超声检查胎儿心脏畸形漏诊原因分析

目的:分析产前超声检查胎儿心脏畸形漏诊的原因,探讨提高诊断准确率的方法。方法:回顾性分析该院44 391例经产前超声检查(包括彩超和黑白超)的胎儿资料。中晚孕期超声检查胎儿心脏采用"三切面法"即四腔心切面和左、右室流出道切面,晚孕期黑白超声仅观察四腔心切面。对超声检查发现可疑心脏异常的胎儿再进行详细的超声心动图检查。结果:出生后超声心动图发现产前漏诊胎儿心脏畸形50例,占受检胎儿的1.13‰。其中复杂性先天性心脏病11例(占0.25‰);房间隔、室间隔缺损等先天性心脏病39例(占0.88‰)。室间隔缺损的直径为(3.64±1.42)mm(1.6～6.7 mm),房间隔缺损的直径为(4.40±1.39)mm(2～7 mm)。结论:适宜的检查时间、获取标准的检查切面、仔细辨识图像特征、熟悉病变特点有助于减少漏诊。但由于胎儿先天性心脏病本身的复杂性和超声检查存在的局限性,不可能在产前检出所有的心脏畸形,应向孕妇及家属说明。

Analysis on the missed diagnosis reasons of prenatal ultrasonograpy in screening fetal heart malformations

Objective:To analyze the missed diagnosis reasons of prenatal ultrasound in screening fetal heart malformations,explore the method of improving diagnostic rate.Methods:The data of 44 391 fetus examinated by prenatal ultrasound were analyzed retrospectively.Four-chamber view,left and right ventricular outflow views were observed with two-dimension fetal echocardiography in second or third trimester.Four-chamber view was observed with gray scale display for some cases in third trimester.The detail fetal echocardiography was acquired if doubtful heart abnormities were detected.Results:50 fetus(1.13‰) with heart malformations were found by postnatal echocardiography,including 11 cases with complex congenital heart disease(0.25‰) and 39 cases with atrial septal defect or ventricular septal defect(0.88‰).The diameter of ventricular septal defect was(3.64±1.42) mm(1.6～6.7mm);the diameter of atrial septal defect was(4.40±1.39) mm(2～7mm).Conclusion:Eligible check out time,obtaining standard detection view,identifying characters of image carefully,acquainting characters of heart malformations would reduce the rate of missed diagnosis.Nevertheless,pregnant women should be informed that many congenital heart diseases cann't be detected before delivery.