The reported prenatal detection rates (PDRs) for significant congenital heart disease (sCHD) have been suboptimal, even in the current era. Changes in prenatal ultrasound policy and training may lead to improved prenatal detection of sCHD. This study analyzed the results of a policy to assess fetal cardiac outflow tracts shown by screening prenatal ultrasound using the electronic medical record (EMR). During a 6-year period, fetuses and patients younger than 1 year with sCHD were identified. The EMR was used to gather detection and outcome data. As an internal control within the same health care system, the PDR of only the surgical cases was compared with that of a similar group in which documentation of the fetal cardiac outflow tracts was not standard policy. Among 25,666 births, sCHD was identified in 93 fetuses or patients, yielding an incidence of 3.6 per 1,000 births. The PDR was 74.1%. Detection after birth but before discharge was 20.4%, and detection after discharge was 5.4%. A significant improvement in the PDR of sCHD was found when a concerted effort was made to obtain fetal cardiac outflow tract views during pregnancy screening (59.3 vs. 28%). Within an integrated health care system and with the use of an EMR, a PDR of 74% can be obtained, and 94% of sCHD can be detected before discharge. A concerted program that includes documentation of fetal cardiac outflow tracts in the pregnancy screening can result in improved PDR of sCHD.
Pulsed Doppler duplex sonography was performed on 58 patients in order to determine whether Doppler ratios of umbilical and uterine artery flow velocity waveforms vary with the site at which measurements are taken along their respective arterial beds. Umbilical artery ratios were significantly higher at the fetal end of the cord when compared to ratios at the placental cord insertion. In the maternal circulation, ratios from arcuate artery waveforms were lower than those obtained from A growing body of literature has assessed the role of umbilical and uterine artery Doppler ratios in the prediction of normal and abnormal pregnancy outcomes. 1 -6 Before an abnormal preg~ nancy can be identified, ratios found in normal pregnancy must be established and the sources of variation affecting the ratios determined. Possible sources of variation include differences in populations, equipment, technique, and methods of analysis. Preliminary studies have suggested that waveforms from umbilical arteries may differ at different locations along the umbilical cord?.S The goal of this investigation was to determine whether Doppler ratios of umbilical and uterine artery flow velocity waveforms vary with the site at which measurements are taken along their respective arterial beds.Received
MATERIALS AND METHODSThe patient population consisted of 58 patients attending the Prenatal Clinic at The Mount Sinai Medical Center who were referred for a dating ultrasound examination. Only patients who had no antepartum complications, who were greater than or equal to 20 weeks gestation, and who signed the informed consent approved by the hospital's institutional review board were included in the study.Pulsed Doppler duplex sonography was performed on an umbilical artery and the right uterine artery of each patient. The equipment used was an ACUSON 128 with dedicated software that enabled measurement of the peak systolic velocity (5), end-diastolic velocity (D), and mean velocity (mean) of the waveform.In order to determine whether the ratios differed according to location, umbilical artery waveforms were obtained at two sites: fetal, near the cord insertion into the fetal abdomen, and placental, near the insertion of the cord into the placenta. Uterine artery waveforms were also obtained at two locations: arcuate, defined as an arterial waveform obtained within the lateral wall of
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