Hill G D, Block J R, Tanem J B, Frommelt M A
Division of Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
Prenat Diagn. 2015 Sep;35(9):859-63. doi: 10.1002/pd.4622. Epub 2015 Jun 15.
Prenatal diagnosis of critical congenital heart disease, which requires surgical or catheter intervention in the first 30 days of life, allows for delivery at a specialized center and can reduce preoperative morbidity and mortality. We sought to identify the risk factors for a missed prenatal diagnosis of critical congenital heart disease.
Patients presenting to the Children's Hospital of Wisconsin with critical congenital heart disease from 2007 to 2013 were included. Those with a prenatal diagnosis were compared with those with a postnatal diagnosis.
The cohort included 535 patients with prenatal diagnosis made in 326 (61%). The prenatal diagnostic rate improved from 44% in 2007 to 69% in 2013. Independent factors associated with a postnatal diagnosis were a lesion that required a view other than a four chamber view to make the diagnosis (p < 0.0001), absence of another organ system anomaly (p < 0.0001), and living in a higher poverty (p = 0.02) or lower population density communities (p = 0.002).
While the prenatal diagnostic rate for critical congenital heart disease is improving, those living in impoverished or rural communities are at highest risk of not having a diagnosis made prenatally. Interventions to improve prenatal detection of congenital heart disease should target these vulnerable areas.
对严重先天性心脏病进行产前诊断，这类疾病在出生后30天内需进行手术或导管介入治疗，产前诊断有助于在专业中心分娩，并可降低术前发病率和死亡率。我们试图确定严重先天性心脏病产前诊断漏诊的危险因素。
纳入2007年至2013年在威斯康星儿童医院就诊的严重先天性心脏病患者。将产前诊断的患者与产后诊断的患者进行比较。
该队列包括535例患者，其中326例（61%）进行了产前诊断。产前诊断率从2007年的44%提高到2013年的69%。与产后诊断相关的独立因素包括：诊断需要除四腔心切面以外的其他切面观察的病变（p<0.0001）、无其他器官系统异常（p<0.0001）以及生活在贫困程度较高（p=0.02）或人口密度较低（p=0.002）的社区。
虽然严重先天性心脏病的产前诊断率在提高，但生活在贫困或农村社区的人群产前未被诊断的风险最高。改善先天性心脏病产前检测的干预措施应针对这些薄弱地区。
