The Royal Belfast Hospital for Sick Children, Belfast, UK.
Ultrasound Obstet Gynecol. 2010 Sep;36(3):279-84. doi: 10.1002/uog.7616.
The aims of this study were to ascertain the effect of a regional training program in fetal echocardiography for obstetric radiographers on the antenatal detection of major congenital heart disease (CHD) and to document short-term outcomes for major CHD.
All 87 obstetric radiographers in Northern Ireland were invited to attend 2.5 days of training during a 1-year period. Data were collected before and after the training, over a 5-year study period, to assess the effect of training on the antenatal detection of CHD in the population.
The antenatal detection of major CHD rose significantly, from 28% (72/262) pretraining to 43% (36/84) in the year of training (P = 0.008). Antenatal diagnosis of four-chamber-view defects rose significantly (from 38% to 54%; P = 0.04), as did detection of outflow-tract-view defects (from 8% to 21%; P = 0.05). Twelve per cent (13/108) of cases died spontaneously in utero and 8% (9/108) were terminated. Only 78% (67/86) of live-born cases in which CHD had been diagnosed antenatally survived the neonatal period, compared to 93% (221/238) with a postnatal diagnosis of CHD (P < 0.001).
Even with a relatively simple training program, significant improvements can be made in the antenatal detection of CHD. With training, obstetric sonographers can successfully assess outflow tracts. Antenatally diagnosed cases have more complex CHD and this probably contributes to poor neonatal survival.
本研究旨在确定针对产科放射技师的胎儿超声心动图区域培训计划对产前检测重大先天性心脏病（CHD）的影响，并记录重大 CHD 的短期结果。
在为期一年的时间里，邀请北爱尔兰的所有 87 名产科放射技师参加为期 2.5 天的培训。在为期 5 年的研究期间，在培训前后收集数据，以评估培训对人群中 CHD 产前检测的影响。
重大 CHD 的产前检出率显著上升，从培训前的 28%（72/262）上升到培训当年的 43%（36/84）（P=0.008）。四腔心切面缺陷的产前诊断明显增加（从 38%升至 54%；P=0.04），流出道切面缺陷的检出率也明显增加（从 8%升至 21%；P=0.05）。12%（13/108）的病例在宫内自然死亡，8%（9/108）的病例终止妊娠。在产前诊断为 CHD 的活产儿中，仅有 78%（67/86）存活至新生儿期，而产后诊断为 CHD 的活产儿中，有 93%（221/238）存活（P<0.001）。
即使采用相对简单的培训计划，也可以显著提高 CHD 的产前检出率。经过培训，产科超声医师能够成功评估流出道。产前诊断的病例 CHD 更为复杂，这可能导致新生儿存活率降低。
