Tegnander E, Eik-Nes S H
National Center for Fetal Medicine, Department of Obstetrics and Gynecology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
Ultrasound Obstet Gynecol. 2006 Jul;28(1):8-14. doi: 10.1002/uog.2804.
To determine whether training and experience in performing ultrasound examinations are factors that influence the prenatal detection of congenital heart defects (CHDs) in a non-selected population, in order to evaluate and improve the current training program.
All pregnant women who received a routine second-trimester ultrasound scan by a sonographer/midwife and delivered at our hospital between February 1991 and December 2001 were registered prospectively. Less experienced sonographer/midwives who had performed between 200 and 2000 routine examinations were compared with experienced sonographer/midwives who had carried out more than 2000 examinations. During the first 5 years of the study the heart structures obtained were registered in detail.
Of 29,035 fetuses, 35/82 (43%) major CHDs were prenatally detected at the routine examination. The experienced sonographer/midwives obtained both the four-chamber view and the great arteries in 75%; the figure for the less experienced sonographer/midwives was 36% (P < 0.001). The differences in detecting major heart defects were 22/42 (52%) and 13/40 (32.5%), isolated CHDs 8/18 (44%) and 6/22 (27%) and CHDs with associated malformations 14/24 (58%) and 7/18 (39%), respectively. In both groups some CHDs with an abnormal four-chamber view were missed, although the experienced sonographer/midwives recognized significantly more of the abnormal views than did the less experienced sonographer/midwives (P = 0.002).
Experience has a significant impact on the examination of the fetal heart and the prenatal detection rate of major CHDs. To avoid a relatively long learning curve, ultrasound education needs to intensify the teaching of the basic four-chamber view. The great arteries should be included after additional training. Those basic views of the fetal heart must be mastered before new views and advanced technology are added to the fetal heart examination.
确定超声检查的培训和经验是否为影响非特定人群先天性心脏病（CHD）产前检出率的因素，以便评估和改进当前的培训方案。
前瞻性登记1991年2月至2001年12月间在我院接受超声科医生/助产士常规孕中期超声检查并分娩的所有孕妇。将进行200至2000次常规检查的经验较少的超声科医生/助产士与进行超过2000次检查的经验丰富的超声科医生/助产士进行比较。在研究的前5年，详细记录所获得的心脏结构。
在29035例胎儿中，35/82（43%）的主要CHD在常规检查中被产前检出。经验丰富的超声科医生/助产士在75%的检查中获得了四腔心切面和大动脉切面；经验较少的超声科医生/助产士的这一比例为36%（P<0.001）。在检出主要心脏缺陷方面，两组的差异分别为22/42（52%）和13/40（32.5%），孤立性CHD分别为8/18（44%）和6/22（27%），合并其他畸形的CHD分别为14/24（58%）和7/18（39%）。两组中一些四腔心切面异常的CHD均有漏诊，尽管经验丰富的超声科医生/助产士比经验较少的超声科医生/助产士识别出的异常切面明显更多（P=0.002）。
经验对胎儿心脏检查及主要CHD的产前检出率有显著影响。为避免较长的学习曲线，超声教育需要强化四腔心基本切面的教学。在额外培训后应增加大动脉切面的教学。在胎儿心脏检查中增加新切面和先进技术之前，必须先掌握胎儿心脏的这些基本切面。
