Zhang Le, Sun Mei-ping, Gao Wei-xian, Hong Shi-xin, Zhang Ya-li
Institute of Reproductive and Child Health of Peking University, Ministry of Health Key Laboratory of Reproductive Health, Beijing 100191, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2014 Jun 18;46(3):373-8.
To explore the feasibility of screening for major fetal heart disease by training sonographers in township or county level hospitals.
Training of B ultrasound scan for congenital heart defects was given to the sonographers from one county hospital, and thirteen township hospitals (or the district hospitals), and training of fetal echocardiography was given to sonographers from four city/county hospitals. The trained sonographers who had passed the examinations and had obtained qualifications after six months of independent practice began to screen fetal congenital heart defects. To evaluate the effectiveness, sensitivity and specificity of screening was calculated by using the diagnosis of expert neonatal/fetal echocardiographers as the gold standard.
A total of 3 425 fetuses received one fetal B ultrasound screening, one fetal echocardiography and one neonatal echocardiography from April 1, 2004 to December 31, 2005. One hundred and sixty-five B ultrasound screening images (4.9%) from township hospitals and fifty-six fetal echocardiography images (1.7%) from county or city centers couldn't be reviewed because of poor quality. The sensitivity of fetal B ultrasound screening in the township and county hospitals was 30% and 0, and the specificity 93.3% and 99.9%, respectively. Nine fetuses with a major congenital heart disease were eventually found by the trained sonographers, and two cases were misdiagnosed and two unnoticed. The total sensitivity and specificity of fetal echocardiography were 81.8% and 99.9%, respectively. The sensitivity in the county and city hospitals was 66.7% and 100%, respectively. The specificity in the county and city hospitals was 99.9% and 100%, respectively.
Under the current circumstances, township hospitals are unable to perform effective fetal cardiac screening. Screening on fetal congenital heart disease is suggested to be taken by trained sonographers in county and city level medical centers.
探讨通过培训县级或乡镇级医院的超声检查人员来筛查胎儿主要心脏病的可行性。
对一家县级医院及13家乡镇医院（或地区医院）的超声检查人员进行先天性心脏缺陷的B超扫描培训，对4家市/县级医院的超声检查人员进行胎儿超声心动图培训。经过培训且在独立实践6个月后通过考试并取得资质的超声检查人员开始筛查胎儿先天性心脏缺陷。以专家新生儿/胎儿超声心动图检查人员的诊断为金标准，计算筛查的有效性、敏感性和特异性来评估效果。
2004年4月1日至2005年12月31日期间，共有3425例胎儿接受了一次胎儿B超筛查、一次胎儿超声心动图检查及一次新生儿超声心动图检查。乡镇医院的165幅B超筛查图像（4.9%）及县或市中心的56幅胎儿超声心动图图像（1.7%）因质量差无法复查。乡镇和县医院胎儿B超筛查的敏感性分别为30%和0，特异性分别为93.3%和99.9%。经过培训的超声检查人员最终发现9例患有主要先天性心脏病的胎儿，2例被误诊，2例未被发现。胎儿超声心动图的总敏感性和特异性分别为81.8%和99.9%。县医院和市医院的敏感性分别为66.7%和100%，县医院和市医院的特异性分别为99.9%和100%。
在当前情况下，乡镇医院无法进行有效的胎儿心脏筛查。建议由经过培训的市县级医疗中心的超声检查人员对胎儿先天性心脏病进行筛查。
