孕中晚期胎儿超声心动图转诊因素分析
Analysis of referral factors for fetal echocardiography in second and third trimesters

目的 分析胎儿超声心动图转诊指征与产前检出胎儿心脏异常之间的关系。方法 回顾性分析1 032例转诊行胎儿超声心动图检查的孕妇。所有转诊病例分为单指征组和多指征组，分析转诊指征的分布情况，统计产前胎儿心脏异常的检出率，并评估转诊指征与产前心脏畸形检出之间的关系。结果 在单指征组中，885例转诊病例共检出172例（19.4%）胎儿心脏异常，通过logistic回归分析发现，孕中期胎儿畸形筛查发现可疑心脏切面与产前诊断胎儿心脏异常相关（OR=13.7，95%CI为9.40～20.00），孤立性心内强回声灶与产前胎儿心脏异常的检出率呈负相关（OR=0.24，95%CI为0.11～0.56）。在多指征组中，产前胎儿心脏异常检出率增加至272%（P=0.336），其中具有胎儿指征的病例，产前诊断胎儿心脏异常的风险明显升高。结论 孕中期胎儿畸形筛查超声检查中发现可疑心脏结构畸形作为单个转诊指征与产前胎儿心脏异常的检出相关，而心腔内的孤立性心内强回声灶不应继续作为进一步转诊胎儿超声心动图的指征。对于具有多个转诊胎儿超声心动图指征的孕妇，如果多个指征中有1个是胎儿指征，胎儿心脏异常的产前检出率显著升高。
： Objective To analyze the correlation between referral indications for fetal echocardiography and prenatally detected fetal cardiac abnormalities. Methods 1 032 pregnant women referred for fetal echocardiography were retrospectively analyzed. All referral cases were assigned to singleindication and multiindication groups. The distribution of referral indications was analyzed, the rate of prenatally detected fetal cardiac abnormalities was obtained, and the correlation between referral indications and prenatally detected fetal cardiac abnormalities was assessed. Results In the singleindication group, 172 cases of fetal cardiac abnormalities (19.4%) were detected in 885 referral cases. Logistic regression analysis demonstrated that suspected cardiac views detected by routine second trimester fetal malformation screening were associated with prenatally diagnosed fetal cardiac abnormalities (OR=13.7; 95%CI=9.40-20.00). Isolated strong intracardiac echogenic foci were negatively correlated to prenatally detected fetal cardiac abnormalities (OR=0.24; 95%CI=0.11-0.56). The rate of prenatally detected fetal cardiac abnormalities increased to 27.2% (P=0.336) in the multiindication group. For cases with fetal indication, the risk of prenatally detected fetal cardiac abnormalities significantly increased. Conclusion As an isolated referral indication, suspected cardiac views detected by routine second trimester fetal malformation ultrasound screening are associated with prenatally detected fetal cardiac abnormalities, while isolated strong intracardiac echogenic foci should no longer serve as a referral indication for fetal echocardiography. For pregnant women with multiple referral indications for fetal echocardiography, if one of them is fetal indication, the rate of prenatally detected fetal cardiac abnormalities will be much higher