The Value Of Ultrasound Soft Markers In Early Pregnancy For Fetal Congenital Heart Disease Screening

ObjectiveThe purpose of this study was to investigate the application value of fetal neck transparent thickness?NT?,abnormality of venous catheter flow a wave?DVa wave?,mild tricuspid regurgitation?TR?,and other soft ultrasound indicators in the fetus congenital heart disease?CHD?screening during the early pregnancy.Method1.Subjects:A retrospective analysis of 5,000 pregnant women who performed the examination of fetal neck transparent layers at the ultrasound department of the Fujian Provincial Maternal and Child Health Hospital from January 2015 to June 2017.Those who had embryonic development arrest,miscarriage,and loss of follow-up were excluded.4590 cases were in the final study.2.Observing indicators:?1?Ultrasonic soft markers:the thickness of the fetal neck in the early pregnancy?NT?,the a-wave of the venous catheter?DVa wave?,the existance of tricuspid regurgitation?TR?;?2?The fetal heart and other structural abnormalities found during early pregnancy and subsequent ultrasound examinations focusing on the congenital heart disease and its types;?3?tracking pregnancy outcomes?natural or induced labor?.3.Grouping and analysis contents:?1?According to the soft markers of early pregnancy,NT?2.5mm was defined as NT thickening.Based on NT thickeness,the subjects were divided into 4 groups:?2.5^&lt;3.0 mm?group A?,?3.0^&lt;3.5m?Group B?,?3.5^&lt;6.0 mm?C group?and?6.0 mm?D group?,with comparation of the rates of detection of CHD in each group;Based on the characteristics of DVa wave,DVa wave abnormal and DVa wave normal groups were identified;based on the presence mild cardiac TR,it was divided into TR positive group and TR negative group.The numbers of detection of CHD in the two groups were compared.?2?The fetus with CHD detected during the whole pregnancy was divided into the early pregnancy diagnosis group and the early pregnancy missed diagnosis group?middle pregnancy diagnosis group?.The status of the soft markers in those two groups was compared.?3?Based on the positive results of screening in the different three soft markers,it was divided into four groups:only one soft markers positive group,NT plus any soft markers positive group,DVa abnormality combined with TR positive group,and three soft markers positive groups,.The value of single or combination of those three soft markers in the sensitivity,specificity,positive predictive,and negative predictive value for CHD during early pregnancy screening was compared and identified.Result1.In 4590 cases,51 cases of CHD?11.1‰,51/4590?were diagnosed through ultrasound during early pregnancy,mid-late pregnancy and late ultrasound screening.27cases?52.9%,27/51?were diagnosed in the first trimester(11¹3⁺⁶ weeks);while 24cases?47.1%,24/51?were diagnosed in the middle trimester?14-24 weeks?.2.In the early pregnancy,there were 35 cases?68.6%,35/51?with any soft markers positive combined with CHD in the early pregnancy period.The detection rates of CHD in NT thickened groups A,B,C,and D were 1.2%,6.7%,11.6%,and 42.4%.As NT thickness increased,the detection rate of CHD increased?P<0.001?.By analyzing the NT value ROC curve,the screening value of CHD with NT?3.0 as the cutoff value was the largest.The incidence of CHD in the DVa wave abnormal group was higher than that was in the DVa wave normal group?19.4%vs 0.6%,P<0.001?;the incidence of CHD in the TR positive group was higher than that was in the TR negative group?10%vs 0.9%P<0.001?.3.Among the 27 cases of fetal soft markers positive combined with CHD in early pregnancy.Among the 24 cases of fetal CHD detected during the second trimester?premature missed group?,The NT thickness,NT?3.0mm ratio,DVa wave abnormality,and TR occurrence rate were all higher in early pregnancy CHD diagnosis group than those in the early pregnancy missed group?P<0.001?.4.When multiple soft markers were combined and screened,NT combined with any one or two soft indicators had the highest probability of having CHD.With a single soft markers screening,the sensitivity of NT thickness?3.0 mm was higher than that of DVa wave abnormalities and TR,and the sensitivity of DVa wave abnormalities were higher than TR.With three soft indicators combined for screening,one or more soft markers positive screening had higher sensitivity than that of single soft-markers screening.Conclusion1.The ultrasound soft markers in early pregnancy can help to screen the fetal CHD?especially when NT?3.0mm?,and the combined use of multiple soft markers can increase the predictive value of CHD;2.The negative ultrasound soft markers in the early pregnancy can not exclude the possibility of CHD in the fetus and requires further systematic ultrasound screening in the second trimester.