摘要
目的探讨产前诊断心脏病的胎儿,孕妇及其家庭选择终止妊娠的影响因素。方法 2011年1月至2014年12月在上海第一妇婴保健院胎儿医学部经超声心动图确诊的心脏病胎儿。每个胎儿家庭接受了多学科咨询会诊,被详细告知疾病的诊断、严重程度、治疗策略和远期预后。回顾性收集孕妇及胎儿的详细临床资料和家庭最终的妊娠选择,行多因素Logistics回归分析,探讨孕妇及家庭选择终止妊娠的主要影响因素。结果 162例胎儿进入分析,平均孕周26.5（17.4~39.5）周,24例（14.8%）胎儿合并有显著心脏外畸形。67例（41.4%）孕妇及家庭选择终止妊娠,其中罹患轻度、中度及重度心脏病胎儿中,孕妇及家庭选择终止妊娠的比例分别为16.0%、51.1%和76.2%;合并有显著心脏外畸形的胎儿中,终止妊娠率高达79.2%。多因素Logistic回归分析显示,胎儿心脏病的严重程度（OR=9.001,95%CI：4.143~19.557,P〈0.001）,是否合并有显著心脏外畸形（OR=3.801,95%CI：1.814~7.962,P〈0.001）及诊断孕周（OR=0.750,95%CI：0.653~0.861,P〈0.001）是影响孕妇及其家庭选择终止妊娠的3个主要因素。结论对于合并有重度心脏病或显著心脏外畸形胎儿,孕妇及其家庭更倾向于选择终止妊娠。
Objective The aim of the study was to identify the factors influencing parental pregnancy decisions after a prenatal diagnosis of cardiac anomalies in Chinese population in the setting of tertiary level diagnosis and consultation. The study may be helpful to estimate the future prevalence of live birth congenital heart disease. Methods A total of 162 fetuses prenatally diagnosed with cardiac anomalies in our institute were retrospectively analyzed from January 2011 to December 2014. Each family was provided with detailed consultation for the diagnosis,severity,treatment options and long-term prognosis of the anomaly with a multidisciplinary approach. Data with respect to the general maternal and fetal characteristics and pregnancy outcome were collected for all cases,and multivariable logistic regression analysis was performed to determine which factors influenced the parents＇ pregnancy decisions. Results Of the 162 cases,the mean gestational age at diagnosis was 26. 5 weeks（ ranging from 17. 4 to 39. 5weeks）,and 24 fetuses（ 14. 8%） were associated with major extra-cardiac malformations. Overall,67（ 41. 4%） pregnancies were interrupted,while the rates of termination in mild,moderate and severe groups of fetuses classified by severity of cardiac anomalies were 16. 0%,51. 1% and 76. 2%,respectively,and that of fetuses associated with major extra-cardiac anomalies reached 79. 2%. Multivariable logistic regression analysis identified that severity of cardiac anomalies（ OR = 9. 001,95% CI：4. 143- 19. 557,P 0. 001）,presence of extra-cardiac anomalies（ OR = 3. 801,95% CI： 1. 814- 7. 962,P 0. 001） and gestational age at diagnosis（ OR = 0. 750,95% CI： 0. 653- 0. 861,P 0. 001） were three major factors contributing to the probability of pregnancy termination. Conclusion In China,the termination of pregnancy following prenatal diagnosis of cardiac anomalies is more frequent than that in the developed countries,mainly due to no restriction of gestational age for termination. The parents are mor
出处
《中国循证儿科杂志》
CSCD
北大核心
2015年第6期405-408,共4页
Chinese Journal of Evidence Based Pediatrics
关键词
先天性心脏病
胎儿超声心动图
产前诊断
终止妊娠
咨询
影响因素
Congenital heart disease
Fetal echocardiography
Prenatal diagnosis
Pregnancy termination
Counseling
Influencing factor
