Fetal echocardiography in the 3rd trimester of pregnancy as an essential element of modern prenatal diagnostics and perinatal care – recommendations of Polish Society of Prenatal Cardiology 2020

Abstract

The purpose of this article is to show that fetal echocardiography should also be performed in the third trimester of pregnancy, both in normal and complicated pregnancies. The article presents a review of the current literature presenting the possibilities and goals of fetal echocardiography in the third trimester of pregnancy in situations such as: coarctation of the aorta, premature constriction of the ductus arteriosus, increased fetal lung vascular resistance, hypoplastic left heart syndrome, dextro-transposition of the great arteries, fetal growth restriction, pregestational diabetes mellitus, and gestational diabetes mellitus. A specific feature of fetal echocardiography in the third trimester is the emphasis on the assessment of fetal heart function; therefore, the article describes the current method of assessing it.

Evaluation of an artificial intelligence algorithm (HeartAssistᵀᴹ) in the assessment of fetal cardiothoracic ratio: a prospective study

“…Measurement of fetal cardiac size is of paramount importance in the study of the fetal thorax, and it has been applied in the identification of different cardiac and non-cardiac diseases [1,2]. The fetal cardiothoracic (C/T) circumference ratio is a parameter more currently used in the assessment of fetal cardiac size -it is the ratio of the cardiac circumference (CC) to the thoracic circumference (TC) and is measured by fetal ultrasonography [3,4].…”

Fetal echocardiography is not only used to detect congenital heart disease but also to monitor fetuses, especially those with different pathologies

“…Unfortunately, the manuscript lacks basic data, as mentioned below: gestational age at diagnosis of the congenital heart defect, more detailed description of fetal cardiovascular function during gestation, number of fetal echocardiographic examinations and strategy of fetal monitoring, fetal cardiovascular physiology changes with gestation, and indication for Cesarean section. As recommended by the Polish Society of Prenatal Cardiology, every congenital heart defect detected prenatally should be monitored using fetal echocardiography [2]. Contemporary fetal echocardiography focuses not only on the analysis of the heart structure but also on the assessment of its function.…”

“…Contemporary fetal echocardiography focuses not only on the analysis of the heart structure but also on the assessment of its function. The evaluation of the fetal heart function is most valuable in the third trimester of pregnancy, just before delivery [2]. If the fetus, especially with a congenital heart defect or functional anomalies, is monitored for several weeks using fetal echocardiography, and the last examination is performed shortly before delivery, the condition of the newborn in the first hours and days of extrauterine life can be reliably predicted [2,3].…”

“…The evaluation of the fetal heart function is most valuable in the third trimester of pregnancy, just before delivery [2]. If the fetus, especially with a congenital heart defect or functional anomalies, is monitored for several weeks using fetal echocardiography, and the last examination is performed shortly before delivery, the condition of the newborn in the first hours and days of extrauterine life can be reliably predicted [2,3]. Life-threatening congenital hydropericardium is an extremely rare condition and may be caused by infection, cardiac masses like tumors, and other chronic diseases, as mentioned by the authors.…”

Fetal echocardiography: One of the most important tools in fetal diagnosis and assessing wellbeing

“…Although some of these anomalies have no physiological impact on the fetal cardiovascular system, serial fetal echocardiographic observation of heart function during for example open fetal surgery for repair provide an insight into the response of the fetal heart to prenatal invasive intervention. [3][4][5][6][7][8] FE as an essential part of ultrasound examination can be also used in monitoring fetus with suspected congenital infection. 8 Viral infections are the major cause of fetal morbidity and mortality.…”