Wang Jian, Ye Yujiao, Xin Tiantian, Zhang Xi, Chen Sun, Wu Yurong, Sun Kun
Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Pediatric, Zhang Jiagang First People Hospital, Suchou University, Jiangsu, China.
J Obstet Gynaecol Res. 2019 Apr;45(4):803-809. doi: 10.1111/jog.13912. Epub 2019 Jan 15.
Previous evidence on the relationship between single umbilical artery (SUA) and congenital heart disease (CHD) is controversial. We thus conducted a retrospective study to explore the potential risk factors associated with CHD in SUA fetuses, and verify if all these SUA fetuses should be referred for detail fetal echocardiography.
We reviewed medical records of SUA fetuses referred to Xinhua Hospital for fetal echocardiography between September 2009 and February 2014. All the pregnancies were divided into two groups of CHD and non-CHD according to the results of fetal echocardiography. The maternal and fetal characteristics were compared via χ test and Fishers' test. Furthermore, Poisson regression was used to analyze the risk factors associated with CHD in SUA pregnancies.
Nineteen CHD cases (12.5%) were detected among 152 SUA fetuses, all with abnormal cardiac views during obstetric screening ultrasound (P < 0.001). χ test showed that abnormal cardiac screening findings, extracardiac abnormality and infection or threatened abortion during first trimester were significantly associated with prenatal detection of CHD (P < 0.001). Multivariable Poisson regression after adjustment found that SUA fetuses with extracardiac abnormality had 4.74 (95% confidence interval: 1.89, 11.90) times higher risk of CHD.
Incidence of CHD was higher in SUA cases, and CHD fetuses could be screened efficiently by abnormal cardiac screening during obstetric screening ultrasound. SUA fetuses with extracardiac abnormality and maternal risk factors have higher risk of CHD, and should be strongly recommended for fetal echocardiography. In contrast, SUA fetuses without above situations might only need routine obstetric follow-up.
先前关于单脐动脉（SUA）与先天性心脏病（CHD）之间关系的证据存在争议。因此，我们进行了一项回顾性研究，以探讨与SUA胎儿CHD相关的潜在风险因素，并验证是否所有这些SUA胎儿都应转诊进行详细的胎儿超声心动图检查。
我们回顾了2009年9月至2014年2月期间转诊至新华医院进行胎儿超声心动图检查的SUA胎儿的病历。根据胎儿超声心动图结果，将所有妊娠分为CHD组和非CHD组。通过χ检验和费舍尔检验比较母体和胎儿特征。此外，采用泊松回归分析SUA妊娠中与CHD相关的风险因素。
在152例SUA胎儿中检测到19例CHD病例（12.5%），所有病例在产科筛查超声检查时心脏视图均异常（P < 0.001）。χ检验显示，心脏筛查异常结果、心脏外异常以及孕早期感染或先兆流产与产前CHD检测显著相关（P < 0.001）。调整后的多变量泊松回归发现，伴有心脏外异常的SUA胎儿患CHD的风险高4.74倍（95%置信区间：1.89, 11.90）。
SUA病例中CHD的发生率较高，通过产科筛查超声检查时的心脏异常筛查可有效筛查出CHD胎儿。伴有心脏外异常和母体风险因素的SUA胎儿患CHD的风险较高，强烈建议进行胎儿超声心动图检查。相比之下，没有上述情况的SUA胎儿可能仅需进行常规产科随访。
