The outcome of structural heart defects diagnosed in the first trimester of pregnancy

Duţă, Simona; Veduță, Alina; Vayna, Ana Maria; Panaitescu, Anca Maria; Nedelea, Florina; Peltecu, Gheorghe

doi:10.1080/14767058.2019.1637849

Cited by 12 publications

(12 citation statements)

References 22 publications

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“…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.…”

Section: Study Protocol Studymentioning

confidence: 99%

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

Bradburn

Roberts

Papageorghiou

et al. 2022

Ultrasound in Obstet & Gyne

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Objectives: To determine the diagnostic accuracy of ultrasound at 11-14 weeks gestational age in the detection of fetal cardiac abnormalities, and to evaluate factors that impact detection rates.Methods: A systematic review of studies evaluating the diagnostic accuracy of ultrasound in the detection of fetal cardiac anomalies at 11-14 weeks gestational age was undertaken by two independent reviewers. Prospective and retrospective studies evaluating pregnancies at all levels of prior risk and in any healthcare setting were eligible for inclusion. The reference standard used was the detection of a major cardiac abnormality on postnatal or post-mortem examination. Data were extracted from included studies to populate 2 x 2 tables. Meta-analysis was performed using a random-effects model in order to determine the overall performance of first trimester ultrasound in the detection of major cardiac abnormalities overall and in addition, for individual types of cardiac abnormalities. Data were analysed separately for high-risk populations vs. non-high risk populations. Pre-planned secondary analyses were conducted in order to assess factors which may impact screening performance including: the imaging protocol used for cardiac assessment (including use of Colour Doppler), mode of ultrasound, publication year of study, and the index of sonographer suspicion at the time of scan. A risk of bias and quality assessment was undertaken for all included studies using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2).Results: An electronic search of four databases (Medline, Embase, Web of Science Core Collection and Cochrane Library) was conducted from January 1998 until July 2020 and identified 4108 citations. This led to 223 full text reviews from which a total of 63 studies were selected for inclusion. Data from a total of 328,214 screened fetuses were included. In non-high risk populations (45 studies, 306,872 fetuses), 1,445 major cardiac anomalies were identified (prevalence 0.41 (95% C.I. 0.39 -0.43)). Of these, 767 were correctly detected by first trimester examination of the heart and 678 were not detected. Pooled sensitivity was 55.80% (95% CI 45.87-65.50%,), specificity 99.98% (95% CI 99.97 -99.99%) and positive predictive value 94.85% (95% CI 91.63-97.32%). The cases diagnosed in the first trimester represent Accepted ArticleThis article is protected by copyright. All rights reserved.63.67% (95% CI 54.35 -72.49%) of all antenatally diagnosed major cardiac abnormalities. In high risk populations (18 studies, 21,342 fetuses) 480 major cardiac anomalies were identified (prevalence 1.36 (95% C.I. 1.20 -1.52)). Of these, 338 were correctly detected in the first trimester, and 142 were not detected. The sensitivity was 67.74% (95% CI 55.25 -79.06%), specificity 99.75% (95% CI 99.47 -99.92%) and positive predictive value 94.22% (95% CI 90.22 -97.22%). The cases diagnosed in the first trimester represent 79.86% (95% CI 69.89 -88.25%) of all antenatally diagnosed major cardiac abnormalities in high risk populati...

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Section: Study Protocol Studymentioning

confidence: 99%

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

Bradburn

Roberts

Papageorghiou

et al. 2022

Ultrasound in Obstet & Gyne

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“…Postnatal diagnosis, post-mortem examination, and even second trimester ultrasound examination are not always available. Pathologic examination of the first-trimester products of conception is not always possible [ 10 , 11 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…There are many studies that show that the detection of major CHD in the first trimester of pregnancy is feasible [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 ]. Most of these studies acknowledge that correct and early diagnosis of the type of CHD still represents a great challenge [ 9 , 10 , 11 , 12 , 13 ]. Although the detection of CHD is the main objective of fetal ultrasound cardiac screening, correct identification of the CHD type is just as important, as different types of CHD can have very different prognoses and neonatal outcomes [ 1 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Ultrasound Patterns in the First Trimester Diagnosis of Congenital Heart Disease

Herghelegiu

Panaitescu

Duţă

et al. 2021

JCM

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Congenital heart disease (CHD) is the most common birth defect, with a reported prevalence of 5–12 per 1000 live births. Very recently, the American Institute of Ultrasound in Medicine published a guideline recommending the use of the four-chamber and the three-vessel and trachea views to screen for CHD in the first trimester of pregnancy. Our aim is to present abnormal image patterns that are seen in the four-chamber, three-vessel, and trachea views of the fetal heart in the first trimester and to describe their association with specific CHD types. We used a total of 29 cases of CHD from the archives of Filantropia Hospital and the Maternal and Child Health Institute (INSMC) fetal medicine units. We selected cases with a clear and well-documented diagnosis of the CHD type. We identified a series of repeating color doppler flow patterns seen in the four-chamber, three-vessel, and trachea views of the studied cases. Our observations could be developed into a diagnosis algorithm to orientate the examiner to the most likely type of CHD in individual cases.

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“…Heterotaxy (left isomerism) and cardiac malformations with L-looped ventricles (L-transposition of great arteries) are the main types of CHD associated with CAVB [ 2 , 10 , 12 ]. Left atrial isomerism and transposition can be sometimes recognized on ultrasound from the first trimester of pregnancy [ 62 , 63 , 64 ]; yet, the unpredictable evolution to CAVB cannot be prevented in such cases. Fetal and neonatal mortality is high in CAVB associated with cardiac malformations, particularly in the setting of hydrops [ 60 ].…”

Section: Bradyarrhythmiasmentioning

confidence: 99%

Treatment of Fetal Arrhythmias

Veduță

Panaitescu

Ciobanu

et al. 2021

JCM

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Fetal arrhythmias are mostly benign and transient. However, some of them are associated with structural defects or can cause heart failure, fetal hydrops, and can lead to intrauterine death. The analysis of fetal heart rhythm is based on ultrasound (M-mode and Doppler echocardiography). Irregular rhythm due to atrial ectopic beats is the most common type of fetal arrhythmia and is generally benign. Tachyarrhythmias are diagnosed when the fetal heart rate is persistently above 180 beats per minute (bpm). The most common fetal tachyarrhythmias are paroxysmal supraventricular tachycardia and atrial flutter. Most fetal tachycardias can be terminated or controlled by transplacental or direct administration of anti-arrhythmic drugs. Fetal bradycardia is diagnosed when the fetal heart rate is slower than 110 bpm. Persistent bradycardia outside labor or in the absence of placental pathology is mostly due to atrioventricular (AV) block. Approximately half of fetal heart blocks are in cases with structural heart defects, and AV block in cases with structurally normal heart is often caused by maternal anti-Ro/SSA antibodies. The efficacy of prenatal treatment for fetal AV block is limited. Our review aims to provide a practical guide for the diagnosis and management of common fetal arrythmias, from the joint perspective of the fetal medicine specialist and the cardiologist.

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The outcome of structural heart defects diagnosed in the first trimester of pregnancy

Cited by 12 publications

References 22 publications

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

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

Ultrasound Patterns in the First Trimester Diagnosis of Congenital Heart Disease

Treatment of Fetal Arrhythmias

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