Froehlich Rosemary J, Maggio Lindsay, Has Phinnara, Werner Erika F, Rouse Dwight J
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Women and Infants Hospital, Warren Alpert Medical School at Brown University, Providence, Rhode Island.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maternal-Fetal Care Center, Florida Hospital Medical Group, Maitland, Florida.
Am J Perinatol. 2017 Jul;34(9):905-910. doi: 10.1055/s-0037-1601309. Epub 2017 Mar 16.
The objective of this study was to evaluate the rate of abnormal fetal echocardiogram after normal detailed anatomy ultrasound when both are performed by maternal-fetal medicine specialists. Retrospective review of women who underwent detailed anatomy ultrasound and fetal echocardiography between 16 and 26 weeks' gestation at a single center. Women included had at least one indication for fetal echocardiography as recommended by the American Institute of Ultrasound in Medicine and normal cardiac anatomy on initial detailed anatomy ultrasound. Women with previous abnormal ultrasound, extracardiac anomalies, and abnormal or incomplete cardiac anatomy on initial examinations were excluded. The primary outcome was abnormal fetal echocardiogram, defined as a structural cardiac anomaly. A total of 1,000 women (1,052 fetuses) were included. The most common indication for echocardiography was family history of congenital heart disease. Five fetuses had an abnormal echocardiogram (0.5%, 95% confidence interval: 0.2-1.1%), only one of which altered care. The other four were suspected ventricular septal defects; of these, three were not seen on postnatal cardiac imaging. The rate of abnormal fetal echocardiogram after a normal detailed anatomy ultrasound interpreted by maternal-fetal medicine specialists is low. Fetal echocardiography as a second screening test is of low clinical utility and unlikely to be cost-effective in this setting.
本研究的目的是评估由母胎医学专家进行正常详细解剖结构超声检查后胎儿超声心动图异常的发生率。对在单一中心妊娠16至26周期间接受详细解剖结构超声检查和胎儿超声心动图检查的女性进行回顾性研究。纳入的女性至少有一项美国医学超声学会推荐的胎儿超声心动图检查指征，且初次详细解剖结构超声检查时心脏解剖结构正常。排除既往超声检查异常、心脏外畸形以及初次检查时心脏解剖结构异常或不完整的女性。主要结局是胎儿超声心动图异常，定义为心脏结构异常。共纳入1000名女性（1052例胎儿）。超声心动图检查最常见的指征是先天性心脏病家族史。5例胎儿超声心动图异常（0.5%，95%置信区间：0.2 - 1.1%），其中只有1例改变了治疗方案。另外4例怀疑有室间隔缺损；其中3例出生后心脏影像学检查未发现异常。母胎医学专家解读正常详细解剖结构超声检查后胎儿超声心动图异常的发生率较低。在这种情况下，胎儿超声心动图作为二次筛查检查临床效用较低，不太可能具有成本效益。
