摘要
目的探讨胎儿心脏超声 Yagel 法扫描对双胎妊娠胎儿先天性心脏病的产前诊断价值。方法 1103例双胎妊娠孕妇中,有胎儿先天性心脏病的高危病史孕妇127例(高危双胎组),正常双胎妊娠孕妇976例(低危双胎组)。应用超声 Yagel 法对两组双胎妊娠胎儿进行心脏5个心脏横切面(胎儿腹部胃泡平面、四腔心平面、五腔心平面、三血管气管平面和动脉弓平面)快速扫描,并对诊断为先天性心脏病而引产的胎儿进行尸体解剖,以核对产前超声 Yagel 法诊断的正确性,同时进行胎儿染色体分析;对未引产或产前诊断未发现明显异常的胎儿进行临床随访,胎儿出生后进行新生儿或婴儿的心脏超声检查,判定产前超声 Yagel 法诊断的正确性。结果 (1)1103例双胎妊娠中,有12例产前发现有先天性心脏病,检出率为1.09%,其中4例(33.3%,4/12)来自高危双胎组,8例(66.7%,8/12)来自低危双胎组。(2)2例双胎为两个胎儿同时患同一种先天性心脏病,其中1例双胎胎儿均为法洛四联症(TOF),另1例双胎两个胎儿均为心脏横纹肌瘤;1例双胎为两个胎儿患不同类型异常,一胎儿为 TOF,另一胎儿心脏正常,但十二指肠闭锁。上述3例患者均选择终止妊娠放弃胎儿,尸体解剖结果与产前超声诊断相同。9例双胎仅一胎儿受累为先天性心脏病,另一胎儿正常,均足月分娩或自然早产,其中7例在行新生儿心脏检查时得出的诊断与产前相同。(3)12例中,2例有先天性心脏病的双胎被发现染色体异常。(4)1091例双胎妊娠孕妇产前超声检查未发现胎儿心脏异常,但其中1例双胎中的1个胎儿出生后被诊断为室间隔缺损(VSD),染色体异常(为21三体),另1个胎儿正常。另1例双胎中的1个胎儿出生后被诊断为动脉导管未闭,另1个胎儿正常。(5)应用超声 Yagel 法产前诊断双胎先天性心脏病的敏感度为82.4%,特异度为100%。结论心脏超声Yagel 法是筛查和诊断双胎妊娠中胎儿先天性心脏病的简单、有效和可靠方法,值得在临床产前诊断中推广应用。
Objective To investigate the value and chnical significance of congenital heart diseases （CHD） detection in twins. Methods A total of 1103 twins were included in this study （127 twins were at high risk for CHD）. The fetal hearts were scanned by ultrasound using Yagel＇s heart examination method. Autopsies were done when the pregnancy was terminated. And blood samples from fetal hearts or umbilical veins were used to evaluate fetal chromosomes. A close follow-up was conducted for normal heart cases and another heart examination was done within three months after birth. Results （ 1 ） 12 twins （ 1.09%, 12/ 1103） had CHD. Among them, 4 cases were from the high risk for CHD group （33. 3%, 4/12）, and 8 cases （66. 7%, 8/12） were from the low risk pregnancy group. （2） Two twins suffered from the same CHD （one pair were both TOF, and the other pair were both rhabdomyoma）. One pair of twins had different abnormalities （ one baby was TOF, and the other was duodenal atresia with a normal heart）. All three pairs of twins chose termination and autopsies were conducted. Unanimous conclusions between prenatal ultrasound and autopsy were obtained. Nine twins were CHD in one baby and a normal heart in the other baby. Seven of them had the same conclusion after delivery. （3） Two twins with CHD were found with fetal abnormal chromosome. （4） 1091 cases were not found having any abnormality, however, one fetus from one twin pair was diagnosed with ventricular septal defect （VSD） with abnormal chromosome after birth, and one fetus from another twin pair had patency of ductus arteriosus after birth. （5） The sensitivity of Yagel＇s heart examination was 82.4% and specificity was 100% in twins. Conclusion Yagel＇s heart examination is an effective and time-saving method to scan fetal hearts in twins.
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2007年第2期83-86,共4页
Chinese Journal of Obstetrics and Gynecology
基金
2004年度人事部留学回国人员科技活动项目
2005年辽宁省科学技术计划项目(200522500801)
关键词
双胎疾病
心脏缺损
先天性
超声检查
产前
Diseases in twins
Heart defects, congenital
Ultrasonography, prenatal
