Obstetric Unit, Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Polyclinic, University of Bologna, Bologna, Italy.
Paediatric Cardiology and Adult Congenital Unit, Department of Cardiac, Thoracic and Vascular Sciences, Sant'Orsola-Malpighi Polyclinic, University of Bologna, Bologna, Italy.
Am J Obstet Gynecol MFM. 2020 Nov;2(4):100207. doi: 10.1016/j.ajogmf.2020.100207. Epub 2020 Aug 15.
The prenatal diagnosis of an isolated congenital heart defect is a matter of concern for parents. The decision of whether to terminate the pregnancy according to the different types of congenital heart defects has not been investigated yet.
This study aimed to evaluate the frequency of voluntary termination of pregnancy after the prenatal diagnosis of a congenital heart defect in a tertiary care center.
This was a retrospective study of patients who were referred to our center from January 2013 to December 2019, underwent fetal echocardiography, and were counseled by a perinatologist and a pediatric cardiologist. The following data were collected: prenatal diagnosis, including genetic testing; gestational age at diagnosis; and outcome of pregnancy. The diagnoses were stratified retrospectively according to the type of congenital heart defect and its severity (low complexity, moderate complexity, and high complexity) by a perinatologist and a pediatric cardiologist.
Of 704 women who received a diagnosis of fetal congenital heart defect, 531 (75.4%) were seen before 23 weeks' gestation, which is the upper limit imposed for the termination of pregnancy by the Italian legislation. Congenital heart defects were apparently isolated in 437 of 531 cases (82.3%). Overall, 108 of 531 patients (20.3%) requested a termination of pregnancy. The rate of termination of pregnancy was found to vary according to the severity of congenital heart defects: low complexity, 0%; moderate complexity, 12.1%, and high complexity, 33.2% (P<.001). The presence or absence of associated anomalies or the ethnicity of the couples was not found to have an influence on women's decisions.
In our population, the decision to terminate a pregnancy after the diagnosis of a fetal congenital heart defect is influenced by the surgical complexity of the congenital heart defect itself. However, most patients, including those with the most severe forms of congenital heart defect, decided to continue the pregnancy.
产前诊断出孤立性先天性心脏病会令父母担忧。对于不同类型的先天性心脏病，是否应根据其类型选择终止妊娠，目前尚未进行相关研究。
本研究旨在评估在三级医疗中心对先天性心脏病进行产前诊断后，自愿终止妊娠的频率。
这是一项回顾性研究，纳入了 2013 年 1 月至 2019 年 12 月期间在我院就诊的、经胎儿超声心动图检查、并由围产医生和儿科心脏病专家进行咨询的患者。收集的数据包括：产前诊断，包括基因检测；诊断时的孕周；妊娠结局。产前诊断由一名围产医生和一名儿科心脏病专家根据先天性心脏病的类型及其严重程度（低复杂性、中复杂性和高复杂性）进行回顾性分层。
在 704 名被诊断为胎儿先天性心脏病的女性中，531 名（75.4%）在 23 孕周之前就诊，这是意大利立法规定的终止妊娠的上限。在 531 例先天性心脏病患者中，437 例（82.3%）表现为孤立性先天性心脏病。总体而言，531 例患者中有 108 例（20.3%）要求终止妊娠。终止妊娠的比率随先天性心脏病严重程度的不同而有所差异：低复杂性为 0%；中复杂性为 12.1%；高复杂性为 33.2%（P<.001）。是否存在相关畸形或夫妇的种族并未发现对女性的决策有影响。
在我们的人群中，终止妊娠的决定取决于先天性心脏病本身的手术复杂性。然而，大多数患者，包括患有最严重先天性心脏病的患者，决定继续妊娠。
