Isolated Single Umbilical Artery and Fetal Echocardiography: A 25‐Year Experience at a Tertiary Care City Hospital

Gurram, Padmalatha; Figueroa, Reinaldo; Sipusic, Elizabeth; Kuhnly, Nicole; Clark, Shealagh; Janicki, Mary Beth

doi:10.1002/jum.14353

Cited by 19 publications

(19 citation statements)

References 29 publications

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“…However, it cannot be overlooked that when Complete cardiac structures are confirmed normal, 50% of those concerning on echocardiogram were false positives with only one of the 10 considered critical. These findings mimic prior studies that demonstrated not only a low detection rate for major CHD on screening fetal echocardiogram with an unremarkable detailed ultrasound, but also a not insignificant false positive rate on echocardiograms . When combining our dataset with those previously reported, only five major/critical CHDs were discovered despite 4237 screening ultrasounds for a detection rate of 0.12% (95% CI, 0.01%‐0.22%) .…”

Section: Discussionsupporting

confidence: 86%

“…These findings mimic prior studies that demonstrated not only a low detection rate for major CHD on screening fetal echocardiogram with an unremarkable detailed ultrasound, but also a not insignificant false positive rate on echocardiograms. [7][8][9]15,16 When combining our dataset with those previously reported, only five major/critical CHDs were discovered despite 4237 screening ultrasounds for a detection rate of 0.12% (95% CI, 0.01%-0.22%). [7][8][9]15,17 Approximately 850 screening fetal echocardiograms would be needed to detect one major/critical CHD missed on detailed anatomy ultrasound with complete normal cardiac structures, which is even higher than our estimated 750 screening fetal echocardiograms needed to detect one critical CHD.…”

Section: Discussionmentioning

confidence: 99%

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The added value of screening fetal echocardiography after normal cardiac views on a detailed ultrasound

et al. 2019

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Objective Evaluate fetal echocardiography's ability to detect critical (lesions requiring immediate neonatal intensive care) congenital heart disease (CHD) after normal anatomic cardiac views on detailed ultrasound. Methods Singletons with both a detailed ultrasound at 18 + 0 to 22 + 6 weeks and echocardiogram performed at least 14 days later and at 20 + 0 to 24 + 6 weeks. Cases with cardiac pathology on detailed ultrasound were excluded. Different combinations of cardiac views were described: Basic (four‐chamber, outflow tracts), Expanded (plus three‐vessel view), and Complete (plus ductal/aortic arches). “Normal” was defined on either 2D gray scale or color Doppler. Primary outcome was rates of critical CHD missed on ultrasound but seen on fetal echocardiogram. Results One thousand two hundred twenty‐three women had normal Basic cardiac views. One thousand one hundred ninety (97.3%) were confirmed normal on echocardiogram. Twenty‐one (1.71%) total CHDs were missed, and three were critical (0.25%; 95% CI, 0.03%‐0.53%). Of the 1,223 women, 763 had Complete views. Ten (1.31%) total CHDs were missed and one (0.13%; 95% CI, 0.13%‐0.36%) was confirmed critical. Conclusion Fetal echocardiography can increase CHD detection despite normal cardiac anatomy on detailed ultrasound; however, CHDs missed are rarely critical. Approximately 750 fetal echocardiograms need to be performed to detect one critical CHD with Complete normal cardiac views on detailed ultrasound.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

The added value of screening fetal echocardiography after normal cardiac views on a detailed ultrasound

et al. 2019

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“…21 The adding of extended basic views during obstetric screening ultrasound also resulted in a change of perspective that isolated SUA might not be an indication for fetal echocardiography. 9,10,22,23 Twenty-five-year experience of Gurram et al 24 also highlighted the view point that fetuses with a SUA need no echocardiogram, in the absence of structural abnormalities, and with normal cardiac views at the anatomic survey. Besides, Chen et al 8 found that SUA pregnancy with low risk did not increase the incidence of CHD, in accordance with our results.…”

Section: Discussionmentioning

confidence: 99%

Is echocardiography necessary for all single umbilical artery fetuses? A retrospective study in a selected Chinese population

Wang

Xin

et al. 2019

J of Obstet and Gynaecol

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Aim Previous evidence on the relationship between single umbilical artery (SUA) and congenital heart disease (CHD) is controversial. We thus conducted a retrospective study to explore the potential risk factors associated with CHD in SUA fetuses, and verify if all these SUA fetuses should be referred for detail fetal echocardiography. Methods We reviewed medical records of SUA fetuses referred to Xinhua Hospital for fetal echocardiography between September 2009 and February 2014. All the pregnancies were divided into two groups of CHD and non‐CHD according to the results of fetal echocardiography. The maternal and fetal characteristics were compared via χ2 test and Fishers’ test. Furthermore, Poisson regression was used to analyze the risk factors associated with CHD in SUA pregnancies. Results Nineteen CHD cases (12.5%) were detected among 152 SUA fetuses, all with abnormal cardiac views during obstetric screening ultrasound (P < 0.001). χ2 test showed that abnormal cardiac screening findings, extracardiac abnormality and infection or threatened abortion during first trimester were significantly associated with prenatal detection of CHD (P < 0.001). Multivariable Poisson regression after adjustment found that SUA fetuses with extracardiac abnormality had 4.74 (95% confidence interval: 1.89, 11.90) times higher risk of CHD. Conclusion Incidence of CHD was higher in SUA cases, and CHD fetuses could be screened efficiently by abnormal cardiac screening during obstetric screening ultrasound. SUA fetuses with extracardiac abnormality and maternal risk factors have higher risk of CHD, and should be strongly recommended for fetal echocardiography. In contrast, SUA fetuses without above situations might only need routine obstetric follow‐up.

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“…Porém, na presença de um ou mais fatores de risco, a incidência de CC era de 15,6%, sendo observados coarctação da aorta, defeito de septo ventricular e defeito de septo atrioventricular entre as mais frequentes. Assim, os autores sugerem que a triagem com ecocardiografia em fetos com AUU não precisa ser universal e pode ser restrita a gravidezes com fatores de risco, 14 fato corroborado por Gurram et al 15 Assim, alertamos o pediatra que, embora a ocorrência de artéria umbilical isolada usualmente não cause grande repercussão ao feto, quando associada a quaisquer fatores de risco, estará indicado aconselhamento genético, ecocardiografia e avaliação ultrassonográfica abdominal e de aparelho geniturinário.…”

Section: Discussionunclassified

Artéria umbilical única - Relato de caso

Sabino¹,

Klein²,

Fernandes³

et al. 2018

Rev Ped SOPERJ

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Artéria umbilical única; Anormalidades congênitas; Relações materno-fetais. Resumo Introdução: apresentamos um caso de artéria umbilical isolada, que, embora seja um achado visto frequentemente ao exame ultrassonográfico pré-natal e nas salas de parto, pode estar associado a outras malformações congênitas. Objetivo: relatar um caso de artéria umbilical única. Descrição do caso: apresentamos um caso de artéria umbilical isolada em um recém-nascido a termo, sem repercussões maternas ou fetais detectáveis. Discussão: a presença de artéria umbilical única pode estar associada a outras malformações congênitas. Na presença de fatores de risco, tais como idade avançada, alterações genéticas, diabetes mellitus durante a gravidez, história familiar de doença cardíaca congênita ou inseminação artificial, deverá ser realizado aconselhamento genético, ecocardiografia e ultrassonografia abdominal e geniturinária.

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Isolated Single Umbilical Artery and Fetal Echocardiography: A 25‐Year Experience at a Tertiary Care City Hospital

Abstract: Fetuses with a single umbilical artery, in the absence of structural abnormalities, and with normal cardiac views at the time of the anatomic survey do not warrant an echocardiogram.

Cited by 19 publications

References 29 publications

The added value of screening fetal echocardiography after normal cardiac views on a detailed ultrasound

The added value of screening fetal echocardiography after normal cardiac views on a detailed ultrasound

Is echocardiography necessary for all single umbilical artery fetuses? A retrospective study in a selected Chinese population

Artéria umbilical única - Relato de caso

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