PDF(Pubmed)
Abstract：
A provincial program combining the effect of a government investment in prenatal screening and a specialized cardiac center was introduced in 2004, to improve prenatal diagnosis by echocardiography for congenital heart diseases (CHDs) in the Guangdong Registry of Congenital Heart Disease, China.
To evaluate the effects of this program on the prenatal diagnosis rate (PDR) by echocardiography and termination of pregnancy (TOP).
A retrospective study from 2004-2015 included 9782 fetuses and infants diagnosed with CHDs. The PDR was calculated for major and minor CHDs during pre-, mid- and post-program time-intervals. Multivariable logistic regression was utilized to analyze the associations between program implementation and the timing of CHD diagnosis (prenatal vs. postnatal) by different hospital levels. The rate for TOP were also evaluated.
The PDR increased by 44% for major CHDs in the post-program interval relative to the pre-program interval. The three most frequently diagnosed subtypes prenatally were hypoplastic left heart syndrome (84%), double outlet right ventricle (83%) and severe pulmonary stenosis (82%). Participants with a high school education experienced a greater increase in PDR than those without a high school education. The odds for a prenatal vs. a postnatal diagnosis for major CHD were greater after introduction of the program than before (adjusted odd ratio= 20.95, 95% CI:2.47, 178.06 in secondary hospitals; and adjusted odd ratio=11.65, 95% CI:6.52, 20.81 in tertiary hospitals). The TOP rate decreased from 52.3% pre-program to 19.6% post-program among minor CHD fetuses with a prenatal diagnosis (P for trend =0.041). A lower proportion of TOP were attributed to minor CHDs after the program.
The program combining the advantages of government investment and a specialized cardiac center appeared to increase the PDR by echocardiography for CHDs in an unselected population. The TOP rate among minor cases with prenatal diagnosis declined significantly after implementation of the program.
To evaluate the effects of this program on the prenatal diagnosis rate (PDR) by echocardiography and termination of pregnancy (TOP).
A retrospective study from 2004-2015 included 9782 fetuses and infants diagnosed with CHDs. The PDR was calculated for major and minor CHDs during pre-, mid- and post-program time-intervals. Multivariable logistic regression was utilized to analyze the associations between program implementation and the timing of CHD diagnosis (prenatal vs. postnatal) by different hospital levels. The rate for TOP were also evaluated.
The PDR increased by 44% for major CHDs in the post-program interval relative to the pre-program interval. The three most frequently diagnosed subtypes prenatally were hypoplastic left heart syndrome (84%), double outlet right ventricle (83%) and severe pulmonary stenosis (82%). Participants with a high school education experienced a greater increase in PDR than those without a high school education. The odds for a prenatal vs. a postnatal diagnosis for major CHD were greater after introduction of the program than before (adjusted odd ratio= 20.95, 95% CI:2.47, 178.06 in secondary hospitals; and adjusted odd ratio=11.65, 95% CI:6.52, 20.81 in tertiary hospitals). The TOP rate decreased from 52.3% pre-program to 19.6% post-program among minor CHD fetuses with a prenatal diagnosis (P for trend =0.041). A lower proportion of TOP were attributed to minor CHDs after the program.
The program combining the advantages of government investment and a specialized cardiac center appeared to increase the PDR by echocardiography for CHDs in an unselected population. The TOP rate among minor cases with prenatal diagnosis declined significantly after implementation of the program.
摘要：
2004年引入了一项省级计划，该计划结合了政府对产前筛查的投资和专门的心脏中心的影响，以改善广东省先天性心脏病登记处超声心动图对先天性心脏病（CHDs）的产前诊断。中国。
通过超声心动图和终止妊娠（TOP）评估该程序对产前诊断率（PDR）的影响。
2004-2015年的一项回顾性研究包括9782例胎儿和被诊断患有冠心病的婴儿。计算主要和次要CHD的PDR，中期和后期程序的时间间隔。利用多变量逻辑回归分析方案实施与冠心病诊断时机之间的关联(产前与产后)由不同的医院级别决定。还评估了TOP的比率。
在程序后间隔中，主要CHD的PDR相对于程序前间隔增加了44％。产前最常见的三种亚型是左心发育不全综合征（84%）。右心室双出口（83％）和重度肺动脉狭窄（82％）。受过高中教育的参与者比没有受过高中教育的参与者的PDR增长更大。产前与实施该计划后,主要CHD的产后诊断比以前更高(二级医院的校正奇数比=20.95,95%CI:2.47,178.06;三级医院的校正奇数比=11.65,95%CI:6.52,20.81).在产前诊断的CHD胎儿中，TOP率从计划前的52.3％下降到计划后的19.6％（趋势P=0.041）。该计划后，TOP的比例较低归因于轻度CHD。
该计划结合了政府投资的优势和专门的心脏中心，似乎可以通过超声心动图在未选择的人群中增加CHD的PDR。该计划实施后，产前诊断的次要病例的TOP率显着下降。
通过超声心动图和终止妊娠（TOP）评估该程序对产前诊断率（PDR）的影响。
2004-2015年的一项回顾性研究包括9782例胎儿和被诊断患有冠心病的婴儿。计算主要和次要CHD的PDR，中期和后期程序的时间间隔。利用多变量逻辑回归分析方案实施与冠心病诊断时机之间的关联(产前与产后)由不同的医院级别决定。还评估了TOP的比率。
在程序后间隔中，主要CHD的PDR相对于程序前间隔增加了44％。产前最常见的三种亚型是左心发育不全综合征（84%）。右心室双出口（83％）和重度肺动脉狭窄（82％）。受过高中教育的参与者比没有受过高中教育的参与者的PDR增长更大。产前与实施该计划后,主要CHD的产后诊断比以前更高(二级医院的校正奇数比=20.95,95%CI:2.47,178.06;三级医院的校正奇数比=11.65,95%CI:6.52,20.81).在产前诊断的CHD胎儿中，TOP率从计划前的52.3％下降到计划后的19.6％（趋势P=0.041）。该计划后，TOP的比例较低归因于轻度CHD。
该计划结合了政府投资的优势和专门的心脏中心，似乎可以通过超声心动图在未选择的人群中增加CHD的PDR。该计划实施后，产前诊断的次要病例的TOP率显着下降。
