Haxel Caitlin S, Ronai Christina, Martens Anna M, Lim Chelsey C, Pinto Nelangi, Chiu Joanne S
Division of Pediatric Cardiology, Department of Pediatrics, University of Vermont Children's Hospital, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA.
Department of Cardiology, Department of Pediatrics, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA.
Prenat Diagn. 2025 Jun;45(6):752-763. doi: 10.1002/pd.6706. Epub 2024 Nov 29.
Prenatal counseling following a fetal diagnosis of critical congenital heart disease (CCHD) is challenging and requires delivery of detailed and complete information to ensure appropriate decision making and pregnancy support.
An anonymous 50-item survey was distributed to providers who performed fetal cardiac counseling. The primary purpose was to evaluate on a national scale physician beliefs and attitudes toward available choices after a fetal diagnosis of CCHD and their association with reported counseling practices. Participants were specifically asked to indicate how likely they were to recommend postnatal interventional and/or surgical treatment, postnatal palliative care, or termination of pregnancy. The primary outcome variables were provider responses to statements about pregnancies complicated by CCHD diagnosed in utero.
There were 138 respondents, with most somewhat or strongly agreeing that providing counseling on surgical and catheter-based interventions anticipated in the short- and long-term (99%, 136/138), counseling on a "comfort care" alternative with limited intervention (97%, 134/138), and options for pregnancy termination at different stages (91%, 126/138) should be included. Physicians that disagreed with the statement "some life is better than no life at all" were statistically more likely (p < 0.001) to report that prenatal counseling regarding "options for pregnancy termination services at different stages of pregnancy" was important. There was a statistically significant difference in the counseling provided to parents based on the physician's personal and professional views on palliative care and termination of pregnancy.
Physicians' self-reported beliefs impact the counseling content provided to families in the setting of a prenatal diagnosis of CCHD.
胎儿被诊断为严重先天性心脏病（CCHD）后的产前咨询具有挑战性，需要提供详细完整的信息以确保做出恰当的决策并给予孕期支持。
向进行胎儿心脏咨询的医疗服务提供者发放了一份包含50个项目的匿名调查问卷。主要目的是在全国范围内评估医生对于胎儿被诊断为CCHD后现有选择的信念和态度，以及它们与所报告的咨询实践之间的关联。特别要求参与者指出他们推荐产后介入和/或手术治疗、产后姑息治疗或终止妊娠的可能性。主要结局变量是医疗服务提供者对关于子宫内诊断为CCHD的妊娠相关陈述的回答。
共有138名受访者，大多数人或多或少或强烈同意应包括对短期和长期预期的手术及导管介入治疗进行咨询（99%，136/138）、对有限干预的“舒适护理”替代方案进行咨询（97%，134/138）以及不同阶段的终止妊娠选择（91%，126/138）。不同意“有生命总比没有生命好”这一陈述的医生在统计学上更有可能（p < 0.001）报告关于“不同孕期终止妊娠服务选择”的产前咨询很重要。根据医生对姑息治疗和终止妊娠的个人及专业观点，为父母提供的咨询存在统计学上的显著差异。
医生自我报告的信念会影响在产前诊断为CCHD的情况下向家庭提供的咨询内容。
