Fetal heart examination at the time of 13 weeks scan: a 5 years’ prospective study

Abstract

Objective To evaluate our ability in classifying the fetal heart as normal or abnormal during the 1st trimester scan through fetal cardiac examination and determining the best time for this examination. Methods This was a prospective study performed on 3240 pregnant women to examine the fetal heart. Four chambers view and ventricular outflow tracts were mainly examined during the scan. We used grayscale and color mapping in the diagnosis. Color Doppler was used if additional information was needed, and all patients were rescanned during the 2nd trimester to confirm or negate our diagnosis. Results The cardiac findings were normal at both scans in 3108 pregnancies. The same cardiac abnormality was detected at both scans in 79 cases. In 36 cases there was false-positive diagnosis at the early scan; in 20 of these cases, there were mildly abnormal functional findings early in pregnancy with no abnormality found later. In 17 fetuses, there was discordance between the early and later diagnosis due to missed or incorrect diagnoses. The best time to do fetal heart examination during 1st trimester is between 13 and 13 + 6 weeks. Conclusion A high degree of accuracy in the identification of congenital heart disease (CHD) can be achieved by a 1st trimester fetal echocardiography.

First‐trimester ultrasound detection of fetal heart anomalies: systematic review and meta‐analysis

“…The included studies were published between 1998 and 2020. Studies were performed in a variety of healthcare settings, although the majority (n = 49) took place, at least in part, in either a university hospital or a tertiary-care affiliated center 16,17,[31][32][33][34]36,38,40,42,43,46,47,49,50,52,[55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][71][72][73][74][75][76][77][78][79]81,[84][85][86][87][88][89][90][91] (Tables S1 and S2). Five studies performed ...…”

“…The electronic search yielded 4108 citations following removal of duplicates, of which 223 underwent full‐text review, resulting in the inclusion of 63 studies 16 , 17 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 ,…”

“…Oztekin (2009) 43 Sinkovskaya (2010) 45 García Fernández (2019) 65 Sainz (2020) 67 Lombardi (2007) 39 Bennasar (2009) 42 Hartge (2011) 46 Krapp (2011) 48 Volpe (2011) 49 Becker (2012) 50 Iliescu (2013) 55 Orlandi (2014) 57 Andrew (2015) 58 Wiechec (2015) 60 Tudorache (2016) 62 De Robertis (2017) 63 Vayna (2018) 68 Zheng (2018) 69 Chen (2019) 70 Duta (2021) 71 Ebrashy (2019) 72 Syngelaki (2019) 74 Pooled estimate 73 1.00 (0.74-1.00) Figure 3 Forest plot of sensitivity of first-trimester ultrasound in the detection of major fetal cardiac abnormalities in non-high-risk populations, which included low-risk, mixed-risk and unselected populations. Only first author of each study is given.…”

The importance of four-chamber and three-vessel (3-V) views in the screening of fetal cardiac anomalies in the first trimester

“…Fetal echocardiography in the first trimester in particular enables the early diagnosis and management of the anomalies (such as consultancy, conducting genetic tests, early termination and case follow-up). [1,2,9] The practicability of fetal heart examination or obtaining the cross-sections is possible in many cases, and the body mass index of pregnant woman, presence of previous surgical operation, CRL, the amount of amniotic fluid and fetal position are very important. In the study of Orlandi et al, [10] cardiac examination could not be performed by neither transabdominal (TA) nor transvaginal (TV) approach in 141 (3.4%) cases.…”

“…Ebrashy et al [9] prospectively assessed basically fourchamber and ventricular outlets of 3240 pregnancy cases in the first trimester and performed fetal heart examination, and they re-assessed all cases in the second trimester. They diagnosed 115 cases with or suspected of the cardiac anomaly in the first trimester.…”