Study Section Combined Standard Prenatal Ultrasound Screening For Fetal Cardiac Malformations

[Objective]Over the years, fetal cardiac malformations screening is an important subject of medical research, The difficulty of ultrasound screening for fetal congenital heart disease and the time-consuming effort, how we can make this simple, fast, safe way of checking in fetal cardiac malformations screening play a bigger and more efficient role has also become a major problem placed in front of clinicians and ultrasound imaging physician.Fetal echocardiography is the first choice to check for congenital heart disease. But its complex, time-consuming, laborious, the technical requirements of the examining physician, the pregnant women to their own conditions and requirements of the fetal position, difficult as a wider range of popular screening tool. In2006, a fetal heart screening guidelines issued by the International Society of Ultrasound in Obstetrics and Gynecology, given the clinical ultrasound guidance to simplify the operation of the fetal heart malformations, reduce the difficulty of the operation, and shorten the inspection time. However, prenatal echocardiography has not been included among the structures of routine prenatal screening project, medical institutions, such examination during prenatal cardiac screening lack of uniform standards.The subject is studied on the basis of the screening guidelines. We proposed exploratory several standard views combination of programs, according to the diagnosis of disease diagnosis section, trying to figure out suitable for China’s national conditions, easy to operate, screening rates highly programs in order to better assist clinical to reduce the fetal birth rate of congenital heart disease, improve the quality of the population.[Methods]Since the beginning of July2010, there are7452cases of pregnant women more than11weeks of pregnancy checking in the First Affiliated Hospital of Kunming Medical University outpatient. They were divided into11-13weeks of gestation,18-24weeks gestation,32-34weeks pregnant38-38weeks of gestation conducted in four categories. Firstly, the ultrasound screening routine fetal ultrasound systems have been done in order to discovery the early detection of heart deformity. Then check the fetal cardiac structure. According to the four-chamber view, the left and right ventricular outflow tract view, the three-vessel tracheal view, long axis view of the aortic arch and pulmonary artery/ductus arteriosus bow, inferior vena cava long axis of the plane several fetal cardiac malformations screening section proposed combination of the following four facets program:a four-chamber view (referred to as the program A);2four-chamber view combined left and right ventricular outflow tract section (referred to as Option B);3four-chamber view, left and right ventricular outflow tract slice joint blood vessels-the trachea section (referred to as program C) four-chamber heart, left and right ventricular outflow tract section, three-vessel-joint trachea section aortic arch and pulmonary artery/ductus arteriosus long axis of the bow section and the inferior vena cava long axis (referred to as the program D). Summing up the incidence of fetal cardiac malformations, different combinations of the display section rate and its to diagnose malformations sensitivity and specificity of different gestational age standard section display rate were analyzed. Fetal echocardiography specialist examination of the fetus in question, select the termination of pregnancy by the consent of the patients after the induction of labor fetal autopsy, to continue the pregnancy should be tracking fetal echocardiography specialist test results and the birth of the fetus underwent echocardiography examination.[Results](1)7452cases observed object, prenatal ultrasound screening for fetal congenital heart defects111cases, the incidence rate of14.8per thousand.(1)7452cases observed object, the overall standard four-chamber view display rate of98.27%, the left ventricular outflow tract view shows the rate of90.24%, right ventricular outflow tract view shows the rate of89.37%, three-vessel-tracheal section, aortic arch/arterial catheter section, inferior vena cava display rate were84.86%,82.07%,79.48%.(2) In four categories, the display section18-24weeks of fetal standard rate highest with the gestational age compared with the other three groups each section display rate and18-24weeks of standard views display rate difference was statistically significant (P<0.001).(2) Of the subject, use Option A sensitivity of81.98%and a specificity of99.87%; using Option B sensitivity of86.49%and a specificity of99.85%; scheme C sensitivity of92.79%, specificity99.80%; using Option D sensitivity of95.50%and a specificity of99.77%.The four scenarios are the consistency of comparison, and clinical follow-up results the program C Option D and clinical follow-up results are in good agreement, kappa value,0.887and0.889, respectively.[Conclusion](1) This study screening for fetal congenital heart disease with a high incidence (14.8%), a high proportion of complex cardiac malformations (36.0%). A considerable number of children with surgical treatment is ineffective, low survival rate, prenatal screening for fetal congenital heart disease has become the focus of prenatal and postnatal care policy projects, while China’s large population of children, not the majority of pregnant women popularity specialist fetal echocardiography, prenatal cardiac screening in reducing congenital heart defects the fetal birth rate has an extremely important significance.(2)Prenatal screening for fetal heart, the section overall display rate and display in different gestational age were high.11-13weeks of pregnancy, except each section in pregnancy a higher rate of advanced display section shows the highest rate of pregnancy18-24weeks, Therefore, this study suggests that screening for fetal cardiac malformations best inspection time second trimester,18-24weeks, the third trimester of pregnancy combined screening for fetal cardiac malformations, contribute to the detection of fetal congenital heart disease.(3)In this study, the implementation of A (four-chamber view), B (four-chamber view co-ventricular outflow tract view), C (four-chamber view, ventricular outflow tract slice joint three-vesse tracheal view), D (four-chamber view, ventricular outflow tract section, three-vessel-joint trachea section aortic arch and pulmonary artery/ductus arteriosus long axis view, inferior vena cava long axis view) four screening programs, comprehensive view shows the rate, screening sensitivity, specificity, Kappa values and other factors, Option C as the preferred screening program, so we suggested that the routine use of fetal cardiac malformations screening of the program, little doubt that the addition of Option D supplement checks, contribute to congenital heart disease diagnosis.(4)In prenatal ultrasound screening for fetal cardiac malformations in the process, we believe that the comprehensive dynamic observation, combined heart joint screening, make full use of the advantages of color Doppler, collaborate with specialist fetal echocardiography physicians, rewarding to further clarify the diagnosis of fetal congenital heart disease.(5) In this study, there is a sample size is not big enough, the cases were lost to follow, chromosomal anomalies can not be synchronized with the study and the time-consuming analysis of scanning is not included, our research in the future will further expand the sample size, establish effective follow-up approach, increase the chromosome research in order to improve the inadequate of our study.