Sarkola Taisto, Ojala Tiina H, Ulander Veli-Matti, Jaeggi Edgar, Pitkänen Olli M
Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland.
Acta Obstet Gynecol Scand. 2015 Mar;94(3):231-5. doi: 10.1111/aogs.12572. Epub 2015 Jan 25.
The majority of congenital heart defects occur without identifiable risk factors. Detection rates are therefore highly dependent on the experience and expertise of the obstetrical screening operator. In the first trimester, the risk of congenital heart defects increases with increasing nuchal thickness (≥2.5 mm detects 44% of major congenital heart defects), but because of the number of false positives, the positive predictive value is only a few percent. The anatomy of major congenital heart defects may be delineated in less than half of the fetuses during early second trimester. The reported yield of congenital heart defects detection during the mid-gestational routine obstetrical screening has improved over time and detection rates up to 85% of major congenital heart defects have been reported when outflow tract and three-vessel views are included in conjunction with the four-chamber view. Improved detection rates have been achieved following screening operator training interventions combined with a low referral threshold to obtain a detailed fetal echocardiographic study.
大多数先天性心脏缺陷的发生没有可识别的危险因素。因此，检出率高度依赖于产科筛查操作人员的经验和专业知识。在孕早期，先天性心脏缺陷的风险随着颈部厚度增加而升高（颈部厚度≥2.5 mm可检测出44%的主要先天性心脏缺陷），但由于假阳性数量较多，阳性预测值仅为百分之几。在妊娠中期早期，不到一半的胎儿能够清晰显示主要先天性心脏缺陷的解剖结构。随着时间的推移，妊娠中期常规产科筛查中先天性心脏缺陷的检出率有所提高，当将流出道和三血管切面与四腔心切面结合起来时，主要先天性心脏缺陷的检出率报告高达85%。通过对筛查操作人员进行培训干预并结合较低的转诊阈值以进行详细的胎儿超声心动图检查，已实现了更高的检出率。
