Xie J S, Yin X J, Yan Y N, Pei Q Y, Yan L H, Zhang L, Liu J, Liu G, Zhang H L, Zhang X H
Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China.
Department of Pediatrics, Peking University People's Hospital, Beijing 100044, China.
Zhonghua Fu Chan Ke Za Zhi. 2020 Dec 25;55(12):830-836. doi: 10.3760/cma.j.cn112141-20200516-00417.
To investigate the prenatal diagnosis, integrated management and prognosis of fetal complete transposition of the great arteries (D-TGA) detected by ultrasonography. The prenatal diagnosis, integrated management and prognosis of 19 D-TGA fetuses found by ultrasound during pregnancy in Peking University People's Hospital from January 2014 to June 2019 were analyzed retrospectively. The incidence of D-TGA was 0.12% (19/16 028) among fetuses diagnosed by ultrasound during 5 years. Among the 19 cases, there were 7 cases (7/19) of D-TGA alone, 7 cases (7/19) of D-TGA combined with ventricular septal defect (VSD), 5 cases (5/19) of D-TGA combined with other cardiac malformations; 2 cases (2/19) of D-TGA combined with extra cardiac malformations, and 1 case (1/19) of fetal growth restriction. Nuchal translucency (NT) thickening was found in 3 cases (3/19) at the first trimester of pregnancy. Among the 19 D-TGA fetuses found by ultrasound examination, 18 (18/19) had chromosome karyotype analysis of fetuses or newborns, and chromosomal abnormalities were found in 2 cases, all of which were terminated in the second trimester of pregnancy. The integrated management and multidisciplinary diagnosis and treatment of D-TGA fetuses during pregnancy and perinatal period were carried out. Nine cases (9/19) had induction in the second trimester of pregnancy, 10 cases (10/19) were delivered at term, and the gestational week of delivery was (38.3±0.7) weeks, among which 6 cases (6/10) were delivered by caesarean section due to obstetric factors, and 4 cases (4/10) were delivered by vaginal birth. The oxygen saturation was (69.2±11.3)% at birth and (77.8±6.7)% when transferred to the department of pediatrics. Except for one case lost to follow-up, the other 9 newborns received operation. The average operation time was (21.8±22.1) days after birth, 8 cases (8/9) completed one operation and 1 case (1/9) performed two operations. All of the 9 cases treated by surgery were followed up well. Prenatal diagnosis, individualized evaluation and integrated management during pregnancy and perinatal period should be carried out for the patients with fetal D-TGA detected by ultrasound. Fetal D-TGA is not an indication of cesarean section. The open of ductus arteriosus can be maintained with drugs when necessary after birth, and a good prognosis could be obtained through surgery.
探讨超声诊断胎儿完全性大动脉转位（D-TGA）的产前诊断、综合管理及预后情况。回顾性分析2014年1月至2019年6月北京大学人民医院孕期超声发现的19例D-TGA胎儿的产前诊断、综合管理及预后。5年期间超声诊断胎儿中D-TGA的发生率为0.12%（19/16 028）。19例中，单纯D-TGA 7例（7/19），D-TGA合并室间隔缺损（VSD）7例（7/19），D-TGA合并其他心脏畸形5例（5/19）；D-TGA合并心外畸形2例（2/19），胎儿生长受限1例（1/19）。孕早期3例（3/19）发现颈项透明层（NT）增厚。超声检查发现的19例D-TGA胎儿中，18例（18/19）进行了胎儿或新生儿染色体核型分析，2例发现染色体异常，均在孕中期终止妊娠。对孕期及围产期D-TGA胎儿进行了综合管理及多学科诊治。9例（9/19）在孕中期引产，10例（10/19）足月分娩，分娩孕周为（38.3±0.7）周，其中6例（6/10）因产科因素剖宫产分娩，4例（4/10）经阴道分娩。出生时血氧饱和度为（69.2±11.3）%，转入儿科时为（77.8±6.7）%。除1例失访外，其余9例新生儿接受了手术。出生后平均手术时间为（21.8±22.1）天，8例（8/9）完成1次手术，1例（1/9）进行了2次手术。手术治疗的9例均随访良好。对于超声诊断胎儿D-TGA的患者，应进行产前诊断、孕期及围产期个体化评估和综合管理。胎儿D-TGA并非剖宫产指征。出生后必要时可用药维持动脉导管开放，手术可获得良好预后。
