Department of Obstetrics and Gynaecology, Amsterdam UMC location, University of Amsterdam, Amsterdam, The Netherlands.
Amsterdam Reproduction and Development, Amsterdam, The Netherlands.
Ultrasound Obstet Gynecol. 2022 Dec;60(6):721-730. doi: 10.1002/uog.26017.
Fetal heart-rate irregularities occur in 1-2% of pregnancies and are usually caused by premature atrial contractions (PAC). Although PAC are considered benign, they may be associated with cardiac defects and tachyarrhythmia. We aimed to determine the incidence of congenital heart defects (CHDs) and complications in fetuses with PAC.
This was a systematic review and meta-analysis conducted in accordance with the PRISMA statement for reporting items for systematic reviews and meta-analyses. MEDLINE and EMBASE were searched from 1990 to June 2021 to identify studies on fetuses with PAC. The primary outcome was CHD; secondary outcomes were complications using the endpoints supraventricular tachyarrhythmia (SVT), cardiac failure and intrauterine fetal demise. Meta-analysis of proportions was performed, subdivided into high-risk and low-risk populations based on reason for referral. Pooled incidences with 95% CIs were calculated.
Of 2443 unique articles identified, 19 cohort studies including 2260 fetuses were included. The pooled incidence of CHD in fetuses with PAC was 2.8% (95% CI, 1.5-4.1%), when 0.6% is the incidence expected in the general population. The pooled incidence of CHD was 7.2% (95% CI, 3.5-10.9%) in the high-risk population and 0.9% (95% CI, 0.0-2.0%) in the low-risk population. SVT occurred in 1.4% (95% CI, 0.6-3.4%) of fetuses diagnosed with PAC. Cardiac failure was described in 16 fetuses (1.4% (95% CI, 0.5-3.5%)), of which eight were CHD-related. Intrauterine fetal demise occurred in four fetuses (0.9% (95% CI, 0.5-1.7%)) and was related to CHD in two cases.
Our findings suggest that the risk of CHD in fetuses with PAC is 4-5 times higher than that in the general population. CHD was present more frequently in the high-risk population. Consequently, an advanced ultrasound examination to diagnose PAC correctly and exclude CHD is recommended. Complications of PAC are rare but can result in fetal demise, thus weekly fetal heart-rate monitoring remains advisable to enable early detection of SVT and to prevent cardiac failure. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
胎儿心率不齐在 1%-2%的妊娠中发生，通常由房性期前收缩（PAC）引起。尽管 PAC 被认为是良性的，但它们可能与心脏缺陷和心动过速有关。我们旨在确定 PAC 胎儿的先天性心脏缺陷（CHD）和并发症的发生率。
这是一项按照系统评价和荟萃分析的 PRISMA 声明进行的系统评价和荟萃分析。从 1990 年到 2021 年 6 月，我们在 MEDLINE 和 EMBASE 上搜索了关于 PAC 胎儿的研究。主要结局是 CHD；次要结局是使用室上性心动过速（SVT）、心力衰竭和宫内胎儿死亡等终点的并发症。采用比例的荟萃分析，根据转诊原因分为高危和低危人群。计算汇总发生率和 95%CI。
在 2443 篇独特的文章中，有 19 项队列研究包括 2260 例胎儿。PAC 胎儿的 CHD 发生率为 2.8%（95%CI，1.5-4.1%），而一般人群的发生率为 0.6%。高危人群的 CHD 发生率为 7.2%（95%CI，3.5-10.9%），低危人群为 0.9%（95%CI，0.0-2.0%）。在诊断为 PAC 的胎儿中，SVT 的发生率为 1.4%（95%CI，0.6-3.4%）。描述了 16 例心力衰竭的胎儿（1.4%（95%CI，0.5-3.5%）），其中 8 例与 CHD 相关。4 例胎儿发生宫内胎儿死亡（0.9%（95%CI，0.5-1.7%）），其中 2 例与 CHD 有关。
我们的研究结果表明，PAC 胎儿的 CHD 风险是一般人群的 4-5 倍。高危人群中 CHD 更为常见。因此，建议进行更先进的超声检查以正确诊断 PAC 并排除 CHD。PAC 的并发症很少见，但可能导致胎儿死亡，因此仍然建议每周进行胎儿心率监测，以便早期发现 SVT 并预防心力衰竭。2022 年，作者。超声在妇产科由约翰威立父子公司出版代表国际妇产科超声学会。
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