International Journal of Reproductive BioMedicine
International Journal of Reproductive BioMedicine
IJRM
Medical Sciences
http://ijrm.ir
1
admin
2476-4108
2476-3772
10.29252/ijrm
en
jalali
1401
3
1
gregorian
2022
6
1
20
6
online
1
fulltext
en
عوامل تأثیرگذار بر ارجاع به موقع اکوکاردیوگرافی جنین در تشخیص نهایی ناهنجاری های مادرزادی قلب: یک مطالعه مقطعی
Factors causing timely referral for fetal echocardiography in the final diagnosis of congenital heart malformations: A cross-sectional study
Perinatology
Original Article
Original Article
<div style="text-align: justify;"><span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:"Times New Roman","serif""><b><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra"">مقدمه: </span></span></b><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra"">بیماری قلبی مادرزادی (</span></span><span dir="LTR" style="font-size:10.0pt">CHD</span><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra"">) شایع­ترین اختلال ارثی است که با عواقب نامطلوب همراه است.</span></span></span></span></span></span></span><br>
<span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:"Times New Roman","serif""><b><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra"">هدف: </span></span></b><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra"">این مطالعه با هدف تعیین علت ارجاع برای اکوکاردیوگرافی جنین در تشخیص نهایی بیماری اصلی </span></span><span dir="LTR" style="font-size:10.0pt">CHD</span><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra""> انجام شد.</span></span></span></span></span></span></span><br>
<span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:"Times New Roman","serif""><b><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra"">مواد و روش ­ها: </span></span></b><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra"">در این مطالعه مقطعی، داده­های 1772 زن باردار مراجعه­کننده به یک کلینیک تشخیصی طی سال­های 2017-2020 وارد شده است. داده</span></span><span dir="LTR" style="font-size:11.0pt"><span style="font-family:"Arial","sans-serif"">­</span></span><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra"">ها از شرکت</span></span><span dir="LTR" style="font-size:11.0pt"><span style="font-family:"Arial","sans-serif"">­</span></span><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra"">کنندگان در مورد سن مادر، سن حاملگی، سابقه بیماری قلبی فرزند قبلی، توده بدنی، ترتیب تولد فرزندان (رتبه تولد نوزاد)، نوع بیماری زن، سابقه مامایی ضعیف، و شفافیت پس گردنی (</span></span><span dir="LTR" style="font-size:10.0pt">NT</span><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra"">) جمع</span></span><span dir="LTR" style="font-size:11.0pt"><span style="font-family:"Arial","sans-serif"">­</span></span><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra"">آوری شد. </span></span></span></span></span></span></span><br>
<span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:"Times New Roman","serif""><b><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra"">نتایج: </span></span></b><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra"">از 1772 زن باردار، تنها 33 زن (8/1%) جنین مبتلا به بیماری­های ماژور مادرزادی قلبی داشتند. ناهنجاری در سونوگرافی (6/۵۷%)، سابقه سقط جنین (4/۳۶%)، و افزایش </span></span><span dir="LTR" style="font-size:11.0pt">NT</span><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra""> (2/۱۸%) و دیابت بارداری <a name="_Hlk101793320">(2/۱۸%) </a>به عنوان شایعترین دلایل ارجاع برای اکوکاردیوگرافی جنین در این زنان شناسایی شدند. تعدادی دیگر از دلایل شامل فرزند قبلی مبتلا به سندرم داون (۱/۱۲%)، فرزند قبلی مبتلا به بیماری قلبی (۱/12%)<a name="_Hlk101791906">،</a> سابقه مرده­زایی (1/12%)، هیپوتیروئیدیسم (1/12%)<a name="_Hlk101792777">،</a> مصرف دارو در بارداری (0/9%)، بدون بیماری زمینه­ای (0/9%)، چندقلویی (۰/6%)<a name="_Hlk101792085">، </a>تشخیص با احتمال خطر بالای بیماری قلبی جنینی (0/3%)، غربالگری پر خطر سه ماهه اول (0/3%)، بارداری در شرایط لقاح مصنوعی <a name="_Hlk101792844">(۰/۳%)، </a>و داشتن بچه با معلولیت ذهنی (0/3%).</span></span> <span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra""></span></span></span></span></span></span></span><br>
<span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:"Times New Roman","serif""><b><span lang="FA" style="font-size:11.0pt"><span style="font-family:"B Mitra"">نتیجه­ گیری:</span></span></b> <span lang="AR-SA" style="font-size:11.0pt"><span style="font-family:"B Mitra"">با توجه به نتایج می­توان نتیجه گرفت که ناهنجاری در سونوگرافی، سقط جنین و افزایش شفافیت پشت گردن مهمترین عوامل ارجاع زنان باردار به اکوکاردیوگرافی جنین می­باشد.</span></span><b><span dir="LTR" style="font-size:11.0pt"><span style="font-family:"Arial","sans-serif""></span></span></b></span></span></span></span></span><br>
<br>
<span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:"Times New Roman","serif""><b><i><span lang="FA" style="font-size:10.0pt"><span style="font-family:"B Mitra"">کلمات کلیدی: </span></span></i></b><i><span lang="FA" style="font-size:10.0pt"><span style="font-family:"B Mitra"">اکوکاردیوگرافی، باروری، بیماری­های قلبی، زنان باردار</span></span></i><span lang="FA" style="font-size:10.0pt"><span style="font-family:"B Mitra"">.<b><i></i></b></span></span></span></span></span></span></span></div>
<div style="text-align: justify;"><span style="font-size:11pt"><span style="line-height:normal"><span style="font-family:Calibri,"sans-serif""><b><span lang="EN-GB" style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">Background:</span></span></b> <span lang="EN-GB" style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">Congenital heart disease (CHD) is one of the most <em><span style="font-style:normal">frequently</span></em></span></span> <span lang="EN-GB" style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">inherited illnesses associated with adverse outcomes. <a name="_Hlk42807578"></a></span></span></span></span></span><br>
<span style="font-size:11pt"><span style="line-height:normal"><span style="font-family:Calibri,"sans-serif""><b><span lang="EN-GB" style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">Objective: </span></span></b><span lang="EN-GB" style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">This study aimed to determine the referral cause for fetal echocardiography in the final <a name="_Hlk42810617">diagnosis of </a></span></span><span lang="EN-GB" style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">major</span></span><span lang="EN-GB" style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif""> CHD</span></span><span lang="EN-GB" style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">.</span></span></span></span></span><br>
<span style="font-size:11pt"><span style="line-height:normal"><span style="font-family:Calibri,"sans-serif""><b><span lang="EN-GB" style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">Materials and Methods: </span></span></b><span lang="EN-GB" style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">In this cross-sectional study, the data of 1772 pregnant women, referred to a diagnostic clinic during <a name="_Hlk42861080">2017-2020</a>, were reviewed. </span></span><span lang="EN-GB" style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">Data were collected from participants on maternal age, gestational age, history of previous child's heart disease, body mass, the order of birth of children </span></span><span lang="EN-GB" style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">(baby birth rank),</span></span> <span lang="EN-GB" style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">type of woman’s disease</span></span><span lang="EN-GB" style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">, history of poor midwifery, and </span></span><span lang="EN-GB" style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">nuchal translucency (NT).</span></span></span></span></span><br>
<span style="font-size:10pt"><span style="font-family:Calibri,"sans-serif""><a name="_Hlk89091807"><b><span lang="EN-GB" style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">Results:</span></span></b></a><span lang="EN-GB" style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif""> Of the 1772 pregnant women, only 33 women (1.8%) had a fetus with CHD major. Abnormality in ultrasound (57.6%), history of abortion (36.4%), </span></span><span lang="EN-GB" style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">increased </span></span><span lang="EN-GB" style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">NT and </span></span><span lang="EN" style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">gestational <a name="_Hlk101793284">diabetes</a></span></span> <span lang="EN-GB" style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">(18.2%)</span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif""> and Gestational diabetes (18.2%)</span></span><span lang="EN-GB" style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif""> were identified as the most common </span></span><span lang="EN-GB" style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">referral</span></span><span lang="EN-GB" style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif""> reasons </span></span><span lang="EN-GB" style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">for fetal echocardiography in these women</span></span><span lang="EN-GB" style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">.</span></span><span lang="EN-GB" style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif""> Other reason included previous child with Down syndrome (12.1%), previous child with heart disease (12.1%), a history of stillbirth (12.1%), hypothyroidism (12.1%), taking medication during the pregnancy period (9.0), no underlying disease (9.0), multiple pregnancies (6.0%), diagnosis with high-risk fetal heart disease (3.0%), High-risk combined aneuploidy screening test </span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">in </span></span><span lang="EN-GB" style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">first trimester (3.0%), <em><span style="font-style:normal">in vitro fertilization</span></em><i> </i>pregnancy (3.0%), and having a child with intellectual disability (3.0%).</span></span><span lang="EN-GB" style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif""></span></span></span></span><br>
<span style="font-size:11pt"><span style="line-height:normal"><span style="font-family:Calibri,"sans-serif""><b><span lang="EN-GB" style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">Conclusion: </span></span></b><a name="_Hlk101792397"><span lang="EN" style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">According to the results, it can be concluded that ultrasounds abnormality, abortion, increased </span></span></a><span lang="EN-GB" style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">NT and gestational diabetes </span></span><span lang="EN" style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">are the most important factors for referring pregnant women for </span></span><span lang="EN-GB" style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">fetal echocardiography.</span></span><span lang="EN-GB" style="font-size:10.0pt"><span style="font-family:"Times New Roman","serif""></span></span></span></span></span></div>
اکوکاردیوگرافی, باروری, بیماریهای قلبی, زنان باردار.
Echocardiography, Fertilization, Heart diseases, Pregnant women.
477
482
http://ijrm.ir/browse.php?a_code=A-10-1575-1&slc_lang=en&sid=1
Mojgan
Barati
barati-m@ajums.ac.ir