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Fetal echocardiography: indications for referral, prenatal diagnoses, and outcomes
N A Callan1, M Maggio, S Steger
1Department of Gynecology & Obstetrics, Johns Hopkins University Medical School, Baltimore, MD 21205.
Insights
Fetal echocardiography identified congenital heart disease (CHD) in 21 fetuses. While severe cases were diagnosed, many fetuses received normal results, highlighting the test's value for at-risk pregnancies.
Area of Science:
- Prenatal diagnosis and cardiology
- Fetal medicine and congenital abnormalities
Background:
- Congenital heart disease (CHD) is a significant concern in fetal development.
- Fetal echocardiography is a key tool for prenatal screening and diagnosis.
Purpose of the Study:
- To evaluate the diagnostic yield of fetal echocardiography for congenital heart disease (CHD).
- To analyze indications for referral, prenatal findings, and postnatal outcomes in fetuses studied.
Main Methods:
- Retrospective review of 303 fetal echocardiography studies.
- Analysis of referral indications, echocardiographic findings, and associated anomalies.
- Correlation of prenatal diagnoses with postnatal outcomes.
Main Results:
- Twenty-one out of 303 fetuses (6.9%) were diagnosed with CHD.
- Common referral indications included family history and fetal dysrhythmia.
- Abnormal four-chamber view, fetal hydrops, and polyhydramnios were associated with higher abnormality rates; 5 of 21 CHD cases had chromosomal defects, 8 had extracardiac anomalies, and only 2 survived.
Conclusions:
- Fetal echocardiography is crucial for diagnosing CHD and assessing associated risks.
- Specific indications like abnormal cardiac views and hydrops yield higher detection rates.
- The study provides reassurance for normal fetuses while identifying severe conditions.
Abstract:
Three hundred three fetuses were studied with fetal echocardiography and 21 were diagnosed with congenital heart disease (CHD). Indications for study, prenatal findings, and postnatal outcomes were examined in all fetuses studied. The most common indications for referral were previous family history and fetal dysrhythmia. Of 189 fetuses studied for these indications, six had CHD. Indications with the highest proportion of abnormal studies included an abnormal four-chamber view of the heart (50% abnormal), fetal hydrops (30.8% abnormal), and polyhydramnios (25% abnormal). Five of 21 with CHD had chromosomal defects and eight had extracardiac anomalies. Two of the 21 fetuses with CHD survived. Present referral indications led to the diagnosis of the most severe lesions, yet reassurance is provided to many couples with normal fetuses. Fetal echocardiography is important in the care of the fetus at risk for CHD.