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中国循证儿科杂志

中国循证儿科杂志 ›› 2015, Vol. 10 ›› Issue (6): 405-408.

• 论著 • 上一篇    下一篇

产前诊断胎儿心脏病孕妇及家庭对妊娠态度影响因素的分析

吴琳1,5，孙琦2,5，杨昊晟3，严卫丽4，赵〓璐1，孙路明2   

  1. 1 复旦大学附属儿科医院心血管中心 上海，201102；2 同济大学附属上海市第一妇婴保健院胎儿医学部 上海，200040；3 上海位育高级中学 上海，200231；4 复旦大学附属儿科医院临床流行病学教研室 上海，201102；5 共同第一作者
  • 收稿日期:2015-12-24 修回日期:2015-12-24 出版日期:2015-12-05 发布日期:2015-12-04
  • 通讯作者: 孙路明

A retrospective analysis to identify the factors influencing parental pregnancy decisions in pregnancies with fetal cardiac anomalies

WU Lin1,5, SUN Qi2,5, YANG Hao-sheng3, YAN Wei-li4, ZHAO Lu1, SUN Lu-ming2   

  1. 1 Cardiovascular center, Children's Hospital of Fudan University, Shanghai 20102, China; 2 Fetal medicine unit, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 200040, China; 3 Weiyu High School, Shanghai 200231, China; 4 Department of Clinical Epidemiology, Children's Hospital of Fudan University, Shanghai 201102, China; 5 Contribute equally to this work
  • Received:2015-12-24 Revised:2015-12-24 Online:2015-12-05 Published:2015-12-04
  • Contact: SUN Lu-ming

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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。

Abstract:

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 39.5 weeks), 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 more likely to adopt for termination in the cases of more complex cardiac anomalies or in association with major extra-cardiac malformations.