Clinical Study Of Ultrosonic Echocardiography Screening For Fetal Heart Disease In The Early Second Trimester

[Objective] Ultrosonic echocardiography is a reliable method for diagnosis of fetal heart disease. Fetal complex cardiac malformation with poor prognosis,is the main cause of death, some children even having operation treatment, the average life expectancy is also much lower than the normal population, early diagnosis of fetal heart disease has become the focus of the study of fetal cardiology. This study aims to apply composite echocardiography technology, including2D, duplex and color Doppler echocardiography using cardiac multiviews for observing fetal heart to determine the clinical value of screening for fetal congenital heart disease in the early second trimester.[Methods]2005pregnant women of high risk in2010January to2011December in Ji’nan City Maternal and child health care hospital were selected as cases of the study group. Pregnant women age from19to42years old, average (28.5±3.3),12+1to19+6gestational week, mean17±2weeks. The fetuses were performed echocardiographic examinations for two times, the first in12+1-19+6gestational week,the second in24to28gestational weeks.2018pregnant cases of low risk in2010January to2011December were randomly selected in Ji’nan City Maternal and child health care hospital as control group. Pregnant women ages from19to41years old, average (26.2±5.1)。Gestational weeks age from24to28weeks of gestation, mean26.3±6.2weeks. All fetuses have echocardiographic examination only1time except for those who had diagnosis of fetal congenital heart diseases requiring follow-up observation in next trimester. Severe cardiac malformations which was induced would have autopsy.Other fetuses with heart dieases will have postnatal echocardiographic examination and/or after operation.Philips IE33and Siemens Sequoia512color Doppler ultrasonography instrument were used in the examinations. Philips IE33convex array scan probe C5-1, with the frequency of1.0-5.0MHZ, was used in prenatal examinations. Philips IE33fan array scan probe S8-3of3.0-8.0MHZ and Siemens Sequoia512fan array scan probe7V3C of3.5-7.0MHZ were used in afterbirth examinations.Sample rate was compared.[Results] The study group consisted of2005patients of high risk who had prenatal echocardiographic examination screening for fetal heart diease pregnant,1989patients enrolled in the study.19cases were diagnosed as congenital structural heart disease,12cases of those were elective induced,7cases of abnormal structure had another echocardiographic examination in24～28week.Among the previous cases of abnormal structure1case of ventricular septal defect was diagnosed as tetralogy of Fallot, which was a missed diagnosis.17cases of congenital structural heart disease were diagnosed.So the research group had36cases of congenital structural heart disease in all, the incidence rate of fetal congenital heart disease is18.1‰. The control group consisted of2018patients of low risk who had prenatal echocardiographic examination screening for fetal heart diease.2000patients enrolled in the study. In24to28week13cases were diagnosed as congenital structural heart disease,8cases of those were elective induced.The incidence rate of fetal congenital heart disease of the control group of pregnant women of low-risk was6.5‰. Compare the incidences of the experimental group and control group of fetuses with structural heart disease,, the difference has statistical significance.Finally30cases of49cases of congenital heart disease were induced,13cases of those were performed autopsies, others who continued to be pregnant woud have echocardiographic examination in3months after birth and/or operation confirmed. [Conclusion]1、The incidence rate of fetal congenital heart disease of high risk pregnant women group is higher than that of low risk pregnant group.So high-risk pregnant women should be strengthened to have echocardiographic examination in the early second trimester,12+1～19+6week to diagnose early and timely;2、 Echocardiographic examination has clinical value of screening for fetal congenital heart disease in the early second trimester;3、In the early second trimester,12+1-19+6week, congenital heart diseases such as small ventricular septal defect, tetralogy of Fallot, valvular heart disease, cardiac tumors, double outlet right ventricle, transposition of the great arteries, pulmonary venous drainage, arterial stenosis, can be misdiagnosed and missed diagnosis. In the early second trimester cases with negative results should repeate chocardiographic examination in24-28week, so as to avoid missed diagnosis and misdiagnosis;4、Prenatal chocardiographic examination screening for fetal congenital heart malformation, is a non-invasive examination, can make the most complex cardiac malformations in fetal period be diagnosed early, which has certain guidance for clinical treatment and has important significance in effects of prenatal and postnatal care.