Bronshtein M, Zimmer E Z, Gerlis L M, Lorber A, Drugan A
Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel.
Obstet Gynecol. 1993 Aug;82(2):225-9.
To evaluate the yield of early second-trimester transvaginal ultrasonography in the detection of congenital heart defects among patients with low or high risk for fetal anomalies.
During 5 years, we performed 12,793 transvaginal ultrasound examinations at 12-16 weeks' gestation, targeted for detection of fetal congenital anomalies. Three thousand four hundred fifty-three (27%) of these patients were considered to be at high risk for fetal congenital heart defects (because of family or medical history or teratogen exposure). The other 9340 patients were considered to be at low risk for fetal anomalies. The four-chamber view and the outflow tracts were evaluated systematically in all patients.
Congenital heart malformations were observed in 47 cases, most of which (29 of 47) were diagnosed in the low-risk group. Additional extracardiac malformations were observed in 29 (62%) of the affected fetuses. Ten of 28 affected pregnancies that were karyotyped (36%) had abnormal chromosomes. Use of the four-chamber view alone would have failed to detect 11 (23%) of the abnormal fetuses.
Transvaginal ultrasonography in the early second trimester is a useful tool for the detection of fetal cardiac structural defects, provided that both the four-chamber view and the outflow tracts are evaluated. When such an anomaly is suspected, additional fetal malformations should be sought and fetal karyotype should be determined.
评估孕中期经阴道超声检查在检测胎儿先天性心脏缺陷方面的效果，这些胎儿具有低或高胎儿异常风险。
在5年期间，我们在妊娠12 - 16周进行了12793次经阴道超声检查，目标是检测胎儿先天性异常。其中3453例（27%）患者被认为有胎儿先天性心脏缺陷的高风险（由于家族史、病史或致畸物暴露）。另外9340例患者被认为有胎儿异常的低风险。对所有患者系统评估四腔心切面和流出道。
观察到47例先天性心脏畸形，其中大多数（47例中的29例）在低风险组中被诊断出来。在29例（62%）受影响胎儿中观察到额外的心外畸形。28例接受核型分析的受影响妊娠中，有10例（36%）染色体异常。仅使用四腔心切面会漏诊11例（23%）异常胎儿。
孕中期经阴道超声检查是检测胎儿心脏结构缺陷的有用工具，前提是同时评估四腔心切面和流出道。当怀疑有此类异常时，应寻找其他胎儿畸形并确定胎儿核型。
