Fetal Medicine Unit, Department of Obstetrics and Gynaecology, SAMID, Hospital Universitario 12 de Octubre, Madrid, Spain. agalindo.hdoc @ salud.madrid.org
Fetal Diagn Ther. 2011;29(4):287-95. doi: 10.1159/000322519. Epub 2010 Dec 24.
Second-trimester fetal screening for congenital heart defects (CHD) included in routine obstetric care provides relevant information for decision making. The aim of this study was to describe the clinical practice of prenatal detection of CHD in terms of the process and results.
The characteristics and results of ultrasound screening for major CHD were documented using data provided by hospitals for a national survey in Spain over the period of 2004-2006. Sixty-seven percent of eligible centers (56/83), covering 36% of total births nationwide, responded to the survey; 33 of these returned complete data regarding the screening results.
The number of major CHD occurring in the centers which provided data with results of screening was 1,060. The overall prenatal detection rate of major CHD was 65.7% (95% CI 57.8-74.7), but the detection rate in the routine second-trimester scan was 52.6% (95% CI 45.6-60.8). In 61% of these cases the parents chose to terminate the pregnancy. Two independent predictors of increased detection by center were identified: first, the uniformity and systematic character of the examination of the heart showing at least the 4-chamber view and outflow tracts (prevalence ratio 1.3, 95% CI 1.0-1.8) and second, the local availability of specialists in fetal echocardiography (prevalence ratio 1.4, 95% CI 1.1-1.9).
The detection of major CHD in the first half of pregnancy has an important impact on parental decision making. The prenatal screening program for CHD should be globally strengthened in terms of qualifications and methodological approaches. To improve its performance locally, close collaboration with fetal heart specialists should be promoted.
将先天性心脏病（CHD）的中期胎儿筛查纳入常规产科护理，为决策提供相关信息。本研究旨在描述产前检测 CHD 的临床实践，包括检测过程和结果。
使用西班牙全国调查期间（2004-2006 年）医院提供的数据，记录主要 CHD 的超声筛查特征和结果。67%的合格中心（83 个中心中的 56 个），占全国总分娩量的 36%，对该调查做出了回应；其中 33 个中心返回了有关筛查结果的完整数据。
提供有筛查结果数据的中心发生的主要 CHD 数量为 1060 例。主要 CHD 的产前总检出率为 65.7%（95%可信区间 57.8-74.7），但常规中期超声检查的检出率为 52.6%（95%可信区间 45.6-60.8）。在这些病例中，61%的父母选择终止妊娠。确定了两个可增加中心检出率的独立预测因素：首先，心脏检查的一致性和系统性，至少显示四腔心切面和流出道（优势比 1.3，95%可信区间 1.0-1.8）；其次，当地是否有胎儿超声心动图专家（优势比 1.4，95%可信区间 1.1-1.9）。
在妊娠前半期发现主要 CHD 对父母的决策有重要影响。CHD 的产前筛查计划应在资质和方法学方面得到全面加强。为了提高其局部表现，应促进与胎儿心脏专家的密切合作。
