深圳市妇幼保健院妊娠子宫超声检查细则

深圳市妇幼保健院妊娠子宫超声检查细则 一、一般产科超声检查要求 1、使用仪器:国产实时黑白超声仪检查，探头频率为3,5MHz，经腹部检查。 2、妊娠中、晚期应包括以下内容: (1)、确定胎儿是否存活、数目、胎先露和胎动情况:是否有胎心搏动。有几个胚胎，如为多胎，观察有几个胎盘。 (2)、测量羊水量(过多、过少、正常):测量最大羊水池深度。 (3)、胎盘位置、形态、成熟度以及胎盘厚度。 (4)、测量双顶径、股骨长、腹围等生长发育参数。 二、妊娠子宫常规超声检查细则: 1、使用仪器:可使用实时黑白及彩色多普勒超声仪检查，可经腹部及阴道检查。 ?、探头频率的选择原则:在能满足穿透力的情况下尽可能选用频率较高的探头，以提高分辨力。 ?、腹部检查:选用3,5MHz，高档仪器，只要有足够穿透力，可使用更高频率，如6.0MHz。 ?、经阴道检查:7,10MHz或更高频率。 2、妊娠早期常规超声检查: 检查时间:14周内均属于此范畴。 检查方法:可经腹或经阴道检查，或两者都使用。 (1)、常规检查子宫附件，判断有无妊娠囊。 ?、如果子宫内无妊娠囊，应仔细检查附件有无包块或妊娠囊，并应结合病史与实验室检查结果综合考虑。应嘱病人在,,7天后复查。 ?、如果子宫内有妊娠囊: 应观察、记录其着床的位置。 应观察、记录妊娠囊内有无胚胎。有胚胎时应测量头臀长(CRL)。 如果胚胎不肯定，孕囊内必须见到卵黄囊，否则不能确定是或不是妊娠囊，这时应嘱病人在,,7天后复查。 administrative leadership of the criticism, resulting in serious consequences, the pursuit of leadership, along with 500-1000 punishment. (5) significant near miss should be attempted as the case of responsible for the accident and construction team injuries accident penalty provisions, mutatis mutandis. Eight, should perform in the construction standards and specifications, serial number a 1 GB3323-2005 steel fusion welded butt joints, welding engineering-Ray lighting and quality rating of 2 GB11345-89 steel welds manual methods of ultrasonic inspection and testing results for grade 3 GB50236-2002 industrial pipe welding engineering code for construction and acceptance of field equipment 4 HGJ222-92 technical specification for welding of aluminium and its alloys 5 low temperature steel welding procedure 6 SH3525-2004 petrochemical JB/ T4708-2000 of welding procedure qualification for steel pressure vessels 7 JB/4709-2000 8 JB4730-2005 pressure vessel welding procedures of steel pressure vessel NDT 9 JB/T4744-2000 steel pressure vessel products mechanical properties test of welded plate II, mechanical equipment installation engineering 1 GB150-98 2 GB50128-2005 vertical cylindrical steel pressure vessel steel welded specification for construction and acceptance of oil tank 3 JB/ T4735-1997 steel welded atmospheric pressure vessel 4 GB50231-2009 mechanical equipment installation engineering construction and acceptance specification for 5 GB50275-98 compressor, fan ?、孕周的估计依据孕囊平均直径估测。 ?、孕囊形态及孕囊内容物对诊断很重要，应注意观察。 ?、在早孕晚期，也可以测量BPD或其他生长发育参数来评估胎龄大小。 (2)、注意观察并报告是否有胎心搏动。 ?、有胎心搏动时可确定胚胎存活。 ?、未检出胎心搏动时，不能轻易下胚胎停育的诊断，应嘱病人5~7天后复查。 ?、经阴道检查时， CRL?5mm时应常规检出心管搏动，如果未检出心管搏动，可考虑胚胎停育。CRL<5mm时，如果没见到心搏，则不能诊断胚胎死亡，应嘱病人5,7天后复诊，以确定胎儿是否存活。 (3)、确定胚胎数目。多胎妊娠必须见到多个胚胎才能诊断。 (4)、检查子宫、附件本身结构及子宫直肠窝。 ?、观察是否有子宫肌瘤和附件肿块，应记录并报告其位置、大小、形态、结构、内部回声等。 ?、应常规探查子宫直肠陷窝是否有积液，如果有积液，应检查两侧腹部及肝下间隙以除外腹水。 (5)、常规测量数据:GS最大内径、平均内径、CRL;10,14周胎儿应测量NT，可测量BPD、FL、HL等参数。 3、妊娠中、晚期常规超声检查: (1)、确定胎儿是否存活、数目、胎先露和胎动情况: ?、观察胎心率和节律是否异常。 ?、多胎妊娠要求:羊膜囊数目、胎盘数目、胎儿之间有无羊膜分隔，胎儿大小的比较。每一个胎儿羊膜腔内羊水的比较。 (2)、测量羊水量(过多、过少、正常):最大羊水池深度、羊水指数。 (3)、胎盘位置、形态、成熟度以及其与宫颈内口的关系。 (4)、观察脐带:脐带内脐血管的数目，脐动脉的数目。 (5)、应联合应用BPD、HC、FL、HL来综合估计孕周大小。BPD、HC、FL、HL应在 标准 excel标准偏差excel标准偏差函数exl标准差函数国标检验抽样标准表免费下载红头文件格式标准下载 平面上测量。 如果胎儿结构有异常(如:胎儿脑积水或肢体发育不全)，则这些有结构异常的测量值不能用来估测孕周。 administrative leadership of the criticism, resulting in serious consequences, the pursuit of leadership, along with 500-1000 punishment. (5) significant near miss should be attempted as the case of responsible for the accident and construction team injuries accident penalty provisions, mutatis mutandis. Eight, should perform in the construction standards and specifications, serial number a 1 GB3323-2005 steel fusion welded butt joints, welding engineering-Ray lighting and quality rating of 2 GB11345-89 steel welds manual methods of ultrasonic inspection and testing results for grade 3 GB50236-2002 industrial pipe welding engineering code for construction and acceptance of field equipment 4 HGJ222-92 technical specification for welding of aluminium and its alloys 5 low temperature steel welding procedure 6 SH3525-2004 petrochemical JB/ T4708-2000 of welding procedure qualification for steel pressure vessels 7 JB/4709-2000 8 JB4730-2005 pressure vessel welding procedures of steel pressure vessel NDT 9 JB/T4744-2000 steel pressure vessel products mechanical properties test of welded plate II, mechanical equipment installation engineering 1 GB150-98 2 GB50128-2005 vertical cylindrical steel pressure vessel steel welded specification for construction and acceptance of oil tank 3 JB/ T4735-1997 steel welded atmospheric pressure vessel 4 GB50231-2009 mechanical equipment installation engineering construction and acceptance specification for 5 GB50275-98 compressor, fan (6)、胎儿体重估计，要求测量腹围(AC)，并在腹围的标准平面上测量。 (7)、检查子宫、宫颈及附件情况，发现有临床意义的潜在病变时要求记录、报告。 (8)、胎儿解剖结构检查: 最少应包括以下解剖方面的内容: 头部:颅骨、大脑、脑中线、侧脑室、丘脑。 颜面部:唇。 心脏:四腔心切面。 脊柱:颈、胸、腰、骶尾段。 腹部:腹壁的完整性、肝、胃、双肾、膀胱。 胎儿脐带及其附着部位。 在胎儿体位允许时，还可以检查其他解剖结构。 ?、常规胎儿检查最少应检查以上胎儿解剖结构。但有时因为胎位、羊水少、母体因素的影响，超声检查并不能很好地显示这些结构，这时超声报告要说明那些结构显示欠清。 ?、怀疑有异常时，最好嘱病人再进行下述详细系统的胎儿畸形超声检查。必要时请上级医师或有经验的医师会诊。 (9)、常规测量数据:BPD、HC、AC、FL、HL、CER。 4、适当留存图片于工作站内。 三、详细系统胎儿畸形超声检查(产前超声诊断): 1、检查时间:适合在妊娠18—24周内检查，超过此时期，胎儿颜面部、四肢、心脏等结构可能观察不完全或不能显示清楚;如果羊水极度过少或无羊水，胎儿的这些结构亦可能显示不清。 2、使用仪器:应使用高分辨力的彩色多普勒血流显像仪检查，一般黑白B超只要求进行上述常规超声检查内容，一般不用黑白B超进行详细系统胎儿畸形超声检查。 3、检查内容除包括上述常规超声检查内容以外，还应包括以下内容: ?脊椎:观察脊柱的连续性、弯曲度、骨化程度。 ?头颅:颅骨结构、骨化程度等。脑内结构包括大脑、大脑镰、侧脑室、第三脑室、丘脑、小脑、小脑蚓部、后颅窝池、第4脑室等结构，必要时显示脑部冠状切面显示胼胝体。 ?颜面部:眼及眼眶、唇。颜面因胎位或其他因素显示不清者，应特别注明。确诊颜面部畸形应采用针对性检查方法，至少要在两个相互正交的切面上显示并印证，否则不能诊断。 administrative leadership of the criticism, resulting in serious consequences, the pursuit of leadership, along with 500-1000 punishment. (5) significant near miss should be attempted as the case of responsible for the accident and construction team injuries accident penalty provisions, mutatis mutandis. Eight, should perform in the construction standards and specifications, serial number a 1 GB3323-2005 steel fusion welded butt joints, welding engineering-Ray lighting and quality rating of 2 GB11345-89 steel welds manual methods of ultrasonic inspection and testing results for grade 3 GB50236-2002 industrial pipe welding engineering code for construction and acceptance of field equipment 4 HGJ222-92 technical specification for welding of aluminium and its alloys 5 low temperature steel welding procedure 6 SH3525-2004 petrochemical JB/ T4708-2000 of welding procedure qualification for steel pressure vessels 7 JB/4709-2000 8 JB4730-2005 pressure vessel welding procedures of steel pressure vessel NDT 9 JB/T4744-2000 steel pressure vessel products mechanical properties test of welded plate II, mechanical equipment installation engineering 1 GB150-98 2 GB50128-2005 vertical cylindrical steel pressure vessel steel welded specification for construction and acceptance of oil tank 3 JB/ T4735-1997 steel welded atmospheric pressure vessel 4 GB50231-2009 mechanical equipment installation engineering construction and acceptance specification for 5 GB50275-98 compressor, fan ?心脏:要求按四腔心平面声束头侧偏转法探测胎儿心脏。 A、要求显示以下切面: a、四腔心切面:明确四腔心是否左右对称，四腔心结构有无异常，心脏中央“十”字交叉是否存在，左、右房室连接是否异常。 b、左、右心室流出道切面:观察大动脉的大小、形态，判断心室与大动脉的连接关系。 B、测量胎儿心率，并观察胎儿心律是否整齐，明确有无心律失常。 ?胎儿腹部:要求检查胎儿胃、肝、肾、膀胱等器官。确定有无大的腹裂;是否有脐膨出;是否有上述器官疝入胸腔(膈疝);有无胸腹水;肠管是否有扩张。 ?胎儿肢体:要求按连续节段顺序追踪扫查法逐一追踪观察胎儿四个肢体及其内的长骨及以手、足形态、结构、手与前臂的关系及手的姿势、足与小腿的关系。明确有无严重短肢畸形，有无肱骨、股骨、胫腓骨、尺桡骨等长骨严重畸形，但对手、足的严重畸形诊断要谨慎。 ?脐带观察:脐带内血管数目、脐带粗细、脐带绕颈、脐带囊肿等。 ?脐动脉血流:测量收缩期最大流速、舒张期最低流速、阻力指数、A/B比值。 4、测量数据:BPD、HC、AC、FL、HL、CER、HR。胎盘厚度。最大羊水深度、羊水指数。 5、畸形诊断至少要两位高年资的医师签名。 6、显示主要切面、照片、图像采集于网络工作站内: 18—28周要求获得以下标准切面: (1)头部应有经过侧脑室及丘脑的横切面，于此切面测量侧脑室内径、BPD、HC。 (2)心脏:四腔心切面，必要时左、右心室流出道切面。 (3)脊椎:颈、胸、腰骶尾椎纵切面。 (4)腹部:腹围测量横切面。 (5)胎盘下缘与宫颈内口关系。 (6)颜面:唇冠状切面，必要时横切面。 对不能获得的标准切面应特别注明原因，如胎儿方面的原因(胎儿体位影响、胎儿太大、胎儿太小、羊水过多、羊水过少、多胎妊娠等)或母亲方面的原因(肥胖、腹壁瘢痕影响等)。对于畸形病变部位至少应保存纵横两个切面图。 四、针对性超声检查要求 针对性超声检查主要是在一般超声检查或常规超声和系统超声检查基础上才能进行，所针对的问题和目的可由临床医师提出或在前面三种检查后提出，要明确某一具体类型的畸形，可administrative leadership of the criticism, resulting in serious consequences, the pursuit of leadership, along with 500-1000 punishment. (5) significant near miss should be attempted as the case of responsible for the accident and construction team injuries accident penalty provisions, mutatis mutandis. Eight, should perform in the construction standards and specifications, serial number a 1 GB3323-2005 steel fusion welded butt joints, welding engineering-Ray lighting and quality rating of 2 GB11345-89 steel welds manual methods of ultrasonic inspection and testing results for grade 3 GB50236-2002 industrial pipe welding engineering code for construction and acceptance of field equipment 4 HGJ222-92 technical specification for welding of aluminium and its alloys 5 low temperature steel welding procedure 6 SH3525-2004 petrochemical JB/ T4708-2000 of welding procedure qualification for steel pressure vessels 7 JB/4709-2000 8 JB4730-2005 pressure vessel welding procedures of steel pressure vessel NDT 9 JB/T4744-2000 steel pressure vessel products mechanical properties test of welded plate II, mechanical equipment installation engineering 1 GB150-98 2 GB50128-2005 vertical cylindrical steel pressure vessel steel welded specification for construction and acceptance of oil tank 3 JB/ T4735-1997 steel welded atmospheric pressure vessel 4 GB50231-2009 mechanical equipment installation engineering construction and acceptance specification for 5 GB50275-98 compressor, fan 以针对这一畸形进行针对性检查，也可以针对某些重要器官或畸形高发生率的器官进行针对性检查。例如针对胎儿心脏的胎儿超声心动图检查、针对胎儿四肢或颜面部的检查等。但在妊娠晚期针对性超声检查也可能受到一些客观条件的限制，检查医师应实事求是地告知患者。下面举例说明针对性超声检查的要求。 1、颜面部畸形的针对性超声检查要求。 (1)颜面部冠状切面观察胎儿上唇、下唇连续性，下颌是否后缩，前额是否凸起或后缩。 (2)颜面部横切面观察胎儿双侧眼球是否对称，其内是否存在晶状体、晶状体回声是否混浊，测量眼距、眼间距及眼外距，观察鼻骨是否发育并测量鼻骨长度，观察上唇、牙槽突及下唇是否连续完整，测量下颌骨的长度。 (3)颜面部矢切面观察前额是否凸起或后缩，鼻骨发育情况，测量鼻骨的长度，上唇及上腭的连续性回声是否完整，下颌是否短小且后缩等。 (4)尽可能观察胎儿双侧耳廓情况，测量耳廓的上下径，必要时观察外耳道是否存在。 2、肢体畸形的针对性超声检查要求 (1)对胎儿四个肢体逐一进行检查，不漏检任何一条肢体。 (2)应对双上肢和双下肢长骨的数目、对称性进行观察，两侧肢体是否对称，测量各骨的长短，测量足长，比较足长和股骨长度，各骨骼长度与孕周是否吻合。 (3)手足的观察，可观察手指数目、手的姿势，足趾数目、足的姿势、足弓是否存在，即使观察不清，也应该有所说明。 (4)对于手足姿势异常的观察一定要说明是在肢体及手足多次运动后总是处于同一姿势才能做出诊断。 3、胎儿超声心动图的针对性超声检查要求，按先天性心脏病节段顺序分析法检查心脏。 (1)首先横切胎儿腹部，观察胎儿腹主动脉和下腔静脉的位置关系。 (2)明确心脏在胸腔内位置、心脏轴是否正常，心尖指向，心胸比值是否正常，测量胎儿心率，并观察胎儿心律是否整齐，明确有无心律失常。 (3)四腔心切面:明确四腔心是否左右对称，四腔心结构有无异常，心脏中央“十”字交叉是否存在，左、右房室连接是否异常，肺静脉回流是否正常。测量心房心室大小、室壁厚度。 (4)左、右心室流出道切面:观察大动脉的大小、形态，判断心室与大动脉的连接关系。 (5)心脏短轴切面:包括双心室短轴切面、房室瓣水平短轴切面、大动脉短轴切面。 (6)动态观察大动脉超始部的交叉关系，注意主、肺动脉大小比较。 administrative leadership of the criticism, resulting in serious consequences, the pursuit of leadership, along with 500-1000 punishment. (5) significant near miss should be attempted as the case of responsible for the accident and construction team injuries accident penalty provisions, mutatis mutandis. Eight, should perform in the construction standards and specifications, serial number a 1 GB3323-2005 steel fusion welded butt joints, welding engineering-Ray lighting and quality rating of 2 GB11345-89 steel welds manual methods of ultrasonic inspection and testing results for grade 3 GB50236-2002 industrial pipe welding engineering code for construction and acceptance of field equipment 4 HGJ222-92 technical specification for welding of aluminium and its alloys 5 low temperature steel welding procedure 6 SH3525-2004 petrochemical JB/ T4708-2000 of welding procedure qualification for steel pressure vessels 7 JB/4709-2000 8 JB4730-2005 pressure vessel welding procedures of steel pressure vessel NDT 9 JB/T4744-2000 steel pressure vessel products mechanical properties test of welded plate II, mechanical equipment installation engineering 1 GB150-98 2 GB50128-2005 vertical cylindrical steel pressure vessel steel welded specification for construction and acceptance of oil tank 3 JB/ T4735-1997 steel welded atmospheric pressure vessel 4 GB50231-2009 mechanical equipment installation engineering construction and acceptance specification for 5 GB50275-98 compressor, fan (7)上下腔静脉长轴切面，观察上下腔静脉回流是否正常。 (8)动脉导管弓切面及主动脉弓切面:观察大动脉、动脉导管及其分支。 (9)主动脉弓水平横切面即三血管-气管平面，观察有无右位主动脉弓、主动脉缩窄或离断等。 (10)彩色血流检查:观察房室瓣和半月瓣血流及其有无返流或其它异常血流，大动脉腔内血流及有无返流或其它异常血流。 4、染色体异常(21-三体)的针对性超声检查 凡是与21三体有关的所有超声指标均应详细检查，去寻找有关指标，目前超声通常可观察以下内容: (1)颜面部:测量两眼内距，正中矢状切面显示前额有无异常，有无舌肥大。 (2)颈部:10-14周在正中矢状切面上测量颈项透明层厚度，14-20周在小脑平面测量颈褶厚度。 (3)心脏:有无心脏畸形，如房室间隔缺损、心内强光点等。 (4)腹部:有无十二指肠闭锁、肠道强回声、肾盂分离。 (5)肢体骨骼:肱骨和股骨是否缩短，髂骨角是否增大，手足姿势是否异常有无草鞋脚等。 (6)有无皮肤水肿及浆膜腔积液。 (7)颅脑:脉络丛有无囊肿、侧脑室是否扩大。 (8)脐动脉血流有无异常。 (9)静脉导管血流有无异常。 孕妇与产前超声诊断 时间:2010-1-28 | 来源: | 发布者:李胜利 | 点击:145 次 【摘要】 孕妇与产前超声诊断: 拥有一个健康活泼可爱的小宝宝是每一位准父母的的愿望。特别是对于一些生育过有严重畸形或先天性疾病的、多次不明原因的流产、死胎、或是家族中有遗传病的孕妇，及在怀孕期间接触过药物、放射线等有害物质的孕妇或高龄初产妇女，胎儿是否发育健康是准父母们最关心的问题。 随着医学的进步与发展，一些准爸爸妈妈们最关心的问题也许可以在产前咨询与产前超administrative leadership of the criticism, resulting in serious consequences, the pursuit of leadership, along with 500-1000 punishment. (5) significant near miss should be attempted as the case of responsible for the accident and construction team injuries accident penalty provisions, mutatis mutandis. Eight, should perform in the construction standards and specifications, serial number a 1 GB3323-2005 steel fusion welded butt joints, welding engineering-Ray lighting and quality rating of 2 GB11345-89 steel welds manual methods of ultrasonic inspection and testing results for grade 3 GB50236-2002 industrial pipe welding engineering code for construction and acceptance of field equipment 4 HGJ222-92 technical specification for welding of aluminium and its alloys 5 low temperature steel welding procedure 6 SH3525-2004 petrochemical JB/ T4708-2000 of welding procedure qualification for steel pressure vessels 7 JB/4709-2000 8 JB4730-2005 pressure vessel welding procedures of steel pressure vessel NDT 9 JB/T4744-2000 steel pressure vessel products mechanical properties test of welded plate II, mechanical equipment installation engineering 1 GB150-98 2 GB50128-2005 vertical cylindrical steel pressure vessel steel welded specification for construction and acceptance of oil tank 3 JB/ T4735-1997 steel welded atmospheric pressure vessel 4 GB50231-2009 mechanical equipment installation engineering construction and acceptance specification for 5 GB50275-98 compressor, fan 声诊断中得到答案。 现在医生拥有良好的手段监控未来宝宝的健康发育，其中包括孕早期超声检测胎儿颈后透明带厚度(Nuchal Translucent) 和母血的游离人类绒毛膜性腺激素(freeβ--hCG)和妊娠相关蛋白A(PAPP-A);孕中期的母血生化标记物筛检即甲型胎儿蛋白(AFP)和游离人类绒毛膜性腺激素( freeβ-hCG)的孕妇血液方面的筛查以及胎儿系统产前超声筛查。对可能怀有染色体异常的高危险孕妇案例，然后再进一步建议产妇接受羊水或脐带血检查。 其中的超声波检查，不仅在孕早期超声测量颈后透明带厚度(NT)，孕中期在胎儿系统超声检查中对一些胎儿结构畸形进行筛选外，还可见发现一些微小异常，多个微小异常的组合可能就是胎儿非整倍体染色体异常的最初线索，也是进行染色体检查的指征之一。所以现在的胎儿超声检查已经进入遗产学超声检查阶段。为了降低出生缺陷，确保每一个出生的婴儿健康，产前超声筛查已成为我院实行四级筛查体系中的一道重要防线， 孕妇往往有一些疑问，什么是产前筛查,为什么做产前筛查,我需要做吗,我的胎儿需要做超声波检查吗,产前超声检查的目的是什么,什么时候去好,做超声检查会不会影响我的小宝宝的发育哪,那么希望下面的几个问答可以帮助你。 1、什么是产前筛查, 答:产前筛查是预防大多数先天缺陷儿出生的一种手段，是产前诊断的第一步，采取相应 措施 《全国民用建筑工程设计技术措施》规划•建筑•景观全国民用建筑工程设计技术措施》规划•建筑•景观软件质量保证措施下载工地伤害及预防措施下载关于贯彻落实的具体措施 最大限度地减少缺陷儿的出生。它是通过化验孕妇血液中的某些特异性指标或孕早期的超声测量胎儿颈厚透明层厚度及孕中期的胎儿系统超声检查来发现某些异常。如果经筛查发现胎儿可能有先天缺陷(如先天愚型)，就需要取羊水做产前诊断来证实。由于羊膜腔穿刺的技术要求很高，只适用某些高危人群的诊断，故不能普及。目前产前筛查的两种主要疾病是唐氏综合征(Down’s Sydrome,又称21三体综合征)和开放性神经管缺陷(Open Neural Tube Defect,或ONDT)，也包括一部分18三体综合征等。根据目前的技术水平的限制，世界各国都不能做到筛查百分之百正确。产前筛查可以在妊娠早期(10-14周)或中期(15-24周)进行。 2、 为什么要进行产前筛查, 答:我国每年约有20万-30万肉眼可见先天畸形儿出生，加上出生后数月和数年才显现出来的缺陷，先天残疾儿童总数高达80万-120万，约占每年出生人口总数的4%-6%。这些情况，不仅使出生缺陷和残疾日益成为影响人口素质的重要问题，同时也给家庭和社会造成沉重的administrative leadership of the criticism, resulting in serious consequences, the pursuit of leadership, along with 500-1000 punishment. (5) significant near miss should be attempted as the case of responsible for the accident and construction team injuries accident penalty provisions, mutatis mutandis. Eight, should perform in the construction standards and specifications, serial number a 1 GB3323-2005 steel fusion welded butt joints, welding engineering-Ray lighting and quality rating of 2 GB11345-89 steel welds manual methods of ultrasonic inspection and testing results for grade 3 GB50236-2002 industrial pipe welding engineering code for construction and acceptance of field equipment 4 HGJ222-92 technical specification for welding of aluminium and its alloys 5 low temperature steel welding procedure 6 SH3525-2004 petrochemical JB/ T4708-2000 of welding procedure qualification for steel pressure vessels 7 JB/4709-2000 8 JB4730-2005 pressure vessel welding procedures of steel pressure vessel NDT 9 JB/T4744-2000 steel pressure vessel products mechanical properties test of welded plate II, mechanical equipment installation engineering 1 GB150-98 2 GB50128-2005 vertical cylindrical steel pressure vessel steel welded specification for construction and acceptance of oil tank 3 JB/ T4735-1997 steel welded atmospheric pressure vessel 4 GB50231-2009 mechanical equipment installation engineering construction and acceptance specification for 5 GB50275-98 compressor, fan 经济负担。为了预防和减少出生缺陷和残疾的发生，进行产前筛查势在必行。生一个健康、聪明的宝宝是每一个家庭的共同愿望。而遗传因素和环境因素(如噪声污染、放射污染、化学污染、微生物污染等)是造成先天缺陷儿出生的主要原因，每一对健康夫妇都有可能出生先天缺陷儿，而且出生后尚无有效的治疗方法，其中，先天愚型和神经管畸形的发生率较高。产前筛查的目的是进一步对高危人群确诊，并为孕妇提供终止妊娠的方法，预防和减少出生缺陷。为了检查先天缺陷儿的出生，所以对每一位孕妇都有必要进行产前筛查。椐统计约80%的胎儿染色体疾病发生在普通孕妇中，这是因为这一人群的生育绝对值超过高危人群，因此从优生的角度对其进行产前筛查诊断同样不能忽视。 3、 什么是21,三体(先天性愚形), 答:由唐.兰登医生(John langdon Down)在一八六六年发现一群人有相同的特征，于是便取其姓氏,Down,定名这症状为唐氏综合症。 唐氏综合症或称21三体，国内又称为先天愚型，是最常见的严重出生缺陷病之一。是一种染色体异常而引起的疾病，正常人的細胞中有四十六个染色体，而唐氏的婴儿則有四十七个，21号染色体为3个故称为21,三体。临床表现为:患者面容特殊，两外眼角上翘，鼻梁扁平，舌头常往外伸出，肌无力及通贯手。患者绝大多数为严重智能障碍并伴有多种脏器的异常，如先天性心脏病、白血病、消化道畸形等。本病发生几乎波及世界各地，很少有人种差异。椐统计染色体异常在新生儿中的发生率为5-6/1000，唐氏综合症约为1/750，绝大多数病人属随机发生，但随母亲年龄的增长其发生率随之升高，一般母亲年龄35岁以上，该患儿的出生率可高达1/350。 以往这类疾病的产前诊断唯有通过做羊水或绒毛检查，而这些方法因费时长，费用高，操作麻烦，故只能局限于部分高危孕妇。而现在随着医疗结束水平的提高，在孕早期的母血生化检查、孕10,14周胎儿颈后透明层厚度(NT)的超声测量及孕中期胎儿系统超声检查中所能发现的微小异常，孕妇年龄等，对胎儿进行综合评估，进行初步筛查，对患染色体异常风险值增加的孕妇进行羊水或脐血检查。 大大提高的对胎儿患染色体异常的检出率。 4、 什么是神经管缺陷, 神经管缺陷是无脑畸形和脊柱裂等一系列疾病的统称。根据神经管发育受阻时间及部位的不同，此类畸形分为无脑畸形、露脑畸形、脊柱裂、脑或脑膜膨出等。神经系统先天畸形administrative leadership of the criticism, resulting in serious consequences, the pursuit of leadership, along with 500-1000 punishment. (5) significant near miss should be attempted as the case of responsible for the accident and construction team injuries accident penalty provisions, mutatis mutandis. Eight, should perform in the construction standards and specifications, serial number a 1 GB3323-2005 steel fusion welded butt joints, welding engineering-Ray lighting and quality rating of 2 GB11345-89 steel welds manual methods of ultrasonic inspection and testing results for grade 3 GB50236-2002 industrial pipe welding engineering code for construction and acceptance of field equipment 4 HGJ222-92 technical specification for welding of aluminium and its alloys 5 low temperature steel welding procedure 6 SH3525-2004 petrochemical JB/ T4708-2000 of welding procedure qualification for steel pressure vessels 7 JB/4709-2000 8 JB4730-2005 pressure vessel welding procedures of steel pressure vessel NDT 9 JB/T4744-2000 steel pressure vessel products mechanical properties test of welded plate II, mechanical equipment installation engineering 1 GB150-98 2 GB50128-2005 vertical cylindrical steel pressure vessel steel welded specification for construction and acceptance of oil tank 3 JB/ T4735-1997 steel welded atmospheric pressure vessel 4 GB50231-2009 mechanical equipment installation engineering construction and acceptance specification for 5 GB50275-98 compressor, fan 发生率较高，据欧美国家的一项长期监测研究表明，出生儿中发生率达3%,4%。自发性流产病例中此类畸形发生率更高。在胚胎发育的第3--4周，形成一个位于胚体背部中轴线上的神经管，神经管的头部发育增大形成脑，其余部分仍保持管状，形成脊髓。在第6周末之前胚胎因某种原因受到损害，可形成无脑畸形(前神经孔闭合失败)或脊柱裂(后神经孔闭合失败)。无脑畸形儿一般在出生前或出生后很短时间内就会死亡，而脊柱裂患儿往往还伴有脑积水、肢体麻痹和大小便失禁等严重合并症，即使存活，也多是终身残疾。 5、怀孕期间要做几次B超检查,什么时候做比较合适, 答:一般需要做3次。第一次在10-14周 。第二次在18-24周，该次检查对所有的孕妇都非常重要。有条件的话，最好要做一次详细的彩超检查。因为彩超比黑白B超的分辨率高，很多畸形都可以表现出来。第三次检查安排在32-36周。 6、超声检查或多次反复超声检查对胎儿会不会有影响呢, 答:由于产前诊断用超声波的输出能量很小，且非长时间持续地对准某一处进行探测，而且超声检查剂量没有累加效应，所以即使多照几次，对胎儿与母体也不会造成伤害。到目前为止，还没有因检查B超而致胚胎死亡或胎儿畸形的报道。 7、产前诊断包括哪些技术, 答:胎儿畸形的产前诊断包括各种技术，如超声诊断、羊膜腔穿刺、脐血管穿刺取脐血染色体检查、绒毛取样染色体检查以及许多生化检测、PCR及DNA检测方法，其中超声检查是最常用的检测方法，由于其对胎儿无创伤、无致畸作用、无附加效应，胎儿图像清晰，诊断准确安全性高，是目前产科唯一的影像检查方法。 8、什么情况下需要做胎儿染色体检查, 答:在产检中发现有两个以上阳性指标，要考虑在第16-20周时做羊水穿刺胎儿细胞培养染色体检查。若羊水检查失败，则应在彩超引导下做胎儿的脐带血管穿刺，取胎儿脐带血液做染色体核型分析、基因检测、胎儿感染等检查(如检查风疹病毒、梅毒、病毒、寄生虫等)。 9、胎儿畸形超声检查的最佳时机, administrative leadership of the criticism, resulting in serious consequences, the pursuit of leadership, along with 500-1000 punishment. (5) significant near miss should be attempted as the case of responsible for the accident and construction team injuries accident penalty provisions, mutatis mutandis. Eight, should perform in the construction standards and specifications, serial number a 1 GB3323-2005 steel fusion welded butt joints, welding engineering-Ray lighting and quality rating of 2 GB11345-89 steel welds manual methods of ultrasonic inspection and testing results for grade 3 GB50236-2002 industrial pipe welding engineering code for construction and acceptance of field equipment 4 HGJ222-92 technical specification for welding of aluminium and its alloys 5 low temperature steel welding procedure 6 SH3525-2004 petrochemical JB/ T4708-2000 of welding procedure qualification for steel pressure vessels 7 JB/4709-2000 8 JB4730-2005 pressure vessel welding procedures of steel pressure vessel NDT 9 JB/T4744-2000 steel pressure vessel products mechanical properties test of welded plate II, mechanical equipment installation engineering 1 GB150-98 2 GB50128-2005 vertical cylindrical steel pressure vessel steel welded specification for construction and acceptance of oil tank 3 JB/ T4735-1997 steel welded atmospheric pressure vessel 4 GB50231-2009 mechanical equipment installation engineering construction and acceptance specification for 5 GB50275-98 compressor, fan 答:胎儿畸形超声检查应以妊娠第16周开始检查，孕18--24周为最佳检查时间，太晚了因羊水少、胎儿大、骨骼骨化严重反而影响检查;太早了大部分畸形尚未出现而不能被检出。 10、产前超声检查有何特点, 答:我院为防止出生缺陷，确保准妈妈们都能生一个健康聪明的宝宝，我们产前超声设置了下述四道防线来严格进行产前超声筛查:第一道防线:孕10,14周进行第一次超声检查，此时期主要进行遗传学超声检查，同时对一些大体结构畸形如无脑儿、联体儿等的检测;第二道防线:18,24周超声检查，此时期是检测大部分结构畸形的最好时期，我们建议此时期每一位准妈妈都应进行一次严格的系统详尽的产前超声诊断。第三道防线:彩超引导下羊水和脐血穿刺，最终从细胞与分子水平来确诊胎儿有无染色体与某些基因异常及是否存在胎儿宫内感染。第四道防线:32周再作一次超声检查，能够发现18-24周不能发现或尚未出现的畸形。 11、哪些孕妇应进行产前诊断, 答:孕妇有下列情形之一的，应当进行产前诊断:羊水过多或者过少的，胎儿发育异常或者胎儿有可疑畸形的，孕早期接触过可能导致胎儿先天畸形的物质的，有遗传病家族史或者曾经分娩过先天性严重缺陷婴儿的，曾经有2次以上不明原因的流产、死胎或新生婴儿死亡的，年龄超过35周岁的。 12、B超检查能100,检查出胎儿畸形吗, 答:不能，尽管超声能发现大部分胎儿畸形，但不能检出所有的胎儿畸形，即诊断符合率不可能达到100,。此外，只有进行系统胎儿检查时，才能检出大部分畸形。一般常规产前超声检查的目的主要是观察胎儿的生长发育情况，而不是检查胎儿有无畸形，因此，如果你想检查胎儿是否有畸形，那么您就应进行系统胎儿检查，我院彩超均进行系统胎儿超声检查，黑白B超只进行常规超声检查。 13、做B超检查为什么要签字, 答:受检者应对B超检查有初步了解:B超是一种无创的高科技检查技术，但仪器具有一定的局限性;B超是一种间接方法，不同于病理学检查。超声诊断意见不等于病理学诊断;administrative leadership of the criticism, resulting in serious consequences, the pursuit of leadership, along with 500-1000 punishment. (5) significant near miss should be attempted as the case of responsible for the accident and construction team injuries accident penalty provisions, mutatis mutandis. Eight, should perform in the construction standards and specifications, serial number a 1 GB3323-2005 steel fusion welded butt joints, welding engineering-Ray lighting and quality rating of 2 GB11345-89 steel welds manual methods of ultrasonic inspection and testing results for grade 3 GB50236-2002 industrial pipe welding engineering code for construction and acceptance of field equipment 4 HGJ222-92 technical specification for welding of aluminium and its alloys 5 low temperature steel welding procedure 6 SH3525-2004 petrochemical JB/ T4708-2000 of welding procedure qualification for steel pressure vessels 7 JB/4709-2000 8 JB4730-2005 pressure vessel welding procedures of steel pressure vessel NDT 9 JB/T4744-2000 steel pressure vessel products mechanical properties test of welded plate II, mechanical equipment installation engineering 1 GB150-98 2 GB50128-2005 vertical cylindrical steel pressure vessel steel welded specification for construction and acceptance of oil tank 3 JB/ T4735-1997 steel welded atmospheric pressure vessel 4 GB50231-2009 mechanical equipment installation engineering construction and acceptance specification for 5 GB50275-98 compressor, fan B超受被检者各种因素、以及胎儿体位、羊水、胎儿活动、胎儿骨骼声影等多因素影响，许多器官或部位可能无法显示或显示不清，超声显像也不可能将胎儿的所有结构显示出来;B超检查的诊断符合率不可能达到100,。受检者应签字对上述情况表示理解。 14、产科超声检查有哪几种, 答:我国为 规范 编程规范下载gsp规范下载钢格栅规范下载警徽规范下载建设厅规范下载 产前超声检查，根据检查目的和内容的不同，将产前超声检查分为:常规产前超声检查，系统胎儿超声检查，胎儿超声心动图检查，针对性超声检查(针对包块胎儿颜面部、四肢等的检查)。 15、常规产前超声检查包括哪些内容, 答:常规产前超声检查包括确定胎儿是否存活、胚胎数目、胎先露和胎动情况，测量羊水量，观察胎盘脐带，测量双顶径、腹围或腹径、股骨长，联合应用双顶径、腹围、股骨综合估计孕周大小，我院常规产前超声检查均用黑白B超检查，除上述内容外，还包括以下解剖方面的内容:颅脑、四腔心、脊柱、胃、双肾、膀胱等结构。能对胎儿畸形做粗略的筛查。但有些畸形如心脏畸形、肢体畸形、颜面部畸形等易漏诊。 16、系统胎儿超声检查包括哪些内容, 答:我国系统胎儿超声检查包括:常规产前超声检查的内容，及胎儿脊柱、四腔心切面、腹部脏器(肝、胃、肾、膀胱)，以求诊断大部分胎儿畸形。我院系统超声检查均用高档彩超仪进行检查，除上述国家 规定 关于下班后关闭电源的规定党章中关于入党时间的规定公务员考核规定下载规定办法文件下载宁波关于闷顶的规定 的内容外，尚为广大孕妇检查胎儿肢体、颜面部、心脏、脐带血流等。 17、胎儿超声心动图检查包括哪些内容, 答:胎儿超声心动图检查指针对胎儿心脏的系统、全方位的检查，包括四腔心切面，左、右心室流出道切面，动脉导管弓及主动脉弓切面，三血管平面等多切面检查胎儿心脏，同时观察大动脉起始部的交叉关系、心脏位置，对大血管及房室瓣的彩色血流检查，测量、观察胎儿心率等内容。胎儿超声心动图检查能诊断大部分心脏畸形，但受体位、羊水、孕周大小的限制以及胎儿心脏生长发育特点，不可能100,胎儿心脏畸形都能被检出，如房间隔缺损、动脉导管未闭是不能产前诊断的，小的室间隔缺损、轻度肺动脉狭窄、轻型法洛四联症等亦administrative leadership of the criticism, resulting in serious consequences, the pursuit of leadership, along with 500-1000 punishment. (5) significant near miss should be attempted as the case of responsible for the accident and construction team injuries accident penalty provisions, mutatis mutandis. Eight, should perform in the construction standards and specifications, serial number a 1 GB3323-2005 steel fusion welded butt joints, welding engineering-Ray lighting and quality rating of 2 GB11345-89 steel welds manual methods of ultrasonic inspection and testing results for grade 3 GB50236-2002 industrial pipe welding engineering code for construction and acceptance of field equipment 4 HGJ222-92 technical specification for welding of aluminium and its alloys 5 low temperature steel welding procedure 6 SH3525-2004 petrochemical JB/ T4708-2000 of welding procedure qualification for steel pressure vessels 7 JB/4709-2000 8 JB4730-2005 pressure vessel welding procedures of steel pressure vessel NDT 9 JB/T4744-2000 steel pressure vessel products mechanical properties test of welded plate II, mechanical equipment installation engineering 1 GB150-98 2 GB50128-2005 vertical cylindrical steel pressure vessel steel welded specification for construction and acceptance of oil tank 3 JB/ T4735-1997 steel welded atmospheric pressure vessel 4 GB50231-2009 mechanical equipment installation engineering construction and acceptance specification for 5 GB50275-98 compressor, fan 难以检出。胎儿超声心动图检查对超声医师及检查仪器要求较高，需应用高分辨力彩超仪进行检查。 18、针对性超声检查包括哪些内容, 答:所谓针对性超声检查就是指临床怀疑某种特定畸形或孕妇曾出生过某种特定畸形儿，此次检查要求特别检查某一结构是否有畸形的。哪些部位的检查属特定检查呢,我国产前诊断专家组将下述结构定为针对性检查，常规或系统胎儿检查是不合适的，主要有:胎儿唇、鼻、眼、耳、四肢、心脏脐动脉血流检测等。 19、产科黑白B超进行胎儿哪些检查, 答:我院产科黑白B超只进行常规超声检查，不进行系统胎儿检查及胎儿超声心动图检查。 20、我院产科彩超进行哪几种检查, 答:我院彩超均进行系统胎儿超声检查，同时进行胎儿超声心动图检查。 21、照B超为什么喝水,做肝胆胃B超为什么要禁食, 答:声波须靠水才能有效传导，所以在怀孕初期羊水不多或照妇科子宫附件B超时，医师会请病人多喝水，以使膀胱充满尿液，藉此为声波介质，探测位于膀胱后方的卵巢与子宫的状况。 做肝胆胃B超要禁食，因为进食会导致胆汁分泌、胆囊收缩，影响对胆囊的观察，所以要禁食8小时以上，待胆囊完全充盈后再行肝胆超声检查。 22、什么是阴道超声检查,为什么要经阴道超声检查子宫、附件, 答:经阴道超声使用特别的阴道内探头。由于缩短了探头与受检组织器官间的声路距离，降低了声衰减。因此，可采用高频阴道探头检查子宫及附件。尤其适合于腹部有疤痕、腹部脂肪过多、胀尿困难的患者。与经腹部超声比较，经阴道超声具有频率高、分辨力高、图像清晰等特点，且病人不需充盈膀胱，深受患者及妇产科临床工作者的欢迎。 administrative leadership of the criticism, resulting in serious consequences, the pursuit of leadership, along with 500-1000 punishment. (5) significant near miss should be attempted as the case of responsible for the accident and construction team injuries accident penalty provisions, mutatis mutandis. Eight, should perform in the construction standards and specifications, serial number a 1 GB3323-2005 steel fusion welded butt joints, welding engineering-Ray lighting and quality rating of 2 GB11345-89 steel welds manual methods of ultrasonic inspection and testing results for grade 3 GB50236-2002 industrial pipe welding engineering code for construction and acceptance of field equipment 4 HGJ222-92 technical specification for welding of aluminium and its alloys 5 low temperature steel welding procedure 6 SH3525-2004 petrochemical JB/ T4708-2000 of welding procedure qualification for steel pressure vessels 7 JB/4709-2000 8 JB4730-2005 pressure vessel welding procedures of steel pressure vessel NDT 9 JB/T4744-2000 steel pressure vessel products mechanical properties test of welded plate II, mechanical equipment installation engineering 1 GB150-98 2 GB50128-2005 vertical cylindrical steel pressure vessel steel welded specification for construction and acceptance of oil tank 3 JB/ T4735-1997 steel welded atmospheric pressure vessel 4 GB50231-2009 mechanical equipment installation engineering construction and acceptance specification for 5 GB50275-98 compressor, fan 23、什么是介入性超声检查, 答:介入性超声就是在超声实时监视下，用细针穿刺病变区进行活检、抽液、注药、取血、取卵、引流，以及宫腔内的操作、子宫输卵管造影等微小创伤的诊断和治疗操作。因超声能实时动态观察到刺入体内的针所到达的具休部位，而不是盲目穿刺，因此相对安全可靠。 24、产前超声检查为什么有时要多次复查, 答:这是因为胎儿生长发育是一个动态过程，在进行胎儿畸形筛查时，有时需多次重复检查，有时需动态观察其生长发育后才能最终做出诊断，而有时由于胎儿方面的原因，某些器官和畸形不被显示，需等体位转变后才能检查。 25、什么是三维或四维超声检查，有什么特点, 答:以往B超图像均为二维超声图像，展现的是脏器或结构的切面图像，B超医师能对其进行观察、诊断，而平常人难以识别;三维超声具有直观、立体、易于识别等特点，例如产前三维超声检查能清晰显示胎儿面部结构，能够让准妈妈看到宝宝的面相。孕周较小时还能显示胎儿整体三维图像。此外三维超声还能对某些结构畸形进行立体显示，使病灶表现得更直观、清楚。但三维或四维超声检查与其他检查一样并不是万能的，对病灶也不是100,能检出。 26、我院的彩超检查有哪些功能, 答:深圳市妇幼保健院拥有从美国引进的目前世界上最先进的彩色多普勒超声诊断系统，这套系统图像清晰，分辨力高，功能齐全，能进行高清晰的二维、彩色多谱勒、频谱多谱勒、心功能测定、胎儿生长发育曲线分析及三维超声检查，应用范围广泛，它既能显示脏器或胎儿的形态、结构等解剖图像信息，又能评价脏器或胎儿、胎盘血流动力学等反映脏器功能方面的信息。这些信息是临床判断胎儿生长发育正常与否的重要内容。 27、彩色多普勒超声检查开展的服务项目有哪些, 答:我院彩超开展的检查项目有:胎儿宫内诊断及三维成像，新生儿及小儿颅脑、超声心动图、心功能测定、腹部脏器、浅表器官检查，成人各器官超声检查，经阴道超声检查，经直肠超声检查，介入性超声检查。 administrative leadership of the criticism, resulting in serious consequences, the pursuit of leadership, along with 500-1000 punishment. (5) significant near miss should be attempted as the case of responsible for the accident and construction team injuries accident penalty provisions, mutatis mutandis. Eight, should perform in the construction standards and specifications, serial number a 1 GB3323-2005 steel fusion welded butt joints, welding engineering-Ray lighting and quality rating of 2 GB11345-89 steel welds manual methods of ultrasonic inspection and testing results for grade 3 GB50236-2002 industrial pipe welding engineering code for construction and acceptance of field equipment 4 HGJ222-92 technical specification for welding of aluminium and its alloys 5 low temperature steel welding procedure 6 SH3525-2004 petrochemical JB/ T4708-2000 of welding procedure qualification for steel pressure vessels 7 JB/4709-2000 8 JB4730-2005 pressure vessel welding procedures of steel pressure vessel NDT 9 JB/T4744-2000 steel pressure vessel products mechanical properties test of welded plate II, mechanical equipment installation engineering 1 GB150-98 2 GB50128-2005 vertical cylindrical steel pressure vessel steel welded specification for construction and acceptance of oil tank 3 JB/ T4735-1997 steel welded atmospheric pressure vessel 4 GB50231-2009 mechanical equipment installation engineering construction and acceptance specification for 5 GB50275-98 compressor, fan administrative leadership of the criticism, resulting in serious consequences, the pursuit of leadership, along with 500-1000 punishment. (5) significant near miss should be attempted as the case of responsible for the accident and construction team injuries accident penalty provisions, mutatis mutandis. Eight, should perform in the construction standards and specifications, serial number a 1 GB3323-2005 steel fusion welded butt joints, welding engineering-Ray lighting and quality rating of 2 GB11345-89 steel welds manual methods of ultrasonic inspection and testing results for grade 3 GB50236-2002 industrial pipe welding engineering code for construction and acceptance of field equipment 4 HGJ222-92 technical specification for welding of aluminium and its alloys 5 low temperature steel welding procedure 6 SH3525-2004 petrochemical JB/ T4708-2000 of welding procedure qualification for steel pressure vessels 7 JB/4709-2000 8 JB4730-2005 pressure vessel welding procedures of steel pressure vessel NDT 9 JB/T4744-2000 steel pressure vessel products mechanical properties test of welded plate II, mechanical equipment installation engineering 1 GB150-98 2 GB50128-2005 vertical cylindrical steel pressure vessel steel welded specification for construction and acceptance of oil tank 3 JB/ T4735-1997 steel welded atmospheric pressure vessel 4 GB50231-2009 mechanical equipment installation engineering construction and acceptance specification for 5 GB50275-98 compressor, fan