Koşger Pelin, Velipaşaoğlu Melih, Keskin Tuğçem, Kıztanır Hikmet, Uçar Birsen
Eskişehir Osmangazi University Faculty of Medicine, Department of Pediatric Cardiology, Eskişehir, Turkey.
Eskişehir Osmangazi University Faculty of Medicine, Department of Obstetrics and Gynecology, Perinatology Unit, Eskişehir, Turkey.
Turk J Obstet Gynecol. 2020 Dec;17(4):285-291. doi: 10.4274/tjod.galenos.2020.04127. Epub 2020 Dec 10.
In the present study, for which reasons fetal cardiac evaluation was requested from our pediatric cardiology clinic, the effects of routine fetal cardiac evaluation in obstetric ultrasonography (USG) on the detection of congenital heart disease (CHD) and the distribution of intrauterine diagnosis of CHD according to pregnancy risk profiles were retrospectively analyzed.
Fetal echocardiography reports which containing the nineteen-month period were retrospectively examined. We performed a fetal echocardiography for all pregnant women who were referred to pediatric cardiology clinic after detail obstetric USG screening. The pregnancies were categorized into two groups based on the risk of CHD: Low-risk and high-risk groups. Detected congenital cardiac structural malformations were classified as complex, moderate, and mild according to perinatal mortality risk.
Of the 736 pregnancies, 22 were twin, and fetal cardiac evaluation was performed in 758 fetuses. There were 341 (46.3%) pregnancies in the high-risk group and 395 (53.6%) pregnancies in the low-risk group. The most common reason for fetal cardiac evaluation request was inability to adequately visualize the fetal heart (36.1%), while suspected fetal cardiac abnormality was the second most common cause (21.3%). Number of fetuses detected with cardiac abnormalities was 80 (23.5%) among high-risk pregnancies, and 20 (5%) among low-risk pregnancies. The most common type of malformation was simple cardiac abnormalities (6%) followed by complex lesions (4.1%). The most common cardiac abnormality was ventricular septal defect comprised of 18 cases (2.4%) while the most common complex cardiac abnormality was pulmonary atresia (1.2%). The rate of consistency was 40.1% between obstetricians and pediatric cardiologist in terms of the diagnosis of the congenital cardiac malformations.
Routine evaluation of the fetal heart by means of obstetric USG, including four chambers, outflow tracts' and three vessel views, would allow for diagnosing congenital cardiac malformations to a large extent during the intrauterine period.
在本研究中，回顾性分析了我院儿科心脏病门诊要求进行胎儿心脏评估的原因、产科超声检查（USG）中常规胎儿心脏评估对先天性心脏病（CHD）检测的影响以及根据妊娠风险概况对CHD进行宫内诊断的分布情况。
回顾性检查了涵盖19个月期间的胎儿超声心动图报告。在详细的产科USG筛查后，我们对所有转诊至儿科心脏病门诊的孕妇进行了胎儿超声心动图检查。根据CHD风险将妊娠分为两组：低风险组和高风险组。根据围产期死亡风险，将检测到的先天性心脏结构畸形分为复杂型、中型和轻型。
736例妊娠中，22例为双胎，共对758例胎儿进行了心脏评估。高风险组有341例（46.3%）妊娠，低风险组有395例（53.6%）妊娠。要求进行胎儿心脏评估的最常见原因是无法充分观察到胎儿心脏（36.1%），而疑似胎儿心脏异常是第二常见原因（21.3%）。高风险妊娠中检测到心脏异常的胎儿有80例（23.5%），低风险妊娠中有20例（5%）。最常见的畸形类型是简单心脏异常（6%），其次是复杂病变（4.1%）。最常见的心脏异常是室间隔缺损，共18例（2.4%），最常见的复杂心脏异常是肺动脉闭锁（1.2%）。产科医生和儿科心脏病专家在先天性心脏畸形诊断方面的一致性率为40.1%。
通过产科USG对胎儿心脏进行常规评估，包括四腔心、流出道和三血管切面，在很大程度上能够在宫内期诊断先天性心脏畸形。
