Indikacijske smjernice za fetalnu ehokardiografiju i njihov utjecaj na prenatalnu dijagnozu srčane bolesti [Indication guidelines for fetal echocardiography and their influence on prenatal diagnosis of a heart disease]

Levicki, Rea and Sović, Slavica and Malčić, Ivan (2017) Indikacijske smjernice za fetalnu ehokardiografiju i njihov utjecaj na prenatalnu dijagnozu srčane bolesti [Indication guidelines for fetal echocardiography and their influence on prenatal diagnosis of a heart disease]. Liječnički vjesnik, 139 (5-6). pp. 150-157. ISSN 0024-3477

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Abstract

Descriptive study: Fetal echocardiography indications and their role in the development of congenital heart defects in newborns. Hypothesis: Congenital heart defects (CHDs) are the most common birth defects diagnosed with the aid of fetal echocardiography (FE) in pregnant women with certain risk factors for CHD, enabling early treatment. Aim: of this study was to determine the connection between the indications which prompted physicians to refer pregnant women for FE and the CHDs caused by these indications. Results: The study involved 1374 pregnant women with 1380 pregnancies, referred by their primary gynecologist and examined in the Fetal cardiology clinic of theUniversityHospital Centre Zagreb, Croatia, between the 1st January 2012 and the 1st January 2015. Most indications for FE were determined by ­obstetricians, while some pregnant women were referred for FE by their rheumatologist, genetic medicine specialist or physicians of other subspecialties. A few pregnant women were examined at their own request. The incidence of CHD was 14.2% (196 fetuses were diagnosed out of 1380 examined), the most common being ventricular septal defect (25%), ­complex CHD (15.3%), arrhythmia (14.79%), cardiomyopathy (10.71%), coarctation of the aorta (7.65%), aortic valve stenosis (6.12%) and bicuspid aortic valve (3.06%). Pathology was more likely to be detected in pregnant women referred for FE with a specific indication, in comparison to those sent for a routine examination. Conclusion: Fetal echocardiography is diagnostically most efficient if we adhere to the prescribed indications which may indicate a primary heart disease (CHD in family, arrhythmias, CMP), fetal syndrome disease, diabetes mellitus or gestational diabetes, and systemic diseases of the mother’s linking tissue (positive specific antibodies).

Abstract in Croatian

Deskriptivno istraživanje: Indikacijske smjernice za fetalnu ehokardiografiju i njihov utjecaj na prenatalnu ­dijagnozu srčane bolesti. Cilj: Istražiti povezanost glavnih indikacija za fetalnu ehokardiografiju (FE) zbog kojih su trud­nice upućene na pregled s konačnim nalazom. Hipoteza: Prirođene srčane grješke (PSG) najčešće su prirođene anomalije koje se kod trudnica s određenim indikacijama, rizičnima za njihov nastanak, uspješno otkrivaju fetalnim ehokardiografskim pregledom. To omogućava njihovo rano zbrinjavanje, a time se smanjuju morbiditet i mortalitet novorođenčadi sa srčanim bolestima te se pozitivno utječe na krivulju perinatalnog mortaliteta. Pridržavanjem propisanih indikacija povećala bi se ukupna učinkovitost FE-a i smanjio broj negativnih nalaza. Rezultati: Istraživanje je rađeno na uzorku od 1374 trud­nice, odnosno 1380 trudnoća, koje su pregledane u Fetalnoj kardiološkoj ambulanti Kliničkoga bolničkog centra Zagreb u razdoblju od 3 godine (1. 1. 2012. do 1. 1. 2015.). Većinu indikacija određivali su opstetričari, dio su uputili reumatolozi, genetičari ili drugi supspecijalisti, dok je dio trudnica tražio pregled prema vlastitoj želji. Prenatalno je srčana bolest otkrivena u 14,2% pregledanih fetusa (196/1380) od čega: ventrikularni septalni defekt (VSD) u 25%, kompleksne PSG u 15,3%, aritmije u 14,79%, kardiomiopatije (KMP) u 10,71%, koarktacija aorte (CoA) u 7,65%, aortalna valvularna stenoza (AVS) u 6,12%, bikuspidalna aortalna valvula (BAV) u 3,06%, ostalo u 16,83%. Patološki je nalaz puno češći kod žena koje su poslane na pregled s propisanom određenom indikacijom nego u onih koje su došle na pregled rutinski ili prema vlastitoj želji. Zaključak: Fetalna ehokardiografija dijagnostički je najučinkovitija ako se pridržavamo propisanih indikacija koje pobuđuju sumnju na primarnu srčanu bolest (PSG u obitelji, aritmije, KMP), neke sindromne bolesti fetusa, dijabetes ­melitus ili gestacijski dijabetes te sistemske bolesti vezivnog tkiva majke (pozitivna specifična protutijela).

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