Role of routine fetal echocardiography in an unselected group of pregnant women for prenatal detection of cardiac malformations

Abstract

Objectives We investigated the potential for improvement in prenatal detection of congenital heart disease (CHD) by routinely performing detailed fetal echocardiography (FE) in all pregnant women. Methods Following routine obstetric sonography, 1445 unselected pregnant women were prospectively subjected to FE at gestational ages between 16 and 24 weeks, or at first visit, if they presented later. Maternal or fetal factors, conventionally known to be associated with risk of CHD, were noted. The prevalence and detection rates of cardiac abnormalities were determined, and confirmation of findings by postnatal follow-up was done to ensure accuracy of FE. Prevalence of CHD was compared in pregnancies with or without conventional risk factors. Results The overall prevalence of CHD was 8.3 per 1000; only 2 CHD cases belonged to the high maternal risk group, while 10 cases were observed without maternal risk factors. Cardiac malformations were suspected in 14 fetuses during obstetric scan; but, only 5 of them had CHD, remaining 9 had structurally normal hearts. 50% of CHD cases occurred in pregnancies not associate with any (fetal or maternal) risk factor. The sensitivity, and specificity for prenatal CHD detection were 91.7% and 100% respectively. Conclusions Our study indicates that a substantial proportion of CHD cases occur in women not having high risk of giving birth to children with CHD. FE is a highly sensitive and specific test with strong predictive values. We recommend that FE should be done in every pregnancy.

Fetal echocardiography in a low‐income setting: relying on local Maternal‐fetal medicine experts for detection of fetal cardiac anomalies

“…By contrast, a study from India in which 1445 unselected pregnant women who were prospectively subjected to FE between 16 and 24 weeks of gestation or at first visit demonstrated that FE has a high sensitivity and specificity in detecting CHD, recommending that it should be done in every pregnancy. The overall prevalence of CHD in that study was found to be 8.3/1000 (12 had CHD, with cardiac tumors and patent ductus arteriosus being identified among the cardiac anomalies detected) 21 . In the present study, the anomalies detected were hypoplastic left heart syndrome, pulmonary stenosis, cardiac tumor, absent Doppler, and supraventricular tachycardia.…”

A study on referral pattern for fetal echocardiography and identifying the various risk factors for congenital heart defects

“…While another study from Northern India found incidence of CHD as 15 per 1000. 12,13 In a recent study by Qiu X and coworkers 14 evaluated fetal echocardiography of 67,834 pregnant women in which 1492 fetuses were found to have CHD. Prenatal genetic examination on amniotic fluid and cord blood, revealed chromosomal abnormalities in 20.43% of foetuses with CHD.…”

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“…While another study from Northern India found incidence of CHD as 15 per 1000. 12,13 In a recent study by Qiu X and coworkers 14 evaluated fetal echocardiography of 67,834 pregnant women in which 1492 fetuses were found to have CHD. Prenatal genetic examination on amniotic fluid and cord blood, revealed chromosomal abnormalities in 20.43% of foetuses with CHD.…”