Paladini Dario, Vassallo Michele, Sglavo Gabriella, Russo Maria Giovanna, Martinelli Pasquale
Fetal Cardiology Unit, Department. of Obstetrics and Gynecology, Federico II University of Naples, Naples, Italy.
Prenat Diagn. 2005 May;25(5):403-6. doi: 10.1002/pd.1172.
(1) To assess the diagnostic accuracy of fetal echocardiography and (2) to evaluate the type and the outcome of congenital heart disease (CHD) detected in fetuses from multiple pregnancies.
tertiary referral center for prenatal diagnosis of CHD.
observational study. In the period 1994-2003, 711 fetuses from 330 multiple pregnancies (282 twins, 45 triplets and 3 quadruplets) underwent fetal echocardiography at our unit. CHD were present in 45 of them. Diagnostic accuracy (sensitivity, specificity, positive and negative predictive values) was calculated for fetal echocardiography. For the fetuses with CHD, the following variables were analysed: gestational age at diagnosis, type of CHD, associated anomalies, fetoneonatal outcome. Confirmation of the diagnosis was obtained in 45/48 cases with CHD and in 580/610 without CHD. Mean follow-up time for diseased neonates was 52 months (range 6-127).
In the study population, there were 40 true positives, 5 false negatives, 1 false positive and 632 true negatives, which yields the following figures: sensitivity 88.8% (40/45), specificity 99.8% (632/633), positive predictive value 97.6% (40/41) and negative predictive value 99.2% (632/637). As for the 45 cases with CHD, type of CHD was evenly distributed among left and right heart, conotruncal and septal defects, with 6/7 right heart lesions occurring in recipient fetuses of pregnancies complicated by TTTS. The aneuploidy rate was 7.0% (3/43). As for the outcome, 26 (57.8%) neonates survived and 17 (37.7%) died prior to or after surgery. Very low birthweight accounted for 7 of the 17 perinatal deaths.
Our data show that the diagnostic performance of fetal echocardiography in multiple gestations is comparable with that obtained in singletons, as far as twin pregnancies are concerned. Data on triplets and quadruplets are too scant to be of statistical relevance. In addition, the importance of prematurity as primary cause of death in this subset of fetuses should be considered when counseling couples with multiple pregnancies and a fetus with CHD.
（1）评估胎儿超声心动图的诊断准确性；（2）评估多胎妊娠胎儿中检测出的先天性心脏病（CHD）的类型及结局。
先天性心脏病产前诊断的三级转诊中心。
观察性研究。1994年至2003年期间，我们单位对来自330例多胎妊娠（282例双胎、45例三胎和3例四胎）的711例胎儿进行了胎儿超声心动图检查。其中45例患有先天性心脏病。计算了胎儿超声心动图的诊断准确性（敏感性、特异性、阳性和阴性预测值）。对于患有先天性心脏病的胎儿，分析了以下变量：诊断时的孕周、先天性心脏病的类型、相关畸形、胎儿-新生儿结局。48例先天性心脏病病例中有45例、610例无先天性心脏病病例中有580例确诊。患病新生儿的平均随访时间为52个月（范围6 - 127个月）。
在研究人群中，有40例假阳性、5例假阴性、1例假阳性和632例真阴性，得出以下数据：敏感性88.8%（40/45），特异性99.8%（632/633），阳性预测值97.6%（40/41），阴性预测值99.2%（632/637）。对于45例先天性心脏病病例，先天性心脏病的类型在左心和右心、圆锥干和间隔缺损中分布均匀，7例右心病变中有6例发生在合并双胎输血综合征的妊娠受血儿中。非整倍体率为7.0%（3/43）。至于结局，26例（57.8%）新生儿存活，17例（37.7%）在手术前后死亡。17例围产期死亡中有7例为极低出生体重儿。
我们的数据表明，就双胎妊娠而言，胎儿超声心动图在多胎妊娠中的诊断性能与单胎妊娠相当。三胎和四胎的数据太少，无统计学意义。此外，在为患有先天性心脏病胎儿的多胎妊娠夫妇提供咨询时，应考虑早产作为该类胎儿主要死亡原因的重要性。
