運用跨專科團隊於產前診斷胎兒心臟異常孕婦及家庭之照顧模式

Multidisciplinary Integrated Care for Pregnant Women and Their Families with Diagnosis of Fetal Congenital Heart Diseases

隨著醫療及產前檢查技術進步，先天性心臟病於產前診斷率日益提昇。針對胎兒患有先天性心臟病的孕婦及其家庭，本團隊整合跨專科照顧模式，提供正確診斷、追蹤、專家諮詢及轉介，使用自編之醫病共享決策工具，並透過胎兒護理師提供孕程管理、情緒支持，以達醫病共享決策之目的。其中228位接受胎兒心臟胎檢專家諮詢、64位接受小兒心臟內外科專家諮詢、27位接受跨專科團隊諮詢；結果共75位孕婦選擇終止妊娠、120位轉介至醫學中心生產；產後7位病嬰接受介入性心導管治療、40位接受手術治療。我們認為透過整合跨專科團隊之照顧模式，可提供孕婦及其家庭充分資訊、幫助決策，並可減輕焦慮、提供適當的醫療轉介，更可避免產後緊急轉送事件、錯失治療時機。

 

Advances in prenatal cardiac screening have resulted in an increasing number of prenatal diagnoses of congenital heart diseases (CHDs). To assist the expectant mothers and their families, we established an integrated care model that provides accurate diagnosis of fetal CHD, prenatal counseling, and referral as needed. We used self-developed patient decision aids. Moreover, a fetal nurse coordinated the pregnancy care management plan, offered support, and assisted these families through the process of shared decision-making (SDM). Among the participating families, 228 received prenatal counseling from fetal cardiologists, 64 received prenatal counseling from pediatric cardiologists and cardiovascular surgeons, and 27 participated in a multidisciplinary meeting in the third trimester. After completing the SDM process with the health care team, 75 families opted to terminate the pregnancy, and 120 mothers delivered in a tertiary center. Among the neonates with severe CHD, seven received interventional catheterization and 40 received cardiac surgery soon after birth. With the integrated care of the multidisciplinary team for the full prenatal-to-postnatal period, we helped the expectant mothers and their families to understand CHD, supported them through the process of decision-making, and assisted in reducing their anxiety. The proposed care model also allows for transfer of expectant mothers to specialized wards for critical CHDs, optimizes perinatal management, and possibly improves outcomes.