Chinn A, Fitzsimmons J, Shepard T H, Fantel A G
Department of Pediatrics, University of Washington School of Medicine, Seattle 98195.
Teratology. 1989 Nov;40(5):475-82. doi: 10.1002/tera.1420400510.
The prevalence, range, and associations of congenital heart disease (CHD) were studied among 400 spontaneous abortuses between 9 and 40 weeks' gestation. Fifty-two (13.0%) cases of CHD were detected. To minimize selection bias the specimens were grouped by external appearance and the prevalence expressed accordingly. CHD was detected in 21 (7.3%) of 289 externally normal and 31 (27.9%) of 111 externally abnormal fetuses. Ventricular septal defect (VSD) was the most frequent CHD found in isolation as well as in combination with extracardiac malformations. Seventy-five percent of isolated CHD was VSD. Forty (69.2%) of the 52 cases of CHD were associated with extracardiac malformations. Chromosomal syndromes were responsible for a minimum of 19.2% of the cases and suspected in up to 36.5%. The most frequent associations involved the musculoskeletal system, central nervous system, abdominal wall, and kidneys. In contrast, studies of liveborn infants have reported 70% of CHD as isolated defects, including many CHD infrequently seen among spontaneous abortuses. This suggests that fetuses with isolated CHD often survive to term, and CHD does not significantly affect the survival of the fetus in utero. Ventricular septum formation may be particularly susceptible to hemodynamic changes and may be indicative of an underlying pathologic condition that also leads to a spontaneous abortion.
对400例妊娠9至40周的自然流产胎儿进行了先天性心脏病（CHD）的患病率、范围及相关性研究。共检测出52例（13.0%）CHD病例。为尽量减少选择偏倚，根据外观对标本进行分组，并据此计算患病率。在289例外观正常的胎儿中检测到21例（7.3%）CHD，在111例外观异常的胎儿中检测到31例（27.9%）CHD。室间隔缺损（VSD）是最常见的CHD类型，既可见于单纯性CHD，也可见于合并心外畸形的情况。单纯性CHD中75%为VSD。52例CHD病例中有40例（69.2%）合并心外畸形。染色体综合征至少占病例的19.2%，怀疑占比高达36.5%。最常见的合并畸形累及肌肉骨骼系统、中枢神经系统、腹壁和肾脏。相比之下，对活产婴儿的研究报告称，70%的CHD为单纯性缺陷，包括许多在自然流产胎儿中不常见的CHD类型。这表明单纯性CHD胎儿往往能存活至足月，且CHD对子宫内胎儿的存活无显著影响。室间隔形成可能对血流动力学变化特别敏感，可能提示存在一种潜在的病理状况，这种状况也会导致自然流产。
