Trends and outcomes after prenatal diagnosis of congenital cardiac malformations by fetal echocardiography in a well defined birth population, Atlanta, Georgia, 1990-1994
Trends and outcomes after prenatal diagnosis of congenital cardiac malformations by fetal echocardiography in a well defined birth population, Atlanta, Georgia, 1990-1994
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DOI：
10.1016/s0735-1097(96)00381-6
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发表时间：
1996-12-01
影响因子：
24
通讯作者：
Fyfe, D
中科院分区：
文献类型：
--
作者：
Montana, E;Khoury, MJ;Fyfe, D
目标。在这项研究中，我们使用了一种基于人群的方法来评估胎儿超声心动图对几乎完全确定心脏缺陷的出生人群的影响。虽然胎儿超声心动图越来越多地用于先天性心脏畸形的产前诊断，但其对心脏缺陷的诊断和监测的影响尚未在确定的人群中描述。1990年1月至1994年12月期间，所有被诊断患有心脏缺陷的死产和活产婴儿，其母亲居住在亚特兰大市地区，都是通过建立的出生缺陷监测系统确定的。所有由儿科心脏病专家产前诊断为心脏缺陷的胎儿都是从临床记录中确定的。描述心脏缺陷的范围、诊断趋势和不良胎儿结局。我们确定了1,589名患有先天性心脏畸形的婴儿，活产患病率为8.1/1000(95%可信区间[CI]7.8至8.6)。总体而言，97例(6.1%)心脏畸形是产前诊断的。产前诊断为心脏缺陷的比例从1990年的2.6%上升到1994年的12.7%，几乎增加了五倍。研究期间产前诊断的心脏缺陷的比例因缺陷类型而异，从房间隔缺陷的低4.7%到左心发育不全综合征的高达28%。产前诊断的心脏畸形与婴儿死亡率(30.9%，95%可信区间2.4~5.4)和胎儿衰减率(17.5%，95%可信区间6.2~11.3)密切相关。这些数据表明，在亚特兰大大都市，胎儿超声心动图正越来越多地被用于先天性心脏畸形的产前诊断。很少有因为这样的诊断而终止妊娠的报道。然而，这项研究的能力有限(10%)，无法检测到先天性心脏病出生患病率的显著下降。此外，胎儿超声心动图产前诊断后，婴儿的存活率并未得到改善。(C)1996年，由美国心脏病学会
Objectives. In this study we used a population-based approach to assess the impact of fetal echocardiography on a well defined birth population with nearly complete ascertainment of cardiac defects.Background. Although fetal echocardiography is being used more frequently in the prenatal diagnosis of congenital cardiac malformations, its impact on the diagnosis and surveillance of cardiac defects has not been described in defined populations.Methods. All stillborn and live-born infants with diagnosed cardiac defects and whose mothers resided in the metropolitan Atlanta area from January 1990 through December 1994 were ascertained through an established birth defects surveillance system. All fetuses with cardiac defects diagnosed prenatally by a pediatric cardiologist were identified from clinical records. The spectrum of cardiac defects, diagnostic trends and adverse fetal outcomes were described.Results. We identified 1,589 infants with congenital cardiac malformations, for a live-birth prevalence rate of 8.1/1,000 (95% confidence interval [CI] 7.8 to 8.6). Overall, 97 (6.1%) of these cases of cardiac malformations were diagnosed prenatally. The proportion of cardiac defects diagnosed prenatally rose from 2.6% in 1990 to 12.7% in 1994, a nearly fivefold increase. The proportion of cardiac defects diagnosed prenatally during the study varied by the type of defect, from a low of 4.7% for atrial septal defects to a high of 28% for hypoplastic left heart syndrome. Prenatally diagnosed cardiac malformations were associated,vith a high incidence of infant mortality (30.9%, 95% CI 2.4 to 5.4) and fetal wastage (17.5%, 95% CI 6.2 to 11.3).Conclusions. These data show that fetal echocardiography is being used increasingly in the prenatal diagnosis of congenital cardiac malformations in metropolitan Atlanta. Few pregnancy terminations were reported as a result of such diagnoses. However, the study had limited power (10%) to detect a meaningful decrease in birth prevalence rates for congenital heart disease. In addition, survival of infants was not improved after prenatal diagnosis with fetal echocardiography. (C) 1996 by the American College of Cardiology