超声心动图联合产前咨询对胎儿先天性心脏病妊娠结局应用分析

The effect of color Doppler echocardiography combined with prenatal consultation on the pregnancy outcome of fetal congenital heart disease

目的探讨胎儿超声心动图联合产前咨询对胎儿先天性心脏病(CHD)妊娠结局应用分析。方法选取我院产前筛查孕妇2152例,均经产前超声心动图筛查,按照预后及出生后手术时机将胎儿心脏出生缺陷分为Ⅰ~Ⅲ级,提出分级标准与包含的常见疾病种类。随访孕妇经产前分级咨询后胎儿结局,评估胎儿预后情况以及治疗结局。结果2152例接受彩色多普勒超声心动图筛查妊娠孕妇中,CHD胎儿为32例,彩色多普勒心动图筛查中阳性预测值、阴性预测值分别为90.63%、99.72%,漏诊室间隔缺损2例、完全型肺静脉异位引流1例;胎儿CHD检查结果分析中II级10例、III级22例;32例CHD胎儿中,继续妊娠22例,引产10例,其中II级、III级中继续妊娠分别为9例、13例,接受手术治疗者分别为5例、13例,均在出生后6~12个月内接受手术治疗,术后死亡3例。结论产前超声心动图应用于胎儿CHD产前诊断中,可有效判断胎儿心脏异常情况。

Objective To explore the impact of fetal echocardiography combined with prenatal counseling on the pregnancy outcome of fetal congenital heart disease.Methods 2152 pregnant women who underwent prenatal screening were selected as the research subjects.All women underwent prenatal echocardiography screening,and fetal cardiac birth defects were classified into gradesⅠtoⅢbased on prognosis and possible surgical timing after birth.Grading standards and common disease types were proposed.We followed up the fetal outcomes of pregnant women after prenatal grading consultation,and evaluated the fetal prognosis and treatment outcomes.Results Among 2152 pregnant women who received color Doppler echocardiography screening,32 had congenital heart disease.The positive predictive value and negative predictive value of color Doppler echocardiography screening were 90.63%and 99.72%respectively.There were 2 cases of missed diagnosis of ventricular septal defect and 1 case of complete anomalous blessing vein drainage;In the analysis of fetal congenital heart disease examination results,there were 10 were cases of grade II congenital heart disease and 22 cases of grade III congenital heart disease;Among the 32 screened fetuses with congenital heart disease,22 continued pregnancy and 10 induced labor.Among them,9 and 13 continued pregnancy were found in grade II and III congenital heart disease,and 5 and 13 underwent surgical treatment respectively.All fetuses received surgical treatment within 6~12 months after surgery,resulting in 3 deaths.Conclusion The application of prenatal echocardiography in the prenatal diagnosis of fetal congenital heart disease can effectively determine fetal heart abnormalities.Through standardized prenatal screening and consultation,it provides scientific consultation and management for fetal families,reduces the birth rate of cardiovascular malformation fetuses with poor prognosis,reduces excessive induction of labor for some heart malformation fetuses with good treatment results,improves population quality,and reduces the socio-economic burden caused by poor prognosis of cardiovascular malformations in infants.