УЛЬТРАЗВУКОВОЕ ИССЛЕДОВАНИЕ В 11-14 НЕДЕЛЬ БЕРЕМЕННОСТИ

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618.1/.2-073.432.19 57.16 63

1113+6 . . . , . -. -, , 2007 . 144 .

ISBN 978-5-9676-0093-0

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....................................................................................... 11 .......................................... 12 .............. 13- - ..................................................................................... 14 ................................ 15 ....................................................................... 16 ......................................................................................................... 18 , (UK National Screening Committee) ............................... 21 , ........... 24 . ........................................................ 24 ...................................................................................................... 28

2. Rosalinde SniJders, Kypros Nicolaides .........................................................29

...................................... 29 ............................................. 33 .... 36 ..................................... 42 ...................................................................................................... 66

3. Victoria Heath, Kypros Nicolaides ...............................................................73

................................................................................................. 69

, ............................................. 11

. .....................................................................................................6 ..............................................................

4 1113+6

................................................................................................. 82 ...................................................................................................... 94

4. Athena Souka, Constantin von Kaisenberg, Kypros Nicolaides ..............97

...................................................................................... 98 , .......... 100 ................................................................................................ 112 ........ 115 .................................................................................................... 120

5. Neil Sebire, Kypros Nicolaides .................................................................... 123

.................... 124 ................ 125 ...................... 127 ............................................................................................... 134 .................................................................................................... 140

6 1113+6

1866 - 21, , , , . 90- , - - . - 21, 10- 13- , 75% - - - 5%. - - ( ) - 1013 , - 8590%. 2001 , 10- 13- 6070% 21 -. - 21 95% .

, - 21, - - , , , .

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, - , - .

, - , , - 1113+6 , - . Fetal Medicine Foundation , - . - 1113+6 - , -, , .

, , *. - . , -, Fetal Medicine Foundation, - - - - .

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8 1113+6

Fetal Medicine Foundation (FMF), - , , , . Fetal Medicine Foundation - - , . - FMF . - 1113+6 - , FMF; FMF ; FMF , - , , - - FMF .

- . 5 FMF - 3 .

21 1866 , - . 1990- - - 10- 13- - . - -. , , , , -

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1013 , 75% , , - 5%.

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- 1113 . . - - . , - .

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107 59 a + b=166

212 9272 c + d=9484

+ = 319 b + d = 9331

= (a/(a+c)) 100% =33,5% = (d/(b+d)) 100% = 99,4%

(+) = = /(100%-) = 33,5%/(100% 99,4%) = 55,8 () = (100%-) / = (100% 33,5%)/99,4% = 0,67

, - - 55,8, 0,67. , - , , 1 1000 (0,1%).

18 1113+6

5,58% (0,1% 55,8), - 0,067% (0,1% 0,67) 1 1493. 4.

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Cochrane A.L., Holland W. W. Validation of screening procedures. Br. Med. Bull. 1971.-27.-3.

Gray J. A. M. Dimensions and de nitions of screening. Milton Keynes: NHS Execu-tive Anglia and Oxford, Research and Development Directorate, 1996.

Holland W. W., Stewart S. Screening in Healthcare. The Nu eld Provincial Hos-pital Trust, 1990.

Sackett D. L., Holland W. W. Controversy in detection of diseases. Lancet. 1975.-2(357).-9.

Sackett D. L., Straus S. E., Richardson W. S. et al. Evidence-based medicine. How to practice and teach EBM. Churchhill Livingstone, 2000.

Wald N. J. Antenatal and Neonatal screening. Oxford University Press, 1984.

Wald N. J. Guidance on terminology. Journal of Medical Screening. 1994.-1.-76.

Wilson J. M. G., Junger G. Principles and practice f screening for disease. Public Health paper number 34. Geneva: WHO, 1968.

2 29

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. - , 21 - . - - - , - - . - -, 21 ( 7).

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48 1113+6

, , ( 8). , , - .

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2 49

8. 12 . . , . , , . B . C . D . E . F . ,

95 - 45 1,2 2,1 , 84 1,9 2,7 (Snijders et al., 1998).

50 1113+6

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2 51

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52 1113+6

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54 1113+6

, - - - -, . - .

Fetal Medicine Foundation FMF ( ) -, -. , - , , - . : - , , - , . ( 12).

- - . . , , , . - .

2 55

1992 , , , (Nicolaides et al., 1992).

, - 1990- . 17 -, 1690 , , 29% (Nicolaides, 2004). - 11% 88%, , 2 10 , .

1990- , , -, ; -, 21 ; -- - - , (Nicolaides et al., 1994, Pandya et al., 1995).

, 1 300 -- 28 80% , 21, 5%.

56 1113+6

- . - - .

, - (Nicolaides et al., 2004).

, .

: --, 99% ; -, - - - , - , , ; -, , 200000 - , 900 21, , - 5% - 75% , - 1% 60% , 21 (Nicolaides, 2004).

2 57

, Fetal Medicine Foundation, 100311 , 306 22 , - FMF (Snijders et al., 1998). - , - , . - 96127 326 21 325 ( 3). 12 , 31 .

- 1 300 8% , 82% 21 78% - . , -- 5% 77% (95% 7282%).

3. , Fetal Medicine Foundation. (1 300 ).

95 1 300

95,476 4,209 (4,4%) 7,907 (8,3%)

21 326 234 (71,2%) 268 (82,2%) 18 119 89 (74.8%) 97 (81,5%) 13 46 33 (71,7%) 37 (80,4%) 54 47 (87,0%) 48 (88,%) 32 19 (59,4%) 20 (62,5%)* 64 41 (64,1%) 51 (79,7%) 96,127 4,767 (5,0%) 8,428 (8,8%)

-

58 1113+6

- . - , , - . 12 30% , , . , , - , , 20% 16 40 .

-, 21 - - . 21 . - , - 21 - . , FMF, 1 300 - 8% 82% 21 (Snijders et al., 1998). , - 21 - 7882%.

2 59

21

, 200000 - 900 21, , - 75% 21 - 5%. , . 21 23% , 21 , .

- , - - . , - , ( ) - (Nicolaides, 2004). , 99% , 75% , - . , 76,8% 21 4,2% , 38,4% 5% .

- -; , , , - . , ,

60 1113+6

, , - 66% (Roberts et al., 1995). 33 54% , 3 , 42% (Kornman et al., 1996). -, 47053 , 616 (Wald et al., 2003a). 23% , , - - .

Crossley et al. (2002). - , 17229 , 73% . - , , 99,8% .

- - , , - , , -. - : - , , 5075% 21 - 5%. - - - 60% - .

2 61

- , - 10%.

21 12 - (- 2 ) - , - ( 0,5 ). - 21 , - . -, , .

- - - 21, -. , - (Spencer et al., 1999). - - - . , 38804 , 182 21, , 21 - 86% - 5% (Nicolaides et al., 2004).

18 13 - - - . - -, - .

62 1113+6

- , - . - -. - - - - 90% - 1% - 21.

- , - , 30 . - -- - OSCAR (One-Stop Clinic for Assessment of Risk) (Bindra et al., 2002, Spencer et al., 2003b).

- , - . - , 21 8590% - - 5%, - (Nicolaides et al., 2004).

2 63

, , - - -, , 94% 21 - 5% (Wald et al., 1999). - : -, , ; - , - ; - . , - , .

- - (SURUSS) 21 (Wald et al., 2003a). . - - , . - 47053 , 60% . 101 21, 75% . , - - 5% - 93% 21. . , - 5% (, ),

64 1113+6

(, , ) (, , , - ) 71%, 77% 83% . , 61%, 66% 75% (Wald et al., 2003b).

(FASTER trial) 33557 , 84 21 (Malone et al., 2004). , - 5,4% 90% 21.

, - - (Bindra et al., 2002, Spencer et al., 2003b). - - - , .

, , , . - - , 21 - , . , 70% -

2 65

- , 21 (Mulvey and Wallace, 2000). - , , - , , .

-. . - . -, - . -, , - , - . , - - (Chasen et al., 2001).

, .

66 1113+6

Bindra R., Heath V., Liao A., Spencer K., Nicolaides K. H. One stop clinic for as-sessment of risk for trisomy 21 at 1114 weeks: A prospective study of 15,030 pregnancies. Ultrasound Obstet Gynecol2002; 20:21 925.

Chosen S. T., Skupski D. W., McCullough L. B., Chervenak F. A. Prenatal informed consent for sonogram: the time for rst-trimester nuchal translucency has come. J Ultrasound Med. 2001; 20:114752.

Crossley J. A., Aitken D. A., Cameron A. D., McBride E., Connor J. M. Combined ul-trasound and biochemical screening for Downs syndrome in the rst trimester: a Scottish multicentre study. BJOG 2002; 109: 66776.

Down L. J. Observations on an ethnic classi cation of idiots. Clin Lectures and Reports, London Hospital 1866; 3:25962.

Hecht C. A., Hook E. B. The imprecision in rates of Down syndrome by 1 -year maternal age intervals: a critical analysis of rates used in biochemical screening. Prenat Diagn 1994; 14:72938.

Kornman L. H., Morssink L. P., Beekhuis J. R., DeWolf BTHM, Heringa M. P., Mant-ingh A. Nuchal translucency cannot be used as a screening test for chromo-somal abnormali ties in the rst trimester of pregnancy in a routine ultrasound practice. Prenat Diagn 1996; 16:797805.

Malone F. D., Wald N. J., Canick J. A., Bail R. H., Nyberg D. A., Comstock C. H., Bu-kowski R., et al. First- and second-trimester evaluation of risk (FASTER) trial: prin-cipal results of the NICHD multicenter Down syndrome screening study. SMFM 2004, Abstract 1.

Mulvey S., Wallace E. M. Womens knowledge of and attitudes to rst and second trimester screening for Downs syndrome. BJOG 2000;107:13025.

Nicolaides K. H., Azar G., Byrne D., Mansur C., Marks K. Fetal nuchal translucency: ultrasound screening for chromosomal defects in rst trimester of pregnancy. BMJ 1992; 304:8679.

Nicolaides K. H., Brizot M. L., Snijders RJM. Fetal nuchal translucency: ultra-sound screen ing for fetal trisomy in the rst trimester of pregnancy. BJOG 1994; 101:7826.

2 67

Nicolaides K. H. Nuchal translucency and other rst-trimester sonographic mark-ers of chromosomal abnormalities. Am J Obstet Gynecol 2004;191:4567.

Pandya P. P., Snijders R. J. M, Johnson S. J., Brizot M., Nicolaides K. H. Screening for fetal trisomies by maternal age and fetal nuchal translucency thickness at 10 to 14 weeks of gestation. BJOG 1995; 102:95762.

Roberts L. J., Bewley S., Mackinson A. M., Rodeck C. H. First trimester fetal nuchal trans lucency: Problems with screening the general population 1. BJOG 1995; 102:3815.

Snijders R. J. M, Sebire N. J., Cuckle H., Nicolaides K.H. Maternal age and gesta-tional age-speci c risks for chromosomal defects. Fetal Diag Ther 1995; 10:35667.

Snijders R. J. M., Nicolaides K. H. Sequential screening. In: Nicolaides K. H., editor. Ultra sound markers for fetal chromosomal defects. Carnforth, UK: Parthenon Publishing, 1996, pp 10913.

Snijders R. J. M., Noble P., Sebire N., Souka A., Nicolaides K. H. UK multicen-tre project on assessment of risk of trisomy 21 by maternal age and fetal nuchal translucency thickness at 1014 weeks of gestation. Lancet 1998; 351:3436.

Snijders R. J. M., Sundberg K., Holzgreve W., Henry G., Nicolaides K. H. Maternal age and gestation-speci c risk for trisomy 21. Ultrasound Obstet Gynecol 1999; 13:16770.

Spencer K., Souter V., Tul N., Snijders R., Nicolaides K. H. A screening pro-gram for trisomy 21 at 1014 weeks using fetal nuchal translucency, mater-nal serum free b-human chorionic gonadotropin and pregnancy-associated plasma protein-A. Ultrasound Obstet Gynecol 1999; 13:2317.

Spencer K., Bindra R., Nix A. B. J., Heath V., Nicolaides K. H. Delta- NT or NT MoM: which is the most appropriate method for calculating accurate patient-speci c risks for trisomy 21 in the rst trimester? Ultrasound Obstet Gynecol 2003a; 22:1428.

Spencer K., Spencer C. E., Power M., Dawson C., Nicolaides K. H. Screening for chromo somal abnormalities in the rst trimester using ultrasound and mater-nal serum biochemistry in a one stop clinic: A review of three years prospective experience. BJOG 2003b; 110:2816.

68 1113+6

Tabor A., Philip J., Madsen M., Bang J., Obel E. B., Norgaard-Pedersen B. Ran-domised controlled trial of genetic amniocentesis in 4,606 low-risk women. Lancet 1986; 1: 28793.

Wald N. J., Watt H. C., Hackshaw A. K. Integrated screening for Downs syndrome on the basis of tests performed during the rst and second trimesters. N Engl J Med 1999; 341:4617.

Wald N. J., Rodeck C., Hackshaw A. K., Walters J., Chitty L., Mackinson A. M.; SU-RUSS Research Group. First and second trimester antenatal screening for Downs syndrome: the results of the Serum, Urine and Ultrasound Screening Study (SU-RUSS). Health Technol Assess 2003a; 7:177.

Wald N. J., Huttly W. J., Hackshaw A. K. Antenatal screening for Downs syndrome with the quadruple test. Lancet 2003b; 361: 8356.

3 69

3

- . - 21 - .

- 1113+6 (Snijders et al., 1998). 21, 18 13 2,5 - - . 8 .

21 6070% , 25% - 80% - . 18 - , 30% , 55% - 75% . 13 70% , 40% , , -. 50%

70 1113+6

. - , 30% , , - 40% - 30% .

1866 , - 21 . - , 50% (Farkas et al., 2001). 21 50% - . - 21 15 24 65% .

- 1113+6 (Cicero et al., 2001). 1113+6 - 21, (Nicolaides, 2004). - , 15822 , , 97,4% , 1,4% 69% 21.

, - , -- . , - 21 (Cicero et al., 2004).

3 71

- 1113+6 -, 100 21 400 - , 21 , - - (Cicero et al., 2003). , - - 5% 21 97%.

1113+6 4584 . , - . , - . - . , , , . , . 1113+6 95% . 1% 10% - . 6070% 21, 50% 18 30% 13. - 5% , , - - - , 95% 21. , , - , , - - .

72 1113+6

-

18 - , 13 - , - 21 ( 1; Nicolaides et al., 1996).

- 18 - . 13 - . 21 .

1. - (5, 50, 95 )

3 73

, 21 - . - . , 50% (Farkas et al., 2001).

- 1113+6 - (Cicero et al., 2004). - , , , , - ( 2). 0,1 . 21 - 0,7 .

2. 12

74 1113+6

- , . , - - 21. - .

- . 1113+6 (Sachini et al., 2003). , 21 - .

21 , - - , , . 1113+6 21 - . 21 , - (Longo et al., 2004).

1% . - -

3 75

. 1113+6 3% - 80% 18 (Rembouskos et al., 2003). 21 , - . 18 . 18 - , - 1113+6 , - , 1620 . - per se - .

80% - 11, 100% 13 -. - , , 6 . 7 1 1500 ( 3). 7 15 20% , , - 13 18, 90% (Liao et al., 2003). , 15 - 10% , , , - . 75% 30% -. 13 18 6,7 .

76 1113+6

3. 12

1113+6 - ( 4) 1 1000, 4 . , - 18, 60% - 30% 15% . 18 , , -. . , - (Snijders et al., 1995).

,

1114 , - 2,2; 0,9 0,6% (Whitlow et al., 1998).

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4. 18 12

, - . , - , , - - .

, 1113+6 , -- . 21 - , 18 .

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170 / 10 , - 155 / 14- . 1113+6 13 , 18 ( 5; Liao et al., 2001). 21 -. , - 21, 13.

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, . - (S-) (D-) - (-). - , -, - .

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- , - , - . - , - .

80 1113+6

6. 12 () () -

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82 1113+6

-, , - (- 1; Snijders and Nicolaides, 1996, Nicolaides et al., 1992). - / - , - , - . - .

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20 . - . , - , . , , , , . : , , , , , , .

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3 85

, .

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86 1113+6

/ 1 800 , - , . / 1% -. 20%, 13 18. - / , - .

1 1000. , , 18 . , - 60%, - - .

15- 24- -, 65% 21 , , 2,5 (Sonek and Nicolaides, 2002, Cicero et al., 2003). - 1% 10% - . - - ,

3 87

. , , , 21 .

1 4000, - . - ( 18) - 20%.

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88 1113+6

- 1 3000. 90% . 34% . - , 18, 20% .

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, -. - , , , , . - . - . , , 21, - , - - 18 13.

3 89

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90 1113+6

. , -.

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3 91

, , -, , . - , .

( -, -) 2 (Nyberg et al., 2001, Bromley et al., 2002, Nicolaides, 2003).

75% - 21 1015% . - , 21 0,3. - - - . , 28,2% 21 4,4% - . , 6,41 (28,2/4,4), - 0,75 (71,8/95,6). , - 6,41, - 0,75 ( 25%).

, 2. , - , -, 1 1000. , ( , - , , ,

92 1113+6

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, . - , .

94 1113+6

Borrell A., Martinez J. M., Seres A., Borobio V., Cararach V., Fortuny A. Ductus ven-osus assessment at the time of nuchal translucency measurement in the detec-tion of fetal aneuploidy. Prenat Diagn 2003; 23:9216.

Bromley B., Lieberman E., Shipp I. D., Benacerraf B. R. The genetic sonogram. A method of risk assessment for Down syndrome in the second trimester. J Ultra-sound Med 2002; 21:1087-96.

Cicero S., Curcio P., Papageorghiou A., Sonek J., Nicolaides K. H. Absence of nasal bone in fetuses with trisorrty 21 at 1114 weeks of gestation: an observational study. Lancet 2001; 358:16657.

Cicero S., Bindra R., Rembouskos G., Spencer K., Nicolaides K. H. Integrated ultra-sound and biochemical screening for trisomy 21 at 11 to 14 weeks. Prenat Diagn 2003; 23:30610.

Cicero S., Sonek J. D., McKenna D. S., Croom C. S., Johnson L., Nicolaides K. H. Na-sal bone hypoplasia in trisomy 21 at 1522 weeks gestation. Ultrasound Obstet Gynecol 2003; 21:158.

Cicero S., Rembouskos G., Vandecruys H., Hogg M., Nicolaides K. H. Likelihood ratio for trisomy 21 in fetuses with absent nasal bone at the 1114 weeks scan. Ultrasound Obstet Gynecol 2004; 23:21823.

Cicero S., Curcio P., Rembouskos G., Sonek J., Nicolaides K. H. Maxillary length at 1114 weeks of gestation in fetuses with trisomy 21. Ultrasound Obstet Gynecol 2004; 24:1922.

Down L. J. Observations on an ethnic classi cation of idiots. Clin Lectures and Reports, London Hospital 1866; 3:25962.

Farkas L. G., Katie M. J.,Forrest C. R., Litsas L. Surface anatomy of the face in Downs syndrome: linear and angular measurements in the craniofacia! regions. J Craniofac Surg 2001; 1 2:3739.

Liao A. W., Snijders R., Geerts L., Spencer K., Nicolaides K. H. Fetal heart rate in chromo-somally abnormal fetuses. Ultrasound Obstet Gynecol 2000; 16:610-3.

3 95

Liao A. W., Sebire N. J., Geerts L., Cicero S., Nicolaides K. H. Megacystis at 1014 weeks of gestation: Chromosomal defects and outcome according to bladder length. Ultrasound Obstet Gynecol 2003; 21:33841.

Longo D., DeFigueiredo D., Cicero S., Sacchini C., Nicolaides K. H. Femur and humerus length in trisomy 21 fetuses at 1114 weeks of gestation. Ultrasound Obstet Gynecol 2004; 23:1437.

Matias A., Gomes C., Flack N., Montenegro N., Nicolaides K. H. Screening for chromo somal abnormalities at 1114 weeks: the role of ductus venosus blood ow. Ultrasound Obstet Gynecol 1998; 2:3804.

Nicolaides K. H., Sebire N. J., Snijders J. M. Crown rump length in chromosomally abnormal fetuses. In Nicolaides K.H. (Ed) The 1114-week scan-The diagnosis of fetal abnormalities. New York: Parthenon Publishing, 1996, pp. 313.

Nicolaides K. H., Snijders R. J. M., Gosden R. J. M., Berry C., Campbell S. Ultraso-no-graphically detectable markers of fetal chromosomal abnormalities. Lancet 1992; 340:7047.

Nicolaides K. H. Screening for chromosomal defects. Ultrasound Obstet Gynecol 2003; 21:31321.

Nicolaides K. H. Nuchal translucency and other rst-trimester sonographic mark-ers of chromosomal abnormalities. Am J Obstet Gyneco! 2004; 191:4567.

Nyberg D. A., Souter V. L., El-Bastawissi A., Young S., Luthhardt F., Luthy D. A. Iso-lated sonographic markers for detection of fetal Down syndrome in the second trimester of pregnancy. J Ultrasound Med 2001; 20:105363.

Rembouskos G., Cicero S., Longo D., Sacchini C., Nicolaides K. H. Single Umbili-cal Artery at 1114 weeks: relation to chromosomal defects. Ultrasound Obstet Gynecol 2003; 22:56770.

Sacchini C., El-Sheikhah A., Cicero S., Rembouskos G., Nicoiaides K. H. Ear length in trisomy 21 fetuses at 1114 weeks of gestation. Ultrasound Obstet Gynecol 2003; 22:4603.

Snijders R. J. M, Noble P., Sebire N., Souka A., Nicolaides K. H. UK multicen-tre project on assessment of risk of trisomy 21 by maternal age and fetal nucha) translucency thickness at 1014 weeks of gestation. Lancet 1998; 351:3436.

96 1113+6

Snijders R. J. M, Brizot M. L, Faria M., Nicolaides K. H. Fetal exomphalos at 1114 weeks of gestation. J Ultrasound Med 1995; 14:56974.

Snijders R. J. M, Nicolaides K. H. Sequential screening. In: Nicolaides K. H., editor. Ultrasound Markers for Fetal Chromosome) Defects. Carnforth, UK: Parthenon Publishing, 1996, pp. 10913.

Sonek J., Nicolaides K. H. Prenatal ultrasonographic diagnosis of nasal bone ab-normalities in three fetuses with Down syndrome. Am J Obstet Gynecol 2002; 186:13941.

Whitlow B. J., Lazanakis M. L., Kadir R. A., Chatzipapas I., Economides D. L. The sig-ni cance of choroid plexus cysts, echogenic heart foci and renal pyelectasis in the rst trimester. Ultrasound Obstet Gynecol 1998; 12:38590.

4 97

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4 99

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100 1113+6

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104 1113+6

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114 1113+6

.

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4 115

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116 1113+6

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99

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118 1113+6

. , 1113+6 -, .

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120 1113+6

Borrell A., Martinez J. M., Seres A., Borobio V., Cararach V., Fortuny A. Ductus ven-osus assessment at the time of nuchal translucency measurement in the detec-tion of fetal aneuploidy. Prenat Diagn 2003; 23:9216.

Bromley B., Lieberman E., Shipp I. D., Benacerraf B. R. The genetic sonogram. A method of risk assessment for Down syndrome in the second trimester. J Ultra-sound Med 2002; 21:108796.

Cicero S., Curcio P., Papageorghiou A., Sonek J., Nicolaides K. H. Absence of nasal bone in fetuses with trisomy 21 at 1114 weeks of gestation: an observational study. Lancet 2001; 358:16657.

Cicero S., Bindra R., Rembouskos G., Spencer K., Nicolaides K. H. Integrated ultra-sound and biochemical screening for trisomy 21 at 11 to 14 weeks. Prenat Diagn 2003; 23:30610.

Cicero S., Sonek J. D., McKenna D. S., Croom C. S., Johnson L., Nicolaides K. H. Na-sal bone hypoplasia in trisomy 21 at 1522 weeks gestation. Ultrasound Obstet Gynecol 2003; 21:158.

Cicero S., Rembouskos G., Vandecruys H., Hogg M., Nicolaides K. H. Likelihood ratio for trisomy 21 in fetuses with absent nasal bone at the 1114 weeks scan. Ultrasound Obstet Gynecol 2004; 23:21823.

Cicero S., Curcio P., Rembouskos G., Sonek J., Nicolaides K. H. Maxillary length at 1114 weeks of gestation in fetuses with trisomy 21. Ultrasound Obstet Gynecol 2004; 24:1922.

Down U. Observations on an ethnic classi cation of idiots. Clin Lectures and Re-ports, London Hospital 1866; 3:25962.

Farkas L G, Katie M. J.,Forrest C. R, Litsas L. Surface anatomy of the face in Downs syndrome: linear and angular measurements in the craniofacial regions. J Craniofac Surg 2001; 12:3739.

Liao AW, Snijders R, Geerts L, Spencer K, Nicolaides KH. Fetal heart rate in chro-mosomally abnormal fetuses. Ultrasound Obstet Gynecol 2000;16:610-3.

4 121

Liao A. W., Sebire N.J., Geerts L., Cicero S., Nicolaides K. H. Megacystis at 1014 weeks of gestation: Chromosomal defects and outcome according to bladder length. Ultrasound Obstet Gynecol 2003; 21:338-41.

Longo D., DeFigueiredo D., Cicero S., Sacchini C., Nicolaides K. H. Femur and humerus length in trisomy 21 fetuses at 1114 weeks of gestation. Ultrasound Obstet Gynecol 2004; 23:1437.

Matias A., Gomes C., Flack N., Montenegro N., Nicolaides K. H. Screening for chromo somal abnormalities at 1114 weeks: the role of ductus veno-sus blood flow. Ultrasound Obstet Gynecol 1998; 2:3804.

Nicolaides K. H., Sebire N. J., Snijders J. M. Crown rump length in chromosomal!/ abnormal fetuses. In Nicolaides K. H. (Ed) The 1114-week scan-The diagnosis of fetal abnormalities. New York: Parthenon Publishing, 1996, pp. 313.

Nicolaides K. H., Snijders R. J.M, Gosden R. J. M, Berry C., Campbell S. Ultrasono-graphically detectable markers of fetal chromosomal abnormalities. Lancet 1992; 340: 7047.

Nicolaides K. H. Screening for chromosomal defects. Ultrasound Obstet Gynecol 2003; 21:31321.

Nicolaides K. H. Nuchal translucency and other rst-trimester sonographic mark-ers of chromosomal abnormalities. Am J Obstet Gynecol 2004; 191:4567.

Nyberg D. A., Souter V. L, El-Bastawissi A., Young S., Luthhardt F., Luthy D. A. Iso-lated sonographic markers for detection of fetal Down syndrome in the second trimester of pregnancy. J Ultrasound Med 2001; 20:105363.

Rembouskos G., Cicero S., Longo D., Sacchini C., Nicolaides K. H. Single Umbili-cal Artery at 1114 weeks: relation to chromosomal defects. Ultrasound Obstet Gynecol 2003; 22:56770.

Sacchini C., El-Sheikhah A., Cicero S., Rembouskos G., Nicolaides K. H. Ear length in trisomy 21 fetuses at 1114 weeks of gestation. Ultrasound Obstet Gynecol 2003; 22:4603.

Snijders R. J. M, Noble P., Sebire N., Souka A., Nicolaides K. H. UK multicen-tre project on assessment of risk of trisomy 21 by maternal age and fetal nuchal translucency thickness at 1014 weeks of gestation. Lancet 1998; 351:3436.

122 1113+6

Snijders R. J. M, Brizot M. L, Faria M., Nicolaides K. H. Fetal exomphalos at 1114 weeks of gestation. J Ultrasound Med 1995; 14:56974.

Snijders R. J. M, Nicolaides K. H. Sequential screening. In: Nicolaides K. H., editor. Ultrasound Markers for Fetal Chromosomal Defects. Carnforth, UK: Parthenon Publishing, 1996, pp. 10913.

Sonek J., Nicolaides K. H. Prenatal ultrasonographic diagnosis of nasal bone ab-normalities in three fetuses with Down syndrome. Am J Obstet Gynecol 2002; 186:13941.

Whitlow B. J., Lazanakis M. L., Kadir R. A., Chatzipapas I., Economides D. L. The sig-ni cance of choroid plexus cysts, echogenic heart foci and renal pyelectasis in the rst trimester. Ultrasound Obstet Gynecol 1998; 12:38590.

5 123

5

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124 1113+6

1.

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SIAMESE

MONOCHORIONIC

MONOCHORIONIC

Placentas

Sacs

Fetuses

Days0 3 9 12 15

5 125

20 , , - , .

- , -, . , , - (Monteagudo et al., 1994).

, - , , . 60% - , , . , , - .

- , , - - . 69 . - . - , - ,

126 1113+6

( ) (Bessis et al., 1981, Sepulveda et al., 1996, Monteagudo et al., 2000).

1113+6 ( 2) - . - , . 20 85% - .

2. () () . , ( )

20 - . , 1113+6 - , , - - .

5 127

1113+6 - , - 11- 24- - 1%. 2% - 10% (Sebire et al., 1997a). - .

- - 1113+6 , , - - - (Ville et al., Senat et al., 2004).

5 , . - , - , - (5%) (2%) (Sebire et al., 1997a). - - - .

, 32 . 24 - 100%,

128 1113+6

32- . 2432 - . 2432 1%, 5% - 10% (Sebire et al., 1997a).

5% 5 , 20% -, 30% (Sebire et al., 1997a, 1998). , - 2% 8% .

, - , . - . , - , , - , . , , 90% , - - .

4 , - - (Savvidou et al., 2001).

5 129

- , . - . .

- , . - 510%, 30%, , - , . - (Fusi et al., 1991). , , , 24 .

: , -, , , - . - . - , - 23

130 1113+6

(Burn et al., 1991, Baldwin et al., 1994). - ( 10% 20% ).

- - (Sebire et al., 1997b). , , - , -. , . - - , , .

-

, - . --, - -. , - , - (Benirschkle et al., 1973). 30% - - () () - - , .

- - 1624 . -

5 131

-- - - -. - - - , ( 3).

3. - 20 . - -,

-

, - - - , 1113+6 - . 1113+6 - , - - , 30%,

132 1113+6

, , 10% (Sebire et al., 2000).

-- - -- (Matias et al., 2000). - - .

, - - , ( 4). 30% - 1517 , (15% - ) ; - - , .

4. - 16 . , - -

66% ,

5 133

- .

- , 1% . - , - - -- -, , , , , - (Van Allen et al., 1983). 50% - , , . - -, -. 16 - - -.

- . - , , , , . - .

134 1113+6

- : -, - - , - , . -, - , - .

, . -. 16 - , - (Evans et al., 1994).

- , , , 2%. 1%, 1% - , - , -. - , , , .

5 135

,

, , , , - , -. - , , .

- , .

- - , 1,6 , - .

, . , - , . , - , -, - . , 21 1 100, - 21 1 50 (1/100+1/100),

136 1113+6

21 1 10 000 (1/100 1/100). , 10% , - , .

, - , 21 5070% -- 5% (Cuckle et al., 1998).

, , . - , - 45% - 5% (Cucke, 1998).

- , , - . -, - - , - - . -, - , . -, - - .

5 137

,

- 7580% - 5%, - - (Sebire et al., 1996a, 1996b). 21 - . , 1113+6 - , - .

, - , .

- - , - , 8%, - . 21 - , - .

,

- - -, , 2 . 21 - , - , - . -

138 1113+6

10% (5% ) - 8590% 21 (Spencer and Nicolaides, 2003). - - - - .

, , . - - . - (Sebire et al., 1997c).

16 - 16 , (Evans et al., 1994). , , , , , . -, .

21 , - . -, , ,

5 139

18, 85% in utero , 15% - . 18 - , , . , , , , , 18 .

21 - . - - - , , 8%, - . 21 , - - - ; - .

21 - 8590% 21 -- 10% (5% ). - , , . 16 - 16 .

140 1113+6

Baldwin V. J. Anomalous development of twins. In Pathology of Multiple Preg-nancy. In Baldwin V. J. (Ed). Springer-Verlag, New York, 1994, pp. 16997.

Benirschke K., Kim C. K. Multiple pregnancy. N Eng J Med 1973; 288:127684.

Bessis R., Papiernik E. Echographic imagery of amniotic membranes in twin preg-nancies. In: Gedda L, Parisi P, eds. Twin research 3: Twin biology and multiple pregnancy. New York: Alan R. Liss, 1981, pp. 1837.

Burn J. Disturbance of morphological laterality in humans. Ciba Found Symp 1991; 162:28296.

Cuckle H. Downs syndrome screening in twins. J Med Screen 1998; 5:34.

Evans M. l., Goldberg J. D., Dommergues M., Wapner R. J., Lynch L., Dock . S., et al. E cacy of second-trimester selective termination for fetal abnormalities: in-ternational col laborative experience among the worlds largest centers. Am J Obstet Gynecol 1994; 171:904.

Fusi L., MacOharland P., Fisk N., Nicolini U., Wigglesworth J. Acute twin-twin trans-fusion: a possible mechanism for brain damaged survivors after intrauterine death of a monozygotic twin. Obstet Gynecol 1991; 78:51722.

Matias A., Montenegro N., Areias J. C. Anticipating twin-twin transfusion syn-drome in monochorionic twin pregnancy. Is there a role for nuchal translucency and ductus venosus blood ow evaluation at 1114 weeks? Twin Res 2000; 3:6570.

Monteagudo A., Timor-Tritsch I., Sharma S. Early and simple determination of chori-onic and amniotic type in multifetal gestations in the rst 14 weeks by high frequency transvaginal ultrasound. Am J Obstet Gynecol 1994; 170:8249.

Monteagudo A., Timor-Tritsch I. E. Second- and third-trimester ultrasound evalu-ation of chorionicity and amnionicity in twin pregnancy. A simple algorithm. J Reprod Med 2000; 45:47680.

Sawidou M. D., Karanastasi E., Skentou C., Geerts L., Nicolaides K. H. Twin chori-onicity and pre-eclampsia. Ultrasound Obstet Gynecol 2001; 18:22831.

5 141

Sebire N. J., Snijders R. J. M, Hughes K., Sepulveda W., Nicolaides K. H. Screening for tri-somy 21 in twin pregnancies by maternal age and fetal nuchal translu-cency thickness at 10-14 weeks of gestation. BJOG 1996a; 103:9991003.

Sebire N. J, Noble P. L, Psarra A., Papapanagiotou G., Nicolaides K. H. Fetal kary-otyping in twin pregnancies: selection of technique by measurement of fetal nuchal trans lucency. BJOG 1996b; 103:88790.

Sebire N. J., Sepulveda W., Hughes K. S., Noble P., Nicolaides K. H. Management of twin pregnancies discordant for anencephaly. BJOG 1997b; 104:2169.

Sebire N. J., Snijders R. J. M, Hughes K., Sepulveda W., Nicolaides K. H. The hidden mortality of monochorionic twin pregnancies. BJOG 1997a; 104:12037.

Sebire N. J., Snijders R. J. M, Santiago C., Papapanagiotou G., Nicolaides K.H. Manage ment of twin pregnancies with fetal trisomies. BJOG 1997c; 104:2202.

Sebire N. J., Carvalho M., DErcole C., Souka A., Nicolaides K. H. Intertwin disparity in fetal size in monochorionic and dichorionic twin pregnancies. Obstet Gynecol 1998a; 91:825.

Sebire N. J., Souka A., Carvalho M., Nicolaides K. H. Inter-twin membrane fold-ing as an early feature of developing twin-to-twin transfusion syndrome. Ultra-sound Obstet Gynecol 1998b; 11:32427.

Sebire N. J., Souka A., Skentou H., Geerts L., Nicolaides K. H. Early prediction of severe twin-to-twin transfusion syndrome. Hum Reprod 2000; 15:200810.

Senat M. V., Deprest J., Boulvain M., Paupe A., Winer N., Ville Y. Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syn-drome. N Engl J Med 2004; 351:1 3644.

Sepulveda W., Sebire N. J, Hughes K., Odibo A., Nicolaides K. H. The lambda sign at 10-14 weeks of gestation as a predictor of chorionicity in twin pregnancies. Ultrasound Obstet Gyneco) 1996; 7:4213.

Sepulveda W., Sebire N. J., Hughes K., Kalogeropoulos A., Nicolaides K. H. Evolu-tion of the lambda or twin/chorionic peak sign in dichorionic twin pregnancies. Obstet Gynecol 1997; 89:43941.

Spencer K., Nicolaides K. H. Screening for trisomy 21 in twins using rst trimester ultra sound and maternal serum biochemistry in a one-stop clinic: a review of three years experience. BJOG 2003; 110:27680.

142 1113+6

Van Allen Ml, Smith DW & Shepard TH. Twin reversed arterial perfusion (TRAP) sequence: study of 14 twin pregnancies with acardius. Semin Perinatal 1983; 7:28593.

Ville Y., Hyett J., Hecher K., Nicolaides K. H. Preliminary experience with endo-scopic laser surgery for severe twin-twin transfusion syndrome. N Engl J Med 1995; 332:2247.

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E-mail: [email protected]. petropolis-ph.spb.ru

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УЛЬТРАЗВУКОВОЕ ИССЛЕДОВАНИЕ В 11-14 НЕДЕЛЬ БЕРЕМЕННОСТИ

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