Clinical Study On Prenatal Diagnosis And Prognosis Of Fetal Biliary Tract System Abnormalities

Objective: The objective of this study was to investigate the prenatal diagnosis and prognostic factors of fetal biliary system abnormalities.Methods: A retrospective analysis was performed on 163 fetuses who received prenatal ultrasonography in Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region from August 2013 to August 2022,indicating abnormal fetal biliary system and receiving prenatal diagnosis.The prenatal ultrasonography results of fetal gallbladder abnormalities were collected,and the ultrasonography was divided into small gallbladder,enlarged gallbladder,choledochal cyst,and unclear gallbladder.To clarify the occurrence of gallbladder size,gallbladder enlargement,choledochal cyst and unclear gallbladder display,and analyze the fetal perinatal outcome combined with prenatal diagnosis.Results:(1)Ultrasonic examination results: The main manifestations of bile system abnormalities in 163 fetuses with prenatal ultrasound were unclear gallbladder display 43.56%(71/163),gallbladder enlargement 36.20%(59/163)and choledochal cyst 12.27%(20/163).(2)Prenatal diagnosis results: there was no significant difference in the rate of fetal chromosome abnormality among the four biliary abnormalities(X~2=4.28,P > 0.05).There was no significant difference in the abnormal rate of fetal gene chip among the four biliary abnormalities(X~2=5.54,P > 0.05).(3)Perinatal outcome: a.13 cases of fetal gallbladder small.(1)There were 7 cases(7/13,53.85%)and 7 live births in the isolated gallbladder group.There were no abnormalities in prenatal genetic results and postnatal follow-up.(2)There were 6 cases(6/13,46.15%) in the group with minimal abnormalities,6 cases were live births,and there were no abnormalities in prenatal genetic results and postnatal follow-up.(3)There were 0 cases with severe malformation.b.59 cases of fetal gallbladder enlargement.(1)There were 24 cases(40.68%,24/59)in the isolated gallbladder enlargement group,24 cases of live birth,0 cases of abnormal chromosome karyotype due to prenatal genetic results,2 cases of abnormal gene chip.No biliary atresia was found in live infants half a year after birth.(2)There were 32 cases(54.24%,32/59),29 cases of live birth,3 cases of induction of labor(including 1 case of stillbirth),1 case of chromosome karyotype abnormality and 4 cases of gene chip abnormality in prenatal genetic results.No biliary atresia was found in live infants half a year after birth.(3)In the severe malformation group,there were 3 cases(5.08%,3/59),1 case of live birth,2 cases of induced labor,1 case of abnormal chromosome karyotype due to prenatal genetic results,1 case of abnormal gene chip,and 1case of live birth without biliary atresia and right kidney absence until half a year after birth.c.20 cases of choledochal cyst.(1)There were 18 cases(90%,18/20)and 18 live births in the isolated choledochal cyst group,and no abnormalities were found in prenatal genetic results.During follow-up to half a year after birth,15 live babies had no biliary atresia,and 3 cases were diagnosed with biliary atresia after delivery.(2)There was 1 case(10%,1/20)in the group with minimal abnormalities.There were no abnormalities in prenatal genetic results and postnatal follow-up.(3)There was 1 case(1/20,10%)in the severe malformation group.No abnormal prenatal genetic results were found,and no autopsy was performed due to multiple malformations such as induced labor complicated with pulmonary dysplasia.d.Gallbladder opacity in 71 cases.(1)There were 29 cases(40.84%,29/71)in the group of isolated gallbladder indistinction,28 cases of live birth,and 1 case of labor induction(stillbirth induction).No abnormality was found in prenatal genetic results,and no biliary atresia was found in live infants half a year after birth.(2)There were 27 cases(38.03%,27/71),18 live births,9 induced labor,4 cases of chromosome abnormality and 6 cases of gene chip abnormality in prenatal genetic results,and no biliary atresia in 18 live babies followed up to half a year after birth.(3)There were 15 cases(21.13%,15/71)in the group with severe malformations,mainly cardiovascular system and nervous system abnormalities were common,followed by urinary system,digestive system,skeletal system,etc.The abnormalities of cardiovascular system were mainly ventricular septal defect,permanent double superior vena cava and tetralogy of fallot,while the abnormalities of urogenital system were mainly renal absence and renal dysplasia.There were 4 live births,11 induced births,4chromosome abnormalities and 6 gene chip abnormalities as a result of prenatal genetics,and no biliary atresia was found in 4 live births until half a year after birth.Conclusion(s):Fetal gallbladder abnormalities are an important feature in the identification of biliary atresia.The ultrasonic diagnosis of fetal biliary system abnormalities is mainly characterized by unclear gallbladder display and gallbladder enlargement.Among the four kinds of biliary system abnormalities,unclear gallbladder display combined with other system abnormalities(cardiovascular system abnormalities,nervous system abnormalities)has poor pregnancy outcome.