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O M DA GAY DAY TRNG HP NHIEM SAC THE BNH THNG
NH THE NAO LA O M DA GAY DAY? 38 48 58 68 78 CRL (mm) 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 NT(mm) 99th centile 95th centile NT N Survivors < 95th centile 6371 6279 (98.6%) 95th 99th centile 162 159 (98.1%) > 99th centile 73 60 (82.2%) Total 6606 6498 (98.4%) Michailidis 2001
o辰 m担淡 da ga湛y: 単a探 tra探i qua 10 na棚m va淡 va達n co淡n la淡 mo辰t ga湛nh na谷ng tre但n vai Ultrasound Obstet Gynecol 2001; 18: 5-8 Tin to叩t la淡 単o辰 m担淡 da ga湛y b狸nh th旦担淡ng va淡 tin xa叩u cu探ng la淡 単o辰 m担淡 da ga湛y b狸nh th旦担淡ng . . . Yves Ville 2001
N=4,767; Snijders et al 1998; Souka et al 1998; 2001; Michailidis & Economides 2001 15%46.2%19.0%64.5%>6.5 mm 30%24.2%10.1%50.5%5.5-6.4 mm 50%18.5%3.4%33.3%4.5-5.4 mm 70%10.0%2.7%21.1%3.5-4.4 mm 93%2.5%1.3%3.7%95th-99th centiles 97%1.6%1.3%0.2%<95th centile So叩ng kho短eThai ba叩t th旦担淡ng na谷ng Thai che叩t BAT THNG NST O M DA GAY NST BNH THNG O M DA GAY DAY HAU QUA TRC MAT
Nguy c担 ha辰u qua短 ba叩t l担誰i ch脱 t旦淡 2- 4% ne叩u MDG da淡y la淡 1 da叩u ch旦湛ng 単担n 単o辰c o辰 m担淡 da ga湛y da淡y- NST b狸nh th旦担淡ng HAU QUA LAU DAI Maymon 2004, Souka 2005 68 / 1837 (3.7%)Cha辰m pha湛t trie奪n ta但m than hoa谷c ma辿c HC di truyen Ville 2001
MDG da淡y va淡 bo辰 NST b狸nh th旦担淡ng: S旦誰 lie但n quan v担湛i nh旦探ng ba叩t th旦担淡ng ve ca叩u tru湛c T畛ng s畛: 14.2% (Maymon 2004) Nh旦探ng b畉t th動畛ng lie但n quan cha谷t che探 v担湛i MDG da淡y Ba叩t th旦担淡ng tim (6%: RR 6.6) Thoa湛t v嘆 hoa淡nh Thoa湛t v嘆 ro叩n Ba叩t th旦担淡ng ve h狸nh da湛ng c担 the奪 Kho叩i u trong long ng旦誰c Ba叩t th旦担淡ng co辰t so叩ng
D嘆 ta辰t tim/ Suy tim Ba叩t th旦担淡ng he辰 ba誰ch huye叩t S旦誰 che淡n e湛p trong long ng旦誰c Ta辿c nghe探n t坦nh ma誰ch: 単au & co奪 Thay 単o奪i ca叩u ta誰o cu短a l担湛p ha誰 b狸 Ta棚ng MDG v担湛i bo辰 NST b狸nh th旦担淡ng Be辰nh nguye但n (1)
Sebire et al 1996 Bo辰 NST b狸nh th旦担淡ng, NT>3.5 mm 426 xe湛t nghie辰m TORCH ma湛u me誰 (+) 6 (1.4%) Nhie達m tru淡ng ba淡o tthai NONE Phu淡 thai kho但ng mong 単担誰i >16 Tuan 63 xe湛t nghie辰m TORCH ma湛u me誰 (+) 6 (9.5%) Nhie達m tru淡ng ba淡o thai Ta叩t ca短 Ta棚ng MDG v担湛i bo辰 NST b狸nh th旦担淡ng Be辰nh nguye但n (2) Nhie達m tru淡ng ba淡o thai Thie叩u ma湛u thai nhi Protid ma湛u thai nhi tha叩p
Ba叩t th旦担淡ng tim + nhie達m sa辿c the奪 b狸nh th旦担淡ng MC Tha但n MP Ong M He誰p Tho但ng lie但n tha叩t the奪 quanh ma淡ng 単旦担誰c van 3 la湛 che phu短 1 phan MDG 6 mm, 単a短o ng旦担誰c so湛ng a cu短c do淡ng ma湛u qua o叩ng t坦nh ma誰ch Bilardo 2001 Hyett 1996 / 7
Be辰nh tim ba奪m sinh 担短 tre短 nho短 0 10 20 30 40 50 60 Che叩t s担 sinh Che叩t 担短 tre短 nho短 OPCS: 1996 data
o辰 nha誰y ca短m cu短a sie但u a但m th旦担淡ng qui (Qua h狸nh 畉nh tim 4 bu畛ng) Grandjean et al. 1998 Eurofetus project 0 10 20 30 40 50 60 70 80 90 Tim TKTW D a ditatC o cotsong N ieu-sinh ducD aday-ruot
Atzei et al 2004, n=6,921 0 50 100 150 >M-95th 95th- 3.5 3.5-4.4 4.5-5.4 >5.5 o辰 m担淡 da ga湛y (mm) Tansua叩tma辿c(/1000) 126.7 64.4 35.2 18.2 8.7 2,064 2,365 6,54 20,2 22,1 <trung b狸nh 1,415 4.9 37.5% Tam soa湛t nh旦探ng d嘆 ta辰t tim ch鱈nh 4.9%160 (2.4)67,256To奪ng 25.9%5.0%27 (2.1)12,978Hafner et al 2003 45.0%2.5%20 (5.5)3,655Ovros et al 2002 15.4%3.5%26 (3.5)7,339Mavrides 2001 36.4%3.5%11(1.7)6,606Michailidis 2001 11.1%2.6%9 (2.0)4,474Schwarzler 1999 56.0%6.2%50 (1.7)29,154Hyett et al 1999 50.0%2.8%4 (2.5)1,590Bilardo et al 1998 38.5%8.9%13 (8.9)1,460Josefsson 1998 DRFPRBTBS n (/1,000) NTa湛c gia短 MDG da淡y v担湛i bo辰 NST b狸nh th旦担淡ng
The叩 na淡o la淡 1 ch旦担ng tr狸nh tam soa湛t tha淡nh co但ng? Ta湛c gia短 n BTBS Tan sua叩t DR (NT 3.5mm) Mavrides 01 7339 26 3.5 / 1000 11.5 % Hyett 99 29154 50 1.7 / 1000 40 % Michailidis 01 6650 11 1.7 / 1000 27.3 % 1 ly湛 do 単e奪 ch脱 単嘆nh sie但u a但m tim Ta湛c gia短 BTBS / n (NT 3.5) PPV Mavrides 3 / 60 1 / 20 (5%) Hyett 20 / 315 1 / 16 (6.3%) Michailidis 3 / 60 1 / 20 (5%)
Sie但u a但m cho phu誰 n旦探 担短 Sydney N = 23,912 , c坦: MDG 3.5mm :251 (1.05%), c坦: Ba叩t th旦担淡ng NST: 91 (36.3%) 28 59 69 89 0 20 40 60 80 100 % 3.5-4.4 4.5-5.4 5.5-6.4 >=6.5 NT (mm) Adverse outcome
SUFW MDG da淡y va淡 bo辰 nhie達m sa辿c the奪 b狸nh th旦担淡ng NT n Thai ch畉t khi sinh Sinh s畛ng (+ abn) Sinh s畛ng (no defects) 3.5-4.4 107 13 5 (2 CHD) 89 (83.2%) 4.5-5.4 29 11 2 (2 CHD) 16 (55.9%) 5.5-6.4 14 5 1 (1 CHD) 8 (57.1%) 6.5 10 5 0 5 (50%) T畛ng c畛ng 160 34 (21.3%) 8 (5.0%) 118 (73.7%) FMF 1320 240 (18.2%) 60 (4.5%) 1020 (77.3%) Souka 2001
Ba叩t th旦担淡ng tim Loa誰i ba叩t th旦担淡ng MDG(mm) Ke叩t qua短 HVM/ TLT/He誰p d旦担湛i van MP 3.5 To叩t/ s旦短a ch旦探a AVSD (Tha叩t P tro辰i) 3.6 CDTK He誰p MC/ He誰p van 2 la湛 3.9 To叩t/ s旦短a ch旦探a Ke湛m co bo湛p tha叩t tra湛i 4.0 CDTK He誰p quai MC 4.2 To叩t/ s旦短a ch旦探a AVSD (dominant RV) 4.3 CDTK Be辰nh c担 tim ph狸 単a誰i / PS 4.9 HC Noonan Thie奪u sa短n van 3 la湛 5.5 CDTK Tho但ng lie但n tha叩t phan c担 5.6 To叩t/ s旦短a ch旦探a Da探n ro辰ng tha叩t P 6.2 FDIU 17wks BTBS ch鱈nh 10/160 1/16 (6.3%) McLennan & Sholler
11-14 tuan SA t狸m ba叩t th旦担淡ng Ba叩t th旦担淡ng NST D嘆 ta辰t l担湛n NST b狸nh th旦担淡ng Kho但ng co湛 d嘆 ta辰t 14-16 tuan SA t狸m ba叩t th旦担淡ng SA tim thai 20 tuan SA t狸m ba叩t th旦担淡ng Sa tim thai Kho但ng d嘆 ta辰t Da ga湛y va達n ra叩t da淡y Ba叩t th旦担淡ng l担湛n Kho但ng d嘆 ta辰t Da ga湛y va達n co淡n da淡y Qua短n ly湛 s旦誰 ta棚ng MDG Kho但ng co湛 ba叩t th旦担淡ng Ba叩t th旦担淡ng l担湛n Da叩u ch旦湛ng cu短a ca湛c HC di truyen Phu淡 thai FBS T soa湛t nhie達m tru淡ng Kie奪m tra di truyen
Ke叩t lua辰n Ne叩u MDG v旦担誰t qua湛 3.5 mm . Khoa短ng 1/3 co湛 ba叩t th旦担淡ng nhie達m sa辿c the奪 So叩 co淡n la誰i: 1/4 se探 co湛 1 ke叩t qua短 ba叩t l担誰i 1/16 se探 co湛 1 ba叩t th旦担淡ng tim l担湛n Ke叩t qua短 ba叩t l担誰i t旦淡 2-4% ne叩u MDG ta棚ng 単担n 単o辰c Can sie但u a但m tim thai (Qu鱈 1/ Qu鱈 2) Ra叩t h旦探u hie辰u khi co湛 1 ch旦担ng tr狸nh tam soa湛t be辰nh tim ba奪m sinh 単旦担誰c thie叩t la辰p No湛 単o湛ng vai tro淡 nh旦 la淡 1 tha淡nh phan trong 1 chuo達i kie奪m tra 単e奪 pha湛t hie辰n thai ky淡 co湛 nguy c担 cao

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N tdomodagayotruonghopnstbinhthuong 100401102728-phpapp01

  • 1. O M DA GAY DAY TRNG HP NHIEM SAC THE BNH THNG
  • 2. NH THE NAO LA O M DA GAY DAY? 38 48 58 68 78 CRL (mm) 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 NT(mm) 99th centile 95th centile NT N Survivors < 95th centile 6371 6279 (98.6%) 95th 99th centile 162 159 (98.1%) > 99th centile 73 60 (82.2%) Total 6606 6498 (98.4%) Michailidis 2001
  • 3. o辰 m担淡 da ga湛y: 単a探 tra探i qua 10 na棚m va淡 va達n co淡n la淡 mo辰t ga湛nh na谷ng tre但n vai Ultrasound Obstet Gynecol 2001; 18: 5-8 Tin to叩t la淡 単o辰 m担淡 da ga湛y b狸nh th旦担淡ng va淡 tin xa叩u cu探ng la淡 単o辰 m担淡 da ga湛y b狸nh th旦担淡ng . . . Yves Ville 2001
  • 4. N=4,767; Snijders et al 1998; Souka et al 1998; 2001; Michailidis & Economides 2001 15%46.2%19.0%64.5%>6.5 mm 30%24.2%10.1%50.5%5.5-6.4 mm 50%18.5%3.4%33.3%4.5-5.4 mm 70%10.0%2.7%21.1%3.5-4.4 mm 93%2.5%1.3%3.7%95th-99th centiles 97%1.6%1.3%0.2%<95th centile So叩ng kho短eThai ba叩t th旦担淡ng na谷ng Thai che叩t BAT THNG NST O M DA GAY NST BNH THNG O M DA GAY DAY HAU QUA TRC MAT
  • 5. Nguy c担 ha辰u qua短 ba叩t l担誰i ch脱 t旦淡 2- 4% ne叩u MDG da淡y la淡 1 da叩u ch旦湛ng 単担n 単o辰c o辰 m担淡 da ga湛y da淡y- NST b狸nh th旦担淡ng HAU QUA LAU DAI Maymon 2004, Souka 2005 68 / 1837 (3.7%)Cha辰m pha湛t trie奪n ta但m than hoa谷c ma辿c HC di truyen Ville 2001
  • 6. MDG da淡y va淡 bo辰 NST b狸nh th旦担淡ng: S旦誰 lie但n quan v担湛i nh旦探ng ba叩t th旦担淡ng ve ca叩u tru湛c T畛ng s畛: 14.2% (Maymon 2004) Nh旦探ng b畉t th動畛ng lie但n quan cha谷t che探 v担湛i MDG da淡y Ba叩t th旦担淡ng tim (6%: RR 6.6) Thoa湛t v嘆 hoa淡nh Thoa湛t v嘆 ro叩n Ba叩t th旦担淡ng ve h狸nh da湛ng c担 the奪 Kho叩i u trong long ng旦誰c Ba叩t th旦担淡ng co辰t so叩ng
  • 7. D嘆 ta辰t tim/ Suy tim Ba叩t th旦担淡ng he辰 ba誰ch huye叩t S旦誰 che淡n e湛p trong long ng旦誰c Ta辿c nghe探n t坦nh ma誰ch: 単au & co奪 Thay 単o奪i ca叩u ta誰o cu短a l担湛p ha誰 b狸 Ta棚ng MDG v担湛i bo辰 NST b狸nh th旦担淡ng Be辰nh nguye但n (1)
  • 8. Sebire et al 1996 Bo辰 NST b狸nh th旦担淡ng, NT>3.5 mm 426 xe湛t nghie辰m TORCH ma湛u me誰 (+) 6 (1.4%) Nhie達m tru淡ng ba淡o tthai NONE Phu淡 thai kho但ng mong 単担誰i >16 Tuan 63 xe湛t nghie辰m TORCH ma湛u me誰 (+) 6 (9.5%) Nhie達m tru淡ng ba淡o thai Ta叩t ca短 Ta棚ng MDG v担湛i bo辰 NST b狸nh th旦担淡ng Be辰nh nguye但n (2) Nhie達m tru淡ng ba淡o thai Thie叩u ma湛u thai nhi Protid ma湛u thai nhi tha叩p
  • 9. Ba叩t th旦担淡ng tim + nhie達m sa辿c the奪 b狸nh th旦担淡ng MC Tha但n MP Ong M He誰p Tho但ng lie但n tha叩t the奪 quanh ma淡ng 単旦担誰c van 3 la湛 che phu短 1 phan MDG 6 mm, 単a短o ng旦担誰c so湛ng a cu短c do淡ng ma湛u qua o叩ng t坦nh ma誰ch Bilardo 2001 Hyett 1996 / 7
  • 10. Be辰nh tim ba奪m sinh 担短 tre短 nho短 0 10 20 30 40 50 60 Che叩t s担 sinh Che叩t 担短 tre短 nho短 OPCS: 1996 data
  • 11. o辰 nha誰y ca短m cu短a sie但u a但m th旦担淡ng qui (Qua h狸nh 畉nh tim 4 bu畛ng) Grandjean et al. 1998 Eurofetus project 0 10 20 30 40 50 60 70 80 90 Tim TKTW D a ditatC o cotsong N ieu-sinh ducD aday-ruot
  • 12. Atzei et al 2004, n=6,921 0 50 100 150 >M-95th 95th- 3.5 3.5-4.4 4.5-5.4 >5.5 o辰 m担淡 da ga湛y (mm) Tansua叩tma辿c(/1000) 126.7 64.4 35.2 18.2 8.7 2,064 2,365 6,54 20,2 22,1 <trung b狸nh 1,415 4.9 37.5% Tam soa湛t nh旦探ng d嘆 ta辰t tim ch鱈nh 4.9%160 (2.4)67,256To奪ng 25.9%5.0%27 (2.1)12,978Hafner et al 2003 45.0%2.5%20 (5.5)3,655Ovros et al 2002 15.4%3.5%26 (3.5)7,339Mavrides 2001 36.4%3.5%11(1.7)6,606Michailidis 2001 11.1%2.6%9 (2.0)4,474Schwarzler 1999 56.0%6.2%50 (1.7)29,154Hyett et al 1999 50.0%2.8%4 (2.5)1,590Bilardo et al 1998 38.5%8.9%13 (8.9)1,460Josefsson 1998 DRFPRBTBS n (/1,000) NTa湛c gia短 MDG da淡y v担湛i bo辰 NST b狸nh th旦担淡ng
  • 13. The叩 na淡o la淡 1 ch旦担ng tr狸nh tam soa湛t tha淡nh co但ng? Ta湛c gia短 n BTBS Tan sua叩t DR (NT 3.5mm) Mavrides 01 7339 26 3.5 / 1000 11.5 % Hyett 99 29154 50 1.7 / 1000 40 % Michailidis 01 6650 11 1.7 / 1000 27.3 % 1 ly湛 do 単e奪 ch脱 単嘆nh sie但u a但m tim Ta湛c gia短 BTBS / n (NT 3.5) PPV Mavrides 3 / 60 1 / 20 (5%) Hyett 20 / 315 1 / 16 (6.3%) Michailidis 3 / 60 1 / 20 (5%)
  • 14. Sie但u a但m cho phu誰 n旦探 担短 Sydney N = 23,912 , c坦: MDG 3.5mm :251 (1.05%), c坦: Ba叩t th旦担淡ng NST: 91 (36.3%) 28 59 69 89 0 20 40 60 80 100 % 3.5-4.4 4.5-5.4 5.5-6.4 >=6.5 NT (mm) Adverse outcome
  • 15. SUFW MDG da淡y va淡 bo辰 nhie達m sa辿c the奪 b狸nh th旦担淡ng NT n Thai ch畉t khi sinh Sinh s畛ng (+ abn) Sinh s畛ng (no defects) 3.5-4.4 107 13 5 (2 CHD) 89 (83.2%) 4.5-5.4 29 11 2 (2 CHD) 16 (55.9%) 5.5-6.4 14 5 1 (1 CHD) 8 (57.1%) 6.5 10 5 0 5 (50%) T畛ng c畛ng 160 34 (21.3%) 8 (5.0%) 118 (73.7%) FMF 1320 240 (18.2%) 60 (4.5%) 1020 (77.3%) Souka 2001
  • 16. Ba叩t th旦担淡ng tim Loa誰i ba叩t th旦担淡ng MDG(mm) Ke叩t qua短 HVM/ TLT/He誰p d旦担湛i van MP 3.5 To叩t/ s旦短a ch旦探a AVSD (Tha叩t P tro辰i) 3.6 CDTK He誰p MC/ He誰p van 2 la湛 3.9 To叩t/ s旦短a ch旦探a Ke湛m co bo湛p tha叩t tra湛i 4.0 CDTK He誰p quai MC 4.2 To叩t/ s旦短a ch旦探a AVSD (dominant RV) 4.3 CDTK Be辰nh c担 tim ph狸 単a誰i / PS 4.9 HC Noonan Thie奪u sa短n van 3 la湛 5.5 CDTK Tho但ng lie但n tha叩t phan c担 5.6 To叩t/ s旦短a ch旦探a Da探n ro辰ng tha叩t P 6.2 FDIU 17wks BTBS ch鱈nh 10/160 1/16 (6.3%) McLennan & Sholler
  • 17. 11-14 tuan SA t狸m ba叩t th旦担淡ng Ba叩t th旦担淡ng NST D嘆 ta辰t l担湛n NST b狸nh th旦担淡ng Kho但ng co湛 d嘆 ta辰t 14-16 tuan SA t狸m ba叩t th旦担淡ng SA tim thai 20 tuan SA t狸m ba叩t th旦担淡ng Sa tim thai Kho但ng d嘆 ta辰t Da ga湛y va達n ra叩t da淡y Ba叩t th旦担淡ng l担湛n Kho但ng d嘆 ta辰t Da ga湛y va達n co淡n da淡y Qua短n ly湛 s旦誰 ta棚ng MDG Kho但ng co湛 ba叩t th旦担淡ng Ba叩t th旦担淡ng l担湛n Da叩u ch旦湛ng cu短a ca湛c HC di truyen Phu淡 thai FBS T soa湛t nhie達m tru淡ng Kie奪m tra di truyen
  • 18. Ke叩t lua辰n Ne叩u MDG v旦担誰t qua湛 3.5 mm . Khoa短ng 1/3 co湛 ba叩t th旦担淡ng nhie達m sa辿c the奪 So叩 co淡n la誰i: 1/4 se探 co湛 1 ke叩t qua短 ba叩t l担誰i 1/16 se探 co湛 1 ba叩t th旦担淡ng tim l担湛n Ke叩t qua短 ba叩t l担誰i t旦淡 2-4% ne叩u MDG ta棚ng 単担n 単o辰c Can sie但u a但m tim thai (Qu鱈 1/ Qu鱈 2) Ra叩t h旦探u hie辰u khi co湛 1 ch旦担ng tr狸nh tam soa湛t be辰nh tim ba奪m sinh 単旦担誰c thie叩t la辰p No湛 単o湛ng vai tro淡 nh旦 la淡 1 tha淡nh phan trong 1 chuo達i kie奪m tra 単e奪 pha湛t hie辰n thai ky淡 co湛 nguy c担 cao