This is an automatically translated article.
Posted by Master, Doctor Dao Kim Phuong - Department of Examination - Vinmec Times City International Hospital
All cardiac lesions can be detected in the fetus based on timely fetal echocardiography, with the exception of a few minor lesions, such as atrial septal defects and ductus arteriosus. In some cases, prenatal diagnosis also offers the opportunity for in-utero treatment.
1. Make a problem
Newborn studies in Baltimore, Washington and studies in the US and UK have shown that a significant number of cases of congenital heart disease go undetected and lead to infant death. birth that was diagnosed only after an autopsy.
Existing studies have some limitations with respect to preoperative mortality assessment. There is a bias by excluding patients who died before heart surgery. Others are constrained by the small number of preoperative deaths or heterogeneous patient populations related to anatomic diagnosis, the presence of risk factors, and the family's desire to pursue surgery. heart surgery. Most studies to date have not allowed accurate comparisons between groups due to lack of detailed information on cardiac anatomy or preoperative causes of death.
This analysis shows that prenatal diagnosis of critical congenital heart disease improves neonatal survival. Infants diagnosed postpartum are more likely to die from cardiovascular damage before planned heart surgery than those diagnosed before birth.
Prenatal identification and management of fetal heart abnormalities is important because birth defects are the leading cause of infant mortality and congenital heart disease accounts for 30 to 50% of cases. this fatality. In general, all cardiac lesions can be detected in the fetus based on timed fetal echocardiography, with the exception of some minor lesions, such as second foraminal septal defects and ductus arteriosus. Atrial septal defect and ductus arteriosus are normal fetal shunts.
Prenatal diagnosis of heart disease offers parents the opportunity to gain prenatal prognostic information, learn about treatment options before and after birth, make decisions regarding management the best management for their family (eg, abortion or undergoing intrauterine intervention, if available; no intervention), and planning for specific birth needs (eg, place of birth, home provides pediatric and obstetric services, delivery, and palliative care). It may also improve neonatal outcomes. Because of the complexity of these issues, referral to a maternal-fetal specialist, pediatric cardiologist, geneticist, and/or neonatologist is recommended.
Prenatal diagnosis of heart disease has also been associated with a reduced incidence of neonatal morbidity, including severe acidosis. Newborns with congenital heart defects that require ductal support for systemic or pulmonary circulation may benefit from early postpartum intervention (prostaglandin E1) to prevent ductal closure. Similarly, readiness to perform transluminal intervention (eg, balloon atrial septal defect resection for patients with type D major artery transposition [TGA] or hypoplastic left heart syndrome [HLHS], angioplasty) balloon valve for patients with critical pulmonary or aortic stenosis) or pacing immediately after birth helps to rapidly stabilize the postpartum circulation and thus may improve outcomes.
Việc xác định và chẩn đoán tim thai trước khi sinh là vô cùng quan trọng đối với cả mẹ và bé
In some cases, prenatal diagnosis also offers the opportunity for in-utero treatment. Transplacental drug therapy improves the prognosis of some fetal arrhythmias, especially tachycardia. Intrauterine invasive cardiac intervention (eg, aortic or balloon angioplasty, atrial septal defect dilation) may improve prognosis for some lesions, such as HLHS or severe valvular abnormalities. eg, severe aortic stenosis, pulmonary hypoplasia); however, these interventions are only performed at some fetal surgery centers.
2. Screening time
The optimal gestational age for screening for structural heart defects is between 18 and 22 weeks. Fetal cardiac anatomy can be well visualized at this stage of pregnancy, and further evaluation (eg, echocardiography, chromosomal) can be performed, if indicated, while the fetus is still alive. .
After 30 weeks of gestation, it can be difficult to obtain an optimal image as the fetus becomes more and more cramped in the amniotic cavity. It should be noted that some fetal heart conditions may not be detected until or may appear for the first time after 18 to 22 weeks of gestation. For example, fetal arrhythmias, myocarditis/myopathy, heart failure, valvular insufficiency or obstruction, and cardiac tumors have variable onset times.
In addition, small atrial or ventricular septal defects, mild valvular lesions, partial pulmonary venous connection abnormalities, and coronary artery anomalies are often not detected in pregnancy.
Siêu âm sàng lọc tim thai hiệu quả nhất là từ tuần 18 đến 22 của thai kỳ
3. Standard Cardiovascular Assessment
There is a large variation in detection rates between screening studies, with some studies reporting only 15% detection of congenital heart disease (CHD). Factors that influence sensitivity include type of ultrasound practice (eg, university versus community hospital), operator training and experience, gestational age, maternal weight, position fetal intelligence and type of disability. Fetal echocardiography is a more sensitive but less cost-effective screening method for low-risk pregnancies for CHD.
4. Advanced Cardiovascular Assessment
Advanced fetal echocardiography should be performed in fetuses at high risk of congenital heart disease (CHD).
American Heart Association (AHA), American Society of Echocardiography (ASE), and Society of Pediatric and Congenital Electrophysiology (PACES) recommend fetal echocardiography in cases of:
Pregnant women with gestational diabetes or diabetes diagnosed in the first 3 months; Phenylketonuria in the mother (uncontrolled); Maternal autoimmune disease, maternal autoantibodies (SSA/SSB), especially if the child has previously had SSA/SSB-related heart disease; Maternal teratogens when administered with drugs (eg, thalidomide, ACE inhibitors, retinoic acid, nonsteroidal anti-inflammatory drugs [NSAIDs] during the third trimester); Maternal rubella infection during the first 3 months of pregnancy; Maternal infection with suspected fetal myocarditis because of poor contractility or effusion on standard 4-chamber cardiac examination (eg, coxsackie virus, adenovirus, cytomegalovirus); Pregnancy using assisted reproductive technology (ART); Congenital heart in a first-degree relative of the fetus (mother, father or sibling); First- or second-degree relatives associated with congenital heart-linked Mendelian disorders (eg, Noonan, tuberous sclerosis, Holt-Oram, DiGeorge syndrome/22q11 deletion, syndrome Alagille, Williams syndrome);
Thai phụ mắc tiểu đường thai kỳ nên tiến hành siêu âm tim thai nhi nâng cao
Suspected fetal heart abnormalities (structure, function, arrhythmia) on obstetric ultrasound; Suspected fetal heart abnormalities on obstetric ultrasound; Fetal chromosomal testing showing genetic mutation, deletion, rearrangement or aneuploidy; Fast or slow fetal heart rate or irregular or persistent heartbeat; Fetal nuchal translucency increased > 95 percent (≥3mm) on first-trimester ultrasound; Twins with the same egg; Effusion or edema. To protect the health of both mother and fetus, especially in the third trimester of pregnancy, which is the period of strong fetal development. Pregnant women need:
Comprehensive fetal malformation screening by superior 4D ultrasound technique. Screening for gestational diabetes, avoiding many dangerous complications for both mother and baby. Control the mother's weight reasonably to assess the health status of the pregnant woman and the development of the fetus. Understand the signs of threatened early delivery (especially in those carrying multiple pregnancies or having a history of miscarriage or premature birth) so that they can receive timely treatment to maintain pregnancy. To protect mother and baby during pregnancy, Vinmec provides a comprehensive Maternity service to monitor the health status of mother and baby, periodical antenatal check-ups with leading Obstetricians and Gynecologists. enough tests, important screening for pregnant women, counseling and timely intervention when detecting abnormalities in the health of mother and baby.
Please dial HOTLINE for more information or register for an appointment HERE. Download MyVinmec app to make appointments faster and to manage your bookings easily.
References
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