胎儿卵圆孔受限192例临床分析

Clinical analysis of 192 cases of foetal foramen ovale restriction

目的:探讨孕期超声提示胎儿卵圆孔受限(FO-R)患者的临床特点,以及其对分娩时机、分娩方式和新生儿预后的影响。方法:选取2015年1月至2018年10月在西安交通大学第一附属医院孕期行胎儿超声心动图检查均提示胎儿FO-R的192例孕妇,分析孕妇的一般情况、胎儿心超指标、终止妊娠时机、终止妊娠方式及新生儿预后等情况。结果:患者年龄18~42岁,平均(29.41±3.29)岁。有妊娠合并症或合并胎儿附属物异常者占35.9%。卵圆孔受限孕周24+3~40+6周,平均孕周35+1周。胎儿卵圆孔瓣口直径平均为(2.64±0.57)mm,卵圆孔血流流速平均为(91.16±13.42)cm/s。早发型FO-R(28周前)9例(4.7%),晚发型FO-R(28周后)183例(95.3%)。胎儿卵圆孔瓣口内径2~3mm者162例,占所有患者的83.9%。192例患者中,单纯卵圆孔缩小81例,占42.2%,合并其他胎儿心脏异常主要包括:伴右心增大57.8%、动脉导管期前收缩10.9%、主动脉弓狭窄10.4%。192例患者中,自然分娩者57例(占29.7%),以“胎儿窘迫”行剖宫产术者占14.1%;足月产179例(占93.2%),早产13例(占6.8%)。早发型FO-R因胎儿窘迫行剖宫产比率高于晚发型FO-R(P=0.016)。不伴右心增大患者的自然分娩率高于伴胎儿右心增大者(P=0.003)。192例新生儿出生后5例确诊为先天性心脏病,占2.6%,包括2例室间隔缺损,3例房间隔缺损。其余97.4%患者随诊过程中未确诊明显心脏畸形。结论:大多数卵圆孔受限并不会导致胎儿严重的血流动力学改变,胎儿预后一般良好。应综合孕周、胎儿大小、胎动、患者有无合并症以及心脏超声的动态变化过程等多项指标处理FO-R患者。

Objective:To investigate the clinical characteristics of fetal foramen ovale restriction,indicated by ultrasound during pregnancy,include the influence on the timing,delivery mode and neonatal prognosis. Methods:192 pregnant women in the First Affiliated Hospital of Xi'an Jiaotong University from Jan.2015 to Oct.2018 were selected.192 pregnant women were indicated FO-R by fetal echocardiography during pregnancy.The general situation of pregnant women,fetal echocardiography indicators,pregnancy termination timing,method and neonatal prognosis were analyzed. Results:The patients were18~42 years old,with an average age of (29.41±3.29) years old.The incidence of pregnancy complications or abnormal fetal appendages was35.9%.FO-R paitents were24 +3 ~40 +6 gestational weeks,with an average of35 +1 weeks.Ovale orifice diameter (2.64±0.57)mm.The flow rate of ovale was (91.16±13.42 )cm/s.There were 9 cases (4.7%) of early FO-R(28 weeks ago) and183 cases ( 95.3 %) of late FO-R(28 weeks later).The diameter of foetal foramen ocyte was within2~3mm accounted for 83.9% of all patients.Among the192 patients,81 cases (42.2%) of the patients had simple FO-R,57.8% combine enlargement of the right heart,10.9% combine preductal contraction,and10.4% combine aortic arch stenosis.Among192 patients,57(29.7%) were vaginal delivered naturally,and14.1% were delivered by cesarean section with "fetal distress".179 cases (93.2%) were term births and13 cases (6.8%) were preterm births.The cesarean section rate of early FO-R for fetal distress was higher than that of late FO-R ( P = 0.016 ).Vaginal delivery rate of patients without right ventricular enlargement was higher than that of patients with right ventricular enlargement of fetus ( P =0.003).Newborns in192 cases were diagnosed congenital heart disease,accounting for2.6%,include2 cases of VSD and3 cases of ASD.The remaining 97.4% of patients were not diagnosed with obvious cardiac malformation during follow-up. Conclusions:Most fetal foramen ovale restriction do not result in severe hemodynamic changes in the fetus and the prognosis is generally good.In clinical practice,we should treat FO-R patients with multiple indicators,such as gestational week,fetal size,fetal movement,whether the patient has complications,and the dynamic change process of cardiac ultrasound.