探讨中、晚孕期胎儿超声检查诊断胎儿颅内出血(FICH)的临床价值。

选择2014年9月至2020年1月，在四川大学华西第二医院经胎儿MRI确诊为FICH的40例胎龄为(28.3±4.2)周(22~36周)胎儿为研究对象，其孕母年龄为(27.5±4.4)岁(19~34岁)。采用Fisher确切概率法，对胎儿超声和MRI检查对中、晚孕期FICH检出率进行统计学比较。本研究遵循的程序符合2013年修订的《世界医学会赫尔辛基宣言》要求。

这40例FICH均于中、晚孕期被发现：①胎儿头颅超声检查结果提示FICH为33例，包括室管膜下稍强回声(3例)、无回声(1例)；脑室内稍强回声(10例)、不均匀回声(2例)；脉络丛稍强回声(2例)、无回声(2例)、弱回声(1例)、不均匀回声(3例)；脑实质稍强回声(3例)、无回声(2例)、弱回声(2例)、不均匀回声(2例)。②这33例FICH胎儿中，17例为胎儿侧脑室增宽(6例为轻度增宽，6例为中度增宽，5例为脑积水)。③40例FICH胎儿的MRI表现为：脑室内出血(15例)、脑实质出血(8例)，生发层出血(16例)，硬膜下出血(1例)。④中、晚孕期胎儿超声的FICH检出率分别为94.4%(17/18)、72.7%(16/22)。晚孕期胎儿超声与MRI对FICH检出率比较，差异有统计学意义(P＝0.010)。

胎儿超声对FICH诊断具有较高准确性，并且方便、安全、经济，可实时采集图像而被作为FICH检查的首选方法。晚孕期胎儿超声对胎儿头颅切面显示困难时，MRI的胎儿头颅检查结果可作为补充。

To explore clinical application value of diagnosis of fetal intracranial hemorrhage (FICH) by fetal ultrasonography in the second and third trimester of pregnancy.

A total of 40 fetuses diagnosed as FICH by fetal MRI during the second and third trimesters in West China Second University Hospital, Sichuan University from September 2014 to January 2020 were enrolled. The gestational age of 40 fetuses were (28.3±4.2) weeks (22-36 gestational weeks), and their maternal age was (27.5±4.4) years (19-34 years). The detection rates of FICH by fetal ultrasonography and MRI during the second and third trimesters were compared by Fisher exact probability test.The procedure followed in this study met requirements of the Helsinki Declaration of the World Medical Association revised in 2013.

The prenatal imaging examination results of 40 cases of FICH by fetal ultrasonography in the second and third trimester were as follows. ①33 cases were diagnosed as FICH. Among their ultrasounic images, subependymal slightly strong echo and echoless were 3 cases and 1 case, respectively; intraventricular slightly strong echo and uneven echo were 10 and 2 cases, respectively; choroid plexus slightly strong and anechoic were 2 cases, choroid plexus weak echo was 1 case and 3 cases of uneven echo respectively; 3 cases of slightly strong brain parenchyma, 2 cases of echoless, weak echo and uneven echo of brain parenchyma. ②Among these 33 cases of FICH, 17 cases were complicated by lateral ventricle widened(slightly widened, moderately widened and hydrocephalus were 6, 6, 5 cases, respectively). ③Among 40 cases of FICH, their imaging features were intraventricular hemorrhage (15 cases), cerebral parenchymal hemorrhage (8 cases), mucous layer hemorrhage (16 cases) and subdural hemorrhage (1 case). ④The detection rate of FICH by fetal ultrasonography in the second and third trimesters of pregnancy were 94.4%(17/18), 72.7%(16/22), respectively. In the third trimester of pregnancy, the detection rate of FICH by fetal MRI was much higher than that by fetal ultrasonography, and the difference was significant (P=0.010).

Diagnostic of FICH by fetal ultrasonography has advantage of convenience, safety and economy, fetal ultrasonography can be used as the first choice method. If the ultrasound section of fetal head shows difficulty, fetal MRI can be used as a supplementary imaging assisted examination method to provide more accurate information for FICH.