Perinatology Department, Health Science University, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey.
Obstetrics Department, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
Arch Gynecol Obstet. 2024 Nov;310(5):2497-2505. doi: 10.1007/s00404-024-07759-w. Epub 2024 Sep 30.
Fetal heart diseases significantly contribute to neonatal mortality. Improved prenatal diagnostics enable defect detection before delivery, emphasizing the need for a personalized approach to address anomalies and predict outcomes. Categorizing diseases into risk classes aids obstetricians in counseling and delivery decisions. This study classifies fetal heart diseases by severity, examining factors related to maternal, fetal, and delivery that affect neonatal mortality. The aim is to identify key determinants of neonatal mortality and create an individual approach to assess and manage risks in the first days of a newborn's life.
A prospective study from 2019 to 2023 at a tertiary care institute involved pregnant women diagnosed with fetal heart disease. 382 women were categorized into three groups based on potential risk for hemodynamic instability at birth: Group-1 (no or low risk, n = 114), Group-2 (moderate risk, n = 201), and Group-3 (high risk, n = 67). Antenatal follow-up used fetal echocardiography. The study explored the association between maternal-fetal-delivery-related factors and neonatal mortality, with statistical significance set at p < 0.05.
Significant associations with neonatal mortality were found in cases with birth weight < 2500 g (p = 0.002), presence of genitourinary system anomaly (p = 0.001), group-2 and 3 heart disease (p < 0.001), and induction of labor (p = 0.01).
Factors influencing neonatal mortality in fetal heart disease cases include heart disease severity (group-3 heart disease), low birth weight, and extracardiac anomalies. While labor induction with prostaglandin ± oxytocin appears to elevate neonatal mortality, this observation requires further validation with larger sample sizes. Obstetricians should consider selective use of prostaglandin for labor induction.
胎儿心脏病是新生儿死亡的主要原因。产前诊断水平的提高使得在分娩前就能发现缺陷，这强调了需要采取个性化的方法来处理异常情况并预测结局。将疾病分为风险类别有助于产科医生做出咨询和分娩决策。本研究根据严重程度对胎儿心脏病进行分类，研究与母亲、胎儿和分娩相关的因素如何影响新生儿死亡率。目的是确定新生儿死亡率的关键决定因素，并创建一种个体方法来评估和管理新生儿生命最初几天的风险。
本研究为前瞻性研究，时间为 2019 年至 2023 年，研究对象为在三级保健机构诊断为胎儿心脏病的孕妇。根据出生时发生血液动力学不稳定的潜在风险，382 名孕妇分为三组：第 1 组（无或低风险，n=114）、第 2 组（中危，n=201）和第 3 组（高危，n=67）。产前随访采用胎儿超声心动图。研究探讨了与母婴分娩相关的因素与新生儿死亡率之间的关系，统计学意义设为 p<0.05。
出生体重<2500g（p=0.002）、存在泌尿生殖系统异常（p=0.001）、第 2 组和第 3 组心脏病（p<0.001）和引产（p=0.01）与新生儿死亡率显著相关。
影响胎儿心脏病新生儿死亡率的因素包括心脏病严重程度（第 3 组心脏病）、低出生体重和心脏外异常。虽然前列腺素联合催产素诱导分娩似乎会增加新生儿死亡率，但这一观察结果需要更大的样本量进一步验证。产科医生应考虑选择性使用前列腺素诱导分娩。
