心血管整体评分评估胎儿心功能不全的价值

目的：探讨心血管整体评分（CVPS）对胎儿心功能不全评估的价值。方法：对2013年1月—2016年1月来天津市中心妇产科医院超声中心就诊的孕妇行常规超声检查，检出其中有心功能异常表现（心脏增大、心肌收缩乏力）的胎儿，记录CVPS评分结果，同时行胎儿超声心动图检查，确定有无心内结构异常。依据追访结果，将病例分为2组：活产组和不良妊娠结局组。结果：共检出心功能不全胎儿38例，其中单胎35例，双胎3例。活产组12例，均为单胎，出生后体健10例，2例合并先心病：1例肺动脉瓣轻度狭窄，1例法乐四联症。不良妊娠结局组21例。单胎不良妊娠结局共18例，其中宫内死胎9例，死产2例，引产7例：CVPS持续降低心功能逐渐恶化直至心力衰竭5例，合并难治型先心病2例。双胎中2例为双胎输血综合征（TTTS）宫内死胎，1例为胎儿脑积水、颅内出血引产。失访5例。活产组胎儿CVPS的中位数（四分位数间距）M（Q）]为7.62（7.00），不良妊娠结局组胎儿CVPS的M（Q）为5.67（3.50）。受试者工作特征（ROC）曲线分析，曲线下面积（AUC）0.823，Cut-off值为6.5，P=0.002，有统计学意义。活产组胎儿脐动脉频谱评分、静脉频谱评分和心脏瓣膜功能评分均高于不良妊娠结局组，差异有统计学意义（均P＜0.05）。结论：随着胎儿心功能不全加重直至心力衰竭，CVPS逐渐降低，CVPS危险临界值为6.5，CVPS是连续动态评估胎儿心功能不全的有效指标。胎儿脐动脉频谱、静脉频谱及心脏瓣膜功能评分对预测不良妊娠结局具有一定价值。

The Value of Cardiovascular Profile Score to Assess Fetal Cardiac Insufficiency

Objective:To explore the value of cadiovascular profile score (CVPS)to estimate fetal cadiac insufficiency. Methods:All pregnant women in ultrasound department,Tianjin Central Hospital of Gynecology Obstetrics proceeded routine examinations between Jan. 2013 and Jan. 2016. Fetal cardiac insufficiency (enlarged heart and myocardial contraction fatigue) were found out. CVPS were recorded. Meanwhile fetal cadiography were performed to define if congenital heart disease were accompanied. All cases divided in two groups based on the follow up results:live birth group and adverse pregnancy outcome group. Results:38 cases of fetal cardiac insufficiency were found out. 35 cases were singleton pregnancy. 3 cases were twins pregnancy. 12 cases were in live birth group (all of them were singleton pregnancy), 10 cases were healthy children, 2 cases were accompanied by congenital heart disease: 1 case was mild pulmonicstenosis, 1 case was tetralogy of Fallot. 21 cases were in adverse pregnancy outcome group. 18 cases were singleton pregnancies: 9 cases were intrauterine fetal demise, 2 cases were stillbirth, 7 cases were induced labour: 5 cases progressed to heart failure because of CVPS declined continuously and fetal cadiac insufficiency worsen, 2 cases were accompanied by fatal congenital heart disease. 2 cases of twins pregnancy were intrauterine fetal demise because of twin to twin transfusion syndrome (TTTS). 1 case of twins pregnancy was induced labour because of hydrocephaly and intracranial hemorrhage. 5 cases were loss to follow up. CVPS of live birth was 7.62 (7.00) and CVPS of adverse pregnancy outcomes was 5.67 (3.50). Statistics analysis:ROC curve analysis, area under ROC:0.823, cut off value was 6.5, P=0.002, difference was statistically significant. The score of umbilical artery doppler spectrum, vein doppler spectrum and cardiac valve function in two groups were significant difference (P<0.05). Conclusions:CVPS declined when fetal cardiac insufficiency worse, dangerous cut off value of CVPS was 6.5, CVPS is an effective index for continuous dynamic assessment of fetal cardiac insufficiency. The score of umbilical artery doppler spectrum, vein doppler spectrum and cardiac valve function were valuable to predict adverse pregnancy outcomes.