Grover A, Dogra M, Ghosh K, Narang A, Anand I S
Department of Cardiology, Postgraduate Institute of Medical Education & Research, Chandigarh.
Indian Heart J. 1991 Mar-Apr;43(2):69-73.
To establish foetal cardiovascular parameters as predictors of perinatal outcome in pregnancy, M-Mode, 2-D echocardiography and pulse Doppler study was performed at 24-32 weeks of gestation in 65 pregnancies. These pregnancies were followed up for perinatal outcome. The studied population included 24 normal pregnancies, 21 pregnant women with heart disease (14 rheumatic and 7 congenital heart disease) and 20 high risk pregnancies (bad obstetric history in 7, suspected intrauterine growth retardation in 4, hypertensive disease of pregnancy in 6 and diabetes mellitus in 3). There was no perinatal mortality. Two foetuses were born with complete heart block and one with a small ventricular septal defect; 6 neonates had intrauterine growth retardation and two of these had neonatal asphyxia with APGAR score less than 6 at one minute. Anatomically normal heart was correctly diagnosed in all 64 foetuses and ventricular septal defect was detected antenatally in one. Antenatal diagnosis of complete heart block was correctly made in two foetuses. One new born with complete heart block required a permanent pacemaker, which was implanted. The ratio of peak velocity across mitral valve during atrial systole (A) to peak velocity during early diastolic ventricular filling (E) was chosen to correlate with perinatal outcome. The ratio was less than 1.0 in 6 foetuses, all of whom were subsequently confirmed to have intrauterine growth retardation. In normal pregnancies A/E ratio was more than 1.0. We conclude that foetal echocardiography is a useful tool for predicting perinatal outcome and may be helpful in screening patients who require specific perinatal management.
为了确定胎儿心血管参数作为妊娠围产期结局的预测指标，在65例妊娠的孕24 - 32周时进行了M型、二维超声心动图和脉冲多普勒研究。对这些妊娠进行围产期结局随访。研究人群包括24例正常妊娠、21例患有心脏病的孕妇（14例风湿性心脏病和7例先天性心脏病）以及20例高危妊娠（7例有不良产科史、4例疑似胎儿生长受限、6例妊娠高血压疾病和3例糖尿病）。无围产儿死亡。2例胎儿出生时患有完全性心脏传导阻滞，1例患有小型室间隔缺损；6例新生儿有胎儿生长受限，其中2例新生儿窒息，1分钟时阿氏评分小于6分。64例胎儿均正确诊断为心脏结构正常，1例产前检测出室间隔缺损。2例胎儿正确做出了完全性心脏传导阻滞的产前诊断。1例患有完全性心脏传导阻滞的新生儿需要植入永久性起搏器。选择心房收缩期二尖瓣峰值速度（A）与舒张早期心室充盈峰值速度（E）的比值与围产期结局相关。6例胎儿该比值小于1.0，所有这些胎儿随后均被证实有胎儿生长受限。正常妊娠中A/E比值大于1.0。我们得出结论，胎儿超声心动图是预测围产期结局的有用工具，可能有助于筛查需要特殊围产期管理的患者。
