| Objective:Congenital heart disease(CHD)has a high degree of disability and mortality,ranking first among birth defects and seriously endangering the health of children in China.Fetuses with complex congenital heart disease screened from prenatal screening urgently need to obtain detailed risk stratification diagnosis,reasonable perinatal management,and timely transportation and treatment pathways after birth,namely integrated perinatal management.The purpose of this study was to evaluate the effectiveness of perinatal integrated management of completeness transposition of great arteries(D-TGA),completeness anomalous pulmonary venous connection(TAPVC),coarctation of aorta(Co A)fetuses,and summarize clinical experience,so as to provide a basis for the development of reasonable and effective perinatal intervention programs for D-TGA,TAPVC,and Co A fetuses.Methods:Retrospective analysis of the integrated management and prognosis of D-TGA,TAPVC,and Co A fetuses diagnosed by prenatal echocardiography at Qingdao University Affiliated Women and Children’s Hospital from January 2016 to December 2020.Integrated perinatal management refers to the multidisciplinary joint diagnosis and treatment of the fetus diagnosed with D-TGA,TAPVC and Co A in the department of obstetrics,fetal medicine,obstetric ultrasound,pediatric cardiology,pediatric anesthesia and neonatology,so as to fully inform pregnant women and their families of the possible risks of the fetus in the perinatal period and after birth and the corresponding treatment methods.All pregnant women and children meet the inclusion and exclusion criteria.Prenatal screening data of pregnant women,clinical related data such as symptoms and signs,laboratory tests,and examinations before and after birth and surgery of the children,as well as follow-up data in the later stage are collected.Randomly collect relevant data of children diagnosed with D-TGA,TAPVC,and Co A in our hospital during the same period.Divide the collected data into an integrated management group and a postpartum diagnosis group based on whether they accept integrated management during the perinatal period.Conduct statistical analysis to explore its effectiveness and provide guidance for clinical work practice.Results:A total of 173 subjects with prenatal diagnosis of D-TGA,TAPVC,Co A and receiving the treatment of integrated perinatal management mode were included in this study.Among them,19 of 37 D-TGA fetuses were followed up during pregnancy,and the average age of induced labor was(26.3±3.5)weeks.18 cases were followed up to full term live delivery.Among the 64 TAPVC fetuses during pregnancy follow-up,37 selected induced labor,the average age of induced labor was(25.8±3.5)weeks,and 27 cases were followed up to full term live delivery.Of the 72 Co A fetuses,25 were induced during pregnancy.The average age of induced labor was(27.2±2.3)weeks.47 cases were followed up to full term live delivery.Among the causes of induced labor,social factors accounted for the first place(73%),followed by maternal factors(16%),and fetal factors accounted for the least(11%).A total of 54 children with perinatal integrated management needed neonatal intervention,including 17 cases(31.5%)of D-TGA,23 cases(42.6%)of TAPVC and 14cases(25.9%)of Co A.A total of 116 cases of postpartum diagnosed children needed neonatal intervention,including 21 cases(18.1%)of D-TGA,42 cases(36.2%)of TAPVC and 53 cases(45.7%)of Co A.There were significant differences in disease distribution between the two groups(P < 0.05).The proportion of D-TGA in somatic management group was significantly higher than that in postpartum diagnosis group(31.5% vs.18.1%,P < 0.05),and the proportion of Co A was significantly lower than that in postpartum diagnosis group(25.9% vs.45.7%,P < 0.05).The time of admission and surgical intervention in the perinatal integrated management group was earlier than that in the postpartum diagnosis group(1.0 vs.11.1±4.3 days,P < 0.05),and the surgical weight was smaller than that in the postpartum diagnosis group(3.7±0.2 vs.3.9±0.4 kg,P <0.05).The rate of emergency operation in the postpartum diagnosis group was higher than that in the integrated group(25.0% vs.9.3%,P < 0.05).The length of stay in the ICU in the integrated group was longer than that in the postpartum diagnosis group(15.0±4.9 vs.9.3±4.5 days,P < 0.05).The total hospital stay in the integrated group was longer than that in the postpartum diagnosis group(24.7±7.2 vs.16.9±5.9 days,P < 0.05).The mortality rate in the integrated group was significantly lower than that in the postpartum diagnosis group(1.9% vs.11.2%,P < 0.05).Conclusion:Perinatal integrated management can provide guidance for pregnant women and their families diagnosed with prenatal D-TGA,TAPVC and Co A,and reduce the rate of nonmedical induced labor.Perinatal integrated management of D-TGA,TAPVC and Co A can significantly shorten the waiting time for postnatal diagnosis and admission,reduce the occurrence of early complications,timely surgical intervention,and reduce the risk of early death,but the duration of children’s cardiac intensive care unit and hospital stay is significantly extended.Fetal diagnosis of D-TGA,TAPVC,Co A and perinatal integrated management mode is the best choice,intrauterine transport is an effective way to improve the preoperative status of D-TGA,TAPVC,Co A newborn and reduce the risk of death. |
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