Raboisson M J, Samson C, Ducreux C, Rudigoz R C, Gaucherand P, Bouvagnet P, Bozio A
Service de Cardiologie Pédiatrique, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France.
Eur J Obstet Gynecol Reprod Biol. 2009 Jan;142(1):18-22. doi: 10.1016/j.ejogrb.2008.09.001. Epub 2008 Nov 20.
A growing percentage of cases of transposition of the great arteries (TGA) are being diagnosed prenatally. A decrease in the percentage of spontaneous deliveries has been reported, but the rate of cesarean section (c-section) in this population has never been studied. Our goal was to determine whether prenatal diagnosis affects delivery and immediate neonatal management of TGA neonates.
A series of 121 TGA arterial switch candidates were included over a 6-year period. Variables on delivery, clinical status at ICU admission, arrival time and atrial septostomy were recorded retrospectively. Comparisons between the two groups were made by Student's t or Chi-squared test.
A cohort of 121 patients was enrolled (48 prenatal and 73 postnatal diagnoses). Induced delivery and c-section were more frequent in the prenatal (54.1% and 31%) than in the postnatal diagnosis group (19.4% and 8%; p<0.0002 and p<0.001, respectively). The mean interval between birth and ICU admission was 2h 30 min in the prenatal compared to 26 h in the postnatal diagnosis group (p<0.001). Arrival times were similar in both groups. Atrial septostomy by umbilical route was more often feasible in the prenatal (81%) than in the postnatal diagnosis group (51%; p<0.001), with a higher rate of failure in the latter.
Prenatal awareness of TGA was associated with a higher percentage of induced deliveries and a major increase in the rate of c-section, without any impact on the newborn except easier umbilical atrial septostomy and earlier ICU admission.
大动脉转位（TGA）病例的产前诊断比例日益增加。据报道，自然分娩的比例有所下降，但该人群的剖宫产（c-section）率从未被研究过。我们的目标是确定产前诊断是否会影响TGA新生儿的分娩及即刻新生儿管理。
在6年期间纳入了一系列121例适合动脉调转术的TGA患者。回顾性记录分娩相关变量、入住重症监护病房（ICU）时的临床状况、到达时间及房间隔造口术情况。两组间比较采用学生t检验或卡方检验。
共纳入121例患者（48例产前诊断和73例产后诊断）。产前诊断组的引产和剖宫产发生率（分别为54.1%和31%）高于产后诊断组（分别为19.4%和8%；p<0.0002和p<0.001）。产前诊断组出生至入住ICU的平均间隔为2小时30分钟，而产后诊断组为26小时（p<0.001）。两组的到达时间相似。产前诊断组经脐途径进行房间隔造口术的可行性更高（81%），高于产后诊断组（51%；p<0.001），且后者失败率更高。
产前诊断TGA与引产比例增加及剖宫产率大幅上升相关，对新生儿无其他影响，只是脐静脉房间隔造口术更易实施且入住ICU更早。
