How To Improve The Prenatal Detection Rate Of Fetal Congenital Heart Disease By Ultrasonography

Objective:To investigate a way to improve the prenatal detection rate of fetal congenital heart disease (CHD) by ultrasonography.Methods:A retrospective study of 679 CHDs which were detected through the systematical structural screening from 2008 to 2011 in matemal-fetal medical center of Affiliated Drum Tower Hospital of Nanjing University Medical School has been taken.Six ultrasound doctors were involved in the CHD screening and divided into two levels by their work experience with three members in each.All cardiac views including four-chamber view,left and right ventricular outflow tracts & three-vessel views were assessed by "Guidelines for cardiac screening examination of the fetus" published in 2006 as quality control.All cases were confirmed by postnatal echocardiogram or autopsy.The variations of detection rate in different cardiac views between different levels of examiners were compared and analyzed. At the same time,the impact of ultrasonic quality control such as the four-chamber view was added with detailed criteria on the detection rate of CHDs and the complementary role of the third trimester scanning in improving the detection rate of CHDs were also observed.Results:Among 48247 fetals,679 CHDs were detected with satisfactory ultrasound images.1、The examiners with more than 3 years work experience showed significantly better detecting rates of CHDs in four-chamber view,left and right ventricular outflow tracts & three-vessel views than those with less than 3 years work experience and the detection rate were 87% vs 75%,79% vs 69%,74% vs 63% and 83% vs 71% respectively;2、Four-chamber view was evaluated according to the detailed criteria since 2010,and the detection rate of examiners in different levels both raised (from 70% to 81%,83%to 89% respectively),especially less than 3 years experienced examiners had a significant advance (χ2=6.35, P> 0.05);3、Among 679 CHDs,147 consecutive CHD fetuses were scanned at both second and third trimesters.138(93.9%) cases have consistent results,while 4 cases were only detected at the third trimester and 5 cases which were detected at the second trimester showed new changes later.Conclusions:1、Intensifying the training program,standardizing the quality control of cardiac views,and adding detailed criteria to the four-chamber view were benefit prenatal diagnosis of fetal congenital heart diseases;2、Repeat screening when necessary at the third trimester provided added value while the economic benefit should be discussed further.