| ObjectivePrenatal diagnosis of congenital heart disease is always the important topic of maternal and fetus medicine.It is proved that fetal echocardiography is the main image technology to detect congenital heart disease in utero, nevertheless,it consumes time,demands high specification for ultrasonographers,so it is hard to put it into routine examination.Hence scholars propose fetal heart scan,which only chooses some heart basic views, then compares the heart structure with itself,and it needs no measurement, operates easily,and saves a lot of examination time,but can detect suspicious case,and soon it has become the utility method,but in our country there is no standard scan views at present.We investigated the clinical significance of《Guidelines for performing fetal cardiac scan》,issued by the International Society of Ultrasound in Obstetrics & Gynecology in 2006.Method5000 single fetuses aged above 18 weeks in maternal-fetal medical center of Nanjing Gulou Hospital for systematical structural screening were included in this study and scanned on《Guidelines for performing fetal cardiac scan》from August 2006 to July 2007.During the screening,the four-chamber 'basic' view and outflow tracts& three-vessel 'extended basic' views examination were added,and questionnaires of high risk for congenital heart disease were conducted simultaneously.Further in case suspicious heart abnormality was found,fetal echocardiography was performed.If diagnosed, amniotic fluid or umbilical veins were used to determine the karyotype.Autopsy was performed when the pregnancy was terminated.And survivors were followed up by echocardiography from 2 months to 6 months after birth.Results(1)73 cases(1.46%)were found with congenital heart diseases,50 cases were diagnosed in utero,in which the sensitivity was 68.49%and the specificity was 99.98%.(2)Among them,1.02%were from the high risk group(26/2558),and 1.92%(47/2442)were from the low risk group.The latter was higher than the former,and there was statistically significant difference (P＜0.05).(3)The four-chamber 'basic' views were obtained successfully in 97.64% eventually,in which left ventricular and right ventricular outflow tracts& three-vessel 'extended basic' views were obtained in 87.69%,82.51%and 96.31%,respectively. 4)There were 2750 fetuses in the second trimester of pregnancy,and there was no statistically significant difference between 18—22weeks and 23 -27weeks(P＞0.05).In the third trimester of pregnancy there were 2250 fetuses,and there was statistically significant difference between 28—32weeks and 33—40weeks(P＜0.05).In all,there was statistically significant difference between the second trimester and the third trimester of pregnancy(P＜0.05).Conclusion(1)The《Guidelines for performing fetal cardiac scan》is practical,easy to abide by and spread if conditioned.(2)It seems no real high risk factors for congenital heart diseases,so it is necessary for every fetus to carry out heart screening.(3)During the fetal heart scan,all the standard views were obtained over 70%,especially in the second trimester.(4)With the good quality control,combining the four-chamber 'basic' view with outflow tracts& three-vessel 'extended basic' views can help to identify more than 60%fetal congenital heart diseases.
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