Prenatal diagnosis of congenital fetal heart abnormalities in twins by Yagel's heart examination method
- Author:
- No author available
- Journal Title:
- CHINESE JOURNAL OF OBSTETRICS AND GYNECOLOGY
- Issue:
- 2
- DOI:
- 10.3760/j.issn:0529-567X.2007.02.004
- Key Word:
- 双胎疾病;心脏缺损,先天性;超声检查,产前
Abstract： 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.
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