Office of Quality Management, Ultrasonography Department, Department of Radiology, Prenatal Diagnostic Center, The Fourth Hospital of Shijiazhuang, Chang'an District, Shijiazhuang City, Hebei, China.
Eur Rev Med Pharmacol Sci. 2023 May;27(9):3846-3853. doi: 10.26355/eurrev_202305_32290.
With the development and widespread use of fetal ultrasound and magnetic resonance technology in recent years, approximately 75% of fetuses are diagnosed prenatally with congenital structural malformations, a serious birth defect that endangers the life and health of the newborn. In this study, we aimed to study and analyze the value of the prenatal-postnatal integrated management model in the screening, diagnosis and treatment of fetal heart malformations.
All pregnant women who were to undergo delivery in our hospital between January 2018 and December 2021 were recruited as the first subjects in this study, and after excluding those who refused to participate in the study, a total of 3,238 cases were finally included as subjects of this study. All pregnant women were screened for fetal heart malformations using the prenatal-postnatal integrated management model. Maternal files were established for all cases of heart malformations, grading the fetuses according to their heart disease grade, observing and recording their deliveries, treatment results and follow-ups.
After screening for heart malformations using the prenatal-postnatal integrated management model, 33 cases of heart malformations were identified, including 5 cases of Grade I (all delivered), 6 cases of Grade II (all delivered), 10 cases of Grade III (1 induced), and 12 cases of Grade IV (1 induced); 2 cases of ventricular septal defect healed spontaneously after delivery, and 18 infants were treated accordingly. The results of the later follow-up showed that 10 children had normalized their heart structure, 7 cases had slight alterations in the heart valves, and 1 case died.
The prenatal-postnatal integrated management model is a multidisciplinary cooperation model with certain clinical value in the screening, diagnosis and treatment of fetal heart malformations, which is beneficial to comprehensively improve the ability of hospital physicians in the grading management of heart malformations, detecting fetal heart malformations early and predicting fetal changes after birth. It further reduces the incidence of serious birth defects, conforms to the development trend of the diagnosis and treatment of congenital heart diseases, enables to reduce child mortality with timely treatment, effectively improves the surgical prognosis of critical and complex congenital heart diseases, with a promising application prospect.
近年来，随着胎儿超声和磁共振技术的发展和广泛应用，约 75%的胎儿在产前被诊断为先天性结构畸形，这是一种严重的出生缺陷，危及新生儿的生命和健康。本研究旨在探讨产前-产后综合管理模式在胎儿心脏畸形筛查、诊断和治疗中的价值。
选取 2018 年 1 月至 2021 年 12 月在我院分娩的孕妇作为本研究的第一组受试者，排除拒绝参与研究的孕妇后，共纳入 3238 例孕妇作为本研究的受试者。所有孕妇均采用产前-产后综合管理模式筛查胎儿心脏畸形。对所有心脏畸形病例建立产妇档案，根据胎儿心脏病分级对胎儿进行分级，观察并记录其分娩、治疗结果及随访情况。
采用产前-产后综合管理模式筛查心脏畸形后，共发现心脏畸形 33 例，其中Ⅰ级 5 例（均经阴道分娩），Ⅱ级 6 例（均经阴道分娩），Ⅲ级 10 例（1 例引产），Ⅳ级 12 例（1 例引产）；2 例室间隔缺损患儿分娩后自行愈合，18 例患儿进行了相应治疗。后期随访结果显示，10 例患儿心脏结构恢复正常，7 例患儿心脏瓣膜有轻微改变，1 例患儿死亡。
产前-产后综合管理模式是一种多学科合作模式，在胎儿心脏畸形的筛查、诊断和治疗中具有一定的临床价值，有利于全面提高医院医师对心脏畸形分级管理的能力，早期发现胎儿心脏畸形，并预测胎儿出生后的变化。进一步降低严重出生缺陷的发生率，符合先天性心脏病诊治的发展趋势，能做到及时治疗减少患儿死亡，有效提高危重症及复杂先天性心脏病的外科预后，具有广阔的应用前景。
