| Objective:To detect fetal heart structure and blood flow by color Doppler ultrasound in second-trimester, and compare differences between normal and abnormal fetuses, screening for fetal congenital heart diseases(FCHD) and investigate the effect of risk factors on the onset of fetal congenital heart diseases.Methods:In this clinical research, 786 cases who came to the clinic and hospitalization in the obstetrical department were enrolled between January 2013 and June 2014. The age range was 20-40 years old, and the average age was 28.1±3.2 years old. Gestational weeks range was 20-26 weeks. The fetal congenital heart diseases(FCHD) were diagnosed by using color Doppler ultrasound, and determined by the ultrasound of the newborn or the result of autopsy. Fetal heart checks section includes fourchamber view, left ventricular outflow tract view, right ventricular outflow tract section, three vessels view, aortic arch section, arterial ductus section and long axis of vena cava section. The main fetal cardiac index includes: the location, size and morphology of fetal heart; vertical and horizontal diameter ratio, atrium and ventricle and the aorta and pulmonary artery; the open and close of every valve; the width of patent foramen ovale. Record the measured value corresponding the different gestation age. Screen the fetal malformation rate and discuss the ideal display section. Ultrasound determination was performed between one and two weeks after birth. Review for prenatal diagnosis of congenital heart disease confirmed, and investigate whether there is a case in diagnosis of congenital heart disease. Check the newborn recommended the hypothesis or left side. Observe the sections as follows: a. sternum beside the long axis plane; b. short shaft section of the aortic root; c. near the sternum four-chamber view; d. apex cordis five cavity ranks of surface. Observing newborn cardiac index mainly includes: the heart cavity size and the relationship between the aorta and the left ventricle; observable position relations between the aorta and pulmonary artery and pulmonary valve stenosis;continuity of the atrio and ventricular septal; arterial catheter closed condition, etc. For cases of pregnancy induced labor, the autopsy results compare to fetal ultrasound examination results, in order to make clear diagnosis. Through follow-up clinical data, record whether pregnant women with fetal congenital heart disease risk factors. These high risk factors included: congenital heart disease family history, history of abortion, adverse pregnancy history, the natural history of congenital heart disease in pregnancy fetal; early pregnancy fever, rash, infection, teratogenic exposure history, medication history, contact with X-ray; history of diabetes, ageing pregnant women, connective tissue disease, chromosomal abnormalities, arrhythmia, single umbilical artery, etc.Results:1. The results showed that normal cardiac apex is toward the left and the right heart by color Doppler ultrasound. Left atrium diameter in gestational age at 20 weeks was 6.7±1.5 mm, while 10.7±2.1 mm at 26 weeks. Right atrium diameter in gestational age at 20 weeks was 7.5±1.7 mm, while 11.7±1.9 mm at 26 weeks. Left ventricle diameter in gestational age at 20 weeks was 6.2±1.4 mm, while 10.2±2.3 mm at 26 weeks. Right ventricle diameter in gestational age at 20 weeks was 7.2±1.5 mm, while 11.3±1.7 mm at 26 weeks.2. 15 cases of fetal congenital heart disease were screened from 786 cases. The relevance rate was 1.91%. The highest incidence rate in fetal congenital heart disease was ventricular septal defect(VSD), and there were 7 cases. The second incidence rate was foramen ovale(diameter>6mm), and there were 3 cases. Others as follows: 2 cases of tetralogy of fallot(TOF), 1 case of complete endocardial cushion defect, 1 case of single atrium and 1 case of hypo plastic left heart syndrome(HLHS). 10 cases of 15 cases diagnosed for congenital heart disease normal labored. The other 5 cases were postmortem examination after induced labored.3. Different heart cavity size between congenital heart disease fetal and normal fetal. The right ventricle diameter in VSD fetus was smaller than that of normal fetal.. The right ventricle diameter in TOF fetus was slightly smaller than that of normal fetal. The left atrium and left ventricle in HLHS fetus was significantly smaller than that of normal fetal.4. Among 10 neonates with FCHD, the ultrasound results in 7 cases of VSD were consistent between before and after birth, 3 cases of fetal with foramen ovale diameter>6mm, 2 cases were diagnosed with patent foramen ovale(PFO) and 1 case was diagnosed with atrial septal defect(ASD). The fetal autopsy results in 5 induction of FCHD were consistent with prenatal echocardiographic diagnosis.5. 4 cases of neonatal congenital heart disease was not detected in the prenatal period, the missed diagnosis rate was 0.51%, including 3 cases of VSD and 1 case of PFO.6. In 19 cases of fetal with congenital heart disease, 16 mothers had high risk factors, the incidence is about 84%. In 767 of normal fetuses, 254 mothers had risk factors, the incidence is about 33%. The difference was statistically significant(P<0.001).7. Among risk factors including: Medication history at the early stages of pregnancy, ageing pregnant women, family history of heart disease, adverse pregnancy, abortion history, teratogenic exposure history and early pregnancy fever. The medicine history at the early pregnancy, elderly parturient women and family history of heart diseases had the significantly difference between the fetal congenital heart disease mother and normal fetus mother(P<0.05 or P<0.01). Multivariate Logistic regression analysis showed that medicine history at the early pregnancy and family history of heart disease are independent risk factors for FCHD.Conclusions:1. The time of detecting fetal congenital heart diseases by fetal echocardiography maybe at 20~26 pregnancy week. The 20-24 weeks of pregnancy maybe more available.2. VSD has a the highest incidence rate in FCHD.3. The heart chamber size is significant differences with FCHD fetus and normal fetal in the same pregnancy week. These my be due to the changes of hemodynamic, the amount of specific cavity filling and chamber pressure.4. The high-risk factors in pregnant women have significant effects on the occurrence of fetal congenital heart disease, the medication history in early period pregnancy and familial history of heart disease are independent risk factors for FCHD.5. Two-dimensional plane of image quality and color Doppler sensitivity are closely related to the detection of FCHD. View from different angles, much like scanning, can improve the diagnosis of FCHD, reduce misdiagnosis. |
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