Concordance Between Obstetric Anatomic Ultrasound and Fetal Echocardiography in Detecting Congenital Heart Disease in High-risk Pregnancies.
Concordance Between Obstetric Anatomic Ultrasound and Fetal Echocardiography in Detecting Congenital Heart Disease in High-risk Pregnancies.
复制标题
产科解剖超声与胎儿超声心动图检测高危妊娠先天性心脏病的一致性。
DOI：
10.1002/jum.15592
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Boyle,Annelee
中科院分区：
文献类型：
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作者：
Krishnan,Rahul;Deal,Laura;Chisholm,Christian;Cortez,Briana;Boyle,Annelee
目的评价妊娠中期解剖超声与胎儿超声在诊断符合美国心脏协会标准的轻度和危重先天性心脏病中的一致性。方法我们根据美国心脏协会的建议，对2012年至2018年在我所进行中期胎儿解剖超声检查(18-26 周)和胎儿超声心动图检查的妊娠进行了一项回顾性队列研究。解剖超声研究由母婴医学专家解释，胎儿超声研究由儿科心脏病专家解释。我们的主要结果是没有通过解剖超声检测到但通过胎儿超声心动图检测到的危重先天性心脏病(CCHD)病例的比例。次要结果是解剖超声遗漏的先天性心脏病病例总数的比例，但胎儿超声心动图发现的比例。当获得并可用时，对所有妊娠的新生儿医疗记录进行审查。结果，总体上，722项研究符合纳入标准。解剖超声与胎儿超声心动图诊断心脏异常的符合率为96.1%(κ=0.803；P<； .001)。未经解剖超声确诊的最常见的诊断是室间隔缺陷，占漏诊的12例先天性心脏病中的9例(75%)。在解剖超声检查心脏检查结果正常的664项研究中，胎儿超声心动图没有发现额外的CCHD病例。结论根据美国心脏协会目前的筛查指南，自动胎儿超声心动图在发现先天性心脏缺陷方面的益处有限，需要在出生后立即进行干预。应该探索在高危妊娠中更有选择地使用自动胎儿超声心动图。
ObjectivesTo evaluate the concordance between second‐trimester anatomic ultrasound and fetal echocardiography in detecting minor and critical congenital heart disease in pregnancies meeting American Heart Association criteria.MethodsWe conducted a retrospective cohort study of pregnancies in which a second‐trimester fetal anatomic ultrasound examination (18–26 weeks) and fetal echocardiography were performed between 2012 and 2018 at our institution based on American Heart Association recommendations. Anatomic ultrasound studies were interpreted by maternal‐fetal medicine specialists and fetal echocardiographic studies by pediatric cardiologists. Our primary outcome was the proportion of critical congenital heart disease (CCHD) cases not detected by anatomic ultrasound but detected by fetal echocardiography. The secondary outcome was the proportion of total congenital heart disease cases missed by anatomic ultrasound but detected by fetal echocardiography. Neonatal medical records were reviewed for all pregnancies when obtained and available.ResultsOverall, 722 studies met inclusion criteria. Anatomic ultrasound and fetal echocardiography were in agreement in detecting cardiac abnormalities in 681(96.1%) studies (κ = 0.803;P< .001). The most common diagnosis not identified by anatomic ultrasound was a ventricular septal defect, accounting for 9 of 12 (75%) missed congenital heart defects. Of 664 studies with normal cardiac findings on the anatomic ultrasound examinations, no additional instances of CCHD were detected by fetal echocardiography. No unanticipated instances of CCHD were diagnosed postnatally.ConclusionsWith current American Heart Association screening guidelines, automatic fetal echocardiography in the setting of normal detailed anatomic ultrasound findings provided limited benefit in detecting congenital heart defects that would warrant immediate postnatal interventions. More selective use of automatic fetal echocardiography in at‐risk pregnancies should be explored.