OGO 6507 Accuracy of fetal echocardiography in high-risk patients

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2016

Background: Congenital heart diseases are the commonest fetal congenital defects and until nowadays most of them are bypassed without prenatal diagnosis to be still considered as unexplained stillbirths or perinatal deaths. In this study, we tried to prove the importance of routine fetal cardiac screening in the ANC visits and also confirming its high accuracy. Methods: This study was prospective longitudinal one, including doing ISUOG extended fetal cardiac screening for one hundred foetuses scheduled at certain gestational age visits, whom their half were at risks for CHDs and the other were not, with comparing the results to antenatal and postnatal detailed fetal echocardiography. Results: The best gestational age for the fetal cardiac screening was at 18-22 weeks gestation. The accuracy of the screening to the antenatal echocardiogram was 96%-100% and to the postnatal one was 96%-98%. Conclusions: CHDs are still the commonest congenital fetal defects and the antenatal fetal cardiac screening by extended basic views has high accuracy. Making this screening a routine in ANC visits will be of great help in improving the fetal outcome.

Obstetrics & …, 1995

To assess the indications, use, and yield of fetal echocardiography. Methods: We reviewed our 8-year experience with fetal echocardiography at a large health maintenance organization in northern California to assess "the yield of abnormal findings for each indi~:ation and the accuracy of prenatal cardiac diagnosis. The study included 915 fetuses undergoing fetal echocardiography between 18-38 weeks' gestation because of accepted indications. All live-born infants had the presence or absence of congenital heart disease (CHD) confirmed postnatally. Results: Family history of CHD led to 34% of all fetal echocardiography studies, with a detection rate of 0.7%. Maternal diabetes mellitus accounted for 28% of all studies, with a detection rate of 1.2%. Exposure of mothers to a potential teratogen led to 48 studies, but no abnormalities were detected. Only 4% of fetal echocardiograms were obtained because of a suspected heart defect noted on a screening obstetric sonogram; this indication had a detection rate of 68% and yielded by far the most cases of severe CHD. Based on the expected occurrence rate of severe CHD in our closed referral system, only about 15% were referred for fetal echocardiography and detected prenatally. Conclusion: Basing fetal echocardiography referral on risk factors misses most clinically significant detectable CHD.

Donald School Journal of Ultrasound in Obstetrics & Gynecology, 2007

Indian Journal of Obstetrics and Gynecology Research, 2020

Fetal echocardiography is a screening tool mostly reserved for high risk pregnant women. Early identification of cardiac anomalies improves perinatal outcomes. However this tool need not be restricted to high risk cases only but can be used for all pregnant women. Materials and Methods: This 6 month observational study included singleton pregnant women aged 18-40yrs attending antenatal clinic with one to two decisive risk factors for fetal congenital heart disease (CHD). A fetal echocardiography was done between 18 to 24 week of pregnancy. Results: Of the 50 cases a total of 4 cases of CHD's were diagnosed by abnormal fetal echocardiography. The remaining 46 cases showed a complete accord between fetal and postnatal echo findings except one case where a membranous VSD with Left to Right shunt, was detected by pretnatal echo but was absent in the post natal finding. Conclusion: Our study strongly endorse all mothers to undergo fetal echocardiogram by trained specialists who are at risk of congenital heart disease such as maternal congenital heart disease and diabetes in pregnancy.

Anadolu Kardiyoloji Dergisi/The Anatolian Journal of Cardiology, 2010

Objective: Fetal echocardiography (FE) is considered for fetal, maternal or hereditary reasons in pregnants with suspect of intrauterine heart disease (IUHD). However, in few studies it was reported that most of the fetuses with IUHD are in the low-risk group (suspicion of IUHD during 2 nd trimester ultrasound, lack of good vision of the heart, self-referral). Our aim is to examine retrospectively the reasons for referral of pregnants, the results of FE, distribution of pregnants having fetuses with IUHD according to low-and high-risk factors and to evaluate reliability of FE. Methods: Our study group consisted of 1395 fetuses and 1370 pregnants underwent FE between 1999 and 2006. These cases included selfreferred women and the pregnants having previous child or family history of cardiac anomaly or referred by obstetricians. The prevalence of IUHDs in low-and high-risk pregnancies was compared by Chi-Square test. Results: The low risk group included 453 patients and the remaining 917 women were in the high-risk group. Intrauterine heart diseases were detected in 152 (10.9%) of 1395 fetuses. The prevalence of IUHDs was 19% in the low-risk group and 7% in the high-risk group. Of the152 fetuses 56.6% were in the low-risk group and 43.4% were in the high-risk group. The sensitivity of FE for diagnose of IUHDs was 97%, the specificity was 100%. Conclusion: Fetal echocardiography is highly reliable method for diagnosing of IUHDs. The most IUHDs occur in the low-risk group.

Pediatrics & Therapeutics, 2016

Early fetal echocardiography (EFEC) is a fetal cardiac ultrasound analysis performed between the 12th and 16th week of pregnancy (compared with the usual 18-22 weeks). In the last 10 years, the introduction of "aneuploidy sonographic markers" in screening for cardiac defects has led to a shift from late second to end of the first trimester or beginning of the second trimester of pregnancy for specialist fetal echocardiography. In this prospective study, early obstetric screening was performed between January 2014 and October 2015, using "aneuploidy sonographic markers" following SIEOG Guidelines 2014. These parameters were then collected and strategically combined in an evaluation score to select the group of pregnancies for performing EFEC, in accordance with the American Society of Echocardiography guidelines for fetal Echocardiography. All second-level examinations were performed transabdominally using a 3D convex volumetric probe with frequency range of 4-8 MHz (Accuvix-Samsung). The outcome data included transabdominal fetal echocardiography from 18 weeks to term and after birth. Overall, 99 pregnant women in the first trimester underwent EFEC (95 singleton and 4 twin pregnancies). Specifically, 30 fetuses were evaluated for extra-cardiac anomalies evidenced by obstetric screening (30%), 25 for family history of congenital heart diseases (25%), 8 for family history of genetic-linked diseases (8%), 4 for heart diseases suspected by obstetric screening (4%) and 19 by normal screening (19%). Was detected 11 (10.7%) CHD, when EFEC detected CHD, were compared to those performed later in pregnancy (18 weeks GA-term), a high degree of diagnosis correspondence was evidenced. The higher sensitivity value of EFEC vs late-FE, in comparison with the post-natal value, coupled with the high EFEC specificity shown vs both the end points, enabled us to consider it as a really reliable diagnostic technology, at least in perienced hands. The introduction of a key combination of the more sensitive obstetric and cardiologic variables should facilitate the formulation of a possible flow-chart as a guide for CHD at-risk pregnancies.

Erciyes Medical Journal, 2020

Objective: Fetal echocardiography is an important and growing diagnostic tool for early detection of congenital heart diseases and rhythm problems. In this study, we evaluated retrospectively indications and prenatal and postnatal diagnoses for fetal echocardiography. Materials and Methods: Prenatal and postnatal echocardiographic diagnoses of the newborns and data of pregnant women who were referred to the Pediatric Cardiology Clinic of Ümraniye Training and Research Hospital between October 2018 and October 2019 and newborns were obtained from medical recordings. Results: In this study, 138 patients were included. Eighty-one (58%) indication was suspected congenital heart disease, twenty-four indications (13%) was screening test positivity, 10 hyperechogenic focus, two advanced age pregnancy, six diabetes mellitus. Two were hydrops fetalis (immune/nonimmune), five dysrhythmias, one fetal anomaly. Hereditary causes were congenital heart disease in seven previous pregnancies. Sixty-eight patients with normal fetal echocardiography were normal in the postnatal period. Diagnosis of cyanotic congenital heart diseases was 24.2% of all patients, and 47.1% were acyanotic congenital heart disease in our study population. Four of the patients had arcus aorta anomalies. One patient had sustained supraventricular tachycardia with hydrops fetalis resolved with sotalol and digoxin treatment. One patient had neonatal thyrotoxicosis because of maternal graves disease Conclusion: Fetal echocardiography is a useful and noninvasive method for early diagnosis and treatment, especially in rhythm problems. Also, diagnosis of congenital heart diseases antenatally is useful for planning the management of the disease.

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2005

Fetal echocardiography has been accepted as a prenatal noninvasive diagnostic tool of cardiovascular diseases in fetuses for more than three decades. There are limited data in Thailand. A retrospective study of prenatal, natal and postnatal data of pregnant women who had fetal echocardiography at Siriraj Hospital, Bangkok, Thailand, from January 1999 to July 2005 was conducted. In total, there were 117 pregnant women who had fetal echocardiography under standard indications. Median age of pregnant women was 30.2 (17.3-44.2) years old. Median gestational age at the first fetal echocardiography was 29 (17-40) weeks. Median number of time the women had fetal echocardiography was 1 (1-10). Indications for fetal echocardiography were; obstetricians suspected of fetal cardiovascular diseases, multiple anomalies, family history of congenital heart diseases, chromosome anomalies, hydrops fetalis, and other indications (53.8%, 12%, 11.1%, 8.5%, 8.5% and 6.0% respectively). There were 49 (41....

Nepalese Heart Journal, 2016

Background and Aims: Fetal echocardiography is helpful in early detection of Congenital Heart Disease.Our study was conducted to evaluate the most common indications of referral and outcome in a tertiary-care fetal echocardiography practice. Methods: A Cross-sectional analysis of all pregnant women referred by obstetricians to cardiology unit for fetal echocardiography over a 1-year period (July 2014 and July 2015) was performed. The primary indications for referral for fetal echocardiography were obtained from the obstetric referral forms. Outcome data were extracted from performa containing client's demographic, physical examination and the fetal echocardiograhic data. Postnatal Echocardiography was advised to all cases having positive echocardiographic finding. Results: A series of 251 fetal cardiac studies were reviewed. Average gestational age was 25.6 weeks (range, 18 to 38 weeks). Thirty-eight (15.1%) pregnant women had abnormal fetal cardiac findings. The most common referral for fetal cardiac scan was related to maternal indications (48.6%). Other indications were abnormal prenatal fetal findings in ultrasonography (23.1%), family history of CHD (12%), general screening (15.5%), and follow up of IVF(In-vitro fertilization) (0.8%). The highest yield of significant abnormal findings was there among patients referred with abnormal prenatal fetal finding in ultrasonography (47%). Conclusion: Majority of referral were for abnormal prenatal ultrasonographic findings. So, fetal echocardiography is an important part of overall management of the pregnancy at risk for producing an infant with congenital heart disease.

2021

The chances of detecting congenital heart disease are improved following structured protocols. Fetal heart disease is one of the main serious congenital malformations. The objective of this review is to present the benefits of sequential and routine cardiac evaluation in the first and early second trimesters and to identify the structures and pathologies that can be detected at this gestational age. The databases of PubMed, Medline, MD consult, Embase, Clinical Key, Scielo, and ScienceDirect, as well as specialized texts in Spanish and English were searched for diagnostic studies, systematic reviews, and meta-analysis related to the terms “early fetal echocardiography” and “congenital heart malformations” published between 2000 and 2019. Technological advances have revolutionized the fetal echocardiographic examination making possible the diagnosis of congenital heart disease from the first and early second trimester of pregnancy. However, it should be recognized that early fetal ec...