孕中期超声多切面检查对超重孕妇胎儿心脏畸形的诊断价值

Diagnostic value of multiplanar ultrasonography in the second trimester for fetal cardiac malformations in overweight pregnant women

摘要:

目的 分析孕中期超声多切面检查对超重孕妇胎儿心脏畸形的诊断价值。方法 回顾性分析2023年6月—2024年12月在商洛市中心医院超声医学科进行孕中期心脏超声检查的114例超重孕妇的临床资料，所有孕妇行超声常规和超声多切面检查，分别在平卧位、侧卧位下完成检查，以随访结果为金标准，分析超声多切面检查的诊断效能及图像质量。结果 超声多切面检查平卧位和侧卧位图像满意度均高于超声常规检查（P <0.05）；侧卧位超声多切面检查和超声常规检查图像满意度均高于平卧位（P <0.05）。随访结果显示，5例（4.39%）心脏畸形胎儿中，室间隔缺损1例、三尖瓣下移畸形2例、左心发育不良1例、单心室1例。超声常规检查的敏感性为20.0%（1/5），特异性为92.7%（101/109），准确度为89.5%（102/114）；超声多切面检查的敏感性为80.0%（4/5），特异性为97.2%（106/109），准确度为96.5%（110/114）；两者联合检查的敏感性、特异性、准确度均为100.0%。孕22～<24周的52例孕妇中，检出心脏畸形1例（1.92%），孕24～<26周的62例孕妇中，检出心脏畸形4例（6.45%）。结论 孕中期超声多切面检查可显著提高超重孕妇胎儿心脏畸形的检出准确性，图像质量优于超声常规检查。联合多切面与常规超声检查可使敏感性、特异性及准确度均达100%，推荐作为超重孕妇胎儿心脏畸形筛查的优选方案。

Abstract:

Objective To analyze the diagnostic value of multiplanar ultrasonography in the second trimester for fetal cardiac malformations in overweight pregnant women.Methods A retrospective analysis was conducted on the clinical data of 114 overweight pregnant women who underwent cardiac ultrasonography in the second trimester at Shangluo Central Hospital from June 2023 to December 2024. All pregnant women received both routine ultrasonic examination and multiplanar ultrasonography, which were performed in both supine and lateral decubitus positions. Using follow-up outcomes as the gold standard, the diagnostic efficacy and image quality of multiplanar ultrasonography were analyzed.Results Image satisfaction scores obtained by multiplanar ultrasonography in both the supine and lateral positions were significantly higher than those obtained by routine ultrasonography (P < 0.05). In addition, image satisfaction scores for both multiplanar and routine ultrasonography were significantly higher in the lateral position than in the supine position (P < 0.05). Follow-up results identified fetal cardiac malformations in 5 of 114 cases (4.39%), including ventricular septal defect (n = 1), Ebstein anomaly (n = 2), hypoplastic left heart syndrome (n = 1), and single ventricle (n = 1). The sensitivity, specificity, and accuracy of routine ultrasonography were 20.0% (1/5), 92.7% (101/109), and 89.5% (102/114), respectively. In contrast, multiplanar ultrasonography demonstrated a sensitivity of 80.0% (4/5), a specificity of 97.2% (106/109), and an accuracy of 96.5% (110/114). When the two methods were combined, the sensitivity, specificity, and accuracy all reached 100.0%. One case of fetal cardiac malformation was detected among 52 pregnant women at 22 to < 24 weeks of gestation (1.92%), whereas 4 cases were detected among 62 pregnant women at 24 to < 26 weeks of gestation (6.45%).Conclusion Multiplanar ultrasonography in the second trimester significantly improves the diagnostic accuracy for fetal cardiac malformations in overweight pregnant women and provides superior image quality compared with routine ultrasonography. The combined use of multiplanar and routine ultrasonography further enhances diagnostic performance, achieving 100% sensitivity, specificity, and accuracy, and may therefore be recommended as a preferred screening strategy for fetal cardiac malformations in overweight pregnant women.