Comparative Analysis The Diagnostic Value Of Ultrasonography In Fetal Cardiovascular Abnormality Of Different Gestational Age

Objective: This study was designed to use two-dimensional and color Doppler ultrasonography,with multi-views continuous scan to explore the display rate of fetal cardio standard views in the different stages of pregnancy,and further explore the value of of diagnosis in fetal congenital heart malformations by fetal echocardiography,Compared with detection rate of fetal heart structure abnormalities in different stages,to find the best gestational stage for fetal heart ultrasound examination.While,to the diagnostic value of fetal cardiac structural abnormalities by compare different combination views,to find the best combination views.To the above in improving the accuracy of the diagnosis of fetal congenital heart malformations,so that early detection,early diagnosis,can improve the effective information for clinical,ultrasonography play an important role in the maternal-fetal medicine.Methods: 16204 cases of pregnant women,from January 2015 to December 2016 in the Yijishan Hospital Affiliated to Wannan Medical College were selected,according to their gestational age,respectively at 18 to 22 weeks group,23 to 27 weeks group and 28 to 32 weeks group,each group in accordance with the International Society of Obstetrics and Gynecology(ISUOG)guidelines were screened for fetal system screening,screen the extracardiac malformations,then according to the American fetal echocardiography guidelines for fetal heart standard view(four-chamber view,left ventricular outflow view,right ventricular outflow tract view and three-vessel-trachea view)line of fetalechocardiography,when it is necessary,to expand the aortic arch view,arterial duct arch view and superior and inferior vena cava view in order to make clear diagnosis.According to the views above we divide the following three groups:(1)Four-chamber view(A);(2)Four-chamber view + three-vessel-trachea view(B);(3)Four-chamber view + three-vessel-trachea view+left and right ventricular outflow tract view(C).Observe the display case oft each view,detect cardiac structural abnormalities,compare the display rate of different section,and the sensitivity and specificity of the diagnosis with fetal abnormalities,compare the views display rate of different gestational stages and fetal cardiac anomaly detection rate were analyzed.About fetal with cardiac structure abnormal,two weeks after the birth for neonatal color doppler echocardiography,fetus anatomy was performed after obtain the consent to the patients who were terminated of pregnacy.Result:1.16204 in the fetus,the prenatal ultrasound screening out of 165 cases of congenital heart disease,the incidence of 10.2 ‰.Ultrasonography has important value for prenatal diagnosis in fetal cardiovascular abnormality.2.16204 in the fetus,3763 cases in 2015,12441 cases in 2016,screening out the abnormal cases 25 cases,140 cases respectively,incidence of 6.6‰,11‰,respectively.3.16204 cases of fetus,the highest overall display rate of the standard view is four-chamber view,followed by three-vessel-trachea view,the left ventricular outflow section,right ventricular outflow section,the display rate was 99.21%,98.57%,99.21%and 98.57% respectively.,development views of the aortic arch/artery duct arch and superior and inferior vena cava view had a higher rate,96.77%,96.33% respectively.4.Compare the display rate of standard view of the three different gestational stages,with 23 to 27 weeks gestation showed the highest rate,compare the display rate of 23 to27 weeks and 18 to 22 weeks with 28 to32 weeks,found that their differences were statistically significant,but compare 18 to 22 weeks with 23 to 27 weeks,the difference ofthe display rate with no significant difference,had obvious statistical significance barely.5.In this study,the sensitivity of the program A was 84.24% and the specificity was99.90%,the sensitivity of the program B was 89.69% and the specificity was 99.86%,the sensitivity of the program C was 93.93% and the specificity was 99.83%.All the three programs were consistent with the clinical follow-up results,kappa values?were0.868,0.882,0.892 respectively,compare the consistentent with the clinical results three programs were satisfactory,which program C and clinical follow-up results have the best consistency.Conclusion:1.This study found that the detection rate of fetal congenital heart disease(10.2 ‰)was also high,,Ultrasonography has important value for prenatal diagnosis with fetal cardiac malformation2.This research suggests that at 18 to 22 weeks and 23-27 weeks gestation stage is the most appropriate screening examination time for fetal cardiac malformation,especially in 23-27 weeks gestation,for the best.But in the late pregnancy is still necessary to screening for fetal cardiac malformation with the prenatal screening guidelines,that can reduce misdiagnosis to a greater extent,and also is of great significance for the detection of fetal congenital heart disease.3.In this study,four chamber view,four-chamber view and three-vessel-trachea view,four-chamber view and three-vessel-trachea view combined with ventricular outflow tract view can as a clinical routine for fetal cardiac screening.Once questionably,with the development views(aortic arch / arterial duct arch view and superior and inferior vena cava view)to supplement the examination will help the diagnosis of congenital heart disease.At the same time,combined with color doppler blood flow and the advantage of frequency spectrum,a comprehensive dynamic observation,is beneficial to further clarify the diagnosis of fetal cardiac structural abnormalities,that can contribute to the diagnosis of congenital heart disease.