| Objective: To research the clinical values of three-step prenatal ultrasound fast screening for fetal congenital heart disease.Materials and methods: From January 2014 to December 2015,a total of 75 pregnant women’s prenatal and postnatal data were collected,who had accepted the two inspections of prenatal ultrasound three-step and fetal echocardiography,age 19-47 years old,average 28.41±5.47 years old,16-28 gestational weeks,average 23.27±1.87 weeks.Methods of prenatal ultrasound three-step:first is fetal positioning to determine heart position;the second observe the four standard sections of fetal heart through two-dimensional ultrasound tissue harmonic imaging,including four chamber view,left ventricular outflow tract,right ventricular outflow tract,and three-vessel view or three vessels and trachea view;the third observe the blood flow imaging of color Doppler and power Doppler for fetal heart screening.Fetal echocardiography were used as the reference standard,calculate the sensitivity,specificity and accuracy of prenatal ultrasound three-step screening for fetal congenital heart disease,and the consistency of prenatal ultrasound three-step and fetal echocardiography.Results:(1)General situation of fetal CHD: 54 cases normal pregnant women,21 cases pregnant women accompany with high-risk factors,which the 21 cases were: 7 cases aged pregnant women(>35 years old),2 pregnant women with a history of adverse pregnancy induced labor,2 pregnant women suffering from hypothyroidism,1 case had a history of missed abortion,1 case long-term exposure to toxic substances,1 case had virul cold early in pregnancy,3 cases with structural abnormalities of heart outside,2 cases with single umbilical artery,1 case with high-risk in Down’s syndrome screening,1 case with older age,twin-pregnancy and IVF-EF factors meanwhile.17 cases with fetal CHD in 21 cases with high-risk factors,account for 81%(17/21);43 cases with fetal CHD in 54 cases normal pregnant women,account for 80%(43/54),there was no statistically significant difference between them(P>0.05).(2)Diagnostic efficiency of prenatal ultrasound three-step screening for fetal CHD: 60 cases fetal CHD were detected by echocardiography among 75 pregnant women,15 cases fetal cardiac structure is normol;Prenatal ultrasound three-step checked out 57 cases fetal CHD from this 75 pregnant women,missed diagnosis 3 cases,misdiagnosis 3 cases.Prenatal ultrasound three-step and fetal echocardiography have good consistency,the Kappa value is 0.75,P<0.001.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of prenatal ultrasound three-step screening for fetal congenital heart disease were 95%(57/60),80%(12/15),92%(69/75),95%(57/60),and 80%(12/15),respectively.(3)Etiological diagnosis of prenatal ultrasound three-step for fetal CHD:57 cases CHD were detected by prenatal ultrasound three-step,45 of them was was consistent with echocardiography,including tetralogy of Fallot in 13 cases,atrioventricular septal defects in 9 cases,hypoplastic left or right heart syndrome in 5 cases,ventricular septal defect in 5 cases,aortic stenosis in 4 cases,transposition of the great arteries in 3 cases,persistent truncus arteriosus in 1 case,double outlet of right ventricle in 1 case,pulmonary stenosis in 1 case,anomalous pulmonary venous drainage in 1 case,cardiac tumor in 1 case,mirror imaging dextrocardia in 1 case,diagnostic coincidence rate was 78.94%(45/57).12 cases fetal CHD etiological diagnosis of prenatal ultrasound three-step was different from echocardiography,and the diagnosis of the two inspections were as follows respectively: double outlet of right ventricle /tetralogy of Fallot in 2 cases,tetralogy of Fallot/ double outlet of right ventricle in 1 case,tetralogy of Fallot/ persistent truncus arteriosus in 1 case,ventricular septal defect/tetralogy of Fallot in 1 case,double outlet of right ventricle with mitral atresia/ transposition of the great arteries with single ventriule,single atrium and pulmonary stenosis in 1 case,aortic stenosis/interruption of aortic arch in 1 case,right heart dysplasia/total anomalous pulmonary venous drainage in 1 case,ventricular septal defect/ atrioventricular septal defects in 1 case,mitral stenosis associated with aortic atresia/endocardial fibroelastosis in 1 case,atrial septal defect/persistent left superior vena cava in 1 case,tricuspid anomaly/ pulmonary stenosis in 1 case.(4)Ending and outcome:60 cases of fetal CHD induced labor in 50 cases,9 cases of pregnancy to postpartum,and inevitable abortion in 1 case.Conclusions: Prenatal ultrasound three-step fast screening for fetal CHD have higher sensitivity and accuracy,and easy operating,so it can be used as a method of screening for fetal CHD of pregnant women. |
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