Fetal cardiac abnormalities identified prior to 14 weeks' gestation

Area of Science:

• Obstetrics and Gynecology
• Fetal Medicine
• Cardiology

Background:

• Increasing use of nuchal translucency ultrasound leads to early identification of high-risk pregnancies for congenital heart disease.
• Fetal echocardiography is a key tool for assessing cardiac health in utero.
• Early gestational age assessment is crucial for timely intervention and management.

Purpose of the Study:

• To evaluate the feasibility and accuracy of fetal echocardiography performed before 14 weeks' gestation.
• To determine the diagnostic capabilities of early fetal echocardiography in high-risk pregnancies.
• To assess the correlation between early echocardiographic findings and later outcomes.

Main Methods:

• Fetal echocardiography was attempted in 478 fetuses with crown-rump length between 40.0-85.0 mm.
• High-risk criteria included increased nuchal translucency, routine scan abnormalities, or family history of heart defects.
• Findings were correlated with autopsy, karyotyping, later scans, and postnatal follow-up for validation.

Main Results:

• Satisfactory images were obtained in 84.1% of fetuses via transabdominal approach.
• Cardiac defects were confidently identified in 60 fetuses, with an additional 49 showing abnormalities of uncertain significance.
• Abnormal karyotypes were found in 72.9% of fetuses with abnormal or suspicious cardiac findings, compared to 24.5% with normal echocardiograms.

Conclusions:

• Fetal echocardiography is feasible and accurate prior to 14 weeks' gestation.
• The majority of cardiac defects can be identified or suspected in early gestation.
• In this high-risk group, heart defects were often associated with chromosomal abnormalities.