Improving fetal congenital heart disease screening using a checklist-based approach

Area of Science:

• Medical Imaging
• Obstetrics & Gynecology
• Cardiology

Background:

• Fetal cardiac screening during ultrasound anatomy surveys is crucial for early detection of congenital heart disease (CHD).
• Standardization of fetal heart examination protocols can be challenging, potentially impacting diagnostic accuracy and completeness.

Purpose of the Study:

• To evaluate the impact of a specific ultrasound image criteria checklist on fetal cardiac exam completion rates.
• To assess whether checklist implementation affects the detection of abnormal fetal hearts and congenital heart disease.

Main Methods:

• Retrospective cohort study comparing fetal anatomy surveys before and after checklist introduction.
• Analysis of cardiac exam completion rates (normal, abnormal, incomplete) and referral rates for echocardiography.
• Comparison of congenital heart disease (CHD) detection rates between the pre-checklist and checklist periods.

Main Results:

• Checklist utilization increased the cardiac exam completion rate by 8.9% (90.1% with checklist vs. 82.7% without, P < .001).
• No significant difference was observed in the rate of abnormal cardiac exams referred for echocardiography (2.1% vs. 1.3%, P = .16).
• Congenital heart disease (CHD) detection rates showed no significant change (1.0% with checklist vs. 0.4% without, P = .14), with no critical CHD missed.

Conclusions:

• A standardized ultrasound checklist effectively improves the completeness of fetal cardiac examinations.
• The checklist enhances screening efficiency without compromising the detection rate of congenital heart disease (CHD).
• Checklists are valuable tools for standardizing obstetric ultrasound protocols and improving diagnostic workflows.