Baś-Budecka Elzbieta, Perenc Małgorzata, Sieroszewski Piotr
Klinika Medycyny Płodu i Ginekologii, I Katedra Ginekologii i Połoznictwa, Uniwersytetu Medycznego w Łodzi.
Ginekol Pol. 2010 Apr;81(4):272-6.
Cardiac defects, the most common forms of congenital defects, are found in 3-8 of every 1000 pregnancies. Currently only 15-30% of CHD in newborns is detected prenatally. There are different strategies to increase the prenatal detection of cardiac abnormalities. Nuchal translucency screening and ductus venosus blood flow have been suggested to be useful methods of identifying cardiac anomalies in chromosomally normal fetuses.
To examine the association between nuchal translucency thickness and ductus venosus blood flow between 11-13.6 week of pregnancy and CHD in chromosomally normal fetuses.
Patients with singleton pregnancies at 11 to 13.6 weeks of gestation were recruited to undergo nuchal translucency sonography. The prevalence of major cardiac defects was determined and the utility of screening for nuchal translucency thickness including sensitivity, specificity, and positive and negative predictive values, were calculated for the NT thickness cut off points of the 95th and 99th centile for CRL. Ductus venosus Doppler ultrasound blood flow velocity waveforms were obtained at 10-13.6 weeks gestation.
4720 gestations were analyzed, of which 13 newborn infants had CHD. The incidence of major CHD increased with increasing NT. Sensitivity specificity and positive predictive values were 45.4%, 92% and 1.5% at 99.8th percentile, and 25%, 98.5%, 3.2% and 99.8% at 99th percentile. Reverse or absent flow during atrial contraction was observed in 8 out of the 13 (61.5%) chromosomally normal fetuses with CHD.
Measurement of fetal nuchal translucency thickness and ductus venosus blood flow at 11-13.6 weeks of pregnancy is a sensitive method of screening for CHD. The prevalence of CHD increases with increasing fetal NT and abnormal ductus venosus blood flow. Increased NT or abnormal ductus venosus blood flow is a strong indication for fetal echocardiography.
心脏缺陷是最常见的先天性缺陷形式，每1000例妊娠中有3 - 8例出现。目前新生儿先天性心脏病（CHD）仅有15% - 30%在产前被检测出。有多种策略可提高心脏异常的产前检测率。颈部透明带筛查和静脉导管血流被认为是识别染色体正常胎儿心脏异常的有用方法。
研究妊娠11 - 13.6周时颈部透明带厚度和静脉导管血流与染色体正常胎儿的CHD之间的关联。
招募妊娠11至13.6周的单胎妊娠患者进行颈部透明带超声检查。确定主要心脏缺陷的患病率，并计算针对头臀长（CRL）第95和第99百分位数的颈部透明带厚度筛查的效用，包括敏感性、特异性以及阳性和阴性预测值。在妊娠10 - 13.6周时获取静脉导管多普勒超声血流速度波形。
分析了4720例妊娠，其中13例新生儿患有CHD。主要CHD的发病率随颈部透明带厚度增加而升高。在第99.8百分位数时，敏感性、特异性和阳性预测值分别为45.4%、92%和1.5%；在第99百分位数时分别为25%、98.5%、3.2%和99.8%。在13例（61.5%）患有CHD的染色体正常胎儿中，有8例在心房收缩期观察到反向或无血流。
妊娠11 - 13.6周时测量胎儿颈部透明带厚度和静脉导管血流是筛查CHD的敏感方法。CHD的患病率随胎儿颈部透明带厚度增加和静脉导管血流异常而升高。颈部透明带厚度增加或静脉导管血流异常强烈提示需进行胎儿超声心动图检查。
