García Delgado Raquel, García Rodríguez Raquel, Ortega Cárdenes Ismael, González Martín Jesús M, De Luis Alvarado María, Segura González Javier, Medina Castellano Margarita, García Hernández Jose A
Department of Obstetrics and Gynecology, Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain.
Bioestatistics Division, Research Unit, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain.
Reprod Sci. 2021 Aug;28(8):2270-2277. doi: 10.1007/s43032-021-00477-7. Epub 2021 Feb 8.
The earlier the detection and diagnosis of congenital heart diseases (CHD), the greater the clinical benefit; however, early fetal cardiac examination can be a challenge. The aim of our study is to demonstrate that the fetal cardiac examination at 13-13 weeks can be as adequately assessed as the examination performed at 16 weeks in patients with low and high body mass index (BMI).
The study was a prospective observational cohort study. One hundred pregnant women at low risk of congenital heart anomalies were divided into two groups: 49 women with low BMI (<25) and 51 women with high BMI (≥ 25). A complete fetal cardiac scan was performed on each patient at 13-13 weeks, via the transvaginal and transabdominal approaches, and at 16 weeks by the transabdominal approach.
The examination at 13-13 weeks was adequately assessed in at least one of the two routes in 97 patients, as opposed to 87 patients at 16 weeks. A significantly higher adequate assessment rate was obtained at 13-13 weeks than at 16 weeks (p=0.017). The transvaginal approach showed the best resolution of the three examinations in 42% of women with BMI ≥35. No CHD were overlooked.
Early fetal echocardiography is feasible and accurate at 13-13 weeks. Within patients with high BMI, early fetal echocardiography may be performed two weeks in advance, since it allows visualization of the fetal heart through the transvaginal route with a higher resolution in a large number of women, which is not feasible at 16 weeks.
先天性心脏病（CHD）的检测和诊断越早，临床获益越大；然而，早期胎儿心脏检查可能具有挑战性。我们研究的目的是证明，对于低体重指数（BMI）和高体重指数的患者，孕13⁺⁶周时的胎儿心脏检查与孕16周时进行的检查评估效果相当。
本研究为前瞻性观察性队列研究。100例先天性心脏异常低风险孕妇被分为两组：49例低BMI（<25）孕妇和51例高BMI（≥25）孕妇。每位患者在孕13⁺⁶周时经阴道和经腹途径进行完整的胎儿心脏扫描，并在孕16周时经腹途径进行扫描。
97例患者在孕13⁺⁶周时通过两种途径中的至少一种得到了充分评估，而在孕16周时为87例。孕13⁺⁶周时的充分评估率显著高于孕16周（p=0.017）。在BMI≥35的女性中，42%的经阴道途径在三项检查中显示出最佳分辨率。未漏诊任何先天性心脏病。
孕13⁺⁶周时早期胎儿超声心动图检查可行且准确。在高BMI患者中，早期胎儿超声心动图检查可提前两周进行，因为它能通过经阴道途径在大量女性中以更高分辨率显示胎儿心脏，而这在孕16周时是不可行的。
