孕早期经腹部超声筛查胎儿先天性心脏病

Transabdominal ultrasonography in screening of fetal congenital heart diseases in the first trimester

目的探讨胎儿颈项透明层(NT)检测期间(孕11～13+6周)经腹部超声筛查胎儿先天性心脏病的可行性。方法于胎儿NT检测期间对200胎单胎妊娠胎儿行超声扫查,主要切面包括四腔心切面、左心室流出道切面、右心室流出道切面和三血管切面;根据头臀长(CRL)将该胎儿分为2组,A组CRL为45～60mm,B组为61～84mm,比较两组胎儿心脏的成功检查率。对200胎均于孕中期(18～24周)行常规胎儿超声检查,出生后行新生儿超声心动图检查。结果 200胎平均CRL为(66.00±4.60)mm。A组88胎中,23胎(23/88,26.14%)胎儿心脏获得成功检查,B组112胎中,85胎(85/112,75.89%)获得成功检查,两组差异有统计学意义(P<0.05)。结论孕早期经腹部超声筛查胎儿先天性心脏病是可行的,有望将某些心脏畸形的检出时间提前4～8周。胎儿CRL>60mm时,胎儿心脏成功检查率明显提高。

Objective To observe the possibility of screening fetal congenital heart diseases with transabdominal ultrasonography during nuchal translucency （NT） scan period （11—13＋6 weeks of gestation）. Methods Fetal heart screening was performed in 200 singleton pregnancy women with transabdominal ultrasonography during NT examination, including four-chamber view, left ventricular outflow tract, right ventricular outflow tract and three vessels view. The fetuses were divided into two groups according to the crown-rump length （CRL）, which in group A was 45—60 mm, in group B was 61—84 mm. Then the success rate of fetal heart screening between the two groups was compared. The fetuses underwent echocardiographic examination in the second trimester as well as after birth. Results The mean CRL of 200 fetuses was （66.004.60）mm, the success rate of fetal heart screening of group B （85/112, 75.89%） was significantly higher than that of group A （23/88, 26.14%, P〈0.05）. Conclusion It is feasible to take fetal heart screening with transabdominal ultrasonography in the first trimester, making the screening of some kind of fetal heart malformations become 4 to 8 weeks earlier. The success rate of fetal heart screening significantly increases when CRL of fetus is longer than 60 mm.