5035.1-36.07.61-7.80409.76-9.9634.60-35.1036.1-36
11、.97.81-8.00419.97-10.1635.20-35.7037.0-37.98.01-8.24210.17-38.0(1)BPD孕31周前,每周增长约3mm,孕31-36周增长1.5mm/周,孕36周后,增长1mm/周;在孕12-28周测值最接近孕周。受胎方位、不同头形或胎头入盆等因素影响,孕晚期BPD测值会出现较大偏差。(2)孕30周前FL增长2.7mm/周,31-36周增长2mm/周, 36周后增长1mm/周。3、超声参数解读:(1)头径指数CI=头短轴径BPD /头长轴径OFD 正常范围70%-86% 头径指数在正常范围时,BPD适合评估体重。头径指数小于70%或大于86%时,
12、应该用头围来评估体重。(2)FL/AC正常 20%24%FL/AC 24% 可能有IUGR,应放弃AC测量(3)FL/BPD正常 71%87%如FL/BPD 87 %,则放弃BPD测量(4)HC/AC正常 0.961.17 正常孕35周前,腹围小于头围;孕35周左右,比值基本相等;孕35周后,腹围大于头围。(5)FL/HC小于3SD 提示骨发育不良。4、胎儿小脑横径正常值(参考美国妇产科学1987年)孕周10th50th90th孕周10th50th90th孕周10th50th90th16141617242225283233384217161718252328293332404418171819
13、26252932343340441918192227263032353140.5472018202228273134363643552119222429293438373745552221232430313540384048.555232224263132384339525255孕24周前,小脑横径约等于孕周,孕20-38周,平均增长约1-2mm/周;孕24周后,小脑横径值明显大于孕周,妊娠38周后,平均增长约0.7mm/周。5、胎儿小脑蚓部正常值孕周(周)前后径(mm)顶尾径(mm)周长(mm)面积(cm2)21-2210. 61.411.11.143.83.30.90.223-2412.9
14、1.112.31.447.55.51.20.225-2613.52.113.60.950.94.41.40.227-2816.32.716.01.658.96.82.00.529-3017.52.217.72.164.76.52.30.431-3219.01.919.21.170.76.92.80.433-3419.21.919.81.072.78.33.00.835-3621.41.521.22.377.65.13.40.337-3822.13.823.04.680.79.93.91.439-4025.72.325.02.686.77.04.90.76、诊断小头畸形头围参考值( cm 李胜利
15、)孕周正常-2SD-3SD-4SD孕周正常-2SD-3SD-4SD201814.513.111.63128.626.024.523.02119.215.714.312.83229.426.825.323.92220.316.915.414.03330.227.626.124.62321.418.016.615.13430.928.326.825.32422.419.117.716.23531.528.927.526.02523.420.218.817.33632.429.528.126.62624.421.319.818.33732.930.128.627.22725.322.320.819.
16、43833.930.629.127.62826.223.321.820.33934.231.029.528.12927.024.222.721.54034.831.429.928.43027.825.123.622.07、胎儿第四脑室正常范围胎儿第四脑室 宽径: 0.480.11mm, 前后径:0.270.0895%百分区间范围 宽径: 0.31-0.68 前后径:0.15-0.418、胎儿眼部生物学测量正常值孕周5th眼外距50th95th5th眼内距50th95th5th眼距50th95th12513234913136138152559142471410182851014358151320
17、306101446916152232610155791717253461115581018192737711166911192229397121679122024314181217810132126334381317811132228354491318912142330374691418101215243139481014191013152533415010151911131626354251111520121416273644531116201214172838455412162113151729394756121721131518304148571317221416183142505813
18、1822141619324351601418231417193345526114192315171934465362151924151720354754631520241518203648556416202516182037495665162125161821385057651721261618213950586617222616192140515967182226161921孕20周前,眼外距=眼内距=眼间距; 孕20周后,眼内距略大于眼外距9、胎儿孕期鼻骨正常值孕周百 分 位 数孕周百 分 位 数5th50th95th5th50th95th121.82.84.2287.69.812.114
19、2.53.85.3307.91012.6163.44.76.2328.610.513.6184.35.77349.110.912.8205.26.78.3367.810.912.8225.87.59.3389.311.715.7246.88.3104010.412.114.5267.48.910.910、胎儿胸围的5、50、95百分位(妇产科超声学第5版)孕周5th50th95th孕周5th50th95th166.49.111.92918.22123.7177.31012.83019.121.924.6188.21113.7312022.825.5199.111.914.63220.923.7
20、26.4201012.815.53321.824.627.3211113.716.43422.825.528.22211.914.617.33523.726.429.12312.815.518.23624.627.3302413.716.419.13725.528.230.92514.617.3203826.429.131.92615.518.2213927.33032.82716.419.121.94028.230.933.72817.32022.8正常胎儿心围/胸围约等于0.40 胎儿心脏面积/胸围面积约为0.25-0.33。胸围与腹围的正常比值在0.83-0.95,胸围与头围的正常比值在
21、0.68-0.92。11、锁骨长度参考值(cm)medison孕周生长参数最小值最大值孕周生长参数最小值最大值353.63.14.1383.93.44.4363.73.24.23943.54.5373.83.34.3404.13.64.612、正常胎儿不同孕周胃泡大小(cm 李胜利书)妊娠龄(周)例数前后径长径13-15150.3-0.50.6-1.216-18290.4-0.80.9-1.719-21170.6-1.01.1-2.122-24110.6-1.21.3-2.525-27140.5-1.51.3-3.328-30170.9-1.51.8-1.831-33181.1-1.71.9-
22、3.734-36151.0-1.81.9-3.737-39161.2-2.02.3-4.113、正常胎儿不同孕周胆囊大小(cm 李胜利书)妊娠龄(周)长径横径15-191.00.320-221.50.423-241.90.625-262.10.627-302.10.731-342.60.735-402.70.6514、胎儿各孕周脾的长度测值(cm 李胜利书)妊娠龄(周)第五百分位均值第95百分位180.71.42.1201.11.82.6221.52.22.9241.92.53.2262.02.73.4282.43.13.8302.73.44.1323.13.84.5343.54.35.0364.14.85.5384.75.46.2405.56.27.015、胎儿孕龄小肠和降结肠直径 mm孕周(周数)小肠腔大小结肠腔大小平均数最大值平均数最大值10-151.011.5215-201.223.6520-251.424.4625-301.838.01330-352.9611.41635-403.7816.826404.4818.72816、正常胎儿不同孕周肾脏径线测值前后径横径纵径
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