产前超声切面检查在胎儿心脏畸形筛查中的应用价值

Application value of prenatal ultrasonography in screening fetal heart malformations

目的分析在胎儿心脏畸形筛查中应用产前超声切面检查的临床价值。方法选择2017年1月至2022年5月在绵阳市第三人民医院进行孕前胎儿心脏畸形筛查的1300例孕产妇,年龄20~46岁,平均年龄34.52岁(标准差8.71岁);孕周18~42周,平均孕周32.61周(标准差9.82周);初产妇965例,经产妇335例;妊娠胎数1015例单胎,285例双胎;分娩结局,引产57例,顺产915例,剖宫产328例。均采用胎儿超声心动图进行筛查,统计四腔心切面、左右心室流出道切面、三血管切面单独筛查和联合筛查情况,并与新生儿心动图结果、引产后或新生儿死亡后解剖结果等妊娠终止后诊断结果进行对比分析,分析单独筛查和联合筛查的诊断价值。结果妊娠终止后检出159例胎儿心脏畸形,四腔心切面单独筛查检出131例胎儿心脏畸形,左右心室流出道切面单独筛查检出124例胎儿心脏畸形,三血管切面单独筛查检出103例胎儿心脏畸形,四腔心切面+左右心室流出道切面+三血管切面联合筛查检出156例胎儿心脏畸形。四腔心切面、左右心室流出道切面、三血管切面单独筛查和联合筛查的诊断符合率、特异度、阳性预测值和阴性预测值差异无统计学意义(P>0.05);联合筛查的漏诊率(1.89%)低于四腔心切面(17.61%)、左右心室流出道切面(22.01%)、三血管切面(35.22%)(均P<0.05);联合筛查的灵敏度(98.11%)高于四腔心切面(82.39%)、左右心室流出道切面(77.99%)、三血管切面(64.78%)(均P<0.05)。结论产前超声切面检查在胎儿心脏畸形筛查中的应用价值高,可提高临床诊断的检出率,且诊断符合率和灵敏度高,有效地减少漏诊情况。

Objective To analyze the clinical value of prenatal ultrasonography in screening fetal heart malformations.Methods From January 2017 to May 2022,a total of 1300 pregnant women screened for fetal heart malformation before pregnancy were enrolled,which aged 20-46 years old with mean age of 34.52 years old(standard deviation 8.71 years old);gestational weeks was 18-42 weeks with mean gestational weeks of 32.61 weeks(standard deviation 9.82 weeks);965 cases of primiparas and 335 of multiparas;1015 cases of singleton pregnancies and 285 of twin pregnancies;57 cases of induced labor,915 of spontaneous labor and 328 of cesarean section.All the pregnant women performed fetal echocardiography,the separate screening and combined screening of four-chamber view,left and right ventricular outflow tract view and three-vessel view were counted.The results of neonatal echocardiography,autopsy results after induction of labor or neonatal death were compared and the diagnostic value of single screening and combined screening was analyzed.Results A total of 159 cases of fetal cardiac malformations were detected after termination of pregnancy.Fetal cardiac malformations were detected by single screening,131 cases were detected by four-chamber view,124 cases by left and right ventricular outflow tract view,103 cases by three-vessel view,and 156 cases of fetal cardiac malformations were detected by combined screening of four-chamber view,left and right ventricular outflow tract view,and three-vessel view.There was no significant difference in diagnostic coincidence rate,specificity,positive predictive value and negative predictive value between single screening method and combined screening method with combined screening of four-chamber view,left and right ventricular outflow tract view and three-vessel view(P>0.05).The missed diagnosis rate of combined screening(1.89%)was lower than that of four-chamber view screening(17.61%),left and right ventricular outflow tract view(22.01%)and three-vessel view(35.22%)(P<0.05).The sensitivity of combined screening(98.11%)was higher than that of four-chamber view(82.39%),left and right ventricular outflow tract view(77.99%)and three-vessel view(64.78%)(P<0.05).Conclusion It is demonstrated that prenatal ultrasound section examination show high application value in fetal heart malformation screening,which can improve detection rate of clinical diagnosis,high diagnostic coincidence rate and sensitivity,and effectively reduce missed diagnosis.